1
|
Kampaite A, Gustafsson R, York EN, Foley P, MacDougall NJJ, Bastin ME, Chandran S, Waldman AD, Meijboom R. Brain connectivity changes underlying depression and fatigue in relapsing-remitting multiple sclerosis: A systematic review. PLoS One 2024; 19:e0299634. [PMID: 38551913 PMCID: PMC10980255 DOI: 10.1371/journal.pone.0299634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 02/13/2024] [Indexed: 04/01/2024] Open
Abstract
Multiple Sclerosis (MS) is an autoimmune disease affecting the central nervous system, characterised by neuroinflammation and neurodegeneration. Fatigue and depression are common, debilitating, and intertwined symptoms in people with relapsing-remitting MS (pwRRMS). An increased understanding of brain changes and mechanisms underlying fatigue and depression in RRMS could lead to more effective interventions and enhancement of quality of life. To elucidate the relationship between depression and fatigue and brain connectivity in pwRRMS we conducted a systematic review. Searched databases were PubMed, Web-of-Science and Scopus. Inclusion criteria were: studied participants with RRMS (n ≥ 20; ≥ 18 years old) and differentiated between MS subtypes; published between 2001-01-01 and 2023-01-18; used fatigue and depression assessments validated for MS; included brain structural, functional magnetic resonance imaging (fMRI) or diffusion MRI (dMRI). Sixty studies met the criteria: 18 dMRI (15 fatigue, 5 depression) and 22 fMRI (20 fatigue, 5 depression) studies. The literature was heterogeneous; half of studies reported no correlation between brain connectivity measures and fatigue or depression. Positive findings showed that abnormal cortico-limbic structural and functional connectivity was associated with depression. Fatigue was linked to connectivity measures in cortico-thalamic-basal-ganglial networks. Additionally, both depression and fatigue were related to altered cingulum structural connectivity, and functional connectivity involving thalamus, cerebellum, frontal lobe, ventral tegmental area, striatum, default mode and attention networks, and supramarginal, precentral, and postcentral gyri. Qualitative analysis suggests structural and functional connectivity changes, possibly due to axonal and/or myelin loss, in the cortico-thalamic-basal-ganglial and cortico-limbic network may underlie fatigue and depression in pwRRMS, respectively, but the overall results were inconclusive, possibly explained by heterogeneity and limited number of studies. This highlights the need for further studies including advanced MRI to detect more subtle brain changes in association with depression and fatigue. Future studies using optimised imaging protocols and validated depression and fatigue measures are required to clarify the substrates underlying these symptoms in pwRRMS.
Collapse
Affiliation(s)
- Agniete Kampaite
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
- Edinburgh Imaging, Edinburgh Imaging Facility, University of Edinburgh, Edinburgh, United Kingdom
| | - Rebecka Gustafsson
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Elizabeth N. York
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
- Edinburgh Imaging, Edinburgh Imaging Facility, University of Edinburgh, Edinburgh, United Kingdom
- Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, Edinburgh, United Kingdom
| | - Peter Foley
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
- Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, Edinburgh, United Kingdom
| | - Niall J. J. MacDougall
- Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, Edinburgh, United Kingdom
- Department of Neurology, Institute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Mark E. Bastin
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
- Edinburgh Imaging, Edinburgh Imaging Facility, University of Edinburgh, Edinburgh, United Kingdom
| | - Siddharthan Chandran
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
- Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, Edinburgh, United Kingdom
- UK Dementia Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Adam D. Waldman
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
- Edinburgh Imaging, Edinburgh Imaging Facility, University of Edinburgh, Edinburgh, United Kingdom
| | - Rozanna Meijboom
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
- Edinburgh Imaging, Edinburgh Imaging Facility, University of Edinburgh, Edinburgh, United Kingdom
| |
Collapse
|
2
|
Harper JG, York EN, Meijboom R, Kampaite A, Thrippleton MJ, Kearns PKA, Valdés Hernández MDC, Chandran S, Waldman AD. Quantitative T 1 brain mapping in early relapsing-remitting multiple sclerosis: longitudinal changes, lesion heterogeneity and disability. Eur Radiol 2023:10.1007/s00330-023-10351-6. [PMID: 37943312 DOI: 10.1007/s00330-023-10351-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 07/20/2023] [Accepted: 08/29/2023] [Indexed: 11/10/2023]
Abstract
OBJECTIVES To quantify brain microstructural changes in recently diagnosed relapsing-remitting multiple sclerosis (RRMS) using longitudinal T1 measures, and determine their associations with clinical disability. METHODS Seventy-nine people with recently diagnosed (< 6 months) RRMS were recruited from a single-centre cohort sub-study, and underwent baseline and 1-year brain MRI, including variable flip angle T1 mapping. Median T1 was measured in white matter lesions (WML), normal-appearing white matter (NAWM), cortical/deep grey matter (GM), thalami, basal ganglia and medial temporal regions. Prolonged T1 (≥ 2.00 s) and supramedian T1 (relative to cohort WML values) WML voxel counts were also measured. Longitudinal change was assessed with paired t-tests and compared with Bland-Altman limits of agreement from healthy control test-retest data. Regression analyses determined relationships with Expanded Disability Status Scale (EDSS) score and dichotomised EDSS outcomes (worsening or stable/improving). RESULTS Sixty-two people with RRMS (mean age 37.2 ± 10.9 [standard deviation], 48 female) and 11 healthy controls (age 44 ± 11, 7 female) contributed data. Prolonged and supramedian T1 WML components increased longitudinally (176 and 463 voxels, respectively; p < .001), and were associated with EDSS score at baseline (p < .05) and follow-up (supramedian: p < .01; prolonged: p < .05). No cohort-wide median T1 changes were found; however, increasing T1 in WML, NAWM, cortical/deep GM, basal ganglia and thalami was positively associated with EDSS worsening (p < .05). CONCLUSION T1 is sensitive to brain microstructure changes in early RRMS. Prolonged WML T1 components and subtle changes in NAWM and GM structures are associated with disability. CLINICAL RELEVANCE STATEMENT MRI T1 brain mapping quantifies disability-associated white matter lesion heterogeneity and subtle microstructural damage in normal-appearing brain parenchyma in recently diagnosed RRMS, and shows promise for early objective disease characterisation and stratification. KEY POINTS • Quantitative T1 mapping detects brain microstructural damage and lesion heterogeneity in recently diagnosed relapsing-remitting multiple sclerosis. • T1 increases in lesions and normal-appearing parenchyma, indicating microstructural damage, are associated with worsening disability. • Brain T1 measures are objective markers of disability-relevant pathology in early multiple sclerosis.
Collapse
Affiliation(s)
- James G Harper
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh BioQuarter: Chancellors Building, Edinburgh, EH16 4SB, UK
| | - Elizabeth N York
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh BioQuarter: Chancellors Building, Edinburgh, EH16 4SB, UK.
- Edinburgh Imaging, University of Edinburgh, Edinburgh, UK.
- Anne Rowling Regenerative Neurology Clinic, Edinburgh, UK.
| | - Rozanna Meijboom
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh BioQuarter: Chancellors Building, Edinburgh, EH16 4SB, UK
- Edinburgh Imaging, University of Edinburgh, Edinburgh, UK
| | - Agniete Kampaite
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh BioQuarter: Chancellors Building, Edinburgh, EH16 4SB, UK
- Edinburgh Imaging, University of Edinburgh, Edinburgh, UK
| | - Michael J Thrippleton
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh BioQuarter: Chancellors Building, Edinburgh, EH16 4SB, UK
- Edinburgh Imaging, University of Edinburgh, Edinburgh, UK
| | - Patrick K A Kearns
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh BioQuarter: Chancellors Building, Edinburgh, EH16 4SB, UK
- Anne Rowling Regenerative Neurology Clinic, Edinburgh, UK
| | - Maria Del C Valdés Hernández
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh BioQuarter: Chancellors Building, Edinburgh, EH16 4SB, UK
- Edinburgh Imaging, University of Edinburgh, Edinburgh, UK
| | - Siddharthan Chandran
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh BioQuarter: Chancellors Building, Edinburgh, EH16 4SB, UK
- Anne Rowling Regenerative Neurology Clinic, Edinburgh, UK
- UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Adam D Waldman
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh BioQuarter: Chancellors Building, Edinburgh, EH16 4SB, UK.
- Edinburgh Imaging, University of Edinburgh, Edinburgh, UK.
| |
Collapse
|
3
|
Meijboom R, York EN, Kampaite A, Harris MA, White N, Valdés Hernández MDC, Thrippleton MJ, MacDougall NJJ, Connick P, Hunt DPJ, Chandran S, Waldman AD. Patterns of brain atrophy in recently-diagnosed relapsing-remitting multiple sclerosis. PLoS One 2023; 18:e0288967. [PMID: 37506096 PMCID: PMC10381059 DOI: 10.1371/journal.pone.0288967] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 07/07/2023] [Indexed: 07/30/2023] Open
Abstract
Recurrent neuroinflammation in relapsing-remitting MS (RRMS) is thought to lead to neurodegeneration, resulting in progressive disability. Repeated magnetic resonance imaging (MRI) of the brain provides non-invasive measures of atrophy over time, a key marker of neurodegeneration. This study investigates regional neurodegeneration of the brain in recently-diagnosed RRMS using volumetry and voxel-based morphometry (VBM). RRMS patients (N = 354) underwent 3T structural MRI <6 months after diagnosis and 1-year follow-up, as part of the Scottish multicentre 'FutureMS' study. MRI data were processed using FreeSurfer to derive volumetrics, and FSL for VBM (grey matter (GM) only), to establish regional patterns of change in GM and normal-appearing white matter (NAWM) over time throughout the brain. Volumetric analyses showed a decrease over time (q<0.05) in bilateral cortical GM and NAWM, cerebellar GM, brainstem, amygdala, basal ganglia, hippocampus, accumbens, thalamus and ventral diencephalon. Additionally, NAWM and GM volume decreased respectively in the following cortical regions, frontal: 14 out of 26 regions and 16/26; temporal: 18/18 and 15/18; parietal: 14/14 and 11/14; occipital: 7/8 and 8/8. Left GM and NAWM asymmetry was observed in the frontal lobe. GM VBM analysis showed three major clusters of decrease over time: 1) temporal and subcortical areas, 2) cerebellum, 3) anterior cingulum and supplementary motor cortex; and four smaller clusters within the occipital lobe. Widespread GM and NAWM atrophy was observed in this large recently-diagnosed RRMS cohort, particularly in the brainstem, cerebellar GM, and subcortical and occipital-temporal regions; indicative of neurodegeneration across tissue types, and in accord with limited previous studies in early disease. Volumetric and VBM results emphasise different features of longitudinal lobar and loco-regional change, however identify consistent atrophy patterns across individuals. Atrophy measures targeted to specific brain regions may provide improved markers of neurodegeneration, and potential future imaging stratifiers and endpoints for clinical decision making and therapeutic trials.
Collapse
Affiliation(s)
- Rozanna Meijboom
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
- Edinburgh Imaging, University of Edinburgh, Edinburgh, United Kingdom
| | - Elizabeth N York
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
- Edinburgh Imaging, University of Edinburgh, Edinburgh, United Kingdom
- Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, Edinburgh, United Kingdom
| | - Agniete Kampaite
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
- Edinburgh Imaging, University of Edinburgh, Edinburgh, United Kingdom
| | - Mathew A Harris
- Department of Psychology, University of Edinburgh, Edinburgh, United Kingdom
| | - Nicole White
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
- Edinburgh Imaging, University of Edinburgh, Edinburgh, United Kingdom
| | - Maria Del C Valdés Hernández
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
- Edinburgh Imaging, University of Edinburgh, Edinburgh, United Kingdom
| | - Michael J Thrippleton
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
- Edinburgh Imaging, University of Edinburgh, Edinburgh, United Kingdom
| | - N J J MacDougall
- Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, Edinburgh, United Kingdom
| | - Peter Connick
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
- Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, Edinburgh, United Kingdom
| | - David P J Hunt
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
- UK Dementia Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Siddharthan Chandran
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
- Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, Edinburgh, United Kingdom
| | - Adam D Waldman
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
- Edinburgh Imaging, University of Edinburgh, Edinburgh, United Kingdom
| |
Collapse
|
4
|
Chang YT, Kearns PKA, Carson A, Gillespie DC, Meijboom R, Kampaite A, Valdés Hernández MDC, Weaver C, Stenson A, MacDougall N, O'Riordan J, Macleod MA, Carod-Artal FJ, Connick P, Waldman AD, Chandran S, Foley P. Network analysis characterizes key associations between subjective fatigue and specific depressive symptoms in early relapsing-remitting multiple sclerosis. Mult Scler Relat Disord 2023; 69:104429. [PMID: 36493562 DOI: 10.1016/j.msard.2022.104429] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 10/26/2022] [Accepted: 11/22/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Fatigue is common and disabling in multiple sclerosis (MS), yet its mechanisms are poorly understood. In particular, overlap in measures of fatigue and depression complicates interpretation. We applied a multivariate network approach to quantify relationships between fatigue and other variables in early MS. METHODS Data were collected from patients with newly diagnosed immunotherapy-naïve relapsing-remitting MS at baseline and month 12 follow-up in FutureMS, a Scottish nationally representative cohort. Subjective fatigue was assessed by Fatigue Severity Scale. Detailed phenotyping included measures assessing each of physical disability, affective disorders, cognitive performance, sleep quality, and structural brain imaging. Network analysis was conducted to estimate partial correlations between variables. Baseline networks were compared between those with persistent and remitted fatigue at one-year follow up. RESULTS Data from 322 participants at baseline, and 323 at month 12, were included. At baseline, 154 patients (47.8%) reported clinically significant fatigue. In the network analysis, fatigue severity showed strongest connections with depression, followed by Expanded Disability Status Scale. Conversely, fatigue severity was not linked to objective cognitive performance or brain imaging variables. Even after controlling for measurement of "tiredness" in our measure of depression, four specific depressive symptoms remained linked to fatigue. Results were consistent at baseline and month 12. Overall network strength was not significantly different between groups with persistent and remitted fatigue (4.89 vs 2.90, p = 0.11). CONCLUSIONS Our findings support robust links between subjective fatigue and depression in early relapsing-remitting MS. Shared mechanisms between specific depressive symptoms and fatigue could be key targets of treatment and research in MS-related fatigue.
Collapse
Affiliation(s)
- Yuan-Ting Chang
- Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SB, UK; Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Patrick K A Kearns
- Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SB, UK; Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK; Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
| | - Alan Carson
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - David C Gillespie
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Rozanna Meijboom
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Agniete Kampaite
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | | | - Christine Weaver
- Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SB, UK; Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Amy Stenson
- Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SB, UK; Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | | | | | | | | | - Peter Connick
- Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SB, UK; Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Adam D Waldman
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Siddharthan Chandran
- Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SB, UK; Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.
| | - Peter Foley
- Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SB, UK; Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.
| |
Collapse
|
5
|
York EN, Meijboom R, Thrippleton MJ, Bastin ME, Kampaite A, White N, Chandran S, Waldman AD. Longitudinal microstructural MRI markers of demyelination and neurodegeneration in early relapsing-remitting multiple sclerosis: Magnetisation transfer, water diffusion and g-ratio. Neuroimage Clin 2022; 36:103228. [PMID: 36265199 PMCID: PMC9668599 DOI: 10.1016/j.nicl.2022.103228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 10/07/2022] [Accepted: 10/08/2022] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Quantitative microstructural MRI, such as myelin-sensitive magnetisation transfer ratio (MTR) or saturation (MTsat), axon-sensitive water diffusion Neurite Orientation Dispersion and Density Imaging (NODDI), and the aggregate g-ratio, may provide more specific markers of white matter integrity than conventional MRI for early patient stratification in relapsing-remitting multiple sclerosis (RRMS). The aim of this study was to determine the sensitivity of such markers to longitudinal pathological change within cerebral white matter lesions (WML) and normal-appearing white matter (NAWM) in recently diagnosed RRMS. METHODS Seventy-nine people with recently diagnosed RRMS, from the FutureMS longitudinal cohort, were recruited to an extended MRI protocol at baseline and one year later. Twelve healthy volunteers received the same MRI protocol, repeated within two weeks. Ethics approval and written informed consent were obtained. 3T MRI included magnetisation transfer, and multi-shell diffusion-weighted imaging. NAWM and whole brain were segmented from 3D T1-weighted MPRAGE, and WML from T2-weighted FLAIR. MTR, MTsat, NODDI isotropic (ISOVF) and intracellular (ICVF) volume fractions, and g-ratio (calculated from MTsat and NODDI data) were measured within WML and NAWM. Brain parenchymal fraction (BPF) was also calculated. Longitudinal change in BPF and microstructural metrics was assessed with paired t-tests (α = 0.05) and linear mixed models, adjusted for confounding factors with False Discovery Rate (FDR) correction for multiple comparisons. Longitudinal changes were compared with test-retest Bland-Altman limits of agreement from healthy control white matter. The influence of longitudinal change on g-ratio was explored through post-hoc analysis in silico by computing g-ratio with realistic simulated MTsat and NODDI values. RESULTS In NAWM, g-ratio and ICVF increased, and MTsat decreased over one year (adjusted mean difference = 0.007, 0.005, and -0.057 respectively, all FDR-corrected p < 0.05). There was no significant change in MTR, ISOVF, or BPF. In WML, MTsat, NODDI ICVF and ISOVF increased over time (adjusted mean difference = 0.083, 0.024 and 0.016, respectively, all FDR-corrected p < 0.05). Group-level longitudinal changes exceeded test-retest limits of agreement for NODDI ISOVF and ICVF in WML only. In silico analysis showed g-ratio may increase due to a decrease in MTsat or ISOVF, or an increase in ICVF. DISCUSSION G-ratio and MTsat changes in NAWM over one year may indicate subtle myelin loss in early RRMS, which were not apparent with BPF or NAWM MTR. Increases in NAWM and WML NODDI ICVF were not anticipated, and raise the possibility of axonal swelling or morphological change. Increases in WML MTsat may reflect myelin repair. Changes in NODDI ISOVF are more likely to reflect alterations in water content. Competing MTsat and ICVF changes may account for the absence of g-ratio change in WML. Longitudinal changes in microstructural measures are significant at a group level, however detection in individual patients in early RRMS is limited by technique reproducibility. CONCLUSION MTsat and g-ratio are more sensitive than MTR to early pathological changes in RRMS, but complex dependence of g-ratio on NODDI parameters limit the interpretation of aggregate measures in isolation. Improvements in technique reproducibility and validation of MRI biophysical models across a range of pathological tissue states are needed.
Collapse
Affiliation(s)
- Elizabeth N York
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom; Edinburgh Imaging, University of Edinburgh, Edinburgh, United Kingdom; Anne Rowling Regenerative Neurology Clinic, Edinburgh, United Kingdom.
| | - Rozanna Meijboom
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom; Edinburgh Imaging, University of Edinburgh, Edinburgh, United Kingdom
| | - Michael J Thrippleton
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom; Edinburgh Imaging, University of Edinburgh, Edinburgh, United Kingdom
| | - Mark E Bastin
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom; Edinburgh Imaging, University of Edinburgh, Edinburgh, United Kingdom
| | - Agniete Kampaite
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom; Edinburgh Imaging, University of Edinburgh, Edinburgh, United Kingdom
| | - Nicole White
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom; Edinburgh Imaging, University of Edinburgh, Edinburgh, United Kingdom
| | - Siddharthan Chandran
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom; Anne Rowling Regenerative Neurology Clinic, Edinburgh, United Kingdom; UK Dementia Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Adam D Waldman
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom; Edinburgh Imaging, University of Edinburgh, Edinburgh, United Kingdom.
| |
Collapse
|
6
|
Watts C, Savage J, Patel A, Mant R, Wykes V, Pohl U, Bulbeck H, Apps J, Sharpe R, Thompson G, Waldman AD, Ansorge O, Billingham L. Protocol for the Tessa Jowell BRAIN MATRIX Platform Study. BMJ Open 2022; 12:e067123. [PMID: 36378622 PMCID: PMC9462095 DOI: 10.1136/bmjopen-2022-067123] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 08/22/2022] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Gliomas are the most common primary tumour of the central nervous system (CNS), with an estimated annual incidence of 6.6 per 100 000 individuals in the USA and around 14 deaths per day from brain tumours in the UK. The genomic and biological landscape of brain tumours has been increasingly defined and, since 2016, the WHO classification of tumours of the CNS incorporates molecular data, along with morphology, to define tumour subtypes more accurately. The Tessa Jowell BRAIN MATRIX Platform (TJBM) study aims to create a transformative clinical research infrastructure that leverages UK National Health Service resources to support research that is patient centric and attractive to both academic and commercial investors. METHODS AND ANALYSIS The TJBM study is a programme of work with the principal purpose to improve the knowledge of glioma and treatment for patients with glioma. The programme includes a platform study and subsequent interventional clinical trials (as separate protocols). The platform study described here is the backbone data-repository of disease, treatment and outcome data from clinical, imaging and pathology data being collected in patients with glioma from secondary care hospitals. The primary outcome measure of the platform is time from biopsy to integrated histological-molecular diagnosis using whole-genome sequencing and epigenomic classification. Secondary outcome measures include those that are process centred, patient centred and framework based. Target recruitment for the study is 1000 patients with interim analyses at 100 and 500 patients. ETHICS AND DISSEMINATION The study will be performed in accordance with the recommendations guiding physicians in biomedical research involving human subjects, adopted by the 18th World Medical Association General Assembly, Helsinki, Finland and stated in the respective participating countries' laws governing human research, and Good Clinical Practice. The protocol was initially approved on 18 February 2020 by West Midlands - Edgbaston Research Ethics Committee; the current protocol (v3.0) was approved on 15 June 2022. Participants will be required to provide written informed consent. A meeting will be held after the end of the study to allow discussion of the main results among the collaborators prior to publication. The results of this study will be disseminated through national and international presentations and peer-reviewed publications. Manuscripts will be prepared by the Study Management Group and authorship will be determined by mutual agreement. TRIAL REGISTRATION NUMBER NCT04274283, 18-Feb-2020; ISRCTN14218060, 03-Feb-2020.
Collapse
Affiliation(s)
- Colin Watts
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Neurosurgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Joshua Savage
- Cancer Research UK Clinical Trials Unit (CRCTU), University of Birmingham, Birmingham, UK
| | - Amit Patel
- Cancer Research UK Clinical Trials Unit (CRCTU), University of Birmingham, Birmingham, UK
| | - Rhys Mant
- Cancer Research UK Clinical Trials Unit (CRCTU), University of Birmingham, Birmingham, UK
| | - Victoria Wykes
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Neurosurgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Ute Pohl
- Pathology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - John Apps
- Cancer Research UK Clinical Trials Unit (CRCTU), University of Birmingham, Birmingham, UK
| | - Rowena Sharpe
- Cancer Research UK Clinical Trials Unit (CRCTU), University of Birmingham, Birmingham, UK
| | - Gerard Thompson
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Adam D Waldman
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Olaf Ansorge
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Lucinda Billingham
- Cancer Research UK Clinical Trials Unit (CRCTU), University of Birmingham, Birmingham, UK
| |
Collapse
|
7
|
Rudà R, Capper D, Waldman AD, Pallud J, Minniti G, Kaley TJ, Bouffet E, Tabatabai G, Aronica E, Jakola AS, Pfister SM, Schiff D, Lassman AB, Solomon DA, Soffietti R, Weller M, Preusser M, Idbaih A, Wen PY, van den Bent MJ. EANO - EURACAN - SNO Guidelines on circumscribed astrocytic gliomas, glioneuronal, and neuronal tumors. Neuro Oncol 2022; 24:2015-2034. [PMID: 35908833 PMCID: PMC9713532 DOI: 10.1093/neuonc/noac188] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
In the new WHO 2021 Classification of CNS Tumors the chapter "Circumscribed astrocytic gliomas, glioneuronal and neuronal tumors" encompasses several different rare tumor entities, which occur more frequently in children, adolescents, and young adults. The Task Force has reviewed the evidence of diagnostic and therapeutic interventions, which is low particularly for adult patients, and draw recommendations accordingly. Tumor diagnosis, based on WHO 2021, is primarily performed using conventional histological techniques; however, a molecular workup is important for differential diagnosis, in particular, DNA methylation profiling for the definitive classification of histologically unresolved cases. Molecular factors are increasing of prognostic and predictive importance. MRI finding are non-specific, but for some tumors are characteristic and suggestive. Gross total resection, when feasible, is the most important treatment in terms of prolonging survival and achieving long-term seizure control. Conformal radiotherapy should be considered in grade 3 and incompletely resected grade 2 tumors. In recurrent tumors reoperation and radiotherapy, including stereotactic radiotherapy, can be useful. Targeted therapies may be used in selected patients: BRAF and MEK inhibitors in pilocytic astrocytomas, pleomorphic xanthoastrocytomas, and gangliogliomas when BRAF altered, and mTOR inhibitor everolimus in subependymal giant cells astrocytomas. Sequencing to identify molecular targets is advocated for diagnostic clarification and to direct potential targeted therapies.
Collapse
Affiliation(s)
- Roberta Rudà
- Corresponding Author: Roberta Rudà, Department of Neurology, Castelfranco Veneto/Treviso Hospital and Division of Neuro-Oncology, Department of Neuroscience, University of Turin, Turin, Italy ()
| | - David Capper
- Department of Neuropathology, Charité Universitätsmedizin Berlin, Berlin and German Cancer Consortium (DKTK), Partner Site Berlin, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Adam D Waldman
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh and Department of Brain Science, Imperial College London, United Kingdom
| | - Johan Pallud
- Department of Neurosurgery, GHU-Paris Psychiatrie et Neurosciences, Hôpital Sainte Anne, Paris, France
| | - Giuseppe Minniti
- Radiation Oncology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy and IRCCS Neuromed (IS), Italy
| | - Thomas J Kaley
- Department of Neurology, Brain Tumor Service, Memorial Sloan Kettering Cancer Center, New York, US
| | - Eric Bouffet
- Division of Paediatric Oncology, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Ghazaleh Tabatabai
- Department of Neurology & Neurooncology, University of Tübingen, German Cancer Consortium (DKTK), DKFZ partner site Tübingen, Germany
| | - Eleonora Aronica
- Department of (Neuro)Pathology, Amsterdam UMC, University of Amsterdam, Amsterdam Neuroscience, Amsterdam and Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, the Netherlands
| | - Asgeir S Jakola
- Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden. Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, Sahlgrenska Academy, Gothenburg, Sweden
| | - Stefan M Pfister
- Hopp Children´s Cancer Center Heidelberg (KiTZ), Division of Pediatric Neuro-oncology, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), and Department of Pediatric Oncology, Hematology and Immunology, University Hospital Heidelberg, Heidelberg, Germany
| | - David Schiff
- Department of Neurology, Division of Neuro-Oncology, University of Virginia, Charlottesville, US
| | - Andrew B Lassman
- Division of Neuro-Oncology, Department of Neurology and the Herbert Irving Comprehensive Cancer Center, Columbia University Vagelos College of Physicians and Surgeons and New York-Presbyterian Hospital, New York, NY, US
| | - David A Solomon
- Department of Pathology, University of California, San Francisco, CA, US
| | - Riccardo Soffietti
- Division of Neuro-Oncology, Department of Neuroscience, University and City of Health and Science Hospital, Turin, Italy
| | - Michael Weller
- Department of Neurology, Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Matthias Preusser
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Ahmed Idbaih
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie 2-Mazarin, Paris, France
| | | | | |
Collapse
|
8
|
Kearns PKA, Martin SJ, Chang J, Meijboom R, York EN, Chen Y, Weaver C, Stenson A, Hafezi K, Thomson S, Freyer E, Murphy L, Harroud A, Foley P, Hunt D, McLeod M, O'Riordan J, Carod-Artal FJ, MacDougall NJJ, Baranzini SE, Waldman AD, Connick P, Chandran S. FutureMS cohort profile: a Scottish multicentre inception cohort study of relapsing-remitting multiple sclerosis. BMJ Open 2022; 12:e058506. [PMID: 35768080 PMCID: PMC9244691 DOI: 10.1136/bmjopen-2021-058506] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
PURPOSE Multiple sclerosis (MS) is an immune-mediated, neuroinflammatory disease of the central nervous system and in industrialised countries is the most common cause of progressive neurological disability in working age persons. While treatable, there is substantial interindividual heterogeneity in disease activity and response to treatment. Currently, the ability to predict at diagnosis who will have a benign, intermediate or aggressive disease course is very limited. There is, therefore, a need for integrated predictive tools to inform individualised treatment decision making. PARTICIPANTS Established with the aim of addressing this need for individualised predictive tools, FutureMS is a nationally representative, prospective observational cohort study of 440 adults with a new diagnosis of relapsing-remitting MS living in Scotland at the time of diagnosis between May 2016 and March 2019. FINDINGS TO DATE The study aims to explore the pathobiology and determinants of disease heterogeneity in MS and combines detailed clinical phenotyping with imaging, genetic and biomarker metrics of disease activity and progression. Recruitment, baseline assessment and follow-up at year 1 is complete. Here, we describe the cohort design and present a profile of the participants at baseline and 1 year of follow-up. FUTURE PLANS A third follow-up wave for the cohort has recently begun at 5 years after first visit and a further wave of follow-up is funded for year 10. Longer-term follow-up is anticipated thereafter.
Collapse
Affiliation(s)
- Patrick K A Kearns
- Anne Rowling Regenerative Neurology Clinic, The University of Edinburgh Centre for Clinical Brain Sciences, Edinburgh, UK
- Chromatin Lab, Genome Regulation Section, The University of Edinburgh MRC Human Genetics Unit, Edinburgh, UK
- Department of Clinical Neurosciences, Royal Infirmary of Edinburgh, Edinburgh, UK
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
- Department of Neurology, Institute of Clinical Neurosciences, NHS Greater Glasgow and Clyde, Glasgow, UK
- Institute of Genetics and Cancer, The University of Edinburgh, Edinburgh, UK
| | - Sarah J Martin
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
- Department of Neurology, Institute of Clinical Neurosciences, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Jessie Chang
- Anne Rowling Regenerative Neurology Clinic, The University of Edinburgh Centre for Clinical Brain Sciences, Edinburgh, UK
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
| | - Rozanna Meijboom
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
| | - Elizabeth N York
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
| | - Yingdi Chen
- Anne Rowling Regenerative Neurology Clinic, The University of Edinburgh Centre for Clinical Brain Sciences, Edinburgh, UK
| | - Christine Weaver
- Anne Rowling Regenerative Neurology Clinic, The University of Edinburgh Centre for Clinical Brain Sciences, Edinburgh, UK
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
| | - Amy Stenson
- Anne Rowling Regenerative Neurology Clinic, The University of Edinburgh Centre for Clinical Brain Sciences, Edinburgh, UK
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
| | | | - Stacey Thomson
- Institute of Genetics and Cancer, The University of Edinburgh, Edinburgh, UK
| | - Elizabeth Freyer
- Institute of Genetics and Cancer, The University of Edinburgh, Edinburgh, UK
| | - Lee Murphy
- Wellcome Trust Clinical Research Facility, Edinburgh, UK
| | - Adil Harroud
- Department of Neurology, Weill Institute of Clinical Neuroscience, San Francisco, California, USA
| | - Peter Foley
- Anne Rowling Regenerative Neurology Clinic, The University of Edinburgh Centre for Clinical Brain Sciences, Edinburgh, UK
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
| | - David Hunt
- Anne Rowling Regenerative Neurology Clinic, The University of Edinburgh Centre for Clinical Brain Sciences, Edinburgh, UK
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
| | - Margaret McLeod
- Department of Neurology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Jonathon O'Riordan
- Tayside Centre for Clinical Neurosciences, University of Dundee Division of Neuroscience, Dundee, UK
| | | | - Niall J J MacDougall
- Anne Rowling Regenerative Neurology Clinic, The University of Edinburgh Centre for Clinical Brain Sciences, Edinburgh, UK
- Department of Neurology, Wishaw General Hospital, Wishaw, UK
| | - Sergio E Baranzini
- Department of Neurology, Weill Institute of Clinical Neuroscience, San Francisco, California, USA
| | - Adam D Waldman
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
| | - Peter Connick
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
| | - Siddharthan Chandran
- Anne Rowling Regenerative Neurology Clinic, The University of Edinburgh Centre for Clinical Brain Sciences, Edinburgh, UK
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
| |
Collapse
|
9
|
Dieckhaus H, Meijboom R, Okar S, Wu T, Parvathaneni P, Mina Y, Chandran S, Waldman AD, Reich DS, Nair G. Logistic Regression-Based Model Is More Efficient Than U-Net Model for Reliable Whole Brain Magnetic Resonance Imaging Segmentation. Top Magn Reson Imaging 2022; 31:31-39. [PMID: 35767314 PMCID: PMC9258518 DOI: 10.1097/rmr.0000000000000296] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 05/24/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Automated whole brain segmentation from magnetic resonance images is of great interest for the development of clinically relevant volumetric markers for various neurological diseases. Although deep learning methods have demonstrated remarkable potential in this area, they may perform poorly in nonoptimal conditions, such as limited training data availability. Manual whole brain segmentation is an incredibly tedious process, so minimizing the data set size required for training segmentation algorithms may be of wide interest. The purpose of this study was to compare the performance of the prototypical deep learning segmentation architecture (U-Net) with a previously published atlas-free traditional machine learning method, Classification using Derivative-based Features (C-DEF) for whole brain segmentation, in the setting of limited training data. MATERIALS AND METHODS C-DEF and U-Net models were evaluated after training on manually curated data from 5, 10, and 15 participants in 2 research cohorts: (1) people living with clinically diagnosed HIV infection and (2) relapsing-remitting multiple sclerosis, each acquired at separate institutions, and between 5 and 295 participants' data using a large, publicly available, and annotated data set of glioblastoma and lower grade glioma (brain tumor segmentation). Statistics was performed on the Dice similarity coefficient using repeated-measures analysis of variance and Dunnett-Hsu pairwise comparison. RESULTS C-DEF produced better segmentation than U-Net in lesion (29.2%-38.9%) and cerebrospinal fluid (5.3%-11.9%) classes when trained with data from 15 or fewer participants. Unlike C-DEF, U-Net showed significant improvement when increasing the size of the training data (24%-30% higher than baseline). In the brain tumor segmentation data set, C-DEF produced equivalent or better segmentations than U-Net for enhancing tumor and peritumoral edema regions across all training data sizes explored. However, U-Net was more effective than C-DEF for segmentation of necrotic/non-enhancing tumor when trained on 10 or more participants, probably because of the inconsistent signal intensity of the tissue class. CONCLUSIONS These results demonstrate that classical machine learning methods can produce more accurate brain segmentation than the far more complex deep learning methods when only small or moderate amounts of training data are available (n ≤ 15). The magnitude of this advantage varies by tissue and cohort, while U-Net may be preferable for deep gray matter and necrotic/non-enhancing tumor segmentation, particularly with larger training data sets (n ≥ 20). Given that segmentation models often need to be retrained for application to novel imaging protocols or pathology, the bottleneck associated with large-scale manual annotation could be avoided with classical machine learning algorithms, such as C-DEF.
Collapse
Affiliation(s)
- Henry Dieckhaus
- qMRI Core Facility, NINDS, National Institutes of Health, Bethesda, MD, USA
| | | | - Serhat Okar
- Translational Neuroradiology Section, NINDS, National Institutes of Health, Bethesda, MD, USA
| | - Tianxia Wu
- Clinical Trials Unit, NINDS, National Institutes of Health, Bethesda, MD, USA
| | - Prasanna Parvathaneni
- Translational Neuroradiology Section, NINDS, National Institutes of Health, Bethesda, MD, USA
| | - Yair Mina
- Viral Immunology Section, NINDS, National Institutes of Health, Bethesda, MD, USA
- Sackler Faculty of Medicine, Tel Aviv University, Israel
| | | | - Adam D. Waldman
- Centre for Clinical Brain Sciences, University of Edinburgh, UK
| | - Daniel S. Reich
- Translational Neuroradiology Section, NINDS, National Institutes of Health, Bethesda, MD, USA
| | - Govind Nair
- qMRI Core Facility, NINDS, National Institutes of Health, Bethesda, MD, USA
- Corresponding Author: Govind Nair, Room 5C440, 10 Center Drive, Bethesda MD 20892, ; 301-402-6391
| |
Collapse
|
10
|
York EN, Thrippleton MJ, Meijboom R, Hunt DPJ, Waldman AD. Quantitative magnetization transfer imaging in relapsing-remitting multiple sclerosis: a systematic review and meta-analysis. Brain Commun 2022; 4:fcac088. [PMID: 35652121 PMCID: PMC9149789 DOI: 10.1093/braincomms/fcac088] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 12/17/2021] [Accepted: 03/31/2022] [Indexed: 11/28/2022] Open
Abstract
Myelin-sensitive MRI such as magnetization transfer imaging has been widely used in multiple sclerosis. The influence of methodology and differences in disease subtype on imaging findings is, however, not well established. Here, we systematically review magnetization transfer brain imaging findings in relapsing-remitting multiple sclerosis. We examine how methodological differences, disease effects and their interaction influence magnetization transfer imaging measures. Articles published before 06/01/2021 were retrieved from online databases (PubMed, EMBASE and Web of Science) with search terms including 'magnetization transfer' and 'brain' for systematic review, according to a pre-defined protocol. Only studies that used human in vivo quantitative magnetization transfer imaging in adults with relapsing-remitting multiple sclerosis (with or without healthy controls) were included. Additional data from relapsing-remitting multiple sclerosis subjects acquired in other studies comprising mixed disease subtypes were included in meta-analyses. Data including sample size, MRI acquisition protocol parameters, treatments and clinical findings were extracted and qualitatively synthesized. Where possible, effect sizes were calculated for meta-analyses to determine magnetization transfer (i) differences between patients and healthy controls; (ii) longitudinal change and (iii) relationships with clinical disability in relapsing-remitting multiple sclerosis. Eighty-six studies met inclusion criteria. MRI acquisition parameters varied widely, and were also underreported. The majority of studies examined the magnetization transfer ratio in white matter, but magnetization transfer metrics, brain regions examined and results were heterogeneous. The analysis demonstrated a risk of bias due to selective reporting and small sample sizes. The pooled random-effects meta-analysis across all brain compartments revealed magnetization transfer ratio was 1.17 per cent units (95% CI -1.42 to -0.91) lower in relapsing-remitting multiple sclerosis than healthy controls (z-value: -8.99, P < 0.001, 46 studies). Linear mixed-model analysis did not show a significant longitudinal change in magnetization transfer ratio across all brain regions [β = 0.12 (-0.56 to 0.80), t-value = 0.35, P = 0.724, 14 studies] or normal-appearing white matter alone [β = 0.037 (-0.14 to 0.22), t-value = 0.41, P = 0.68, eight studies]. There was a significant negative association between the magnetization transfer ratio and clinical disability, as assessed by the Expanded Disability Status Scale [r = -0.32 (95% CI -0.46 to -0.17); z-value = -4.33, P < 0.001, 13 studies]. Evidence suggests that magnetization transfer imaging metrics are sensitive to pathological brain changes in relapsing-remitting multiple sclerosis, although effect sizes were small in comparison to inter-study variability. Recommendations include: better harmonized magnetization transfer acquisition protocols with detailed methodological reporting standards; larger, well-phenotyped cohorts, including healthy controls; and, further exploration of techniques such as magnetization transfer saturation or inhomogeneous magnetization transfer ratio.
Collapse
Affiliation(s)
- Elizabeth N. York
- Centre for Clinical Brain Sciences, University of
Edinburgh, Edinburgh, UK
- Correspondence to: Elizabeth N. York Centre for Clinical
Brain Sciences University of Edinburgh, Edinburgh BioQuarter Chancellors
Building, Edinburgh EH16 4SB, UK E-mail:
| | | | - Rozanna Meijboom
- Centre for Clinical Brain Sciences, University of
Edinburgh, Edinburgh, UK
| | - David P. J. Hunt
- Centre for Clinical Brain Sciences, University of
Edinburgh, Edinburgh, UK
- UK Dementia Research Institute, University of
Edinburgh, Edinburgh, UK
- Anne Rowling Regenerative Neurology Clinic,
University of Edinburgh, Edinburgh, UK
| | - Adam D. Waldman
- Centre for Clinical Brain Sciences, University of
Edinburgh, Edinburgh, UK
- UK Dementia Research Institute, University of
Edinburgh, Edinburgh, UK
- Correspondence may also be addressed to: Adam D. Waldman
E-mail:
| |
Collapse
|
11
|
Meijboom R, Wiseman SJ, York EN, Bastin ME, Valdés Hernández MDC, Thrippleton MJ, Mollison D, White N, Kampaite A, Ng Kee Kwong K, Rodriguez Gonzalez D, Job D, Weaver C, Kearns PKA, Connick P, Chandran S, Waldman AD. Rationale and design of the brain magnetic resonance imaging protocol for FutureMS: a longitudinal multi-centre study of newly diagnosed patients with relapsing-remitting multiple sclerosis in Scotland. Wellcome Open Res 2022; 7:94. [PMID: 36865371 PMCID: PMC9971644 DOI: 10.12688/wellcomeopenres.17731.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2022] [Indexed: 12/22/2022] Open
Abstract
Introduction: Multiple sclerosis (MS) is a chronic neuroinflammatory and neurodegenerative disease. MS prevalence varies geographically and is notably high in Scotland. Disease trajectory varies significantly between individuals and the causes for this are largely unclear. Biomarkers predictive of disease course are urgently needed to allow improved stratification for current disease modifying therapies and future targeted treatments aimed at neuroprotection and remyelination. Magnetic resonance imaging (MRI) can detect disease activity and underlying damage non-invasively in vivo at the micro and macrostructural level. FutureMS is a prospective Scottish longitudinal multi-centre cohort study, which focuses on deeply phenotyping patients with recently diagnosed relapsing-remitting MS (RRMS). Neuroimaging is a central component of the study and provides two main primary endpoints for disease activity and neurodegeneration. This paper provides an overview of MRI data acquisition, management and processing in FutureMS. FutureMS is registered with the Integrated Research Application System (IRAS, UK) under reference number 169955. Methods and analysis: MRI is performed at baseline (N=431) and 1-year follow-up, in Dundee, Glasgow and Edinburgh (3T Siemens) and in Aberdeen (3T Philips), and managed and processed in Edinburgh. The core structural MRI protocol comprises T1-weighted, T2-weighted, FLAIR and proton density images. Primary imaging outcome measures are new/enlarging white matter lesions (WML) and reduction in brain volume over one year. Secondary imaging outcome measures comprise WML volume as an additional quantitative structural MRI measure, rim lesions on susceptibility-weighted imaging, and microstructural MRI measures, including diffusion tensor imaging and neurite orientation dispersion and density imaging metrics, relaxometry, magnetisation transfer (MT) ratio, MT saturation and derived g-ratio measures. Conclusions: FutureMS aims to reduce uncertainty around disease course and allow for targeted treatment in RRMS by exploring the role of conventional and advanced MRI measures as biomarkers of disease severity and progression in a large population of RRMS patients in Scotland.
Collapse
Affiliation(s)
- Rozanna Meijboom
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Edinburgh Imaging, University of Edinburgh, Edinburgh, UK
| | - Stewart J. Wiseman
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Edinburgh Imaging, University of Edinburgh, Edinburgh, UK
| | - Elizabeth N. York
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Edinburgh Imaging, University of Edinburgh, Edinburgh, UK
| | - Mark E. Bastin
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Edinburgh Imaging, University of Edinburgh, Edinburgh, UK
| | - Maria del C. Valdés Hernández
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Edinburgh Imaging, University of Edinburgh, Edinburgh, UK
| | - Michael J. Thrippleton
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Edinburgh Imaging, University of Edinburgh, Edinburgh, UK
| | - Daisy Mollison
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Edinburgh Imaging, University of Edinburgh, Edinburgh, UK
| | - Nicole White
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Edinburgh Imaging, University of Edinburgh, Edinburgh, UK
| | - Agniete Kampaite
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Edinburgh Imaging, University of Edinburgh, Edinburgh, UK
| | - Koy Ng Kee Kwong
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Edinburgh Imaging, University of Edinburgh, Edinburgh, UK
| | - David Rodriguez Gonzalez
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Edinburgh Imaging, University of Edinburgh, Edinburgh, UK
| | - Dominic Job
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Edinburgh Imaging, University of Edinburgh, Edinburgh, UK
| | - Christine Weaver
- Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, Edinburgh, UK
| | - Patrick K. A. Kearns
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, Edinburgh, UK
| | - Peter Connick
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, Edinburgh, UK
| | - Siddharthan Chandran
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, Edinburgh, UK
| | - Adam D. Waldman
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Edinburgh Imaging, University of Edinburgh, Edinburgh, UK
| |
Collapse
|
12
|
Ng Kee Kwong KC, Mollison D, Meijboom R, York EN, Kampaite A, Martin SJ, Hunt DPJ, Thrippleton MJ, Chandran S, Waldman AD. Rim lesions are demonstrated in early relapsing-remitting multiple sclerosis using 3 T-based susceptibility-weighted imaging in a multi-institutional setting. Neuroradiology 2022; 64:109-117. [PMID: 34664112 PMCID: PMC8724059 DOI: 10.1007/s00234-021-02768-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 07/06/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE Rim lesions, characterised by a paramagnetic rim on susceptibility-based MRI, have been suggested to reflect chronic inflammatory demyelination in multiple sclerosis (MS) patients. Here, we assess, through susceptibility-weighted imaging (SWI), the prevalence, longitudinal volume evolution and clinical associations of rim lesions in subjects with early relapsing-remitting MS (RRMS). METHODS Subjects (n = 44) with recently diagnosed RRMS underwent 3 T MRI at baseline (M0) and 1 year (M12) as part of a multi-centre study. SWI was acquired at M12 using a 3D segmented gradient-echo echo-planar imaging sequence. Rim lesions identified on SWI were manually segmented on FLAIR images at both time points for volumetric analysis. RESULTS Twelve subjects (27%) had at least one rim lesion at M12. A linear mixed-effects model, with 'subject' as a random factor, revealed mixed evidence for the difference in longitudinal volume change between rim lesions and non-rim lesions (p = 0.0350 and p = 0.0556 for subjects with and without rim lesions, respectively). All 25 rim lesions identified showed T1-weighted hypointense signal. Subjects with and without rim lesions did not differ significantly with respect to age, disease duration or clinical measures of disability (p > 0.05). CONCLUSION We demonstrate that rim lesions are detectable in early-stage RRMS on 3 T MRI across multiple centres, although their relationship to lesion enlargement is equivocal in this small cohort. Identification of SWI rims was subjective. Agreed criteria for defining rim lesions and their further validation as a biomarker of chronic inflammation are required for translation of SWI into routine MS clinical practice.
Collapse
Affiliation(s)
- Koy Chong Ng Kee Kwong
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh bioQuarter, Chancellor’s Building, 49 Little France Crescent, Edinburgh, EH16 4SB UK
| | - Daisy Mollison
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh bioQuarter, Chancellor’s Building, 49 Little France Crescent, Edinburgh, EH16 4SB UK
| | - Rozanna Meijboom
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh bioQuarter, Chancellor’s Building, 49 Little France Crescent, Edinburgh, EH16 4SB UK
| | - Elizabeth N. York
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh bioQuarter, Chancellor’s Building, 49 Little France Crescent, Edinburgh, EH16 4SB UK
| | - Agniete Kampaite
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh bioQuarter, Chancellor’s Building, 49 Little France Crescent, Edinburgh, EH16 4SB UK
| | | | - David P. J. Hunt
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh bioQuarter, Chancellor’s Building, 49 Little France Crescent, Edinburgh, EH16 4SB UK
| | - Michael J. Thrippleton
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh bioQuarter, Chancellor’s Building, 49 Little France Crescent, Edinburgh, EH16 4SB UK
| | - Siddharthan Chandran
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh bioQuarter, Chancellor’s Building, 49 Little France Crescent, Edinburgh, EH16 4SB UK
| | - Adam D. Waldman
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh bioQuarter, Chancellor’s Building, 49 Little France Crescent, Edinburgh, EH16 4SB UK
| | | |
Collapse
|
13
|
Ng Kee Kwong KC, Mollison D, Meijboom R, York EN, Kampaite A, Martin SJ, Hunt DPJ, Thrippleton MJ, Chandran S, Waldman AD. Correction to: Rim lesions are demonstrated in early relapsing-remitting multiple sclerosis using 3 T‑based susceptibility‑weighted imaging in a multi‑institutional setting. Neuroradiology 2021; 64:211. [PMID: 34738181 DOI: 10.1007/s00234-021-02844-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Koy Chong Ng Kee Kwong
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh bioQuarter, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Daisy Mollison
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh bioQuarter, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Rozanna Meijboom
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh bioQuarter, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Elizabeth N York
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh bioQuarter, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Agniete Kampaite
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh bioQuarter, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
| | | | - David P J Hunt
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh bioQuarter, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Michael J Thrippleton
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh bioQuarter, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Siddharthan Chandran
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh bioQuarter, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Adam D Waldman
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh bioQuarter, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK.
| | | |
Collapse
|
14
|
York EN, Martin SJ, Meijboom R, Thrippleton MJ, Bastin ME, Carter E, Overell J, Connick P, Chandran S, Waldman AD, Hunt DPJ. MRI-derived g-ratio and lesion severity in newly diagnosed multiple sclerosis. Brain Commun 2021; 3:fcab249. [PMID: 34877533 PMCID: PMC8643503 DOI: 10.1093/braincomms/fcab249] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 08/24/2021] [Accepted: 08/30/2021] [Indexed: 01/19/2023] Open
Abstract
Myelin loss is associated with axonal damage in established multiple sclerosis. This relationship is challenging to study in vivo in early disease. Here, we ask whether myelin loss is associated with axonal damage at diagnosis by combining non-invasive neuroimaging and blood biomarkers. We performed quantitative microstructural MRI and single-molecule ELISA plasma neurofilament measurement in 73 patients with newly diagnosed, immunotherapy naïve relapsing-remitting multiple sclerosis. Myelin integrity was evaluated using aggregate g-ratios, derived from magnetization transfer saturation and neurite orientation dispersion and density imaging diffusion data. We found significantly higher g-ratios within cerebral white matter lesions (suggesting myelin loss) compared with normal-appearing white matter (0.61 versus 0.57, difference 0.036, 95% CI: 0.029-0.043, P < 0.001). Lesion volume (Spearman's rho rs= 0.38, P < 0.001) and g-ratio (rs= 0.24, P < 0.05) correlated independently with plasma neurofilament. In patients with substantial lesion load (n = 38), those with higher g-ratio (defined as greater than median) were more likely to have abnormally elevated plasma neurofilament than those with normal g-ratio (defined as less than median) [11/23 (48%) versus 2/15 (13%), P < 0.05]. These data suggest that, even at multiple sclerosis diagnosis, reduced myelin integrity is associated with axonal damage. MRI-derived g-ratio may provide useful additional information regarding lesion severity and help to identify individuals with a high degree of axonal damage at disease onset.
Collapse
Affiliation(s)
- Elizabeth N York
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh EH16 4SB, UK
| | - Sarah-Jane Martin
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh EH16 4SB, UK
- Department of Neurosciences, University of Glasgow, Glasgow G51 4LB, UK
| | - Rozanna Meijboom
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh EH16 4SB, UK
| | | | - Mark E Bastin
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh EH16 4SB, UK
| | - Edwin Carter
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh EH4 2XU, UK
| | - James Overell
- Department of Neurosciences, University of Glasgow, Glasgow G51 4LB, UK
| | - Peter Connick
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh EH16 4SB, UK
| | - Siddharthan Chandran
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh EH16 4SB, UK
- UK Dementia Research Institute, University of Edinburgh, Edinburgh EH16 4SB, UK
- Anne Rowling Clinic, University of Edinburgh, Edinburgh EH16 4SB, UK
| | - Adam D Waldman
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh EH16 4SB, UK
- Anne Rowling Clinic, University of Edinburgh, Edinburgh EH16 4SB, UK
| | - David P J Hunt
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh EH16 4SB, UK
- UK Dementia Research Institute, University of Edinburgh, Edinburgh EH16 4SB, UK
- Anne Rowling Clinic, University of Edinburgh, Edinburgh EH16 4SB, UK
| |
Collapse
|
15
|
Ng Kee Kwong KC, Mollison D, Meijboom R, York EN, Kampaite A, Thrippleton MJ, Chandran S, Waldman AD. The prevalence of paramagnetic rim lesions in multiple sclerosis: A systematic review and meta-analysis. PLoS One 2021; 16:e0256845. [PMID: 34495999 PMCID: PMC8425533 DOI: 10.1371/journal.pone.0256845] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 08/17/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Recent findings from several studies have shown that paramagnetic rim lesions identified using susceptibility-based MRI could represent potential diagnostic and prognostic biomarkers in multiple sclerosis (MS). Here, we perform a systematic review and meta-analysis of the existing literature to assess their pooled prevalence at lesion-level and patient-level. METHODS Both database searching (PubMed and Embase) and handsearching were conducted to identify studies allowing the lesion-level and/or patient-level prevalence of rim lesions or chronic active lesions to be calculated. Pooled prevalence was estimated using the DerSimonian-Laird random-effects model. Subgroup analysis and meta-regression were performed to explore possible sources of heterogeneity. PROSPERO registration: CRD42020192282. RESULTS 29 studies comprising 1230 patients were eligible for analysis. Meta-analysis estimated pooled prevalences of 9.8% (95% CI: 6.6-14.2) and 40.6% (95% CI: 26.2-56.8) for rim lesions at lesion-level and patient-level, respectively. Pooled lesion-level and patient-level prevalences for chronic active lesions were 12.0% (95% CI: 9.0-15.8) and 64.8% (95% CI: 54.3-74.0), respectively. Considerable heterogeneity was observed across studies (I2>75%). Subgroup analysis revealed a significant difference in patient-level prevalence between studies conducted at 3T and 7T (p = 0.0312). Meta-regression analyses also showed significant differences in lesion-level prevalence with respect to age (p = 0.0018, R2 = 0.20) and disease duration (p = 0.0018, R2 = 0.48). Other moderator analyses demonstrated no significant differences according to MRI sequence, gender and expanded disability status scale (EDSS). CONCLUSION In this study, we show that paramagnetic rim lesions may be present in an important proportion of MS patients, notwithstanding significant variation in their assessment across studies. In view of their possible clinical relevance, we believe that clear guidelines should be introduced to standardise their assessment across research centres to in turn facilitate future analyses.
Collapse
Affiliation(s)
| | - Daisy Mollison
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Rozanna Meijboom
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Elizabeth N. York
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Agniete Kampaite
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | | | - Siddharthan Chandran
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Adam D. Waldman
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| |
Collapse
|
16
|
Kucikova L, Goerdten J, Dounavi ME, Mak E, Su L, Waldman AD, Danso S, Muniz-Terrera G, Ritchie CW. Resting-state brain connectivity in healthy young and middle-aged adults at risk of progressive Alzheimer's disease. Neurosci Biobehav Rev 2021; 129:142-153. [PMID: 34310975 DOI: 10.1016/j.neubiorev.2021.07.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 05/18/2021] [Accepted: 07/21/2021] [Indexed: 11/15/2022]
Abstract
Functional brain connectivity of the resting-state networks has gained recent attention as a possible biomarker of Alzheimer's Disease (AD). In this paper, we review the literature of functional connectivity differences in young adults and middle-aged cognitively intact individuals with non-modifiable risk factors of AD (n = 17). We focus on three main intrinsic resting-state networks: The Default Mode network, Executive network, and the Salience network. Overall, the evidence from the literature indicated early vulnerability of functional connectivity across different at-risk groups, particularly in the Default Mode Network. While there was little consensus on the interpretation on directionality, the topography of the findings showed frequent overlap across studies, especially in regions that are characteristic of AD (i.e., precuneus, posterior cingulate cortex, and medial prefrontal cortex areas). We conclude that while resting-state functional connectivity markers have great potential to identify at-risk individuals, implementing more data-driven approaches, further longitudinal and cross-validation studies, and the analysis of greater sample sizes are likely to be necessary to fully establish the effectivity and utility of resting-state network-based analyses.
Collapse
Affiliation(s)
- Ludmila Kucikova
- Edinburgh Dementia Prevention and Centre for Clinical Brain Sciences, Edinburgh Medical School, University of Edinburgh, Edinburgh, United Kingdom.
| | - Jantje Goerdten
- Department of Epidemiological Methods and Etiological Research, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Maria-Eleni Dounavi
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Elijah Mak
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Li Su
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Adam D Waldman
- Edinburgh Dementia Prevention and Centre for Clinical Brain Sciences, Edinburgh Medical School, University of Edinburgh, Edinburgh, United Kingdom
| | - Samuel Danso
- Edinburgh Dementia Prevention and Centre for Clinical Brain Sciences, Edinburgh Medical School, University of Edinburgh, Edinburgh, United Kingdom
| | - Graciela Muniz-Terrera
- Edinburgh Dementia Prevention and Centre for Clinical Brain Sciences, Edinburgh Medical School, University of Edinburgh, Edinburgh, United Kingdom
| | - Craig W Ritchie
- Edinburgh Dementia Prevention and Centre for Clinical Brain Sciences, Edinburgh Medical School, University of Edinburgh, Edinburgh, United Kingdom
| |
Collapse
|
17
|
Ingala S, De Boer C, Masselink LA, Vergari I, Lorenzini L, Blennow K, Chételat G, Di Perri C, Ewers M, van der Flier WM, Fox NC, Gispert JD, Haller S, Molinuevo JL, Muniz‐Terrera G, Mutsaerts HJMM, Ritchie CW, Ritchie K, Schmidt M, Schwarz AJ, Vermunt L, Waldman AD, Wardlaw J, Wink AM, Wolz R, Wottschel V, Scheltens P, Visser PJ, Barkhof F. Application of the ATN classification scheme in a population without dementia: Findings from the EPAD cohort. Alzheimers Dement 2021; 17:1189-1204. [PMID: 33811742 PMCID: PMC8359976 DOI: 10.1002/alz.12292] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 11/11/2020] [Accepted: 12/22/2020] [Indexed: 01/18/2023]
Abstract
BACKGROUND We classified non-demented European Prevention of Alzheimer's Dementia (EPAD) participants through the amyloid/tau/neurodegeneration (ATN) scheme and assessed their neuropsychological and imaging profiles. MATERIALS AND METHODS From 1500 EPAD participants, 312 were excluded. Cerebrospinal fluid cut-offs of 1000 pg/mL for amyloid beta (Aß)1-42 and 27 pg/mL for p-tau181 were validated using Gaussian mixture models. Given strong correlation of p-tau and t-tau (R2 = 0.98, P < 0.001), neurodegeneration was defined by age-adjusted hippocampal volume. Multinomial regressions were used to test whether neuropsychological tests and regional brain volumes could distinguish ATN stages. RESULTS Age was 65 ± 7 years, with 58% females and 38% apolipoprotein E (APOE) ε4 carriers; 57.1% were A-T-N-, 32.5% were in the Alzheimer's disease (AD) continuum, and 10.4% suspected non-Alzheimer's pathology. Age and cerebrovascular burden progressed with biomarker positivity (P < 0.001). Cognitive dysfunction appeared with T+. Paradoxically higher regional gray matter volumes were observed in A+T-N- compared to A-T-N- (P < 0.001). DISCUSSION In non-demented individuals along the AD continuum, p-tau drives cognitive dysfunction. Memory and language domains are affected in the earliest stages.
Collapse
Affiliation(s)
- Silvia Ingala
- Department of Radiology and Nuclear MedicineAmsterdam UMC Location VUmcVrije Universiteit Amsterdam, Amsterdam NeuroscienceAmsterdamthe Netherlands
- Alzheimer Center AmsterdamDepartment of NeurologyAmsterdam UMC Location VUmcVrije Universiteit Amsterdam, Amsterdam NeuroscienceAmsterdamthe Netherlands
| | - Casper De Boer
- Alzheimer Center AmsterdamDepartment of NeurologyAmsterdam UMC Location VUmcVrije Universiteit Amsterdam, Amsterdam NeuroscienceAmsterdamthe Netherlands
| | - Larissa A Masselink
- Alzheimer Center AmsterdamDepartment of NeurologyAmsterdam UMC Location VUmcVrije Universiteit Amsterdam, Amsterdam NeuroscienceAmsterdamthe Netherlands
| | - Ilaria Vergari
- Department of Radiology and Nuclear MedicineAmsterdam UMC Location VUmcVrije Universiteit Amsterdam, Amsterdam NeuroscienceAmsterdamthe Netherlands
- Alzheimer Center AmsterdamDepartment of NeurologyAmsterdam UMC Location VUmcVrije Universiteit Amsterdam, Amsterdam NeuroscienceAmsterdamthe Netherlands
| | - Luigi Lorenzini
- Department of Radiology and Nuclear MedicineAmsterdam UMC Location VUmcVrije Universiteit Amsterdam, Amsterdam NeuroscienceAmsterdamthe Netherlands
| | - Kaj Blennow
- Department of Psychiatry and NeurochemistryInstitute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of GothenburgMölndalSweden
- Clinical Neurochemistry LaboratorySahlgrenska University HospitalMölndalSweden
| | - Gaël Chételat
- Normandie Univ, UNICAEN, INSERM, U1237, PhIND “Physiopathology and Imaging of Neurological Disorders,”Institut Blood and Brain @ Caen‐NormandieCyceronCaenFrance
| | - Carol Di Perri
- Centre for Dementia PreventionEdinburgh Imaging, UK Dementia Research Institute at The University of EdinburghEdinburghUK
| | - Michael Ewers
- Institute for Stroke and Dementia ResearchKlinikum der Universitat MünchenLudwig‐Maximilians‐Universitat LMUMunichGermany
| | - Wiesje M van der Flier
- Alzheimer Center AmsterdamDepartment of NeurologyAmsterdam UMC Location VUmcVrije Universiteit Amsterdam, Amsterdam NeuroscienceAmsterdamthe Netherlands
| | - Nick C Fox
- Dementia Research CentreDepartment of Neurodegenerative Disease & UK Dementia Research InstituteInstitute of NeurologyUniversity College LondonLondonUK
| | - Juan Domingo Gispert
- Barcelonaβeta Brain Research Center (BBRC)Pasqual Maragall FoundationBarcelonaSpain
- CIBER Fragilidad y Envejecimiento Saludable (CIBERFES)MadridSpain
- Universitat Pompeu FabraBarcelonaSpain
| | - Sven Haller
- CIRD Centre d'Imagerie Rive DroiteGenevaSwitzerland
| | - José Luís Molinuevo
- Barcelonaβeta Brain Research Center (BBRC)Pasqual Maragall FoundationBarcelonaSpain
- Hopsital Clínic‐IDIBAPSAlzheimer's Disease & Other Cognitive Disorders UnitBarcelonaSpain
| | - Graciela Muniz‐Terrera
- Centre for Dementia PreventionEdinburgh Imaging, UK Dementia Research Institute at The University of EdinburghEdinburghUK
| | - Henri JMM Mutsaerts
- Department of Radiology and Nuclear MedicineAmsterdam UMC Location VUmcVrije Universiteit Amsterdam, Amsterdam NeuroscienceAmsterdamthe Netherlands
- Ghent Institute for Functional and Metabolic Imaging (GIfMI)Ghent UniversityGhentBelgium
| | - Craig W Ritchie
- Centre for Clinical Brain SciencesUniversity of EdinburghEdinburghUK
| | - Karen Ritchie
- Centre for Clinical Brain SciencesUniversity of EdinburghEdinburghUK
| | | | - Adam J Schwarz
- Takeda Pharmaceutical Company LtdCambridgeMassachusettsUSA
| | - Lisa Vermunt
- Alzheimer Center AmsterdamDepartment of NeurologyAmsterdam UMC Location VUmcVrije Universiteit Amsterdam, Amsterdam NeuroscienceAmsterdamthe Netherlands
| | - Adam D Waldman
- Centre for Dementia PreventionEdinburgh Imaging, UK Dementia Research Institute at The University of EdinburghEdinburghUK
- Centre for Clinical Brain SciencesUniversity of EdinburghEdinburghUK
| | - Joanna Wardlaw
- Centre for Dementia PreventionEdinburgh Imaging, UK Dementia Research Institute at The University of EdinburghEdinburghUK
- Centre for Clinical Brain SciencesUniversity of EdinburghEdinburghUK
| | - Alle Meije Wink
- Department of Radiology and Nuclear MedicineAmsterdam UMC Location VUmcVrije Universiteit Amsterdam, Amsterdam NeuroscienceAmsterdamthe Netherlands
| | | | - Viktor Wottschel
- Department of Radiology and Nuclear MedicineAmsterdam UMC Location VUmcVrije Universiteit Amsterdam, Amsterdam NeuroscienceAmsterdamthe Netherlands
| | - Philip Scheltens
- Alzheimer Center AmsterdamDepartment of NeurologyAmsterdam UMC Location VUmcVrije Universiteit Amsterdam, Amsterdam NeuroscienceAmsterdamthe Netherlands
| | - Pieter Jelle Visser
- Alzheimer Center AmsterdamDepartment of NeurologyAmsterdam UMC Location VUmcVrije Universiteit Amsterdam, Amsterdam NeuroscienceAmsterdamthe Netherlands
- Department of Psychiatry & NeuropsychologySchool for Mental Health and NeuroscienceMaastricht UniversityMaastrichtthe Netherlands
| | - Frederik Barkhof
- Department of Radiology and Nuclear MedicineAmsterdam UMC Location VUmcVrije Universiteit Amsterdam, Amsterdam NeuroscienceAmsterdamthe Netherlands
- Institutes of Neurology and Healthcare EngineeringUniversity College LondonLondonUK
| | - the EPAD consortium
- Department of Radiology and Nuclear MedicineAmsterdam UMC Location VUmcVrije Universiteit Amsterdam, Amsterdam NeuroscienceAmsterdamthe Netherlands
| |
Collapse
|
18
|
McKeever A, Paris AF, Cullen J, Hayes L, Ritchie CW, Ritchie K, Waldman AD, Wells K, Busza A, Carriere I, O'Brien JT, Su L. Hippocampal Subfield Volumes in Middle-Aged Adults at Risk of Dementia. J Alzheimers Dis 2021; 75:1211-1218. [PMID: 32417786 DOI: 10.3233/jad-200238] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Alzheimer's disease (AD) begins decades before the onset of dementia. There is a need to investigate biomarkers of early AD for use in clinical trials and to facilitate early intervention. OBJECTIVE We aimed to determine whether changes in hippocampal subfield volumes in healthy middle-aged adults were associated with risk of future dementia. METHODS We included 150 participants from the PREVENT-Dementia cohort, which recruited subjects aged 40-59 with or without a family history of dementia (FHD; included here were 81 with FHD and 69 without). Hippocampal subfield volumes were segmented from high resolution T2-weighted 3T MRI images taken at baseline and 2-year follow-up. RESULTS FHD and greater 20 year-risk of dementia due to cardiovascular risk factors were both associated with lower CA1 volume. FHD was also associated with a relative increase in combined CA3, CA4, and dentate gyrus volume between baseline and follow-up. CONCLUSION CA1 atrophy may commence as early as middle-age in those with a high risk of future dementia, while increases in CA3, CA4, and dentate gyrus volume may be a response to early AD in the form of inflammation or neurogenesis.
Collapse
Affiliation(s)
- Anna McKeever
- Department of Psychiatry, University of Cambridge, UK
| | - Alvar F Paris
- Department of Psychiatry, University of Cambridge, UK
| | - James Cullen
- Department of Psychiatry, University of Cambridge, UK
| | | | | | - Karen Ritchie
- Centre for Dementia Prevention, University of Edinburgh, UK.,Inserm, University Montpellier, France
| | - Adam D Waldman
- Centre for Dementia Prevention, University of Edinburgh, UK
| | - Katie Wells
- The Centre for Psychiatry, Imperial College London, UK
| | - Albert Busza
- Clinical Imaging Facility, Imperial College London, UK
| | | | | | - Li Su
- Department of Psychiatry, University of Cambridge, UK
| |
Collapse
|
19
|
Booth TC, Thompson G, Bulbeck H, Boele F, Buckley C, Cardoso J, Dos Santos Canas L, Jenkinson D, Ashkan K, Kreindler J, Huskens N, Luis A, McBain C, Mills SJ, Modat M, Morley N, Murphy C, Ourselin S, Pennington M, Powell J, Summers D, Waldman AD, Watts C, Williams M, Grant R, Jenkinson MD. A Position Statement on the Utility of Interval Imaging in Standard of Care Brain Tumour Management: Defining the Evidence Gap and Opportunities for Future Research. Front Oncol 2021; 11:620070. [PMID: 33634034 PMCID: PMC7900557 DOI: 10.3389/fonc.2021.620070] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 01/06/2021] [Indexed: 12/19/2022] Open
Abstract
Objectiv e To summarise current evidence for the utility of interval imaging in monitoring disease in adult brain tumours, and to develop a position for future evidence gathering while incorporating the application of data science and health economics. Methods Experts in 'interval imaging' (imaging at pre-planned time-points to assess tumour status); data science; health economics, trial management of adult brain tumours, and patient representatives convened in London, UK. The current evidence on the use of interval imaging for monitoring brain tumours was reviewed. To improve the evidence that interval imaging has a role in disease management, we discussed specific themes of data science, health economics, statistical considerations, patient and carer perspectives, and multi-centre study design. Suggestions for future studies aimed at filling knowledge gaps were discussed. Results Meningioma and glioma were identified as priorities for interval imaging utility analysis. The "monitoring biomarkers" most commonly used in adult brain tumour patients were standard structural MRI features. Interval imaging was commonly scheduled to provide reported imaging prior to planned, regular clinic visits. There is limited evidence relating interval imaging in the absence of clinical deterioration to management change that alters morbidity, mortality, quality of life, or resource use. Progression-free survival is confounded as an outcome measure when using structural MRI in glioma. Uncertainty from imaging causes distress for some patients and their caregivers, while for others it provides an important indicator of disease activity. Any study design that changes imaging regimens should consider the potential for influencing current or planned therapeutic trials, ensure that opportunity costs are measured, and capture indirect benefits and added value. Conclusion Evidence for the value, and therefore utility, of regular interval imaging is currently lacking. Ongoing collaborative efforts will improve trial design and generate the evidence to optimise monitoring imaging biomarkers in standard of care brain tumour management.
Collapse
Affiliation(s)
- Thomas C Booth
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom.,Department of Neuroradiology, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Gerard Thompson
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | | | - Florien Boele
- Leeds Institute of Medical Research at St James's, St James's University Hospital, Leeds, United Kingdom.,Faculty of Medicine and Health, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
| | | | - Jorge Cardoso
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Liane Dos Santos Canas
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | | | - Keyoumars Ashkan
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | | | - Nicky Huskens
- The Tessa Jowell Brain Cancer Mission, London, United Kingdom
| | - Aysha Luis
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom.,Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Catherine McBain
- Department of Oncology, Christie Hospital NHS Foundation Trust, Manchester, United Kingdom
| | - Samantha J Mills
- Department of Neuroradiology, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Marc Modat
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Nick Morley
- Department of Radiology, Wales Research and Diagnostic PET Imaging Centre, Cardiff University School of Medicine, Cardiff, United Kingdom
| | - Caroline Murphy
- King's College Trials Unit, King's College London, London, United Kingdom
| | - Sebastian Ourselin
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Mark Pennington
- King's Health Economics, King's College London, London, United Kingdom
| | - James Powell
- Department of Oncology, Velindre Cancer Centre, Cardiff, United Kingdom
| | - David Summers
- Department of Neuroradiology, Western General Hospital, Edinburgh, United Kingdom
| | - Adam D Waldman
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Colin Watts
- Birmingham Brain Cancer Program, University of Birmingham, Birmingham, United Kingdom.,University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Matthew Williams
- Department of Neuro-oncology, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Robin Grant
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Michael D Jenkinson
- Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom.,Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| |
Collapse
|
20
|
Orban C, McGonigle J, Flechais RS, Paterson LM, Elliott R, Erritzoe D, Ersche KD, Murphy A, Nestor LJ, Passetti F, Reed LJ, Ribeiro AS, Smith DG, Suckling J, Taylor EM, Waldman AD, Wing VC, Deakin JW, Robbins TW, Nutt DJ, Lingford‐Hughes AR, Nutt D, Lingford‐Hughes A, Paterson L, McGonigle J, Flechais R, Orban C, Deakin B, Elliott R, Murphy A, Taylor E, Robbins T, Ersche K, Suckling J, Smith D, Reed L, Passetti F, Faravelli L, Erritzoe D, Mick I, Kalk N, Waldman A, Nestor L, Kuchibatla S, Boyapati V, Metastasio A, Faluyi Y, Fernandez‐Egea E, Abbott S, Sahakian B, Voon V, Rabiner I. Chronic alcohol exposure differentially modulates structural and functional properties of amygdala: A cross‐sectional study. Addict Biol 2020. [DOI: 10.1111/adb.12980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Csaba Orban
- Neuropsychopharmacology Unit, Centre for Psychiatry, Division of Brain Sciences Imperial College London London UK
- Centre for Sleep and Cognition National University of Singapore Singapore
- N.1 Institute for Health, ECE & CIRC National University of Singapore Singapore
| | - John McGonigle
- Neuropsychopharmacology Unit, Centre for Psychiatry, Division of Brain Sciences Imperial College London London UK
| | - Remy S.A. Flechais
- Neuropsychopharmacology Unit, Centre for Psychiatry, Division of Brain Sciences Imperial College London London UK
| | - Louise M. Paterson
- Neuropsychopharmacology Unit, Centre for Psychiatry, Division of Brain Sciences Imperial College London London UK
| | - Rebecca Elliott
- Neuroscience and Psychiatry Unit, Institute of Brain, Behaviour and Mental Health The University of Manchester Manchester UK
| | - David Erritzoe
- Neuropsychopharmacology Unit, Centre for Psychiatry, Division of Brain Sciences Imperial College London London UK
| | - Karen D. Ersche
- Behavioural and Clinical Neuroscience Institute University of Cambridge Cambridge UK
- Department of Psychiatry University of Cambridge Cambridge UK
| | - Anna Murphy
- Neuroscience and Psychiatry Unit, Institute of Brain, Behaviour and Mental Health The University of Manchester Manchester UK
| | - Liam J. Nestor
- Neuropsychopharmacology Unit, Centre for Psychiatry, Division of Brain Sciences Imperial College London London UK
- Department of Psychiatry University of Cambridge Cambridge UK
| | - Filippo Passetti
- Neuropsychopharmacology Unit, Centre for Psychiatry, Division of Brain Sciences Imperial College London London UK
- Behavioural and Clinical Neuroscience Institute University of Cambridge Cambridge UK
- Department of Psychiatry University of Cambridge Cambridge UK
| | - Laurence J. Reed
- Neuropsychopharmacology Unit, Centre for Psychiatry, Division of Brain Sciences Imperial College London London UK
| | - Andre S. Ribeiro
- Neuropsychopharmacology Unit, Centre for Psychiatry, Division of Brain Sciences Imperial College London London UK
| | - Dana G. Smith
- Behavioural and Clinical Neuroscience Institute University of Cambridge Cambridge UK
- Department of Psychology University of Cambridge Cambridge UK
| | - John Suckling
- Behavioural and Clinical Neuroscience Institute University of Cambridge Cambridge UK
- Department of Psychiatry University of Cambridge Cambridge UK
- Cambridgeshire and Peterborough NHS Foundation Trust Cambridgeshire UK
| | - Eleanor M. Taylor
- Neuroscience and Psychiatry Unit, Institute of Brain, Behaviour and Mental Health The University of Manchester Manchester UK
| | - Adam D. Waldman
- Centre for Neuroinflammation and Neurodegeneration Imperial College London London UK
| | - Victoria C. Wing
- Neuropsychopharmacology Unit, Centre for Psychiatry, Division of Brain Sciences Imperial College London London UK
| | - J.F. William Deakin
- Neuroscience and Psychiatry Unit, Institute of Brain, Behaviour and Mental Health The University of Manchester Manchester UK
| | - Trevor W. Robbins
- Behavioural and Clinical Neuroscience Institute University of Cambridge Cambridge UK
- Department of Psychology University of Cambridge Cambridge UK
| | - David J. Nutt
- Neuropsychopharmacology Unit, Centre for Psychiatry, Division of Brain Sciences Imperial College London London UK
| | - Anne R. Lingford‐Hughes
- Neuropsychopharmacology Unit, Centre for Psychiatry, Division of Brain Sciences Imperial College London London UK
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Sadigh G, Saindane AM, Waldman AD, Lava NS, Hu R. Comparison of Unenhanced and Gadolinium-Enhanced Imaging in Multiple Sclerosis: Is Contrast Needed for Routine Follow-Up MRI? AJNR Am J Neuroradiol 2019; 40:1476-1480. [PMID: 31439627 DOI: 10.3174/ajnr.a6179] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 07/06/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Gadolinium enhanced MRI is routinely used for follow-up of patients with multiple sclerosis. Our aim was to evaluate whether enhancing multiple sclerosis lesions on follow-up MR imaging can be detected by visual assessment of unenhanced double inversion recovery and FLAIR sequences. MATERIALS AND METHODS A total of 252 consecutive MRIs in 172 adult patients with a known diagnosis of multiple sclerosis were reviewed. The co-presence or absence of associated double inversion recovery and FLAIR signal abnormality within contrast-enhancing lesions was recorded by 3 neuroradiologists. In a subset of patients with prior comparisons, the number of progressive lesions on each of the 3 sequences was assessed. RESULTS A total of 34 of 252 MRIs (13%) demonstrated 55 enhancing lesions, of which 52 (95%) had corresponding hyperintensity on double inversion recovery and FLAIR. All lesions were concordant between double inversion recovery and FLAIR, and the 3 enhancing lesions not visible on either sequence were small (<2 mm) and cortical/subcortical (n = 2) or periventricular (n = 1). A total of 17 (22%) of the 76 MRIs with a prior comparison had imaging evidence of disease progression: Ten (59%) of these showed new lesions on double inversion recovery or FLAIR only, 6 (35%) showed progression on all sequences, and 1 (6%) was detectable only on postcontrast T1, being located in a region of confluent double inversion recovery and FLAIR abnormality. CONCLUSIONS There was a high concordance between enhancing lesions and hyperintensity on either double inversion recovery or FLAIR. Serial follow-up using double inversion recovery or FLAIR alone may capture most imaging progression, but isolated enhancing lesions in confluent areas of white matter abnormality could present a pitfall for this approach.
Collapse
Affiliation(s)
- G Sadigh
- From the Departments of Radiology and Imaging Sciences (G.S., A.M.S., A.D.W., R.H.)
| | - A M Saindane
- From the Departments of Radiology and Imaging Sciences (G.S., A.M.S., A.D.W., R.H.)
| | - A D Waldman
- From the Departments of Radiology and Imaging Sciences (G.S., A.M.S., A.D.W., R.H.)
| | - N S Lava
- Neurology (N.S.L.), Emory University School of Medicine, Atlanta, Georgia
| | - R Hu
- From the Departments of Radiology and Imaging Sciences (G.S., A.M.S., A.D.W., R.H.)
| |
Collapse
|
22
|
Inglese M, Ordidge KL, Honeyfield L, Barwick TD, Aboagye EO, Waldman AD, Grech-Sollars M. Reliability of dynamic contrast-enhanced magnetic resonance imaging data in primary brain tumours: a comparison of Tofts and shutter speed models. Neuroradiology 2019; 61:1375-1386. [PMID: 31392385 PMCID: PMC6848046 DOI: 10.1007/s00234-019-02265-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 07/12/2019] [Indexed: 12/12/2022]
Abstract
Purpose The purpose of this study is to investigate the robustness of pharmacokinetic modelling of DCE-MRI brain tumour data and to ascertain reliable perfusion parameters through a model selection process and a stability test. Methods DCE-MRI data of 14 patients with primary brain tumours were analysed using the Tofts model (TM), the extended Tofts model (ETM), the shutter speed model (SSM) and the extended shutter speed model (ESSM). A no-effect model (NEM) was implemented to assess overfitting of data by the other models. For each lesion, the Akaike Information Criteria (AIC) was used to build a 3D model selection map. The variability of each pharmacokinetic parameter extracted from this map was assessed with a noise propagation procedure, resulting in voxel-wise distributions of the coefficient of variation (CV). Results The model selection map over all patients showed NEM had the best fit in 35.5% of voxels, followed by ETM (32%), TM (28.2%), SSM (4.3%) and ESSM (< 0.1%). In analysing the reliability of Ktrans, when considering regions with a CV < 20%, ≈ 25% of voxels were found to be stable across all patients. The remaining 75% of voxels were considered unreliable. Conclusions The majority of studies quantifying DCE-MRI data in brain tumours only consider a single model and whole tumour statistics for the output parameters. Appropriate model selection, considering tissue biology and its effects on blood brain barrier permeability and exchange conditions, together with an analysis on the reliability and stability of the calculated parameters, is critical in processing robust brain tumour DCE-MRI data.
Collapse
Affiliation(s)
- Marianna Inglese
- Department of Surgery and Cancer, GN1 Commonwealth building, Hammersmith Hospital, Imperial College London, Du Cane Road, London, W12 0NN, UK.
| | | | - Lesley Honeyfield
- Department of Imaging, Imperial College Healthcare NHS Trust, London, UK
| | - Tara D Barwick
- Department of Surgery and Cancer, GN1 Commonwealth building, Hammersmith Hospital, Imperial College London, Du Cane Road, London, W12 0NN, UK.,Department of Imaging, Imperial College Healthcare NHS Trust, London, UK
| | - Eric O Aboagye
- Department of Surgery and Cancer, GN1 Commonwealth building, Hammersmith Hospital, Imperial College London, Du Cane Road, London, W12 0NN, UK
| | - Adam D Waldman
- Department of Medicine, Imperial College London, London, UK.,Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
| | - Matthew Grech-Sollars
- Department of Surgery and Cancer, GN1 Commonwealth building, Hammersmith Hospital, Imperial College London, Du Cane Road, London, W12 0NN, UK.,Department of Imaging, Imperial College Healthcare NHS Trust, London, UK
| |
Collapse
|
23
|
Wiseman SJ, Meijboom R, Valdés Hernández MDC, Pernet C, Sakka E, Job D, Waldman AD, Wardlaw JM. Longitudinal multi-centre brain imaging studies: guidelines and practical tips for accurate and reproducible imaging endpoints and data sharing. Trials 2019; 20:21. [PMID: 30616680 PMCID: PMC6323670 DOI: 10.1186/s13063-018-3113-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 12/06/2018] [Indexed: 11/10/2022] Open
Abstract
Background Research involving brain imaging is important for understanding common brain diseases. Study endpoints can include features and measures derived from imaging modalities, providing a benchmark against which other phenotypical data can be assessed. In trials, imaging data provide objective evidence of beneficial and adverse outcomes. Multi-centre studies increase generalisability and statistical power. However, there is a lack of practical guidelines for the set-up and conduct of large neuroimaging studies. Methods We address this deficit by describing aspects of study design and other essential practical considerations that will help researchers avoid common pitfalls and data loss. Results The recommendations are grouped into seven categories: (1) planning, (2) defining the imaging endpoints, developing an imaging manual and managing the workflow, (3) performing a dummy run and testing the analysis methods, (4) acquiring the scans, (5) anonymising and transferring the data, (6) monitoring quality, and (7) using structured data and sharing data. Conclusions Implementing these steps will lead to valuable and usable data and help to avoid imaging data wastage.
Collapse
Affiliation(s)
- Stewart J Wiseman
- Edinburgh Imaging and Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK. .,UK Dementia Research Institute Edinburgh, University of Edinburgh, Edinburgh, UK. .,CCBS, Chancellor's Building, Royal Infirmary of Edinburgh, 49 Little France Crescent, Edinburgh, EH16 4SB, UK.
| | - Rozanna Meijboom
- Edinburgh Imaging and Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.,UK Dementia Research Institute Edinburgh, University of Edinburgh, Edinburgh, UK
| | - Maria Del C Valdés Hernández
- Edinburgh Imaging and Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.,UK Dementia Research Institute Edinburgh, University of Edinburgh, Edinburgh, UK
| | - Cyril Pernet
- Edinburgh Imaging and Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Eleni Sakka
- Edinburgh Imaging and Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Dominic Job
- Edinburgh Imaging and Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Adam D Waldman
- Edinburgh Imaging and Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Joanna M Wardlaw
- Edinburgh Imaging and Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.,UK Dementia Research Institute Edinburgh, University of Edinburgh, Edinburgh, UK
| |
Collapse
|
24
|
Grech-Sollars M, Zhou FL, Waldman AD, Parker GJM, Hubbard Cristinacce PL. Stability and reproducibility of co-electrospun brain-mimicking phantoms for quality assurance of diffusion MRI sequences. Neuroimage 2018; 181:395-402. [PMID: 29936312 DOI: 10.1016/j.neuroimage.2018.06.059] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 05/23/2018] [Accepted: 06/20/2018] [Indexed: 10/28/2022] Open
Abstract
Grey and white matter mimicking phantoms are important for assessing variations in diffusion MR measures at a single time point and over an extended period of time. This work investigates the stability of brain-mimicking microfibre phantoms and reproducibility of their MR derived diffusion parameters. The microfibres were produced by co-electrospinning and characterized by scanning electron microscopy (SEM). Grey matter and white matter phantoms were constructed from random and aligned microfibres, respectively. MR data were acquired from these phantoms over a period of 33 months. SEM images revealed that only small changes in fibre microstructure occurred over 30 months. The coefficient of variation in MR measurements across all time-points was between 1.6% and 3.4% for MD across all phantoms and FA in white matter phantoms. This was within the limits expected for intra-scanner variability, thereby confirming phantom stability over 33 months. These specialised diffusion phantoms may be used in a clinical environment for intra and inter-site quality assurance purposes, and for validation of quantitative diffusion biomarkers.
Collapse
Affiliation(s)
- Matthew Grech-Sollars
- Department of Surgery and Cancer, Imperial College London, London, UK; Department of Imaging, Imperial College Healthcare NHS Trust, London, UK.
| | - Feng-Lei Zhou
- Division of Informatics, Imaging and Data Sciences, The University of Manchester, Manchester, UK; The School of Materials, The University of Manchester, Manchester, United Kingdom.
| | - Adam D Waldman
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK; Department of Medicine, Imperial College London, UK
| | - Geoff J M Parker
- Division of Informatics, Imaging and Data Sciences, The University of Manchester, Manchester, UK; Bioxydyn Limited, Manchester, UK
| | | |
Collapse
|
25
|
Ritchie CW, Russ TC, Banerjee S, Barber B, Boaden A, Fox NC, Holmes C, Isaacs JD, Leroi I, Lovestone S, Norton M, O'Brien J, Pearson J, Perry R, Pickett J, Waldman AD, Wong WL, Rossor MN, Burns A. Correction to: The Edinburgh Consensus: preparing for the advent of disease-modifying therapies for Alzheimer's disease. Alzheimers Res Ther 2018; 10:73. [PMID: 30060761 PMCID: PMC6065145 DOI: 10.1186/s13195-018-0372-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 04/06/2018] [Indexed: 11/10/2022]
Abstract
Since the publication of this article [1], it has come to the attention of the authors that information for one of the authors was not included in the competing interests section. Craig Richie has declared potential competing interests with the following companies; Janssen, Eisai, Pfizer, Eli Lilly, Roche Diagnostics, Boeringher Ingleheim, Novartis, AC Immune, Ixico, Aridhia, Amgen, Berry Consultants, Lundbeck, Sanofi, Quintiles (IQVIA) and Takeda. The full competing interests section for this article can be found below.
Collapse
Affiliation(s)
- Craig W Ritchie
- Centre for Dementia Prevention, University of Edinburgh, 9a Edinburgh Bio Quarter, 9 Little France Road, Edinburgh, EH16 4UX, UK. .,Division of Psychiatry, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.
| | - Tom C Russ
- Centre for Dementia Prevention, University of Edinburgh, 9a Edinburgh Bio Quarter, 9 Little France Road, Edinburgh, EH16 4UX, UK.,Division of Psychiatry, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.,Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK.,Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
| | - Sube Banerjee
- Centre for Dementia Studies, Brighton and Sussex Medical School, Brighton, UK
| | - Bob Barber
- Old Age Faculty, Royal College of Psychiatrists, London, UK
| | | | - Nick C Fox
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL, London, UK
| | - Clive Holmes
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Jeremy D Isaacs
- St George's University Hospitals NHS Foundation Trust, London, UK
| | - Ira Leroi
- Division of Neuroscience & Experimental Psychology, University of Manchester, Manchester, UK
| | | | | | - John O'Brien
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | | | | | | | - Adam D Waldman
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Wai Lup Wong
- East and North Hertfordshire NHS Trust, Stevenage, UK
| | - Martin N Rossor
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL, London, UK
| | - Alistair Burns
- Division of Neuroscience & Experimental Psychology, University of Manchester, Manchester, UK
| |
Collapse
|
26
|
Thust SC, Heiland S, Falini A, Jäger HR, Waldman AD, Sundgren PC, Godi C, Katsaros VK, Ramos A, Bargallo N, Vernooij MW, Yousry T, Bendszus M, Smits M. Glioma imaging in Europe: A survey of 220 centres and recommendations for best clinical practice. Eur Radiol 2018. [PMID: 29536240 PMCID: PMC6028837 DOI: 10.1007/s00330-018-5314-5] [Citation(s) in RCA: 129] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Objectives At a European Society of Neuroradiology (ESNR) Annual Meeting 2015 workshop, commonalities in practice, current controversies and technical hurdles in glioma MRI were discussed. We aimed to formulate guidance on MRI of glioma and determine its feasibility, by seeking information on glioma imaging practices from the European Neuroradiology community. Methods Invitations to a structured survey were emailed to ESNR members (n=1,662) and associates (n=6,400), European national radiologists’ societies and distributed via social media. Results Responses were received from 220 institutions (59% academic). Conventional imaging protocols generally include T2w, T2-FLAIR, DWI, and pre- and post-contrast T1w. Perfusion MRI is used widely (85.5%), while spectroscopy seems reserved for specific indications. Reasons for omitting advanced imaging modalities include lack of facility/software, time constraints and no requests. Early postoperative MRI is routinely carried out by 74% within 24–72 h, but only 17% report a percent measure of resection. For follow-up, most sites (60%) issue qualitative reports, while 27% report an assessment according to the RANO criteria. A minority of sites use a reporting template (23%). Conclusion Clinical best practice recommendations for glioma imaging assessment are proposed and the current role of advanced MRI modalities in routine use is addressed. Key Points • We recommend the EORTC-NBTS protocol as the clinical standard glioma protocol. • Perfusion MRI is recommended for diagnosis and follow-up of glioma. • Use of advanced imaging could be promoted with increased education activities. • Most response assessment is currently performed qualitatively. • Reporting templates are not widely used, and could facilitate standardisation. Electronic supplementary material The online version of this article (10.1007/s00330-018-5314-5) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- S C Thust
- Lysholm Neuroradiology Department, National Hospital for Neurology and Neurosurgery, London, UK
- Department of Brain Rehabilitation and Repair, UCL Institute of Neurology, London, UK
- Imaging Department, University College London Hospital, London, UK
| | - S Heiland
- Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany
| | - A Falini
- Department of Neuroradiology, San Raffaele Scientific Institute, Milan, Italy
| | - H R Jäger
- Lysholm Neuroradiology Department, National Hospital for Neurology and Neurosurgery, London, UK
- Department of Brain Rehabilitation and Repair, UCL Institute of Neurology, London, UK
- Imaging Department, University College London Hospital, London, UK
| | - A D Waldman
- Neuroimaging Sciences, University of Edinburgh, Edinburgh, UK
| | - P C Sundgren
- Institution for Clinical Sciences/Radiology, Lund University, Lund, Sweden
- Centre for Imaging and Physiology, Skåne University hospital, Lund, Sweden
| | - C Godi
- Department of Neuroradiology, San Raffaele Scientific Institute, Milan, Italy
| | - V K Katsaros
- General Anti-Cancer and Oncological Hospital "Agios Savvas", Athens, Greece
- Central Clinic of Athens, Athens, Greece
- University of Athens, Athens, Greece
| | - A Ramos
- Hospital 12 de Octubre, Madrid, Spain
| | - N Bargallo
- Image Diagnostic Centre, Hospital Clinic de Barcelona, Barcelona, Spain
- Magnetic Resonance Core Facility, Institut per la Recerca Biomedica August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - M W Vernooij
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands
| | - T Yousry
- Lysholm Neuroradiology Department, National Hospital for Neurology and Neurosurgery, London, UK
| | - M Bendszus
- Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany
| | - M Smits
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands.
| |
Collapse
|
27
|
Mick I, Ramos AC, Myers J, Stokes PR, Chandrasekera S, Erritzoe D, Mendez MA, Gunn RN, Rabiner EA, Searle GE, Galduróz JCF, Waldman AD, Bowden-Jones H, Clark L, Nutt DJ, Lingford-Hughes AR. Evidence for GABA-A receptor dysregulation in gambling disorder: correlation with impulsivity. Addict Biol 2017; 22:1601-1609. [PMID: 27739164 PMCID: PMC5697606 DOI: 10.1111/adb.12457] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 07/14/2016] [Accepted: 08/30/2016] [Indexed: 12/11/2022]
Abstract
As a behavioural addiction, gambling disorder (GD) provides an opportunity to characterize addictive processes without the potentially confounding effects of chronic excessive drug and alcohol exposure. Impulsivity is an established precursor to such addictive behaviours, and GD is associated with greater impulsivity. There is also evidence of GABAergic dysregulation in substance addiction and in impulsivity. This study therefore investigated GABAA receptor availability in 15 individuals with GD and 19 healthy volunteers (HV) using [11C]Ro15‐4513, a relatively selective α5 benzodiazepine receptor PET tracer and its relationship with impulsivity. We found significantly higher [11C]Ro15‐4513 total distribution volume (VT) in the right hippocampus in the GD group compared with HV. We found higher levels of the ‘Negative Urgency’ construct of impulsivity in GD, and these were positively associated with higher [11C]Ro15‐4513 VT in the amygdala in the GD group; no such significant correlations were evident in the HV group. These results contrast with reduced binding of GABAergic PET ligands described previously in alcohol and opiate addiction and add to growing evidence for distinctions in the neuropharmacology between substance and behavioural addictions. These results provide the first characterization of GABAA receptors in GD with [11C]Ro15‐4513 PET and show greater α5 receptor availability and positive correlations with trait impulsivity. This GABAergic dysregulation is potential target for treatment.
Collapse
Affiliation(s)
- Inge Mick
- Centre for Neuropsychopharmacology, Division of Brain Sciences, Faculty of Medicine; Imperial College London; UK
| | - Anna C. Ramos
- Centre for Neuropsychopharmacology, Division of Brain Sciences, Faculty of Medicine; Imperial College London; UK
- Department of Psychobiology; Universidade Federal de São Paulo; Brazil
| | - Jim Myers
- Centre for Neuropsychopharmacology, Division of Brain Sciences, Faculty of Medicine; Imperial College London; UK
| | - Paul R. Stokes
- Centre for Neuropsychopharmacology, Division of Brain Sciences, Faculty of Medicine; Imperial College London; UK
- Centre for Affective Disorders, Department of Psychological Medicine; Institute of Psychiatry, Psychology and Neuroscience, King's College London; UK
| | - Samantha Chandrasekera
- Centre for Neuropsychopharmacology, Division of Brain Sciences, Faculty of Medicine; Imperial College London; UK
| | - David Erritzoe
- Centre for Neuropsychopharmacology, Division of Brain Sciences, Faculty of Medicine; Imperial College London; UK
| | - Maria A. Mendez
- Forensic and Neurodevelopmental Sciences; Institute of Psychiatry, King's College; UK
| | - Roger N. Gunn
- Centre for Neuropsychopharmacology, Division of Brain Sciences, Faculty of Medicine; Imperial College London; UK
- Imanova Ltd.; Centre for Imaging Sciences; UK
| | - Eugenii A. Rabiner
- Imanova Ltd.; Centre for Imaging Sciences; UK
- Department of Neuroimaging; Institute of Psychiatry, King's College; UK
| | | | | | - Adam D. Waldman
- Department of Imaging, Division of Experimental Medicine, Department of Medicine; Imperial College; UK
| | - Henrietta Bowden-Jones
- National Problem Gambling Clinic, CNWL NHS Foundation Trust; Imperial College London; UK
| | - Luke Clark
- Centre for Gambling Research at UBC, Department of Psychology; University of British Columbia; Canada
| | - David J. Nutt
- Centre for Neuropsychopharmacology, Division of Brain Sciences, Faculty of Medicine; Imperial College London; UK
| | - Anne R. Lingford-Hughes
- Centre for Neuropsychopharmacology, Division of Brain Sciences, Faculty of Medicine; Imperial College London; UK
| |
Collapse
|
28
|
Ritchie CW, Russ TC, Banerjee S, Barber B, Boaden A, Fox NC, Holmes C, Isaacs JD, Leroi I, Lovestone S, Norton M, O'Brien J, Pearson J, Perry R, Pickett J, Waldman AD, Wong WL, Rossor MN, Burns A. The Edinburgh Consensus: preparing for the advent of disease-modifying therapies for Alzheimer's disease. Alzheimers Res Ther 2017; 9:85. [PMID: 29070066 PMCID: PMC5657110 DOI: 10.1186/s13195-017-0312-4] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
CONTEXT This commentary discusses the implications of disease-modifying treatments for Alzheimer's disease which seem likely to appear in the next few years and results from a meeting of British experts in neurodegenerative diseases in Edinburgh. The availability of such treatments would help change public and professional attitudes and accelerate engagement with the prodromal and preclinical populations who might benefit from them. However, this would require an updated understanding of Alzheimer's disease, namely the important distinction between Alzheimer's disease and Alzheimer's dementia. CONSENSUS Since treatments are likely to be most effective in the early stages, identification of clinically relevant brain changes (for example, amyloid burden using imaging or cerebrospinal fluid biomarkers) will be crucial. While current biomarkers could be useful in identifying eligibility for new therapies, trial data are not available to aid decisions about stopping or continuing treatment in clinical practice. Therefore, effective monitoring of safety and effectiveness when these treatments are introduced into clinical practice will be necessary to inform wide-scale use. Equity of access is key but there is a tension between universal access for everyone with a diagnosis of Alzheimer's disease and specifying an eligible population most likely to respond. We propose the resources necessary for an optimal care pathway as well as the necessary education and training for primary and secondary care. CONCLUSION The majority of current services in the UK and elsewhere would not be able to accommodate the specialist investigations required to select patients and prescribe these therapies. Therefore, a stepped approach would be necessary: from innovating sentinel clinical-academic centres that already have capacity to deliver the necessary phase IV trials, through early adoption in a hub and spoke model, to nationwide adoption for true equity of access. The optimism generated by recent and anticipated developments in the understanding and treatment of Alzheimer's disease presents a great opportunity to innovate and adapt our services to incorporate the next exciting development in the field of dementia.
Collapse
Affiliation(s)
- Craig W Ritchie
- Centre for Dementia Prevention, University of Edinburgh, 9a Edinburgh BioQuarter, 9 Little France Road, Edinburgh, EH16 4UX, UK. .,Division of Psychiatry, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.
| | - Tom C Russ
- Centre for Dementia Prevention, University of Edinburgh, 9a Edinburgh BioQuarter, 9 Little France Road, Edinburgh, EH16 4UX, UK.,Division of Psychiatry, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.,Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK.,Centre for Cognitive Ageing & Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
| | - Sube Banerjee
- Centre for Dementia Studies, Brighton and Sussex Medical School, Brighton, UK
| | - Bob Barber
- Old Age Faculty, Royal College of Psychiatrists, London, UK
| | | | - Nick C Fox
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL, London, UK
| | - Clive Holmes
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Jeremy D Isaacs
- St George's University Hospitals NHS Foundation Trust, London, UK
| | - Ira Leroi
- Division of Neuroscience & Experimental Psychology, University of Manchester, Manchester, UK
| | | | | | - John O'Brien
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | | | | | | | - Adam D Waldman
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Wai Lup Wong
- East and North Hertfordshire NHS Trust, Stevenage, UK
| | - Martin N Rossor
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL, London, UK
| | - Alistair Burns
- Division of Neuroscience & Experimental Psychology, University of Manchester, Manchester, UK
| |
Collapse
|
29
|
Saleem A, Searle GE, Kenny LM, Huiban M, Kozlowski K, Waldman AD, Woodley L, Palmieri C, Lowdell C, Kaneko T, Murphy PS, Lau MR, Aboagye EO, Coombes RC. Erratum to: Lapatinib access into normal brain and brain metastases in patients with Her-2 overexpressing breast cancer. EJNMMI Res 2017; 7:74. [PMID: 28887806 PMCID: PMC5591177 DOI: 10.1186/s13550-017-0323-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 08/25/2017] [Indexed: 11/25/2022] Open
Affiliation(s)
- Azeem Saleem
- Imanova Centre for Imaging Sciences, Imperial College London, Hammersmith Hospital, Burlington Danes Building, Du Cane Road, London, W12 0NN, UK.
| | - Graham E Searle
- Imanova Centre for Imaging Sciences, Imperial College London, Hammersmith Hospital, Burlington Danes Building, Du Cane Road, London, W12 0NN, UK
| | - Laura M Kenny
- Department of Surgery and Cancer, Imperial College London, Charing Cross Hospital, Fulham Palace Road, London, W6 8RF, UK
| | - Mickael Huiban
- Imanova Centre for Imaging Sciences, Imperial College London, Hammersmith Hospital, Burlington Danes Building, Du Cane Road, London, W12 0NN, UK
| | - Kasia Kozlowski
- Department of Surgery and Cancer, Imperial College London, Charing Cross Hospital, Fulham Palace Road, London, W6 8RF, UK
| | - Adam D Waldman
- Division of Brain Sciences, Imperial College Department of Imaging, Imperial College Healthcare NHS Trust, Charing Cross Hospital, Fulham Palace Road, London, W6 8RF, UK
| | - Laura Woodley
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, Du Cane Road, London, W12 0NN, UK
| | - Carlo Palmieri
- Department of Molecular and Clinical Cancer Medicine, Duncan Building, Daulby Street, Liverpool, L69 3GA, UK
| | - Charles Lowdell
- Imperial College Healthcare NHS Trust, Charing Cross Hospital, Fulham Palace Road, London, W6 8RF, UK
| | - Tomomi Kaneko
- GlaxoSmithKline Oncology, Stockley Park West, Uxbridge, Middlesex, UB11 1BT, UK
| | - Philip S Murphy
- Clinical Imaging and Medicines Development, GlaxoSmithKline, Gunnels Wood Road, Stevenage, Hertfordshire, SG1 2NY, UK
| | - Mike R Lau
- Clinical Imaging and Medicines Development, GlaxoSmithKline, Gunnels Wood Road, Stevenage, Hertfordshire, SG1 2NY, UK
| | - Eric O Aboagye
- Department of Surgery and Cancer, Imperial College London, Charing Cross Hospital, Fulham Palace Road, London, W6 8RF, UK
| | - Raoul C Coombes
- Department of Surgery and Cancer, Imperial College London, Charing Cross Hospital, Fulham Palace Road, London, W6 8RF, UK
| |
Collapse
|
30
|
Grech-Sollars M, Vaqas B, Thompson G, Barwick T, Honeyfield L, O'Neill K, Waldman AD. An MRS- and PET-guided biopsy tool for intraoperative neuronavigational systems. J Neurosurg 2017:1-7. [PMID: 28306418 DOI: 10.3171/2016.7.jns16106.test] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Glioma heterogeneity and the limitations of conventional structural MRI for identifying aggressive tumor components can limit the reliability of stereotactic biopsy and, hence, tumor characterization, which is a hurdle for developing and selecting effective treatment strategies. In vivo MR spectroscopy (MRS) and PET enable noninvasive imaging of cellular metabolism relevant to proliferation and can detect regions of more highly active tumor. Here, the authors integrated presurgical PET and MRS with intraoperative neuronavigation to guide surgical biopsy and tumor sampling of brain gliomas with the aim of improving intraoperative tumor-tissue characterization and imaging biomarker validation. METHODS A novel intraoperative neuronavigation tool was developed as part of a study that aimed to sample high-choline tumor components identified by multivoxel MRS and 18F-methylcholine PET-CT. Spatially coregistered PET and MRS data were integrated into structural data sets and loaded onto an intraoperative neuronavigation system. High and low choline uptake/metabolite regions were represented as color-coded hollow spheres for targeted stereotactic biopsy and tumor sampling. RESULTS The neurosurgeons found the 3D spherical targets readily identifiable on the interactive neuronavigation system. In one case, areas of high mitotic activity were identified on the basis of high 18F-methylcholine uptake and elevated choline ratios found with MRS in an otherwise low-grade tumor, which revealed the possible use of this technique for tumor characterization. CONCLUSIONS These PET and MRI data can be combined and represented usefully for the surgeon in neuronavigation systems. This method enables neurosurgeons to sample tumor regions based on physiological and molecular imaging markers. The technique was applied for characterizing choline metabolism using MRS and 18F PET; however, this approach provides proof of principle for using different radionuclide tracers and other MRI methods, such as MR perfusion and diffusion.
Collapse
Affiliation(s)
- Matthew Grech-Sollars
- Departments of 1 Imaging and
- Division of Brain Sciences, Imperial College London; and
| | - Babar Vaqas
- Neurosurgery, Imperial College Healthcare NHS Trust
| | - Gerard Thompson
- Department of Neuroradiology, Salford Royal NHS Foundation Trust, Salford, United Kingdom
| | - Tara Barwick
- Departments of 1 Imaging and
- Department of Surgery and Cancer, and
| | | | | | - Adam D Waldman
- Departments of 1 Imaging and
- Division of Brain Sciences, Imperial College London; and
| |
Collapse
|
31
|
Grover VPB, McPhail MJW, Wylezinska-Arridge M, Crossey MME, Fitzpatrick JA, Southern L, Saxby BK, Cook NA, Cox IJ, Waldman AD, Dhanjal NS, Bak-Bol A, Williams R, Morgan MY, Taylor-Robinson SD. A longitudinal study of patients with cirrhosis treated with L-ornithine L-aspartate, examined with magnetization transfer, diffusion-weighted imaging and magnetic resonance spectroscopy. Metab Brain Dis 2017; 32:77-86. [PMID: 27488112 PMCID: PMC5225223 DOI: 10.1007/s11011-016-9881-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Accepted: 07/19/2016] [Indexed: 12/31/2022]
Abstract
The presence of overt hepatic encephalopathy (HE) is associated with structural, metabolic and functional changes in the brain discernible by use of a variety of magnetic resonance (MR) techniques. The changes in patients with minimal HE are less well documented. Twenty-two patients with well-compensated cirrhosis, seven of whom had minimal HE, were examined with cerebral 3 Tesla MR techniques, including T1- and T2-weighted, magnetization transfer and diffusion-weighted imaging and proton magnetic resonance spectroscopy sequences. Studies were repeated after a 4-week course of oral L-ornithine L-aspartate (LOLA). Results were compared with data obtained from 22 aged-matched healthy controls. There was no difference in mean total brain volume between patients and controls at baseline. Mean cerebral magnetization transfer ratios were significantly reduced in the globus pallidus and thalamus in the patients with cirrhosis irrespective of neuropsychiatric status; the mean ratio was significantly reduced in the frontal white matter in patients with minimal HE compared with healthy controls but not when compared with their unimpaired counterparts. There were no significant differences in either the median apparent diffusion coefficients or the mean fractional anisotropy, calculated from the diffusion-weighted imaging, or in the mean basal ganglia metabolite ratios between patients and controls. Psychometric performance improved in 50 % of patients with minimal HE following LOLA, but no significant changes were observed in brain volumes, cerebral magnetization transfer ratios, the diffusion weighted imaging variables or the cerebral metabolite ratios. MR variables, as applied in this study, do not identify patients with minimal HE, nor do they reflect changes in psychometric performance following LOLA.
Collapse
Affiliation(s)
- Vijay P B Grover
- Liver Unit, Division of Digestive Health, Department of Surgery and Cancer, Imperial College London, 10th Floor QEQM Wing, St Mary's Hospital, Praed Street, London, W2 1NY, UK
- Robert Steiner MRI Unit, Imaging Sciences Department, MRC Clinical Sciences Centre, Imperial College London, London, UK
| | - Mark J W McPhail
- Liver Unit, Division of Digestive Health, Department of Surgery and Cancer, Imperial College London, 10th Floor QEQM Wing, St Mary's Hospital, Praed Street, London, W2 1NY, UK
- Robert Steiner MRI Unit, Imaging Sciences Department, MRC Clinical Sciences Centre, Imperial College London, London, UK
| | - Marzena Wylezinska-Arridge
- Liver Unit, Division of Digestive Health, Department of Surgery and Cancer, Imperial College London, 10th Floor QEQM Wing, St Mary's Hospital, Praed Street, London, W2 1NY, UK
- Robert Steiner MRI Unit, Imaging Sciences Department, MRC Clinical Sciences Centre, Imperial College London, London, UK
| | - Mary M E Crossey
- Liver Unit, Division of Digestive Health, Department of Surgery and Cancer, Imperial College London, 10th Floor QEQM Wing, St Mary's Hospital, Praed Street, London, W2 1NY, UK
| | - Julie A Fitzpatrick
- Liver Unit, Division of Digestive Health, Department of Surgery and Cancer, Imperial College London, 10th Floor QEQM Wing, St Mary's Hospital, Praed Street, London, W2 1NY, UK
- Robert Steiner MRI Unit, Imaging Sciences Department, MRC Clinical Sciences Centre, Imperial College London, London, UK
| | - Louise Southern
- Liver Unit, Division of Digestive Health, Department of Surgery and Cancer, Imperial College London, 10th Floor QEQM Wing, St Mary's Hospital, Praed Street, London, W2 1NY, UK
| | - Brian K Saxby
- Centre for Ageing and Health, Newcastle University, Newcastle-upon-Tyne, UK
| | - Nicola A Cook
- Liver Unit, Division of Digestive Health, Department of Surgery and Cancer, Imperial College London, 10th Floor QEQM Wing, St Mary's Hospital, Praed Street, London, W2 1NY, UK
| | - I Jane Cox
- The Foundation for Liver Research, Institute of Hepatology, 69-75 Chenies Mews, London, WC1E 6HX, UK
| | - Adam D Waldman
- Robert Steiner MRI Unit, Imaging Sciences Department, MRC Clinical Sciences Centre, Imperial College London, London, UK
| | - Novraj S Dhanjal
- Division of Brain Sciences, Hammersmith Hospital Campus, Imperial College London, London, UK
| | - Aluel Bak-Bol
- Liver Unit, Division of Digestive Health, Department of Surgery and Cancer, Imperial College London, 10th Floor QEQM Wing, St Mary's Hospital, Praed Street, London, W2 1NY, UK
- Robert Steiner MRI Unit, Imaging Sciences Department, MRC Clinical Sciences Centre, Imperial College London, London, UK
| | - Roger Williams
- The Foundation for Liver Research, Institute of Hepatology, 69-75 Chenies Mews, London, WC1E 6HX, UK
| | - Marsha Y Morgan
- UCL Institute for Liver & Digestive Health, Division of Medicine, Royal Free Campus, University College London, London, UK
| | - Simon D Taylor-Robinson
- Liver Unit, Division of Digestive Health, Department of Surgery and Cancer, Imperial College London, 10th Floor QEQM Wing, St Mary's Hospital, Praed Street, London, W2 1NY, UK.
| |
Collapse
|
32
|
McGonigle J, Murphy A, Paterson LM, Reed LJ, Nestor L, Nash J, Elliott R, Ersche KD, Flechais RSA, Newbould R, Orban C, Smith DG, Taylor EM, Waldman AD, Robbins TW, Deakin JFW, Nutt DJ, Lingford-Hughes AR, Suckling J. The ICCAM platform study: An experimental medicine platform for evaluating new drugs for relapse prevention in addiction. Part B: fMRI description. J Psychopharmacol 2017; 31:3-16. [PMID: 27703042 PMCID: PMC5367542 DOI: 10.1177/0269881116668592] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES We aimed to set up a robust multi-centre clinical fMRI and neuropsychological platform to investigate the neuropharmacology of brain processes relevant to addiction - reward, impulsivity and emotional reactivity. Here we provide an overview of the fMRI battery, carried out across three centres, characterizing neuronal response to the tasks, along with exploring inter-centre differences in healthy participants. EXPERIMENTAL DESIGN Three fMRI tasks were used: monetary incentive delay to probe reward sensitivity, go/no-go to probe impulsivity and an evocative images task to probe emotional reactivity. A coordinate-based activation likelihood estimation (ALE) meta-analysis was carried out for the reward and impulsivity tasks to help establish region of interest (ROI) placement. A group of healthy participants was recruited from across three centres (total n=43) to investigate inter-centre differences. Principle observations: The pattern of response observed for each of the three tasks was consistent with previous studies using similar paradigms. At the whole brain level, significant differences were not observed between centres for any task. CONCLUSIONS In developing this platform we successfully integrated neuroimaging data from three centres, adapted validated tasks and applied whole brain and ROI approaches to explore and demonstrate their consistency across centres.
Collapse
Affiliation(s)
- John McGonigle
- Centre for Neuropsychopharmacology, Division of Brain Sciences, Imperial College London, London, UK
| | - Anna Murphy
- Neuroscience and Psychiatry Unit, Institute of Brain, Behaviour and Mental Health, The University of Manchester, Manchester, UK
| | - Louise M Paterson
- Centre for Neuropsychopharmacology, Division of Brain Sciences, Imperial College London, London, UK
| | - Laurence J Reed
- Centre for Neuropsychopharmacology, Division of Brain Sciences, Imperial College London, London, UK
| | - Liam Nestor
- Centre for Neuropsychopharmacology, Division of Brain Sciences, Imperial College London, London, UK,Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Jonathan Nash
- Centre for Neuropsychopharmacology, Division of Brain Sciences, Imperial College London, London, UK
| | - Rebecca Elliott
- Neuroscience and Psychiatry Unit, Institute of Brain, Behaviour and Mental Health, The University of Manchester, Manchester, UK
| | - Karen D Ersche
- Department of Psychiatry, University of Cambridge, Cambridge, UK,Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
| | - Remy SA Flechais
- Centre for Neuropsychopharmacology, Division of Brain Sciences, Imperial College London, London, UK
| | | | - Csaba Orban
- Centre for Neuropsychopharmacology, Division of Brain Sciences, Imperial College London, London, UK
| | - Dana G Smith
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
| | - Eleanor M Taylor
- Neuroscience and Psychiatry Unit, Institute of Brain, Behaviour and Mental Health, The University of Manchester, Manchester, UK
| | - Adam D Waldman
- Centre for Neuroinflammation and Neurodegeneration, Division of Brain Sciences, Imperial College London, London, UK
| | - Trevor W Robbins
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK,Department of Psychology, University of Cambridge, Cambridge, UK
| | - JF William Deakin
- Neuroscience and Psychiatry Unit, Institute of Brain, Behaviour and Mental Health, The University of Manchester, Manchester, UK
| | - David J Nutt
- Centre for Neuropsychopharmacology, Division of Brain Sciences, Imperial College London, London, UK
| | - Anne R Lingford-Hughes
- Centre for Neuropsychopharmacology, Division of Brain Sciences, Imperial College London, London, UK,Anne Lingford-Hughes, Centre for Neuropsychopharmacology, Imperial College London, Burlington Danes Building, Hammersmith Hospital campus, 160 Du Cane Road, London W12 0NN, UK.
| | - John Suckling
- Department of Psychiatry, University of Cambridge, Cambridge, UK,Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK,Cambridgeshire and Peterborough NHS Foundation Trust, Fulbourn, UK
| | | |
Collapse
|
33
|
Grover VPB, Crossey MME, Fitzpatrick JA, Saxby BK, Shaw R, Waldman AD, Morgan MY, Taylor-Robinson SD. Quantitative magnetic resonance imaging in patients with cirrhosis: a cross-sectional study. Metab Brain Dis 2016; 31:1315-1325. [PMID: 26251205 DOI: 10.1007/s11011-015-9716-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 07/26/2015] [Indexed: 12/11/2022]
Abstract
Cerebral magnetic resonance imaging was undertaken, at 3 Tesla field strength, employing magnetization transfer (MT) and diffusion-weighted imaging (DWI) sequences, in 26 patients with well-compensated cirrhosis, free of overt hepatic encephalopathy. Results were compared to those from 18 aged-matched healthy volunteers. Cerebral magnetization transfer ratios (MTR) were reduced in the frontal white matter, caudate, putamen and globus pallidus in patients with cirrhosis, compared to healthy controls, while the apparent diffusion coefficients (ADC) on DWI were significantly increased in the genu and body of the corpus callosum. An association between previous excessive alcohol consumption and both MTR and ADCs was noted, but this association was lost when controls were exercised for the severity of liver disease and psychometric impairment on multivariate analysis. Eight (31 %) of the 26 patients had impaired psychometric performance consistent with a diagnosis of minimal hepatic encephalopathy. No statistically significant difference in regional cerebral MTRs or ADCs was found in relation to neuropsychiatric status, although there was a trend towards lower MTRs in patients with impaired psychometric performance. The alterations in MTR and ADC in the patients with functionally compensated cirrhosis are compatible with theories governing the genesis of hepatic encephalopathy, including changes in astrocyte membrane permeability, with subsequent redistribution of macromolecules.
Collapse
Affiliation(s)
- Vijay P B Grover
- Liver Unit, Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, Imperial College London, 10th Floor QEQM Wing, St. Mary's Hospital Campus, South Wharf Street, London, W2 1NY, UK
- Robert Steiner MRI Unit, Imaging Sciences Department, MRC Clinical Sciences Centre, Imperial College London, London, UK
| | - Mary M E Crossey
- Liver Unit, Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, Imperial College London, 10th Floor QEQM Wing, St. Mary's Hospital Campus, South Wharf Street, London, W2 1NY, UK
| | - Julie A Fitzpatrick
- Liver Unit, Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, Imperial College London, 10th Floor QEQM Wing, St. Mary's Hospital Campus, South Wharf Street, London, W2 1NY, UK
- Robert Steiner MRI Unit, Imaging Sciences Department, MRC Clinical Sciences Centre, Imperial College London, London, UK
| | - Brian K Saxby
- Centre for Ageing and Health, Newcastle University, Newcastle-upon-Tyne, UK
| | - Roberta Shaw
- Liver Unit, Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, Imperial College London, 10th Floor QEQM Wing, St. Mary's Hospital Campus, South Wharf Street, London, W2 1NY, UK
| | - Adam D Waldman
- Robert Steiner MRI Unit, Imaging Sciences Department, MRC Clinical Sciences Centre, Imperial College London, London, UK
| | - Marsha Y Morgan
- UCL Institute for Liver & Digestive Health, Division of Medicine, University College London, Royal Free Campus, London, UK
| | - Simon D Taylor-Robinson
- Liver Unit, Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, Imperial College London, 10th Floor QEQM Wing, St. Mary's Hospital Campus, South Wharf Street, London, W2 1NY, UK.
| |
Collapse
|
34
|
Grech-Sollars M, Vaqas B, Thompson G, Barwick T, Honeyfield L, O'Neill K, Waldman AD. An MRS- and PET-guided biopsy tool for intraoperative neuronavigational systems. J Neurosurg 2016; 127:812-818. [PMID: 27834593 DOI: 10.3171/2016.7.jns16106] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Glioma heterogeneity and the limitations of conventional structural MRI for identifying aggressive tumor components can limit the reliability of stereotactic biopsy and, hence, tumor characterization, which is a hurdle for developing and selecting effective treatment strategies. In vivo MR spectroscopy (MRS) and PET enable noninvasive imaging of cellular metabolism relevant to proliferation and can detect regions of more highly active tumor. Here, the authors integrated presurgical PET and MRS with intraoperative neuronavigation to guide surgical biopsy and tumor sampling of brain gliomas with the aim of improving intraoperative tumor-tissue characterization and imaging biomarker validation. METHODS A novel intraoperative neuronavigation tool was developed as part of a study that aimed to sample high-choline tumor components identified by multivoxel MRS and 18F-methylcholine PET-CT. Spatially coregistered PET and MRS data were integrated into structural data sets and loaded onto an intraoperative neuronavigation system. High and low choline uptake/metabolite regions were represented as color-coded hollow spheres for targeted stereotactic biopsy and tumor sampling. RESULTS The neurosurgeons found the 3D spherical targets readily identifiable on the interactive neuronavigation system. In one case, areas of high mitotic activity were identified on the basis of high 18F-methylcholine uptake and elevated choline ratios found with MRS in an otherwise low-grade tumor, which revealed the possible use of this technique for tumor characterization. CONCLUSIONS These PET and MRI data can be combined and represented usefully for the surgeon in neuronavigation systems. This method enables neurosurgeons to sample tumor regions based on physiological and molecular imaging markers. The technique was applied for characterizing choline metabolism using MRS and 18F PET; however, this approach provides proof of principle for using different radionuclide tracers and other MRI methods, such as MR perfusion and diffusion.
Collapse
Affiliation(s)
- Matthew Grech-Sollars
- Departments of 1 Imaging and.,Division of Brain Sciences, Imperial College London; and
| | - Babar Vaqas
- Neurosurgery, Imperial College Healthcare NHS Trust
| | - Gerard Thompson
- Department of Neuroradiology, Salford Royal NHS Foundation Trust, Salford, United Kingdom
| | - Tara Barwick
- Departments of 1 Imaging and.,Department of Surgery and Cancer, and
| | | | | | - Adam D Waldman
- Departments of 1 Imaging and.,Division of Brain Sciences, Imperial College London; and
| |
Collapse
|
35
|
De Simoni S, Grover PJ, Jenkins PO, Honeyfield L, Quest RA, Ross E, Scott G, Wilson MH, Majewska P, Waldman AD, Patel MC, Sharp DJ. Disconnection between the default mode network and medial temporal lobes in post-traumatic amnesia. Brain 2016; 139:3137-3150. [PMID: 27797805 PMCID: PMC5382939 DOI: 10.1093/brain/aww241] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Revised: 04/25/2016] [Accepted: 08/05/2016] [Indexed: 01/10/2023] Open
Abstract
See Bigler (doi:10.1093/aww277) for a scientific commentary on this article. Post-traumatic amnesia is very common immediately after traumatic brain injury. It is characterized by a confused, agitated state and a pronounced inability to encode new memories and sustain attention. Clinically, post-traumatic amnesia is an important predictor of functional outcome. However, despite its prevalence and functional importance, the pathophysiology of post-traumatic amnesia is not understood. Memory processing relies on limbic structures such as the hippocampus, parahippocampus and parts of the cingulate cortex. These structures are connected within an intrinsic connectivity network, the default mode network. Interactions within the default mode network can be assessed using resting state functional magnetic resonance imaging, which can be acquired in confused patients unable to perform tasks in the scanner. Here we used this approach to test the hypothesis that the mnemonic symptoms of post-traumatic amnesia are caused by functional disconnection within the default mode network. We assessed whether the hippocampus and parahippocampus showed evidence of transient disconnection from cortical brain regions involved in memory processing. Nineteen patients with traumatic brain injury were classified into post-traumatic amnesia and traumatic brain injury control groups, based on their performance on a paired associates learning task. Cognitive function was also assessed with a detailed neuropsychological test battery. Functional interactions between brain regions were investigated using resting-state functional magnetic resonance imaging. Together with impairments in associative memory, patients in post-traumatic amnesia demonstrated impairments in information processing speed and spatial working memory. Patients in post-traumatic amnesia showed abnormal functional connectivity between the parahippocampal gyrus and posterior cingulate cortex. The strength of this functional connection correlated with both associative memory and information processing speed and normalized when these functions improved. We have previously shown abnormally high posterior cingulate cortex connectivity in the chronic phase after traumatic brain injury, and this abnormality was also observed in patients with post-traumatic amnesia. Patients with post-traumatic amnesia showed evidence of widespread traumatic axonal injury measured using diffusion magnetic resonance imaging. This change was more marked within the cingulum bundle, the tract connecting the parahippocampal gyrus to the posterior cingulate cortex. These findings provide novel insights into the pathophysiology of post-traumatic amnesia and evidence that memory impairment acutely after traumatic brain injury results from altered parahippocampal functional connectivity, perhaps secondary to the effects of axonal injury on white matter tracts connecting limbic structures involved in memory processing.
Collapse
Affiliation(s)
- Sara De Simoni
- 1 Computational, Cognitive and Clinical Neuroimaging Laboratory, Imperial College London, Division of Brain Sciences, Hammersmith Hospital, London, UK
| | - Patrick J Grover
- 1 Computational, Cognitive and Clinical Neuroimaging Laboratory, Imperial College London, Division of Brain Sciences, Hammersmith Hospital, London, UK
| | - Peter O Jenkins
- 1 Computational, Cognitive and Clinical Neuroimaging Laboratory, Imperial College London, Division of Brain Sciences, Hammersmith Hospital, London, UK
| | | | | | - Ewan Ross
- 1 Computational, Cognitive and Clinical Neuroimaging Laboratory, Imperial College London, Division of Brain Sciences, Hammersmith Hospital, London, UK
| | - Gregory Scott
- 1 Computational, Cognitive and Clinical Neuroimaging Laboratory, Imperial College London, Division of Brain Sciences, Hammersmith Hospital, London, UK
| | - Mark H Wilson
- 3 Traumatic Brain Injury Centre, Imperial College, St Mary's Hospital, London, UK
| | - Paulina Majewska
- 1 Computational, Cognitive and Clinical Neuroimaging Laboratory, Imperial College London, Division of Brain Sciences, Hammersmith Hospital, London, UK
| | - Adam D Waldman
- 2 Department of Imaging, Charing Cross Hospital, London, UK
| | | | - David J Sharp
- 1 Computational, Cognitive and Clinical Neuroimaging Laboratory, Imperial College London, Division of Brain Sciences, Hammersmith Hospital, London, UK
| |
Collapse
|
36
|
Lema A, Bishop C, Malik O, Mattoscio M, Ali R, Nicholas R, Muraro PA, Matthews PM, Waldman AD, Newbould RD. A Comparison of Magnetization Transfer Methods to Assess Brain and Cervical Cord Microstructure in Multiple Sclerosis. J Neuroimaging 2016; 27:221-226. [PMID: 27491693 DOI: 10.1111/jon.12377] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 06/25/2016] [Accepted: 06/26/2016] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Demyelination is a core pathological feature of multiple sclerosis (MS) and spontaneous remyelination appears to be an important mechanism for repair in the disease. Magnetization transfer ratio imaging (MTR) has been used extensively to evaluate demyelination, although limitations to its specificity are recognized. MT saturation imaging (MTsat) removes some of the T1 dependence of MTR. We have performed a comparative evaluation of MTR and MTsat imaging in a mixed group of subjects with active MS, to explore their relative sensitivity to pathology relevant to explaining clinical outcomes. METHODS A total of 134 subjects underwent MRI of their brain and cervical spinal cord. Isotropic 3-dimensional pre- and postcontrast T1-weighted and T2-weighted fluid-attenuated inversion recovery (FLAIR) volumes were segmented into brain normal appearing white matter (NAWM), brain WM lesions (WML), normal appearing spinal cord (NASC), and spinal cord lesions. Volumes and metrics for MTR and MTsat histograms were calculated for each region. RESULTS Significant Spearman correlations were found with the Expanded Disability Status Scale and timed 25-foot walk for the whole brain and WML MTR, but not in that from the NAWM or any cervical spinal cord region. By contrast, the MTsat was correlated with both disability metrics in all these regions in both the brain and spine. CONCLUSIONS This study extends prior work relating atrophy and lesion load with disability, by characterization of MTsat parameters. MTsat is practical in routine clinical applications and may be more sensitive to tissue damage than MTR for both brain and cervical spinal cord.
Collapse
Affiliation(s)
- Alfonso Lema
- Division of Brain Sciences, Department of Medicine, Imperial College London, London, UK
| | | | - Omar Malik
- Division of Brain Sciences, Department of Medicine, Imperial College London, London, UK
| | - Miriam Mattoscio
- Division of Brain Sciences, Department of Medicine, Imperial College London, London, UK
| | - Rehiana Ali
- Division of Brain Sciences, Department of Medicine, Imperial College London, London, UK
| | - Richard Nicholas
- Division of Brain Sciences, Department of Medicine, Imperial College London, London, UK
| | - Paolo A Muraro
- Division of Brain Sciences, Department of Medicine, Imperial College London, London, UK
| | - Paul M Matthews
- Division of Brain Sciences, Department of Medicine, Imperial College London, London, UK
| | - Adam D Waldman
- Department of Imaging, Imperial College Healthcare NHS Trust, London, UK
| | | |
Collapse
|
37
|
Booth TC, Ashkan K, Brazil L, Jäger R, Waldman AD. Re: Tumour progression or pseudoprogression? A review of post-treatment radiological appearances of glioblastoma. Clin Radiol 2016; 71:495-6. [PMID: 26896081 DOI: 10.1016/j.crad.2016.01.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 11/23/2015] [Accepted: 01/24/2016] [Indexed: 10/22/2022]
Affiliation(s)
- T C Booth
- King's College Hospital NHS Foundation Trust, London, UK.
| | - K Ashkan
- King's College Hospital NHS Foundation Trust, London, UK
| | - L Brazil
- King's College Hospital NHS Foundation Trust, London, UK
| | - R Jäger
- National Hospital for Neurology & Neurosurgery, London, UK
| | - A D Waldman
- Imperial College Healthcare NHS Trust, London, UK
| |
Collapse
|
38
|
Wardlaw JM, Davies H, Booth TC, Laurie G, Compston A, Freeman C, Leach MO, Waldman AD, Lomas DJ, Kessler K, Crabbe F, Jackson A. Acting on incidental findings in research imaging. BMJ 2015; 351:h5190. [PMID: 26556813 DOI: 10.1136/bmj.h5190] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- J M Wardlaw
- Division of Neuroimaging Sciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh EH16 4SB, UK
| | - H Davies
- Health Research Authority, Skipton House, London
| | - T C Booth
- Department of Neuroradiology, King's College Hospital NHS Foundation Trust, Denmark Hill, London
| | - G Laurie
- JK Mason Institute for Medicine, Life Sciences and the Law, School of Law, University of Edinburgh
| | - A Compston
- Department of Clinical Neurosciences, University of Cambridge
| | - C Freeman
- College Centre for Quality Improvement, Royal College of Psychiatrists, London
| | - M O Leach
- Cancer Research UK Cancer Imaging Centre, Institute of Cancer Research and Royal Marsden Hospital, London
| | - A D Waldman
- Department of Imaging, Imperial College London
| | - D J Lomas
- Department of Radiology, University of Cambridge and Addenbrooke's Hospital, Cambridge Biomedical Campus
| | - K Kessler
- Aston Brain Centre, School of Life and Health Sciences, Aston University, Birmingham
| | - F Crabbe
- Institute of Neuroscience and Psychology, University of Glasgow
| | - A Jackson
- Wolfson Molecular Imaging Centre, University of Manchester
| |
Collapse
|
39
|
Grech-Sollars M, Vaqas B, Thompson G, Honeyfield L, O'Neil K, Waldman AD. NIMG-30AN MRS AND PET GUIDED BIOPSY TOOL FOR ULTRASOUND-BASED INTRA-OPERATIVE NEURO-NAVIGATIONAL SYSTEMS. Neuro Oncol 2015. [DOI: 10.1093/neuonc/nov225.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
40
|
Paterson LM, Flechais RSA, Murphy A, Reed LJ, Abbott S, Boyapati V, Elliott R, Erritzoe D, Ersche KD, Faluyi Y, Faravelli L, Fernandez-Egea E, Kalk NJ, Kuchibatla SS, McGonigle J, Metastasio A, Mick I, Nestor L, Orban C, Passetti F, Rabiner EA, Smith DG, Suckling J, Tait R, Taylor EM, Waldman AD, Robbins TW, Deakin JFW, Nutt DJ, Lingford-Hughes AR. The Imperial College Cambridge Manchester (ICCAM) platform study: An experimental medicine platform for evaluating new drugs for relapse prevention in addiction. Part A: Study description. J Psychopharmacol 2015; 29:943-60. [PMID: 26246443 DOI: 10.1177/0269881115596155] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Drug and alcohol dependence are global problems with substantial societal costs. There are few treatments for relapse prevention and therefore a pressing need for further study of brain mechanisms underpinning relapse circuitry. The Imperial College Cambridge Manchester (ICCAM) platform study is an experimental medicine approach to this problem: using functional magnetic resonance imaging (fMRI) techniques and selective pharmacological tools, it aims to explore the neuropharmacology of putative relapse pathways in cocaine, alcohol, opiate dependent, and healthy individuals to inform future drug development. Addiction studies typically involve small samples because of recruitment difficulties and attrition. We established the platform in three centres to assess the feasibility of a multisite approach to address these issues. Pharmacological modulation of reward, impulsivity and emotional reactivity were investigated in a monetary incentive delay task, an inhibitory control task, and an evocative images task, using selective antagonists for µ-opioid, dopamine D3 receptor (DRD3) and neurokinin 1 (NK1) receptors (naltrexone, GSK598809, vofopitant/aprepitant), in a placebo-controlled, randomised, crossover design. In two years, 609 scans were performed, with 155 individuals scanned at baseline. Attrition was low and the majority of individuals were sufficiently motivated to complete all five sessions (n=87). We describe herein the study design, main aims, recruitment numbers, sample characteristics, and explain the test hypotheses and anticipated study outputs.
Collapse
Affiliation(s)
- Louise M Paterson
- Centre for Neuropsychopharmacology, Imperial College London, London, UK
| | - Remy S A Flechais
- Centre for Neuropsychopharmacology, Imperial College London, London, UK
| | - Anna Murphy
- Neuroscience and Psychiatry Unit, University of Manchester, Manchester, UK
| | - Laurence J Reed
- Centre for Neuropsychopharmacology, Imperial College London, London, UK
| | - Sanja Abbott
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
| | | | - Rebecca Elliott
- Neuroscience and Psychiatry Unit, University of Manchester, Manchester, UK
| | - David Erritzoe
- Centre for Neuropsychopharmacology, Imperial College London, London, UK
| | - Karen D Ersche
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Yetunde Faluyi
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Luca Faravelli
- Centre for Neuropsychopharmacology, Imperial College London, London, UK
| | - Emilio Fernandez-Egea
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Nicola J Kalk
- Centre for Neuropsychopharmacology, Imperial College London, London, UK
| | | | - John McGonigle
- Centre for Neuropsychopharmacology, Imperial College London, London, UK
| | - Antonio Metastasio
- Neuroscience and Psychiatry Unit, University of Manchester, Manchester, UK 5 Boroughs Partnership NHS Foundation Trust, Warrington, UK
| | - Inge Mick
- Centre for Neuropsychopharmacology, Imperial College London, London, UK
| | - Liam Nestor
- Centre for Neuropsychopharmacology, Imperial College London, London, UK Clinical Research Unit, GlaxoSmithKline, Cambridge, UK
| | - Csaba Orban
- Centre for Neuropsychopharmacology, Imperial College London, London, UK
| | - Filippo Passetti
- Centre for Neuropsychopharmacology, Imperial College London, London, UK Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK Department of Psychiatry, University of Cambridge, Cambridge, UK
| | | | - Dana G Smith
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK Department of Psychology, University of Cambridge, Cambridge, UK
| | - John Suckling
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Roger Tait
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
| | - Eleanor M Taylor
- Neuroscience and Psychiatry Unit, University of Manchester, Manchester, UK
| | - Adam D Waldman
- Centre for Neuroinflammation and Neurodegeneration, Imperial College London, London, UK
| | - Trevor W Robbins
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK Department of Psychology, University of Cambridge, Cambridge, UK
| | - J F William Deakin
- Neuroscience and Psychiatry Unit, University of Manchester, Manchester, UK
| | - David J Nutt
- Centre for Neuropsychopharmacology, Imperial College London, London, UK
| | | | | |
Collapse
|
41
|
Lavdas I, Rockall AG, Castelli F, Sandhu RS, Papadaki A, Honeyfield L, Waldman AD, Aboagye EO. Apparent Diffusion Coefficient of Normal Abdominal Organs and Bone Marrow From Whole-Body DWI at 1.5 T: The Effect of Sex and Age. AJR Am J Roentgenol 2015; 205:242-50. [PMID: 26204271 DOI: 10.2214/ajr.14.13964] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2024]
Abstract
OBJECTIVE The objectives of this study were to define the range of apparent diffusion coefficients (ADCs) from whole-body DWI in normal abdominal organs and bone marrow, to identify ADC differences between sexes and changes occurring with age, and to evaluate the effect of the fat fraction (FF) on the ADC of normal liver parenchyma and bone marrow. MATERIALS AND METHODS Fifty-one healthy volunteers (mean age = 38 years; age range = 23-68 years) underwent whole-body DWI using single-shot echo-planar imaging (b = 0, 150, 400, 750, and 1000 s/mm(2)). A two-point Dixon technique was used to evaluate the FF. Perfusion-sensitive ADCs, which we refer to as "ADCALL," and perfusion-insensitive ADCs, which we refer to as "ADCHIGH," of the liver and renal parenchyma, spleen, pancreatic tail, and red and yellow bone marrow were calculated. The relationships between ADC and sex, age, and FF were examined. RESULTS ADCALL and ADCHIGH were significantly higher in female volunteers for the pancreatic tail (p = 0.046 and 0.008, respectively), red bone marrow (p = 0.029 and 0.001), and yellow bone marrow (p < 0.001 for both) but with considerable overlap. There were significant negative correlations between ADCALL and ADCHIGH and age in the liver parenchyma (p = 0.008 and 0.01, respectively) and in the yellow bone marrow (p = 0.013 and 0.039) for all subjects. ADCALL and ADCHIGH were also negatively correlated with FF in the liver parenchyma (p = 0.006 and 0.008, respectively) and in yellow bone marrow (p < 0.001 and p = 0.001) in all subjects. CONCLUSION The ADCs of normal liver parenchyma and bone marrow change significantly with age. The ADCs of bone marrow in women are significantly higher than those of men and correlate strongly with FF. These effects may have an impact on image interpretation when using whole-body DWI to assess disease burden and treatment response.
Collapse
Affiliation(s)
- Ioannis Lavdas
- 1 Department of Surgery and Cancer, Comprehensive Cancer Imaging Centre, Imperial College, Hammersmith Campus, DuCane Rd, London W12 0NN, UK
| | - Andrea G Rockall
- 2 Imaging Department, Imperial College Healthcare NHS Trust, London, UK
| | | | - Ranbir S Sandhu
- 2 Imaging Department, Imperial College Healthcare NHS Trust, London, UK
| | - Annie Papadaki
- 4 Radiological Sciences Unit, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
| | - Lesley Honeyfield
- 2 Imaging Department, Imperial College Healthcare NHS Trust, London, UK
| | - Adam D Waldman
- 2 Imaging Department, Imperial College Healthcare NHS Trust, London, UK
- 5 Department of Medicine, Division of Brain Sciences, Imperial College, London, UK
| | - Eric O Aboagye
- 1 Department of Surgery and Cancer, Comprehensive Cancer Imaging Centre, Imperial College, Hammersmith Campus, DuCane Rd, London W12 0NN, UK
| |
Collapse
|
42
|
Saleem A, Searle GE, Kenny LM, Huiban M, Kozlowski K, Waldman AD, Woodley L, Palmieri C, Lowdell C, Kaneko T, Murphy PS, Lau MR, Aboagye EO, Coombes RC. Lapatinib access into normal brain and brain metastases in patients with Her-2 overexpressing breast cancer. EJNMMI Res 2015; 5:30. [PMID: 25977884 PMCID: PMC4424224 DOI: 10.1186/s13550-015-0103-5] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 04/11/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Brain metastases are common in human epidermal growth factor receptor (Her)-2-positive breast cancer. Drug access to brain metastases and normal brain is key to management of cranial disease. In this study, positron emission tomography (PET) scanning after administration of radiolabelled lapatinib was used to obtain direct evidence of cranial drug access. METHODS Patients with Her-2+ metastatic breast cancer either with at least one 1-cm diameter brain metastasis or without brain metastases underwent dynamic carbon-11 radiolabelled lapatinib ([(11)C]lapatinib)-PET. Less than 20 μg of [(11)C]lapatinib was administered before and after 8 days of oral lapatinib (1,500 mg once daily). Radial arterial blood sampling was performed throughout the 90-min scan. The contribution of blood volume activity to the tissue signal was excluded to calculate lapatinib uptake in normal brain and metastases. Partitioning of radioactivity between plasma and tissue (V T) was calculated and the tissue concentration of lapatinib derived. Plasma lapatinib levels were measured and adverse events noted. RESULTS Six patients (three with brain metastases) were recruited. About 80% plasma radioactivity corresponded to intact [(11)C]lapatinib after 60 min. PET signal in the brain corresponded to circulating radioactivity levels, with no [(11)C]lapatinib uptake observed in normal brain tissue. In contrast, radioactivity uptake in cranial metastases was significantly higher (p = 0.002) than that could be accounted by circulating radioactivity levels, consistent with [(11)C]lapatinib uptake in brain metastases. There was no difference in lapatinib uptake between the baseline and day 8 scans, suggesting no effect of increased drug access by inhibition of the drug efflux proteins by therapeutic doses of lapatinib. CONCLUSIONS Increased lapatinib uptake was observed in brain metastases but not in normal brain. TRIAL REGISTRATION ClinicalTrials.gov: NCT01290354.
Collapse
Affiliation(s)
- Azeem Saleem
- Imanova Centre for Imaging Sciences, Imperial College London, Hammersmith Hospital, Burlington Danes Building, Du Cane Road, London, W12 0NN UK
| | - Graham E Searle
- Imanova Centre for Imaging Sciences, Imperial College London, Hammersmith Hospital, Burlington Danes Building, Du Cane Road, London, W12 0NN UK
| | - Laura M Kenny
- Department of Surgery and Cancer, Imperial College London, Charing Cross Hospital, Fulham Palace Road, London, W6 8RF UK
| | - Mickael Huiban
- Imanova Centre for Imaging Sciences, Imperial College London, Hammersmith Hospital, Burlington Danes Building, Du Cane Road, London, W12 0NN UK
| | - Kasia Kozlowski
- Department of Surgery and Cancer, Imperial College London, Charing Cross Hospital, Fulham Palace Road, London, W6 8RF UK
| | - Adam D Waldman
- Division of Brain Sciences, Imperial College Department of Imaging, Imperial College Healthcare NHS Trust, Charing Cross Hospital, Fulham Palace Road, London, W6 8RF UK
| | - Laura Woodley
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, Du Cane Road, London, W12 0NN UK
| | - Carlo Palmieri
- Department of Molecular and Clinical Cancer Medicine, Duncan Building, Daulby Street, Liverpool, L69 3GA UK
| | - Charles Lowdell
- Imperial College Healthcare NHS Trust, Charing Cross Hospital, Fulham Palace Road, W6 8RF London, UK
| | - Tomomi Kaneko
- GlaxoSmithKline Oncology, Stockley Park West, Uxbridge, Middlesex, UB11 1BT UK
| | - Philip S Murphy
- Clinical Imaging and Medicines Development, GlaxoSmithKline, Gunnels Wood Road, Stevenage, Hertfordshire SG1 2NY UK
| | - Mike R Lau
- Clinical Imaging and Medicines Development, GlaxoSmithKline, Gunnels Wood Road, Stevenage, Hertfordshire SG1 2NY UK
| | - Eric O Aboagye
- Department of Surgery and Cancer, Imperial College London, Charing Cross Hospital, Fulham Palace Road, London, W6 8RF UK
| | - Raoul C Coombes
- Department of Surgery and Cancer, Imperial College London, Charing Cross Hospital, Fulham Palace Road, London, W6 8RF UK
| |
Collapse
|
43
|
Mattoscio M, Nicholas R, Sormani MP, Malik O, Lee JS, Waldman AD, Dazzi F, Muraro PA. Hematopoietic mobilization: Potential biomarker of response to natalizumab in multiple sclerosis. Neurology 2015; 84:1473-82. [PMID: 25762712 DOI: 10.1212/wnl.0000000000001454] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 12/22/2014] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To ascertain the mobilization from the bone marrow and the functional relevance of the increased number of circulating hematopoietic stem and progenitor cells (HSPC) induced by the anti-α-4 integrin antibody natalizumab in patients with multiple sclerosis (MS). METHODS We evaluated CD45(low)CD34+ HSPC frequency by flow cytometry in blood from 45 natalizumab-treated patients (12 of whom were prospectively followed during the first year of treatment as part of a pilot cohort and 16 prospectively followed for validation), 10 untreated patients with MS, and 24 healthy donors. In the natalizumab-treated group, we also assessed sorted HSPC cell cycle status, T- and B-lymphocyte subpopulation frequencies (n = 29), and HSPC differentiation potential (n = 10). RESULTS Natalizumab-induced circulating HSPC were predominantly quiescent, suggesting recent mobilization from the bone marrow, and were capable of differentiating ex vivo. Circulating HSPC numbers were significantly increased during natalizumab, but heterogeneously, allowing the stratification of mobilizer and nonmobilizer subgroups. Nonmobilizer status was associated with persistence of disease activity during treatment. The frequency of B cells and CD103+CD8+ regulatory T cells persistently increased, more significantly in mobilizer patients, who also showed a specific naive/memory B-cell profile. CONCLUSIONS The data suggest that natalizumab-induced circulating HSPC increase is the result of true mobilization from the bone marrow and has clinical and immunologic relevance. HSPC mobilization, associated with clinical remission and increased proportion of circulating B and regulatory T cells, may contribute to the treatment's mode of action; thus, HSPC blood counts could represent an early biomarker of responsiveness to natalizumab.
Collapse
Affiliation(s)
- Miriam Mattoscio
- From the Department of Medicine, Division of Brain Sciences, Centre for Neuroscience, Wolfson Neuroscience Laboratories (M.M., R.N., O.M., P.A.M.), and the Department of Medicine, Division of Experimental Medicine, Centre for Haematology (F.D.), Imperial College London, UK; the Departments of Neurosciences (R.N., O.M.) and Imaging (J.S.L., A.D.W.), Imperial College Healthcare NHS Trust, London, UK; and the Biostatistics Unit, Department of Health Sciences (M.P.S.), University of Genoa, Italy
| | - Richard Nicholas
- From the Department of Medicine, Division of Brain Sciences, Centre for Neuroscience, Wolfson Neuroscience Laboratories (M.M., R.N., O.M., P.A.M.), and the Department of Medicine, Division of Experimental Medicine, Centre for Haematology (F.D.), Imperial College London, UK; the Departments of Neurosciences (R.N., O.M.) and Imaging (J.S.L., A.D.W.), Imperial College Healthcare NHS Trust, London, UK; and the Biostatistics Unit, Department of Health Sciences (M.P.S.), University of Genoa, Italy
| | - Maria P Sormani
- From the Department of Medicine, Division of Brain Sciences, Centre for Neuroscience, Wolfson Neuroscience Laboratories (M.M., R.N., O.M., P.A.M.), and the Department of Medicine, Division of Experimental Medicine, Centre for Haematology (F.D.), Imperial College London, UK; the Departments of Neurosciences (R.N., O.M.) and Imaging (J.S.L., A.D.W.), Imperial College Healthcare NHS Trust, London, UK; and the Biostatistics Unit, Department of Health Sciences (M.P.S.), University of Genoa, Italy
| | - Omar Malik
- From the Department of Medicine, Division of Brain Sciences, Centre for Neuroscience, Wolfson Neuroscience Laboratories (M.M., R.N., O.M., P.A.M.), and the Department of Medicine, Division of Experimental Medicine, Centre for Haematology (F.D.), Imperial College London, UK; the Departments of Neurosciences (R.N., O.M.) and Imaging (J.S.L., A.D.W.), Imperial College Healthcare NHS Trust, London, UK; and the Biostatistics Unit, Department of Health Sciences (M.P.S.), University of Genoa, Italy
| | - Jean S Lee
- From the Department of Medicine, Division of Brain Sciences, Centre for Neuroscience, Wolfson Neuroscience Laboratories (M.M., R.N., O.M., P.A.M.), and the Department of Medicine, Division of Experimental Medicine, Centre for Haematology (F.D.), Imperial College London, UK; the Departments of Neurosciences (R.N., O.M.) and Imaging (J.S.L., A.D.W.), Imperial College Healthcare NHS Trust, London, UK; and the Biostatistics Unit, Department of Health Sciences (M.P.S.), University of Genoa, Italy
| | - Adam D Waldman
- From the Department of Medicine, Division of Brain Sciences, Centre for Neuroscience, Wolfson Neuroscience Laboratories (M.M., R.N., O.M., P.A.M.), and the Department of Medicine, Division of Experimental Medicine, Centre for Haematology (F.D.), Imperial College London, UK; the Departments of Neurosciences (R.N., O.M.) and Imaging (J.S.L., A.D.W.), Imperial College Healthcare NHS Trust, London, UK; and the Biostatistics Unit, Department of Health Sciences (M.P.S.), University of Genoa, Italy
| | - Francesco Dazzi
- From the Department of Medicine, Division of Brain Sciences, Centre for Neuroscience, Wolfson Neuroscience Laboratories (M.M., R.N., O.M., P.A.M.), and the Department of Medicine, Division of Experimental Medicine, Centre for Haematology (F.D.), Imperial College London, UK; the Departments of Neurosciences (R.N., O.M.) and Imaging (J.S.L., A.D.W.), Imperial College Healthcare NHS Trust, London, UK; and the Biostatistics Unit, Department of Health Sciences (M.P.S.), University of Genoa, Italy
| | - Paolo A Muraro
- From the Department of Medicine, Division of Brain Sciences, Centre for Neuroscience, Wolfson Neuroscience Laboratories (M.M., R.N., O.M., P.A.M.), and the Department of Medicine, Division of Experimental Medicine, Centre for Haematology (F.D.), Imperial College London, UK; the Departments of Neurosciences (R.N., O.M.) and Imaging (J.S.L., A.D.W.), Imperial College Healthcare NHS Trust, London, UK; and the Biostatistics Unit, Department of Health Sciences (M.P.S.), University of Genoa, Italy.
| |
Collapse
|
44
|
Booth TC, Waldman AD, Jefferies S, Jäger R. Comment on "The role of imaging in the management of progressive glioblastoma. A systematic review and evidence-based clinical practice guideline" [J Neurooncol 2014; 118:435-460]. J Neurooncol 2014; 121:423-4. [PMID: 25366364 DOI: 10.1007/s11060-014-1649-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2014] [Accepted: 10/27/2014] [Indexed: 11/28/2022]
|
45
|
Orban C, McGonigle J, Kalk NJ, Erritzoe D, Waldman AD, Nutt DJ, Rabiner EA, Lingford-Hughes AR. Resting state synchrony in anxiety-related circuits of abstinent alcohol-dependent patients. Am J Drug Alcohol Abuse 2014; 39:433-40. [PMID: 24200213 DOI: 10.3109/00952990.2013.846348] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Anxiety has been linked to initiation, maintenance and relapse of alcohol dependence. Neurobiological models of anxiety have proposed important roles for amygdala-insula and amygdala-medial prefrontal cortex interactions in the generation and regulation of anxiety states, respectively. OBJECTIVES This study tested the hypotheses that abstinent alcohol-dependent patients would show a disruption of synchrony in these circuits as measured by resting state functional MRI. METHODS The study examined recently abstinent (n = 13), longer-term abstinent (n = 16) alcohol-dependent patients and healthy controls (n = 22). Resting-state synchrony (RSS) was examined in specific circuits, where degree of synchrony has been found to correlate with state anxiety levels in previous studies. RESULTS Alcohol-dependent patients showed significantly elevated scores on anxiety and depression inventories compared with controls. No significant group differences in synchrony were observed between right amygdala and right ventromedial prefrontal cortex (vmPFC), between left amygdala and left vmPFC, or, after correction for multiple comparisons, right amygdala and dorsomedial prefrontal cortex (dmPFC). However, significantly decreased positive synchrony was found between left basolateral amygdala and left anterior insula, in patients relative to controls. CONCLUSION Both early and longer-term abstinent alcohol-dependent patients showed increased anxiety levels relative to controls and altered resting state synchrony in circuits previously linked to state anxiety. Notably, the significant group differences in synchrony were in the opposite direction to our predictions based on the literature. These results may point to a lack of generalizability of models derived from young healthy homogeneous samples.
Collapse
Affiliation(s)
- Csaba Orban
- Centre for Neuropsychopharmacology, Imperial College London , London , UK
| | | | | | | | | | | | | | | |
Collapse
|
46
|
Booth TC, Nathan M, Waldman AD, Quigley AM, Schapira AH, Buscombe J. The role of functional dopamine-transporter SPECT imaging in parkinsonian syndromes, part 2. AJNR Am J Neuroradiol 2014; 36:236-44. [PMID: 24924549 DOI: 10.3174/ajnr.a3971] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
SUMMARY The functional imaging technique most widely used in European clinics to differentiate a true parkinsonian syndrome from vascular parkinsonism, drug-induced changes, or essential tremor is dopamine-transporter SPECT. This technique commonly reports dopamine-transporter function, with decreasing striatal uptake demonstrating increasingly severe disease. The strength of dopamine-transporter SPECT is that nigrostriatal degeneration is observed in both clinically inconclusive parkinsonism and early, even premotor, disease. In this clinical review (Part 2), we present the dopamine-transporter SPECT findings in a variety of neurodegenerative diseases, including multiple system atrophy, progressive supranuclear palsy, corticobasal degeneration, and dementia with Lewy bodies. The findings in vascular parkinsonism, drug-induced parkinsonism, and essential tremor are also described. It is hoped that this technique will be the forerunner of a range of routinely used, process-specific ligands that can identify early degenerative disease and subsequently guide disease-modifying interventions.
Collapse
Affiliation(s)
- T C Booth
- From the Department of Neuroradiology (T.C.B.), National Hospital for Neurology and Neurosurgery, London, UK
| | - M Nathan
- Department of Nuclear Medicine (M.N., A.-M.Q.), Royal Free Hospital NHS Trust, London, UK
| | - A D Waldman
- Department of Imaging (A.D.W.), Imperial College Healthcare NHS Trust, London, UK
| | - A-M Quigley
- Department of Nuclear Medicine (M.N., A.-M.Q.), Royal Free Hospital NHS Trust, London, UK
| | - A H Schapira
- Department of Clinical Neurosciences (A.H.S.), Institute of Neurology, University College London, London, UK
| | - J Buscombe
- Department of Nuclear Medicine (J.B.), Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| |
Collapse
|
47
|
Booth TC, Nathan M, Waldman AD, Quigley AM, Schapira AH, Buscombe J. The role of functional dopamine-transporter SPECT imaging in parkinsonian syndromes, part 1. AJNR Am J Neuroradiol 2014; 36:229-35. [PMID: 24904053 DOI: 10.3174/ajnr.a3970] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
SUMMARY As we defeat infectious diseases and cancer, one of the greatest medical challenges facing us in the mid-21st century will be the increasing prevalence of degenerative disease. Those diseases, which affect movement and cognition, can be the most debilitating. Dysfunction of the extrapyramidal system results in increasing motor disability often manifest as tremor, bradykinesia, and rigidity. The common pathologic pathway of these diseases, collectively described as parkinsonian syndromes, such as Parkinson disease, multiple system atrophy, progressive supranuclear palsy, corticobasal degeneration, and dementia with Lewy bodies, is degeneration of the presynaptic dopaminergic pathways in the basal ganglia. Conventional MR imaging is insensitive, especially in early disease, so functional imaging has become the primary method used to differentiate a true parkinsonian syndrome from vascular parkinsonism, drug-induced changes, or essential tremor. Unusually for a modern functional imaging technique, the method most widely used in European clinics depends on SPECT and not PET. This SPECT technique (described in the first of 2 parts) commonly reports dopamine-transporter function, with decreasing striatal uptake demonstrating increasingly severe disease.
Collapse
Affiliation(s)
- T C Booth
- From the Department of Neuroradiology (T.C.B.), National Hospital for Neurology and Neurosurgery, London, UK
| | - M Nathan
- Department of Nuclear Medicine (M.N., A.-M.Q.), Royal Free Hospital National Health Service Trust, London, UK
| | - A D Waldman
- Department of Imaging (A.D.W.), Imperial College Healthcare National Health Service Trust, London, UK
| | - A-M Quigley
- Department of Nuclear Medicine (M.N., A.-M.Q.), Royal Free Hospital National Health Service Trust, London, UK
| | - A H Schapira
- Department of Clinical Neurosciences (A.H.S.), Institute of Neurology, University College London, London, UK
| | - J Buscombe
- Department of Nuclear Medicine (J.B.), Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| |
Collapse
|
48
|
Goldstone AP, Prechtl CG, Scholtz S, Miras AD, Chhina N, Durighel G, Deliran SS, Beckmann C, Ghatei MA, Ashby DR, Waldman AD, Gaylinn BD, Thorner MO, Frost GS, Bloom SR, Bell JD. Ghrelin mimics fasting to enhance human hedonic, orbitofrontal cortex, and hippocampal responses to food. Am J Clin Nutr 2014; 99:1319-30. [PMID: 24760977 PMCID: PMC6410902 DOI: 10.3945/ajcn.113.075291] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Ghrelin, which is a stomach-derived hormone, increases with fasting and energy restriction and may influence eating behaviors through brain hedonic reward-cognitive systems. Therefore, changes in plasma ghrelin might mediate counter-regulatory responses to a negative energy balance through changes in food hedonics. OBJECTIVE We investigated whether ghrelin administration (exogenous hyperghrelinemia) mimics effects of fasting (endogenous hyperghrelinemia) on the hedonic response and activation of brain-reward systems to food. DESIGN In a crossover design, 22 healthy, nonobese adults (17 men) underwent a functional magnetic resonance imaging (fMRI) food-picture evaluation task after a 16-h overnight fast (Fasted-Saline) or after eating breakfast 95 min before scanning (730 kcal, 14% protein, 31% fat, and 55% carbohydrate) and receiving a saline (Fed-Saline) or acyl ghrelin (Fed-Ghrelin) subcutaneous injection before scanning. One male subject was excluded from the fMRI analysis because of excess head motion, which left 21 subjects with brain-activation data. RESULTS Compared with the Fed-Saline visit, both ghrelin administration to fed subjects (Fed-Ghrelin) and fasting (Fasted-Saline) significantly increased the appeal of high-energy foods and associated orbitofrontal cortex activation. Both fasting and ghrelin administration also increased hippocampus activation to high-energy- and low-energy-food pictures. These similar effects of endogenous and exogenous hyperghrelinemia were not explicable by consistent changes in glucose, insulin, peptide YY, and glucagon-like peptide-1. Neither ghrelin administration nor fasting had any significant effect on nucleus accumbens, caudate, anterior insula, or amygdala activation during the food-evaluation task or on auditory, motor, or visual cortex activation during a control task. CONCLUSIONS Ghrelin administration and fasting have similar acute stimulatory effects on hedonic responses and the activation of corticolimbic reward-cognitive systems during food evaluations. Similar effects of recurrent or chronic hyperghrelinemia on an anticipatory food reward may contribute to the negative impact of skipping breakfast on dietary habits and body weight and the long-term failure of energy restriction for weight loss.
Collapse
Affiliation(s)
- Anthony P Goldstone
- From the Metabolic and Molecular Imaging Group (APG, CGP, SS, ADM, NC, SSD, and JDB) and Robert Steiner MRI Unit (GD), Medical Research Council Clinical Sciences Centre, the Computational, Cognitive and Clinical Neuroimaging Laboratory, Division of Brain Sciences (CB), the Section of Investigative Medicine, Division of Diabetes, Endocrinology and Metabolism (MAG, DRA, GSF, and SRB), and the Division of Brain Sciences (ADW), Imperial College London, Hammersmith Hospital, London, United Kingdom, and the Department of Endocrinology, University of Virginia, Charlottesville, VA (BDG and MOT)
| | - Christina G Prechtl
- From the Metabolic and Molecular Imaging Group (APG, CGP, SS, ADM, NC, SSD, and JDB) and Robert Steiner MRI Unit (GD), Medical Research Council Clinical Sciences Centre, the Computational, Cognitive and Clinical Neuroimaging Laboratory, Division of Brain Sciences (CB), the Section of Investigative Medicine, Division of Diabetes, Endocrinology and Metabolism (MAG, DRA, GSF, and SRB), and the Division of Brain Sciences (ADW), Imperial College London, Hammersmith Hospital, London, United Kingdom, and the Department of Endocrinology, University of Virginia, Charlottesville, VA (BDG and MOT)
| | - Samantha Scholtz
- From the Metabolic and Molecular Imaging Group (APG, CGP, SS, ADM, NC, SSD, and JDB) and Robert Steiner MRI Unit (GD), Medical Research Council Clinical Sciences Centre, the Computational, Cognitive and Clinical Neuroimaging Laboratory, Division of Brain Sciences (CB), the Section of Investigative Medicine, Division of Diabetes, Endocrinology and Metabolism (MAG, DRA, GSF, and SRB), and the Division of Brain Sciences (ADW), Imperial College London, Hammersmith Hospital, London, United Kingdom, and the Department of Endocrinology, University of Virginia, Charlottesville, VA (BDG and MOT)
| | - Alexander D Miras
- From the Metabolic and Molecular Imaging Group (APG, CGP, SS, ADM, NC, SSD, and JDB) and Robert Steiner MRI Unit (GD), Medical Research Council Clinical Sciences Centre, the Computational, Cognitive and Clinical Neuroimaging Laboratory, Division of Brain Sciences (CB), the Section of Investigative Medicine, Division of Diabetes, Endocrinology and Metabolism (MAG, DRA, GSF, and SRB), and the Division of Brain Sciences (ADW), Imperial College London, Hammersmith Hospital, London, United Kingdom, and the Department of Endocrinology, University of Virginia, Charlottesville, VA (BDG and MOT)
| | - Navpreet Chhina
- From the Metabolic and Molecular Imaging Group (APG, CGP, SS, ADM, NC, SSD, and JDB) and Robert Steiner MRI Unit (GD), Medical Research Council Clinical Sciences Centre, the Computational, Cognitive and Clinical Neuroimaging Laboratory, Division of Brain Sciences (CB), the Section of Investigative Medicine, Division of Diabetes, Endocrinology and Metabolism (MAG, DRA, GSF, and SRB), and the Division of Brain Sciences (ADW), Imperial College London, Hammersmith Hospital, London, United Kingdom, and the Department of Endocrinology, University of Virginia, Charlottesville, VA (BDG and MOT)
| | - Giuliana Durighel
- From the Metabolic and Molecular Imaging Group (APG, CGP, SS, ADM, NC, SSD, and JDB) and Robert Steiner MRI Unit (GD), Medical Research Council Clinical Sciences Centre, the Computational, Cognitive and Clinical Neuroimaging Laboratory, Division of Brain Sciences (CB), the Section of Investigative Medicine, Division of Diabetes, Endocrinology and Metabolism (MAG, DRA, GSF, and SRB), and the Division of Brain Sciences (ADW), Imperial College London, Hammersmith Hospital, London, United Kingdom, and the Department of Endocrinology, University of Virginia, Charlottesville, VA (BDG and MOT)
| | - Seyedeh S Deliran
- From the Metabolic and Molecular Imaging Group (APG, CGP, SS, ADM, NC, SSD, and JDB) and Robert Steiner MRI Unit (GD), Medical Research Council Clinical Sciences Centre, the Computational, Cognitive and Clinical Neuroimaging Laboratory, Division of Brain Sciences (CB), the Section of Investigative Medicine, Division of Diabetes, Endocrinology and Metabolism (MAG, DRA, GSF, and SRB), and the Division of Brain Sciences (ADW), Imperial College London, Hammersmith Hospital, London, United Kingdom, and the Department of Endocrinology, University of Virginia, Charlottesville, VA (BDG and MOT)
| | - Christian Beckmann
- From the Metabolic and Molecular Imaging Group (APG, CGP, SS, ADM, NC, SSD, and JDB) and Robert Steiner MRI Unit (GD), Medical Research Council Clinical Sciences Centre, the Computational, Cognitive and Clinical Neuroimaging Laboratory, Division of Brain Sciences (CB), the Section of Investigative Medicine, Division of Diabetes, Endocrinology and Metabolism (MAG, DRA, GSF, and SRB), and the Division of Brain Sciences (ADW), Imperial College London, Hammersmith Hospital, London, United Kingdom, and the Department of Endocrinology, University of Virginia, Charlottesville, VA (BDG and MOT)
| | - Mohammad A Ghatei
- From the Metabolic and Molecular Imaging Group (APG, CGP, SS, ADM, NC, SSD, and JDB) and Robert Steiner MRI Unit (GD), Medical Research Council Clinical Sciences Centre, the Computational, Cognitive and Clinical Neuroimaging Laboratory, Division of Brain Sciences (CB), the Section of Investigative Medicine, Division of Diabetes, Endocrinology and Metabolism (MAG, DRA, GSF, and SRB), and the Division of Brain Sciences (ADW), Imperial College London, Hammersmith Hospital, London, United Kingdom, and the Department of Endocrinology, University of Virginia, Charlottesville, VA (BDG and MOT)
| | - Damien R Ashby
- From the Metabolic and Molecular Imaging Group (APG, CGP, SS, ADM, NC, SSD, and JDB) and Robert Steiner MRI Unit (GD), Medical Research Council Clinical Sciences Centre, the Computational, Cognitive and Clinical Neuroimaging Laboratory, Division of Brain Sciences (CB), the Section of Investigative Medicine, Division of Diabetes, Endocrinology and Metabolism (MAG, DRA, GSF, and SRB), and the Division of Brain Sciences (ADW), Imperial College London, Hammersmith Hospital, London, United Kingdom, and the Department of Endocrinology, University of Virginia, Charlottesville, VA (BDG and MOT)
| | - Adam D Waldman
- From the Metabolic and Molecular Imaging Group (APG, CGP, SS, ADM, NC, SSD, and JDB) and Robert Steiner MRI Unit (GD), Medical Research Council Clinical Sciences Centre, the Computational, Cognitive and Clinical Neuroimaging Laboratory, Division of Brain Sciences (CB), the Section of Investigative Medicine, Division of Diabetes, Endocrinology and Metabolism (MAG, DRA, GSF, and SRB), and the Division of Brain Sciences (ADW), Imperial College London, Hammersmith Hospital, London, United Kingdom, and the Department of Endocrinology, University of Virginia, Charlottesville, VA (BDG and MOT)
| | - Bruce D Gaylinn
- From the Metabolic and Molecular Imaging Group (APG, CGP, SS, ADM, NC, SSD, and JDB) and Robert Steiner MRI Unit (GD), Medical Research Council Clinical Sciences Centre, the Computational, Cognitive and Clinical Neuroimaging Laboratory, Division of Brain Sciences (CB), the Section of Investigative Medicine, Division of Diabetes, Endocrinology and Metabolism (MAG, DRA, GSF, and SRB), and the Division of Brain Sciences (ADW), Imperial College London, Hammersmith Hospital, London, United Kingdom, and the Department of Endocrinology, University of Virginia, Charlottesville, VA (BDG and MOT)
| | - Michael O Thorner
- From the Metabolic and Molecular Imaging Group (APG, CGP, SS, ADM, NC, SSD, and JDB) and Robert Steiner MRI Unit (GD), Medical Research Council Clinical Sciences Centre, the Computational, Cognitive and Clinical Neuroimaging Laboratory, Division of Brain Sciences (CB), the Section of Investigative Medicine, Division of Diabetes, Endocrinology and Metabolism (MAG, DRA, GSF, and SRB), and the Division of Brain Sciences (ADW), Imperial College London, Hammersmith Hospital, London, United Kingdom, and the Department of Endocrinology, University of Virginia, Charlottesville, VA (BDG and MOT)
| | - Gary S Frost
- From the Metabolic and Molecular Imaging Group (APG, CGP, SS, ADM, NC, SSD, and JDB) and Robert Steiner MRI Unit (GD), Medical Research Council Clinical Sciences Centre, the Computational, Cognitive and Clinical Neuroimaging Laboratory, Division of Brain Sciences (CB), the Section of Investigative Medicine, Division of Diabetes, Endocrinology and Metabolism (MAG, DRA, GSF, and SRB), and the Division of Brain Sciences (ADW), Imperial College London, Hammersmith Hospital, London, United Kingdom, and the Department of Endocrinology, University of Virginia, Charlottesville, VA (BDG and MOT)
| | - Stephen R Bloom
- From the Metabolic and Molecular Imaging Group (APG, CGP, SS, ADM, NC, SSD, and JDB) and Robert Steiner MRI Unit (GD), Medical Research Council Clinical Sciences Centre, the Computational, Cognitive and Clinical Neuroimaging Laboratory, Division of Brain Sciences (CB), the Section of Investigative Medicine, Division of Diabetes, Endocrinology and Metabolism (MAG, DRA, GSF, and SRB), and the Division of Brain Sciences (ADW), Imperial College London, Hammersmith Hospital, London, United Kingdom, and the Department of Endocrinology, University of Virginia, Charlottesville, VA (BDG and MOT)
| | - Jimmy D Bell
- From the Metabolic and Molecular Imaging Group (APG, CGP, SS, ADM, NC, SSD, and JDB) and Robert Steiner MRI Unit (GD), Medical Research Council Clinical Sciences Centre, the Computational, Cognitive and Clinical Neuroimaging Laboratory, Division of Brain Sciences (CB), the Section of Investigative Medicine, Division of Diabetes, Endocrinology and Metabolism (MAG, DRA, GSF, and SRB), and the Division of Brain Sciences (ADW), Imperial College London, Hammersmith Hospital, London, United Kingdom, and the Department of Endocrinology, University of Virginia, Charlottesville, VA (BDG and MOT)
| |
Collapse
|
49
|
Scholtz S, Miras AD, Chhina N, Prechtl CG, Sleeth ML, Daud NM, Ismail NA, Durighel G, Ahmed AR, Olbers T, Vincent RP, Alaghband-Zadeh J, Ghatei MA, Waldman AD, Frost GS, Bell JD, le Roux CW, Goldstone AP. Obese patients after gastric bypass surgery have lower brain-hedonic responses to food than after gastric banding. Gut 2014; 63:891-902. [PMID: 23964100 PMCID: PMC4033279 DOI: 10.1136/gutjnl-2013-305008] [Citation(s) in RCA: 180] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Roux-en-Y gastric bypass (RYGB) has greater efficacy for weight loss in obese patients than gastric banding (BAND) surgery. We hypothesise that this may result from different effects on food hedonics via physiological changes secondary to distinct gut anatomy manipulations. DESIGN We used functional MRI, eating behaviour and hormonal phenotyping to compare body mass index (BMI)-matched unoperated controls and patients after RYGB and BAND surgery for obesity. RESULTS Obese patients after RYGB had lower brain-hedonic responses to food than patients after BAND surgery. RYGB patients had lower activation than BAND patients in brain reward systems, particularly to high-calorie foods, including the orbitofrontal cortex, amygdala, caudate nucleus, nucleus accumbens and hippocampus. This was associated with lower palatability and appeal of high-calorie foods and healthier eating behaviour, including less fat intake, in RYGB compared with BAND patients and/or BMI-matched unoperated controls. These differences were not explicable by differences in hunger or psychological traits between the surgical groups, but anorexigenic plasma gut hormones (GLP-1 and PYY), plasma bile acids and symptoms of dumping syndrome were increased in RYGB patients. CONCLUSIONS The identification of these differences in food hedonic responses as a result of altered gut anatomy/physiology provides a novel explanation for the more favourable long-term weight loss seen after RYGB than after BAND surgery, highlighting the importance of the gut-brain axis in the control of reward-based eating behaviour.
Collapse
Affiliation(s)
- Samantha Scholtz
- Metabolic and Molecular Imaging Group, MRC Clinical Sciences Centre, Imperial College London, Hammersmith Hospital, London, UK
| | - Alexander D Miras
- Metabolic and Molecular Imaging Group, MRC Clinical Sciences Centre, Imperial College London, Hammersmith Hospital, London, UK
| | - Navpreet Chhina
- Metabolic and Molecular Imaging Group, MRC Clinical Sciences Centre, Imperial College London, Hammersmith Hospital, London, UK
| | - Christina G Prechtl
- Metabolic and Molecular Imaging Group, MRC Clinical Sciences Centre, Imperial College London, Hammersmith Hospital, London, UK
| | - Michelle L Sleeth
- Section of Investigative Medicine, Division of Diabetes, Endocrinology, and Metabolism, Imperial College London, Hammersmith Hospital, London, UK
| | - Norlida M Daud
- Section of Investigative Medicine, Division of Diabetes, Endocrinology, and Metabolism, Imperial College London, Hammersmith Hospital, London, UK
| | - Nurhafzan A Ismail
- Section of Investigative Medicine, Division of Diabetes, Endocrinology, and Metabolism, Imperial College London, Hammersmith Hospital, London, UK
| | - Giuliana Durighel
- Robert Steiner MRI Unit, MRC Clinical Sciences Centre, Imperial College London, Hammersmith Hospital, London, UK
| | - Ahmed R Ahmed
- Department of General Surgery, Imperial Weight Centre, Imperial College Healthcare NHS Trust, London, UK
| | - Torsten Olbers
- Department of Gastro Surgical Research and Education, University of Gothenburg, Gothenburg, Sweden
| | - Royce P Vincent
- Department of Clinical Biochemistry, King's College Hospital, London, UK
| | | | - Mohammad A Ghatei
- Section of Investigative Medicine, Division of Diabetes, Endocrinology, and Metabolism, Imperial College London, Hammersmith Hospital, London, UK
| | - Adam D Waldman
- Division of Brain Sciences, Imperial College London, Hammersmith Hospital, London, UK
| | - Gary S Frost
- Section of Investigative Medicine, Division of Diabetes, Endocrinology, and Metabolism, Imperial College London, Hammersmith Hospital, London, UK
| | - Jimmy D Bell
- Metabolic and Molecular Imaging Group, MRC Clinical Sciences Centre, Imperial College London, Hammersmith Hospital, London, UK
| | - Carel W le Roux
- Section of Investigative Medicine, Division of Diabetes, Endocrinology, and Metabolism, Imperial College London, Hammersmith Hospital, London, UK,Department of Gastro Surgical Research and Education, University of Gothenburg, Gothenburg, Sweden,Department of Clinical Biochemistry, King's College Hospital, London, UK,Department of Experimental Pathology, UCD Conway Institute, School of Medicine and Medical Science, University College Dublin, Ireland
| | - Anthony P Goldstone
- Metabolic and Molecular Imaging Group, MRC Clinical Sciences Centre, Imperial College London, Hammersmith Hospital, London, UK
| |
Collapse
|
50
|
Newbould RD, Nicholas R, Thomas CL, Quest R, Lee JSZ, Honeyfield L, Colasanti A, Malik O, Mattoscio M, Matthews PM, Sormani MP, Waldman AD, Muraro PA. Age independently affects myelin integrity as detected by magnetization transfer magnetic resonance imaging in multiple sclerosis. Neuroimage Clin 2014; 4:641-8. [PMID: 24936415 PMCID: PMC4053639 DOI: 10.1016/j.nicl.2014.02.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Revised: 01/23/2014] [Accepted: 02/14/2014] [Indexed: 11/25/2022]
Abstract
Background Multiple sclerosis (MS) is a heterogeneous disorder with a progressive course that is difficult to predict on a case-by-case basis. Natural history studies of MS have demonstrated that age influences clinical progression independent of disease duration. Objective To determine whether age would be associated with greater CNS injury as detected by magnetization transfer MRI. Materials and methods Forty MS patients were recruited from out-patient clinics into two groups stratified by age but with similar clinical disease duration as well as thirteen controls age-matched to the older MS group. Images were segmented by automated programs and blinded readers into normal appearing white matter (NAWM), normal appearing gray matter (NAGM), and white matter lesions (WMLs) and gray matter lesions (GMLs) in the MS groups. WML and GML were delineated on T2-weighted 3D fluid-attenuated inversion recovery (FLAIR) and T1 weighted MRI volumes. Mean magnetization transfer ratio (MTR), region volume, as well as MTR histogram skew and kurtosis were calculated for each region. Results All MTR measures in NAGM and MTR histogram metrics in NAWM differed between MS subjects and controls, as expected and previously reported by several studies, but not between MS groups. However, MTR measures in the WML did significantly differ between the MS groups, in spite of no significant differences in lesion counts and volumes. Conclusions Despite matching for clinical disease duration and recording no significant WML volume difference, we demonstrated strong MTR differences in WMLs between younger and older MS patients. These data suggest that aging-related processes modify the tissue response to inflammatory injury and its clinical outcome correlates in MS. Magnetization transfer MRI was used in a cohort of 40 MS subjects differing by age. MTR metrics were different between MS groups and controls, as expected. MTR in normal appearing tissue did not differ between age-stratified MS groups. MTR in white matter lesions was strongly different between age-stratified MS groups. Results imply an age-related effect in tissue integrity in MR-visible lesions.
Collapse
Affiliation(s)
- R D Newbould
- Imanova Centre for Imaging Sciences, London, UK ; Division of Experimental Medicine, Imperial College London, UK
| | - R Nicholas
- Division of Brain Sciences, Imperial College London, UK
| | - C L Thomas
- Division of Brain Sciences, Imperial College London, UK
| | - R Quest
- Department of Imaging, Imperial College Healthcare NHS Trust, UK
| | - J S Z Lee
- Division of Brain Sciences, Imperial College London, UK
| | - L Honeyfield
- Department of Imaging, Imperial College Healthcare NHS Trust, UK
| | - A Colasanti
- Imanova Centre for Imaging Sciences, London, UK ; Division of Brain Sciences, Imperial College London, UK
| | - O Malik
- Division of Brain Sciences, Imperial College London, UK
| | - M Mattoscio
- Division of Brain Sciences, Imperial College London, UK
| | - P M Matthews
- Division of Brain Sciences, Imperial College London, UK ; Neurosciences, GlaxoSmithKline Research and Development, UK
| | - M P Sormani
- Department of Health Sciences (DISSAL), University of Genoa, Italy
| | - A D Waldman
- Division of Brain Sciences, Imperial College London, UK ; Department of Imaging, Imperial College Healthcare NHS Trust, UK
| | - P A Muraro
- Division of Brain Sciences, Imperial College London, UK ; Department of Clinical Neurosciences, Imperial College Healthcare NHS Trust, UK
| |
Collapse
|