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Zhang LJ, Tian DC, Yang L, Shi K, Liu Y, Wang Y, Shi FD. White matter disease derived from vascular and demyelinating origins. Stroke Vasc Neurol 2023:svn-2023-002791. [PMID: 37699727 DOI: 10.1136/svn-2023-002791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 08/21/2023] [Indexed: 09/14/2023] Open
Abstract
Damage or microstructural alterations of the white matter can cause dysfunction of the intrinsic neural networks in a condition termed as white matter disease (WMD). Frequently detected on brain computed tomography and magnetic resonance imaging scans, WMD is commonly presented in inflammatory demyelinating diseases like multiple sclerosis (MS) and vascular diseases such as cerebral small vessel disease (CSVD). Prevention of MS and CSVD progression requires early treatments with drastically different medications and approaches, as such, early and accurate diagnosis of WMD, derived from vascular or demyelinating etiologies, is of paramount importance. However, the clinical and imaging similarities between MS, especially during the early stage, and CSVD, pose a significant dilemma in differentiating these two conditions. In this review, we attempt to summarize and contrast the distinguishing features of MS and CSVD for aiding accurate diagnosis to ensure timely corresponding management in the early stages of MS and CSVD.
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Affiliation(s)
- Lin-Jie Zhang
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, Tianjin, China
| | - De-Cai Tian
- National Clinical Research Center for Neurological Diseases of China, Beijing Tiantan Hospital, Capital Medical University, Beijing, Beijing, China
| | - Li Yang
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, Tianjin, China
| | - Kaibin Shi
- National Clinical Research Center for Neurological Diseases of China, Beijing Tiantan Hospital, Capital Medical University, Beijing, Beijing, China
| | - Yaou Liu
- National Clinical Research Center for Neurological Diseases of China, Beijing Tiantan Hospital, Capital Medical University, Beijing, Beijing, China
| | - Yilong Wang
- National Clinical Research Center for Neurological Diseases of China, Beijing Tiantan Hospital, Capital Medical University, Beijing, Beijing, China
| | - Fu-Dong Shi
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, Tianjin, China
- National Clinical Research Center for Neurological Diseases of China, Beijing Tiantan Hospital, Capital Medical University, Beijing, Beijing, China
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Quantified hemodynamic parameters of the venous system in multiple sclerosis: A systematic review. Mult Scler Relat Disord 2022; 57:103477. [PMID: 34990911 DOI: 10.1016/j.msard.2021.103477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 12/07/2021] [Accepted: 12/26/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Multiple Sclerosis (MS) is a complex neurodegenerative condition that is influenced by a combination of genetic and environmental factors. Included in these factors is the venous system, however, the extent to which it influences the etiology of MS has yet to be fully characterised. The aim of this review is to critically summarize the literature available concerning the venous system in MS, primarily concerning specific data on the venous pressure and blood flow in this system. METHODS A systematic review was conducted with the application of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria. The advanced search functions of both the Scopus and PubMed databases were used to conduct the literature search, resulting in 136 unique articles initially identified. Applying relevant exclusion criteria, 22 of the studies were chosen for this review. RESULTS The selected studies were analysed for venous pressure and blood flow related findings, with 14 studies contributing data on the internal jugular vein (IJV) flow rate, 5 on blood flows of the intracranial venous sinuses, 2 on blood flow pulsatility and 6 supplying information relevant to the venous pressure (3 studies contributed to multiple areas). The general findings of the review included that the IJV flow was not significantly different between MS patients and controls, however, there were variances between stenotic (S) and non-stenotic (NS) MS patients. Due to the limited data in the other two areas defined in this review, further research is required to establish if any variances in MS are present. CONCLUSION It remains unclear if there are significant differences in many flow variables between MS patients and controls considered in this review. It would be advantageous if future work in this area focused on understanding the hemodynamics of this system, primarily concerning how the flow rate, venous pressure and vascular resistance are related, and any impact that these factors have on the etiology of MS.
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NO-HYPE: a novel hydrodynamic phantom for the evaluation of MRI flow measurements. Med Biol Eng Comput 2021; 59:1889-1899. [PMID: 34365590 PMCID: PMC8382656 DOI: 10.1007/s11517-021-02390-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 06/07/2021] [Indexed: 10/24/2022]
Abstract
Accurate and reproducible measurement of blood flow profile is very important in many clinical investigations for diagnosing cardiovascular disorders. Given that many factors could affect human circulation, and several parameters must be set to properly evaluate blood flows with phase-contrast techniques, we developed an MRI-compatible hydrodynamic phantom to simulate different physiological blood flows. The phantom included a programmable hydraulic pump connected to a series of pipes immersed in a solution mimicking human soft tissues, with a blood-mimicking fluid flowing in the pipes. The pump is able to shape and control the flow by driving a piston through a dedicated software. Periodic waveforms are used as input to the pump to move the fluid into the pipes, with synchronization of the MRI sequences to the flow waveforms. A dedicated software is used to extract and analyze flow data from magnitude and phase images. The match between the nominal and the measured flows was assessed, and the scope of phantom variables useful for a reliable calibration of an MRI system was accordingly defined. Results showed that the NO-HYPE phantom is a valuable tool for the assessment of MRI scanners and sequence design for the MR evaluation of blood flows. Overview of the NOvel HYdrodynamic Phantom for the Evaluation of MRI flow measurements (NO-HYPE). Left: internal of the CompuFlow 1000 MR pump unit. Right: Setting of the NO-HYPE before a MRI acquisition session. Soft tissue mimicking material is hosted in the central part of the phantom (light blue chamber). Glass pipes pass through the chamber carrying the blood mimicking fluid.
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RESUME N: A flexible class of multi-parameter qMRI protocols. Phys Med 2021; 88:23-36. [PMID: 34171573 DOI: 10.1016/j.ejmp.2021.04.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/16/2021] [Accepted: 04/02/2021] [Indexed: 12/30/2022] Open
Abstract
PURPOSE To introduce a class of fast 3D quantitative MRI (qMRI) schemes (RESUMEN, for N=1,…,4) that allow for a thorough characterization of microstructural properties of brain tissues. METHODS An arbitrary multi-echo GRE acquisition optimized for quantitative susceptibility mapping (QSM) is complemented with an appropriate low flip-angle GRE sequence drawn from four possible choices. The acquired signals are processed to analytically derive the longitudinal relaxation (R1) and free induction decay (R2∗) rates, as well as the proton density (PD) and QSM. A comprehensive modeling of the excitation and B1- profiles and of the RF-spoiling is included in the acquisition and processing pipeline. RESULTS The RESUMEN maps appear homogeneous throughout the field-of-view and exhibit comparable values and high SNR across the considered range of N values. CONCLUSIONS The introduced schemes represent a class of robust and flexible strategies to derive a thorough and fast qMRI study, suitable for a whole-brain acquisition with isotropic voxel resolution of 700 μm in less than 15 min.
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Schuchardt FF, Kaller CP, Strecker C, Lambeck J, Wehrum T, Hennemuth A, Anastasopoulos C, Mader I, Harloff A. Hemodynamics of cerebral veins analyzed by 2d and 4d flow mri and ultrasound in healthy volunteers and patients with multiple sclerosis. J Magn Reson Imaging 2019; 51:205-217. [PMID: 31102341 DOI: 10.1002/jmri.26782] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 04/25/2019] [Accepted: 04/25/2019] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Hemodynamic alterations of extracranial veins are considered an etiologic factor in multiple sclerosis (MS). However, ultrasound and MRI studies could not confirm a pathophysiological link. Because of technical challenges using standard diagnostics, information about the involvement of superficial intracranial veins in proximity to the affected brain in MS is scarce. PURPOSE To comprehensively investigate the hemodynamics of intracranial veins and of the venous outflow tract in MS patients and controls. STUDY TYPE Prospective. POPULATION Twenty-eight patients with relapsing-remitting MS (EDSS1.9 ± 1.1; range 0-3) and 41 healthy controls. FIELD STRENGTH/SEQUENCE 3T/2D phase-contrast and time-resolved 4D flow MRI, extra- and transcranial sonography. ASSESSMENT Hemodynamics within the superficial and deep intracranial venous system and outflow tract including the internal, basal, and great cerebral vein, straight, superior sagittal, and transverse sinuses, internal jugular and vertebral veins. Sonography adhered to the chronic cerebrospinal venous insufficiency (CCSVI) criteria. STATISTICAL TESTS Multivariate repeated measure analysis of variance, Student's two-sample t-test, chi-square, Fisher's exact test; separate analysis of the entire cohort and 32 age- and sex-matched participants. RESULTS Multi- and univariate main effects of the factor group (MS patient vs. control) and its interactions with the factor vessel position (lower flow within dorsal superior sagittal sinus in MS, 3 ± 1 ml/s vs. 3.8 ± 1 ml/s; P < 0.05) in the uncontrolled cohort were attributable to age-related differences. Age- and sex-matched pairs showed a different velocity gradient in a single segment within the deep cerebral veins (great cerebral vein, vena cerebri magna [VCM] 7.6 ± 1.7 cm/s; straight sinus [StS] 10.5 ± 2.2 cm/s vs. volunteers: VCM 9.2 ± 2.3 cm/s; StS 10.2 ± 2.3 cm/s; P = 0.01), reaching comparable velocities instantaneously downstream. Sonography was not statistically different between groups. DATA CONCLUSION Consistent with previous studies focusing on extracranial hemodynamics, our comprehensive analysis of intracerebral venous blood flow did not reveal relevant differences between MS patients and controls. Level of Evidence 1. Technical Efficacy Stage 3. J. Magn. Reson. Imaging 2020;51:205-217.
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Affiliation(s)
- Florian F Schuchardt
- Faculty of Medicine, University of Freiburg, Germany.,Department of Neurology and Neurophysiology, Medical Center, University of Freiburg, Germany
| | - Christoph P Kaller
- Faculty of Medicine, University of Freiburg, Germany.,Department of Neurology and Neurophysiology, Medical Center, University of Freiburg, Germany.,Department of Neuroradiology, Medical Center, University of Freiburg, Germany
| | - Christoph Strecker
- Faculty of Medicine, University of Freiburg, Germany.,Department of Neurology and Neurophysiology, Medical Center, University of Freiburg, Germany
| | - Johann Lambeck
- Faculty of Medicine, University of Freiburg, Germany.,Department of Neurology and Neurophysiology, Medical Center, University of Freiburg, Germany
| | - Thomas Wehrum
- Faculty of Medicine, University of Freiburg, Germany.,Department of Neurology and Neurophysiology, Medical Center, University of Freiburg, Germany
| | - Anja Hennemuth
- Fraunhofer Institute for Medical Image Computing MEVIS, Berlin, Germany.,Institute for Cardiovascular Computer-assisted Medicine, Charité, Universitätsmedizin Berlin, Campus Virchow-Klinikum, Germany
| | - Constantinos Anastasopoulos
- Faculty of Medicine, University of Freiburg, Germany.,Department of Neuroradiology, Medical Center, University of Freiburg, Germany.,Department of Radiology, University of Basel, Basel, Switzerland
| | - Irina Mader
- Faculty of Medicine, University of Freiburg, Germany.,Department of Neuroradiology, Medical Center, University of Freiburg, Germany.,Department of Radiology, Schön-Klinik, Vogtareuth, Germany
| | - Andreas Harloff
- Faculty of Medicine, University of Freiburg, Germany.,Department of Neurology and Neurophysiology, Medical Center, University of Freiburg, Germany
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Pontillo G, Cocozza S, Lanzillo R, Russo C, Stasi MD, Paolella C, Vola EA, Criscuolo C, Borrelli P, Palma G, Tedeschi E, Morra VB, Elefante A, Brunetti A. Determinants of Deep Gray Matter Atrophy in Multiple Sclerosis: A Multimodal MRI Study. AJNR Am J Neuroradiol 2018; 40:99-106. [PMID: 30573464 DOI: 10.3174/ajnr.a5915] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 10/29/2018] [Indexed: 01/30/2023]
Abstract
BACKGROUND AND PURPOSE Deep gray matter involvement is a consistent feature in multiple sclerosis. The aim of this study was to evaluate the relationship between different deep gray matter alterations and the development of subcortical atrophy, as well as to investigate the possible different substrates of volume loss between phenotypes. MATERIALS AND METHODS Seventy-seven patients with MS (52 with relapsing-remitting and 25 with progressive MS) and 41 healthy controls were enrolled in this cross-sectional study. MR imaging investigation included volumetric, DTI, PWI and Quantitative Susceptibility Mapping analyses. Deep gray matter structures were automatically segmented to obtain volumes and mean values for each MR imaging metric in the thalamus, caudate, putamen, and globus pallidus. Between-group differences were probed by ANCOVA analyses, while the contribution of different MR imaging metrics to deep gray matter atrophy was investigated via hierarchic multiple linear regression models. RESULTS Patients with MS showed a multifaceted involvement of the thalamus and basal ganglia, with significant atrophy of all deep gray matter structures (P < .001). In the relapsing-remitting MS group, WM lesion burden proved to be the main contributor to volume loss for all deep gray matter structures (P ≤ .006), with a minor role of local microstructural damage, which, in turn, was the main determinant of deep gray matter atrophy in patients with progressive MS (P ≤ .01), coupled with thalamic susceptibility changes (P = .05). CONCLUSIONS Our study confirms the diffuse involvement of deep gray matter in MS, demonstrating a different behavior between MS phenotypes, with subcortical GM atrophy mainly determined by global WM lesion burden in patients with relapsing-remitting MS, while local microstructural damage and susceptibility changes mainly accounted for the development of deep gray matter volume loss in patients with progressive MS.
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Affiliation(s)
- G Pontillo
- From the Departments of Advanced Biomedical Sciences (G.P., S.C., C.R., M.D.S., C.P., E.A.V., E.T., A.E., A.B.).,Institute of Biostructure and Bioimaging (G.P.), National Research Council, Naples, Italy
| | - S Cocozza
- From the Departments of Advanced Biomedical Sciences (G.P., S.C., C.R., M.D.S., C.P., E.A.V., E.T., A.E., A.B.)
| | - R Lanzillo
- Neurosciences and Reproductive and Odontostomatological Sciences (R.L., C.C., V.B.M.), University of Naples "Federico II", Naples, Italy
| | - C Russo
- From the Departments of Advanced Biomedical Sciences (G.P., S.C., C.R., M.D.S., C.P., E.A.V., E.T., A.E., A.B.)
| | - M D Stasi
- From the Departments of Advanced Biomedical Sciences (G.P., S.C., C.R., M.D.S., C.P., E.A.V., E.T., A.E., A.B.)
| | - C Paolella
- From the Departments of Advanced Biomedical Sciences (G.P., S.C., C.R., M.D.S., C.P., E.A.V., E.T., A.E., A.B.)
| | - E A Vola
- From the Departments of Advanced Biomedical Sciences (G.P., S.C., C.R., M.D.S., C.P., E.A.V., E.T., A.E., A.B.)
| | - C Criscuolo
- Neurosciences and Reproductive and Odontostomatological Sciences (R.L., C.C., V.B.M.), University of Naples "Federico II", Naples, Italy
| | | | - G Palma
- From the Departments of Advanced Biomedical Sciences (G.P., S.C., C.R., M.D.S., C.P., E.A.V., E.T., A.E., A.B.)
| | - E Tedeschi
- From the Departments of Advanced Biomedical Sciences (G.P., S.C., C.R., M.D.S., C.P., E.A.V., E.T., A.E., A.B.)
| | - V B Morra
- Neurosciences and Reproductive and Odontostomatological Sciences (R.L., C.C., V.B.M.), University of Naples "Federico II", Naples, Italy
| | - A Elefante
- From the Departments of Advanced Biomedical Sciences (G.P., S.C., C.R., M.D.S., C.P., E.A.V., E.T., A.E., A.B.)
| | - A Brunetti
- From the Departments of Advanced Biomedical Sciences (G.P., S.C., C.R., M.D.S., C.P., E.A.V., E.T., A.E., A.B.)
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Pelizzari L, Jakimovski D, Laganà MM, Bergsland N, Hagemeier J, Baselli G, Weinstock-Guttman B, Zivadinov R. Five-Year Longitudinal Study of Neck Vessel Cross-Sectional Area in Multiple Sclerosis. AJNR Am J Neuroradiol 2018; 39:1703-1709. [PMID: 30049718 DOI: 10.3174/ajnr.a5738] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 06/06/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND PURPOSE Alterations of neck vessel cross-sectional area in multiple sclerosis have been reported. Our aim was to investigate the evolution of the neck vessel cross-sectional area in patients with MS and healthy controls during 5 years. MATERIALS AND METHODS Sixty-nine patients with MS (44 relapsing-remitting MS, 25 progressive MS) and 22 age- and sex-matched healthy controls were examined twice, 5 years apart, on a 3T MR imaging scanner using 2D neck MR angiography. Cross-sectional areas were computed for the common carotid/internal carotid arteries, vertebral arteries, and internal jugular veins for all slices between the C3 and C7 cervical levels. Longitudinal cross-sectional area differences at each cervical level and the whole-vessel course were tested within study groups and between patients with MS with and without cardiovascular disease using mixed-model analysis and the related-samples Wilcoxon singed rank test. The Benjamini-Hochberg procedure was performed to correct for multiple comparisons. RESULTS No significant cross-sectional area differences were seen between patients with MS and healthy controls at baseline or at follow-up. During the follow-up, significant cross-sectional area decrease was found in patients with MS for the common carotid artery-ICAs (C4: P = .048; C7: P = .005; whole vessel: P = .012), for vertebral arteries (C3: P = .028; C4: P = .028; C7: P = .028; whole vessel: P = .012), and for the internal jugular veins (C3: P = .014; C4: P = .008; C5: P = .010; C6: P = .010; C7: P = .008; whole vessel: P = .002). Patients with MS without cardiovascular disease had significantly greater change than patients with MS with cardiovascular disease for internal jugular veins at all levels. CONCLUSIONS For 5 years, patients with MS showed significant cross-sectional area decrease of all major neck vessels, regardless of the disease course and cardiovascular status.
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Affiliation(s)
- L Pelizzari
- From the Department of Electronics Information and Bioengineering (L.P., G.B.), Politecnico di Milano, Milan, Italy.,Istituto di Ricovero e Cura a Carattere Scientifico (L.P., M.M.L.), Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | - D Jakimovski
- Buffalo Neuroimaging Analysis Center (D.J., N.B., J.H., R.Z.), Department of Neurology, Jacobs School of Medicine and Biomedical Sciences
| | - M M Laganà
- Istituto di Ricovero e Cura a Carattere Scientifico (L.P., M.M.L.), Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | - N Bergsland
- Buffalo Neuroimaging Analysis Center (D.J., N.B., J.H., R.Z.), Department of Neurology, Jacobs School of Medicine and Biomedical Sciences
| | - J Hagemeier
- Buffalo Neuroimaging Analysis Center (D.J., N.B., J.H., R.Z.), Department of Neurology, Jacobs School of Medicine and Biomedical Sciences
| | - G Baselli
- From the Department of Electronics Information and Bioengineering (L.P., G.B.), Politecnico di Milano, Milan, Italy
| | - B Weinstock-Guttman
- Jacobs Multiple Sclerosis Center (B.W.-G.), Department of Neurology, School of Medicine and Biomedical Sciences
| | - R Zivadinov
- Buffalo Neuroimaging Analysis Center (D.J., N.B., J.H., R.Z.), Department of Neurology, Jacobs School of Medicine and Biomedical Sciences .,Center for Biomedical Imaging at Clinical Translational Science Institute (R.Z.), University at Buffalo, State University of New York, Buffalo, New York
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