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Wooliscroft L, Salter A, Adusumilli G, Levasseur VA, Sun P, Lancia S, Perantie DC, Trinkaus K, Naismith RT, Song SK, Cross AH. Diffusion basis spectrum imaging and diffusion tensor imaging predict persistent black hole formation in multiple sclerosis. Mult Scler Relat Disord 2024; 84:105494. [PMID: 38359694 PMCID: PMC10978237 DOI: 10.1016/j.msard.2024.105494] [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: 09/20/2023] [Revised: 12/13/2023] [Accepted: 02/10/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND AND OBJECTIVES Diffusion basis spectrum imaging (DBSI) extracts multiple anisotropic and isotropic diffusion tensors, providing greater histopathologic specificity than diffusion tensor imaging (DTI). Persistent black holes (PBH) represent areas of severe tissue damage in multiple sclerosis (MS), and a high PBH burden is associated with worse MS disability. This study evaluated the ability of DBSI and DTI to predict which acute contrast-enhancing lesions (CELs) would persist as T1 hypointensities (i.e. PBHs) 12 months later. We expected that a higher radial diffusivity (RD), representing demyelination, and higher DBSI-derived isotropic non-restricted fraction, representing edema and increased extracellular space, of the acute CEL would increase the likelihood of future PBH development. METHODS In this prospective cohort study, relapsing MS patients with ≥1 CEL(s) underwent monthly MRI scans for 4 to 6 months until gadolinium resolution. DBSI and DTI metrics were quantified when the CEL was most conspicuous during the monthly scans. To determine whether the CEL became a PBH, a follow-up MRI was performed at least 12 months after the final monthly scan. RESULTS The cohort included 20 MS participants (median age 33 years; 13 women) with 164 CELs. Of these, 59 (36 %) CELs evolved into PBHs. At Gd-max, DTI RD and AD of all CELs increased, and both metrics were significantly elevated for CELs which became PBHs, as compared to non-black holes (NBHs). DTI RD above 0.74 conferred an odds ratio (OR) of 7.76 (CI 3.77-15.98) for a CEL becoming a PBH (AUC 0.80, CI 0.73-0.87); DTI axial diffusivity (AD) above 1.22 conferred an OR of 7.32 (CI 3.38-15.86) for becoming a PBH (AUC 0.75, CI 0.66-0.83). DBSI RD and AD did not predict PBH development in a multivariable model. At Gd-max, DBSI restricted fraction decreased and DBSI non-restricted fraction increased in all CELs, and both metrics were significantly different for CELs which became PBHs, as compared to NBHs. A CEL with a DBSI non-restricted fraction above 0.45 had an OR of 4.77 (CI 2.35-9.66) for becoming a PBH (AUC 0.74, CI 0.66-0.81); a CEL with a DBSI restricted fraction below 0.07 had an OR of 9.58 (CI 4.59-20.02) for becoming a PBH (AUC 0.80, 0.72-0.87). CONCLUSION Our findings suggest that greater degree of edema/extracellular space in a CEL is a predictor of tissue destruction, as evidenced by PBH evolution.
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Affiliation(s)
- Lindsey Wooliscroft
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA; Department of Neurology, VA Portland Health Care System, Portland, OR, USA; Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA.
| | - Amber Salter
- Department of Biostatistics, Washington University School of Medicine, St. Louis, MO, USA; Department of Biostatistics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Gautam Adusumilli
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA; Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Victoria A Levasseur
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA; Minneapolis Clinic of Neurology, Coon Rapids, MN, USA
| | - Peng Sun
- Department of Imaging Physics, University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Samantha Lancia
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA; Department of Biostatistics, Washington University School of Medicine, St. Louis, MO, USA; Department of Biostatistics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Dana C Perantie
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Kathryn Trinkaus
- Biostatistics Shared Resource, Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Robert T Naismith
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Sheng-Kwei Song
- Department of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Anne H Cross
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
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Zhang W, Gorelik AJ, Wang Q, Norton SA, Hershey T, Agrawal A, Bijsterbosch JD, Bogdan R. Associations between COVID-19 and putative markers of neuroinflammation: A diffusion basis spectrum imaging study. Brain Behav Immun Health 2024; 36:100722. [PMID: 38298902 PMCID: PMC10825665 DOI: 10.1016/j.bbih.2023.100722] [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] [Received: 07/24/2023] [Revised: 12/27/2023] [Accepted: 12/27/2023] [Indexed: 02/02/2024] Open
Abstract
COVID-19 remains a significant international public health concern. Yet, the mechanisms through which symptomatology emerges remain poorly understood. While SARS-CoV-2 infection may induce prolonged inflammation within the central nervous system, the evidence primarily stems from limited small-scale case investigations. To address this gap, our study capitalized on longitudinal UK Biobank neuroimaging data acquired prior to and following COVID-19 testing (N = 416 including n = 224 COVID-19 cases; Mage = 58.6). Putative neuroinflammation was assessed in gray matter structures and white matter tracts using non-invasive Diffusion Basis Spectrum Imaging (DBSI), which estimates inflammation-related cellularity (DBSI-restricted fraction; DBSI-RF) and vasogenic edema (DBSI-hindered fraction; DBSI-HF). We hypothesized that COVID-19 case status would be associated with increases in DBSI markers after accounting for potential confound (age, sex, race, body mass index, smoking frequency, and data acquisition interval) and multiple testing. COVID-19 case status was not significantly associated with DBSI-RF (|β|'s < 0.28, pFDR >0.05), but with greater DBSI-HF in left pre- and post-central gyri and right middle frontal gyrus (β's > 0.3, all pFDR = 0.03). Intriguingly, the brain areas exhibiting increased putative vasogenic edema had previously been linked to COVID-19-related functional and structural alterations, whereas brain regions displaying subtle differences in cellularity between COVID-19 cases and controls included regions within or functionally connected to the olfactory network, which has been implicated in COVID-19 psychopathology. Nevertheless, our study might not have captured acute and transitory neuroinflammatory effects linked to SARS-CoV-2 infection, possibly due to symptom resolution before the imaging scan. Future research is warranted to explore the potential time- and symptom-dependent neuroinflammatory relationship with COVID-19.
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Affiliation(s)
- Wei Zhang
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, United States
| | - Aaron J. Gorelik
- Department of Psychological & Brain Sciences, Washington University, St. Louis, MO, United States
| | - Qing Wang
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, United States
| | - Sara A. Norton
- Department of Psychological & Brain Sciences, Washington University, St. Louis, MO, United States
| | - Tamara Hershey
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, United States
- Department of Psychological & Brain Sciences, Washington University, St. Louis, MO, United States
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, United States
| | - Arpana Agrawal
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States
| | - Janine D. Bijsterbosch
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, United States
| | - Ryan Bogdan
- Department of Psychological & Brain Sciences, Washington University, St. Louis, MO, United States
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Sun J, Xu S, Tian D, Duan Y, Xu X, Lv S, Cao G, Shi FD, Chard D, Barkhof F, Zhuo Z, Zhang X, Liu Y. Periventricular gradients in NAWM abnormalities differ in MS, NMOSD and MOGAD. Mult Scler Relat Disord 2023; 75:104732. [PMID: 37167759 DOI: 10.1016/j.msard.2023.104732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 04/24/2023] [Indexed: 05/13/2023]
Affiliation(s)
- Jun Sun
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China; Tiantan Image Research Center, China National Clinical Research Center for Neurological Diseases, Beijing 100070, China
| | - Siyao Xu
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China; Tiantan Image Research Center, China National Clinical Research Center for Neurological Diseases, Beijing 100070, China
| | - Decai Tian
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China; China National Clinical Research Center for Neurological Diseases, Beijing 100070, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing 100070, China
| | - Yunyun Duan
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China; Tiantan Image Research Center, China National Clinical Research Center for Neurological Diseases, Beijing 100070, China
| | - Xiaolu Xu
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China; Tiantan Image Research Center, China National Clinical Research Center for Neurological Diseases, Beijing 100070, China
| | - Shan Lv
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China; Tiantan Image Research Center, China National Clinical Research Center for Neurological Diseases, Beijing 100070, China
| | - Guanmei Cao
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China; Tiantan Image Research Center, China National Clinical Research Center for Neurological Diseases, Beijing 100070, China
| | - Fu-Dong Shi
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China; China National Clinical Research Center for Neurological Diseases, Beijing 100070, China; Department of Neurology and Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Declan Chard
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, Faculty of Brain Sciences, University College London, London, United Kingdom; National Institute for Health Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre, London, United Kingdom
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam 1007 MB, the Netherlands; Queen Square Institute of Neurology and Center for Medical Image Computing, University College London, London, United Kingdom
| | - Zhizheng Zhuo
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China; Tiantan Image Research Center, China National Clinical Research Center for Neurological Diseases, Beijing 100070, China.
| | - Xinghu Zhang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Yaou Liu
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China; Tiantan Image Research Center, China National Clinical Research Center for Neurological Diseases, Beijing 100070, China.
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Li ZA, Samara A, Ray MK, Rutlin J, Raji CA, Shimony JS, Sun P, Song SK, Hershey T, Eisenstein SA. Childhood obesity is linked to putative neuroinflammation in brain white matter, hypothalamus, and striatum. Cereb Cortex Commun 2023; 4:tgad007. [PMID: 37207193 PMCID: PMC10191798 DOI: 10.1093/texcom/tgad007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 04/19/2023] [Accepted: 04/22/2023] [Indexed: 05/21/2023] Open
Abstract
Neuroinflammation is both a consequence and driver of overfeeding and weight gain in rodent obesity models. Advances in magnetic resonance imaging (MRI) enable investigations of brain microstructure that suggests neuroinflammation in human obesity. To assess the convergent validity across MRI techniques and extend previous findings, we used diffusion basis spectrum imaging (DBSI) to characterize obesity-associated alterations in brain microstructure in 601 children (age 9-11 years) from the Adolescent Brain Cognitive DevelopmentSM Study. Compared with children with normal-weight, greater DBSI restricted fraction (RF), reflecting neuroinflammation-related cellularity, was seen in widespread white matter in children with overweight and obesity. Greater DBSI-RF in hypothalamus, caudate nucleus, putamen, and, in particular, nucleus accumbens, correlated with higher baseline body mass index and related anthropometrics. Comparable findings were seen in the striatum with a previously reported restriction spectrum imaging (RSI) model. Gain in waist circumference over 1 and 2 years related, at nominal significance, to greater baseline RSI-assessed restricted diffusion in nucleus accumbens and caudate nucleus, and DBSI-RF in hypothalamus, respectively. Here we demonstrate that childhood obesity is associated with microstructural alterations in white matter, hypothalamus, and striatum. Our results also support the reproducibility, across MRI methods, of findings of obesity-related putative neuroinflammation in children.
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Affiliation(s)
- Zhaolong Adrian Li
- Department of Psychiatry, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, United States
- Department of Psychological and Brain Sciences, Washington University in St. Louis, St. Louis, MO 63130, United States
| | - Amjad Samara
- Department of Psychiatry, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, United States
- Department of Neurology, Washington University in St. Louis School of Medicine, St. Louis, MO 63110 United States
| | - Mary Katherine Ray
- Department of Psychiatry, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, United States
| | - Jerrel Rutlin
- Department of Psychiatry, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, United States
| | - Cyrus A Raji
- Department of Neurology, Washington University in St. Louis School of Medicine, St. Louis, MO 63110 United States
- Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, United States
| | - Joshua S Shimony
- Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, United States
| | - Peng Sun
- Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, United States
- Department of Imaging Physics, University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
| | - Sheng-Kwei Song
- Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, United States
| | - Tamara Hershey
- Department of Psychiatry, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, United States
- Department of Psychological and Brain Sciences, Washington University in St. Louis, St. Louis, MO 63130, United States
- Department of Neurology, Washington University in St. Louis School of Medicine, St. Louis, MO 63110 United States
- Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, United States
| | - Sarah A Eisenstein
- Department of Psychiatry, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, United States
- Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, United States
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5
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Gilli F, Ceccarelli A. Magnetic resonance imaging approaches for studying mouse models of multiple sclerosis: A mini review. J Neurosci Res 2023. [DOI: 10.1002/jnr.25193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 01/30/2023] [Accepted: 03/10/2023] [Indexed: 04/03/2023]
Affiliation(s)
- Francesca Gilli
- Department of Neurology, Dartmouth Hitchcock Medical Center Geisel School of Medicine at Dartmouth Lebanon New Hampshire USA
| | - Antonia Ceccarelli
- Department of Neurology EpiCURA Centre Hospitalier Ath Belgium
- Hearthrhythmanagement, UZB Brussels Belgium
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6
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Han RH, Johanns TM, Roberts KF, Tao Y, Luo J, Ye Z, Sun P, Blum J, Lin TH, Song SK, Kim AH. Diffusion basis spectrum imaging as an adjunct to conventional MRI leads to earlier diagnosis of high-grade glioma tumor progression versus treatment effect. Neurooncol Adv 2023; 5:vdad050. [PMID: 37215950 PMCID: PMC10195207 DOI: 10.1093/noajnl/vdad050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2023] Open
Abstract
Background Following chemoradiotherapy for high-grade glioma (HGG), it is often challenging to distinguish treatment changes from true tumor progression using conventional MRI. The diffusion basis spectrum imaging (DBSI) hindered fraction is associated with tissue edema or necrosis, which are common treatment-related changes. We hypothesized that DBSI hindered fraction may augment conventional imaging for earlier diagnosis of progression versus treatment effect. Methods Adult patients were prospectively recruited if they had a known histologic diagnosis of HGG and completed standard-of-care chemoradiotherapy. DBSI and conventional MRI data were acquired longitudinally beginning 4 weeks post-radiation. Conventional MRI and DBSI metrics were compared with respect to their ability to diagnose progression versus treatment effect. Results Twelve HGG patients were enrolled between August 2019 and February 2020, and 9 were ultimately analyzed (5 progression, 4 treatment effect). Within new or enlarging contrast-enhancing regions, DBSI hindered fraction was significantly higher in the treatment effect group compared to progression group (P = .0004). Compared to serial conventional MRI alone, inclusion of DBSI would have led to earlier diagnosis of either progression or treatment effect in 6 (66.7%) patients by a median of 7.7 (interquartile range = 0-20.1) weeks. Conclusions In the first longitudinal prospective study of DBSI in adult HGG patients, we found that in new or enlarging contrast-enhancing regions following therapy, DBSI hindered fraction is elevated in cases of treatment effect compared to those with progression. Hindered fraction map may be a valuable adjunct to conventional MRI to distinguish tumor progression from treatment effect.
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Affiliation(s)
- Rowland H Han
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Tanner M Johanns
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
- The Brain Tumor Center, Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Kaleigh F Roberts
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Yu Tao
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jingqin Luo
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Zezhong Ye
- Department of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Peng Sun
- Department of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jacob Blum
- Department of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Tsen-Hsuan Lin
- Department of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Sheng-Kwei Song
- Department of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Albert H Kim
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
- The Brain Tumor Center, Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri, USA
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Rahmani F, Ghezzi L, Tosti V, Liu J, Song SK, Wu AT, Rajamanickam J, Obert KA, Benzinger TL, Mittendorfer B, Piccio L, Raji CA. Twelve Weeks of Intermittent Caloric Restriction Diet Mitigates Neuroinflammation in Midlife Individuals with Multiple Sclerosis: A Pilot Study with Implications for Prevention of Alzheimer's Disease. J Alzheimers Dis 2023; 93:263-273. [PMID: 37005885 PMCID: PMC10460547 DOI: 10.3233/jad-221007] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
BACKGROUND Multiple sclerosis (MS) is a prototype neuroinflammatory disorder with increasingly recognized role for neurodegeneration. Most first-line treatments cannot prevent the progression of neurodegeneration and the resultant disability. Interventions can improve symptoms of MS and might provide insights into the underlying pathology. OBJECTIVE To investigate the effect of intermittent caloric restriction on neuroimaging markers of MS. METHODS We randomized ten participants with relapsing remitting MS to either a 12-week intermittent calorie restriction (iCR) diet (n = 5) or control (n = 5). Cortical thickness and volumes were measured through FreeSurfer, cortical perfusion was measured by arterial spin labeling and neuroinflammation through diffusion basis spectrum imaging. RESULTS After 12 weeks of iCR, brain volume increased in the left superior and inferior parietal gyri (p: 0.050 and 0.049, respectively) and the banks of the superior temporal sulcus (p: 0.01). Similarly in the iCR group, cortical thickness improved in the bilateral medial orbitofrontal gyri (p: 0.04 and 0.05 in right and left, respectively), the left superior temporal gyrus (p: 0.03), and the frontal pole (p: 0.008) among others. Cerebral perfusion decreased in the bilateral fusiform gyri (p: 0.047 and 0.02 in right and left, respectively) and increased in the bilateral deep anterior white matter (p: 0.03 and 0.013 in right and left, respectively). Neuroinflammation, demonstrated through hindered and restricted water fractions (HF and RF), decreased in the left optic tract (HF p: 0.02), and the right extreme capsule (RF p: 0.007 and HF p: 0.003). CONCLUSION These pilot data suggest therapeutic effects of iCR in improving cortical volume and thickness and mitigating neuroinflammation in midlife adults with MS.
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Affiliation(s)
- Farzaneh Rahmani
- Mallinckrodt Institute of Radiology, Division of Neuroradiology, Washington University in St. Louis, St. Louis, MO, USA
| | - Laura Ghezzi
- Department of Neurology, Washington University in St. Louis, St. Louis, MO, USA
| | - Valeria Tosti
- Department of Neurology, Washington University in St. Louis, St. Louis, MO, USA
| | - Jingxia Liu
- Mallinckrodt Institute of Radiology, Division of Neuroradiology, Washington University in St. Louis, St. Louis, MO, USA
- Department of Surgery, Division of Public Health Sciences, Washington University in St. Louis, St. Louis, MO, USA
| | - Sheng-Kwei Song
- Department of Physics, Washington University in St. Louis, St. Louis, MO, USA
- Hope Center for Neurological Disorders, Washington University in St. Louis, St. Louis, MO, USA
| | - Anthony T. Wu
- Department of Physics, Washington University in St. Louis, St. Louis, MO, USA
- Hope Center for Neurological Disorders, Washington University in St. Louis, St. Louis, MO, USA
| | - Jayashree Rajamanickam
- Mallinckrodt Institute of Radiology, Division of Neuroradiology, Washington University in St. Louis, St. Louis, MO, USA
| | - Kathleen A. Obert
- Department of Neurology, Washington University in St. Louis, St. Louis, MO, USA
| | - Tammie L.S. Benzinger
- Mallinckrodt Institute of Radiology, Division of Neuroradiology, Washington University in St. Louis, St. Louis, MO, USA
- Charles F. and Joanne Knight Alzheimer Disease Research Center, Washington University in St Louis, St. Louis, MO, USA
| | - Bettina Mittendorfer
- Department of Medicine, Division of Geriatrics and Nutritional Science, Washington University in St. Louis, St. Louis, MO, USA
| | - Laura Piccio
- Department of Neurology, Washington University in St. Louis, St. Louis, MO, USA
- Hope Center for Neurological Disorders, Washington University in St. Louis, St. Louis, MO, USA
- Brain and Mind Centre, School of Medical Sciences, The University of Sydney, NSW, Australia
- Charles Perkin Centre, The University of Sydney NSW, Australia
| | - Cyrus A. Raji
- Mallinckrodt Institute of Radiology, Division of Neuroradiology, Washington University in St. Louis, St. Louis, MO, USA
- Charles F. and Joanne Knight Alzheimer Disease Research Center, Washington University in St Louis, St. Louis, MO, USA
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Radial diffusivity reflects general decline rather than specific cognitive deterioration in multiple sclerosis. Sci Rep 2022; 12:21771. [PMID: 36526708 PMCID: PMC9758146 DOI: 10.1038/s41598-022-26204-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
Advanced structural brain imaging techniques, such as diffusion tensor imaging (DTI), have been used to study the relationship between DTI-parameters and cognitive scores in multiple sclerosis (MS). In this study, we assessed cognitive function in 61 individuals with MS and a control group of 35 healthy individuals with the Symbol Digit Modalities Test, the California Verbal Learning Test-II, the Brief Visuospatial Memory Test-Revised, the Controlled Oral Word Association Test, and Stroop-test. We also acquired diffusion-weighted images (b = 1000; 32 directions), which were processed to obtain the following DTI scalars: fractional anisotropy, mean, axial, and radial diffusivity. The relation between DTI scalars and cognitive parameters was assessed through permutations. Although fractional anisotropy and axial diffusivity did not correlate with any of the cognitive tests, mean and radial diffusivity were negatively correlated with all of these tests. However, this effect was not specific to any specific white matter tract or cognitive test and demonstrated a general effect with only low to moderate individual voxel-based correlations of <0.6. Similarly, lesion and white matter volume show a general effect with medium to high voxel-based correlations of 0.5-0.8. In conclusion, radial diffusivity is strongly related to cognitive impairment in MS. However, the strong associations of radial diffusivity with both cognition and whole brain lesion volume suggest that it is a surrogate marker for general decline in MS, rather than a marker for specific cognitive functions.
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Zhang X. Magnetic resonance imaging of the monkey fetal brain in utero. INVESTIGATIVE MAGNETIC RESONANCE IMAGING 2022; 26:177-190. [PMID: 36937817 PMCID: PMC10019598 DOI: 10.13104/imri.2022.26.4.177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Non-human primates (NHPs) are the closest living relatives of the human and play a critical role in investigating the effects of maternal viral infection and consumption of medicines, drugs, and alcohol on fetal development. With the advance of contemporary fast MRI techniques with parallel imaging, fetal MRI is becoming a robust tool increasingly used in clinical practice and preclinical studies to examine congenital abnormalities including placental dysfunction, congenital heart disease (CHD), and brain abnormalities non-invasively. Because NHPs are usually scanned under anesthesia, the motion artifact is reduced substantially, allowing multi-parameter MRI techniques to be used intensively to examine the fetal development in a single scanning session or longitudinal studies. In this paper, the MRI techniques for scanning monkey fetal brains in utero in biomedical research are summarized. Also, a fast imaging protocol including T2-weighted imaging, diffusion MRI, resting-state functional MRI (rsfMRI) to examine rhesus monkey fetal brains in utero on a clinical 3T scanner is introduced.
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Affiliation(s)
- Xiaodong Zhang
- EPC Imaging Center and Division of Neuropharmacology and Neurologic Diseases, Emory National Primate Research Center, Emory University, Atlanta, Georgia, 30329, USA
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10
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Isaacs AM, Neil JJ, McAllister JP, Dahiya S, Castaneyra-Ruiz L, Merisaari H, Botteron HE, Alexopoulos D, George A, Sun P, Morales DM, Shimony JS, Strahle J, Yan Y, Song SK, Limbrick DD, Smyser CD. Microstructural Periventricular White Matter Injury in Post-hemorrhagic Ventricular Dilatation. Neurology 2022; 98:e364-e375. [PMID: 34799460 PMCID: PMC8793106 DOI: 10.1212/wnl.0000000000013080] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 09/15/2021] [Accepted: 11/12/2021] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The neurologic deficits of neonatal post-hemorrhagic hydrocephalus (PHH) have been linked to periventricular white matter injury. To improve understanding of PHH-related injury, diffusion basis spectrum imaging (DBSI) was applied in neonates, modeling axonal and myelin integrity, fiber density, and extrafiber pathologies. Objectives included characterizing DBSI measures in periventricular tracts, associating measures with ventricular size, and examining MRI findings in the context of postmortem white matter histology from similar cases. METHODS A prospective cohort of infants born very preterm underwent term equivalent MRI, including infants with PHH, high-grade intraventricular hemorrhage without hydrocephalus (IVH), and controls (very preterm [VPT]). DBSI metrics extracted from the corpus callosum, corticospinal tracts, and optic radiations included fiber axial diffusivity, fiber radial diffusivity, fiber fractional anisotropy, fiber fraction (fiber density), restricted fractions (cellular infiltration), and nonrestricted fractions (vasogenic edema). Measures were compared across groups and correlated with ventricular size. Corpus callosum postmortem immunohistochemistry in infants with and without PHH assessed intra- and extrafiber pathologies. RESULTS Ninety-five infants born very preterm were assessed (68 VPT, 15 IVH, 12 PHH). Infants with PHH had the most severe white matter abnormalities and there were no consistent differences in measures between IVH and VPT groups. Key tract-specific white matter injury patterns in PHH included reduced fiber fraction in the setting of axonal or myelin injury, increased cellular infiltration, vasogenic edema, and inflammation. Specifically, measures of axonal injury were highest in the corpus callosum; both axonal and myelin injury were observed in the corticospinal tracts; and axonal and myelin integrity were preserved in the setting of increased extrafiber cellular infiltration and edema in the optic radiations. Increasing ventricular size correlated with worse DBSI metrics across groups. On histology, infants with PHH had high cellularity, variable cytoplasmic vacuolation, and low synaptophysin marker intensity. DISCUSSION PHH was associated with diffuse white matter injury, including tract-specific patterns of axonal and myelin injury, fiber loss, cellular infiltration, and inflammation. Larger ventricular size was associated with greater disruption. Postmortem immunohistochemistry confirmed MRI findings. These results demonstrate DBSI provides an innovative approach extending beyond conventional diffusion MRI for investigating neuropathologic effects of PHH on neonatal brain development.
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Affiliation(s)
- Albert M Isaacs
- From the Department of Neuroscience (A.M.I.), Washington University in St. Louis, MO; Department of Clinical Neurosciences (A.M.I.), University of Calgary, Canada; and Departments of Neurology (J.J.N., D.A., C.D.S.), Neurosurgery (J.P.A., L.C.-R., H.E.B., D.M.M., J.S., D.D.L.), Pathology (S.D.), Public Health Sciences (Y.Y.,), and Pediatrics (C.D.S.), and Mallinckrodt Institute of Radiology (H.M., A.G., P.S., J.S., S.-K.S., C.D.S.), Washington University School of Medicine, St. Louis, MO.
| | - Jeffrey J Neil
- From the Department of Neuroscience (A.M.I.), Washington University in St. Louis, MO; Department of Clinical Neurosciences (A.M.I.), University of Calgary, Canada; and Departments of Neurology (J.J.N., D.A., C.D.S.), Neurosurgery (J.P.A., L.C.-R., H.E.B., D.M.M., J.S., D.D.L.), Pathology (S.D.), Public Health Sciences (Y.Y.,), and Pediatrics (C.D.S.), and Mallinckrodt Institute of Radiology (H.M., A.G., P.S., J.S., S.-K.S., C.D.S.), Washington University School of Medicine, St. Louis, MO
| | - James P McAllister
- From the Department of Neuroscience (A.M.I.), Washington University in St. Louis, MO; Department of Clinical Neurosciences (A.M.I.), University of Calgary, Canada; and Departments of Neurology (J.J.N., D.A., C.D.S.), Neurosurgery (J.P.A., L.C.-R., H.E.B., D.M.M., J.S., D.D.L.), Pathology (S.D.), Public Health Sciences (Y.Y.,), and Pediatrics (C.D.S.), and Mallinckrodt Institute of Radiology (H.M., A.G., P.S., J.S., S.-K.S., C.D.S.), Washington University School of Medicine, St. Louis, MO
| | - Sonika Dahiya
- From the Department of Neuroscience (A.M.I.), Washington University in St. Louis, MO; Department of Clinical Neurosciences (A.M.I.), University of Calgary, Canada; and Departments of Neurology (J.J.N., D.A., C.D.S.), Neurosurgery (J.P.A., L.C.-R., H.E.B., D.M.M., J.S., D.D.L.), Pathology (S.D.), Public Health Sciences (Y.Y.,), and Pediatrics (C.D.S.), and Mallinckrodt Institute of Radiology (H.M., A.G., P.S., J.S., S.-K.S., C.D.S.), Washington University School of Medicine, St. Louis, MO
| | - Leandro Castaneyra-Ruiz
- From the Department of Neuroscience (A.M.I.), Washington University in St. Louis, MO; Department of Clinical Neurosciences (A.M.I.), University of Calgary, Canada; and Departments of Neurology (J.J.N., D.A., C.D.S.), Neurosurgery (J.P.A., L.C.-R., H.E.B., D.M.M., J.S., D.D.L.), Pathology (S.D.), Public Health Sciences (Y.Y.,), and Pediatrics (C.D.S.), and Mallinckrodt Institute of Radiology (H.M., A.G., P.S., J.S., S.-K.S., C.D.S.), Washington University School of Medicine, St. Louis, MO
| | - Harri Merisaari
- From the Department of Neuroscience (A.M.I.), Washington University in St. Louis, MO; Department of Clinical Neurosciences (A.M.I.), University of Calgary, Canada; and Departments of Neurology (J.J.N., D.A., C.D.S.), Neurosurgery (J.P.A., L.C.-R., H.E.B., D.M.M., J.S., D.D.L.), Pathology (S.D.), Public Health Sciences (Y.Y.,), and Pediatrics (C.D.S.), and Mallinckrodt Institute of Radiology (H.M., A.G., P.S., J.S., S.-K.S., C.D.S.), Washington University School of Medicine, St. Louis, MO
| | - Haley E Botteron
- From the Department of Neuroscience (A.M.I.), Washington University in St. Louis, MO; Department of Clinical Neurosciences (A.M.I.), University of Calgary, Canada; and Departments of Neurology (J.J.N., D.A., C.D.S.), Neurosurgery (J.P.A., L.C.-R., H.E.B., D.M.M., J.S., D.D.L.), Pathology (S.D.), Public Health Sciences (Y.Y.,), and Pediatrics (C.D.S.), and Mallinckrodt Institute of Radiology (H.M., A.G., P.S., J.S., S.-K.S., C.D.S.), Washington University School of Medicine, St. Louis, MO
| | - Dimitrios Alexopoulos
- From the Department of Neuroscience (A.M.I.), Washington University in St. Louis, MO; Department of Clinical Neurosciences (A.M.I.), University of Calgary, Canada; and Departments of Neurology (J.J.N., D.A., C.D.S.), Neurosurgery (J.P.A., L.C.-R., H.E.B., D.M.M., J.S., D.D.L.), Pathology (S.D.), Public Health Sciences (Y.Y.,), and Pediatrics (C.D.S.), and Mallinckrodt Institute of Radiology (H.M., A.G., P.S., J.S., S.-K.S., C.D.S.), Washington University School of Medicine, St. Louis, MO
| | - Ajit George
- From the Department of Neuroscience (A.M.I.), Washington University in St. Louis, MO; Department of Clinical Neurosciences (A.M.I.), University of Calgary, Canada; and Departments of Neurology (J.J.N., D.A., C.D.S.), Neurosurgery (J.P.A., L.C.-R., H.E.B., D.M.M., J.S., D.D.L.), Pathology (S.D.), Public Health Sciences (Y.Y.,), and Pediatrics (C.D.S.), and Mallinckrodt Institute of Radiology (H.M., A.G., P.S., J.S., S.-K.S., C.D.S.), Washington University School of Medicine, St. Louis, MO
| | - Peng Sun
- From the Department of Neuroscience (A.M.I.), Washington University in St. Louis, MO; Department of Clinical Neurosciences (A.M.I.), University of Calgary, Canada; and Departments of Neurology (J.J.N., D.A., C.D.S.), Neurosurgery (J.P.A., L.C.-R., H.E.B., D.M.M., J.S., D.D.L.), Pathology (S.D.), Public Health Sciences (Y.Y.,), and Pediatrics (C.D.S.), and Mallinckrodt Institute of Radiology (H.M., A.G., P.S., J.S., S.-K.S., C.D.S.), Washington University School of Medicine, St. Louis, MO
| | - Diego M Morales
- From the Department of Neuroscience (A.M.I.), Washington University in St. Louis, MO; Department of Clinical Neurosciences (A.M.I.), University of Calgary, Canada; and Departments of Neurology (J.J.N., D.A., C.D.S.), Neurosurgery (J.P.A., L.C.-R., H.E.B., D.M.M., J.S., D.D.L.), Pathology (S.D.), Public Health Sciences (Y.Y.,), and Pediatrics (C.D.S.), and Mallinckrodt Institute of Radiology (H.M., A.G., P.S., J.S., S.-K.S., C.D.S.), Washington University School of Medicine, St. Louis, MO
| | - Joshua S Shimony
- From the Department of Neuroscience (A.M.I.), Washington University in St. Louis, MO; Department of Clinical Neurosciences (A.M.I.), University of Calgary, Canada; and Departments of Neurology (J.J.N., D.A., C.D.S.), Neurosurgery (J.P.A., L.C.-R., H.E.B., D.M.M., J.S., D.D.L.), Pathology (S.D.), Public Health Sciences (Y.Y.,), and Pediatrics (C.D.S.), and Mallinckrodt Institute of Radiology (H.M., A.G., P.S., J.S., S.-K.S., C.D.S.), Washington University School of Medicine, St. Louis, MO
| | - Jennifer Strahle
- From the Department of Neuroscience (A.M.I.), Washington University in St. Louis, MO; Department of Clinical Neurosciences (A.M.I.), University of Calgary, Canada; and Departments of Neurology (J.J.N., D.A., C.D.S.), Neurosurgery (J.P.A., L.C.-R., H.E.B., D.M.M., J.S., D.D.L.), Pathology (S.D.), Public Health Sciences (Y.Y.,), and Pediatrics (C.D.S.), and Mallinckrodt Institute of Radiology (H.M., A.G., P.S., J.S., S.-K.S., C.D.S.), Washington University School of Medicine, St. Louis, MO
| | - Yan Yan
- From the Department of Neuroscience (A.M.I.), Washington University in St. Louis, MO; Department of Clinical Neurosciences (A.M.I.), University of Calgary, Canada; and Departments of Neurology (J.J.N., D.A., C.D.S.), Neurosurgery (J.P.A., L.C.-R., H.E.B., D.M.M., J.S., D.D.L.), Pathology (S.D.), Public Health Sciences (Y.Y.,), and Pediatrics (C.D.S.), and Mallinckrodt Institute of Radiology (H.M., A.G., P.S., J.S., S.-K.S., C.D.S.), Washington University School of Medicine, St. Louis, MO
| | - Sheng-Kwei Song
- From the Department of Neuroscience (A.M.I.), Washington University in St. Louis, MO; Department of Clinical Neurosciences (A.M.I.), University of Calgary, Canada; and Departments of Neurology (J.J.N., D.A., C.D.S.), Neurosurgery (J.P.A., L.C.-R., H.E.B., D.M.M., J.S., D.D.L.), Pathology (S.D.), Public Health Sciences (Y.Y.,), and Pediatrics (C.D.S.), and Mallinckrodt Institute of Radiology (H.M., A.G., P.S., J.S., S.-K.S., C.D.S.), Washington University School of Medicine, St. Louis, MO
| | - David D Limbrick
- From the Department of Neuroscience (A.M.I.), Washington University in St. Louis, MO; Department of Clinical Neurosciences (A.M.I.), University of Calgary, Canada; and Departments of Neurology (J.J.N., D.A., C.D.S.), Neurosurgery (J.P.A., L.C.-R., H.E.B., D.M.M., J.S., D.D.L.), Pathology (S.D.), Public Health Sciences (Y.Y.,), and Pediatrics (C.D.S.), and Mallinckrodt Institute of Radiology (H.M., A.G., P.S., J.S., S.-K.S., C.D.S.), Washington University School of Medicine, St. Louis, MO
| | - Christopher D Smyser
- From the Department of Neuroscience (A.M.I.), Washington University in St. Louis, MO; Department of Clinical Neurosciences (A.M.I.), University of Calgary, Canada; and Departments of Neurology (J.J.N., D.A., C.D.S.), Neurosurgery (J.P.A., L.C.-R., H.E.B., D.M.M., J.S., D.D.L.), Pathology (S.D.), Public Health Sciences (Y.Y.,), and Pediatrics (C.D.S.), and Mallinckrodt Institute of Radiology (H.M., A.G., P.S., J.S., S.-K.S., C.D.S.), Washington University School of Medicine, St. Louis, MO
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Herthum H, Hetzer S, Scheel M, Shahryari M, Braun J, Paul F, Sack I. In vivo stiffness of multiple sclerosis lesions is similar to that of normal-appearing white matter. Acta Biomater 2022; 138:410-421. [PMID: 34757062 DOI: 10.1016/j.actbio.2021.10.038] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 10/18/2021] [Accepted: 10/19/2021] [Indexed: 12/15/2022]
Abstract
In 1868, French neurologist Jean-Martin Charcot coined the term multiple sclerosis (MS) after his observation that numerous white matter (WM) glial scars felt like sclerotic tissue. Nowadays, magnetic resonance elastography (MRE) can generate images with contrast of stiffness (CS) in soft in vivo tissues and may therefore be sensitive to MS lesions, provided that sclerosis is indeed a mechanical signature of this disease. We analyzed CS in a total of 147 lesions in patients with relapsing-remitting MS, compared with control regions in contralateral brain regions, and phantom data as well as performed numerical simulations to determine the delineation limits of multifrequency MRE (20 - 40 Hz) in MS. MRE analysis of simulated waves revealed a delineation limit of approximately 10% CS for detecting 9-mm lesions (mean size in our patient population). Due to inversion bias, this limit is reached when true CS is -11% for soft and 35% for stiff lesions. In vivo MRE identified 35 stiffer lesions and 17 softer lesions compared with surrounding WM (mean stiffness: 934±82 Pa). However, a similar pattern was found in the contralateral brain, suggesting that the range of stiffness changes in WM lesions due to MS is within the normal range of WM variability and normal heterogeneity-related CS. Consequently, Charcot's original intuition that MS is a focal sclerotic disease can neither be dismissed nor confirmed by in vivo MRE. However, the observation that MS lesions do not markedly differ in stiffness from surrounding brain tissue suggests that marked tissue sclerosis is not a mechanical signature of MS. STATEMENT OF SIGNIFICANCE: Multiple sclerosis (MS) was named by J.M. Charcot after the sclerotic changes in brain tissue he found in post-mortem autopsies. Since then, nothing has been revealed about the actual stiffening of MS lesions in vivo. Studying the viscoelastic properties of plaques in their natural environment is a major challenge that can only be overcome by MR elastography (MRE). Therefore, we used multifrequency MRE to answer the question whether MS lesions in patients with a relapsing-remitting disease course are mechanically different than surrounding tissue. Our findings suggest that the range of stiffness changes in white matter lesions due to MS is within the normal range of white matter variability and in vivo tissue sclerosis might not be a mechanical signature of MS.
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Heckova E, Dal-Bianco A, Strasser B, Hangel GJ, Lipka A, Motyka S, Hingerl L, Rommer PS, Berger T, Hnilicová P, Kantorová E, Leutmezer F, Kurča E, Gruber S, Trattnig S, Bogner W. Extensive Brain Pathologic Alterations Detected with 7.0-T MR Spectroscopic Imaging Associated with Disability in Multiple Sclerosis. Radiology 2022; 303:141-150. [PMID: 34981978 DOI: 10.1148/radiol.210614] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Background MR spectroscopic imaging (MRSI) allows in vivo assessment of brain metabolism and is of special interest in multiple sclerosis (MS), where morphologic MRI cannot depict major parts of disease activity. Purpose To evaluate the ability of 7.0-T MRSI to depict and visualize pathologic alterations in the normal-appearing white matter (NAWM) and cortical gray matter (CGM) in participants with MS and to investigate their relation to disability. Materials and Methods Free-induction decay MRSI was performed at 7.0 T. Participants with MS and age- and sex-matched healthy controls were recruited prospectively between January 2016 and December 2017. Metabolic ratios were obtained in white matter lesions, NAWM, and CGM regions. Subgroup analysis for MS-related disability based on Expanded Disability Status Scale (EDSS) scores was performed using analysis of covariance. Partial correlations were applied to explore associations between metabolic ratios and disability. Results Sixty-five participants with MS (mean age ± standard deviation, 34 years ± 9; 34 women) and 20 age- and sex-matched healthy controls (mean age, 32 years ± 7; 11 women) were evaluated. Higher signal intensity of myo-inositol (mI) with and without reduced signal intensity of N-acetylaspartate (NAA) was visible on metabolic images in the NAWM of participants with MS. A higher ratio of mI to total creatine (tCr) was observed in the NAWM of the centrum semiovale of all MS subgroups, including participants without disability (marginal mean ± standard error, healthy controls: 0.78 ± 0.04; EDSS 0-1: 0.86 ± 0.03 [P = .02]; EDSS 1.5-3: 0.95 ± 0.04 [P < .001]; EDSS ≥3.5: 0.94 ± 0.04 [P = .001]). A lower ratio of NAA to tCr was found in MS subgroups with disabilities, both in their NAWM (marginal mean ± standard error, healthy controls: 1.46 ± 0.04; EDSS 1.5-3: 1.33 ± 0.03 [P = .03]; EDSS ≥3.5: 1.30 ± 0.04 [P = .01]) and CGM (marginal mean ± standard error, healthy controls: 1.42 ± 0.05; EDSS ≥3.5: 1.23 ± 0.05 [P = .006]). mI/NAA correlated with EDSS (NAWM of centrum semiovale: r = 0.47, P < .001; parietal NAWM: r = 0.43, P = .002; frontal NAWM: r = 0.34, P = .01; frontal CGM: r = 0.37, P = .004). Conclusion MR spectroscopic imaging at 7.0 T allowed in vivo visualization of multiple sclerosis pathologic findings not visible at T1- or T2-weighted MRI. Metabolic abnormalities in the normal-appearing white matter and cortical gray matter were associated with disability. © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Barker in this issue.
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Affiliation(s)
- Eva Heckova
- From the High Field MR Centre, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Lazarettgasse 14, A-1090 Vienna, Austria (E.H., B.S., G.J.H., A.L., S.M., L.H., S.G., S.T., W.B.); Departments of Neurology (A.D.B., P.S.R., T.B., F.L.) and Neurosurgery (G.J.H.), Medical University of Vienna, Vienna, Austria; Biomedical Center Martin (P.H.) and Clinic of Neurology (E. Kantorová, E. Kurča), Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia; and Karl Landsteiner Institute for Clinical Molecular MRI in Musculoskeletal System, Vienna, Austria (S.T.)
| | - Assunta Dal-Bianco
- From the High Field MR Centre, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Lazarettgasse 14, A-1090 Vienna, Austria (E.H., B.S., G.J.H., A.L., S.M., L.H., S.G., S.T., W.B.); Departments of Neurology (A.D.B., P.S.R., T.B., F.L.) and Neurosurgery (G.J.H.), Medical University of Vienna, Vienna, Austria; Biomedical Center Martin (P.H.) and Clinic of Neurology (E. Kantorová, E. Kurča), Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia; and Karl Landsteiner Institute for Clinical Molecular MRI in Musculoskeletal System, Vienna, Austria (S.T.)
| | - Bernhard Strasser
- From the High Field MR Centre, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Lazarettgasse 14, A-1090 Vienna, Austria (E.H., B.S., G.J.H., A.L., S.M., L.H., S.G., S.T., W.B.); Departments of Neurology (A.D.B., P.S.R., T.B., F.L.) and Neurosurgery (G.J.H.), Medical University of Vienna, Vienna, Austria; Biomedical Center Martin (P.H.) and Clinic of Neurology (E. Kantorová, E. Kurča), Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia; and Karl Landsteiner Institute for Clinical Molecular MRI in Musculoskeletal System, Vienna, Austria (S.T.)
| | - Gilbert J Hangel
- From the High Field MR Centre, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Lazarettgasse 14, A-1090 Vienna, Austria (E.H., B.S., G.J.H., A.L., S.M., L.H., S.G., S.T., W.B.); Departments of Neurology (A.D.B., P.S.R., T.B., F.L.) and Neurosurgery (G.J.H.), Medical University of Vienna, Vienna, Austria; Biomedical Center Martin (P.H.) and Clinic of Neurology (E. Kantorová, E. Kurča), Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia; and Karl Landsteiner Institute for Clinical Molecular MRI in Musculoskeletal System, Vienna, Austria (S.T.)
| | - Alexandra Lipka
- From the High Field MR Centre, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Lazarettgasse 14, A-1090 Vienna, Austria (E.H., B.S., G.J.H., A.L., S.M., L.H., S.G., S.T., W.B.); Departments of Neurology (A.D.B., P.S.R., T.B., F.L.) and Neurosurgery (G.J.H.), Medical University of Vienna, Vienna, Austria; Biomedical Center Martin (P.H.) and Clinic of Neurology (E. Kantorová, E. Kurča), Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia; and Karl Landsteiner Institute for Clinical Molecular MRI in Musculoskeletal System, Vienna, Austria (S.T.)
| | - Stanislav Motyka
- From the High Field MR Centre, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Lazarettgasse 14, A-1090 Vienna, Austria (E.H., B.S., G.J.H., A.L., S.M., L.H., S.G., S.T., W.B.); Departments of Neurology (A.D.B., P.S.R., T.B., F.L.) and Neurosurgery (G.J.H.), Medical University of Vienna, Vienna, Austria; Biomedical Center Martin (P.H.) and Clinic of Neurology (E. Kantorová, E. Kurča), Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia; and Karl Landsteiner Institute for Clinical Molecular MRI in Musculoskeletal System, Vienna, Austria (S.T.)
| | - Lukas Hingerl
- From the High Field MR Centre, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Lazarettgasse 14, A-1090 Vienna, Austria (E.H., B.S., G.J.H., A.L., S.M., L.H., S.G., S.T., W.B.); Departments of Neurology (A.D.B., P.S.R., T.B., F.L.) and Neurosurgery (G.J.H.), Medical University of Vienna, Vienna, Austria; Biomedical Center Martin (P.H.) and Clinic of Neurology (E. Kantorová, E. Kurča), Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia; and Karl Landsteiner Institute for Clinical Molecular MRI in Musculoskeletal System, Vienna, Austria (S.T.)
| | - Paulus S Rommer
- From the High Field MR Centre, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Lazarettgasse 14, A-1090 Vienna, Austria (E.H., B.S., G.J.H., A.L., S.M., L.H., S.G., S.T., W.B.); Departments of Neurology (A.D.B., P.S.R., T.B., F.L.) and Neurosurgery (G.J.H.), Medical University of Vienna, Vienna, Austria; Biomedical Center Martin (P.H.) and Clinic of Neurology (E. Kantorová, E. Kurča), Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia; and Karl Landsteiner Institute for Clinical Molecular MRI in Musculoskeletal System, Vienna, Austria (S.T.)
| | - Thomas Berger
- From the High Field MR Centre, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Lazarettgasse 14, A-1090 Vienna, Austria (E.H., B.S., G.J.H., A.L., S.M., L.H., S.G., S.T., W.B.); Departments of Neurology (A.D.B., P.S.R., T.B., F.L.) and Neurosurgery (G.J.H.), Medical University of Vienna, Vienna, Austria; Biomedical Center Martin (P.H.) and Clinic of Neurology (E. Kantorová, E. Kurča), Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia; and Karl Landsteiner Institute for Clinical Molecular MRI in Musculoskeletal System, Vienna, Austria (S.T.)
| | - Petra Hnilicová
- From the High Field MR Centre, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Lazarettgasse 14, A-1090 Vienna, Austria (E.H., B.S., G.J.H., A.L., S.M., L.H., S.G., S.T., W.B.); Departments of Neurology (A.D.B., P.S.R., T.B., F.L.) and Neurosurgery (G.J.H.), Medical University of Vienna, Vienna, Austria; Biomedical Center Martin (P.H.) and Clinic of Neurology (E. Kantorová, E. Kurča), Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia; and Karl Landsteiner Institute for Clinical Molecular MRI in Musculoskeletal System, Vienna, Austria (S.T.)
| | - Ema Kantorová
- From the High Field MR Centre, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Lazarettgasse 14, A-1090 Vienna, Austria (E.H., B.S., G.J.H., A.L., S.M., L.H., S.G., S.T., W.B.); Departments of Neurology (A.D.B., P.S.R., T.B., F.L.) and Neurosurgery (G.J.H.), Medical University of Vienna, Vienna, Austria; Biomedical Center Martin (P.H.) and Clinic of Neurology (E. Kantorová, E. Kurča), Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia; and Karl Landsteiner Institute for Clinical Molecular MRI in Musculoskeletal System, Vienna, Austria (S.T.)
| | - Fritz Leutmezer
- From the High Field MR Centre, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Lazarettgasse 14, A-1090 Vienna, Austria (E.H., B.S., G.J.H., A.L., S.M., L.H., S.G., S.T., W.B.); Departments of Neurology (A.D.B., P.S.R., T.B., F.L.) and Neurosurgery (G.J.H.), Medical University of Vienna, Vienna, Austria; Biomedical Center Martin (P.H.) and Clinic of Neurology (E. Kantorová, E. Kurča), Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia; and Karl Landsteiner Institute for Clinical Molecular MRI in Musculoskeletal System, Vienna, Austria (S.T.)
| | - Egon Kurča
- From the High Field MR Centre, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Lazarettgasse 14, A-1090 Vienna, Austria (E.H., B.S., G.J.H., A.L., S.M., L.H., S.G., S.T., W.B.); Departments of Neurology (A.D.B., P.S.R., T.B., F.L.) and Neurosurgery (G.J.H.), Medical University of Vienna, Vienna, Austria; Biomedical Center Martin (P.H.) and Clinic of Neurology (E. Kantorová, E. Kurča), Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia; and Karl Landsteiner Institute for Clinical Molecular MRI in Musculoskeletal System, Vienna, Austria (S.T.)
| | - Stephan Gruber
- From the High Field MR Centre, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Lazarettgasse 14, A-1090 Vienna, Austria (E.H., B.S., G.J.H., A.L., S.M., L.H., S.G., S.T., W.B.); Departments of Neurology (A.D.B., P.S.R., T.B., F.L.) and Neurosurgery (G.J.H.), Medical University of Vienna, Vienna, Austria; Biomedical Center Martin (P.H.) and Clinic of Neurology (E. Kantorová, E. Kurča), Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia; and Karl Landsteiner Institute for Clinical Molecular MRI in Musculoskeletal System, Vienna, Austria (S.T.)
| | - Siegfried Trattnig
- From the High Field MR Centre, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Lazarettgasse 14, A-1090 Vienna, Austria (E.H., B.S., G.J.H., A.L., S.M., L.H., S.G., S.T., W.B.); Departments of Neurology (A.D.B., P.S.R., T.B., F.L.) and Neurosurgery (G.J.H.), Medical University of Vienna, Vienna, Austria; Biomedical Center Martin (P.H.) and Clinic of Neurology (E. Kantorová, E. Kurča), Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia; and Karl Landsteiner Institute for Clinical Molecular MRI in Musculoskeletal System, Vienna, Austria (S.T.)
| | - Wolfgang Bogner
- From the High Field MR Centre, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Lazarettgasse 14, A-1090 Vienna, Austria (E.H., B.S., G.J.H., A.L., S.M., L.H., S.G., S.T., W.B.); Departments of Neurology (A.D.B., P.S.R., T.B., F.L.) and Neurosurgery (G.J.H.), Medical University of Vienna, Vienna, Austria; Biomedical Center Martin (P.H.) and Clinic of Neurology (E. Kantorová, E. Kurča), Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia; and Karl Landsteiner Institute for Clinical Molecular MRI in Musculoskeletal System, Vienna, Austria (S.T.)
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13
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Granziera C, Wuerfel J, Barkhof F, Calabrese M, De Stefano N, Enzinger C, Evangelou N, Filippi M, Geurts JJG, Reich DS, Rocca MA, Ropele S, Rovira À, Sati P, Toosy AT, Vrenken H, Gandini Wheeler-Kingshott CAM, Kappos L. Quantitative magnetic resonance imaging towards clinical application in multiple sclerosis. Brain 2021; 144:1296-1311. [PMID: 33970206 PMCID: PMC8219362 DOI: 10.1093/brain/awab029] [Citation(s) in RCA: 73] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 10/25/2020] [Accepted: 11/16/2020] [Indexed: 12/11/2022] Open
Abstract
Quantitative MRI provides biophysical measures of the microstructural integrity of the CNS, which can be compared across CNS regions, patients, and centres. In patients with multiple sclerosis, quantitative MRI techniques such as relaxometry, myelin imaging, magnetization transfer, diffusion MRI, quantitative susceptibility mapping, and perfusion MRI, complement conventional MRI techniques by providing insight into disease mechanisms. These include: (i) presence and extent of diffuse damage in CNS tissue outside lesions (normal-appearing tissue); (ii) heterogeneity of damage and repair in focal lesions; and (iii) specific damage to CNS tissue components. This review summarizes recent technical advances in quantitative MRI, existing pathological validation of quantitative MRI techniques, and emerging applications of quantitative MRI to patients with multiple sclerosis in both research and clinical settings. The current level of clinical maturity of each quantitative MRI technique, especially regarding its integration into clinical routine, is discussed. We aim to provide a better understanding of how quantitative MRI may help clinical practice by improving stratification of patients with multiple sclerosis, and assessment of disease progression, and evaluation of treatment response.
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Affiliation(s)
- Cristina Granziera
- Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland
- Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Jens Wuerfel
- Medical Image Analysis Center, Basel, Switzerland
- Quantitative Biomedical Imaging Group (qbig), Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, multiple sclerosis Center Amsterdam, Amsterdam University Medical Center, Amsterdam, The Netherlands
- UCL Institutes of Healthcare Engineering and Neurology, London, UK
| | - Massimiliano Calabrese
- Neurology B, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Nicola De Stefano
- Neurology, Department of Medicine, Surgery and Neuroscience, University of Siena, Italy
| | - Christian Enzinger
- Department of Neurology and Division of Neuroradiology, Medical University of Graz, Graz, Austria
| | - Nikos Evangelou
- Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - Massimo Filippi
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, and Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Jeroen J G Geurts
- Department of Anatomy and Neurosciences, multiple sclerosis Center Amsterdam, Neuroscience Amsterdam, Amsterdam University Medical Centers, location VUmc, Amsterdam, The Netherlands
| | - Daniel S Reich
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD, USA
| | - Maria A Rocca
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, and Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Stefan Ropele
- Neuroimaging Research Unit, Department of Neurology, Medical University of Graz, Graz, Austria
| | - Àlex Rovira
- Section of Neuroradiology (Department of Radiology), Vall d'Hebron University Hospital and Research Institute, Barcelona, Spain
| | - Pascal Sati
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD, USA
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Ahmed T Toosy
- Queen Square multiple sclerosis Centre, Department of Neuroinflammation, Queen Square Institute of Neurology, University College London, London, UK
| | - Hugo Vrenken
- Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, multiple sclerosis Center Amsterdam, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Claudia A M Gandini Wheeler-Kingshott
- Queen Square multiple sclerosis Centre, Department of Neuroinflammation, Queen Square Institute of Neurology, University College London, London, UK
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
- Brain MRI 3T Research Centre, IRCCS Mondino Foundation, Pavia, Italy
| | - Ludwig Kappos
- Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland
- Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland
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14
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Yang R, Lin TH, Zhan J, Lai S, Song C, Sun P, Ye Z, Wallendorf M, George A, Cross AH, Song SK. Diffusion basis spectrum imaging measures anti-inflammatory and neuroprotective effects of fingolimod on murine optic neuritis. NEUROIMAGE-CLINICAL 2021; 31:102732. [PMID: 34166868 PMCID: PMC8240023 DOI: 10.1016/j.nicl.2021.102732] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 06/12/2021] [Accepted: 06/14/2021] [Indexed: 10/30/2022]
Abstract
OBJECTIVE To prospectively determine whether diffusion basis spectrum imaging (DBSI) detects, differentiates and quantitates coexisting inflammation, demyelination, axonal injury and axon loss in mice with optic neuritis (ON) due to experimental autoimmune encephalomyelitis (EAE), and to determine if DBSI accurately measures effects of fingolimod on underlying pathology. METHODS EAE was induced in 7-week-old C57BL/6 female mice. Visual acuity (VA) was assessed daily to detect onset of ON after which daily oral-treatment with either fingolimod (1 mg/kg) or saline was given for ten weeks. In vivo DBSI scans of optic nerves were performed at baseline, 2-, 6- and 10-weeks post treatment. DBSI-derived metrics including restricted isotropic diffusion tensor fraction (putatively reflecting cellularity), non-restricted isotropic diffusion tensor fraction (putatively reflecting vasogenic edema), DBSI-derived axonal volume, axial diffusivity, λ∥ (putatively reflecting axonal integrity), and increased radial diffusivity, λ⊥ (putatively reflecting demyelination). Mice were killed immediately after the last DBSI scan for immunohistochemical assessment. RESULTS Optic nerves of fingolimod-treated mice exhibited significantly better (p < 0.05) VA than saline-treated group at each time point. During ten-week of treatment, DBSI-derived non-restricted and restricted-isotropic-diffusion-tensor fractions, and axonal volumes were not significantly different (p > 0.05) from the baseline values in fingolimod-treated mice. Transient DBSI-λ∥ decrease and DBSI-λ⊥ increase were detected during Fingolimod treatment. DBSI-derived metrics assessed in vivo significantly correlated (p < 0.05) with the corresponding histological markers. CONCLUSION DBSI was used to assess changes of the underlying optic nerve pathologies in EAE mice with ON, exhibiting great potential as a noninvasive outcome measure for monitoring disease progression and therapeutic efficacy for MS.
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Affiliation(s)
- Ruimeng Yang
- Department of Radiology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong 510640, China; Department of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Tsen-Hsuan Lin
- Department of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Jie Zhan
- Department of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Shengsheng Lai
- Department of Medical Equipment, Guangdong Food and Drug Vocational College, Guangzhou, Guangdong 510520, China
| | - Chunyu Song
- Department of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Peng Sun
- Department of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Zezhong Ye
- Department of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Michael Wallendorf
- Department of Biostatistics, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Ajit George
- Department of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Anne H Cross
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, USA; Hope Center for Neurological Disorders, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Sheng-Kwei Song
- Department of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA; Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, USA; Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO 63130, USA.
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15
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Vavasour IM, Sun P, Graf C, Yik JT, Kolind SH, Li DK, Tam R, Sayao AL, Schabas A, Devonshire V, Carruthers R, Traboulsee A, Moore GW, Song SK, Laule C. Characterization of multiple sclerosis neuroinflammation and neurodegeneration with relaxation and diffusion basis spectrum imaging. Mult Scler 2021; 28:418-428. [PMID: 34132126 DOI: 10.1177/13524585211023345] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Advanced magnetic resonance imaging (MRI) methods can provide more specific information about various microstructural tissue changes in multiple sclerosis (MS) brain. Quantitative measurement of T1 and T2 relaxation, and diffusion basis spectrum imaging (DBSI) yield metrics related to the pathology of neuroinflammation and neurodegeneration that occurs across the spectrum of MS. OBJECTIVE To use relaxation and DBSI MRI metrics to describe measures of neuroinflammation, myelin and axons in different MS subtypes. METHODS 103 participants (20 clinically isolated syndrome (CIS), 33 relapsing-remitting MS (RRMS), 30 secondary progressive MS and 20 primary progressive MS) underwent quantitative T1, T2, DBSI and conventional 3T MRI. Whole brain, normal-appearing white matter, lesion and corpus callosum MRI metrics were compared across MS subtypes. RESULTS A gradation of MRI metric values was seen from CIS to RRMS to progressive MS. RRMS demonstrated large oedema-related differences, while progressive MS had the most extensive abnormalities in myelin and axonal measures. CONCLUSION Relaxation and DBSI-derived MRI measures show differences between MS subtypes related to the severity and composition of underlying tissue damage. RRMS showed oedema, demyelination and axonal loss compared with CIS. Progressive MS had even more evidence of increased oedema, demyelination and axonal loss compared with CIS and RRMS.
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Affiliation(s)
- Irene M Vavasour
- Department of Radiology, The University of British Columbia, UBC Hospital, Vancouver, BC, Canada/International Collaboration on Repair Discoveries (ICORD), The University of British Columbia, Vancouver, BC, Canada
| | - Peng Sun
- Department of Radiology, Washington University, St. Louis, MO, USA
| | - Carina Graf
- Department of Physics & Astronomy, The University of British Columbia, Vancouver, BC, Canada
| | - Jackie T Yik
- Department of Physics & Astronomy, The University of British Columbia, Vancouver, BC, Canada
| | - Shannon H Kolind
- Department of Radiology, The University of British Columbia, Vancouver, BC, Canada/International Collaboration on Repair Discoveries (ICORD), The University of British Columbia, Vancouver, BC, Canada/Department of Physics & Astronomy, The University of British Columbia, Vancouver, BC, Canada/Department of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - David Kb Li
- Department of Radiology, The University of British Columbia, Vancouver, BC, Canada/Department of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Roger Tam
- Department of Radiology, The University of British Columbia, Vancouver, BC, Canada/School of Biomedical Engineering, The University of British Columbia, Vancouver, BC, Canada
| | - Ana-Luiza Sayao
- Department of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Alice Schabas
- Department of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Virginia Devonshire
- Department of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Robert Carruthers
- Department of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Anthony Traboulsee
- Department of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Gr Wayne Moore
- Department of Medicine, The University of British Columbia, Vancouver, BC, Canada/Department of Pathology and Laboratory Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Sheng-Kwei Song
- Department of Radiology, Washington University, St. Louis, MO, USA
| | - Cornelia Laule
- Department of Radiology, The University of British Columbia, Vancouver, BC, Canada/International Collaboration on Repair Discoveries (ICORD), The University of British Columbia, Vancouver, BC, Canada/Department of Physics & Astronomy, The University of British Columbia, Vancouver, BC, Canada/Department of Pathology and Laboratory Medicine, The University of British Columbia, Vancouver, BC, Canada
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16
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Schiavi S, Petracca M, Sun P, Fleysher L, Cocozza S, El Mendili MM, Signori A, Babb JS, Podranski K, Song SK, Inglese M. Non-invasive quantification of inflammation, axonal and myelin injury in multiple sclerosis. Brain 2021; 144:213-223. [PMID: 33253366 DOI: 10.1093/brain/awaa381] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 08/12/2020] [Accepted: 08/21/2020] [Indexed: 02/06/2023] Open
Abstract
The aim of this study was to determine the feasibility of diffusion basis spectrum imaging in multiple sclerosis at 7 T and to investigate the pathological substrates of tissue damage in lesions and normal-appearing white matter. To this end, 43 patients with multiple sclerosis (24 relapsing-remitting, 19 progressive), and 21 healthy control subjects were enrolled. White matter lesions were classified in T1-isointense, T1-hypointense and black holes. Mean values of diffusion basis spectrum imaging metrics (fibres, restricted and non-restricted fractions, axial and radial diffusivities and fractional anisotropy) were measured from whole brain white matter lesions and from both lesions and normal appearing white matter of the corpus callosum. Significant differences were found between T1-isointense and black holes (P ranging from 0.005 to <0.001) and between lesions' centre and rim (P < 0.001) for all the metrics. When comparing the three subject groups in terms of metrics derived from corpus callosum normal appearing white matter and T2-hyperintense lesions, a significant difference was found between healthy controls and relapsing-remitting patients for all metrics except restricted fraction and fractional anisotropy; between healthy controls and progressive patients for all metrics except restricted fraction and between relapsing-remitting and progressive multiple sclerosis patients for all metrics except fibres and restricted fractions (P ranging from 0.05 to <0.001 for all). Significant associations were found between corpus callosum normal-appearing white matter fibres fraction/non-restricted fraction and the Symbol Digit Modality Test (respectively, r = 0.35, P = 0.043; r = -0.35, P = 0.046), and between black holes radial diffusivity and Expanded Disability Status Score (r = 0.59, P = 0.002). We showed the feasibility of diffusion basis spectrum imaging metrics at 7 T, confirmed the role of the derived metrics in the characterization of lesions and normal appearing white matter tissue in different stages of the disease and demonstrated their clinical relevance. Thus, suggesting that diffusion basis spectrum imaging is a promising tool to investigate multiple sclerosis pathophysiology, monitor disease progression and treatment response.
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Affiliation(s)
- Simona Schiavi
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Italy.,Ospedale Policlinico San Martino-IRCCS, Genoa, Italy
| | - Maria Petracca
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Peng Sun
- Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Lazar Fleysher
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sirio Cocozza
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | | | - Alessio Signori
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - James S Babb
- Department of Radiology, Center for Biomedical Imaging, New York University, Langone Medical Center, New York, USA
| | - Kornelius Podranski
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sheng-Kwei Song
- Radiology, Washington University School of Medicine, St. Louis, MO, USA.,Hope Center for Neurological Disorders, Washington University School of Medicine, St. Louis, MO, USA.,Biomedical Engineering, Washington University, St. Louis, MO, USA.,Biomedical MR Laboratory, Washington University School of Medicine, St. Louis, MO, USA
| | - Matilde Inglese
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Italy.,Ospedale Policlinico San Martino-IRCCS, Genoa, Italy
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17
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Diffusion histology imaging differentiates distinct pediatric brain tumor histology. Sci Rep 2021; 11:4749. [PMID: 33637807 PMCID: PMC7910493 DOI: 10.1038/s41598-021-84252-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 02/08/2021] [Indexed: 11/08/2022] Open
Abstract
High-grade pediatric brain tumors exhibit the highest cancer mortality rates in children. While conventional MRI has been widely adopted for examining pediatric high-grade brain tumors clinically, accurate neuroimaging detection and differentiation of tumor histopathology for improved diagnosis, surgical planning, and treatment evaluation, remains an unmet need in their clinical management. We employed a novel Diffusion Histology Imaging (DHI) approach employing diffusion basis spectrum imaging (DBSI) derived metrics as the input classifiers for deep neural network analysis. DHI aims to detect, differentiate, and quantify heterogeneous areas in pediatric high-grade brain tumors, which include normal white matter (WM), densely cellular tumor, less densely cellular tumor, infiltrating edge, necrosis, and hemorrhage. Distinct diffusion metric combination would thus indicate the unique distributions of each distinct tumor histology features. DHI, by incorporating DBSI metrics and the deep neural network algorithm, classified pediatric tumor histology with an overall accuracy of 85.8%. Receiver operating analysis (ROC) analysis suggested DHI’s great capability in distinguishing individual tumor histology with AUC values (95% CI) of 0.984 (0.982–0.986), 0.960 (0.956–0.963), 0.991 (0.990–0.993), 0.950 (0.944–0.956), 0.977 (0.973–0.981) and 0.976 (0.972–0.979) for normal WM, densely cellular tumor, less densely cellular tumor, infiltrating edge, necrosis and hemorrhage, respectively. Our results suggest that DBSI-DNN, or DHI, accurately characterized and classified multiple tumor histologic features in pediatric high-grade brain tumors. If these results could be further validated in patients, the novel DHI might emerge as a favorable alternative to the current neuroimaging techniques to better guide biopsy and resection as well as monitor therapeutic response in patients with high-grade brain tumors.
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18
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Ye Z, Gary SE, Sun P, Mustafi SM, Glenn GR, Yeh FC, Merisaari H, Song C, Yang R, Huang GS, Kao HW, Lin CY, Wu YC, Jensen JH, Song SK. The impact of edema and fiber crossing on diffusion MRI metrics assessed in an ex vivo nerve phantom: Multi-tensor model vs. diffusion orientation distribution function. NMR IN BIOMEDICINE 2021; 34:e4414. [PMID: 33015890 PMCID: PMC9743958 DOI: 10.1002/nbm.4414] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 08/23/2020] [Accepted: 09/06/2020] [Indexed: 05/30/2023]
Abstract
Diffusion tensor imaging (DTI) has been employed for over 2 decades to noninvasively quantify central nervous system diseases/injuries. However, DTI is an inadequate simplification of diffusion modeling in the presence of coexisting inflammation, edema and crossing nerve fibers. We employed a tissue phantom using fixed mouse trigeminal nerves coated with various amounts of agarose gel to mimic crossing fibers in the presence of vasogenic edema. Diffusivity measures derived by DTI and diffusion basis spectrum imaging (DBSI) were compared at increasing levels of simulated edema and degrees of fiber crossing. Furthermore, we assessed the ability of DBSI, diffusion kurtosis imaging (DKI), generalized q-sampling imaging (GQI), q-ball imaging (QBI) and neurite orientation dispersion and density imaging to resolve fiber crossing, in reference to the gold standard angles measured from structural images. DTI-computed diffusivities and fractional anisotropy were significantly confounded by gel-mimicked edema and crossing fibers. Conversely, DBSI calculated accurate diffusivities of individual fibers regardless of the extent of simulated edema and degrees of fiber crossing angles. Additionally, DBSI accurately and consistently estimated crossing angles in various conditions of gel-mimicked edema when compared with the gold standard (r2 = 0.92, P = 1.9 × 10-9 , bias = 3.9°). Small crossing angles and edema significantly impact the diffusion orientation distribution function, making DKI, GQI and QBI less accurate in detecting and estimating fiber crossing angles. Lastly, we used diffusion tensor ellipsoids to demonstrate that DBSI resolves the confounds of edema and crossing fibers in the peritumoral edema region from a patient with lung cancer metastasis, while DTI failed. In summary, DBSI is able to separate two crossing fibers and accurately recover their diffusivities in a complex environment characterized by increasing crossing angles and amounts of gel-mimicked edema. DBSI also indicated better angular resolution compared with DKI, QBI and GQI.
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Affiliation(s)
- Zezhong Ye
- Department of Radiology, Washington University School of Medicine, St. Louis, MO 63110
| | - Sam E. Gary
- Medical Scientist Training Program, University of Alabama at Birmingham, Birmingham, AL 35294
| | - Peng Sun
- Department of Radiology, Washington University School of Medicine, St. Louis, MO 63110
| | - Sourajit Mitra Mustafi
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN 46202
| | - George Russell Glenn
- Department of Radiology and Imaging Science, Emory University School of Medicine, Atlanta, GA 30322
| | - Fang-Cheng Yeh
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213
| | - Harri Merisaari
- Department of Diagnostic Radiology, University of Turku, Turku, Finland 20014
| | - Chunyu Song
- Department of Biomedical Engineering, Washington University, St. Louis, MO 63130
| | - Ruimeng Yang
- Department of Radiology, Guangzhou First People’s Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong 510180, China
| | - Guo-Shu Huang
- Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan 114
| | - Hung-Wen Kao
- Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan 114
| | | | - Yu-Chien Wu
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN 46202
| | - Jens H. Jensen
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC 29425
- Department of Neuroscience, Medical University of South Carolina, Charleston, SC 29425
- Center for Biomedical Imaging, Medical University of South Carolina, Charleston, SC 29425
| | - Sheng-Kwei Song
- Department of Radiology, Washington University School of Medicine, St. Louis, MO 63110
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19
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Ye Z, Price RL, Liu X, Lin J, Yang Q, Sun P, Wu AT, Wang L, Han RH, Song C, Yang R, Gary SE, Mao DD, Wallendorf M, Campian JL, Li JS, Dahiya S, Kim AH, Song SK. Diffusion Histology Imaging Combining Diffusion Basis Spectrum Imaging (DBSI) and Machine Learning Improves Detection and Classification of Glioblastoma Pathology. Clin Cancer Res 2020; 26:5388-5399. [PMID: 32694155 DOI: 10.1158/1078-0432.ccr-20-0736] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 06/01/2020] [Accepted: 07/15/2020] [Indexed: 01/10/2023]
Abstract
PURPOSE Glioblastoma (GBM) is one of the deadliest cancers with no cure. While conventional MRI has been widely adopted to examine GBM clinically, accurate neuroimaging assessment of tumor histopathology for improved diagnosis, surgical planning, and treatment evaluation remains an unmet need in the clinical management of GBMs. EXPERIMENTAL DESIGN We employ a novel diffusion histology imaging (DHI) approach, combining diffusion basis spectrum imaging (DBSI) and machine learning, to detect, differentiate, and quantify areas of high cellularity, tumor necrosis, and tumor infiltration in GBM. RESULTS Gadolinium-enhanced T1-weighted or hyperintense fluid-attenuated inversion recovery failed to reflect the morphologic complexity underlying tumor in patients with GBM. Contrary to the conventional wisdom that apparent diffusion coefficient (ADC) negatively correlates with increased tumor cellularity, we demonstrate disagreement between ADC and histologically confirmed tumor cellularity in GBM specimens, whereas DBSI-derived restricted isotropic diffusion fraction positively correlated with tumor cellularity in the same specimens. By incorporating DBSI metrics as classifiers for a supervised machine learning algorithm, we accurately predicted high tumor cellularity, tumor necrosis, and tumor infiltration with 87.5%, 89.0%, and 93.4% accuracy, respectively. CONCLUSIONS Our results suggest that DHI could serve as a favorable alternative to current neuroimaging techniques in guiding biopsy or surgery as well as monitoring therapeutic response in the treatment of GBM.
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Affiliation(s)
- Zezhong Ye
- Department of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Richard L Price
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Xiran Liu
- Department of Electrical & System Engineering, Washington University, St. Louis, Missouri
| | - Joshua Lin
- Department of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Qingsong Yang
- Department of Radiology, Changhai Hospital, Yangpu District, Shanghai, China
| | - Peng Sun
- Department of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Anthony T Wu
- Department of Biomedical Engineering, Washington University, St. Louis, Missouri
| | - Liang Wang
- Department of Electrical & System Engineering, Washington University, St. Louis, Missouri
| | - Rowland H Han
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Chunyu Song
- Department of Biomedical Engineering, Washington University, St. Louis, Missouri
| | - Ruimeng Yang
- Department of Radiology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, China
| | - Sam E Gary
- Medical Scientist Training Program, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Diane D Mao
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Michael Wallendorf
- Department of Biostatistics, Washington University School of Medicine, St. Louis, Missouri
| | - Jian L Campian
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Jr-Shin Li
- Department of Electrical & System Engineering, Washington University, St. Louis, Missouri
| | - Sonika Dahiya
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri.
| | - Albert H Kim
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri.
| | - Sheng-Kwei Song
- Department of Radiology, Washington University School of Medicine, St. Louis, Missouri
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20
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Ye Z, George A, Wu AT, Niu X, Lin J, Adusumilli G, Naismith RT, Cross AH, Sun P, Song SK. Deep learning with diffusion basis spectrum imaging for classification of multiple sclerosis lesions. Ann Clin Transl Neurol 2020; 7:695-706. [PMID: 32304291 PMCID: PMC7261762 DOI: 10.1002/acn3.51037] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 02/24/2020] [Accepted: 03/13/2020] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE Multiple sclerosis (MS) lesions are heterogeneous with regard to inflammation, demyelination, axonal injury, and neuronal loss. We previously developed a diffusion basis spectrum imaging (DBSI) technique to better address MS lesion heterogeneity. We hypothesized that the profiles of multiple DBSI metrics can identify lesion-defining patterns. Here we test this hypothesis by combining a deep learning algorithm using deep neural network (DNN) with DBSI and other imaging methods. METHODS Thirty-eight MS patients were scanned with diffusion-weighted imaging, magnetization transfer imaging, and standard conventional MRI sequences (cMRI). A total of 499 regions of interest were identified on standard MRI and labeled as persistent black holes (PBH), persistent gray holes (PGH), acute black holes (ABH), acute gray holes (AGH), nonblack or gray holes (NBH), and normal appearing white matter (NAWM). DBSI, diffusion tensor imaging (DTI), and magnetization transfer ratio (MTR) were applied to the 43,261 imaging voxels extracted from these ROIs. The optimized DNN with 10 fully connected hidden layers was trained using the imaging metrics of the lesion subtypes and NAWM. RESULTS Concordance, sensitivity, specificity, and accuracy were determined for the different imaging methods. DBSI-DNN derived lesion classification achieved 93.4% overall concordance with predetermined lesion types, compared with 80.2% for DTI-DNN model, 78.3% for MTR-DNN model, and 74.2% for cMRI-DNN model. DBSI-DNN also produced the highest specificity, sensitivity, and accuracy. CONCLUSIONS DBSI-DNN improves the classification of different MS lesion subtypes, which could aid clinical decision making. The efficacy and efficiency of DBSI-DNN shows great promise for clinical applications in automatic MS lesion detection and classification.
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Affiliation(s)
- Zezhong Ye
- Department of Radiology, Washington University School of Medicine, St. Louis, Missouri, 63110
| | - Ajit George
- Department of Radiology, Washington University School of Medicine, St. Louis, Missouri, 63110
| | - Anthony T Wu
- Department of Biomedical Engineering, Washington University, St. Louis, Missouri, 63130
| | - Xuan Niu
- Department of Radiology, Washington University School of Medicine, St. Louis, Missouri, 63110
| | - Joshua Lin
- Keck School of Medicine, University of Southern California, Los Angeles, California, 90033
| | - Gautam Adusumilli
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, 63110
| | - Robert T Naismith
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, 63110
| | - Anne H Cross
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, 63110
| | - Peng Sun
- Department of Radiology, Washington University School of Medicine, St. Louis, Missouri, 63110
| | - Sheng-Kwei Song
- Department of Radiology, Washington University School of Medicine, St. Louis, Missouri, 63110
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