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Reinhardt C, Angstwurm K, Freudenstein D, Lee DH, Wendl C, Linker RA. Real-world analysis of brain atrophy in multiple sclerosis patients with an artificial intelligence based software tool. Neurol Res Pract 2024; 6:40. [PMID: 39113151 PMCID: PMC11308334 DOI: 10.1186/s42466-024-00339-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 07/22/2024] [Indexed: 08/10/2024] Open
Abstract
BACKGROUND Atrophy of white and grey matter volumes occurs early in the brains of people with multiple sclerosis (pwMS) and has great clinical relevance. In clinical trials, brain atrophy can be quantified by magnetic resonance imaging (MRI) with automated software tools. METHODS In this study, we analyze volumes of various brain regions with the software "md brain" based on routine MRI scans of 53 pwMS in a real-world setting. We compare brain volumes of pwMS with an EDSS ≥ 3.5 and a disease duration ≥ 10 years to the brain volumes of pwMS with an EDSS < 3.5 and a disease duration < 10 years as well as with or without immunotherapy. RESULTS pwMS with an EDSS ≥ 3.5 and a disease duration ≥ 10 years had significantly lower volumes of the total brain, the grey matter and of the frontal, temporal, parietal and occipital lobe regions as compared to pwMS with an EDSS < 3.5 and a disease duration < 10 years. Regional brain volumes were significantly lower in pwMS without immunotherapy. CONCLUSIONS The study showed that higher EDSS, longer disease duration and absence of immunotherapy was associated with lower volumes in a number of brain regions. Further real-world studies may include larger patient cohorts in longitudinal analyses.
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Affiliation(s)
- Caroline Reinhardt
- Department of Neurology, University of Regensburg, Universitätsstr. 84, 93053, Regensburg, Germany
| | - Klemens Angstwurm
- Department of Neurology, University of Regensburg, Universitätsstr. 84, 93053, Regensburg, Germany
| | - David Freudenstein
- Department of Neurology, University of Regensburg, Universitätsstr. 84, 93053, Regensburg, Germany
| | - De-Hyung Lee
- Department of Neurology, University of Regensburg, Universitätsstr. 84, 93053, Regensburg, Germany
| | - Christina Wendl
- Department of Neuroradiology, University of Regensburg, Regensburg, Germany
| | - Ralf A Linker
- Department of Neurology, University of Regensburg, Universitätsstr. 84, 93053, Regensburg, Germany.
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2
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Friesen E, Hari K, Sheft M, Thiessen JD, Martin M. Magnetic resonance metrics for identification of cuprizone-induced demyelination in the mouse model of neurodegeneration: a review. MAGMA (NEW YORK, N.Y.) 2024:10.1007/s10334-024-01160-z. [PMID: 38635150 DOI: 10.1007/s10334-024-01160-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 03/17/2024] [Accepted: 03/26/2024] [Indexed: 04/19/2024]
Abstract
Neurodegenerative disorders, including Multiple Sclerosis (MS), are heterogenous disorders which affect the myelin sheath of the central nervous system (CNS). Magnetic Resonance Imaging (MRI) provides a non-invasive method for studying, diagnosing, and monitoring disease progression. As an emerging research area, many studies have attempted to connect MR metrics to underlying pathophysiological presentations of heterogenous neurodegeneration. Most commonly, small animal models are used, including Experimental Autoimmune Encephalomyelitis (EAE), Theiler's Murine Encephalomyelitis (TMEV), and toxin models including cuprizone (CPZ), lysolecithin, and ethidium bromide (EtBr). A contrast and comparison of these models is presented, with focus on the cuprizone model, followed by a review of literature studying neurodegeneration using MRI and the cuprizone model. Conventional MRI methods including T1 Weighted (T1W) and T2 Weighted (T2W) Imaging are mentioned. Quantitative MRI methods which are sensitive to diffusion, magnetization transfer, susceptibility, relaxation, and chemical composition are discussed in relation to studying the CPZ model. Overall, additional studies are needed to improve both the sensitivity and specificity of MRI metrics for underlying pathophysiology of neurodegeneration and the relationships in attempts to clear the clinico-radiological paradox. We therefore propose a multiparametric approach for the investigation of MR metrics for underlying pathophysiology.
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Affiliation(s)
- Emma Friesen
- Chemistry, University of Winnipeg, Winnipeg, Canada.
| | - Kamya Hari
- Physics, University of Winnipeg, Winnipeg, Canada
- Electronics and Communication Engineering, SSN College of Engineering, Chennai, India
| | - Maxina Sheft
- Physics, University of Winnipeg, Winnipeg, Canada
- Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, USA
| | - Jonathan D Thiessen
- Imaging Program, Lawson Health Research Institute, London, Canada
- Medical Biophysics, Western University, London, Canada
- Medical Imaging, Western University, London, Canada
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3
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Wang J, Chen T, Xie J, Zhao S, Jiang Y, Zhang H, Zhu W. A bibliometric analysis of international publication trends in brain atrophy research (2008-2023). Front Neurol 2024; 15:1348778. [PMID: 38356880 PMCID: PMC10864491 DOI: 10.3389/fneur.2024.1348778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 01/15/2024] [Indexed: 02/16/2024] Open
Abstract
Background Brain atrophy is a type of neurological and psychiatric disorder characterized by a decrease in brain tissue volume and weight for various reasons and can have a serious impact on the quality of life of patients. Although there are many studies on brain atrophy, there is a lack of relevant bibliometric studies. Therefore, this study aims to provide a visual analysis of global trends in brain atrophy research over the past 16 years. Methods CiteSpace and VOSviewer were used to visually analyze publication output, scientific collaborations, cocitations, publishing journals, and keywords to determine the current status and future trends of brain atrophy research. Materials published from 2008 to 2023 were collected from the Web of Science Core Collection (WoSCC) database. This study placed no restrictions on the types of literature and focused on English language publications. Results A total of 3,371 publications were included in the analysis. From 2008 to 2023, the number of publications increased annually. In terms of national and academic institutions, universities in the United States and University College London rank first in publication out. Barkhof Frederik and Zivadinov Robert are the most prolific researchers in this field. The publication with the highest cocitation strength is "Deep gray matter volume loss drives disability worsening in multiple sclerosis." Keyword clustering analysis showed that "Alzheimer's disease" and "multiple sclerosis" are current popular topics. The analysis of emergent words indicates that "cerebral small vessel disease," "neurodegeneration," and "cortex/gray matter volume" may become hot research topics in the coming years. Conclusion This study analyses papers on brain atrophy from the past 16 years, providing a new perspective for research in this field. In the past 16 years, research on brain atrophy has received increasing attention. The quality of articles in this field is generally high. Extensive national cooperation already exists. The statistical results indicate that a stable core author group in the field of brain atrophy has almost formed.
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Affiliation(s)
- Juwei Wang
- Zhejiang Chinese Medical University, Department of Graduate College, Hangzhou, China
| | - Tingting Chen
- Zhejiang Chinese Medical University, Department of Graduate College, Hangzhou, China
| | - Jiayi Xie
- Zhejiang Chinese Medical University, Department of Graduate College, Hangzhou, China
| | - Sheng Zhao
- Zhejiang Chinese Medical University, Department of Graduate College, Hangzhou, China
| | - Yue Jiang
- Department of Acupuncture, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Huihe Zhang
- Department of Neurology, Wenzhou Hospital of Traditional Chinese Medicine, Wenzhou, China
| | - Wenzong Zhu
- Department of Neurology, Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine, Zhejiang Chinese Medical University, Wenzhou, China
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4
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Silva RV, Morr AS, Herthum H, Koch SP, Mueller S, Batzdorf CS, Bertalan G, Meyer T, Tzschätzsch H, Kühl AA, Boehm-Sturm P, Braun J, Scheel M, Paul F, Infante-Duarte C, Sack I. Cortical matrix remodeling as a hallmark of relapsing-remitting neuroinflammation in MR elastography and quantitative MRI. Acta Neuropathol 2024; 147:8. [PMID: 38175305 PMCID: PMC10766667 DOI: 10.1007/s00401-023-02658-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 11/03/2023] [Accepted: 11/23/2023] [Indexed: 01/05/2024]
Abstract
Multiple sclerosis (MS) is a chronic neuroinflammatory disease that involves both white and gray matter. Although gray matter damage is a major contributor to disability in MS patients, conventional clinical magnetic resonance imaging (MRI) fails to accurately detect gray matter pathology and establish a clear correlation with clinical symptoms. Using magnetic resonance elastography (MRE), we previously reported global brain softening in MS and experimental autoimmune encephalomyelitis (EAE). However, it needs to be established if changes of the spatiotemporal patterns of brain tissue mechanics constitute a marker of neuroinflammation. Here, we use advanced multifrequency MRE with tomoelastography postprocessing to investigate longitudinal and regional inflammation-induced tissue changes in EAE and in a small group of MS patients. Surprisingly, we found reversible softening in synchrony with the EAE disease course predominantly in the cortex of the mouse brain. This cortical softening was associated neither with a shift of tissue water compartments as quantified by T2-mapping and diffusion-weighted MRI, nor with leukocyte infiltration as seen by histopathology. Instead, cortical softening correlated with transient structural remodeling of perineuronal nets (PNNs), which involved abnormal chondroitin sulfate expression and microgliosis. These mechanisms also appear to be critical in humans with MS, where tomoelastography for the first time demonstrated marked cortical softening. Taken together, our study shows that neuroinflammation (i) critically affects the integrity of PNNs in cortical brain tissue, in a reversible process that correlates with disease disability in EAE, (ii) reduces the mechanical integrity of brain tissue rather than leading to water accumulation, and (iii) shows similar spatial patterns in humans and mice. These results raise the prospect of leveraging MRE and quantitative MRI for MS staging and monitoring treatment in affected patients.
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Affiliation(s)
- Rafaela V Silva
- Experimental and Clinical Research Center, a cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité - Universitätsmedizin Berlin, Berlin, Germany
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, ECRC - Experimental and Clinical Research Center, Berlin, Germany
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
- Charité - Universitätsmedizin Berlin, Einstein Center for Neurosciences Berlin, Berlin, Germany
| | - Anna S Morr
- Charité - Universitätsmedizin Berlin, Department of Radiology, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Helge Herthum
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Advanced Neuroimaging, Berlin, Germany
| | - Stefan P Koch
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Experimental Neurology and Center for Stroke Research Berlin, Berlin, Germany
- Charité-Universitätsmedizin Berlin, NeuroCure Cluster of Excellence and Charité Core Facility 7T Experimental MRI, Berlin, Germany
| | - Susanne Mueller
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Experimental Neurology and Center for Stroke Research Berlin, Berlin, Germany
- Charité-Universitätsmedizin Berlin, NeuroCure Cluster of Excellence and Charité Core Facility 7T Experimental MRI, Berlin, Germany
| | - Clara S Batzdorf
- Experimental and Clinical Research Center, a cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité - Universitätsmedizin Berlin, Berlin, Germany
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, ECRC - Experimental and Clinical Research Center, Berlin, Germany
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
| | - Gergely Bertalan
- Charité - Universitätsmedizin Berlin, Department of Radiology, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Tom Meyer
- Charité - Universitätsmedizin Berlin, Department of Radiology, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Heiko Tzschätzsch
- Charité - Universitätsmedizin Berlin, Department of Radiology, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Anja A Kühl
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, iPATH.Berlin, Berlin, Germany
| | - Philipp Boehm-Sturm
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Experimental Neurology and Center for Stroke Research Berlin, Berlin, Germany
- Charité-Universitätsmedizin Berlin, NeuroCure Cluster of Excellence and Charité Core Facility 7T Experimental MRI, Berlin, Germany
| | - Jürgen Braun
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Medical Informatics, Berlin, Germany
| | - Michael Scheel
- Charité - Universitätsmedizin Berlin Corporate, Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, NeuroCure Clinical Research Center, Berlin, Germany
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Department of Neuroradiology, Berlin, Germany
| | - Friedemann Paul
- Experimental and Clinical Research Center, a cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Carmen Infante-Duarte
- Experimental and Clinical Research Center, a cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité - Universitätsmedizin Berlin, Berlin, Germany.
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, ECRC - Experimental and Clinical Research Center, Berlin, Germany.
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany.
| | - Ingolf Sack
- Charité - Universitätsmedizin Berlin, Department of Radiology, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
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Gadhave DG, Sugandhi VV, Kokare CR. Potential biomaterials and experimental animal models for inventing new drug delivery approaches in the neurodegenerative disorder: Multiple sclerosis. Brain Res 2024; 1822:148674. [PMID: 37952871 DOI: 10.1016/j.brainres.2023.148674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 09/14/2023] [Accepted: 11/07/2023] [Indexed: 11/14/2023]
Abstract
The tight junction of endothelial cells in the central nervous system (CNS) has an ideal characteristic, acting as a biological barrier that can securely regulate the movement of molecules in the brain. Tightly closed astrocyte cell junctions on blood capillaries are the blood-brain barrier (BBB). This biological barrier prohibits the entry of polar drugs, cells, and ions, which protect the brain from harmful toxins. However, delivering any therapeutic agent to the brain in neurodegenerative disorders (i.e., schizophrenia, multiple sclerosis, etc.) is extremely difficult. Active immune responses such as microglia, astrocytes, and lymphocytes cross the BBB and attack the nerve cells, which causes the demyelination of neurons. Therefore, there is a hindrance in transmitting electrical signals properly, resulting in blindness, paralysis, and neuropsychiatric problems. The main objective of this article is to shed light on the performance of biomaterials, which will help researchers to create nanocarriers that can cross the blood-brain barrier and achieve a therapeutic concentration of drugs in the CNS of patients with multiple sclerosis (MS). The present review focuses on the importance of biomaterials with diagnostic and therapeutic efficacy that can help enhance multiple sclerosis therapeutic potential. Currently, the development of MS in animal models is limited by immune responses, which prevent MS induction in healthy animals. Therefore, this article also showcases animal models currently used for treating MS. A future advance in developing a novel effective strategy for treating MS is now a potential area of research.
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Affiliation(s)
- Dnyandev G Gadhave
- Department of Pharmaceutics, Sinhgad Technical Education Society's, Sinhgad Institute of Pharmacy (Affiliated to Savitribai Phule Pune University), Narhe, Pune 411041, Maharashtra, India; Department of Pharmaceutical Sciences, College of Pharmacy and Health Sciences, St. John's University, 8000 Utopia Parkway, Queens, NY 11439, USA; Department of Pharmaceutics, Dattakala Shikshan Sanstha's, Dattakala College of Pharmacy (Affiliated to Savitribai Phule Pune University), Swami Chincholi, Daund, Pune 413130, Maharashtra, India.
| | - Vrashabh V Sugandhi
- Department of Pharmaceutical Sciences, College of Pharmacy and Health Sciences, St. John's University, 8000 Utopia Parkway, Queens, NY 11439, USA
| | - Chandrakant R Kokare
- Department of Pharmaceutics, Sinhgad Technical Education Society's, Sinhgad Institute of Pharmacy (Affiliated to Savitribai Phule Pune University), Narhe, Pune 411041, Maharashtra, India
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6
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Menon RG, Sharafi A, Muccio M, Smith T, Kister I, Ge Y, Regatte RR. Three-dimensional multi-parameter brain mapping using MR fingerprinting. RESEARCH SQUARE 2023:rs.3.rs-2675278. [PMID: 36993561 PMCID: PMC10055680 DOI: 10.21203/rs.3.rs-2675278/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
The purpose of this study was to develop and test a 3D multi-parameter MR fingerprinting (MRF) method for brain imaging applications. The subject cohort included 5 healthy volunteers, repeatability tests done on 2 healthy volunteers and tested on two multiple sclerosis (MS) patients. A 3D-MRF imaging technique capable of quantifying T1, T2 and T1ρ was used. The imaging sequence was tested in standardized phantoms and 3D-MRF brain imaging with multiple shots (1, 2 and 4) in healthy human volunteers and MS patients. Quantitative parametric maps for T1, T2, T1ρ, were generated. Mean gray matter (GM) and white matter (WM) ROIs were compared for each mapping technique, Bland-Altman plots and intra-class correlation coefficient (ICC) were used to assess repeatability and Student T-tests were used to compare results in MS patients. Standardized phantom studies demonstrated excellent agreement with reference T1/T2/T1ρ mapping techniques. This study demonstrates that the 3D-MRF technique is able to simultaneously quantify T1, T2 and T1ρ for tissue property characterization in a clinically feasible scan time. This multi-parametric approach offers increased potential to detect and differentiate brain lesions and to better test imaging biomarker hypotheses for several neurological diseases, including MS.
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Affiliation(s)
| | | | | | - Tyler Smith
- New York University Grossman School of Medicine
| | - Ilya Kister
- New York University Grossman School of Medicine
| | - Yulin Ge
- New York University Grossman School of Medicine
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7
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Quigley S, Yiannakas MC, Bede P, Meaney J, Kearney H. Neuropathologically informed imaging of cortical grey matter lesions in MS - A pilot study. Mult Scler Relat Disord 2023; 71:104555. [PMID: 36870314 DOI: 10.1016/j.msard.2023.104555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 01/06/2023] [Accepted: 02/05/2023] [Indexed: 02/10/2023]
Abstract
Multiple sclerosis (MS) is frequently misdiagnosed based on MRI abnormalities detected in the brain white matter. Cortical lesions have been well described neuropathologically, but remain challenging to detect in clinical practice. Therefore, the ability to detect cortical lesions offers real potential to reduce misdiagnosis. Cortical lesions have been shown to have a predilection for regions with CSF stasis - such as the insula and cingulate gyrus. This pathological observation forms the basis of our current pilot MR imaging study, which successfully uses high spatial resolution imaging of these two anatomical regions to clearly identify cortical lesions in MS.
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Affiliation(s)
- S Quigley
- Department of Neurology, St James's Hospital, Dublin, Ireland
| | - M C Yiannakas
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - P Bede
- Department of Neurology, St James's Hospital, Dublin, Ireland; Computational Neuroimaging Group (CNG), TBSI, Trinity College Dublin, Ireland
| | - J Meaney
- Centre for Advanced Medical Imaging, St James's Hospital and Trinity College Dublin, Dublin, Ireland
| | - H Kearney
- Department of Neurology, St James's Hospital, Dublin, Ireland; Academic Unit of Neurology, Trinity College Dublin, Ireland.
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8
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Lesion-Specific Metabolic Alterations in Relapsing-Remitting Multiple Sclerosis Via 7 T Magnetic Resonance Spectroscopic Imaging. Invest Radiol 2023; 58:156-165. [PMID: 36094811 PMCID: PMC9835681 DOI: 10.1097/rli.0000000000000913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Magnetic resonance spectroscopic imaging (MRSI) of the brain enables in vivo assessment of metabolic alterations in multiple sclerosis (MS). This provides complementary insights into lesion pathology that cannot be obtained via T1- and T2-weighted conventional magnetic resonance imaging (cMRI). PURPOSE The aims of this study were to assess focal metabolic alterations inside and at the periphery of lesions that are visible or invisible on cMRI, and to correlate their metabolic changes with T1 hypointensity and the distance of lesions to cortical gray matter (GM). METHODS A 7 T MRSI was performed on 51 patients with relapsing-remitting MS (30 female/21 male; mean age, 35.4 ± 9.9 years). Mean metabolic ratios were calculated for segmented regions of interest (ROIs) of normal-appearing white matter, white matter lesions, and focal regions of increased mIns/tNAA invisible on cMRI. A subgroup analysis was performed after subdividing based on T1 relaxation and distance to cortical GM. Metabolite ratios were correlated with T1 and compared between different layers around cMRI-visible lesions. RESULTS Focal regions of, on average, 2.8-fold higher mIns/tNAA than surrounding normal-appearing white matter and with an appearance similar to that of MS lesions were found, which were not visible on cMRI (ie, ~4% of metabolic hotspots). T1 relaxation was positively correlated with mIns/tNAA ( P ≤ 0.01), and negatively with tNAA/tCr ( P ≤ 0.01) and tCho/tCr ( P ≤ 0.01). mIns/tCr was increased outside lesions, whereas tNAA/tCr distributions resembled macroscopic tissue damage inside the lesions. mIns/tCr was -21% lower for lesions closer to cortical GM ( P ≤ 0.05). CONCLUSIONS 7 T MRSI allows in vivo visualization of focal MS pathology not visible on cMRI and the assessment of metabolite levels in the lesion center, in the active lesion periphery and in cortical lesions. This demonstrated the potential of MRSI to image mIns as an early biomarker in lesion development.
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Ceccarelli A. Structural and functional brain damage in women with multiple sclerosis: A mini-review of neuroimaging sex-based studies. Front Neurol 2022; 13:1057446. [PMID: 36619939 PMCID: PMC9815112 DOI: 10.3389/fneur.2022.1057446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 12/07/2022] [Indexed: 12/24/2022] Open
Abstract
Neuroimaging literature in healthy humans has shown that there are sex-related differences in healthy brain's anatomical structure, associated function and susceptibility to neurological diseases. This mini-review summarizes findings derived from the current neuroimaging studies focused on sex-related brain structural and functional damage in women with multiple sclerosis (MS). MS is a chronic, multifactorial, immune-mediated disorder of the central nervous system that affects mostly women. Even if recent neuroimaging studies have shed light on distinctive features of sex-related MS differences in brain structural and functional damage, more research is needed to better elucidate sex-related MS pathological changes and susceptibility and to implement sex-tailored treatment strategies in MS.
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Affiliation(s)
- Antonia Ceccarelli
- Department of Neurology, EpiCURA Centre Hospitalier, Ath, Belgium,Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, Brussels, Belgium,*Correspondence: Antonia Ceccarelli ✉
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10
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Baghdadi M, Badwey ME, Khalil M, Dawoud RM. Brain magnetic resonance imaging surface-based analysis and cortical thickness measurement in relapsing remission multiple sclerosis. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2022. [DOI: 10.1186/s43055-021-00686-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Damage occurs in the brain tissue in MS which appears normal on standard conventional imaging (normal appearing brain tissue). This slow, evolving damage can be monitored by nonconventional advanced MR imaging techniques. New techniques for the measurement of cortical thickness have been validated against histological analysis and manual measurements. The aim of our study was to study the role of MRI surface-based analysis and cortical thickness measurement in the evaluation of patients with Relapsing Remitting Multiple Sclerosis and to detect if there is localized rather than generalized cortical atrophy in Multiple Sclerosis patients and correlating these findings with clinical data.
Results
30 patients and 30 healthy control were included in this study and they were subjected to cortical thickness analysis using MRI. The patients in our study showed decreased thickness of the precentral, paracentral, postcentral, posterior cingulate cortices and mean cortical thickness in both hemispheres when compared with the normal control group. Statistical analysis was significant (P value < 0.05) for the precentral, paracentral, postcentral, posterior cingulate cortices and mean cortical thickness in both hemispheres. On the other hand, statistical analysis was not significant (P value > 0.05) for other cortices. There was a significant negative correlation between the precentral, paracentral, postcentral, posterior cingulate cortices and mean cortical thickness in both hemispheres and EDSS scores with correlation coefficients ranging from − 0.9878 to − 0.7977.
Conclusions
MRI and post-processing segmentation analysis for cortical thickness is non-invasive imaging techniques that can increase the level of diagnostic confidence in diagnosis of MS patients and should be included as routine modality when evaluating patients with MS.
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11
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Voskuhl RR, MacKenzie-Graham A. Chronic experimental autoimmune encephalomyelitis is an excellent model to study neuroaxonal degeneration in multiple sclerosis. Front Mol Neurosci 2022; 15:1024058. [PMID: 36340686 PMCID: PMC9629273 DOI: 10.3389/fnmol.2022.1024058] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 09/30/2022] [Indexed: 08/19/2023] Open
Abstract
Animal models of multiple sclerosis (MS), specifically experimental autoimmune encephalomyelitis (EAE), have been used extensively to develop anti-inflammatory treatments. However, the similarity between MS and one particular EAE model does not end at inflammation. MS and chronic EAE induced in C57BL/6 mice using myelin oligodendrocyte glycoprotein (MOG) peptide 35-55 share many neuropathologies. Beyond both having white matter lesions in spinal cord, both also have widespread neuropathology in the cerebral cortex, hippocampus, thalamus, striatum, cerebellum, and retina/optic nerve. In this review, we compare neuropathologies in each of these structures in MS with chronic EAE in C57BL/6 mice, and find evidence that this EAE model is well suited to study neuroaxonal degeneration in MS.
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Affiliation(s)
- Rhonda R. Voskuhl
- UCLA MS Program, Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
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12
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Mueller C, Baird JF, Motl RW. Whole-Brain Metabolic Abnormalities Are Associated With Mobility in Older Adults With Multiple Sclerosis. Neurorehabil Neural Repair 2022; 36:286-297. [PMID: 35164595 DOI: 10.1177/15459683221076461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Older adults with multiple sclerosis (MS) experience mobility impairments, but conventional brain imaging is a poor predictor of walking abilities in this population. OBJECTIVE To test whether brain metabolites measured with Magnetic Resonance Spectroscopy (MRS) are associated with walking performance in older adults with MS. METHODS Fifteen older adults with MS (mean age: 60.9, SD: 5.1) and 22 age-matched healthy controls (mean age: 64.2, SD: 5.7) underwent whole-brain MRS and mobility testing. Levels of N-acetylaspartate (NAA), myo-inositol (MI), choline (CHO), and temperature in 47 brain regions were compared between groups and correlated with walking speed (Timed 25 Foot Walk) and walking endurance (Six-Minute Walk). RESULTS Older adults with MS had higher MI in 23 areas, including the bilateral frontal (right: t (21.449) = -2.605, P = .016; left: t (35) = -2.434, P = .020), temporal (right: t (35) = -3.063, P = .004; left: t (35) = -3.026, P = .005), and parietal lobes (right: t (21.100) = -2.886, P = .009; left: t (35) = -2.507, P = .017), and right thalamus (t (35) = -2.840, P = .007). MI in eleven regions correlated with walking speed, and MI in twelve regions correlated with walking endurance. NAA was lower in MS in the bilateral thalami (right: t (35) = 3.449, P < .001; left: t (35) = 2.061, P = .047), caudate nuclei (right: t (33) = 2.828, P = .008; left: t (32) = 2.132, P = .041), and posterior cingulum (right: t (35) = 3.077, P = .004; left: t (35) = 2.972, P = .005). NAA in four regions correlated with walking speed and endurance. Brain temperature was higher in MS patients in four regions, but did not correlate with mobility measures. There were no group differences in CHO. CONCLUSION MI and NAA may be useful imaging end-points for walking ability as a clinical outcome in older adults with MS.
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Affiliation(s)
- Christina Mueller
- Department of Neurology, 9967University of Alabama at Birmingham, Birmingham, AL, United States
| | - Jessica F Baird
- Department of Physical Therapy, 9968University of Alabama at Birmingham, Birmingham, AL, United States
| | - Robert W Motl
- Department of Physical Therapy, 9968University of Alabama at Birmingham, Birmingham, AL, United States
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13
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Torkhani E, Dematte E, Slawinski J, Csillik A, Gay MC, Bensmaïl D, Heinzlef O, de Marco G. Improving Health of People With Multiple Sclerosis From a Multicenter Randomized Controlled Study in Parallel Groups: Preliminary Results on the Efficacy of a Mindfulness Intervention and Intention Implementation Associated With a Physical Activity Program. Front Psychol 2022; 12:767784. [PMID: 35002857 PMCID: PMC8740326 DOI: 10.3389/fpsyg.2021.767784] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 12/03/2021] [Indexed: 11/30/2022] Open
Abstract
Objectives: The objective of this study is to investigate the efficacy of psychological Interventions – Mindfulness or Implementation Intention – associated with a Physical Activity program, delivered via internet, in reducing Multiple Sclerosis symptoms. Method: Thirty-five adults were randomly assigned to one of the three groups: a Mindfulness-Based Intervention group (N = 12), Implementation Intention group (N = 11), and a Control Group (N = 12). All the groups received the same Physical Activity program. The Mindfulness condition group received daily training in the form of pre-recorded sessions while the Implementation group elaborated their specific plans once a week. Mobility, fatigue, and the impact of the disease on the patient’s life were measured. Two measurement times are carried out in pre-post intervention, at baseline and after eight weeks. Results: Overall, after 8 weeks intervention, results show that there was a significant increase in Walking distance in the three groups. In addition, the within-group analysis showed a statistically significant improvement between pre and post intervention on the physical component of the Disease Impact scale in the Implementation Intention group (p = 0.023) with large effect size, in the Mindfulness-Based Intervention group (p = 0.008) with a medium effect size and in the control group (p = 0.028) with small effect size. In the Implementation Intention group, all physical, psychosocial and cognitive Fatigue Impact subscales scores decreased significantly (p = 0.022, p = 0.023, and p = 0.012, respectively) and the physical component was statistically and negatively correlated (r = −0.745; p = 0.008) when Implementation Intention group practice a mild to moderate physical activity. In the Mindfulness-Based Intervention group, the physical component (MFIS) showed a statistically significant improvement (p = 0.028) but no correlation with moderate-to-vigorous physical activity (MVPA); the control group outcomes did not reveal any significant change. Conclusion: The results of this study are very encouraging and show the feasibility of Mindfulness interventions associated with physical activity to improve the health of people with MS. Further study should assess Mindfulness interventions tailored to MS condition and using both hedonic and eudemonic measures of happiness.
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Affiliation(s)
- Eya Torkhani
- Laboratoire LINP2, Université Paris Nanterre, UPL, Nanterre, France
| | - Emilie Dematte
- Laboratoire LINP2, Université Paris Nanterre, UPL, Nanterre, France
| | - Jean Slawinski
- Laboratoire LINP2, Université Paris Nanterre, UPL, Nanterre, France.,French National Institute of Sport, Expertise and Performance, Sport, Expertise and Performance Laboratory, Paris, France
| | - Antonia Csillik
- iMSpire (International Multiple Sclerosis Partnership in Research) Special Interest Group, Paris Nanterre University, Nanterre, France.,Department of Psychology, Université Paris Nanterre, Nanterre, France
| | - Marie-Claire Gay
- iMSpire (International Multiple Sclerosis Partnership in Research) Special Interest Group, Paris Nanterre University, Nanterre, France.,Department of Psychology, Université Paris Nanterre, Nanterre, France
| | - Djamel Bensmaïl
- Department of Physical and Rehabilitation Medicine, Raymond Poincaré Hospital - APHP Paris Saclay, Garches, France.,UMR 1179 INSERM-UVSQ, Neuromuscular Handicap - University of Versailles, Montigny-le-Bretonneux, France
| | - Olivier Heinzlef
- Laboratoire LINP2, Université Paris Nanterre, UPL, Nanterre, France.,iMSpire (International Multiple Sclerosis Partnership in Research) Special Interest Group, Paris Nanterre University, Nanterre, France.,CHI de Poissy-St Germain, Conflans-Sainte-Honorine, France
| | - Giovanni de Marco
- Laboratoire LINP2, Université Paris Nanterre, UPL, Nanterre, France.,iMSpire (International Multiple Sclerosis Partnership in Research) Special Interest Group, Paris Nanterre University, Nanterre, France
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14
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Rizkallah M, Hefida M, Khalil M, Dawoud RM. Automated quantification of deep grey matter structures and white matter lesions using magnetic resonance imaging in relapsing remission multiple sclerosis. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2021. [DOI: 10.1186/s43055-021-00582-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Brain volume loss (BVL) is widespread in MS and occurs throughout the disease course at a rate considerably greater than in the general population. In MS, brain volume correlates with and predicts future disability, making BVL a relevant measure of diffuse CNS damage leading to clinical disease progression, as well as serving as a useful outcome in evaluating MS therapies. The aim of our study was to evaluate the role of automated segmentation and quantification of deep grey matter structures and white matter lesions in Relapsing Remitting Multiple Sclerosis patients using MR images and to correlate the volumetric results with different degrees of disability based on expanded disability status scale (EDSS) scores.
Results
All the patients in our study showed relative atrophy of the thalamus and the putamen bilaterally when compared with the normal control group. Statistical analysis was significant for the thalamus and the putamen atrophy (P value < 0.05). On the other hand, statistical analysis was not significant for the caudate and the hippocampus (P value > 0.05); there was a significant positive correlation between the white matter lesions volume and EDSS scores (correlation coefficient of 0.7505). On the other hand, there was a significant negative correlation between the thalamus and putamen volumes, and EDSS scores (correlation coefficients < − 0.9), while the volumes of the caudate and the hippocampus had a very weak and non-significant correlation with the EDSS scores (correlation coefficients > − 0.35).
Conclusions
The automated segmentation and quantification tools have a great role in the assessment of brain structural changes in RRMS patients, and that it became essential to integrate these tools in the daily medical practice for the great value they add to the current evaluation measures.
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15
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Madsen MAJ, Wiggermann V, Bramow S, Christensen JR, Sellebjerg F, Siebner HR. Imaging cortical multiple sclerosis lesions with ultra-high field MRI. Neuroimage Clin 2021; 32:102847. [PMID: 34653837 PMCID: PMC8517925 DOI: 10.1016/j.nicl.2021.102847] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 08/19/2021] [Accepted: 08/25/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cortical lesions are abundant in multiple sclerosis (MS), yet difficult to visualize in vivo. Ultra-high field (UHF) MRI at 7 T and above provides technological advances suited to optimize the detection of cortical lesions in MS. PURPOSE To provide a narrative and quantitative systematic review of the literature on UHF MRI of cortical lesions in MS. METHODS A systematic search of all literature on UHF MRI of cortical lesions in MS published before September 2020. Quantitative outcome measures included cortical lesion numbers reported using 3 T and 7 T MRI and between 7 T MRI sequences, along with sensitivity of UHF MRI towards cortical lesions verified by histopathology. RESULTS 7 T MRI detected on average 52 ± 26% (mean ± 95% confidence interval) more cortical lesions than the best performing image contrast at 3 T, with the largest increase in type II-IV intracortical lesion detection. Across all studies, the mean cortical lesion number was 17 ± 6 per patient. In progressive MS cohorts, approximately four times more cortical lesions were reported than in CIS/early RRMS, and RRMS. Yet, there was no difference in lesion type ratio between these MS subtypes. Furthermore, superiority of one MRI sequence over another could not be established from available data. Post-mortem lesion detection with UHF MRI agreed only modestly with pathological examinations. Mean pro- and retrospective sensitivity was 33 ± 6% and 71 ± 10%, respectively, with the highest sensitivity towards type I and type IV lesions. CONCLUSION UHF MRI improves cortical lesion detection in MS considerably compared to 3 T MRI, particularly for type II-IV lesions. Despite modest sensitivity, 7 T MRI is still capable of visualizing all aspects of cortical lesion pathology and could potentially aid clinicians in diagnosing and monitoring MS, and progressive MS in particular. However, standardization of acquisition and segmentation protocols is needed.
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Affiliation(s)
- Mads A J Madsen
- Danish Research Centre for Magnetic Resonance, Copenhagen University Hospital - Amager & Hvidovre, Kettegard Allé 30, 2650 Hvidovre, Denmark.
| | - Vanessa Wiggermann
- Danish Research Centre for Magnetic Resonance, Copenhagen University Hospital - Amager & Hvidovre, Kettegard Allé 30, 2650 Hvidovre, Denmark
| | - Stephan Bramow
- Danish Multiple Sclerosis Center, Department of Neurology, Copenhagen University Hospital - Rigshospitalet, Valdemar Hansens Vej 1-23, 2600 Glostrup, Denmark
| | - Jeppe Romme Christensen
- Danish Multiple Sclerosis Center, Department of Neurology, Copenhagen University Hospital - Rigshospitalet, Valdemar Hansens Vej 1-23, 2600 Glostrup, Denmark
| | - Finn Sellebjerg
- Danish Multiple Sclerosis Center, Department of Neurology, Copenhagen University Hospital - Rigshospitalet, Valdemar Hansens Vej 1-23, 2600 Glostrup, Denmark; Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3b, 2200 Copenhagen, Denmark
| | - Hartwig R Siebner
- Danish Research Centre for Magnetic Resonance, Copenhagen University Hospital - Amager & Hvidovre, Kettegard Allé 30, 2650 Hvidovre, Denmark; Department of Neurology, Copenhagen University Hospital - Bispebjerg, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3b, 2200 Copenhagen, Denmark
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16
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Ma S, Wang N, Fan Z, Kaisey M, Sicotte NL, Christodoulou AG, Li D. Three-dimensional whole-brain simultaneous T1, T2, and T1ρ quantification using MR Multitasking: Method and initial clinical experience in tissue characterization of multiple sclerosis. Magn Reson Med 2020; 85:1938-1952. [PMID: 33107126 DOI: 10.1002/mrm.28553] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 09/22/2020] [Accepted: 09/23/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE To develop a 3D whole-brain simultaneous T1/T2/T1ρ quantification method with MR Multitasking that provides high quality, co-registered multiparametric maps in 9 min. METHODS MR Multitasking conceptualizes T1/T2/T1ρ relaxations as different time dimensions, simultaneously resolving all three dimensions with a low-rank tensor image model. The proposed method was validated on a phantom and in healthy volunteers, comparing quantitative measurements against corresponding reference methods and evaluating the scan-rescan repeatability. Initial clinical validation was performed in age-matched relapsing-remitting multiple sclerosis (RRMS) patients to examine the feasibility of quantitative tissue characterization and to compare with the healthy control cohort. The feasibility of synthesizing six contrast-weighted images was also examined. RESULTS Our framework produced high quality, co-registered T1/T2/T1ρ maps that closely resemble the reference maps. Multitasking T1/T2/T1ρ measurements showed substantial agreement with reference measurements on the phantom and in healthy controls. Bland-Altman analysis indicated good in vivo repeatability of all three parameters. In RRMS patients, lesions were conspicuously delineated on all three maps and on four synthetic weighted images (T2-weighted, T2-FLAIR, double inversion recovery, and a novel "T1ρ-FLAIR" contrast). T1 and T2 showed significant differences for normal appearing white matter between patients and controls, while T1ρ showed significant differences for normal appearing white matter, cortical gray matter, and deep gray matter. The combination of three parameters significantly improved the differentiation between RRMS patients and healthy controls, compared to using any single parameter alone. CONCLUSION MR Multitasking simultaneously quantifies whole-brain T1/T2/T1ρ and is clinically promising for quantitative tissue characterization of neurological diseases, such as MS.
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Affiliation(s)
- Sen Ma
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.,Department of Bioengineering, University of California, Los Angeles, California, USA
| | - Nan Wang
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.,Department of Bioengineering, University of California, Los Angeles, California, USA
| | - Zhaoyang Fan
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.,Department of Bioengineering, University of California, Los Angeles, California, USA
| | - Marwa Kaisey
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Nancy L Sicotte
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Anthony G Christodoulou
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.,Department of Bioengineering, University of California, Los Angeles, California, USA
| | - Debiao Li
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.,Department of Bioengineering, University of California, Los Angeles, California, USA
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17
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Milosevic A, Janjic MM, Lavrnja I, Savic D, Bozic ID, Tesovic K, Jakovljevic M, Pekovic S, Stojilkovic SS, Bjelobaba I. The sex-specific patterns of changes in hypothalamic-pituitary-gonadal axis during experimental autoimmune encephalomyelitis. Brain Behav Immun 2020; 89:233-244. [PMID: 32592862 DOI: 10.1016/j.bbi.2020.06.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 06/09/2020] [Accepted: 06/18/2020] [Indexed: 12/16/2022] Open
Abstract
Multiple sclerosis develops during reproductive years in a sex-specific manner. Various neuroendocrine changes have been described in this inflammatory, demyelinating, and debilitating disease. We here aimed to determine the extent and sex specificity of alterations in the hypothalamic-pituitary-gonadal axis in the rat model of multiple sclerosis named experimental autoimmune encephalomyelitis. During the disease course, the hypothalamic tissue showed transient upregulation of inflammatory marker genes Gfap, Cd68, Ccl2, and Il1b in both sexes, but accompanied by sex-specific downregulation of Kiss1 (in females only) and Gnrh1 (in males only) expression. In females, the expression of gonadotrope-specific genes Lhb, Cga, and Gnrhr was also inhibited, accompanied by decreased basal but not stimulated serum luteinizing hormone levels and a transient arrest of the estrous cycle. In contrast, Fshb expression and serum progesterone levels were transiently elevated, findings consistent with the maintenance of the corpora lutea, and elevated immunohistochemical labeling of ovarian StAR, a rate limiting protein in steroidogenic pathway. In males, downregulation of Gnrhr expression and basal and stimulated serum luteinizing hormone and testosterone levels were accompanied by inhibited testicular StAR protein expression. We propose that inflammation of hypothalamic tissue downregulates Kiss1 and Gnrh1 expression in females and males, respectively, leading to sex-specific changes downstream the axis.
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Affiliation(s)
- Ana Milosevic
- Institute for Biological Research "Sinisa Stankovic"- National Institute of Republic of Serbia, University of Belgrade, Belgrade, Serbia
| | - Marija M Janjic
- Institute for Biological Research "Sinisa Stankovic"- National Institute of Republic of Serbia, University of Belgrade, Belgrade, Serbia
| | - Irena Lavrnja
- Institute for Biological Research "Sinisa Stankovic"- National Institute of Republic of Serbia, University of Belgrade, Belgrade, Serbia
| | - Danijela Savic
- Institute for Biological Research "Sinisa Stankovic"- National Institute of Republic of Serbia, University of Belgrade, Belgrade, Serbia
| | - Iva D Bozic
- Institute for Biological Research "Sinisa Stankovic"- National Institute of Republic of Serbia, University of Belgrade, Belgrade, Serbia
| | - Katarina Tesovic
- Institute for Biological Research "Sinisa Stankovic"- National Institute of Republic of Serbia, University of Belgrade, Belgrade, Serbia
| | - Marija Jakovljevic
- Institute for Biological Research "Sinisa Stankovic"- National Institute of Republic of Serbia, University of Belgrade, Belgrade, Serbia
| | - Sanja Pekovic
- Institute for Biological Research "Sinisa Stankovic"- National Institute of Republic of Serbia, University of Belgrade, Belgrade, Serbia
| | - Stanko S Stojilkovic
- Section on Cellular Signaling, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Ivana Bjelobaba
- Institute for Biological Research "Sinisa Stankovic"- National Institute of Republic of Serbia, University of Belgrade, Belgrade, Serbia.
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18
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Hnilicová P, Štrbák O, Kolisek M, Kurča E, Zeleňák K, Sivák Š, Kantorová E. Current Methods of Magnetic Resonance for Noninvasive Assessment of Molecular Aspects of Pathoetiology in Multiple Sclerosis. Int J Mol Sci 2020; 21:E6117. [PMID: 32854318 PMCID: PMC7504207 DOI: 10.3390/ijms21176117] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 08/13/2020] [Accepted: 08/21/2020] [Indexed: 12/29/2022] Open
Abstract
Multiple sclerosis (MS) is an autoimmune disease with expanding axonal and neuronal degeneration in the central nervous system leading to motoric dysfunctions, psychical disability, and cognitive impairment during MS progression. The exact cascade of pathological processes (inflammation, demyelination, excitotoxicity, diffuse neuro-axonal degeneration, oxidative and metabolic stress, etc.) causing MS onset is still not fully understood, although several accompanying biomarkers are particularly suitable for the detection of early subclinical changes. Magnetic resonance (MR) methods are generally considered to be the most sensitive diagnostic tools. Their advantages include their noninvasive nature and their ability to image tissue in vivo. In particular, MR spectroscopy (proton 1H and phosphorus 31P MRS) is a powerful analytical tool for the detection and analysis of biomedically relevant metabolites, amino acids, and bioelements, and thus for providing information about neuro-axonal degradation, demyelination, reactive gliosis, mitochondrial and neurotransmitter failure, cellular energetic and membrane alternation, and the imbalance of magnesium homeostasis in specific tissues. Furthermore, the MR relaxometry-based detection of accumulated biogenic iron in the brain tissue is useful in disease evaluation. The early description and understanding of the developing pathological process might be critical for establishing clinically effective MS-modifying therapies.
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Affiliation(s)
- Petra Hnilicová
- Biomedical Center Martin, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, 036 01 Martin, Slovakia; (O.Š.); (M.K.)
| | - Oliver Štrbák
- Biomedical Center Martin, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, 036 01 Martin, Slovakia; (O.Š.); (M.K.)
| | - Martin Kolisek
- Biomedical Center Martin, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, 036 01 Martin, Slovakia; (O.Š.); (M.K.)
| | - Egon Kurča
- Clinic of Neurology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, 036 01 Martin, Slovakia; (E.K.); (Š.S.); (E.K.)
| | - Kamil Zeleňák
- Clinic of Radiology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, 036 01 Martin, Slovakia;
| | - Štefan Sivák
- Clinic of Neurology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, 036 01 Martin, Slovakia; (E.K.); (Š.S.); (E.K.)
| | - Ema Kantorová
- Clinic of Neurology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, 036 01 Martin, Slovakia; (E.K.); (Š.S.); (E.K.)
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19
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Woitek R, Leutmezer F, Dal-Bianco A, Furtner J, Kasprian G, Prayer D, Schöpf V. Diffusion tensor imaging of the normal-appearing deep gray matter in primary and secondary progressive multiple sclerosis. Acta Radiol 2020; 61:85-92. [PMID: 31169410 DOI: 10.1177/0284185119852735] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Despite strongly overlapping patterns of clinical and histopathologic findings in primary and secondary progressive multiple sclerosis, differences concerning motor symptoms, central nervous system inflammation, atrophy, and demyelination that cannot be accounted for by lesion load alone remain to be elucidated. Purpose To evaluate the normal-appearing deep gray matter in patients with primary and secondary progressive multiple sclerosis, diffusion tensor imaging was used in this study. Material and Methods In 14 multiple sclerosis patients with primary and secondary progressive multiple sclerosis, axial echo-planar single-shot diffusion tensor imaging sequences with 32 diffusion-encoding directions and axial FLAIR sequences were acquired on a 3T system using an eight-channel SENSE head coil. FLAIR hyperintense multiple sclerosis lesions were outlined semi-automatically and normal-appearing deep gray matter was outlined manually (caudate nucleus, globus pallidus, putamen, thalamus, substantia nigra, and red nucleus). Fractional anisotropy and mean diffusivity values within the normal-appearing deep gray matter for the two groups were compared. Results Interhemispheric differences in mean diffusivity values (but not in fractional anisotropy), were significantly higher in primary progressive multiple sclerosis than in secondary progressive multiple sclerosis for the substantia nigra ( P = 0.04) and the putamen ( P = 0.021). Volumes, mean diffusivity, or fractional anisotropy of the remaining normal-appearing deep gray matter did not differ significantly. Conclusion This study showed a higher interhemispheric difference in the mean diffusivity in the substantia nigra and putamen in patients with primary progressive multiple sclerosis than in those with secondary progressive multiple sclerosis. These changes may represent edema, as well as axonal and myelin loss that can affect the normal-appearing deep gray matter of the two hemispheres differently and may point to differences in the laterality of motor symptoms.
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Affiliation(s)
- Ramona Woitek
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Fritz Leutmezer
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | | | - Julia Furtner
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Gregor Kasprian
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Daniela Prayer
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Veronika Schöpf
- Institute of Psychology, University of Graz, Graz, Austria
- BioTechMed, Graz, Austria
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20
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Altered hypothalamic metabolism in early multiple sclerosis – MR spectroscopy study. J Neurol Sci 2019; 407:116458. [DOI: 10.1016/j.jns.2019.116458] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 08/19/2019] [Accepted: 09/10/2019] [Indexed: 12/31/2022]
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21
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Rahmanzadeh R, Brück W, Minagar A, Sahraian MA. Multiple sclerosis pathogenesis: missing pieces of an old puzzle. Rev Neurosci 2019; 30:67-83. [PMID: 29883325 DOI: 10.1515/revneuro-2018-0002] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Accepted: 03/30/2018] [Indexed: 11/15/2022]
Abstract
Traditionally, multiple sclerosis (MS) was considered to be a CD4 T cell-mediated CNS autoimmunity, compatible with experimental autoimmune encephalitis model, which can be characterized by focal lesions in the white matter. However, studies of recent decades revealed several missing pieces of MS puzzle and showed that MS pathogenesis is more complex than the traditional view and may include the following: a primary degenerative process (e.g. oligodendroglial pathology), generalized abnormality of normal-appearing brain tissue, pronounced gray matter pathology, involvement of innate immunity, and CD8 T cells and B cells. Here, we review these findings and discuss their implications in MS pathogenesis.
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Affiliation(s)
- Reza Rahmanzadeh
- MS Research Center, Neuroscience Institute, Tehran University of Medical Science, Department of Neurology, Sina Hospital, 1136746911 Tehran, Iran
| | - Wolfgang Brück
- Institute of Neuropathology, University Medical Center, D-37075 Göttingen, Germany
| | - Alireza Minagar
- Department of Neurology, LSU Health Sciences Center, Shreveport, LA 71130, USA
| | - Mohammad Ali Sahraian
- MS Research Center, Neuroscience Institute, Tehran University of Medical Science, Department of Neurology, Sina Hospital, 1136746911 Tehran, Iran.,Iranian Center for Neurological Research, Neuroscience Institute, Tehran University of Medical Science, 1136746890 Tehran, Iran
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22
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Rumrill, PD, Bishop M. Multiple sclerosis: A high-incidence immune-mediated disease of the central nervous system. JOURNAL OF VOCATIONAL REHABILITATION 2019. [DOI: 10.3233/jvr-191020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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23
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Central nervous system targeted autoimmunity causes regional atrophy: a 9.4T MRI study of the EAE mouse model of Multiple Sclerosis. Sci Rep 2019; 9:8488. [PMID: 31186441 PMCID: PMC6560061 DOI: 10.1038/s41598-019-44682-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 05/02/2019] [Indexed: 12/28/2022] Open
Abstract
Atrophy has become a clinically relevant marker of progressive neurodegeneration in multiple sclerosis (MS). To better understand atrophy, mouse models that feature atrophy along with other aspects of MS are needed. The experimental autoimmune encephalomyelitis (EAE) mouse model of MS was used to determine the extent of atrophy in a model of inflammation-associated central nervous system pathology. High-resolution magnetic resonance imaging (MRI) and atlas-based volumetric analysis were performed to measure brain regional volumes in EAE mice. EAE brains were larger at peak clinical disease (days 14–16) compared to controls, with affected regions including the cerebellum, hippocampus, and corpus callosum. Following peak clinical disease, EAE mice exhibited significant loss of volume at chronic long-term disease duration (day 66+). Atrophy was identified in both white and grey matter regions including the cerebral cortex, cerebellum, hippocampus, corpus callosum, basal forebrain, midbrain, optic tract, and colliculus. Histological analysis of the atrophied cortex, cerebellum, and hippocampus showed demyelination, and axonal/neuronal loss. We hypothesize this atrophy could be a result of inflammatory associated neurodegenerative processes, which may also be involved in MS. Using MRI and atlas-based volumetrics, EAE has the potential to be a test bed for treatments aimed at reducing progressive neurological deterioration in MS.
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Lommers E, Simon J, Reuter G, Delrue G, Dive D, Degueldre C, Balteau E, Phillips C, Maquet P. Multiparameter MRI quantification of microstructural tissue alterations in multiple sclerosis. NEUROIMAGE-CLINICAL 2019; 23:101879. [PMID: 31176293 PMCID: PMC6555891 DOI: 10.1016/j.nicl.2019.101879] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 04/23/2019] [Accepted: 05/25/2019] [Indexed: 01/25/2023]
Abstract
Objectives Conventional MRI is not sensitive to many pathological processes underpinning multiple sclerosis (MS) ongoing in normal appearing brain tissue (NABT). Quantitative MRI (qMRI) and a multiparameter mapping (MPM) protocol are used to simultaneously quantify magnetization transfer (MT) saturation, transverse relaxation rate R2* (1/T2*) and longitudinal relaxation rate R1 (1/T1), and assess differences in NABT microstructure between MS patients and healthy controls (HC). Methods This prospective cross-sectional study involves 36 MS patients (21 females, 15 males; age range 22–63 years; 15 relapsing-remitting MS - RRMS; 21 primary or secondary progressive MS - PMS) and 36 age-matched HC (20 females, 16 males); age range 21–61 years). The qMRI maps are computed and segmented in lesions and 3 normal appearing cerebral tissue classes: normal appearing cortical grey matter (NACGM), normal appearing deep grey matter (NADGM), normal appearing white matter (NAWM). Individual median values are extracted for each tissue class and MR parameter. MANOVAs and stepwise regressions assess differences between patients and HC. Results MS patients are characterized by a decrease in MT, R2* and R1 within NACGM (p < .0001) and NAWM (p < .0001). In NADGM, MT decreases (p < .0001) but R2* and R1 remain normal. These observations tend to be more pronounced in PMS. Quantitative MRI parameters are independent predictors of clinical status: EDSS is significantly related to R1 in NACGM and R2* in NADGM; the latter also predicts motor score. Cognitive score is best predicted by MT parameter within lesions. Conclusions Multiparametric data of brain microstructure concord with the literature, predict clinical performance and suggest a diffuse reduction in myelin and/or iron content within NABT of MS patients. We revisit microstructural alterations of NABT in MS patients by simultaneously quantifying three MRI parameters. Data suggest reduction of MT/R2*/R1 in NABT of MS patients, suggesting a reduction in myelin and/or iron content. Quantitative MRI parameters in NABT are independent predictors of clinical status.
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Affiliation(s)
- Emilie Lommers
- GIGA - CRC in vivo Imaging, University of Liège, Liège, Belgium; Clinical Neuroimmunology Unit, Neurology Department, CHU Liège, Belgium.
| | - Jessica Simon
- Psychology and Neurosciences of Cognition Research Unit, University of Liège, Belgium
| | - Gilles Reuter
- GIGA - CRC in vivo Imaging, University of Liège, Liège, Belgium; Neurosurgery Department, CHU Liège, Belgium
| | - Gaël Delrue
- Clinical Neuroimmunology Unit, Neurology Department, CHU Liège, Belgium
| | - Dominique Dive
- Clinical Neuroimmunology Unit, Neurology Department, CHU Liège, Belgium
| | | | - Evelyne Balteau
- GIGA - CRC in vivo Imaging, University of Liège, Liège, Belgium
| | - Christophe Phillips
- GIGA - CRC in vivo Imaging, University of Liège, Liège, Belgium; GIGA - in silico Medicine, University of Liège, Liège, Belgium
| | - Pierre Maquet
- GIGA - CRC in vivo Imaging, University of Liège, Liège, Belgium; Clinical Neuroimmunology Unit, Neurology Department, CHU Liège, Belgium
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Zivadinov R, Bergsland N, Hagemeier J, Carl E, Kolb H, Hojnacki D, Weinstock-Guttman B. Effect of teriflunomide on gray and white matter brain pathology in multiple sclerosis using volumetric and diffusion-tensor imaging MRI measures. J Neurol Sci 2018; 388:175-181. [DOI: 10.1016/j.jns.2018.03.028] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 02/28/2018] [Accepted: 03/15/2018] [Indexed: 01/15/2023]
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Deep learning of joint myelin and T1w MRI features in normal-appearing brain tissue to distinguish between multiple sclerosis patients and healthy controls. NEUROIMAGE-CLINICAL 2017; 17:169-178. [PMID: 29071211 PMCID: PMC5651626 DOI: 10.1016/j.nicl.2017.10.015] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 10/08/2017] [Accepted: 10/11/2017] [Indexed: 01/12/2023]
Abstract
Myelin imaging is a form of quantitative magnetic resonance imaging (MRI) that measures myelin content and can potentially allow demyelinating diseases such as multiple sclerosis (MS) to be detected earlier. Although focal lesions are the most visible signs of MS pathology on conventional MRI, it has been shown that even tissues that appear normal may exhibit decreased myelin content as revealed by myelin-specific images (i.e., myelin maps). Current methods for analyzing myelin maps typically use global or regional mean myelin measurements to detect abnormalities, but ignore finer spatial patterns that may be characteristic of MS. In this paper, we present a machine learning method to automatically learn, from multimodal MR images, latent spatial features that can potentially improve the detection of MS pathology at early stage. More specifically, 3D image patches are extracted from myelin maps and the corresponding T1-weighted (T1w) MRIs, and are used to learn a latent joint myelin-T1w feature representation via unsupervised deep learning. Using a data set of images from MS patients and healthy controls, a common set of patches are selected via a voxel-wise t-test performed between the two groups. In each MS image, any patches overlapping with focal lesions are excluded, and a feature imputation method is used to fill in the missing values. A feature selection process (LASSO) is then utilized to construct a sparse representation. The resulting normal-appearing features are used to train a random forest classifier. Using the myelin and T1w images of 55 relapse-remitting MS patients and 44 healthy controls in an 11-fold cross-validation experiment, the proposed method achieved an average classification accuracy of 87.9% (SD = 8.4%), which is higher and more consistent across folds than those attained by regional mean myelin (73.7%, SD = 13.7%) and T1w measurements (66.7%, SD = 10.6%), or deep-learned features in either the myelin (83.8%, SD = 11.0%) or T1w (70.1%, SD = 13.6%) images alone, suggesting that the proposed method has strong potential for identifying image features that are more sensitive and specific to MS pathology in normal-appearing brain tissues.
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27
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Abstract
Cross-population covariance of brain morphometric quantities provides a measure of interareal connectivity, as it is believed to be determined by the coordinated neurodevelopment of connected brain regions. Although useful, structural covariance analysis predominantly employed bulky morphological measures with mixed compartments, whereas studies of the structural covariance of any specific subdivisions such as myelin are rare. Characterizing myelination covariance is of interest, as it will reveal connectivity patterns determined by coordinated development of myeloarchitecture between brain regions. Using myelin content MRI maps from the Human Connectome Project, here we showed that the cortical myelination covariance was highly reproducible, and exhibited a brain organization similar to that previously revealed by other connectivity measures. Additionally, the myelination covariance network shared common topological features of human brain networks such as small-worldness. Furthermore, we found that the correlation between myelination covariance and resting-state functional connectivity (RSFC) was uniform within each resting-state network (RSN), but could considerably vary across RSNs. Interestingly, this myelination covariance-RSFC correlation was appreciably stronger in sensory and motor networks than cognitive and polymodal association networks, possibly due to their different circuitry structures. This study has established a new brain connectivity measure specifically related to axons, and this measure can be valuable to investigating coordinated myeloarchitecture development. Hum Brain Mapp 38:4730-4743, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Zhiwei Ma
- Department of Biomedical Engineering, The Pennsylvania State University, University Park, Pennsylvania
| | - Nanyin Zhang
- Department of Biomedical Engineering, The Pennsylvania State University, University Park, Pennsylvania
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Mollison D, Sellar R, Bastin M, Mollison D, Chandran S, Wardlaw J, Connick P. The clinico-radiological paradox of cognitive function and MRI burden of white matter lesions in people with multiple sclerosis: A systematic review and meta-analysis. PLoS One 2017; 12:e0177727. [PMID: 28505177 PMCID: PMC5432109 DOI: 10.1371/journal.pone.0177727] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 05/02/2017] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Moderate correlation exists between the imaging quantification of brain white matter lesions and cognitive performance in people with multiple sclerosis (MS). This may reflect the greater importance of other features, including subvisible pathology, or methodological limitations of the primary literature. OBJECTIVES To summarise the cognitive clinico-radiological paradox and explore the potential methodological factors that could influence the assessment of this relationship. METHODS Systematic review and meta-analysis of primary research relating cognitive function to white matter lesion burden. RESULTS Fifty papers met eligibility criteria for review, and meta-analysis of overall results was possible in thirty-two (2050 participants). Aggregate correlation between cognition and T2 lesion burden was r = -0.30 (95% confidence interval: -0.34, -0.26). Wide methodological variability was seen, particularly related to key factors in the cognitive data capture and image analysis techniques. CONCLUSIONS Resolving the persistent clinico-radiological paradox will likely require simultaneous evaluation of multiple components of the complex pathology using optimum measurement techniques for both cognitive and MRI feature quantification. We recommend a consensus initiative to support common standards for image analysis in MS, enabling benchmarking while also supporting ongoing innovation.
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Affiliation(s)
- Daisy Mollison
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Robin Sellar
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Mark Bastin
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Denis Mollison
- Department of Actuarial Mathematics and Statistics, Heriot-Watt University, Edinburgh, United Kingdom
| | - Siddharthan Chandran
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Joanna Wardlaw
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Peter Connick
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
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Klaren RE, Hubbard EA, Wetter NC, Sutton BP, Motl RW. Objectively measured sedentary behavior and brain volumetric measurements in multiple sclerosis. Neurodegener Dis Manag 2017; 7:31-37. [DOI: 10.2217/nmt-2016-0036] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Aim: This study examined the association between sedentary behavior patterns and whole brain gray matter (GM), white matter (WM) and subcortical GM structures in persons with multiple sclerosis (MS). Methods: 36 persons with MS wore an accelerometer and underwent a brain MRI. Whole brain GM and WM and deep GM structures were calculated from 3D T1-weighted structural brain images. Results: There were statistically significant (p < 0.01) and moderate or large associations between number of sedentary bouts/day and brain volume measures. The primary result was a consistent negative association between number of sedentary bouts/day and whole brain GM and WM, and deep GM structures. Conclusion: We provide novel evidence for decreased brain volume as a correlate of a sedentary behavior pattern in persons with MS.
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Affiliation(s)
- Rachel E Klaren
- Department of Kinesiology & Community Health, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
| | - Elizabeth A Hubbard
- Department of Kinesiology & Community Health, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
| | - Nathan C Wetter
- Jump Trading Stimulation & Education Center, Peoria, IL 61603, USA
| | - Bradley P Sutton
- Department of Bioengineering, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
| | - Robert W Motl
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL 35233, USA
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Cerina M, Narayanan V, Göbel K, Bittner S, Ruck T, Meuth P, Herrmann AM, Stangel M, Gudi V, Skripuletz T, Daldrup T, Wiendl H, Seidenbecher T, Ehling P, Kleinschnitz C, Pape HC, Budde T, Meuth SG. The quality of cortical network function recovery depends on localization and degree of axonal demyelination. Brain Behav Immun 2017; 59:103-117. [PMID: 27569659 DOI: 10.1016/j.bbi.2016.08.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Revised: 08/12/2016] [Accepted: 08/25/2016] [Indexed: 10/21/2022] Open
Abstract
Myelin loss is a severe pathological hallmark common to a number of neurodegenerative diseases, including multiple sclerosis (MS). Demyelination in the central nervous system appears in the form of lesions affecting both white and gray matter structures. The functional consequences of demyelination on neuronal network and brain function are not well understood. Current therapeutic strategies for ameliorating the course of such diseases usually focus on promoting remyelination, but the effectiveness of these approaches strongly depends on the timing in relation to the disease state. In this study, we sought to characterize the time course of sensory and behavioral alterations induced by de- and remyelination to establish a rational for the use of remyelination strategies. By taking advantage of animal models of general and focal demyelination, we tested the consequences of myelin loss on the functionality of the auditory thalamocortical system: a well-studied neuronal network consisting of both white and gray matter regions. We found that general demyelination was associated with a permanent loss of the tonotopic cortical organization in vivo, and the inability to induce tone-frequency-dependent conditioned behaviors, a status persisting after remyelination. Targeted, focal lysolecithin-induced lesions in the white matter fiber tract, but not in the gray matter regions of cortex, were fully reversible at the morphological, functional and behavioral level. These findings indicate that remyelination of white and gray matter lesions have a different functional regeneration potential, with the white matter being able to regain full functionality while cortical gray matter lesions suffer from permanently altered network function. Therefore therapeutic interventions aiming for remyelination have to consider both region- and time-dependent strategies.
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Affiliation(s)
- Manuela Cerina
- Department of Neurology, University of Münster, Münster, Germany.
| | - Venu Narayanan
- Department of Neurology, University of Münster, Münster, Germany
| | - Kerstin Göbel
- Department of Neurology, University of Münster, Münster, Germany
| | - Stefan Bittner
- Department of Neurology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Tobias Ruck
- Department of Neurology, University of Münster, Münster, Germany
| | - Patrick Meuth
- Department of Neurology, University of Münster, Münster, Germany
| | | | - Martin Stangel
- Clinical Neuroimmunology and Neurochemistry, Department of Neurology, Hannover Medical School and Centre for Systems Neuroscience, Hannover, Germany
| | - Viktoria Gudi
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | | | - Thiemo Daldrup
- Institute of Physiology I, University of Münster, Münster, Germany
| | - Heinz Wiendl
- Department of Neurology, University of Münster, Münster, Germany
| | | | - Petra Ehling
- Department of Neurology, University of Münster, Münster, Germany
| | | | | | - Thomas Budde
- Institute of Physiology I, University of Münster, Münster, Germany
| | - Sven G Meuth
- Department of Neurology, University of Münster, Münster, Germany.
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Zivadinov R, Khan N, Medin J, Christoffersen P, Price J, Korn JR, Bonzani I, Dwyer MG, Bergsland N, Carl E, Silva D, Weinstock-Guttman B. An Observational Study to Assess Brain MRI Change and Disease Progression in Multiple Sclerosis Clinical Practice-The MS-MRIUS Study. J Neuroimaging 2016; 27:339-347. [PMID: 27918139 PMCID: PMC5434824 DOI: 10.1111/jon.12411] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 10/05/2016] [Accepted: 10/29/2016] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND & PURPOSE To describe methodology, interim baseline, and longitudinal magnetic resonance imaging (MRI) acquisition parameter characteristics of the multiple sclerosis clinical outcome and MRI in the United States (MS‐MRIUS). MATERIAL & METHODS The MS‐MRIUS is an ongoing longitudinal and retrospective study of MS patients on fingolimod. Clinical and brain MRI image scan data were collected from 600 patients across 33 MS centers in the United States. MRI brain outcomes included change in whole‐brain volume, lateral ventricle volume, T2‐ and T1‐lesion volumes, and new/enlarging T2 and gadolinium‐enhancing lesions. RESULTS Interim baseline and longitudinal MRI acquisition parameters results are presented for 252 patients. Mean age was 44 years and 81% were female. Forty percent of scans had 3‐dimensional (3D) T1 sequence in the preindex period, increasing to 50% in the postindex period. Use of 2‐dimensional (2D) T1 sequence decreased over time from 85% in the preindex period to 65% in the postindex. About 95% of the scans with FLAIR and 2D T1‐WI were considered acceptable or good quality compared to 99–100% with 3D T1‐WI. There were notable changes in MRI hardware, software, and coil (39.5% in preindex to index and 50% in index to postindex). MRI sequence parameters (orientation, thickness, or protocol) differed for 36%, 29%, and 20% of index/postindex scans for FLAIR, 2D T1‐WI, and 3D T1‐WI, respectively. CONCLUSIONS The MS‐MRIUS study linked the clinical and brain MRI outcomes into an integrated database to create a cohort of fingolimod patients in real‐world practice. Variability was observed in MRI acquisition protocols overtime.
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Affiliation(s)
- Robert Zivadinov
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY.,MR Imaging Clinical Translational Research Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY
| | | | | | | | | | | | | | - Michael G Dwyer
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY
| | - Niels Bergsland
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY.,IRCCS "S.Maria Nascente", Don Gnocchi Foundation, Milan, Italy
| | - Ellen Carl
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY
| | - Diego Silva
- Novartis Pharmaceuticals AG, Basel, Switzerland
| | - Bianca Weinstock-Guttman
- Jacobs Multiple Sclerosis Center, Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY
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Steenwijk MD, Vrenken H, Jonkman LE, Daams M, Geurts JJG, Barkhof F, Pouwels PJW. High-resolution T1-relaxation time mapping displays subtle, clinically relevant, gray matter damage in long-standing multiple sclerosis. Mult Scler 2016; 22:1279-88. [DOI: 10.1177/1352458515615953] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 10/14/2015] [Indexed: 01/02/2023]
Abstract
Background: Gray matter (GM) pathology has high clinical relevance in multiple sclerosis (MS), but conventional magnetic resonance imaging (MRI) is insufficiently sensitive to visualize the rather subtle damage. Objective: To investigate whether high spatial resolution T1-relaxation time (T1-RT) measurements can detect changes in the normal-appearing GM of patients with long-standing MS and whether these changes are associated with physical and cognitive impairment. Methods: High spatial resolution (1.05 × 1.05 × 1.2 mm3) T1-RT measurements were performed at 3 T in 156 long-standing MS patients and 54 healthy controls. T1-RT histogram parameters in several regions were analyzed to investigate group differences. Stepwise linear regression analyses were used to assess the relation of T1-RT with physical and cognitive impairment. Results: In both thalamus and cortex, T1-RT histogram skewness was higher in patients than controls. In the cortex, this was driven by the frontal and temporal lobes. No differences were found in other GM histogram parameters. Cortical skewness, thalamus volume, and average white matter (WM) lesion T1-RT emerged as the strongest predictors for cognitive performance (adjusted R2 = 0.39). Conclusion: Subtle GM damage was present in the cortex and thalamus of MS patients, as indicated by increased T1-RT skewness. Increased cortical skewness emerged as an independent predictor of cognitive dysfunction.
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Affiliation(s)
- Martijn D Steenwijk
- Department of Radiology and Nuclear Medicine, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands/Department of Physics and Medical Technology, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Hugo Vrenken
- Department of Radiology and Nuclear Medicine, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands/Department of Physics and Medical Technology, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Laura E Jonkman
- Department of Anatomy and Neurosciences, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Marita Daams
- Department of Radiology and Nuclear Medicine, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands/Department of Anatomy and Neurosciences, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Jeroen JG Geurts
- Department of Anatomy and Neurosciences, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Petra JW Pouwels
- Department of Physics and Medical Technology, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
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Deppe M, Krämer J, Tenberge JG, Marinell J, Schwindt W, Deppe K, Groppa S, Wiendl H, Meuth SG. Early silent microstructural degeneration and atrophy of the thalamocortical network in multiple sclerosis. Hum Brain Mapp 2016; 37:1866-79. [PMID: 26920497 DOI: 10.1002/hbm.23144] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2015] [Revised: 02/03/2016] [Accepted: 02/04/2016] [Indexed: 12/29/2022] Open
Abstract
Recent studies on patients with clinically isolated syndrome (CIS) and multiple sclerosis (MS) demonstrated thalamic atrophy. Here we addressed the following question: Is early thalamic atrophy in patients with CIS and relapsing-remitting MS (RRMS) mainly a direct consequence of white matter (WM) lesions-as frequently claimed-or is the atrophy stronger correlated to "silent" (nonlesional) microstructural thalamic alterations? One-hundred and ten patients with RRMS, 12 with CIS, and 30 healthy controls were admitted to 3 T magnetic resonance imaging. Fractional anisotropy (FA) was computed from diffusion tensor imaging (DTI) to assess thalamic and WM microstructure. The relative thalamic volume (RTV) and thalamic FA were significantly reduced in patients with CIS and RRMS relative to healthy controls. Both measures were also correlated. The age, gender, WM lesion load, thalamic FA, and gray matter volume-corrected RTV were reduced even in the absence of thalamic and extensive white matter lesions-also in patients with short disease duration (≤24 months). A voxel-based correlation analysis revealed that the RTV reduction had a significant effect on local WM FA-in areas next to the thalamus and basal ganglia. These WM alterations could not be explained by WM lesions, which had a differing spatial distribution. Early thalamic atrophy is mainly driven by silent microstructural thalamic alterations. Lesions do not disclose the early damage of thalamocortical circuits, which seem to be much more affected in CIS and RRMS than expected. Thalamocortical damage can be detected by DTI in normal appearing brain tissue. Hum Brain Mapp 37:1866-1879, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Michael Deppe
- Department of Neurology, Westfälische Wilhelms University, Münster, Germany
| | - Julia Krämer
- Department of Neurology, Westfälische Wilhelms University, Münster, Germany
| | - Jan-Gerd Tenberge
- Department of Neurology, Westfälische Wilhelms University, Münster, Germany
| | - Jasmin Marinell
- Department of Neurology, Westfälische Wilhelms University, Münster, Germany
| | - Wolfram Schwindt
- Department of Clinical Radiology, Westfälische Wilhelms University, Münster, Germany
| | - Katja Deppe
- Radiologische Praxis Göb & Hovestadt, Coesfeld, Germany
| | - Sergiu Groppa
- Department of Neurology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Heinz Wiendl
- Department of Neurology, Westfälische Wilhelms University, Münster, Germany
| | - Sven G Meuth
- Department of Neurology, Westfälische Wilhelms University, Münster, Germany
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Stojanovic-Radic J, Wylie G, Voelbel G, Chiaravalloti N, DeLuca J. Neuroimaging and cognition using functional near infrared spectroscopy (fNIRS) in multiple sclerosis. Brain Imaging Behav 2016; 9:302-11. [PMID: 24916919 DOI: 10.1007/s11682-014-9307-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The present study utilized functional near infrared spectroscopy (fNIRS) to detect neural activation differences in the orbitofrontal brain region between individuals with multiple sclerosis (MS) and healthy controls (HCs) during a working memory (WM) task. Thirteen individuals with MS and 12 HCs underwent fNIRS recording while performing the n-back WM task with four levels of difficulty (0-, 1-, 2-, and 3-back). Subjects were fitted with the fNIRS cap consisting of 30 'optodes' positioned over the forehead. The results revealed different patterns of brain activation in MS and HCs. The MS group showed an increase in brain activation, as measured by the concentration of oxygenated hemoglobin (oxyHb), in the left superior frontal gyrus (LSFG) at lower task difficulty levels (i.e. 1-back), followed by a decrease at higher task difficulty (2- and 3-back) as compared with the HC group. HC group achieved higher accuracy than the MS group on the lower task loads (i.e. 0- and 1-back), however there were no performance differences between the groups at the higher task loads (i.e. 2- and 3-back). Taken together, the results suggest that individuals with MS experience a task with the lower cognitive load as more difficult than the HC group, and the brain activation patterns observed during the task confirm some of the previous findings from functional magnetic resonance imaging (fMRI) studies. This study is the first to investigate brain activation by utilizing the method of fNIRS in MS during the performance of a cognitive task.
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Affiliation(s)
- Jelena Stojanovic-Radic
- Kessler Foundation, Neuropsychology and Neuroscience Laboratory, 300 Executive Drive, Suite 70, West Orange, NJ, 07052, USA
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35
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Hutchinson M. Neurodegeneration in multiple sclerosis is a process separate from inflammation: No. Mult Scler 2015; 21:1628-31. [DOI: 10.1177/1352458515612244] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Michael Hutchinson
- St Vincent’s University Hospital, Dublin; School of Medicine and Medical Sciences, University College Dublin, Ireland
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Early and Degressive Putamen Atrophy in Multiple Sclerosis. Int J Mol Sci 2015; 16:23195-209. [PMID: 26404239 PMCID: PMC4632693 DOI: 10.3390/ijms161023195] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 09/07/2015] [Accepted: 09/08/2015] [Indexed: 01/12/2023] Open
Abstract
Putamen atrophy and its long-term progress during disease course were recently shown in patients with multiple sclerosis (MS). Here we investigated retrospectively the time point of atrophy onset in patients with relapsing-remitting MS (RRMS). 68 patients with RRMS and 26 healthy controls (HC) were admitted to 3T MRI in a cross-sectional study. We quantitatively analyzed the putamen volume of individual patients in relation to disease duration by correcting for age and intracranial volume (ICV). Patient’s relative putamen volume (RPV), expressed in percent of ICV, was significantly reduced compared to HC. Based on the correlation between RPV and age, we computed the age-corrected RPV deviation (ΔRPV) from HC. Patients showed significantly negative ΔRPV. Interestingly, the age-corrected ΔRPV depended logarithmically on disease duration: Directly after first symptom manifestation, patients already showed a reduced RPV followed by a further degressive volumetric decline. This means that atrophy progression was stronger in the first than in later years of disease. Putamen atrophy starts directly after initial symptom manifestation or even years before, and progresses in a degressive manner. Due to its important role in neurological functions, early detection of putamen atrophy seems necessary. High-resolution structural MRI allows monitoring of disease course.
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Deletion of mitochondrial anchoring protects dysmyelinating shiverer: implications for progressive MS. J Neurosci 2015; 35:5293-306. [PMID: 25834054 DOI: 10.1523/jneurosci.3859-14.2015] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The demyelinating disease multiple sclerosis (MS) has an early inflammatory phase followed by an incurable progressive phase with subdued inflammation and poorly understood neurodegenerative mechanism. In this study, we identified various parallelisms between progressive MS and the dysmyelinating mouse model Shiverer and then genetically deleted a major neuron-specific mitochondrial anchoring protein Syntaphilin (SNPH) from the mouse. Prevailing evidence suggests that deletion of SNPH is harmful in demyelination. Surprisingly, SNPH deletion produces striking benefits in the Shiverer by prolonging survival, reducing cerebellar damage, suppressing oxidative stress, and improving mitochondrial health. In contrast, SNPH deletion does not benefit clinical symptoms in experimental autoimmune encephalomyelitis (EAE), a model for early-phase MS. We propose that deleting mitochondrial anchoring is a novel, specific treatment for progressive MS.
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Objectively Measured Physical Activity Is Associated with Brain Volumetric Measurements in Multiple Sclerosis. Behav Neurol 2015; 2015:482536. [PMID: 26146460 PMCID: PMC4471328 DOI: 10.1155/2015/482536] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 05/20/2015] [Accepted: 05/24/2015] [Indexed: 01/05/2023] Open
Abstract
Background. Little is known about physical activity and its association with volumes of whole brain gray matter and white matter and deep gray matter structures in persons with multiple sclerosis (MS). Purpose. This study examined the association between levels of physical activity and brain volumetric measures from magnetic resonance imaging (MRI) in MS. Method. 39 persons with MS wore an accelerometer for a 7-day period and underwent a brain MRI. Normalized GM volume (NGMV), normalized WM volume (NWMV), and deep GM structures were calculated from 3D T1-weighted structural brain images. We conducted partial correlations (pr) controlling for demographic and clinical variables. Results. Moderate-to-vigorous physical activity (MVPA) was significantly associated with NGMV (pr = 0.370, p < 0.05), NWMV (pr = 0.433, p < 0.01), hippocampus (pr = 0.499, p < 0.01), thalamus (pr = 0.380, p < 0.05), caudate (pr = 0.539, p < 0.01), putamen (pr = 0.369, p < 0.05), and pallidum (pr = 0.498, p < 0.01) volumes, when controlling for sex, age, clinical course of MS, and Expanded Disability Status Scale score. There were no associations between sedentary and light physical activity with MRI outcomes. Conclusion. Our results provide the first evidence that MVPA is associated with volumes of whole brain GM and WM and deep GM structures that are involved in motor and cognitive functions in MS.
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Gramsch C, Nensa F, Kastrup O, Maderwald S, Deuschl C, Ringelstein A, Schelhorn J, Forsting M, Schlamann M. Diagnostic value of 3D fluid attenuated inversion recovery sequence in multiple sclerosis. Acta Radiol 2015; 56:622-7. [PMID: 24867222 DOI: 10.1177/0284185114534413] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 04/15/2014] [Indexed: 12/18/2022]
Abstract
BACKGROUND Magnetic resonance imaging (MRI) is an indispensable tool in the diagnostic work-up of multiple sclerosis (MS). To date, guidelines suggest MRI protocols containing axial dual-echo, unenhanced and post-contrast T1-weighted sequences. Especially the usage of dual-echo sequences has markedly improved the ability of MRI to detect cortical and infratentorial lesions. Newer 3D FLAIR sequences are supposed to provide even more positive imaging features such as improved detection of white matter lesions and a better resolution due to smaller slice thickness. PURPOSE To evaluate the diagnostic impact of 3D FLAIR sequences in comparison to conventional T2 and PD sequences. MATERIAL AND METHODS Examinations of 20 MS patients (10 women, 10 men) were reviewed retrospectively. All patients received MRI standard protocol containing PD and T2 sequences and a mid-sagittal T2 sequence. Additionally an isotropic 3D FLAIR sequence was performed. Whole-brain lesion load and number of lesions in juxtacortical, infratentorial, and midcallosal localizations were assessed by two observers independently and compared. RESULTS Whole lesion load and the count of detectable lesions at the 3D FLAIR sequence were significantly higher in the juxtacortical and infratentorial regions compared to the PD/T2 sequence. Detection rate of midcallosal lesions did not differ significantly in sagittal T2 and 3D FLAIR sequence. CONCLUSION 3D FLAIR sequences can improve the detection of brain lesions in patients with MS and are even more sensitive in depicting lesions in cortical and infratentorial locations than current dual-echo sequences. The sequence can replace both PD/T2 sequences and mid-sagittal T2 sequences of the corpus callosum.
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Affiliation(s)
- Carolin Gramsch
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Felix Nensa
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Oliver Kastrup
- Department of Neurology, University Hospital Essen, Essen, Germany
| | - Stefan Maderwald
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, University Duisburg-Essen, Essen, Germany
| | - Cornelius Deuschl
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Adrian Ringelstein
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Juliane Schelhorn
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Michael Forsting
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Marc Schlamann
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
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40
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Zhen C, Feng X, Li Z, Wang Y, Li B, Li L, Quan M, Wang G, Guo L. Suppression of murine experimental autoimmune encephalomyelitis development by 1,25-dihydroxyvitamin D3 with autophagy modulation. J Neuroimmunol 2015; 280:1-7. [DOI: 10.1016/j.jneuroim.2015.01.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2014] [Accepted: 01/28/2015] [Indexed: 12/21/2022]
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Russi AE, Brown MA. The meninges: new therapeutic targets for multiple sclerosis. Transl Res 2015; 165:255-69. [PMID: 25241937 PMCID: PMC4424790 DOI: 10.1016/j.trsl.2014.08.005] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 08/25/2014] [Accepted: 08/26/2014] [Indexed: 12/19/2022]
Abstract
The central nervous system (CNS) largely comprises nonregenerating cells, including neurons and myelin-producing oligodendrocytes, which are particularly vulnerable to immune cell-mediated damage. To protect the CNS, mechanisms exist that normally restrict the transit of peripheral immune cells into the brain and spinal cord, conferring an "immune-specialized" status. Thus, there has been a long-standing debate as to how these restrictions are overcome in several inflammatory diseases of the CNS, including multiple sclerosis (MS). In this review, we highlight the role of the meninges, tissues that surround and protect the CNS and enclose the cerebral spinal fluid, in promoting chronic inflammation that leads to neuronal damage. Although the meninges have traditionally been considered structures that provide physical protection for the brain and spinal cord, new data have established these tissues as sites of active immunity. It has been hypothesized that the meninges are important players in normal immunosurveillance of the CNS but also serve as initial sites of anti-myelin immune responses. The resulting robust meningeal inflammation elicits loss of localized blood-brain barrier (BBB) integrity and facilitates a large-scale influx of immune cells into the CNS parenchyma. We propose that targeting the cells and molecules mediating these inflammatory responses within the meninges offers promising therapies for MS that are free from the constraints imposed by the BBB. Importantly, such therapies may avoid the systemic immunosuppression often associated with the existing treatments.
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Affiliation(s)
- Abigail E Russi
- Department of Microbiology and Immunology, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Melissa A Brown
- Department of Microbiology and Immunology, Northwestern University Feinberg School of Medicine, Chicago, Ill.
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Steenwijk MD, Daams M, Pouwels PJW, J Balk L, Tewarie PK, Geurts JJG, Barkhof F, Vrenken H. Unraveling the relationship between regional gray matter atrophy and pathology in connected white matter tracts in long-standing multiple sclerosis. Hum Brain Mapp 2015; 36:1796-807. [PMID: 25627545 DOI: 10.1002/hbm.22738] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 11/23/2014] [Accepted: 01/06/2015] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Gray matter (GM) atrophy is common in multiple sclerosis (MS), but the relationship with white matter (WM) pathology is largely unknown. Some studies found a co-occurrence in specific systems, but a regional analysis across the brain in different clinical phenotypes is necessary to further understand the disease mechanism underlying GM atrophy in MS. Therefore, we investigated the association between regional GM atrophy and pathology in anatomically connected WM tracts. METHODS Conventional and diffusion tensor imaging was performed at 3T in 208 patients with long-standing MS and 60 healthy controls. Deep and cortical GM regions were segmented and quantified, and both lesion volumes and average normal appearing WM fractional anisotropy of their associated tracts were derived using an atlas obtained by probabilistic tractography in the controls. Linear regression was then performed to quantify the amount of regional GM atrophy that can be explained by WM pathology in the connected tract. RESULTS MS patients showed extensive deep and cortical GM atrophy. Cortical atrophy was particularly present in frontal and temporal regions. Pathology in connected WM tracts statistically explained both regional deep and cortical GM atrophy in relapsing-remitting (RR) patients, but only deep GM atrophy in secondary-progressive (SP) patients. CONCLUSION In RRMS patients, both deep and cortical GM atrophy were associated with pathology in connected WM tracts. In SPMS patients, only regional deep GM atrophy could be explained by pathology in connected WM tracts. This suggests that in SPMS patients cortical GM atrophy and WM damage are (at least partly) independent disease processes.
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Affiliation(s)
- Martijn D Steenwijk
- Department of Radiology and Nuclear Medicine, Neuroscience Campus Amsterdam, VU University Medical Center, The Netherlands
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43
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Dudink J, Pieterman K, Leemans A, Kleinnijenhuis M, van Cappellen van Walsum AM, Hoebeek FE. Recent advancements in diffusion MRI for investigating cortical development after preterm birth-potential and pitfalls. Front Hum Neurosci 2015; 8:1066. [PMID: 25653607 PMCID: PMC4301014 DOI: 10.3389/fnhum.2014.01066] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 12/22/2014] [Indexed: 12/13/2022] Open
Abstract
Preterm infants are born during a critical period of brain maturation, in which even subtle events can result in substantial behavioral, motor and cognitive deficits, as well as psychiatric diseases. Recent evidence shows that the main source for these devastating disabilities is not necessarily white matter (WM) damage but could also be disruptions of cortical microstructure. Animal studies showed how moderate hypoxic-ischemic conditions did not result in significant neuronal loss in the developing brain, but did cause significantly impaired dendritic growth and synapse formation alongside a disturbed development of neuronal connectivity as measured using diffusion magnetic resonance imaging (dMRI). When using more advanced acquisition settings such as high-angular resolution diffusion imaging (HARDI), more advanced reconstruction methods can be applied to investigate the cortical microstructure with higher levels of detail. Recent advances in dMRI acquisition and analysis have great potential to contribute to a better understanding of neuronal connectivity impairment in preterm birth. We will review the current understanding of abnormal preterm cortical development, novel approaches in dMRI, and the pitfalls in scanning vulnerable preterm infants.
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Affiliation(s)
- J Dudink
- Department of Neonatology, Pediatric Intensive Care and Pediatric Radiology, Erasmus Medical Center - Sophia Children's Hospital Rotterdam, Netherlands
| | - K Pieterman
- Department of Neonatology, Pediatric Intensive Care and Pediatric Radiology, Erasmus Medical Center - Sophia Children's Hospital Rotterdam, Netherlands
| | - A Leemans
- Image Sciences Institute, University Medical Center Utrecht Utrecht, Netherlands
| | - M Kleinnijenhuis
- Oxford Centre for Functional Magnetic Resonance Imaging of the Brain, University of Oxford Oxford, UK
| | - A M van Cappellen van Walsum
- Department of Anatomy, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Center Nijmegen, Netherlands
| | - F E Hoebeek
- Department of Neuroscience, Erasmus Medical Center Rotterdam Rotterdam, Netherlands
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44
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Walker-Caulfield ME, Hatfield JK, Brown MA. Dynamic changes in meningeal inflammation correspond to clinical exacerbations in a murine model of relapsing-remitting multiple sclerosis. J Neuroimmunol 2014; 278:112-22. [PMID: 25595260 DOI: 10.1016/j.jneuroim.2014.12.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 12/08/2014] [Accepted: 12/09/2014] [Indexed: 01/20/2023]
Abstract
Inflammation in the meninges, tissues surrounding the brain and spinal cord that enclose the cerebrospinal fluid, closely parallels clinical exacerbations in relapsing-remitting experimental autoimmune encephalomyelitis (EAE). In preclinical disease, an influx of innate immune cells precedes loss of blood brain barrier (BBB) integrity and large-scale inflammation in the central nervous system (CNS). T cell infiltration into the meninges is observed in acute disease as well as during relapse, when neither BBB permeability nor significant increases in peripherally-derived immune cell numbers in the CNS are observed. These findings support the idea that the meninges are a gateway for immune cell access into the CNS, a finding that has important therapeutic implications.
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Affiliation(s)
- Margaret E Walker-Caulfield
- Department of Microbiology and Immunology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Julianne K Hatfield
- Department of Microbiology and Immunology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Melissa A Brown
- Department of Microbiology and Immunology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.
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45
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Brinar VV, Barun B. Challenges in multiple sclerosis; how to define occurence of progression. Clin Neurol Neurosurg 2014; 115 Suppl 1:S30-4. [PMID: 24321151 DOI: 10.1016/j.clineuro.2013.09.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The challenges in MS are related to number of controversies in various aspects of disease but the relationship between relapses and disability progression, or aspects of MS as an inflammatory and/or neurodegenerative disease are extremely important because of its implications on prognosis and therapy of MS. MS was classically regarded as white matter inflammatory disease, while disability progression, brain and spinal cord atrophy were regarded as a consequence of global inflammation of NAWM and secondary involvement of grey matter. More recent histopathology studies, but also new, modern MRI techniques changed this view in MS as a prominent grey and white matter disease. Inflammatory demyelination of grey matter occurs early in MS sometimes even before occurrence of white matter lesions. Inspite of early therapy of MS with immunomodulatory drugs disability progression and neurodegeneration are still important and common part of MS pathogenesis. This indicate that treatment is not adequate to the predicted severity of MS, or perhaps to the basic pathogenetic mechanisms in MS. Beside acute clinical symptoms, conclusions about the severity of the disease are reflection of MRI sensitivity to detect focal WM lesions and insensitivity to detect grey matter lesions which correlate better with clinical symptoms. All presented studies and evaluations point to the necessity of changing the established diagnostic evaluation and treatment in MS. At the earliest stage of MS as well as in follow up of disease it would be necessary to apply a new MRI techniques more available for clinical practice such as DIR brain MR imaging at 3T because of their sensitivity to detect grey matter lesions. In patient with present cortical lesions even in earliest stages of MS depending on severity of grey matter involvement more efficacious therapy like second or even third line therapy should start.
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Affiliation(s)
- V V Brinar
- School of Medicine, University of Zagreb, Zagreb, Croatia; Association for MS Research Zagreb, Zagreb, Croatia.
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46
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Jacobsen C, Hagemeier J, Myhr KM, Nyland H, Lode K, Bergsland N, Ramasamy DP, Dalaker TO, Larsen JP, Farbu E, Zivadinov R. Brain atrophy and disability progression in multiple sclerosis patients: a 10-year follow-up study. J Neurol Neurosurg Psychiatry 2014; 85:1109-15. [PMID: 24554101 DOI: 10.1136/jnnp-2013-306906] [Citation(s) in RCA: 129] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVES To identify MRI biomarkers associated with long-term disability progression in patients with multiple sclerosis (MS), and to define the rate of evolution of global, tissue-specific and regional atrophy in patients with MS over long-term. METHODS MRI of the brain and clinical neurological assessment was performed in 81 patients at time of first visit and after 5 and 10 years of follow-up. MRI was acquired on 1.5 T scanners. T1-lesion and T2-lesion volumes (LVs) were calculated. Global and tissue-specific atrophy changes were longitudinally assessed, using a direct measurement approach, by calculating percentage volume changes between different time points. Regional tissue volumes for the subcortical deep grey matter (SDGM) structures were also obtained. Disability progression was defined as an increase in Expanded Disability Status Scale of ≥ 1.0 compared to baseline at 5-year and 10-year follow-up. RESULTS Over 5 years, patients with disability progression showed significantly increased loss of whole brain (-3.8% vs -2.0%, p<0.001), cortical (-3.4% vs -1.8%, p=0.009) and putamen volume changes (-10.6% vs -3.8%, p=0.003) compared to patients with no disability progression. No significant change in white matter (WM) volume was observed when comparing progressing and non-progressing patients. Over 10 years, there was a trend for greater decrease in whole brain volume (-5.5% vs -3.7%, p=0.015) in the progressing patients. No significant changes in LV measures were detected between the patients with and without disability progression. CONCLUSION This long-term study shows that whole brain, cortical and putamen atrophy occurs throughout the 10-year follow-up of this MS cohort and is more pronounced in the group that showed disability progression at 5, but not at 10 years of follow-up. Overall, GM atrophy showed better association with disease progression than WM atrophy over 5-year and 10-year follow-up.
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Affiliation(s)
- Cecilie Jacobsen
- Department of Neurology, Stavanger University Hospital, Stavanger, Norway Department of Neurology, School of Medicine and Biomedical Sciences, Buffalo Neuroimaging Analysis Center, University at Buffalo, State University of New York, Buffalo, New York, USA Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Jesper Hagemeier
- Department of Neurology, School of Medicine and Biomedical Sciences, Buffalo Neuroimaging Analysis Center, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - Kjell-Morten Myhr
- KG Jebsen Centre for MS-Research, Department of Clinical Medicine, University of Bergen, Bergen, Norway Department of Neurology, Norwegian Multiple Sclerosis Competence Centre, Haukeland University Hospital, Bergen, Norway
| | - Harald Nyland
- KG Jebsen Centre for MS-Research, Department of Clinical Medicine, University of Bergen, Bergen, Norway Department of Neurology, Norwegian Multiple Sclerosis Competence Centre, Haukeland University Hospital, Bergen, Norway
| | - Kirsten Lode
- Department of Neurology, Stavanger University Hospital, Stavanger, Norway
| | - Niels Bergsland
- Department of Neurology, School of Medicine and Biomedical Sciences, Buffalo Neuroimaging Analysis Center, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - Deepa P Ramasamy
- Department of Neurology, School of Medicine and Biomedical Sciences, Buffalo Neuroimaging Analysis Center, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - Turi O Dalaker
- Department of Clinical Medicine, University of Bergen, Bergen, Norway Department of Radiology, Stavanger University Hospital, Stavanger, Norway
| | - Jan Petter Larsen
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Elisabeth Farbu
- Department of Neurology, Stavanger University Hospital, Stavanger, Norway Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Robert Zivadinov
- Department of Neurology, School of Medicine and Biomedical Sciences, Buffalo Neuroimaging Analysis Center, University at Buffalo, State University of New York, Buffalo, New York, USA MR Imaging Clinical Translational Research Center, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA
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Steenwijk MD, Daams M, Pouwels PJW, Balk LJ, Tewarie PK, Killestein J, Uitdehaag BMJ, Geurts JJG, Barkhof F, Vrenken H. What Explains Gray Matter Atrophy in Long-standing Multiple Sclerosis? Radiology 2014; 272:832-42. [PMID: 24761837 DOI: 10.1148/radiol.14132708] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Martijn D Steenwijk
- From the Departments of Radiology and Nuclear Medicine (M.D.S., M.D., F.B., H.V.), Anatomy and Neurosciences (M.D., J.J.G.G.), Physics and Medical Technology (P.J.W.P., H.V.), and Neurology (L.J.B., P.K.T., J.K., B.M.J.U.), Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, the Netherlands
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48
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Menéndez-González M, Salas-Pacheco JM, Arias-Carrión O. The yearly rate of Relative Thalamic Atrophy (yrRTA): a simple 2D/3D method for estimating deep gray matter atrophy in Multiple Sclerosis. Front Aging Neurosci 2014; 6:219. [PMID: 25206331 PMCID: PMC4144089 DOI: 10.3389/fnagi.2014.00219] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Accepted: 08/04/2014] [Indexed: 01/10/2023] Open
Abstract
Despite a strong correlation to outcome, the measurement of gray matter (GM) atrophy is not being used in daily clinical practice as a prognostic factor and monitor the effect of treatments in Multiple Sclerosis (MS). This is mainly because the volumetric methods available to date are sophisticated and difficult to implement for routine use in most hospitals. In addition, the meanings of raw results from volumetric studies on regions of interest are not always easy to understand. Thus, there is a huge need of a methodology suitable to be applied in daily clinical practice in order to estimate GM atrophy in a convenient and comprehensive way. Given the thalamus is the brain structure found to be more consistently implied in MS both in terms of extent of atrophy and in terms of prognostic value, we propose a solution based in this structure. In particular, we propose to compare the extent of thalamus atrophy with the extent of unspecific, global brain atrophy, represented by ventricular enlargement. We name this ratio the “yearly rate of Relative Thalamic Atrophy” (yrRTA). In this report we aim to describe the concept of yrRTA and the guidelines for computing it under 2D and 3D approaches and explain the rationale behind this method. We have also conducted a very short crossectional retrospective study to proof the concept of yrRTA. However, we do not seek to describe here the validity of this parameter since these researches are being conducted currently and results will be addressed in future publications.
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Affiliation(s)
- Manuel Menéndez-González
- Unidad de Neurología, Hospital Álvarez-Buylla Mieres, Spain ; Departamento de Morfología y Biología Celular, Universidad de Oviedo Oviedo, Spain ; Instituto de Neurociencias, Universidad de Oviedo Oviedo, Spain
| | - José M Salas-Pacheco
- Instituto de Investigación Científica, Universidad Juárez del Estado de Durango Durango, México
| | - Oscar Arias-Carrión
- Unidad de Trastornos del Movimiento y Sueño, Hospital General Dr. Manuel Gea González/Universidad Nacional Autónoma de México Mexico City, Mexico ; Unidad de Trastornos del Movimiento y Sueño, Hospital General Ajusco Medio Mexico City, Mexico
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49
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Daams M, Weiler F, Steenwijk MD, Hahn HK, Geurts JJ, Vrenken H, van Schijndel RA, Balk LJ, Tewarie PK, Tillema JM, Killestein J, Uitdehaag BM, Barkhof F. Mean upper cervical cord area (MUCCA) measurement in long-standing multiple sclerosis: relation to brain findings and clinical disability. Mult Scler 2014; 20:1860-5. [PMID: 24812042 DOI: 10.1177/1352458514533399] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The majority of patients with multiple sclerosis (MS) present with spinal cord pathology. Spinal cord atrophy is thought to be a marker of disease severity, but in long-disease duration its relation to brain pathology and clinical disability is largely unknown. OBJECTIVE Our aim was to investigate mean upper cervical cord area (MUCCA) in patients with long-standing MS and assess its relation to brain magnetic resonance imaging (MRI) measures and clinical disability. METHODS MUCCA was measured in 196 MS patients and 55 healthy controls using 3DT1-weighted cervical images obtained at 3T MRI. Clinical disability was measured using the Expanded Disability Status Scale (EDSS), Nine-Hole-Peg test (9-HPT), and 25 feet Timed Walk Test (TWT). Stepwise linear regression was performed to assess the association between MUCCA and MRI measures, and between MUCCA and clinical disability. RESULTS MUCCA was smaller (mean 11.7%) in MS patients compared with healthy controls (72.56±9.82 and 82.24±7.80 mm2 respectively; p<0.001), most prominently in male patients. MUCCA was associated with normalized brain volume, and number of cervical cord lesions. MUCCA was independently associated with EDSS, TWT, and 9-HPT. CONCLUSION MUCCA was reduced in MS patients compared with healthy controls. It provides a relevant marker for clinical disability in long-standing disease, independent of other MRI measures.
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Affiliation(s)
- Marita Daams
- VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands
| | - Florian Weiler
- Fraunhofer MEVIS, Institute for Medical Image Computing, Bremen, Germany
| | - Martijn D Steenwijk
- Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Horst K Hahn
- Fraunhofer MEVIS, Institute for Medical Image Computing, Bremen, Germany
| | - Jeroen Jg Geurts
- Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Hugo Vrenken
- Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | | | - Lisanne J Balk
- Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Prejaas K Tewarie
- Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Jan-Mendelt Tillema
- Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands/ Mayo Clinic, Rochester, MN, USA
| | - Joep Killestein
- Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Bernard Mj Uitdehaag
- Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Frederik Barkhof
- Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
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Dwyer MG, Bergsland N, Zivadinov R. Improved longitudinal gray and white matter atrophy assessment via application of a 4-dimensional hidden Markov random field model. Neuroimage 2014; 90:207-17. [DOI: 10.1016/j.neuroimage.2013.12.004] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Revised: 12/01/2013] [Accepted: 12/03/2013] [Indexed: 10/25/2022] Open
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