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Silvagni E, Inglese F, Bortoluzzi A, Borrelli M, Goeman JJ, Revenaz A, Groppo E, Steup-Beekman GM, Huizinga TWJ, Ronen I, de Bresser J, Fainardi E, Govoni M, Ercan E. Longitudinal changes in cerebral white matter microstructure in newly diagnosed systemic lupus erythematosus patients. Rheumatology (Oxford) 2021; 60:2678-2687. [PMID: 33507240 PMCID: PMC8213425 DOI: 10.1093/rheumatology/keaa677] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 06/26/2020] [Revised: 09/10/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To evaluate longitudinal variations in diffusion tensor imaging (DTI) metrics of different white matter (WM) tracts of newly diagnosed SLE patients, and to assess whether DTI changes relate to changes in clinical characteristics over time. METHODS A total of 17 newly diagnosed SLE patients (19-55 years) were assessed within 24 months from diagnosis with brain MRI (1.5 T Philips Achieva) at baseline, and after at least 12 months. Fractional anisotropy, mean diffusivity (MD), radial diffusivity (RD) and axial diffusivity values were calculated in several normal-appearing WM tracts. Longitudinal variations in DTI metrics were analysed by repeated measures analysis of variance. DTI changes were separately assessed for 21 WM tracts. Associations between longitudinal alterations of DTI metrics and clinical variables (SLEDAI-2K, complement levels, glucocorticoid dosage) were evaluated using adjusted Spearman correlation analysis. RESULTS Mean MD and RD values from the normal-appearing WM significantly increased over time (P = 0.019 and P = 0.021, respectively). A significant increase in RD (P = 0.005) and MD (P = 0.012) was found in the left posterior limb of the internal capsule; RD significantly increased in the left retro-lenticular part of the internal capsule (P = 0.013), and fractional anisotropy significantly decreased in the left corticospinal tract (P = 0.029). No significant correlation was found between the longitudinal change in DTI metrics and the change in clinical measures. CONCLUSION Increase in diffusivity, reflecting a compromised WM tissue microstructure, starts in initial phases of the SLE disease course, even in the absence of overt neuropsychiatric (NP) symptoms. These results indicate the importance of monitoring NP involvement in SLE, even shortly after diagnosis.
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Affiliation(s)
- Ettore Silvagni
- Rheumatology Unit, Department of Medical Sciences, University of Ferrara and Azienda Ospedaliero-Universitaria S. Anna, Cona (Ferrara), Italy
| | - Francesca Inglese
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Alessandra Bortoluzzi
- Rheumatology Unit, Department of Medical Sciences, University of Ferrara and Azienda Ospedaliero-Universitaria S. Anna, Cona (Ferrara), Italy
| | - Massimo Borrelli
- Neuroradiology Unit, Department of Radiology, Azienda Ospedaliero-Universitaria Sant'Anna, Cona (Ferrara), Italy
| | - Jelle J Goeman
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
| | - Alfredo Revenaz
- Neuroradiology Unit, Department of Radiology, Azienda Ospedaliero-Universitaria Sant'Anna, Cona (Ferrara), Italy
| | | | - Gerda M Steup-Beekman
- Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Tom W J Huizinga
- Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Itamar Ronen
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Jeroen de Bresser
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Enrico Fainardi
- Neuroradiology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Marcello Govoni
- Rheumatology Unit, Department of Medical Sciences, University of Ferrara and Azienda Ospedaliero-Universitaria S. Anna, Cona (Ferrara), Italy
| | - Ece Ercan
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
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Revenaz A, Ruggeri M, Laganà M, Bergsland N, Groppo E, Rovaris M, Fainardi E. A semi-automated measuring system of brain diffusion and perfusion magnetic resonance imaging abnormalities in patients with multiple sclerosis based on the integration of coregistration and tissue segmentation procedures. BMC Med Imaging 2016; 16:4. [PMID: 26762399 PMCID: PMC4712616 DOI: 10.1186/s12880-016-0108-1] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 01/06/2016] [Indexed: 12/31/2022] Open
Abstract
Background Diffusion-weighted imaging (DWI) and perfusion-weighted imaging (PWI) abnormalities in patients with multiple sclerosis (MS) are currently measured by a complex combination of separate procedures. Therefore, the purpose of this study was to provide a reliable method for reducing analysis complexity and obtaining reproducible results. Methods We implemented a semi-automated measuring system in which different well-known software components for magnetic resonance imaging (MRI) analysis are integrated to obtain reliable measurements of DWI and PWI disturbances in MS. Results We generated the Diffusion/Perfusion Project (DPP) Suite, in which a series of external software programs are managed and harmonically and hierarchically incorporated by in-house developed Matlab software to perform the following processes: 1) image pre-processing, including imaging data anonymization and conversion from DICOM to Nifti format; 2) co-registration of 2D and 3D non-enhanced and Gd-enhanced T1-weighted images in fluid-attenuated inversion recovery (FLAIR) space; 3) lesion segmentation and classification, in which FLAIR lesions are at first segmented and then categorized according to their presumed evolution; 4) co-registration of segmented FLAIR lesion in T1 space to obtain the FLAIR lesion mask in the T1 space; 5) normal appearing tissue segmentation, in which T1 lesion mask is used to segment basal ganglia/thalami, normal appearing grey matter (NAGM) and normal appearing white matter (NAWM); 6) DWI and PWI map generation; 7) co-registration of basal ganglia/thalami, NAGM, NAWM, DWI and PWI maps in previously segmented FLAIR space; 8) data analysis. All these steps are automatic, except for lesion segmentation and classification. Conclusion We developed a promising method to limit misclassifications and user errors, providing clinical researchers with a practical and reproducible tool to measure DWI and PWI changes in MS.
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Affiliation(s)
- Alfredo Revenaz
- Unità Operativa di Neuroradiologia, Dipartimento di Neuroscienze e Riabilitazione, Azienda Ospedaliero-Universitaria of Ferrara, Arcispedale S. Anna, Via Aldo Moro 8, 44124, Cona, Ferrara, Italy.
| | | | - Marcella Laganà
- MR Research Laboratory, IRCCS Don Gnocchi Foundation ONLUS, Milan, Italy.
| | - Niels Bergsland
- MR Research Laboratory, IRCCS Don Gnocchi Foundation ONLUS, Milan, Italy. .,Buffalo Neuroimaging Analysis Center, Department of Neurology, University at Buffalo SUNY, Buffalo, NY, USA.
| | - Elisabetta Groppo
- Sezione di Neurologia, Dipartimento di Scienze Biomediche e Chirurgico Specialistiche, Università di Ferrara, Ferrara, Italy.
| | - Marco Rovaris
- Unità Operativa di Sclerosi Multipla, Fondazione Don Gnocchi ONLUS, IRCCS S. Maria Nascente, 20148, Milano, Italy.
| | - Enrico Fainardi
- Unità Operativa di Neuroradiologia, Dipartimento di Neuroscienze e Riabilitazione, Azienda Ospedaliero-Universitaria of Ferrara, Arcispedale S. Anna, Via Aldo Moro 8, 44124, Cona, Ferrara, Italy.
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