1
|
Sternberg Z, Podolsky R, Yu J, Tian M, Hojnacki D, Schaller B. Delayed Decline of Cognitive Function by Antihypertensive Agents: A Cohort Study Linked with Genotype Data. J Prev Alzheimers Dis 2022; 9:679-691. [PMID: 36281672 DOI: 10.14283/jpad.2022.73] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Arterial hypertension is among factors with the potential for increasing the risk of cognitive impairment in elderly subjects. However, studies investigating the effects of antihypertensives on cognitive function have reported mixed results. METHODS We have used the National Alzheimer's Coordinating Center (NACC) Uniform Data Set (UDS) to investigate the effect of each class of antihypertensives, both as single and combined, in reducing the rate of conversion from normal to mild cognitive impairment (MCI). RESULTS The use of antihypertensive drugs was associated with 21% (Hazard ratio: 0.79, p<01001) delay in the rate of conversion to MCI. This effect was modulated by age, gender, and genotypic APOE4 allele. Among different antihypertensive subclasses, calcium channel blockers (CCBs) (24%, HR: 0.76, P=0.004), diuretics (21%, HR: 0.79, P=0.006), and α1-adrenergic blockers (α1-ABs) (23%, HR: 0.77, P=0.034) significantly delayed the rate of MCI conversion. A significant effect was observed with the selective L-type voltage-gated CCBs, dihydropyridines, amlodipine (47%, HR=0.53, P<0.001) and nifedipine (49%, HR=0.51, P=0.012), whereas non-DHPs showed insignificant effect. Loop diuretics, potassium sparing diuretics, and thiazides all significantly reduced the rate of MCI conversion. Combination of α1-AB and diuretics led to synergistic effects; combination of vasodilators plus β-blockers (βBs), and α1-AB plus βBs led to additive effect in delaying the rate of MCI conversion, when compared to a single drug. CONCLUSION Our results could have implications for the more effective treatment of hypertensive elderly adults who are likely to be at high risk of cognitive decline and dementia. The choice of combination of antihypertensive therapy should also consider the combination which would lead to an optimum benefit on cognitive function.
Collapse
Affiliation(s)
- Z Sternberg
- Zohara Sternberg, PhD, Clinical Associate Professor of Neurology, Buffalo Medical Center, Buffalo, NY, 14203, USA, Tel: 716-8597540, Fax: 716-8592430, 859-7573,
| | | | | | | | | | | |
Collapse
|
2
|
Ghione E, Bergsland N, Dwyer MG, Hagemeier J, Jakimovski D, Ramasamy DP, Hojnacki D, Lizarraga AA, Kolb C, Eckert S, Weinstock-Guttman B, Zivadinov R. Disability Improvement Is Associated with Less Brain Atrophy Development in Multiple Sclerosis. AJNR Am J Neuroradiol 2020; 41:1577-1583. [PMID: 32763899 DOI: 10.3174/ajnr.a6684] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 11/24/2019] [Accepted: 06/01/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND PURPOSE It is unknown whether deceleration of brain atrophy is associated with disability improvement in patients with MS. Our aim was to investigate whether patients with MS with disability improvement develop less brain atrophy compared with those who progress in disability or remain stable. MATERIALS AND METHODS We followed 980 patients with MS for a mean of 4.8 ± 2.4 years. Subjects were divided into 3 groups: progress in disability (n = 241, 24.6%), disability improvement (n = 101, 10.3%), and stable (n = 638, 65.1%) at follow-up. Disability improvement and progress in disability were defined on the basis of the Expanded Disability Status Scale score change using standardized guidelines. Stable was defined as nonoccurrence of progress in disability or disability improvement. Normalized whole-brain volume was calculated using SIENAX on 3D T1WI, whereas the lateral ventricle was measured using NeuroSTREAM on 2D-T2-FLAIR images. The percentage brain volume change and percentage lateral ventricle volume change were calculated using SIENA and NeuroSTREAM, respectively. Differences among groups were investigated using ANCOVA, adjusted for age at first MR imaging, race, T2 lesion volume, and corresponding baseline structural volume and the Expanded Disability Status Scale. RESULTS At first MR imaging, there were no differences among progress in disability, disability improvement, and the stable groups in whole-brain volume (P = .71) or lateral ventricle volume (P = .74). During follow-up, patients with disability improvement had the lowest annualized percentage lateral ventricle volume change (1.6% ± 2.7%) followed by patients who were stable (2.1% ± 3.7%) and had progress in disability (4.1% ± 5.5%), respectively (P < .001). The annualized percentage brain volume change values were -0.7% ± 0.7% for disability improvement, -0.8% ± 0.7% for stable, and -1.1% ± 1.1% for progress in disability (P = .001). CONCLUSIONS Patients with MS who improve in their clinical disability develop less brain atrophy across time compared with those who progress.
Collapse
Affiliation(s)
- E Ghione
- From the Department of Neurology (E.G., N.B., M.G.D., J.H., D.J., D.P.R., R.Z.), Buffalo Neuroimaging Analysis Center
| | - N Bergsland
- From the Department of Neurology (E.G., N.B., M.G.D., J.H., D.J., D.P.R., R.Z.), Buffalo Neuroimaging Analysis Center
- IRCCS (N.B.), Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | - M G Dwyer
- From the Department of Neurology (E.G., N.B., M.G.D., J.H., D.J., D.P.R., R.Z.), Buffalo Neuroimaging Analysis Center
- Center for Biomedical Imaging at the Clinical Translational Science Institute (M.G.D., R.Z.),University at Buffalo, State University of New York, Buffalo, New York
| | - J Hagemeier
- From the Department of Neurology (E.G., N.B., M.G.D., J.H., D.J., D.P.R., R.Z.), Buffalo Neuroimaging Analysis Center
| | - D Jakimovski
- From the Department of Neurology (E.G., N.B., M.G.D., J.H., D.J., D.P.R., R.Z.), Buffalo Neuroimaging Analysis Center
| | - D P Ramasamy
- From the Department of Neurology (E.G., N.B., M.G.D., J.H., D.J., D.P.R., R.Z.), Buffalo Neuroimaging Analysis Center
| | - D Hojnacki
- Department of Neurology (D.H., A.A.L., C.K., S.E., B.W.-G.), Jacobs Comprehensive MS Treatment and Research Center, Jacobs School of Medicine and Biomedical Sciences
| | - A A Lizarraga
- Department of Neurology (D.H., A.A.L., C.K., S.E., B.W.-G.), Jacobs Comprehensive MS Treatment and Research Center, Jacobs School of Medicine and Biomedical Sciences
| | - C Kolb
- Department of Neurology (D.H., A.A.L., C.K., S.E., B.W.-G.), Jacobs Comprehensive MS Treatment and Research Center, Jacobs School of Medicine and Biomedical Sciences
| | - S Eckert
- Department of Neurology (D.H., A.A.L., C.K., S.E., B.W.-G.), Jacobs Comprehensive MS Treatment and Research Center, Jacobs School of Medicine and Biomedical Sciences
| | - B Weinstock-Guttman
- Department of Neurology (D.H., A.A.L., C.K., S.E., B.W.-G.), Jacobs Comprehensive MS Treatment and Research Center, Jacobs School of Medicine and Biomedical Sciences
| | - R Zivadinov
- From the Department of Neurology (E.G., N.B., M.G.D., J.H., D.J., D.P.R., R.Z.), Buffalo Neuroimaging Analysis Center
- Center for Biomedical Imaging at the Clinical Translational Science Institute (M.G.D., R.Z.),University at Buffalo, State University of New York, Buffalo, New York
| |
Collapse
|
3
|
Bergsland N, Ramasamy D, Tavazzi E, Hojnacki D, Weinstock-Guttman B, Zivadinov R. Leptomeningeal Contrast Enhancement Is Related to Focal Cortical Thinning in Relapsing-Remitting Multiple Sclerosis: A Cross-Sectional MRI Study. AJNR Am J Neuroradiol 2019; 40:620-625. [PMID: 30872420 DOI: 10.3174/ajnr.a6011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 02/16/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND PURPOSE Leptomeningeal inflammation is associated with the development of global cortical gray matter atrophy in multiple sclerosis. However, its association with localized loss of tissue remains unclear. The purpose of this study was to evaluate the relationship between leptomeningeal contrast enhancement, a putative marker of leptomeningeal inflammation, and focal cortical thinning in MS. MATERIALS AND METHODS Forty-three patients with relapsing-remitting MS and 15 with secondary-progressive MS were imaged on a 3T scanner. Cortical reconstruction was performed with FreeSurfer. Leptomeningeal contrast-enhancement foci were visually identified on 3D-FLAIR postcontrast images and confirmed using subtraction imaging. Leptomeningeal contrast-enhancement foci were mapped onto the cortex, and ROIs were obtained by dilating along the surface multiple times (n = 5, 10, 15, 20, 25, 30, 35, 40). Resulting ROIs were then mapped onto the homologous region of the contralateral hemisphere. Paired t tests compared the thickness of the cortex surrounding individual leptomeningeal contrast-enhancement foci and the corresponding contralateral region. Results were corrected for the false discovery rate. RESULTS Differences between ipsilateral and contralateral ROIs progressively decreased with larger ROIs, but no significant effects were detected when considering the entire MS sample. In patients with relapsing-remitting MS only, significantly reduced cortical thickness was found for 5 dilations (-8.53%, corrected P = .04) and 10 dilations (-5.20%, corrected P = .044). CONCLUSIONS Focal leptomeningeal contrast enhancement is associated with reduced thickness of the surrounding cortex in patients with relapsing-remitting MS, but not in those with secondary-progressive MS. Our results suggest that pathology associated with the presence of leptomeningeal contrast-enhancement foci has a stronger, localized effect on cortical tissue loss earlier in the disease.
Collapse
Affiliation(s)
- N Bergsland
- From the Buffalo Neuroimaging Analysis Center (N.B., D.R., E.T., R.Z.)
| | - D Ramasamy
- From the Buffalo Neuroimaging Analysis Center (N.B., D.R., E.T., R.Z.)
| | - E Tavazzi
- From the Buffalo Neuroimaging Analysis Center (N.B., D.R., E.T., R.Z.)
| | - D Hojnacki
- Jacobs Comprehensive MS Treatment and Research Center (D.H., B.W.-G.), Department of Neurology
| | - B Weinstock-Guttman
- Jacobs Comprehensive MS Treatment and Research Center (D.H., B.W.-G.), Department of Neurology
| | - R Zivadinov
- From the Buffalo Neuroimaging Analysis Center (N.B., D.R., E.T., R.Z.).,Jacobs School of Medicine and Biomedical Sciences, Center for Biomedical Imaging at Clinical Translational Science Institute (R.Z.), University at Buffalo, State University of New York, Buffalo, New York
| |
Collapse
|
4
|
Ghione E, Bergsland N, Dwyer MG, Hagemeier J, Jakimovski D, Paunkoski I, Ramasamy DP, Silva D, Carl E, Hojnacki D, Kolb C, Weinstock-Guttman B, Zivadinov R. Brain Atrophy Is Associated with Disability Progression in Patients with MS followed in a Clinical Routine. AJNR Am J Neuroradiol 2018; 39:2237-2242. [PMID: 30467212 DOI: 10.3174/ajnr.a5876] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 09/08/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND PURPOSE The assessment of brain atrophy in a clinical routine is not performed routinely in multiple sclerosis. Our aim was to determine the feasibility of brain atrophy measurement and its association with disability progression in patients with MS followed in a clinical routine for 5 years. MATERIALS AND METHODS A total of 1815 subjects, 1514 with MS and 137 with clinically isolated syndrome and 164 healthy individuals, were collected retrospectively. Of 11,794 MR imaging brain scans included in the analysis, 8423 MRIs were performed on a 3T, and 3371 MRIs, on a 1.5T scanner. All patients underwent 3D T1WI and T2-FLAIR examinations at all time points of the study. Whole-brain volume changes were measured by percentage brain volume change/normalized brain volume change using SIENA/SIENAX on 3D T1WI and percentage lateral ventricle volume change using NeuroSTREAM on T2-FLAIR. RESULTS Percentage brain volume change failed in 36.7% of the subjects; percentage normalized brain volume change, in 19.2%; and percentage lateral ventricle volume change, in 3.3% because of protocol changes, poor scan quality, artifacts, and anatomic variations. Annualized brain volume changes were significantly different between those with MS and healthy individuals for percentage brain volume change (P < .001), percentage normalized brain volume change (P = .002), and percentage lateral ventricle volume change (P = .01). In patients with MS, mixed-effects model analysis showed that disability progression was associated with a 21.9% annualized decrease in percentage brain volume change (P < .001) and normalized brain volume (P = .002) and a 33% increase in lateral ventricle volume (P = .004). CONCLUSIONS All brain volume measures differentiated MS and healthy individuals and were associated with disability progression, but the lateral ventricle volume assessment was the most feasible.
Collapse
Affiliation(s)
- E Ghione
- From the Department of Neurology (E.G., N.B., M.G.D., J.H., D.J., I.P., D.P.R., E.C., R.Z.), Buffalo Neuroimaging Analysis Center
| | - N Bergsland
- From the Department of Neurology (E.G., N.B., M.G.D., J.H., D.J., I.P., D.P.R., E.C., R.Z.), Buffalo Neuroimaging Analysis Center
| | - M G Dwyer
- From the Department of Neurology (E.G., N.B., M.G.D., J.H., D.J., I.P., D.P.R., E.C., R.Z.), Buffalo Neuroimaging Analysis Center.,Center for Biomedical Imaging at Clinical Translational Research Center (M.G.D., R.Z.), State University of New York, Buffalo, New York
| | - J Hagemeier
- From the Department of Neurology (E.G., N.B., M.G.D., J.H., D.J., I.P., D.P.R., E.C., R.Z.), Buffalo Neuroimaging Analysis Center
| | - D Jakimovski
- From the Department of Neurology (E.G., N.B., M.G.D., J.H., D.J., I.P., D.P.R., E.C., R.Z.), Buffalo Neuroimaging Analysis Center
| | - I Paunkoski
- From the Department of Neurology (E.G., N.B., M.G.D., J.H., D.J., I.P., D.P.R., E.C., R.Z.), Buffalo Neuroimaging Analysis Center
| | - D P Ramasamy
- From the Department of Neurology (E.G., N.B., M.G.D., J.H., D.J., I.P., D.P.R., E.C., R.Z.), Buffalo Neuroimaging Analysis Center
| | - D Silva
- Novartis Pharmaceuticals AG (D.S.), Basel, Switzerland
| | - E Carl
- From the Department of Neurology (E.G., N.B., M.G.D., J.H., D.J., I.P., D.P.R., E.C., R.Z.), Buffalo Neuroimaging Analysis Center
| | - D Hojnacki
- Jacobs Comprehensive MS Treatment and Research Center (D.H., C.K., B.W.-G.), Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York
| | - C Kolb
- Jacobs Comprehensive MS Treatment and Research Center (D.H., C.K., B.W.-G.), Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York
| | - B Weinstock-Guttman
- Jacobs Comprehensive MS Treatment and Research Center (D.H., C.K., B.W.-G.), Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York
| | - R Zivadinov
- From the Department of Neurology (E.G., N.B., M.G.D., J.H., D.J., I.P., D.P.R., E.C., R.Z.), Buffalo Neuroimaging Analysis Center .,Center for Biomedical Imaging at Clinical Translational Research Center (M.G.D., R.Z.), State University of New York, Buffalo, New York
| |
Collapse
|
5
|
Jakimovski D, Gandhi S, Paunkoski I, Bergsland N, Hagemeier J, Ramasamy DP, Hojnacki D, Kolb C, Benedict RHB, Weinstock‐Guttman B, Zivadinov R. Hypertension and heart disease are associated with development of brain atrophy in multiple sclerosis: a 5‐year longitudinal study. Eur J Neurol 2018; 26:87-e8. [DOI: 10.1111/ene.13769] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 08/09/2018] [Indexed: 11/26/2022]
Affiliation(s)
- D. Jakimovski
- Buffalo Neuroimaging Analysis Center Department of Neurology Jacobs School of Medicine and Biomedical Sciences University at Buffalo State University of New York Buffalo NYUSA
| | - S. Gandhi
- Buffalo Neuroimaging Analysis Center Department of Neurology Jacobs School of Medicine and Biomedical Sciences University at Buffalo State University of New York Buffalo NYUSA
| | - I. Paunkoski
- Buffalo Neuroimaging Analysis Center Department of Neurology Jacobs School of Medicine and Biomedical Sciences University at Buffalo State University of New York Buffalo NYUSA
| | - N. Bergsland
- Buffalo Neuroimaging Analysis Center Department of Neurology Jacobs School of Medicine and Biomedical Sciences University at Buffalo State University of New York Buffalo NYUSA
| | - J. Hagemeier
- Buffalo Neuroimaging Analysis Center Department of Neurology Jacobs School of Medicine and Biomedical Sciences University at Buffalo State University of New York Buffalo NYUSA
| | - D. P. Ramasamy
- Buffalo Neuroimaging Analysis Center Department of Neurology Jacobs School of Medicine and Biomedical Sciences University at Buffalo State University of New York Buffalo NYUSA
| | - D. Hojnacki
- Jacobs Comprehensive MS Treatment and Research Center Department of Neurology Jacobs School of Medicine and Biomedical Sciences University at Buffalo State University of New York Buffalo NYUSA
| | - C. Kolb
- Jacobs Comprehensive MS Treatment and Research Center Department of Neurology Jacobs School of Medicine and Biomedical Sciences University at Buffalo State University of New York Buffalo NYUSA
| | - R. H. B. Benedict
- Jacobs Comprehensive MS Treatment and Research Center Department of Neurology Jacobs School of Medicine and Biomedical Sciences University at Buffalo State University of New York Buffalo NYUSA
| | - B. Weinstock‐Guttman
- Jacobs Comprehensive MS Treatment and Research Center Department of Neurology Jacobs School of Medicine and Biomedical Sciences University at Buffalo State University of New York Buffalo NYUSA
| | - R. Zivadinov
- Buffalo Neuroimaging Analysis Center Department of Neurology Jacobs School of Medicine and Biomedical Sciences University at Buffalo State University of New York Buffalo NYUSA
- Center for Biomedical Imaging at Clinical Translational Science Institute University at Buffalo State University of New York Buffalo NY USA
| |
Collapse
|
6
|
Zivadinov R, Ramasamy DP, Hagemeier J, Kolb C, Bergsland N, Schweser F, Dwyer MG, Weinstock-Guttman B, Hojnacki D. Evaluation of Leptomeningeal Contrast Enhancement Using Pre-and Postcontrast Subtraction 3D-FLAIR Imaging in Multiple Sclerosis. AJNR Am J Neuroradiol 2018; 39:642-647. [PMID: 29439125 DOI: 10.3174/ajnr.a5541] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 11/28/2017] [Indexed: 01/13/2023]
Abstract
BACKGROUND AND PURPOSE Leptomeningeal contrast enhancement is found in patients with multiple sclerosis, though reported rates have varied. The use of 3D-fluid-attenuated inversion recovery pre- and postcontrast subtraction imaging may more accurately determine the frequency of leptomeningeal contrast enhancement. The purpose of this study was to investigate the frequency of leptomeningeal contrast enhancement using the pre- and postcontrast subtraction approach and to evaluate 3 different methods of assessing the presence of leptomeningeal contrast enhancement. MATERIALS AND METHODS We enrolled 258 consecutive patients with MS (212 with relapsing-remitting MS, 32 with secondary-progressive MS, and 14 with clinically isolated syndrome) who underwent both pre- and 10-minute postcontrast 3D-FLAIR sequences after a single dose of gadolinium injection on 3T MR imaging. The analysis included leptomeningeal contrast-enhancement evaluation on 3D-FLAIR postcontrast images in native space (method A), on pre- and postcontrast 3D-FLAIR images in native space (method B), and on pre-/postcontrast 3D-FLAIR coregistered and subtracted images (method C, used as the criterion standard). RESULTS In total, 51 (19.7%) patients with MS showed the presence of leptomeningeal contrast enhancement using method A; 39 (15.1%), using method B; and 39 (15.1%), using method C (P = .002). Compared with method C as the criterion standard, method A showed 89.8% sensitivity and 92.7% specificity, while method B showed 84.6% sensitivity and 97.3% specificity (P < .001) at the patient level. Reproducibility was the highest using method C (κ agreement, r = 088, P < .001). The mean time to analyze the 3D-FLAIR images was significantly lower with method C compared with methods A and B (P < .001). CONCLUSIONS 3D-FLAIR postcontrast imaging offers a sensitive method for detecting leptomeningeal contrast enhancement in patients with MS. However, the use of subtraction imaging helped avoid false-positive cases, decreased reading time, and increased the accuracy of leptomeningeal contrast-enhancement foci detection in a clinical routine.
Collapse
Affiliation(s)
- R Zivadinov
- From the Department of Neurology (R.Z., D.P.R., J.H., N.B., F.S., M.G.D.), Buffalo Neuroimaging Analysis Center, Jacobs School of Medicine and Biomedical Sciences
- Department of Neurology (R.Z., C.K., D.H.), Jacobs Comprehensive MS Treatment and Research Center, University at Buffalo, State University of New York, Buffalo, New York
| | - D P Ramasamy
- From the Department of Neurology (R.Z., D.P.R., J.H., N.B., F.S., M.G.D.), Buffalo Neuroimaging Analysis Center, Jacobs School of Medicine and Biomedical Sciences
| | - J Hagemeier
- From the Department of Neurology (R.Z., D.P.R., J.H., N.B., F.S., M.G.D.), Buffalo Neuroimaging Analysis Center, Jacobs School of Medicine and Biomedical Sciences
| | - C Kolb
- Department of Neurology (R.Z., C.K., D.H.), Jacobs Comprehensive MS Treatment and Research Center, University at Buffalo, State University of New York, Buffalo, New York
| | - N Bergsland
- From the Department of Neurology (R.Z., D.P.R., J.H., N.B., F.S., M.G.D.), Buffalo Neuroimaging Analysis Center, Jacobs School of Medicine and Biomedical Sciences
| | - F Schweser
- From the Department of Neurology (R.Z., D.P.R., J.H., N.B., F.S., M.G.D.), Buffalo Neuroimaging Analysis Center, Jacobs School of Medicine and Biomedical Sciences
| | - M G Dwyer
- From the Department of Neurology (R.Z., D.P.R., J.H., N.B., F.S., M.G.D.), Buffalo Neuroimaging Analysis Center, Jacobs School of Medicine and Biomedical Sciences
| | - B Weinstock-Guttman
- Translational Imaging Center at Clinical Translational Science Institute (B.W.-G.)
| | - D Hojnacki
- Department of Neurology (R.Z., C.K., D.H.), Jacobs Comprehensive MS Treatment and Research Center, University at Buffalo, State University of New York, Buffalo, New York
| |
Collapse
|
7
|
Zivadinov R, Hojnacki D, Bergsland N, Kennedy C, Hagemeier J, Melia R, Ramasamy DP, Durfee J, Carl E, Dwyer MG, Weinstock-Guttman B. Effect of natalizumab on brain atrophy and disability progression in multiple sclerosis patients over 5 years. Eur J Neurol 2016; 23:1101-9. [DOI: 10.1111/ene.12992] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 02/02/2016] [Indexed: 01/21/2023]
Affiliation(s)
- R. Zivadinov
- Department of Neurology; Buffalo Neuroimaging Analysis Center; University at Buffalo; State University of New York; Buffalo NY USA
- MR Imaging Clinical Translational Research Center; School of Medicine and Biomedical Sciences; University at Buffalo; State University of New York; Buffalo NY USA
| | - D. Hojnacki
- Jacobs MS Center; Department of Neurology; University at Buffalo; State University of New York; Buffalo NY USA
| | - N. Bergsland
- Department of Neurology; Buffalo Neuroimaging Analysis Center; University at Buffalo; State University of New York; Buffalo NY USA
- Magnetic Resonance Laboratory; IRCCS Don Gnocchi Foundation; Milan Italy
| | - C. Kennedy
- Department of Neurology; Buffalo Neuroimaging Analysis Center; University at Buffalo; State University of New York; Buffalo NY USA
| | - J. Hagemeier
- Department of Neurology; Buffalo Neuroimaging Analysis Center; University at Buffalo; State University of New York; Buffalo NY USA
| | - R. Melia
- Department of Neurology; Buffalo Neuroimaging Analysis Center; University at Buffalo; State University of New York; Buffalo NY USA
| | - D. P. Ramasamy
- Department of Neurology; Buffalo Neuroimaging Analysis Center; University at Buffalo; State University of New York; Buffalo NY USA
| | - J. Durfee
- Department of Neurology; Buffalo Neuroimaging Analysis Center; University at Buffalo; State University of New York; Buffalo NY USA
| | - E. Carl
- Department of Neurology; Buffalo Neuroimaging Analysis Center; University at Buffalo; State University of New York; Buffalo NY USA
| | - M. G. Dwyer
- Department of Neurology; Buffalo Neuroimaging Analysis Center; University at Buffalo; State University of New York; Buffalo NY USA
| | - B. Weinstock-Guttman
- Jacobs MS Center; Department of Neurology; University at Buffalo; State University of New York; Buffalo NY USA
| |
Collapse
|
8
|
Zivadinov R, Raj B, Ramanathan M, Teter B, Durfee J, Dwyer MG, Bergsland N, Kolb C, Hojnacki D, Benedict RH, Weinstock-Guttman B. Autoimmune Comorbidities Are Associated with Brain Injury in Multiple Sclerosis. AJNR Am J Neuroradiol 2016; 37:1010-6. [PMID: 26892983 DOI: 10.3174/ajnr.a4681] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 11/25/2015] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND PURPOSE The effect of comorbidities on disease severity in MS has not been extensively characterized. We determined the association of comorbidities with MR imaging disease severity outcomes in MS. MATERIALS AND METHODS Demographic and clinical history of 9 autoimmune comorbidities confirmed by retrospective chart review and quantitative MR imaging data were obtained in 815 patients with MS. The patients were categorized on the basis of the presence/absence of total and specific comorbidities. We analyzed the MR imaging findings, adjusting for key covariates and correcting for multiple comparisons. RESULTS Two hundred forty-one (29.6%) study subjects presented with comorbidities. Thyroid disease had the highest frequency (n = 97, 11.9%), followed by asthma (n = 41, 5%), type 2 diabetes mellitus (n = 40, 4.9%), psoriasis (n = 33, 4%), and rheumatoid arthritis (n = 22, 2.7%). Patients with MS with comorbidities showed decreased whole-brain and cortical volumes (P < .001), gray matter volume and magnetization transfer ratio of normal-appearing brain tissue (P < .01), and magnetization transfer ratio of gray matter (P < .05). Psoriasis, thyroid disease, and type 2 diabetes mellitus comorbidities were associated with decreased whole-brain, cortical, and gray matter volumes (P < .05). Psoriasis was associated with a decreased magnetization transfer ratio of normal-appearing brain tissue (P < .05), while type 2 diabetes mellitus was associated with increased mean diffusivity (P < .01). CONCLUSIONS The presence of comorbidities in patients with MS is associated with brain injury on MR imaging. Psoriasis, thyroid disease, and type 2 diabetes mellitus comorbidities were associated with more severe nonconventional MR imaging outcomes.
Collapse
Affiliation(s)
- R Zivadinov
- From the, Department of Neurology (R.Z., B.R., J.D., M.G.D., N.B.), Buffalo Neuroimaging Analysis Center MR Imaging Clinical Translational Research Center (R.Z.)
| | - B Raj
- From the, Department of Neurology (R.Z., B.R., J.D., M.G.D., N.B.), Buffalo Neuroimaging Analysis Center
| | - M Ramanathan
- Department of Pharmaceutical Sciences (M.R.), School of Medicine and Biomedical Sciences, State University of New York, Buffalo, New York
| | - B Teter
- Department of Neurology (B.T., C.K., D.H., R.H.B., B.W.-G.), Jacobs MS Center, University at Buffalo, State University of New York, Buffalo, New York
| | - J Durfee
- From the, Department of Neurology (R.Z., B.R., J.D., M.G.D., N.B.), Buffalo Neuroimaging Analysis Center
| | - M G Dwyer
- From the, Department of Neurology (R.Z., B.R., J.D., M.G.D., N.B.), Buffalo Neuroimaging Analysis Center
| | - N Bergsland
- From the, Department of Neurology (R.Z., B.R., J.D., M.G.D., N.B.), Buffalo Neuroimaging Analysis Center Magnetic Resonance Laboratory (N.B.), IRCCS Don Gnocchi Foundation, Milan, Italy
| | - C Kolb
- Department of Neurology (B.T., C.K., D.H., R.H.B., B.W.-G.), Jacobs MS Center, University at Buffalo, State University of New York, Buffalo, New York
| | - D Hojnacki
- Department of Neurology (B.T., C.K., D.H., R.H.B., B.W.-G.), Jacobs MS Center, University at Buffalo, State University of New York, Buffalo, New York
| | - R H Benedict
- Department of Neurology (B.T., C.K., D.H., R.H.B., B.W.-G.), Jacobs MS Center, University at Buffalo, State University of New York, Buffalo, New York
| | - B Weinstock-Guttman
- Department of Neurology (B.T., C.K., D.H., R.H.B., B.W.-G.), Jacobs MS Center, University at Buffalo, State University of New York, Buffalo, New York
| |
Collapse
|
9
|
Gabelic T, Ramasamy DP, Weinstock-Guttman B, Hagemeier J, Kennedy C, Melia R, Hojnacki D, Ramanathan M, Zivadinov R. Prevalence of radiologically isolated syndrome and white matter signal abnormalities in healthy relatives of patients with multiple sclerosis. AJNR Am J Neuroradiol 2014; 35:106-12. [PMID: 23886745 PMCID: PMC7966501 DOI: 10.3174/ajnr.a3653] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Accepted: 04/19/2013] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The exact prevalence of WM signal abnormalities in healthy relatives of MS patients and their impact on disease development has not been fully elucidated. The purpose of this study was to compare WM signal abnormality characteristics and the prevalence of radiologically isolated syndrome in healthy control subjects selected randomly from the population with the healthy relatives of patients with MS. MATERIALS AND METHODS Healthy control subjects (n = 150) underwent physical and 3T MR imaging examinations. Healthy control subjects were classified as non-familial healthy control subjects (n = 82) if they had no family history of MS or as healthy relatives of patients with MS (n = 68) if they had ≥1 relative affected with MS. The presence of radiologically isolated syndrome was evaluated according to the Okuda criteria; dissemination in space on MR imaging and fulfillment of radiologically isolated syndrome criteria were also evaluated according to Swanton criteria. RESULTS There was a significantly higher total volume of WM signal abnormality in the healthy relatives of patients with MS compared with the non-familial healthy control subjects (P = .024 for signal abnormality ≥3 mm in size and P = .025 for all sizes). Periventricular localization and the number of lesions in all groups (P = .034 and P = .043) were significantly higher in the healthy relatives of patients with MS; 8.8% of the healthy relatives of patients with MS and 4.9% of non-familial healthy control subjects showed ≥9 WM signal abnormalities; 2.9% of subjects in the healthy relatives of patients with MS group and 2.4% of non-familial healthy control subjects fulfilled radiologically isolated syndrome according to the Okuda criteria, whereas 10.3% and 3.7% of subjects fulfilled radiologically isolated syndrome according to the Swanton criteria. In the healthy relatives of patients with MS, smoking was associated with the presence of WM signal abnormalities, whereas obesity was related to the presence of ≥9 WM signal abnormalities and to fulfillment of radiologically isolated syndrome according to the Swanton criteria. CONCLUSIONS The frequency of WM signal abnormalities and radiologically isolated syndrome is higher in the healthy relatives of patients with multiple sclerosis patients compared with non-familial healthy control subjects.
Collapse
Affiliation(s)
- T Gabelic
- Buffalo Neuroimaging Analysis Center
| | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Hagemeier J, Weinstock-Guttman B, Bergsland N, Heininen-Brown M, Carl E, Kennedy C, Magnano C, Hojnacki D, Dwyer MG, Zivadinov R. Iron deposition on SWI-filtered phase in the subcortical deep gray matter of patients with clinically isolated syndrome may precede structure-specific atrophy. AJNR Am J Neuroradiol 2012; 33:1596-601. [PMID: 22460343 DOI: 10.3174/ajnr.a3030] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND AND PURPOSE Increasing evidence suggests that iron deposition is present in the later stages of MS. In this study we examined abnormal phase values, indicative of increased iron content on SWI-filtered phase images of the SDGM in CIS patients and HC. We also examined the association of abnormal phase with conventional MR imaging outcomes at first clinical onset. MATERIALS AND METHODS Forty-two patients with CIS (31 female, 11 male) and 65 age and sex-matched HC (41 female, 24 male) were scanned on a 3T scanner. Mean age was 40.1 (SD = 10.4) years in patients with CIS, and 42.8 (SD = 14) years in HC, while mean disease duration was 1.2 years (SD = 1.3) in patients with CIS. MP-APT, NPTV, and normalized volume measurements were derived for all SDGM structures. Parametric and nonparametric group-wise comparisons were performed, and associations were determined with other MR imaging metrics. RESULTS Patients with CIS had significantly increased MP-APT (P = .029) and MP-APT volume (P = .045) in the pulvinar nucleus of the thalamus compared with HC. Furthermore, the putamen (P = .004), caudate (P = .035), and total SDGM (P = .048) displayed significant increases in MP-APT volume, while MP-APT was also significantly increased in the putamen (P = .029). No global or regional volumetric MR imaging differences were found between the study groups. Significant correlations were observed between increased MP-APT volumes of total SDGM, caudate, thalamus, hippocampus, and substantia nigra with white matter atrophy and increased T2 lesion volume (P < .05). CONCLUSION Patients with CIS showed significantly increased content and volume of iron, as determined by abnormal SWI-phase measurement, in the various SDGM structures, suggesting that iron deposition may precede structure-specific atrophy.
Collapse
Affiliation(s)
- J Hagemeier
- Buffalo Neuroimaging Analysis Center, State University of New York at Buffalo, Buffalo, NY 14203, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Zivadinov R, Dwyer MG, Hussein S, Carl E, Kennedy C, Andrews M, Hojnacki D, Heininen-Brown M, Willis L, Cherneva M, Bergsland N, Weinstock-Guttman B. Voxel-wise magnetization transfer imaging study of effects of natalizumab and IFNβ-1a in multiple sclerosis. Mult Scler 2012; 18:1125-1134. [DOI: 10.1177/1352458511433304] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
Objective: To determine the effects of intravenous natalizumab and intramuscular interferon beta-1a (IFNβ-1a) on the volume of white-matter (WM) lesions and normal appearing brain tissue (NABT) undergoing voxel-wise (VW) increases in magnetization transfer ratio (MTR) suggestive of remyelination in patients with relapsing multiple sclerosis. Methods: This prospective, open-label, single-blinded study enrolled patients with relapsing–remitting multiple sclerosis (RRMS) and relapsing secondary progressive multiple sclerosis (RSPMS) as well as a group of age/sex-matched healthy controls ( n=22). Patients with multiple sclerosis were assigned to receive natalizumab monotherapy ( n=77; RRMS/RSPMS) or intramuscular IFNβ-1a ( n=26) as either monotherapy (RRMS) or combined with pulsed i.v. methylprednisolone, as needed (RSPMS). The primary endpoint was the two-year change in volume of NABT VWMTR, by quantifying the number of voxels that increased (suggesting remyelination) or decreased (suggesting demyelination) in their MTR value. Results: The volume of tissue undergoing increases in VWMTR was significantly larger in natalizumab compared with IFNβ-1a-treated patients (year 1: p=0.001 in NABT and p<0.006 in WM lesions; year 2: p=0.008 in NABT) and compared with healthy control subjects (year 1: p=0.05 and year 2: p=0.007 in NABT). The larger volume within NABT undergoing decreases in VWMTR was detected in multiple sclerosis patients compared with healthy controls ( p<0.001), and in the IFNβ-1a group compared with the natalizumab group (year 1: p=0.05; year 2: p=0.002). One patient on natalizumab died from progressive multifocal leukoencephalopathy eight months after completing the study. Conclusion: Natalizumab may promote remyelination and stabilize demyelination in lesions and NABT in relapsing multiple sclerosis, compared with intramuscular IFNβ-1a.
Collapse
Affiliation(s)
- R Zivadinov
- Buffalo Neuroimaging Analysis Center, State University of New York, Buffalo, USA
- The Jacobs Neurological Institute, Department of Neurology, University at Buffalo, State University of New York, Buffalo, USA
| | - MG Dwyer
- Buffalo Neuroimaging Analysis Center, State University of New York, Buffalo, USA
| | - S Hussein
- Buffalo Neuroimaging Analysis Center, State University of New York, Buffalo, USA
| | - E Carl
- Buffalo Neuroimaging Analysis Center, State University of New York, Buffalo, USA
| | - C Kennedy
- Buffalo Neuroimaging Analysis Center, State University of New York, Buffalo, USA
| | - M Andrews
- Buffalo Neuroimaging Analysis Center, State University of New York, Buffalo, USA
| | - D Hojnacki
- Buffalo Neuroimaging Analysis Center, State University of New York, Buffalo, USA
| | - M Heininen-Brown
- Buffalo Neuroimaging Analysis Center, State University of New York, Buffalo, USA
| | - L Willis
- Buffalo Neuroimaging Analysis Center, State University of New York, Buffalo, USA
| | - M Cherneva
- Buffalo Neuroimaging Analysis Center, State University of New York, Buffalo, USA
| | - N Bergsland
- Buffalo Neuroimaging Analysis Center, State University of New York, Buffalo, USA
| | - B Weinstock-Guttman
- Buffalo Neuroimaging Analysis Center, State University of New York, Buffalo, USA
- The Jacobs Neurological Institute, Department of Neurology, University at Buffalo, State University of New York, Buffalo, USA
| |
Collapse
|
12
|
Zivadinov R, Cutter G, Marr K, Ramanathan M, Benedict RHB, Bergsland N, Morgan C, Carl E, Hojnacki D, Yeh EA, Willis L, Cherneva M, Kennedy C, Dwyer MG, Weinstock-Guttman B. No association between conventional brain MR imaging and chronic cerebrospinal venous insufficiency in multiple sclerosis. AJNR Am J Neuroradiol 2012; 33:1913-7. [PMID: 22576891 DOI: 10.3174/ajnr.a3112] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [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
BACKGROUND AND PURPOSE CCSVI has been reported to occur at high frequency in MS. Its significance in relation to MR imaging parameters also needs to be determined, both in patients with MS and HCs. Therefore, this study determined the associations of CCSVI and conventional MR imaging outcomes in patients with MS and in HCs. MATERIALS AND METHODS T2, T1, and gadolinium lesion number, LV, and brain atrophy were assessed on 3T MR imaging in 301 subjects, of whom 162 had RRMS, 66 had secondary-progressive MS subtype, and 73 were HCs. CCSVI was assessed using extracranial and transcranial Doppler evaluation. The MR imaging measure differences were explored with 27 borderline cases for CCSVI, added to both the negative and positive CCSVI groups to assess sensitivity of the results of these cases. RESULTS No significant differences between subjects with and without CCSVI were found in any of the individual diagnostic subgroups or MS disease subtypes for lesion burden and atrophy measures, independently of the CCSVI classification criteria used, except for a trend for higher T2 lesion number (irrespective of how borderline cases were classified) and lower brain volume (when borderline cases were included in the positive group) in patients with RRMS with CCSVI. No CCSVI or MR imaging differences were found between 26 HCs with, or 47 without, a familial relationship. CONCLUSIONS CCSVI is not associated with more severe lesion burden or brain atrophy in patients with MS or in HCs.
Collapse
Affiliation(s)
- R Zivadinov
- Buffalo Neuroimaging Analysis Center, Department of Neurology, School of Medicine and Biomedical Sciences, Buffalo, NY 14203, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Hojnacki D, Zivadinov R, Weinstock-Guttman B. Subtle Lesion Appearance on MRI May Precede Development of Progressive Multifocal Leukoencephalopathy in Multiple Sclerosis Patients Treated with Natalizumab (P07.059). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p07.059] [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: 11/15/2022] Open
|
14
|
Hojnacki D, Zivadinov R, Weinstock-Guttman B. Successful Treatment of Natalizumab Induced PML with CMX001 and the Side Effects Associated with Its Use (P07.060). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p07.060] [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: 11/15/2022] Open
|
15
|
Karmon Y, Morrow S, Weinstock L, Hojnacki D, Weinstock-Guttman B. Limb Ataxia Originating from Peri-Central Sulcus Demyelinating Lesion in Multiple Sclerosis Patients (P06.176). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p06.176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
16
|
Hagemeier J, Weinstock-Guttman B, Bergsland N, Heininen-Brown M, Carl E, Kennedy C, Magnano C, Hojnacki D, Dwyer M, Zivadinov R. Iron Deposition on SWI Filtered Phase in the Subcortical Deep Gray Matter of Clinically Isolated Syndrome Patients May Precede Structure-Specific Atrophy (P03.032). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p03.032] [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: 11/15/2022] Open
|
17
|
Livshits I, Hussein S, Kennedy C, Weinstock-Guttman B, Hojnacki D, Zivadinov R. Comparison of a 1.5T Standard vs. 3T Optimized Protocols in Multiple Sclerosis Patients (P03.053). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p03.053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
18
|
Livshits I, Hussein S, Kennedy C, Weinstock-Guttman B, Hojnacki D, Zivadinov R. Comparison of a 1.5T standard vs. 3T optimized protocols in multiple sclerosis patients. Minerva Med 2012; 103:97-102. [PMID: 22513514] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
AIM Use of postcontrast T1-weighted imaging (WI) is an important tool in diagnosing and predicting the course of multiple sclerosis (MS). Application of optimized imaging strategies has the potential to increase detection of magnetic resonance imaging (MRI) disease activity. This study investigated the superiority of the 3T optimized vs. the 1.5T standardized protocols in detecting gadolinium enhancing (GD-E) lesions in patients with MS. METHODS A standard protocol was defined as a 1.5T scan with a single-dose of Gd and a 5-minute scanning delay after injection. An optimized protocol was defined as a 3T MRI scan, using a triple dose of Gd, 20 min scan delay, and using an off-resonance saturated magnetization transfer pulse to reduce the background signal. Fourteen relapsing-remitting MS patients and 3 healthy controls (HC) were scanned with 1.5T standardized and a 3T optimized protocols in random order over 72 hours. RESULTS There were 47 Gd-E lesions in the MS patients on 3T optimized and 34 on 1.5T standard protocols, a 38.2% increase. There was a significant increase in Gd-enhanced lesion volume (LV) detected with the optimized protocol (179.6%, P<0.05), with 94.6% of the mean Gd-enhanced LV detected only on the 3T optimized protocol. No Gd-E lesions were detected in HC on either protocol. CONCLUSION The 3T optimized protocol is a useful technique for increasing sensitivity of MRI to detect Gd-E lesions.
Collapse
Affiliation(s)
- I Livshits
- Buffalo Neuroimaging Analysis Center, State University of New York, Buffalo, NY, USA.
| | | | | | | | | | | |
Collapse
|
19
|
Dolic K, Marr K, Valnarov V, Dwyer MG, Carl E, Karmon Y, Kennedy C, Brooks C, Kilanowski C, Hunt K, Siddiqui AH, Hojnacki D, Weinstock-Guttman B, Zivadinov R. Intra- and extraluminal structural and functional venous anomalies in multiple sclerosis, as evidenced by 2 noninvasive imaging techniques. AJNR Am J Neuroradiol 2011; 33:16-23. [PMID: 22194367 DOI: 10.3174/ajnr.a2877] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [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
BACKGROUND AND PURPOSE Chronic cerebrospinal venous insufficiency (CCSVI) is a vascular condition characterized by anomalies of the main extracranial cerebrospinal venous routes that interfere with normal venous outflow. Research into CCSVI will determine its sensitivity and specificity for a diagnosis of MS, its prevalence in MS patients, and its clinical, MRI, and genetic correlates. Our aim was to investigate the prevalence and number of intra- and extraluminal structural and functional extracranial venous abnormalities by using DS and MRV, in patients with MS and HCs. MATERIALS AND METHODS One hundred fifty patients with MS, 104 (69.3%) with RR and 46 (30.7%) with a progressive MS course, and 63 age- and sex-matched HCs were scanned with 3T MR imaging by using TOF and TRICKS sequences (only patients with MS). All subjects underwent DS examination for intra- and extraluminal structural and functional abnormalities of the IJVs. Absent/pinpoint IJV flow morphology on MRV was considered an abnormal finding. Prominence of collateral extracranial veins was assessed with MRV. RESULTS Patients with MS had a significantly higher number of functional (P < .0001), total (P = .001), and intraluminal (P = .005) structural IJV DS abnormalities than HCs. There was a trend for more patients with MS with extraluminal IJV DS abnormalities (P = .023). No significant differences were found on the MRV IJV flow morphology scale between patients with MS and HCs. Patients with progressive MS showed more extraluminal IJV DS abnormalities (P = .01) and more MRV flow abnormalities on TOF (P = .006) and TRICKS (P = .01) than patients with nonprogressive MS. There was a trend for a higher number of collateral veins in patients with MS than in HCs (P = .016). CONCLUSIONS DS is more sensitive than MRV in detecting intraluminal structural and functional venous abnormalities in patients with MS compared with HCs, whereas MRV is more sensitive in showing collaterals.
Collapse
Affiliation(s)
- K Dolic
- Buffalo Neuroimaging Analysis Center, State University of New York, Buffalo, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Zivadinov R, Marr K, Cutter G, Ramanathan M, Benedict RHB, Kennedy C, Elfadil M, Yeh AE, Reuther J, Brooks C, Hunt K, Andrews M, Carl E, Dwyer MG, Hojnacki D, Weinstock-Guttman B. Prevalence, sensitivity, and specificity of chronic cerebrospinal venous insufficiency in MS. Neurology 2011; 77:138-44. [PMID: 21490322 DOI: 10.1212/wnl.0b013e318212a901] [Citation(s) in RCA: 142] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Chronic cerebrospinal venous insufficiency (CCSVI) was recently described in patients with multiple sclerosis (MS). A subject is considered CCSVI positive if ≥ 2 venous hemodynamic (VH) criteria are fulfilled. OBJECTIVE To determine prevalence of CCSVI in a large cohort of patients with MS, clinically isolated syndrome (CIS), other neurologic diseases (OND), and healthy controls (HC), using specific proposed echo-color Doppler (ECD) criteria. METHODS Transcranial and extracranial ECD were carried out in 499 enrolled subjects (289 MS, 163 HC, 26 OND, 21 CIS). Prevalence rates for CCSVI were calculated in 3 ways: first, using only the subjects for whom diagnosis was certain (i.e., borderline subjects were excluded); secondly, including the borderline subjects in the "no CCSVI" group; and finally, taking into account subjects who presented any of the VH criteria. RESULTS CCSVI prevalence with borderline cases included in the "no CCSVI" group was 56.1% in MS, 42.3% in OND, 38.1% in CIS, and 22.7% in HC (p < 0.001). The CCSVI prevalence figures were 62.5% for MS, 45.8% for OND, 42.1% for CIS, and 25.5% for HC when borderline cases were excluded (p < 0.001). The prevalence of one or more positive VH criteria was the highest in MS (81.3%), followed by CIS (76.2%), OND (65.4%), and HC (55.2%) (p < 0.001). CCSVI prevalence was higher in patients with progressive than in nonprogressive MS (p = 0.004). CONCLUSIONS Our findings are consistent with an increased prevalence of CCSVI in MS but with modest sensitivity/specificity. Our findings point against CCSVI having a primary causative role in the development of MS.
Collapse
Affiliation(s)
- R Zivadinov
- Department of Neurology, School of Medicine and Biomedical Sciences Buffalo Neuroimaging Analysis Center, Buffalo, NY 14203, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Zivadinov R, Galeotti R, Hojnacki D, Menegatti E, Dwyer MG, Schirda C, Malagoni AM, Marr K, Kennedy C, Bartolomei I, Magnano C, Salvi F, Weinstock-Guttman B, Zamboni P. Value of MR venography for detection of internal jugular vein anomalies in multiple sclerosis: a pilot longitudinal study. AJNR Am J Neuroradiol 2011; 32:938-46. [PMID: 21474626 DOI: 10.3174/ajnr.a2386] [Citation(s) in RCA: 52] [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
BACKGROUND AND PURPOSE CCSVI was recently described in patients with MS. CCSVI is diagnosed noninvasively by Doppler sonography and invasively by catheter venography. We assessed the role of conventional MRV for the detection of IJV anomalies in patients with MS diagnosed with CCSVI and in healthy controls who underwent MRV and Doppler sonography examinations during 6 months. MATERIALS AND METHODS Ten patients with MS underwent TOF, TRICKS, Doppler sonography, and catheter venography at baseline. They were treated at baseline with percutaneous angioplasty and re-evaluated 6 months' posttreatment with MRV and Doppler sonography. In addition, 6 healthy controls underwent a baseline and a 6-month follow-up evaluation by Doppler sonography and MRV. RESULTS At baseline, the sensitivity, specificity, PPV, and NPV of Doppler sonography for detecting IJV abnormalities relative to catheter venography in patients with MS were calculated, respectively, at 82%, 100%, 99%, and 95%. The figures were 99%, 33%, 33%, 99% for TOF and 99%, 39%, 35%, and 99% for TRICKS. Venous anomalies included the annulus, septum, membrane, and malformed valve. No agreement was found between TOF and catheter venography in 70% of patients with MS and between TRICKS and catheter venography in 60% of patients with MS. At follow-up, 50% of the patients with MS presented with abnormalities on Doppler sonography but only 30% were diagnosed with restenosis. CONCLUSIONS Conventional MRV has limited value for assessing IJV anomalies for both diagnostic and posttreatment purposes.
Collapse
Affiliation(s)
- R Zivadinov
- Buffalo Neuroimaging Analysis Center, State University of New York, Buffalo, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Zivadinov R, Schirda C, Dwyer MG, Haacke ME, Weinstock-Guttman B, Menegatti E, Heininen-Brown M, Magnano C, Malagoni AM, Wack DS, Hojnacki D, Kennedy C, Carl E, Bergsland N, Hussein S, Poloni G, Bartolomei I, Salvi F, Zamboni P. Chronic cerebrospinal venous insufficiency and iron deposition on susceptibility-weighted imaging in patients with multiple sclerosis: a pilot case-control study. INT ANGIOL 2010; 29:158-175. [PMID: 20351672] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
AIM Chronic cerebrospinal venous insufficiency (CCSVI) is a vascular phenomenon recently described in multiple sclerosis (MS) that is characterized by stenoses affecting the main extracranial venous outflow pathways and by a high rate of cerebral venous reflux that may lead to increased iron deposition in the brain. Aim of this study was to investigate the relationship between CCSVI and iron deposition in the brain of MS patients by correlating venous hemodynamic (VH) parameters and iron concentration in deep-gray matter structures and lesions, as measured by susceptibility-weighted imaging (SWI), and to preliminarily define the relationship between iron measures and clinical and other magnetic resonance imaging (MRI) outcomes. METHODS Sixteen (16) consecutive relapsing-remitting MS patients and 8 age- and sex-matched healthy controls (HC) were scanned on a GE 3T scanner, using SWI. RESULTS All 16 MS patients fulfilled the diagnosis of CCSVI (median VH=4), compared to none of the HC. In MS patients, the higher iron concentration in the pulvinar nucleus of the thalamus, thalamus, globus pallidus, and hippocampus was related to a higher number of VH criteria (P<0.05). There was also a significant association between a higher number of VH criteria and higher iron concentration of overlapping T2 (r=-0.64, P=0.007) and T1 (r=-0.56, P=0.023) phase lesions. Iron concentration measures were related to longer disease duration and increased disability as measured by EDSS and MSFC, and to increased MRI lesion burden and decreased brain volume. CONCLUSION The findings from this pilot study suggest that CCSVI may be an important mechanism related to iron deposition in the brain parenchyma of MS patients. In turn, iron deposition, as measured by SWI, is a modest-to-strong predictor of disability progression, lesion volume accumulation and atrophy development in patients with MS.
Collapse
Affiliation(s)
- R Zivadinov
- Buffalo Neuroimaging Analysis Center, University at Buffalo, Buffalo, NY, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Hojnacki D, Zamboni P, Lopez-Soriano A, Galleotti R, Menegatti E, Weinstock-Guttman B, Schirda C, Magnano C, Malagoni AM, Kennedy C, Bartolomei I, Salvi F, Zivadinov R. Use of neck magnetic resonance venography, Doppler sonography and selective venography for diagnosis of chronic cerebrospinal venous insufficiency: a pilot study in multiple sclerosis patients and healthy controls. INT ANGIOL 2010; 29:127-139. [PMID: 20351669] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
AIM Chronic cerebrospinal venous insufficiency (CCSVI) is a vascular condition characterized by anomalies of primary veins outside the skull that restrict normal outflow of blood from the brain. CCSVI was recently described as highly prevalent in patients with multiple sclerosis (MS), and can be non-invasively diagnosed by Doppler sonography (DS) and invasively by selective venography (SV). The aim of this paper was to investigate the value of neck magnetic resonance venography (MRV) for the diagnosis of CCSVI compared to DS and SV in patients with MS and in healthy controls (HC). METHODS Ten MS patients and 7 HC underwent DS, 2D-Time-Of-Flight venography (TOF) and 3D-Time Resolved Imaging of Contrast Kinetics angiography (TRICKS). MS patients also underwent SV. The internal jugular veins (IJVs) and the vertebral veins (VVs) were assessed by both MRV sequences, and the findings were validated against SV and DS. SV has been considered the diagnostic gold standard for MS patients. RESULTS All MS patients and none of the HC presented CCSVI, according to the DS criteria. This was confirmed by SV. For CCSVI diagnosis, DS showed sensitivity, specificity, accuracy, PPV and NPV of 100%, whereas the figures were 40%, 85%, 58%, 80% and 50% for 3D-TRICKS, and 30%, 85%, 52%, 75% and 46% for 2D-TOF in the IJVs. In MS patients, compared to SV, DS showed sensitivity, specificity, accuracy, PPV and NPV of 100%, 75%, 95%, 94% and 100%, whereas the figures were 31%, 100%, 45%, 100% and 26% for 3D-TRICKS and 25%, 100%, 40%, 100% and 25% for 2D-TOF in the IJVs. CONCLUSION The use of MRV for diagnosis of CCSVI in MS patients has limited value, and the findings should be interpreted with caution and confirmed by other imaging techniques such as DS and SV.
Collapse
Affiliation(s)
- D Hojnacki
- The Jacobs Neurological Institute, State University of New York, Buffalo, NY, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Zamboni P, Menegatti E, Weinstock-Guttman B, Schirda C, Cox JL, Malagoni AM, Hojnacki D, Kennedy C, Carl E, Dwyer MG, Bergsland N, Galeotti R, Hussein S, Bartolomei I, Salvi F, Ramanathan M, Zivadinov R. CSF dynamics and brain volume in multiple sclerosis are associated with extracranial venous flow anomalies: a pilot study. INT ANGIOL 2010; 29:140-148. [PMID: 20351670] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
AIM We previously reported unexpectedly robust associations between vascular haemodynamic (VH) anomalies in the principal extracranial cerebral veins, causing chronic cerebrospinal venous insufficiency (CCSVI), and multiple sclerosis (MS). Aim of this study was to investigate the relationship between the VH changes and MRI measures of MS disease severity in a cross sectional survey. METHODS The number of anomalous VH criteria were measured using an echo-color Doppler, whereas CSF flow, atrophy and lesion measures were obtained from quantitative magnetic resonance imaging (MRI) analysis in sixteen consecutive relapsing-remitting MS patients, (mean age: 36.1+/-SD 7.3 years, disease duration: 7.5+/-1.9 years and median EDSS: 2.5) and in 8 healthy controls (HC) with similar age and sex distributions. RESULTS All 16 MS patients investigated and none of the HCs met the VH criteria for CCSVI (P<0.0001). MS patients showed significantly lower net CSF flow compared to the HC (P=0.038) that was associated with number of anomalous VH criteria present (r=0.79, P<0.001). Moreover, increases in the number of anomalous VH criteria present were negatively associated with lower whole brain volume (Spearman R=-0.5, P=0.05). CONCLUSION VH changes occur more frequently in MS patients than controls. Altered VH is associated with abnormal CSF flow dynamics and decreased brain volume.
Collapse
Affiliation(s)
- P Zamboni
- Vascular Diseases Center, University of Ferrara-Bellaria Neurosciences, Ferrara and Bologna, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Weinstock-Guttman B, Ramanathan M, Hashmi K, Abdelrahman N, Hojnacki D, Dwyer MG, Hussein S, Bergsland N, Munschauer FE, Zivadinov R. Increased tissue damage and lesion volumes in African Americans with multiple sclerosis. Neurology 2010; 74:538-44. [DOI: 10.1212/wnl.0b013e3181cff6fb] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
26
|
Drake AS, Weinstock-Guttman B, Morrow SA, Hojnacki D, Munschauer FE, Benedict RHB. Psychometrics and normative data for the Multiple Sclerosis Functional Composite: replacing the PASAT with the Symbol Digit Modalities Test. Mult Scler 2009; 16:228-37. [PMID: 20028710 DOI: 10.1177/1352458509354552] [Citation(s) in RCA: 191] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The MS Functional Composite (MSFC) is a continuous scale of neurological disability for patients with multiple sclerosis (MS). Cognition is represented by the Paced Auditory Serial Addition Test (PASAT), although the Symbol Digit Modalities Test (SDMT) has been proposed as a promising alternative. MSFC scores were calculated using either the PASAT or the SDMT with the following reference populations: National Multiple Sclerosis Society (NMSS) Task Force, 400 MS patients, and 100 normal controls. A subgroup of 115 patients was followed longitudinally, with a test-retest interval of 2.3 +/- 1.2 years. Pearson correlations were calculated and analyses of variance (ANOVAs) were used to assess relationships among the MSFC components and composite scores, and differences in performance between patients and controls. Longitudinal changes were also assessed. Logistic regression was performed to determine which MSFC scores are most predictive of diagnosis, course, and work disability. All MSFCs had similar test-retest reliability and correlations with other measures including neurological disability, depression, and fatigue. The SDMT showed slightly better validity with respect to predicting diagnosis, course, and work disability, although the amount of variance accounted for was similar for each version of the MSFC. Our data, derived from a large sample of MS patients and normal controls, supports the validity of both PASAT and SDMT versions of the MSFC. Because the SDMT has slightly better predictive validity and has a relatively easier administration procedure, some clinicians and researchers may wish to replace the PASAT with the SDMT in future calculations of the MSFC using the calculation methods provided in this manuscript.
Collapse
Affiliation(s)
- A S Drake
- Department of Neurology, State University of New York (SUNY) at Buffalo School of Medicine, Buffalo, NY, USA
| | | | | | | | | | | |
Collapse
|
27
|
Morrow SA, Weinstock-Guttman B, Munschauer FE, Hojnacki D, Benedict RHB. Subjective fatigue is not associated with cognitive impairment in multiple sclerosis: cross-sectional and longitudinal analysis. Mult Scler 2009; 15:998-1005. [DOI: 10.1177/1352458509106213] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Studies in multiple sclerosis (MS) report conflicting conclusions regarding fatigue and cognition, which may partly be due to the use of small sample sizes and frequent reliance on a cross-sectional approach. Objective The ability to distinguish between these two disabling symptoms is necessary in order to properly assess and treat MS patients. Methods In a retrospective analysis, we assessed the correlation between fatigue and neuropsychological (NP) testing using a cross-sectional ( n = 465) and longitudinal approach ( n = 69). Cognition was measured using a comprehensive battery called the Minimal Assessment of Cognitive Function in MS (MACFIMS), and fatigue was measured with the Fatigue Severity Scale (FSS). FSS scores were categorized as normal (≤4.0), borderline fatigue (4 < FSS < 5.0), and fatigued (≥5.0). Repeat assessments ( n = 69) were categorized as improved or worsened by a change in FSS of either 0.5 or 1.0. Results MS patients had significantly higher FSS scores than normal controls ( P < 0.001). No correlation was found between FSS and NP scores in either cross-sectional or longitudinal analyses. Fatigue was moderately correlated with depression, assessed using the Beck Depression Inventory Fast Screen (BDIFS) ( r = 0.44, P < 0.001). Longitudinally, there was a medium correlation between change in FSS and BDIFS ( r = 0.34, P = 0.001), but no significant differences on NP scores using either definition of change. Conclusion We conclude that self-reported fatigue, while correlated with self-reported depression, is not significantly related to cognitive capacity in MS.
Collapse
Affiliation(s)
- SA Morrow
- School of Medicine, The Jacobs Neurological Institute, State University of New York at Buffalo, Buffalo, New York, USA
| | - B Weinstock-Guttman
- School of Medicine, The Jacobs Neurological Institute, State University of New York at Buffalo, Buffalo, New York, USA
| | - FE Munschauer
- School of Medicine, The Jacobs Neurological Institute, State University of New York at Buffalo, Buffalo, New York, USA
| | - D Hojnacki
- School of Medicine, The Jacobs Neurological Institute, State University of New York at Buffalo, Buffalo, New York, USA
| | - RHB Benedict
- School of Medicine, The Jacobs Neurological Institute, State University of New York at Buffalo, Buffalo, New York, USA
| |
Collapse
|
28
|
Sternberg Z, Weinstock-Guttman B, Hojnacki D, Zamboni P, Zivadinov R, Chadha K, Lieberman A, Kazim L, Drake A, Rocco P, Grazioli E, Munschauer F. Soluble receptor for advanced glycation end products in multiple sclerosis: a potential marker of disease severity. Mult Scler 2008; 14:759-63. [PMID: 18505774 DOI: 10.1177/1352458507088105] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To compare serum levels of the receptor for advanced glycation end products (sRAGE) between multiple sclerosis (MS) patients and healthy control subjects, and to investigate whether serum sRAGE levels correlate with MS disease severity as indicated by the Kurtzke Expanded Disability Status Scale (EDSS). METHOD 37 patients with clinical diagnosis of MS and 22 healthy control subjects were investigated in a cross-sectional study using enzyme-linked immunosorbent assays (ELISA). RESULTS Serum levels of sRAGE were found to be significantly lower in MS patients compared to levels in healthy controls (p = 0.005). A trend toward lower levels of serum sRAGE was observed in female MS patients compared to their male counterparts (p = 0.05). A relationship between sRAGE and EDSS, and sRAGE and rate of clinical relapse was observed (p = 0.012). CONCLUSION The significant reduction of sRAGE in MS patients relative to healthy controls supports the potential role for RAGE axis in MS clinical pathology. Lower levels of sRAGE may be associated with enhanced inflammatory responses. Based on these observations, further investigations into the role of sRAGE in MS clinical pathology is warranted.
Collapse
Affiliation(s)
- Z Sternberg
- Department of Neurology, Baird MS Center, Jacobs Neurological Institute, Buffalo, NY 14203, USA.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
King ND, Hojnacki D, O'Brian MR. The Bradyrhizobium japonicum proline biosynthesis gene proC is essential for symbiosis. Appl Environ Microbiol 2000; 66:5469-71. [PMID: 11097929 PMCID: PMC92483 DOI: 10.1128/aem.66.12.5469-5471.2000] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2000] [Accepted: 09/15/2000] [Indexed: 11/20/2022] Open
Abstract
Plant host-derived proline is proposed to serve as an energy source for rhizobia in the rhizosphere and in symbiotic root nodules. The Bradyrhizobium japonicum proC gene was isolated, and a proC mutant strain that behaved as a strict proline auxotroph in culture was constructed. The proC strain elicited undeveloped nodules on soybeans that lacked nitrogen fixation activity and plant hemoglobin. We conclude that the proC gene is essential for symbiosis and suggest that the mutant does not obtain an exogenous supply of proline in association with soybeans sufficient to satisfy its auxotrophy.
Collapse
Affiliation(s)
- N D King
- Department of Biochemistry and Center for Microbial Pathogenesis, State University of New York at Buffalo, Buffalo, New York 14214, USA
| | | | | |
Collapse
|