1
|
Zhou Q, Zhang T, Meng H, Shen D, Li Y, He L, Gao Y, Zhang Y, Huang X, Meng H, Li B, Zhang M, Chen S. Characteristics of cerebral blood flow in an Eastern sample of multiple sclerosis patients: A potential quantitative imaging marker associated with disease severity. Front Immunol 2022; 13:1025908. [PMID: 36325320 PMCID: PMC9618793 DOI: 10.3389/fimmu.2022.1025908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 09/22/2022] [Indexed: 11/30/2022] Open
Abstract
Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system that is rare in China. At present, there are no widespread quantitative imaging markers associated with disease severity in MS. Despite several previous studies reporting cerebral blood flow (CBF) changes in MS, no consensus has been reached. In this study, we enrolled 30 Eastern MS patients to investigate CBF changes in different brain regions using the arterial spin labeling technique and their relationship with disease severity. The average CBF in MS patients were higher than those in health controls in various brain regions except cerebellum. The results indicated that MS patients with strongly increased CBF showed worse disease severity, including higher Expanded Disability Status Scale (EDSS) scores and serum neurofilament light chain (sNfL) values than those with mildly increased CBF in the parietal lobes, temporal lobes, basal ganglia, and damaged white matter (DWM). From another perspective, MS patients with worse disease severity (higher EDSS score and sNfL values, longer disease duration) showed increased CBF in parietal lobes, temporal lobes, basal ganglia, normal-appearing white matter (NAWM), and DWM. Correlation analysis showed that there was a strong association among CBF, EDSS score and sNfL. MS patients with strongly increased CBF in various brain regions had more ratio in relapsing phase than patients with mildly increased CBF. And relapsing patients showed significantly higher CBF in some regions (temporal lobes, left basal ganglia, right NAWM) compared to remitting patients. In addition, MS patients with cognitive impairment had higher CBF than those without cognitive impairment in the right parietal lobe and NAWM. However, there were no significant differences in CBF between MS patients with and without other neurologic dysfunctions (e.g., motor impairment, visual disturbance, sensory dysfunction). These findings expand our understanding of CBF in MS and imply that CBF could be a potential quantitative imaging marker associated with disease severity.
Collapse
Affiliation(s)
- Qinming Zhou
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tianxiao Zhang
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Huanyu Meng
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dingding Shen
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yao Li
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Lu He
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yining Gao
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yizongheng Zhang
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xinyun Huang
- Department of Nuclear Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hongping Meng
- Department of Nuclear Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Biao Li
- Department of Nuclear Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Min Zhang
- Department of Nuclear Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- *Correspondence: Sheng Chen, ; Min Zhang,
| | - Sheng Chen
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Co-innovation Center of Neuroregeneration, Nantong University, Nantong, China
- Department of Neurology, Xinrui Hospital, Wuxi, China
- *Correspondence: Sheng Chen, ; Min Zhang,
| |
Collapse
|
2
|
Testud B, Delacour C, El Ahmadi AA, Brun G, Girard N, Duhamel G, Heesen C, Häußler V, Thaler C, Has Silemek AC, Stellmann JP. Brain grey matter perfusion in primary progressive multiple sclerosis: Mild decrease over years and regional associations with cognition and hand function. Eur J Neurol 2022; 29:1741-1752. [PMID: 35167161 DOI: 10.1111/ene.15289] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 02/11/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Extend and dynamic of neurodegeneration in progressive Multiple Sclerosis (MS) might be reflected by global and regional brain perfusion, an outcome at the intercept between structure and function. Here, we provide a first insight in the evolution of brain perfusion and its association with disability in primary progressive MS (PPMS) over several years. METHODS 77 persons with PPMS were followed over up to 5 years. Visits included a 3T MRI with pulsed Arterial spin labelling (ASL) perfusion, the Timed-25-Foot-Walk, 9-Hole-Peg-Test (NHPT), Symbol-Digit-Modalities-Test (SDMT) and Expanded Disability Status Scale (EDSS). We extracted regional cerebral blood flow surrogates and compared them to 11 controls. Analyses focused in cortical and deep gray matter, the change over time and associations with disability on regional and global level. RESULTS Baseline brain perfusion of patients and controls was comparable for the cortex (p=0.716) and deep grey matter (p=0.095). EDSS disability increased mildly (p=0.023) while brain perfusion decreased during follow up (p<0.001) and with disease duration (p=0.009). Lower global perfusion correlated with higher disability as indicated by EDSS, NHPT and Timed-25-Foot-Walk (p<0.001). The motor task NHPT showed associations with twenty gray matter regions. In contrast, better SDMT performance correlated with lower perfusion (p<0.001) in seven predominantly frontal regions indicating a functional maladaptation. CONCLUSION Decreasing perfusion indicates a putative association with MS disease mechanisms such as neurodegeneration, reduced metabolism, and loss of resilience. A low alteration rate limits its use in clinical practice, but regional association patterns might provide a snapshot of adaptive and maladaptive functional reorganization.
Collapse
Affiliation(s)
- Benoit Testud
- APHM La Timone, CEMEREM, Marseille, France.,Aix-Marseille Univ, CNRS, CRMBM, UMR 7339, Marseille, France.,APHM La Timone, Department of Neuroradiology, Marseille, France
| | - Clara Delacour
- APHM La Timone, Department of Neuroradiology, Marseille, France
| | | | - Gilles Brun
- APHM La Timone, Department of Neuroradiology, Marseille, France
| | - Nadine Girard
- Aix-Marseille Univ, CNRS, CRMBM, UMR 7339, Marseille, France.,APHM La Timone, Department of Neuroradiology, Marseille, France
| | - Guillaume Duhamel
- APHM La Timone, CEMEREM, Marseille, France.,Aix-Marseille Univ, CNRS, CRMBM, UMR 7339, Marseille, France
| | - Christoph Heesen
- Institute of Neuroimmunology and MS (INIMS), University Medical Centre Hamburg-Eppendorf, Germany.,Department of Neurology, University Medical Centre Hamburg-Eppendorf, Germany
| | - Vivien Häußler
- Institute of Neuroimmunology and MS (INIMS), University Medical Centre Hamburg-Eppendorf, Germany.,Department of Neurology, University Medical Centre Hamburg-Eppendorf, Germany
| | - Christian Thaler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Arzu Ceylan Has Silemek
- Institute of Neuroimmunology and MS (INIMS), University Medical Centre Hamburg-Eppendorf, Germany
| | - Jan-Patrick Stellmann
- APHM La Timone, CEMEREM, Marseille, France.,Aix-Marseille Univ, CNRS, CRMBM, UMR 7339, Marseille, France.,Institute of Neuroimmunology and MS (INIMS), University Medical Centre Hamburg-Eppendorf, Germany.,Department of Neurology, University Medical Centre Hamburg-Eppendorf, Germany
| |
Collapse
|
3
|
Granziera C, Wuerfel J, Barkhof F, Calabrese M, De Stefano N, Enzinger C, Evangelou N, Filippi M, Geurts JJG, Reich DS, Rocca MA, Ropele S, Rovira À, Sati P, Toosy AT, Vrenken H, Gandini Wheeler-Kingshott CAM, Kappos L. Quantitative magnetic resonance imaging towards clinical application in multiple sclerosis. Brain 2021; 144:1296-1311. [PMID: 33970206 PMCID: PMC8219362 DOI: 10.1093/brain/awab029] [Citation(s) in RCA: 73] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 10/25/2020] [Accepted: 11/16/2020] [Indexed: 12/11/2022] Open
Abstract
Quantitative MRI provides biophysical measures of the microstructural integrity of the CNS, which can be compared across CNS regions, patients, and centres. In patients with multiple sclerosis, quantitative MRI techniques such as relaxometry, myelin imaging, magnetization transfer, diffusion MRI, quantitative susceptibility mapping, and perfusion MRI, complement conventional MRI techniques by providing insight into disease mechanisms. These include: (i) presence and extent of diffuse damage in CNS tissue outside lesions (normal-appearing tissue); (ii) heterogeneity of damage and repair in focal lesions; and (iii) specific damage to CNS tissue components. This review summarizes recent technical advances in quantitative MRI, existing pathological validation of quantitative MRI techniques, and emerging applications of quantitative MRI to patients with multiple sclerosis in both research and clinical settings. The current level of clinical maturity of each quantitative MRI technique, especially regarding its integration into clinical routine, is discussed. We aim to provide a better understanding of how quantitative MRI may help clinical practice by improving stratification of patients with multiple sclerosis, and assessment of disease progression, and evaluation of treatment response.
Collapse
Affiliation(s)
- Cristina Granziera
- Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland
- Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Jens Wuerfel
- Medical Image Analysis Center, Basel, Switzerland
- Quantitative Biomedical Imaging Group (qbig), Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, multiple sclerosis Center Amsterdam, Amsterdam University Medical Center, Amsterdam, The Netherlands
- UCL Institutes of Healthcare Engineering and Neurology, London, UK
| | - Massimiliano Calabrese
- Neurology B, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Nicola De Stefano
- Neurology, Department of Medicine, Surgery and Neuroscience, University of Siena, Italy
| | - Christian Enzinger
- Department of Neurology and Division of Neuroradiology, Medical University of Graz, Graz, Austria
| | - Nikos Evangelou
- Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - Massimo Filippi
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, and Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Jeroen J G Geurts
- Department of Anatomy and Neurosciences, multiple sclerosis Center Amsterdam, Neuroscience Amsterdam, Amsterdam University Medical Centers, location VUmc, Amsterdam, The Netherlands
| | - Daniel S Reich
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD, USA
| | - Maria A Rocca
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, and Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Stefan Ropele
- Neuroimaging Research Unit, Department of Neurology, Medical University of Graz, Graz, Austria
| | - Àlex Rovira
- Section of Neuroradiology (Department of Radiology), Vall d'Hebron University Hospital and Research Institute, Barcelona, Spain
| | - Pascal Sati
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD, USA
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Ahmed T Toosy
- Queen Square multiple sclerosis Centre, Department of Neuroinflammation, Queen Square Institute of Neurology, University College London, London, UK
| | - Hugo Vrenken
- Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, multiple sclerosis Center Amsterdam, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Claudia A M Gandini Wheeler-Kingshott
- Queen Square multiple sclerosis Centre, Department of Neuroinflammation, Queen Square Institute of Neurology, University College London, London, UK
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
- Brain MRI 3T Research Centre, IRCCS Mondino Foundation, Pavia, Italy
| | - Ludwig Kappos
- Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland
- Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland
| |
Collapse
|
4
|
Pelizzari L, Laganà MM, Baglio F, Bergsland N, Cecconi P, Viotti S, Pugnetti L, Nemni R, Baselli G, Clerici M, Mendozzi L. Cerebrovascular reactivity and its correlation with age in patients with multiple sclerosis. Brain Imaging Behav 2021; 14:1889-1898. [PMID: 31175576 DOI: 10.1007/s11682-019-00132-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
We assessed cerebral blood flow (CBF) and cerebrovascular reactivity (CVR) within gray matter (GM), normal appearing white matter (NAWM) and white matter (WM) lesions in a group of multiple sclerosis (MS) patients. Furthermore, correlations between CBF, CVR and age were investigated. 31 MS patients and 25 healthy controls (HC) were examined on a 1.5 T MRI scanner, using pseudo-continuous arterial spin labeling MRI. MS vs HC CBF and CVR differences were assessed in GM regions of interest (i.e. resting state networks and vascular territories), and within WM. Correlations between CBF/CVR and age were then computed for MS and HC groups. Whereas no significant CBF and CVR differences were observed between MS and HC in any of the considered brain areas, significantly lower CBF was found in WM lesions with respect to NAWM (p < 0.001) in MS patients. Furthermore, CVR was significantly correlated with age in HC, but not in MS patients. The relatively low-grade of inflammation of our MS cohort may be associated with the observed lack of significant CVR differences between MS patients and HC. The loss of correlation between CVR and age in the MS group suggests that CVR may be influenced by MS-related factors.
Collapse
Affiliation(s)
- Laura Pelizzari
- IRCCS, Fondazione Don Carlo Gnocchi ONLUS, MRI Laboratory, Via Alfonso Capecelatro, 66, Milan, Italy
| | - Maria M Laganà
- IRCCS, Fondazione Don Carlo Gnocchi ONLUS, MRI Laboratory, Via Alfonso Capecelatro, 66, Milan, Italy.
| | - Francesca Baglio
- IRCCS, Fondazione Don Carlo Gnocchi ONLUS, MRI Laboratory, Via Alfonso Capecelatro, 66, Milan, Italy
| | - Niels Bergsland
- IRCCS, Fondazione Don Carlo Gnocchi ONLUS, MRI Laboratory, Via Alfonso Capecelatro, 66, Milan, Italy.,Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Pietro Cecconi
- IRCCS, Fondazione Don Carlo Gnocchi ONLUS, MRI Laboratory, Via Alfonso Capecelatro, 66, Milan, Italy
| | - Stefano Viotti
- IRCCS, Fondazione Don Carlo Gnocchi ONLUS, MRI Laboratory, Via Alfonso Capecelatro, 66, Milan, Italy
| | - Luigi Pugnetti
- IRCCS, Fondazione Don Carlo Gnocchi ONLUS, MRI Laboratory, Via Alfonso Capecelatro, 66, Milan, Italy
| | - Raffaello Nemni
- IRCCS, Fondazione Don Carlo Gnocchi ONLUS, MRI Laboratory, Via Alfonso Capecelatro, 66, Milan, Italy.,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Giuseppe Baselli
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Mario Clerici
- IRCCS, Fondazione Don Carlo Gnocchi ONLUS, MRI Laboratory, Via Alfonso Capecelatro, 66, Milan, Italy.,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Laura Mendozzi
- IRCCS, Fondazione Don Carlo Gnocchi ONLUS, MRI Laboratory, Via Alfonso Capecelatro, 66, Milan, Italy
| |
Collapse
|
5
|
Wengler K, Ha J, Syritsyna O, Bangiyev L, Coyle PK, Duong TQ, Schweitzer ME, He X. Abnormal blood-brain barrier water exchange in chronic multiple sclerosis lesions: A preliminary study. Magn Reson Imaging 2020; 70:126-133. [DOI: 10.1016/j.mri.2020.04.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 04/24/2020] [Accepted: 04/25/2020] [Indexed: 12/17/2022]
|
6
|
Lagana MM, Pelizzari L, Baglio F. Relationship between MRI perfusion and clinical severity in multiple sclerosis. Neural Regen Res 2020; 15:646-652. [PMID: 31638086 PMCID: PMC6975150 DOI: 10.4103/1673-5374.266906] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Perfusion alterations within several brain regions have been shown in multiple sclerosis patients using different magnetic resonance imaging (MRI) techniques. Furthermore, MRI-derived brain perfusion metrics have been investigated in association with multiple sclerosis phenotypes, physical disability, and cognitive impairment. However, a review focused on these aspects is still missing. Our aim was to review all the studies investigating the relationship between perfusion MRI and clinical severity during the last fifteen years to understand the clinical relevance of these findings. Perfusion differences among phenotypes were observed both with 1.5T and 3T scanners, with progressive multiple sclerosis presenting with lower perfusion values than relapsing-remitting multiple sclerosis patients. However, only 3T scanners showed a statistically significant distinction. Controversial results about the association between MRI-derived perfusion metrics and physical disability scores were found. However, the majority of the studies showed that lower brain perfusion and longer transit time are associated with more severe physical disability and worse cognitive performances.
Collapse
|
7
|
Jakimovski D, Topolski M, Genovese AV, Weinstock-Guttman B, Zivadinov R. Vascular aspects of multiple sclerosis: emphasis on perfusion and cardiovascular comorbidities. Expert Rev Neurother 2019; 19:445-458. [PMID: 31003583 DOI: 10.1080/14737175.2019.1610394] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Multiple sclerosis (MS) is a chronic inflammatory, demyelinating, and neurodegenerative disease of the central nervous system. Over the last two decades, more favorable MS long-term outcomes have contributed toward increase in prevalence of the aged MS population. Emergence of age-associated pathology, such as cardiovascular diseases, may interact with the MS pathophysiology and further contribute to disease progression. Areas covered: This review summarizes the cardiovascular involvement in MS pathology, its disease activity, and progression. The cardiovascular health, the presence of various cardiovascular diseases, and their effect on MS cognitive performance are further explored. In similar fashion, the emerging evidence of a higher incidence of extracranial arterial pathology and its association with brain MS pathology are discussed. Finally, the authors outline the methodologies behind specific perfusion magnetic resonance imaging (MRI) and ultrasound Doppler techniques, which allow measurement of disease-specific and age-specific vascular changes in the aging population and MS patients. Expert opinion: Cardiovascular pathology significantly contributes to worse clinical and MRI-derived disease outcomes in MS. Global and regional cerebral hypoperfusion may be associated with poorer physical and cognitive performance. Prevention, improved detection, and treatment of the cardiovascular-based pathology may improve the overall long-term health of MS patients.
Collapse
Affiliation(s)
- Dejan Jakimovski
- a Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences , University at Buffalo, State University of New York , Buffalo , NY , USA.,b Jacobs Multiple Sclerosis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences , University at Buffalo, The State University of New York , Buffalo , NY , USA
| | - Matthew Topolski
- a Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences , University at Buffalo, State University of New York , Buffalo , NY , USA
| | - Antonia Valentina Genovese
- a Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences , University at Buffalo, State University of New York , Buffalo , NY , USA.,c Institute of Radiology, Department of Clinical Surgical Diagnostic and Pediatric Sciences , University of Pavia , Pavia , Italy
| | - Bianca Weinstock-Guttman
- b Jacobs Multiple Sclerosis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences , University at Buffalo, The State University of New York , Buffalo , NY , USA
| | - Robert Zivadinov
- a Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences , University at Buffalo, State University of New York , Buffalo , NY , USA.,b Jacobs Multiple Sclerosis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences , University at Buffalo, The State University of New York , Buffalo , NY , USA.,d Center for Biomedical Imaging at Clinical Translational Science Institute , University at Buffalo, State University of New York , Buffalo , NY , USA
| |
Collapse
|
8
|
Jakimovski D, Benedict RH, Marr K, Gandhi S, Bergsland N, Weinstock-Guttman B, Zivadinov R. Lower total cerebral arterial flow contributes to cognitive performance in multiple sclerosis patients. Mult Scler 2019; 26:201-209. [PMID: 30625030 DOI: 10.1177/1352458518819608] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND The cognitive performance in multiple sclerosis (MS) patients declines with aging, longer disease duration, and possibly cardiovascular comorbidities. OBJECTIVES We investigated whether lower total cerebral arterial blood flow (CABF) measured at the level of the carotid and vertebral arteries may contribute to worse cognitive performance in 132 MS patients and 47 healthy controls. METHODS Total CABF was evaluated with extracranial Doppler, whereas structural T2-lesion volume (LV) and gray matter volume (GMV) were measured on 3T MRI. The cognitive performance was assessed by Symbol Digit Modalities Test (SDMT), Brief Visuospatial Memory Test-Revised (BVMT-R), and California Verbal Learning Test-Second Edition (CVLT-II). Analysis of covariance, partial correlation, and regression models were used to test the differences between study groups and cognition/CABF correlations. False discovery rate (FDR)-corrected (Benjamini-Hochberg) p-values (i.e. q-values) less than 0.05 were considered significant. RESULTS Association between lower total CABF and the lower cognitive performance was observed only in MS patients (r = 0.318, q < 0.001 and r = 0.244, q = 0.012 for SDMT and BVMT-R, respectively). Lower GMV, higher T2-LV, and CABF were significantly associated with poorer performance on the processing speed measure of SDMT (adjusted R2 = 0.295, t-statistics = 2.538, standardized β = 0.203, and q = 0.020), but not with memory tests. Cognitively impaired MS patients had lower total CABF compared to cognitively preserved (884.5 vs 1020.2 mL/min, q = 0.008). CONCLUSION Cognitively impaired MS patients presented with lower total CABF. Altered CABF may be a result of reduced metabolic rate and might contribute to abnormal cognitive aging in MS.
Collapse
Affiliation(s)
- Dejan Jakimovski
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Ralph Hb Benedict
- Jacobs Multiple Sclerosis Center for Treatment and Research, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Karen Marr
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Sirin Gandhi
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Niels Bergsland
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Bianca Weinstock-Guttman
- Jacobs Multiple Sclerosis Center for Treatment and Research, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Robert Zivadinov
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA/Center for Biomedical Imaging, Clinical Translational Science Institute, University at Buffalo, The State University of New York, Buffalo, NY, USA
| |
Collapse
|
9
|
Liu M, Chen Z, Ma L. Test-retest reliability of perfusion of the precentral cortex and precentral subcortical white matter on three-dimensional pseudo-continuous arterial spin labeling. J Int Med Res 2018; 46:3788-3795. [PMID: 29926756 PMCID: PMC6136019 DOI: 10.1177/0300060518779716] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Objective This study was performed to evaluate the test–retest reliability of perfusion
of the cortex and subcortical white matter on three-dimensional spiral fast
spin echo pseudo-continuous arterial spin labeling (3D-ASL). Methods Eight healthy subjects underwent 3D-ASL and structural imaging at the same
time each day for 1 week. ASL data acquisition was performed in the resting
state and right finger-tapping state. Cerebral blood flow (CBF) images were
calculated, and the CBF values of the precentral cortex (PCC) and precentral
subcortical white matter (PCSWM) were automatically extracted based on the
structural images and CBF images. Results In the resting state, the intraclass correlation coefficient (ICC) of the
bilateral PCC was 0.84 (left) and 0.81 (right) and that of the bilateral
SCWM was 0.89 (left) and 0.85 (right). In the finger-tapping state, the ICC
of the bilateral PCC was 0.91 (left) and 0.87 (right) and that of the
bilateral PCSWM was 0.87 (left) and 0.92 (right). The CBF value of the left
PCC and PCSWM was not significantly different between the resting state and
finger-tapping state on two ASL scans. Conclusion 3D-ASL provides reliable CBF measurement in the cortex and subcortical white
matter in the resting or controlled state.
Collapse
Affiliation(s)
- Mengqi Liu
- 1 Department of Radiology, Chinese PLA General Hospital, Beijing, China.,2 Department of Radiology, Hainan Branch of Chinese PLA General Hospital, Sanya, China
| | - Zhiye Chen
- 1 Department of Radiology, Chinese PLA General Hospital, Beijing, China.,2 Department of Radiology, Hainan Branch of Chinese PLA General Hospital, Sanya, China
| | - Lin Ma
- 1 Department of Radiology, Chinese PLA General Hospital, Beijing, China
| |
Collapse
|
10
|
Jezzard P, Chappell MA, Okell TW. Arterial spin labeling for the measurement of cerebral perfusion and angiography. J Cereb Blood Flow Metab 2018; 38:603-626. [PMID: 29168667 PMCID: PMC5888859 DOI: 10.1177/0271678x17743240] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Arterial spin labeling (ASL) is an MRI technique that was first proposed a quarter of a century ago. It offers the prospect of non-invasive quantitative measurement of cerebral perfusion, making it potentially very useful for research and clinical studies, particularly where multiple longitudinal measurements are required. However, it has suffered from a number of challenges, including a relatively low signal-to-noise ratio, and a confusing number of sequence variants, thus hindering its clinical uptake. Recently, however, there has been a consensus adoption of an accepted acquisition and analysis framework for ASL, and thus a better penetration onto clinical MRI scanners. Here, we review the basic concepts in ASL and describe the current state-of-the-art acquisition and analysis approaches, and the versatility of the method to perform both quantitative cerebral perfusion measurement, along with quantitative cerebral angiographic measurement.
Collapse
Affiliation(s)
- Peter Jezzard
- 1 Wellcome Centre for Integrative Neuroimaging, FMRIB Division, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | | | - Thomas W Okell
- 1 Wellcome Centre for Integrative Neuroimaging, FMRIB Division, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| |
Collapse
|
11
|
Lapointe E, Li DKB, Traboulsee AL, Rauscher A. What Have We Learned from Perfusion MRI in Multiple Sclerosis? AJNR Am J Neuroradiol 2018; 39:994-1000. [PMID: 29301779 DOI: 10.3174/ajnr.a5504] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Using MR imaging, perfusion can be assessed either by dynamic susceptibility contrast MR imaging or arterial spin-labeling. Alterations of cerebral perfusion have repeatedly been described in multiple sclerosis compared with healthy controls. Acute lesions exhibit relative hyperperfusion in comparison with normal-appearing white matter, a finding mostly attributed to inflammation in this stage of lesion development. In contrast, normal-appearing white and gray matter of patients with MS has been mostly found to be hypoperfused compared with controls, and correlations with cognitive impairment as well as fatigue in multiple sclerosis have been described. Mitochondrial failure, axonal degeneration, and vascular dysfunction have been hypothesized to underlie the perfusion MR imaging findings. Clinically, perfusion MR imaging could allow earlier detection of the acute focal inflammatory changes underlying relapses and new lesions, and could constitute a marker for cognitive dysfunction in MS. Nevertheless, the clinical relevance and pathogenesis of the brain perfusion changes in MS remain to be clarified.
Collapse
Affiliation(s)
- E Lapointe
- From the Division of Neurology (E.L., A.L.T.) .,Department of Medicine (E.L., A.L.T.)
| | - D K B Li
- Radiology (D.K.B.L.), University of British Columbia, Djavad Mowafaghian Center for Brain Health, Vancouver, British Columbia, Canada
| | - A L Traboulsee
- From the Division of Neurology (E.L., A.L.T.).,Department of Medicine (E.L., A.L.T.)
| | - A Rauscher
- MRI Research Center (A.R.).,Departments of Pediatrics (A.R.)
| |
Collapse
|
12
|
刘 梦, 陈 志, 马 林. [Test-retest reliability of 3D spiral fast-spin-echo pseudo-continuous arterial spin labeling for cerebral perfusion imaging of subcortical gray matter in healthy adults]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2017; 37:1242-1247. [PMID: 28951369 PMCID: PMC6765499 DOI: 10.3969/j.issn.1673-4254.2017.09.17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To evaluate the test-retest reliability of 3D spiral fast-spin-echo (FSE) pseudo-continuous arterial spin labeling (3D pc-ASL) for cerebral perfusion imaging of the subcortical gray matter in healthy adults in resting state. METHODS 3D spiral FSE ASL and 3D T1-weighted fast spoiled gradient recalled echo (3D T1-FSPGR) sequences were used for cerebral perfusion imaging in 8 healthy adult subjects, and a repeat imaging examination was performed after one week. The subcortical gray matter structures including the putamen, globus pallidus, caudate nucleus, thalamus, amygdala and hippocampus were segmented on the brain structural 3D images to generate the cerebral blood flow (CBF) map. The CBF value was extracted based on the segmented images and the CBF maps. The reliability and reproducibility of the measurements were evaluated using the intraclass correlation coefficient (ICC) and Bland-Altman plot. RESULTS The mean ICC value of the subcortical gray matter structures was 0.88∓0.04 (range, 0.80-0.93). The Bland-Altman plot analysis demonstrated that the differences between the two measurements at all the points corresponding to the subcortical gray matter structures were within 95% CI of the limits of agreement. CONCLUSION 3D spiral FSE pseudo-continuous ASL is a reliable method for assessing the perfusion of the cerebral subcortical gray matter structures.
Collapse
Affiliation(s)
- 梦琦 刘
- 中国人民解放军总医院海南分院放射科,海南 三亚 572013Department of Radiology, Hainan Branch of General Hospital of PLA, Sanya 572013, China
- 中国人民解放军总医院放射科,北京 100853Department of Radiology, General Hospital of PLA, Beijing 100853, China
| | - 志晔 陈
- 中国人民解放军总医院海南分院放射科,海南 三亚 572013Department of Radiology, Hainan Branch of General Hospital of PLA, Sanya 572013, China
- 中国人民解放军总医院放射科,北京 100853Department of Radiology, General Hospital of PLA, Beijing 100853, China
| | - 林 马
- 中国人民解放军总医院放射科,北京 100853Department of Radiology, General Hospital of PLA, Beijing 100853, China
| |
Collapse
|
13
|
Doche E, Lecocq A, Maarouf A, Duhamel G, Soulier E, Confort-Gouny S, Rico A, Guye M, Audoin B, Pelletier J, Ranjeva JP, Zaaraoui W. Hypoperfusion of the thalamus is associated with disability in relapsing remitting multiple sclerosis. J Neuroradiol 2017; 44:158-164. [DOI: 10.1016/j.neurad.2016.10.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 08/12/2016] [Accepted: 10/06/2016] [Indexed: 10/20/2022]
|
14
|
Ma AY, Vitorino RC, Hojjat SP, Mulholland AD, Zhang L, Lee L, Carroll TJ, Cantrell CG, Figley CR, Aviv RI. The relationship between white matter fiber damage and gray matter perfusion in large-scale functionally defined networks in multiple sclerosis. Mult Scler 2017; 23:1884-1892. [PMID: 28178867 DOI: 10.1177/1352458517691149] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Recent studies utilizing perfusion as a surrogate of cortical integrity show promise for overall cognition, but the association between white matter (WM) damage and gray matter (GM) integrity in specific functional networks is not previously studied. OBJECTIVE To investigate the relationship between WM fiber integrity and GM node perfusion within six functional networks of relapsing-remitting multiple sclerosis (RRMS) and secondary progressive multiple sclerosis (SPMS) patients. METHODS Magnetic resonance imaging (MRI) and neurocognitive testing were performed on 19 healthy controls (HC), 39 RRMS, and 45 SPMS patients. WM damage extent and severity were quantified with T2-hyper/T1-hypointense (T2h/T1h) lesion volume and degree of perfusion reduction in lesional and normal-appearing white matter (NAWM), respectively. A two-step linear regression corrected for confounders was employed. RESULTS Cognitive impairment was present in 20/39 (51%) RRMS and 25/45 (53%) SPMS patients. GM node perfusion was associated with WM fiber damage severity (WM hypoperfusion) within each network-including both NAWM ( R2 = 0.67-0.89, p < 0.0001) and T2h ( R2 = 0.39-0.62, p < 0.0001) WM regions-but was not significantly associated ( p > 0.01) with WM fiber damage extent (i.e. T2h/T1h lesion volumes). CONCLUSION Overall, GM node perfusion was associated with severity rather than extent of WM network damage, supporting a primary etiology of GM hypoperfusion.
Collapse
Affiliation(s)
- Ashley Y Ma
- Department of Physical Sciences, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Rita C Vitorino
- Department of Physical Sciences, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Seyed-Parsa Hojjat
- Department of Physical Sciences, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Alannah D Mulholland
- Department of Physical Sciences, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Liying Zhang
- Department of Physical Sciences, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Liesly Lee
- Department of Neurology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Timothy J Carroll
- Department of Biomedical Engineering and Radiology, Northwestern University, Chicago, IL, USA
| | - Charles G Cantrell
- Department of Biomedical Engineering, Northwestern University, Chicago, IL, USA
| | - Chase R Figley
- Department of Radiology, University of Manitoba, Winnipeg, MB, Canada/Neuroscience Research Program and Division of Diagnostic Imaging, Kleysen Institute for Advanced Medicine, Health Sciences Centre, Winnipeg, MB, Canada
| | - Richard I Aviv
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, Toronto, ON, Canada/Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
15
|
Giezendanner S, Fisler MS, Soravia LM, Andreotti J, Walther S, Wiest R, Dierks T, Federspiel A. Microstructure and Cerebral Blood Flow within White Matter of the Human Brain: A TBSS Analysis. PLoS One 2016; 11:e0150657. [PMID: 26942763 PMCID: PMC4778945 DOI: 10.1371/journal.pone.0150657] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 02/16/2016] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND White matter (WM) fibers connect different brain regions and are critical for proper brain function. However, little is known about the cerebral blood flow in WM and its relation to WM microstructure. Recent improvements in measuring cerebral blood flow (CBF) by means of arterial spin labeling (ASL) suggest that the signal in white matter may be detected. Its implications for physiology needs to be extensively explored. For this purpose, CBF and its relation to anisotropic diffusion was analyzed across subjects on a voxel-wise basis with tract-based spatial statistics (TBSS) and also across white matter tracts within subjects. METHODS Diffusion tensor imaging and ASL were acquired in 43 healthy subjects (mean age = 26.3 years). RESULTS CBF in WM was observed to correlate positively with fractional anisotropy across subjects in parts of the splenium of corpus callosum, the right posterior thalamic radiation (including the optic radiation), the forceps major, the right inferior fronto-occipital fasciculus, the right inferior longitudinal fasciculus and the right superior longitudinal fasciculus. Furthermore, radial diffusivity correlated negatively with CBF across subjects in similar regions. Moreover, CBF and FA correlated positively across white matter tracts within subjects. CONCLUSION The currently observed findings on a macroscopic level might reflect the metabolic demand of white matter on a microscopic level involving myelination processes or axonal function. However, the exact underlying physiological mechanism of this relationship needs further evaluation.
Collapse
Affiliation(s)
- Stéphanie Giezendanner
- Center for Translational Research, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Melanie Sarah Fisler
- Center for Translational Research, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Leila Maria Soravia
- Center for Translational Research, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Jennifer Andreotti
- Center for Translational Research, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Sebastian Walther
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Roland Wiest
- Support Center for Advanced Neuroimaging (SCAN), Institute for Diagnostic and Interventional Neuroradiology, University Hospital Inselspital and University of Bern, Bern, Switzerland
| | - Thomas Dierks
- Center for Translational Research, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Andrea Federspiel
- Center for Translational Research, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| |
Collapse
|
16
|
Arterial Spin Labeling Techniques 2009-2014. J Med Imaging Radiat Sci 2016; 47:98-107. [PMID: 31047171 DOI: 10.1016/j.jmir.2015.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 07/03/2015] [Accepted: 08/18/2015] [Indexed: 12/23/2022]
Abstract
PURPOSE Arterial spin labeling (ASL) techniques have been implemented across a diverse range of clinical and experimental applications. This review aims to evaluate the current feasibility of ASL in clinical neuroradiology based on recent improvements to ASL sequences and highlight areas for potential clinical applications. METHODS AND MATERIALS In December 2014, a literature search was conducted on PubMed Central, EMBASE, and Scopus using the search terms: "arterial spin labeling, neuroradiology," for studies published between 2009 and 2014 (inclusive). Of 483 studies matching the inclusion criteria, the number of studies using continuous, pseudocontinuous, pulsed, and velocity-selective ASL sequences was 42, 209, 226, and 3, respectively. Studies were classified based on several common clinical applications according to the type of ASL sequence used. Studies using pulsed ASL and pseudo-continuous ASL were grouped based on common sequences. RESULTS The number of clinical studies was 264. Numerous studies applied ASL to stroke management (43 studies), drug testing (21 studies), neurodegenerative diseases (40 studies), and psychiatric disorders (26 studies). CONCLUSIONS This review discusses several factors hindering the implementation of clinical ASL and ASL-related radiofrequency safety issues encountered in clinical practice. However, a limited number of search terms were used. Further development of robust sequences with multislice imaging capabilities and reduced radiofrequency energy deposition will hopefully improve the clinical acceptance of ASL.
Collapse
|
17
|
Abstract
Due to its sensitivity to the different multiple sclerosis (MS)-related abnormalities, magnetic resonance imaging (MRI) has become an established tool to diagnose MS and to monitor its evolution. MRI has been included in the diagnostic workup of patients with clinically isolated syndromes suggestive of MS, and ad hoc criteria have been proposed and are regularly updated. In patients with definite MS, the ability of conventional MRI techniques to explain patients' clinical status and progression of disability is still suboptimal. Several advanced MRI-based technologies have been applied to estimate overall MS burden in the different phases of the disease. Their use has allowed the heterogeneity of MS pathology in focal lesions, normal-appearing white matter and gray matter to be graded in vivo. Recently, additional features of MS pathology, including macrophage infiltration and abnormal iron deposition, have become quantifiable. All of this, combined with functional imaging techniques, is improving our understanding of the mechanisms associated with MS evolution. In the near future, the use of ultrahigh-field systems is likely to provide additional insight into disease pathophysiology. However, the utility of advanced MRI techniques in clinical trial monitoring and in assessing individual patients' response to treatment still needs to be assessed.
Collapse
Affiliation(s)
- Massimo Filippi
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.
| | - Paolo Preziosa
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Maria A Rocca
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| |
Collapse
|
18
|
Abstract
Aspirin is widely used to lessen the risks of cardiovascular events. Some studies suggest that patients with multiple sclerosis have an increased risk for some cardiovascular events, for example, venous thromboembolism and perhaps ischemic strokes, raising the possibility that aspirin could lessen these increased risks in this population or subgroups (patients with limited mobility and/or antiphospholipid antibodies). However, aspirin causes a small increased risk of hemorrhagic stroke, which is a concern as it could potentially worsen a compromised blood-brain barrier. Aspirin has the potential to ameliorate the disease process in multiple sclerosis (for example, by limiting some components of inflammation), but aspirin also has the potential to inhibit mitochondrial complex I activity, which is already reduced in multiple sclerosis. In an experimental setting of a cerebral ischemic lesion, aspirin promoted the proliferation and/or differentiation of oligodendrocyte precursors, raising the possibility that aspirin could facilitate remyelination efforts in multiple sclerosis. Other actions by aspirin may lead to small improvements of some symptoms (for example, lessening fatigue). Here we consider potential benefits and risks of aspirin usage by patients with multiple sclerosis.
Collapse
Affiliation(s)
- Sheila Tsau
- Department of Molecular and Integrative Physiology, University of Kansas Medical Center, Kansas City, KS, USA.
| | - Mitchell R Emerson
- Department of Pharmaceutical Sciences, College of Pharmacy-Glendale, Midwestern University, Glendale, AZ, USA.
| | - Sharon G Lynch
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA.
| | - Steven M LeVine
- Department of Molecular and Integrative Physiology, University of Kansas Medical Center, Kansas City, KS, USA.
| |
Collapse
|
19
|
Viallon M, Cuvinciuc V, Delattre B, Merlini L, Barnaure-Nachbar I, Toso-Patel S, Becker M, Lovblad KO, Haller S. State-of-the-art MRI techniques in neuroradiology: principles, pitfalls, and clinical applications. Neuroradiology 2015; 57:441-67. [PMID: 25859832 DOI: 10.1007/s00234-015-1500-1] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 02/04/2015] [Indexed: 12/20/2022]
Abstract
This article reviews the most relevant state-of-the-art magnetic resonance (MR) techniques, which are clinically available to investigate brain diseases. MR acquisition techniques addressed include notably diffusion imaging (diffusion-weighted imaging (DWI), diffusion tensor imaging (DTI), and diffusion kurtosis imaging (DKI)) as well as perfusion imaging (dynamic susceptibility contrast (DSC), arterial spin labeling (ASL), and dynamic contrast enhanced (DCE)). The underlying models used to process these images are described, as well as the theoretic underpinnings of quantitative diffusion and perfusion MR imaging-based methods. The technical requirements and how they may help to understand, classify, or follow-up neurological pathologies are briefly summarized. Techniques, principles, advantages but also intrinsic limitations, typical artifacts, and alternative solutions developed to overcome them are discussed. In this article, we also review routinely available three-dimensional (3D) techniques in neuro MRI, including state-of-the-art and emerging angiography sequences, and briefly introduce more recently proposed 3D quantitative neuro-anatomy sequences, and new technology, such as multi-slice and multi-transmit imaging.
Collapse
Affiliation(s)
- Magalie Viallon
- CREATIS, UMR CNRS 5220 - INSERM U1044, INSA de Lyon, Université de Lyon, Lyon, France,
| | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Paling D, Thade Petersen E, Tozer DJ, Altmann DR, Wheeler-Kingshott CAM, Kapoor R, Miller DH, Golay X. Cerebral arterial bolus arrival time is prolonged in multiple sclerosis and associated with disability. J Cereb Blood Flow Metab 2014; 34:34-42. [PMID: 24045400 PMCID: PMC3887342 DOI: 10.1038/jcbfm.2013.161] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Revised: 07/17/2013] [Accepted: 08/14/2013] [Indexed: 12/20/2022]
Abstract
Alterations in the overall cerebral hemodynamics have been reported in multiple sclerosis (MS); however, their cause and significance is unknown. While potential venous causes have been examined, arterial causes have not. In this study, a multiple delay time arterial spin labeling magnetic resonance imaging sequence at 3T was used to quantify the arterial hemodynamic parameter bolus arrival time (BAT) and cerebral blood flow (CBF) in normal-appearing white matter (NAWM) and deep gray matter in 33 controls and 35 patients with relapsing-remitting MS. Bolus arrival time was prolonged in MS in NAWM (1.0±0.2 versus 0.9±0.2 seconds, P=0.031) and deep gray matter (0.90±0.18 versus 0.80±0.14 seconds, P=0.001) and CBF was increased in NAWM (14±4 versus 10±2 mL/100 g/min, P=0.001). Prolonged BAT in NAWM (P=0.042) and deep gray matter (P=0.01) were associated with higher expanded disability status score. This study demonstrates alteration in cerebral arterial hemodynamics in MS. One possible cause may be widespread inflammation. Bolus arrival time was longer in patients with greater disability independent of atrophy and T2 lesion load, suggesting alterations in cerebral arterial hemodynamics may be a marker of clinically relevant pathology.
Collapse
Affiliation(s)
- David Paling
- Department of Neuroinflammation, UCL Institute of Neurology, Queen Square MS Centre, London, UK
| | - Esben Thade Petersen
- Department of Radiology and Radiotherapy E01.132, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Daniel J Tozer
- Department of Neuroinflammation, UCL Institute of Neurology, Queen Square MS Centre, London, UK
| | - Daniel R Altmann
- 1] Department of Neuroinflammation, UCL Institute of Neurology, Queen Square MS Centre, London, UK [2] Medical Statistics Department, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Raju Kapoor
- Department of Neuroinflammation, UCL Institute of Neurology, Queen Square MS Centre, London, UK
| | - David H Miller
- Department of Neuroinflammation, UCL Institute of Neurology, Queen Square MS Centre, London, UK
| | - Xavier Golay
- Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, Queen Square MS Centre, London, UK
| |
Collapse
|
21
|
Filippi M, Evangelou N, Kangarlu A, Inglese M, Mainero C, Horsfield MA, Rocca MA. Ultra-high-field MR imaging in multiple sclerosis. J Neurol Neurosurg Psychiatry 2014; 85:60-6. [PMID: 23813636 DOI: 10.1136/jnnp-2013-305246] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
In multiple sclerosis (MS), MRI is the most important paraclinical tool used to inform diagnosis and for monitoring disease evolution, either natural or modified by treatment. The increased availability of ultra-high-field magnets (7 Tesla or higher) gives rise to questions about the main benefits of and challenges for their use in patients with MS. The main advantages of ultra-high-field MRI are the improved signal-to-noise ratio, greater chemical shift dispersion, and improved contrast due to magnetic susceptibility variations, which lead to increased sensitivity to the heterogeneous pathological substrates of the disease. At present, ultra-high-field MRI is mainly used to improve our understanding of MS pathogenesis. This review discusses the main achievements that have so far come from the use of these scanners, which are: better visualisation of white matter lesions and their morphological characteristics; an improvement in the ability to visualise grey matter lesions and their exact location; the quantification of 'novel' metabolites which may have a role in axonal degeneration; and greater sensitivity to iron accumulation. The application of ultra-high-field systems in standard clinical practice is still some way off since their role in the diagnostic work-up of patients at presentation with clinically isolated syndromes, or in monitoring disease progression or treatment response in patients with definite MS, needs to be established. Additional challenges remain in the development of morphological, quantitative and functional imaging methods at these field strengths, techniques which may ultimately lead to novel biomarkers for monitoring disease evolution and treatment response.
Collapse
Affiliation(s)
- Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, Institute of Experimental Neurology, , San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | | | | | | | | | | | | |
Collapse
|
22
|
Denier N, Gerber H, Vogel M, Klarhöfer M, Riecher-Rossler A, Wiesbeck GA, Lang UE, Borgwardt S, Walter M. Reduction in cerebral perfusion after heroin administration: a resting state arterial spin labeling study. PLoS One 2013; 8:e71461. [PMID: 24039715 PMCID: PMC3769358 DOI: 10.1371/journal.pone.0071461] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Accepted: 07/05/2013] [Indexed: 11/18/2022] Open
Abstract
Heroin dependence is a chronic relapsing brain disorder, characterized by the compulsion to seek and use heroin. Heroin itself has a strong potential to produce subjective experiences characterized by intense euphoria, relaxation and release from craving. The neurofunctional foundations of these perceived effects are not well known. In this study, we have used pharmacological magnetic resonance imaging (phMRI) in 15 heroin-dependent patients from a stable heroin-assisted treatment program to observe the steady state effects of heroin (60 min after administration). Patients were scanned in a cross-over and placebo controlled design. They received an injection of their regular dose of heroin or saline (placebo) before or after the scan. As phMRI method, we used a pulsed arterial spin labeling (ASL) sequence based on a flow-sensitive alternating inversion recovery (FAIR) spin labeling scheme combined with a single-shot 3D GRASE (gradient-spin echo) readout on a 3 Tesla scanner. Analysis was performed with Statistical Parametric Mapping (SPM 8), using a general linear model for whole brain comparison between the heroin and placebo conditions. We found that compared to placebo, heroin was associated with reduced perfusion in the left anterior cingulate cortex (ACC), the left medial prefrontal cortex (mPFC) and in the insula (both hemispheres). Analysis of extracted perfusion values indicate strong effect sizes and no gender related differences. Reduced perfusion in these brain areas may indicate self- and emotional regulation effects of heroin in maintenance treatment.
Collapse
Affiliation(s)
- Niklaus Denier
- University Hospital of Psychiatry, Basel, Switzerland
- * E-mail:
| | - Hana Gerber
- University Hospital of Psychiatry, Basel, Switzerland
- Department of Psychology, University of Basel, Basel, Switzerland
| | - Marc Vogel
- University Hospital of Psychiatry, Basel, Switzerland
| | - Markus Klarhöfer
- Department of Radiological Physics, Basel University Hospital, Basel, Switzerland
| | | | | | | | - Stefan Borgwardt
- University Hospital of Psychiatry, Basel, Switzerland
- Medical Image Analysis Centre, Basel University Hospital, Basel, Switzerland
| | - Marc Walter
- University Hospital of Psychiatry, Basel, Switzerland
| |
Collapse
|
23
|
Narayana PA, Zhou Y, Hasan KM, Datta S, Sun X, Wolinsky JS. Hypoperfusion and T1-hypointense lesions in white matter in multiple sclerosis. Mult Scler 2013; 20:365-73. [PMID: 23836878 DOI: 10.1177/1352458513495936] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Longitudinal magnetic resonance imaging (MRI) studies show that a fraction of the multiple sclerosis (MS) T2-lesions contain T1-hypointense components that may persist to represent severe, irreversible tissue damage. It is not known why certain lesions convert to persistent T1-hypointense lesions. OBJECTIVE We hypothesized that the T1-hypointense lesions disproportionately distribute in the more hypoperfused areas of the brain. Here we investigated the association between hypoperfusion and T1-hypointense lesion distributions. METHODS MRI and cerebral blood flow (CBF) data were acquired on 45 multiple sclerosis (MS) patients and 20 healthy controls. CBF maps were generated using pseudo-continuous arterial spin labeling technique. The lesion probability distribution maps were superimposed on the CBF maps. RESULTS Two distinct CBF clusters were observed in the white matter (WM) both in healthy controls and MS patients. An overall reduction in CBF was observed in MS patients compared to healthy controls. The majority of the T1-hypointense lesions were concentrated almost exclusively in the WM regions with lower CBF. The T2-hyperintense lesions were more generally distributed in both higher and lower perfused WM. CONCLUSION This study suggests an association between hypoperfusion and T1-hypointense lesions.
Collapse
|
24
|
Abnormalities of cerebral blood flow in multiple sclerosis: a pseudocontinuous arterial spin labeling MRI study. Magn Reson Imaging 2013; 31:990-5. [PMID: 23582984 DOI: 10.1016/j.mri.2013.03.016] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Revised: 01/30/2013] [Accepted: 03/09/2013] [Indexed: 11/22/2022]
Abstract
Arterial spin labeling (ASL) is a noninvasive technique that can measure cerebral blood flow (CBF). To our knowledge, there is no study that examined regional CBF of multiple sclerosis (MS) patients by using this technique. The present study assessed the relationship between clinical presentations and functional imaging data in MS using pseudocontinuous arterial spin labeling (pCASL). Twenty-seven patients with MS and 24 healthy volunteers underwent magnetic resonance imaging and pCASL to assess CBF. Differences in CBF between the two groups and the relationships of CBF values with the T2-hyperintense volume were evaluated. Compared to the healthy volunteers, reduced CBF was found in the bilateral thalami and right frontal region of the MS patients. The volume of the T2-hyperintense lesion was negatively correlated with regional CBF in some areas, such as both thalami. Our results suggest that demyelinated lesions in MS mainly have a remote effect on the thalamus and that the measurement of CBF using ASL could be an objective marker for monitoring disease activity in MS.
Collapse
|
25
|
Utriainen D, Trifan G, Sethi S, Elias S, Hewett J, Feng W, Haacke EM. Magnetic resonance imaging signatures of vascular pathology in multiple sclerosis. Neurol Res 2013; 34:780-92. [PMID: 22971468 DOI: 10.1179/1743132812y.0000000078] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Venous vascular contributing factors to multiple sclerosis (MS) have been known for some time. Only recently has the scope of their potential role become more apparent with the theory of chronic cerebrospinal venous insufficiency (CCSVI). As research expands to further explore the role of vascular pathology in the MS population, it is expedient to review the evidence from an imaging perspective. In this paper, we review the current state-of-the-art methods using magnetic resonance imaging (MRI) as applied to imaging MS patients and CCSVI. This includes evaluating imaging signatures of vascular structure and flow as well as brain iron content. Upon review of the literature, we find that extracranial venous anomalies including stenosis, venous malformations, and collateralization of flow in the major veins of the neck have been observed to be prevalent in the MS population. Abnormal flow has been reported in MS patients both in major vessels using phase-contrast flow quantification and in the brain using perfusion-weighted imaging. We discuss the role of quantitative flow imaging and its potential in assessing possible biomarkers for abnormal flow. Finally, it has been suggested that the presence of high iron content may indirectly indicate progression of existing vascular pathology. To that end, we review the use of susceptibility-weighted imaging in monitoring iron in the thalamus, basal ganglia, and MS lesions.
Collapse
|
26
|
Denier N, Schmidt A, Gerber H, Schmid O, Riecher-Rössler A, Wiesbeck GA, Huber CG, Lang UE, Radue EW, Walter M, Borgwardt S. Association of frontal gray matter volume and cerebral perfusion in heroin addiction: a multimodal neuroimaging study. Front Psychiatry 2013; 4:135. [PMID: 24151470 PMCID: PMC3801154 DOI: 10.3389/fpsyt.2013.00135] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Accepted: 10/02/2013] [Indexed: 12/12/2022] Open
Abstract
Structure and function are closely related in the healthy human brain. In patients with chronic heroin exposure, brain imaging studies have identified long-lasting changes in gray matter (GM) volume. More recently, we showed that acute application of heroin in dependent patients results in hypoperfusion of fronto-temporal areas compared with the placebo condition. However, the relationship between structural and cerebral blood flow (CBF) changes in heroin addiction has not yet been investigated. Moreover, it is not known whether there is any interaction between the chronic structural changes and the short and long-term effects on perfusion caused by heroin. Using a double-blind, within-subject design, heroin or placebo (saline) was administered to 14 heroin-dependent patients from a stable heroin-assisted treatment program, in order to observe acute short-term effects. Arterial spin labeling (ASL) was used to calculate perfusion quantification maps in both treatment conditions, while Voxel-Based Morphometry (VBM) was conducted to calculate regional GM density. VBM and ASL data were used to calculate homologous correlation fields by Biological Parametric Mapping (BPM) and a whole-brain Pearson r correlation. We correlated each perfusion condition (heroin and placebo) separately with a VBM sample that was identical for the two treatment conditions. It was assumed that heroin-associated perfusion is manifested in short-term effects, while placebo-associated perfusion is more related to long-term effects. In order to restrict our analyses to fronto-temporal regions, we used an explicit mask for our analyses. Correlation analyses revealed a significant positive correlation in frontal areas between GM and both perfusion conditions (heroin and placebo). Heroin-associated perfusion was also negatively correlated with GM in the inferior temporal gyrus on both hemispheres. These findings indicate that, in heroin-dependent patients, low GM volume is positively associated with low perfusion within frontal regions.
Collapse
Affiliation(s)
- Niklaus Denier
- Department of Psychiatry (UPK), University of Basel , Basel , Switzerland
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|