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Routine Gadolinium Use for MRI Follow-up of Multiple Sclerosis: Counterpoint-Gadolinium Should Not Always Be Used to Assess Disease Activity. AJR Am J Roentgenol 2021; 219:26-27. [PMID: 34786958 DOI: 10.2214/ajr.21.27069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Bagnato F. Gadolinium should always be used to assess disease activity in MS – Commentary. Mult Scler 2020; 26:769-770. [DOI: 10.1177/1352458520923976] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Francesca Bagnato
- Neuroimaging Unit, Neuroimmunology Division, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA/Department of Neurology, Nashville VA Medical Center, Tennessee Valley Healthcare System, Nashville, TN, USA
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Kamintsky L, Cairns KA, Veksler R, Bowen C, Beyea SD, Friedman A, Calkin C. Blood-brain barrier imaging as a potential biomarker for bipolar disorder progression. Neuroimage Clin 2019; 26:102049. [PMID: 31718955 PMCID: PMC7229352 DOI: 10.1016/j.nicl.2019.102049] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 09/05/2019] [Accepted: 10/21/2019] [Indexed: 11/29/2022]
Abstract
Bipolar disorder affects approximately 2% of the population and is typically characterized by recurrent episodes of mania and depression. While some patients achieve remission using mood-stabilizing treatments, a significant proportion of patients show progressive changes in symptomatology over time. Bipolar progression is diverse in nature and may include a treatment-resistant increase in the frequency and severity of episodes, worse psychiatric and functional outcomes, and a greater risk of suicide. The mechanisms underlying bipolar disorder progression remain poorly understood and there are currently no biomarkers for identifying patients at risk. The objective of this study was to explore the potential of blood-brain barrier (BBB) imaging as such a biomarker, by acquiring the first imaging data of BBB leakage in bipolar patients, and evaluating the potential association between BBB dysfunction and bipolar symptoms. To this end, a cohort of 36 bipolar patients was recruited through the Mood Disorders Clinic (Nova Scotia Health Authority, Canada). All patients, along with 14 control subjects (matched for sex, age and metabolic status), underwent contrast-enhanced dynamic MRI scanning for quantitative assessment of BBB leakage as well as clinical and psychiatric evaluations. Outlier analysis has identified a group of 10 subjects with significantly higher percentages of brain volume with BBB leakage (labeled the "extensive BBB leakage" group). This group consisted exclusively of bipolar patients, while the "normal BBB leakage" group included the entire control cohort and the remaining 26 bipolar subjects. Among the bipolar cohort, patients with extensive BBB leakage were found to have more severe depression and anxiety, and a more chronic course of illness. Furthermore, all bipolar patients within this group were also found to have co-morbid insulin resistance, suggesting that insulin resistance may increase the risk of BBB dysfunction in bipolar patients. Our findings demonstrate a clear link between BBB leakage and greater psychiatric morbidity in bipolar patients and highlight the potential of BBB imaging as a mechanism-based biomarker for bipolar disorder progression.
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Affiliation(s)
- Lyna Kamintsky
- Department of Medical Neuroscience, Dalhousie University, Sir Charles Tupper Building, 5850 College Street, Halifax, NS, B3H 4R2, Canada
| | - Kathleen A Cairns
- Nova Scotia Health Authority, Mood Disorders Clinic, 5909 Veterans Memorial Lane, Halifax, NS, B3H 2E2, Canada
| | - Ronel Veksler
- Department of Physiology and Cell Biology, Medicine, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Chris Bowen
- Biomedical Translational Imaging Centre (BIOTIC), QEII Health Sciences Centre, and Department of Diagnostic Radiology, Dalhousie University, 1796 Summer Street, Halifax, NS, B3H 3A7, Canada
| | - Steven D Beyea
- Biomedical Translational Imaging Centre (BIOTIC), QEII Health Sciences Centre, and Department of Diagnostic Radiology, Dalhousie University, 1796 Summer Street, Halifax, NS, B3H 3A7, Canada
| | - Alon Friedman
- Department of Medical Neuroscience, Dalhousie University, Sir Charles Tupper Building, 5850 College Street, Halifax, NS, B3H 4R2, Canada; Department of Physiology and Cell Biology, Medicine, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | - Cynthia Calkin
- Departments of Psychiatry and Medical Neuroscience, Dalhousie University, Mood Disorders Clinic, 5909 Veterans Memorial Lane, Halifax, NS, B3H 2E2, Canada
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