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Kappos L, Traboulsee A, Li DKB, Bar-Or A, Barkhof F, Montalban X, Leppert D, Baldinotti A, Schneble HM, Koendgen H, Sauter A, Wang Q, Hauser SL. Ocrelizumab exposure in relapsing-remitting multiple sclerosis: 10-year analysis of the phase 2 randomized clinical trial and its extension. J Neurol 2024; 271:642-657. [PMID: 37906326 PMCID: PMC10827899 DOI: 10.1007/s00415-023-11943-4] [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] [Received: 05/12/2023] [Revised: 08/10/2023] [Accepted: 08/14/2023] [Indexed: 11/02/2023]
Abstract
Open-label extension (OLE) studies help inform long-term safety and efficacy of disease-modifying therapies in multiple sclerosis (MS). We report exploratory analyses from a phase 2 trial on the longest follow-up to date of ocrelizumab-treated patients with relapsing-remitting MS (RRMS). The primary treatment period (PTP) comprised four 24-week treatment cycles; participants were randomized to double-blind ocrelizumab (2000 mg or 600 mg), placebo, or interferon β-1a (open label) for one cycle, then dose-blinded ocrelizumab 1000 mg or 600 mg for the remaining cycles. The PTP was followed by consecutive assessed and unassessed treatment-free periods (TFPs) and then the OLE (ocrelizumab 600 mg every 24 weeks). Safety and efficacy were prospectively assessed. Of 220 participants randomized, 183 (84%) completed the PTP. After the TFP, 103 entered OLE (median OLE ocrelizumab exposure 6.5 years). Most common adverse events across all periods were infusion-related reactions. MRI activity, annualized relapse rate, and confirmed disability progression (CDP) rates remained low throughout. During the assessed TFP, there was a trend toward less and later B-cell repletion, and later CDP, for patients randomized to ocrelizumab; MRI activity was observed in 16.3% of patients, the earliest 24 weeks after the last ocrelizumab dose. This is the longest follow-up of ocrelizumab-treated patients with RRMS, with no new safety signals emerging during an observation period from 2008 to 2020. Results reinforce the sustained efficacy of long-term ocrelizumab. Reduced disease activity was maintained following interruption of 6-month dosing cycles, with no evidence of rebound.
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Affiliation(s)
- Ludwig Kappos
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital and University of Basel, Basel, Switzerland.
| | - Anthony Traboulsee
- Department of Medicine (Neurology), University of British Columbia, Vancouver, BC, Canada
| | - David K B Li
- Department of Radiology and Medicine (Neurology), University of British Columbia, Vancouver, BC, Canada
| | - Amit Bar-Or
- Center for Neuroinflammation and Experimental Therapeutics, and Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Frederik Barkhof
- VU University Medical Centre, Amsterdam, The Netherlands
- UCL Institutes of Biomedical Engineering and Neurology, London, UK
| | - Xavier Montalban
- Department of Neurology-Neuroimmunology, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - David Leppert
- Departments of Medicine, Biomedicine and Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | | | | | - Harold Koendgen
- F. Hoffmann-La Roche Ltd, Basel, Switzerland
- UCB Farchim SA, Bulle, Switzerland
| | - Annette Sauter
- F. Hoffmann-La Roche Ltd, Basel, Switzerland
- Janssen Pharmaceuticals, Allschwil, Basel-Landschaft, Switzerland
| | - Qing Wang
- F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - Stephen L Hauser
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
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2
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Tayyab M, Metz LM, Li DKB, Kolind S, Carruthers R, Traboulsee A, Tam RC. Accounting for uncertainty in training data to improve machine learning performance in predicting new disease activity in early multiple sclerosis. Front Neurol 2023; 14:1165267. [PMID: 37305756 PMCID: PMC10251494 DOI: 10.3389/fneur.2023.1165267] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 05/09/2023] [Indexed: 06/13/2023] Open
Abstract
Introduction Machine learning (ML) has great potential for using health data to predict clinical outcomes in individual patients. Missing data are a common challenge in training ML algorithms, such as when subjects withdraw from a clinical study, leaving some samples with missing outcome labels. In this study, we have compared three ML models to determine whether accounting for label uncertainty can improve a model's predictions. Methods We used a dataset from a completed phase-III clinical trial that evaluated the efficacy of minocycline for delaying the conversion from clinically isolated syndrome to multiple sclerosis (MS), using the McDonald 2005 diagnostic criteria. There were a total of 142 participants, and at the 2-year follow-up 81 had converted to MS, 29 remained stable, and 32 had uncertain outcomes. In a stratified 7-fold cross-validation, we trained three random forest (RF) ML models using MRI volumetric features and clinical variables to predict the conversion outcome, which represented new disease activity within 2 years of a first clinical demyelinating event. One RF was trained using subjects with the uncertain labels excluded (RFexclude), another RF was trained using the entire dataset but with assumed labels for the uncertain group (RFnaive), and a third, a probabilistic RF (PRF, a type of RF that can model label uncertainty) was trained on the entire dataset, with probabilistic labels assigned to the uncertain group. Results Probabilistic random forest outperformed both the RF models with the highest AUC (0.76, compared to 0.69 for RFexclude and 0.71 for RFnaive) and F1-score (86.6% compared to 82.6% for RFexclude and 76.8% for RFnaive). Conclusion Machine learning algorithms capable of modeling label uncertainty can improve predictive performance in datasets in which a substantial number of subjects have unknown outcomes.
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Affiliation(s)
- Maryam Tayyab
- School of Biomedical Engineering, University of British Columbia, Vancouver, BC, Canada
- Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Luanne M Metz
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - David K B Li
- Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Shannon Kolind
- Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Robert Carruthers
- Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Anthony Traboulsee
- Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Roger C Tam
- School of Biomedical Engineering, University of British Columbia, Vancouver, BC, Canada
- Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
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3
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Johnson P, Vavasour IM, Stojkova BJ, Abel S, Lee LE, Laule C, Tam R, Li DKB, Ackermans N, Schabas AJ, Chan J, Cross H, Sayao AL, Devonshire V, Carruthers R, Traboulsee A, Kolind SH. Myelin heterogeneity for assessing normal appearing white matter myelin damage in multiple sclerosis. J Neuroimaging 2023; 33:227-234. [PMID: 36443960 DOI: 10.1111/jon.13069] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 11/04/2022] [Accepted: 11/08/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND AND PURPOSE Conventional MRI measures of multiple sclerosis (MS) disease severity, such as lesion volume and brain atrophy, do not provide information about microstructural tissue changes, which may be driving physical and cognitive progression. Myelin damage in normal-appearing white matter (NAWM) is likely an important contributor to MS disability. Myelin water fraction (MWF) provides quantitative measurements of myelin. Mean MWF reflects average myelin content, while MWF standard deviation (SD) describes variation in myelin within regions. The myelin heterogeneity index (MHI = SD/mean MWF) is a composite metric of myelin content and myelin variability. We investigated how mean MWF, SD, and MHI compare in differentiating MS from controls and their associations with physical and cognitive disability. METHODS Myelin water imaging data were acquired from 91 MS participants and 31 healthy controls (HC). Segmented whole-brain NAWM and corpus callosum (CC) NAWM, mean MWF, SD, and MHI were compared between groups. Associations of mean MWF, SD, and MHI with Expanded Disability Status Scale and Symbol Digit Modalities Test were assessed. RESULTS NAWM and CC MHI had the highest area under the curve: .78 (95% confidence interval [CI]: .69, .86) and .84 (95% CI: .76, .91), respectively, distinguishing MS from HC. CONCLUSIONS Mean MWF, SD, and MHI provide complementary information when assessing regional and global NAWM abnormalities in MS and associations with clinical outcome measures. Examining all three metrics (mean MWF, SD, and MHI) enables a more detailed interpretation of results, depending on whether regions of interest include areas that are more heterogeneous, earlier in the demyelination process, or uniformly injured.
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Affiliation(s)
- Poljanka Johnson
- Department of Medicine (Neurology), University of British Columbia, Vancouver, British Columbia, Canada
| | - Irene M Vavasour
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada.,International Collaboration on Repair and Discoveries, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Shawna Abel
- Department of Medicine (Neurology), University of British Columbia, Vancouver, British Columbia, Canada
| | - Lisa Eunyoung Lee
- Department of Medicine (Neurology), University of British Columbia, Vancouver, British Columbia, Canada
| | - Cornelia Laule
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Physics and Astronomy, University of British Columbia, Vancouver, British Columbia, Canada.,International Collaboration on Repair and Discoveries, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Pathology & Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Roger Tam
- School of Biomedical Engineering, University of British Columbia, Vancouver, British Columbia, Canada
| | - David K B Li
- Department of Medicine (Neurology), University of British Columbia, Vancouver, British Columbia, Canada.,Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nathalie Ackermans
- Department of Medicine (Neurology), University of British Columbia, Vancouver, British Columbia, Canada
| | - Alice J Schabas
- Department of Medicine (Neurology), University of British Columbia, Vancouver, British Columbia, Canada
| | - Jillian Chan
- Department of Medicine (Neurology), University of British Columbia, Vancouver, British Columbia, Canada
| | - Helen Cross
- Department of Medicine (Neurology), University of British Columbia, Vancouver, British Columbia, Canada
| | - Ana-Luiza Sayao
- Department of Medicine (Neurology), University of British Columbia, Vancouver, British Columbia, Canada
| | - Virginia Devonshire
- Department of Medicine (Neurology), University of British Columbia, Vancouver, British Columbia, Canada
| | - Robert Carruthers
- Department of Medicine (Neurology), University of British Columbia, Vancouver, British Columbia, Canada
| | - Anthony Traboulsee
- Department of Medicine (Neurology), University of British Columbia, Vancouver, British Columbia, Canada
| | - Shannon H Kolind
- Department of Medicine (Neurology), University of British Columbia, Vancouver, British Columbia, Canada.,Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Physics and Astronomy, University of British Columbia, Vancouver, British Columbia, Canada.,International Collaboration on Repair and Discoveries, University of British Columbia, Vancouver, British Columbia, Canada
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4
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Salter A, Cross AH, Cutter GR, Fox RJ, Li DKB, Bebo B, Halper J, Kanellis P, Rammohan K, Newsome SD. COVID-19 in the pregnant or postpartum MS patient: Symptoms and outcomes. Mult Scler Relat Disord 2022; 65:104028. [PMID: 35839562 PMCID: PMC9252864 DOI: 10.1016/j.msard.2022.104028] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 06/17/2022] [Accepted: 07/03/2022] [Indexed: 11/21/2022]
Abstract
Women with multiple sclerosis (MS) are often of childbearing age. Thirty-six women with MS who were pregnant (n = 27) or within 6 weeks postpartum (n = 9) were reported in the North American COViMS registry and their COVID-19 outcomes were described. One pregnant and one postpartum woman were hospitalized. No deaths occurred. To compare COVID-19 clinical outcomes in pregnant and postpartum females with females who were not pregnant or postpartum, a 1:2 propensity score match was performed. While not powered to detect small differences, it was reassuring that no increased risks for those with MS who were pregnant/postpartum were revealed.
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Affiliation(s)
- Amber Salter
- University of Texas Southwestern, Dallas, TX, United States
| | - Anne H Cross
- Department of Neurology, Washington University in St. Louis, 660 S. Euclid Avenue, St. Louis, MO 63110, United States.
| | - Gary R Cutter
- University of Alabama Birmingham, Birmingham, AL, United States
| | | | - David K B Li
- The University of British Columbia, Vancouver, British Columbia, Canada
| | - Bruce Bebo
- National Multiple Sclerosis Society, Chicago, IL, United States
| | - June Halper
- Consortium of MS Centers, Hackensack, NJ, United States
| | | | - Kottil Rammohan
- University of Miami School of Medicine, Miami, FL, United States
| | - Scott D Newsome
- Johns Hopkins University School of Medicine, Baltimore, MD, United States
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5
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Johnson P, Chan JK, Vavasour IM, Abel S, Lee LE, Yong H, Laule C, Li DKB, Tam R, Traboulsee A, Carruthers RL, Kolind SH. Quantitative MRI findings indicate diffuse white matter damage in Susac Syndrome. Mult Scler J Exp Transl Clin 2022; 8:20552173221078834. [PMID: 35186315 PMCID: PMC8851927 DOI: 10.1177/20552173221078834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 07/16/2021] [Accepted: 01/21/2022] [Indexed: 11/15/2022] Open
Abstract
Background Susac Syndrome (SuS) is an autoimmune endotheliopathy impacting the brain, retina and cochlea that can clinically mimic multiple sclerosis (MS). Objective To evaluate non-lesional white matter demyelination changes in SuS compared to MS and healthy controls (HC) using quantitative MRI. Methods 3T MRI including myelin water imaging and diffusion basis spectrum imaging were acquired for 7 SuS, 10 MS and 10 HC participants. Non-lesional white matter was analyzed in the corpus callosum (CC) and normal appearing white matter (NAWM). Groups were compared using ANCOVA with Tukey correction. Results SuS CC myelin water fraction (mean 0.092) was lower than MS(0.11, p = 0.01) and HC(0.11, p = 0.04). Another myelin marker, radial diffusivity, was increased in SuS CC(0.27μm2/ms) compared to HC(0.21μm2/ms, p = 0.008) and MS(0.23μm2/ms, p = 0.05). Fractional anisotropy was lower in SuS CC(0.82) than HC(0.86, p = 0.04). Fiber fraction (reflecting axons) did not differ from HC or MS. In NAWM, radial diffusivity and apparent diffusion coefficient were significantly increased in SuS compared to HC(p < 0.001 for both measures) and MS(p = 0.003, p < 0.001 respectively). Conclusions Our results provided evidence of myelin damage in SuS, particularly in the CC, and more extensive microstructural injury in NAWM, supporting the hypothesis that there are widespread microstructural changes in SuS syndrome including diffuse demyelination.
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Affiliation(s)
| | - JK Chan
- Department of Medicine (Neurology), University of British Columbia, Canada
| | - IM Vavasour
- Department of Radiology, University of British Columbia, Canada
- International Collaboration on Repair Discoveries (ICORD)
| | | | | | - H Yong
- Department of Medicine (Neurology), University of British Columbia, Canada
| | - C Laule
- Department of Radiology, University of British Columbia, Canada
- International Collaboration on Repair Discoveries (ICORD)
- Department of Pathology and Laboratory Medicine, University of British Columbia, Canada
- Department of Physics and Astronomy, University of British Columbia, Canada
| | - DKB Li
- Department of Medicine (Neurology), University of British Columbia, Canada
- Department of Radiology, University of British Columbia, Canada
| | - R Tam
- Department of Radiology, University of British Columbia, Canada
- School of Biomedical Engineering, University of British Columbia, Canada
| | | | - RL Carruthers
- Department of Medicine (Neurology), University of British Columbia, Canada
| | - SH Kolind
- Department of Medicine (Neurology), University of British Columbia, Canada
- Department of Radiology, University of British Columbia, Canada
- International Collaboration on Repair Discoveries (ICORD)
- Department of Physics and Astronomy, University of British Columbia, Canada
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6
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Cherkasova MV, Fu JF, Jarrett M, Johnson P, Abel S, Tam R, Rauscher A, Sossi V, Kolind S, Li DKB, Sadovnick AD, Machan L, Girard JM, Emond F, Vosoughi R, Traboulsee A, Stoessl AJ. Cortical morphology predicts placebo response in multiple sclerosis. Sci Rep 2022; 12:732. [PMID: 35031632 PMCID: PMC8760243 DOI: 10.1038/s41598-021-04462-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 07/13/2021] [Accepted: 12/22/2021] [Indexed: 11/27/2022] Open
Abstract
Despite significant insights into the neural mechanisms of acute placebo responses, less is known about longer-term placebo responses, such as those seen in clinical trials, or their interactions with brain disease. We examined brain correlates of placebo responses in a randomized trial of a then controversial and now disproved endovascular treatment for multiple sclerosis. Patients received either balloon or sham extracranial venoplasty and were followed for 48 weeks. Venoplasty had no therapeutic effect, but a subset of both venoplasty- and sham-treated patients reported a transient improvement in health-related quality of life, suggesting a placebo response. Placebo responders did not differ from non-responders in total MRI T2 lesion load, count or location, nor were there differences in normalized brain volume, regional grey or white matter volume or cortical thickness (CT). However, responders had higher lesion activity. Graph theoretical analysis of CT covariance showed that non-responders had a more small-world-like CT architecture. In non-responders, lesion load was inversely associated with CT in somatosensory, motor and association areas, precuneus, and insula, primarily in the right hemisphere. In responders, lesion load was unrelated to CT. The neuropathological process in MS may produce in some a cortical configuration less capable of generating sustained placebo responses.
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Affiliation(s)
- Mariya V Cherkasova
- Department of Psychology, University of British Columbia, Vancouver, Canada. .,Department of Psychology, West Virginia University, 2128 Life Science Building, Morgantown, WV, 26506, USA.
| | - Jessie F Fu
- Department of Physics and Astronomy, University of British Columbia, Vancouver, BC, Canada
| | - Michael Jarrett
- Population Data BC, University of British Columbia, Vancouver, BC, Canada
| | - Poljanka Johnson
- Department of Medicine (Division of Neurology), Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
| | - Shawna Abel
- Department of Medicine (Division of Neurology), Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
| | - Roger Tam
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada.,School of Biomedical Engineering, University of British Columbia, Vancouver, BC, Canada
| | - Alexander Rauscher
- Depatment of Pediatrics (Division of Neurology), University of British Columbia, Vancouver, BC, Canada
| | - Vesna Sossi
- Department of Physics and Astronomy, University of British Columbia, Vancouver, BC, Canada
| | - Shannon Kolind
- Department of Medicine (Division of Neurology), Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
| | - David K B Li
- Department of Medicine (Division of Neurology), Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada.,Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - A Dessa Sadovnick
- Department of Medicine (Division of Neurology), Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada.,Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada
| | - Lindsay Machan
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - J Marc Girard
- Centre Hospitalier de L'Université de Montréal, Montréal, QC, Canada
| | - Francois Emond
- CHU de Québec-Université Laval, Hôpital de L'Enfant-Jésus, Québec, Canada
| | - Reza Vosoughi
- Department of Internal Medicine (Neurology), University of Manitoba, Winnipeg, Canada
| | - Anthony Traboulsee
- Department of Medicine (Division of Neurology), Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
| | - A Jon Stoessl
- Department of Medicine (Division of Neurology), Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
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7
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Yik JT, Becquart P, Gill J, Petkau J, Traboulsee A, Carruthers R, Kolind SH, Devonshire V, Sayao AL, Schabas A, Tam R, Moore GRW, Li DKB, Stukas S, Wellington C, Quandt JA, Vavasour IM, Laule C. Serum neurofilament light chain correlates with myelin and axonal magnetic resonance imaging markers in multiple sclerosis. Mult Scler Relat Disord 2022; 57:103366. [PMID: 35158472 DOI: 10.1016/j.msard.2021.103366] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 10/08/2021] [Accepted: 11/01/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Neurofilaments are cytoskeletal proteins that are detectable in the blood after neuroaxonal injury. Multiple sclerosis (MS) disease progression, greater lesion volume, and brain atrophy are associated with higher levels of serum neurofilament light chain (NfL), but few studies have examined the relationship between NfL and advanced magnetic resonance imaging (MRI) measures related to myelin and axons. We assessed the relationship between serum NfL and brain MRI measures in a diverse group of MS participants. METHODS AND MATERIALS 103 participants (20 clinically isolated syndrome, 33 relapsing-remitting, 30 secondary progressive, 20 primary progressive) underwent 3T MRI to obtain myelin water fraction (MWF), geometric mean T2 (GMT2), water content, T1; high angular resolution diffusion imaging (HARDI)-derived axial diffusivity (AD), radial diffusivity (RD), fractional anisotropy (FA); diffusion basis spectrum imaging (DBSI)-derived AD, RD, FA; restricted, hindered, water and fiber fractions; and volume measurements of normalized brain, lesion, thalamic, deep gray matter (GM), and cortical thickness. Multiple linear regressions assessed the strength of association between serum NfL (dependent variable) and each MRI measure in whole brain (WB), normal appearing white matter (NAWM) and T2 lesions (independent variables), while controlling for age, expanded disability status scale, and disease duration. RESULTS Serum NfL levels were significantly associated with metrics of axonal damage (FA: R2WB-HARDI = 0.29, R2NAWM-HARDI = 0.31, R2NAWM-DBSI = 0.30, R2Lesion-DBSI = 0.31; AD: R2WB-HARDI=0.31), myelin damage (MWF: R2WB = 0.29, R2NAWM = 0.30, RD: R2WB-HARDI = 0.32, R2NAWM-HARDI = 0.34, R2Lesion-DBSI = 0.30), edema and inflammation (T1: R2Lesion = 0.32; GMT2: R2WB = 0.31, R2Lesion = 0.31), and cellularity (restricted fraction R2WB = 0.30, R2NAWM = 0.32) across the entire MS cohort. Higher serum NfL levels were associated with significantly higher T2 lesion volume (R2 = 0.35), lower brain structure volumes (thalamus R2 = 0.31; deep GM R2 = 0.33; normalized brain R2 = 0.31), and smaller cortical thickness R2 = 0.31). CONCLUSION The association between NfL and myelin MRI markers suggest that elevated serum NfL is a useful biomarker that reflects not only acute axonal damage, but also damage to myelin and inflammation, likely due to the known synergistic myelin-axon coupling relationship.
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Affiliation(s)
- Jackie T Yik
- Department of Physics and Astronomy, University of British Columbia, Vancouver, BC, Canada; International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC, Canada
| | - Pierre Becquart
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Jasmine Gill
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - John Petkau
- Department of Statistics, University of British Columbia, Vancouver, BC, Canada
| | - Anthony Traboulsee
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Robert Carruthers
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Shannon H Kolind
- Department of Physics and Astronomy, University of British Columbia, Vancouver, BC, Canada; International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC, Canada; Department of Medicine, University of British Columbia, Vancouver, BC, Canada; Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Virginia Devonshire
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Ana-Luiza Sayao
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Alice Schabas
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Roger Tam
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - G R Wayne Moore
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC, Canada; Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - David K B Li
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada; Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Sophie Stukas
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Cheryl Wellington
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC, Canada; Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Jacqueline A Quandt
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Irene M Vavasour
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC, Canada; Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Cornelia Laule
- Department of Physics and Astronomy, University of British Columbia, Vancouver, BC, Canada; International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC, Canada; Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada; Department of Radiology, University of British Columbia, Vancouver, BC, Canada.
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8
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Vavasour IM, Becquart P, Gill J, Zhao G, Yik JT, Traboulsee A, Carruthers RL, Kolind SH, Schabas AJ, Sayao AL, Devonshire V, Tam R, Moore GRW, Stukas S, Wellington CL, Quandt JA, Li DKB, Laule C. Diffusely abnormal white matter in clinically isolated syndrome is associated with parenchymal loss and elevated neurofilament levels. Mult Scler Relat Disord 2021; 57:103422. [PMID: 34871858 DOI: 10.1016/j.msard.2021.103422] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 10/23/2021] [Accepted: 11/20/2021] [Indexed: 11/19/2022]
Abstract
We characterized the frequency of diffusely abnormal white matter (DAWM) across a broad spectrum of multiple sclerosis (MS) participants. 35% of clinically isolated syndrome (CIS), 57% of relapsing remitting and 64% of secondary progressive MS participants demonstrated DAWM. CIS with DAWM had decreased cortical thickness, higher lesion load and a higher concentration of serum neurofilament light chain compared to CIS without DAWM. DAWM may be useful in identifying CIS patients with greater injury to their brains. Larger and longitudinal studies are warranted.
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Affiliation(s)
- I M Vavasour
- Radiology, University of British Columbia, Vancouver, British Columbia, Canada; International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, British Columbia, Canada.
| | - P Becquart
- Pathology & Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - J Gill
- Pathology & Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - G Zhao
- MS/MRI Research Group, University of British Columbia, Vancouver, British Columbia, Canada
| | - J T Yik
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, British Columbia, Canada; Physics & Astronomy, University of British Columbia, Vancouver, British Columbia, Canada
| | - A Traboulsee
- MS/MRI Research Group, University of British Columbia, Vancouver, British Columbia, Canada; Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - R L Carruthers
- Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - S H Kolind
- Radiology, University of British Columbia, Vancouver, British Columbia, Canada; International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, British Columbia, Canada; MS/MRI Research Group, University of British Columbia, Vancouver, British Columbia, Canada; Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Physics & Astronomy, University of British Columbia, Vancouver, British Columbia, Canada
| | - A J Schabas
- Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - A L Sayao
- Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - V Devonshire
- Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - R Tam
- Radiology, University of British Columbia, Vancouver, British Columbia, Canada; MS/MRI Research Group, University of British Columbia, Vancouver, British Columbia, Canada; School of Biomedical Engineering, University of British Columbia, Vancouver, British Columbia, Canada
| | - G R W Moore
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, British Columbia, Canada; Pathology & Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - S Stukas
- Pathology & Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - C L Wellington
- Pathology & Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - J A Quandt
- Pathology & Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - D K B Li
- Radiology, University of British Columbia, Vancouver, British Columbia, Canada; MS/MRI Research Group, University of British Columbia, Vancouver, British Columbia, Canada; Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - C Laule
- Radiology, University of British Columbia, Vancouver, British Columbia, Canada; International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, British Columbia, Canada; Pathology & Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Physics & Astronomy, University of British Columbia, Vancouver, British Columbia, Canada
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9
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Cairns J, Vavasour IM, Traboulsee A, Carruthers R, Kolind SH, Li DKB, Moore GRW, Laule C. Diffusely abnormal white matter in multiple sclerosis. J Neuroimaging 2021; 32:5-16. [PMID: 34752664 DOI: 10.1111/jon.12945] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 10/08/2021] [Revised: 10/17/2021] [Accepted: 10/18/2021] [Indexed: 02/06/2023] Open
Abstract
MRI enables detailed in vivo depiction of multiple sclerosis (MS) pathology. Localized areas of MS damage, commonly referred to as lesions, or plaques, have been a focus of clinical and research MRI studies for over four decades. A nonplaque MRI abnormality which is present in at least 25% of MS patients but has received far less attention is diffusely abnormal white matter (DAWM). DAWM has poorly defined boundaries and a signal intensity that is between normal-appearing white matter and classic lesions on proton density and T2 -weighted images. All clinical phenotypes of MS demonstrate DAWM, including clinically isolated syndrome, where DAWM is associated with higher lesion volume, reduced brain volume, and earlier conversion to MS. Advanced MRI metric abnormalities in DAWM tend to be greater than those in NAWM, but not as severe as focal lesions, with myelin, axons, and water-related changes commonly reported. Histological studies demonstrate a primary lipid abnormality in DAWM, with some axonal damage and lesser involvement of myelin proteins. This review provides an overview of DAWM identification, summarizes in vivo and postmortem observations, and comments on potential pathophysiological mechanisms, which may underlie DAWM in MS. Given the prevalence and potential clinical impact of DAWM, the number of imaging studies focusing on DAWM is insufficient. Characterization of DAWM significance and microstructure would benefit from larger longitudinal and additional quantitative imaging efforts. Revisiting data from previous studies that included proton density and T2 imaging would enable retrospective DAWM identification and analysis.
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Affiliation(s)
- James Cairns
- Department of Medicine (Neurology), University of British Columbia, British Columbia, Vancouver, Canada.,Department of Radiology, University of British Columbia, British Columbia, Vancouver, Canada
| | - Irene M Vavasour
- Department of Radiology, University of British Columbia, British Columbia, Vancouver, Canada.,International Collaboration on Repair Discoveries, Blusson Spinal Cord Centre, University of British Columbia, British Columbia, Vancouver, Canada
| | - Anthony Traboulsee
- Department of Medicine (Neurology), University of British Columbia, British Columbia, Vancouver, Canada
| | - Robert Carruthers
- Department of Medicine (Neurology), University of British Columbia, British Columbia, Vancouver, Canada
| | - Shannon H Kolind
- Department of Medicine (Neurology), University of British Columbia, British Columbia, Vancouver, Canada.,Department of Radiology, University of British Columbia, British Columbia, Vancouver, Canada.,International Collaboration on Repair Discoveries, Blusson Spinal Cord Centre, University of British Columbia, British Columbia, Vancouver, Canada.,Department of Physics & Astronomy, University of British Columbia, British Columbia, Vancouver, Canada
| | - David K B Li
- Department of Medicine (Neurology), University of British Columbia, British Columbia, Vancouver, Canada.,Department of Radiology, University of British Columbia, British Columbia, Vancouver, Canada
| | - G R Wayne Moore
- Department of Medicine (Neurology), University of British Columbia, British Columbia, Vancouver, Canada.,International Collaboration on Repair Discoveries, Blusson Spinal Cord Centre, University of British Columbia, British Columbia, Vancouver, Canada.,Department of Pathology & Laboratory Medicine, University of British Columbia, British Columbia, Vancouver, Canada
| | - Cornelia Laule
- Department of Radiology, University of British Columbia, British Columbia, Vancouver, Canada.,International Collaboration on Repair Discoveries, Blusson Spinal Cord Centre, University of British Columbia, British Columbia, Vancouver, Canada.,Department of Physics & Astronomy, University of British Columbia, British Columbia, Vancouver, Canada.,Department of Pathology & Laboratory Medicine, University of British Columbia, British Columbia, Vancouver, Canada
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10
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Liu H, Joseph TS, Xiang QS, Tam R, Kozlowski P, Li DKB, MacKay AL, Kramer JLK, Laule C. A data-driven T 2 relaxation analysis approach for myelin water imaging: Spectrum analysis for multiple exponentials via experimental condition oriented simulation (SAME-ECOS). Magn Reson Med 2021; 87:915-931. [PMID: 34490909 DOI: 10.1002/mrm.29000] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 08/16/2021] [Accepted: 08/17/2021] [Indexed: 11/08/2022]
Abstract
PURPOSE The decomposition of multi-exponential decay data into a T2 spectrum poses substantial challenges for conventional fitting algorithms, including non-negative least squares (NNLS). Based on a combination of the resolution limit constraint and machine learning neural network algorithm, a data-driven and highly tailorable analysis method named spectrum analysis for multiple exponentials via experimental condition oriented simulation (SAME-ECOS) was proposed. THEORY AND METHODS The theory of SAME-ECOS was derived. Then, a paradigm was presented to demonstrate the SAME-ECOS workflow, consisting of a series of calculation, simulation, and model training operations. The performance of the trained SAME-ECOS model was evaluated using simulations and six in vivo brain datasets. The code is available at https://github.com/hanwencat/SAME-ECOS. RESULTS Using NNLS as the baseline, SAME-ECOS achieved over 15% higher overall cosine similarity scores in producing the T2 spectrum, and more than 10% lower mean absolute error in calculating the myelin water fraction (MWF), as well as demonstrated better robustness to noise in the simulation tests. Applying to in vivo data, MWF from SAME-ECOS and NNLS was highly correlated among all study participants. However, a distinct separation of the myelin water peak and the intra/extra-cellular water peak was only observed in the mean T2 spectra determined using SAME-ECOS. In terms of data processing speed, SAME-ECOS is approximately 30 times faster than NNLS, achieving a whole-brain analysis in 3 min. CONCLUSION Compared with NNLS, the SAME-ECOS method yields much more reliable T2 spectra in a dramatically shorter time, increasing the feasibility of multi-component T2 decay analysis in clinical settings.
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Affiliation(s)
- Hanwen Liu
- Physics & Astronomy, University of British Columbia, Vancouver, British Columbia, Canada.,International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tigris S Joseph
- Physics & Astronomy, University of British Columbia, Vancouver, British Columbia, Canada.,International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, British Columbia, Canada
| | - Qing-San Xiang
- Physics & Astronomy, University of British Columbia, Vancouver, British Columbia, Canada.,Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Roger Tam
- Radiology, University of British Columbia, Vancouver, British Columbia, Canada.,Biomedical Engineering, University of British Columbia, Vancouver, British Columbia, Canada
| | - Piotr Kozlowski
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, British Columbia, Canada.,Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - David K B Li
- Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alex L MacKay
- Physics & Astronomy, University of British Columbia, Vancouver, British Columbia, Canada.,Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - John L K Kramer
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, British Columbia, Canada.,Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Cornelia Laule
- Physics & Astronomy, University of British Columbia, Vancouver, British Columbia, Canada.,International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, British Columbia, Canada.,Radiology, University of British Columbia, Vancouver, British Columbia, Canada.,Pathology & Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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11
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Ontaneda D, Raza PC, Mahajan KR, Arnold DL, Dwyer MG, Gauthier SA, Greve DN, Harrison DM, Henry RG, Li DKB, Mainero C, Moore W, Narayanan S, Oh J, Patel R, Pelletier D, Rauscher A, Rooney WD, Sicotte NL, Tam R, Reich DS, Azevedo CJ. Deep grey matter injury in multiple sclerosis: a NAIMS consensus statement. Brain 2021; 144:1974-1984. [PMID: 33757115 PMCID: PMC8370433 DOI: 10.1093/brain/awab132] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [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: 10/27/2020] [Revised: 01/28/2021] [Accepted: 02/01/2021] [Indexed: 11/13/2022] Open
Abstract
Although multiple sclerosis has traditionally been considered a white matter disease, extensive research documents the presence and importance of grey matter injury including cortical and deep regions. The deep grey matter exhibits a broad range of pathology and is uniquely suited to study the mechanisms and clinical relevance of tissue injury in multiple sclerosis using magnetic resonance techniques. Deep grey matter injury has been associated with clinical and cognitive disability. Recently, MRI characterization of deep grey matter properties, such as thalamic volume, have been tested as potential clinical trial end points associated with neurodegenerative aspects of multiple sclerosis. Given this emerging area of interest and its potential clinical trial relevance, the North American Imaging in Multiple Sclerosis (NAIMS) Cooperative held a workshop and reached consensus on imaging topics related to deep grey matter. Herein, we review current knowledge regarding deep grey matter injury in multiple sclerosis from an imaging perspective, including insights from histopathology, image acquisition and post-processing for deep grey matter. We discuss the clinical relevance of deep grey matter injury and specific regions of interest within the deep grey matter. We highlight unanswered questions and propose future directions, with the aim of focusing research priorities towards better methods, analysis, and interpretation of results.
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Affiliation(s)
- Daniel Ontaneda
- Cleveland Clinic Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland, OH 44195, USA
| | - Praneeta C Raza
- Cleveland Clinic Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland, OH 44195, USA
| | - Kedar R Mahajan
- Cleveland Clinic Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland, OH 44195, USA
| | - Douglas L Arnold
- McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, Quebec H3A 2B4, Canada
| | - Michael G Dwyer
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, The State University of New York, Buffalo, NY 14214, USA
| | - Susan A Gauthier
- Department of Neurology, Weill Cornell Medicine, New York, NY 10021, USA
| | - Douglas N Greve
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, MA 02129, USA
- Department of Radiology, Harvard Medical School, Boston, MA 02129, USA
| | - Daniel M Harrison
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Roland G Henry
- Department of Neurology, Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA 94143, USA
- The UC San Francisco and Berkeley Bioengineering Graduate Group, University of California San Francisco, San Francisco, CA 94143, USA
| | - David K B Li
- Department of Radiology and Medicine (Neurology), University of British Columbia, Vancouver, British Columbia V6T 2B5, Canada
| | - Caterina Mainero
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, MA 02129, USA
- Department of Radiology, Harvard Medical School, Boston, MA 02129, USA
| | - Wayne Moore
- Department of Pathology and Laboratory Medicine, and International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, British Columbia V6T 1Z4, Canada
| | - Sridar Narayanan
- McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, Quebec H3A 2B4, Canada
| | - Jiwon Oh
- Division of Neurology, St. Michael’s Hospital, University of Toronto, Toronto, Ontario M5B 1W8, Canada
| | - Raihaan Patel
- Cerebral Imaging Centre, Douglas Mental Health University Institute, Verdun, Quebec H4H 1R3, Canada
- Department of Biological and Biomedical Engineering, McGill University, Montreal, Quebec H3A 2B4, Canada
| | - Daniel Pelletier
- Department of Neurology, University of Southern California Keck School of Medicine, Los Angeles, CA 90033, USA
| | - Alexander Rauscher
- Physics and Astronomy, University of British Columbia, Vancouver, British Columbia V6T 1Z4, Canada
| | - William D Rooney
- Advanced Imaging Research Center, Oregon Health and Science University, Portland, OR 97239, USA
| | - Nancy L Sicotte
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Roger Tam
- Department of Radiology and Medicine (Neurology), University of British Columbia, Vancouver, British Columbia V6T 2B5, Canada
- Biomedical Engineering, University of British Columbia, Vancouver, British Columbia V6T 1Z4, Canada
| | - Daniel S Reich
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, Bethesda, MD 20824, USA
| | - Christina J Azevedo
- Department of Neurology, University of Southern California Keck School of Medicine, Los Angeles, CA 90033, USA
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12
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Vavasour IM, Chang KL, Combes AJE, Meyers SM, Kolind SH, Rauscher A, Li DKB, Traboulsee A, MacKay AL, Laule C. Water content changes in new multiple sclerosis lesions have a minimal effect on the determination of myelin water fraction values. J Neuroimaging 2021; 31:1119-1125. [PMID: 34310789 DOI: 10.1111/jon.12908] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 03/30/2021] [Revised: 07/07/2021] [Accepted: 07/07/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND AND PURPOSE Myelin water fraction (MWF) is a histopathologically validated in vivo myelin marker. As MWF is the proportion of water with a short T2 relative to the total water, increases in water from edema and inflammation may confound MWF determination in multiple sclerosis (MS) lesions. Total water content (TWC) measurement enables calculation of absolute myelin water content (MWC) and can be used to distinguish edema/inflammation from demyelination. We assessed what influence changes in total water might have on MWF by calculating MWC values in new MS lesions. METHODS 3T 32-echo T2 relaxation data were collected monthly for 6 months from six relapsing-remitting MS participants. TWC was determined and multiplied with MWF images to calculate corrected MWC images. The effect of this water content correction was examined in 20 new lesions by comparing mean MWF and MWC over time. RESULTS On average, at lesion first appearance, lesion TWC increased by 6.4% (p = .003; range: -1% to +21%), MWF decreased by 24% (p = .006; range: -70% to +12%), and MWC decreased by 20% (p = .026; range: -68% to +21%), relative to prelesion values. Average TWC in lesions then gradually decreased, whereas MWF and MWC remained low. The shape of the MWF and MWC lesion evolution curves was nearly identical, differing only by an offset. CONCLUSION MWF mirrors MWC and is able to monitor myelin in new lesions. Even after taking into account water content increases, MWC still decreased at lesion first appearance attributed to demyelination.
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Affiliation(s)
- Irene M Vavasour
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada.,International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, British Columbia, Canada
| | - Kimberley L Chang
- Department of Medicine, Division of Neurology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Anna J E Combes
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Sandra M Meyers
- Department of Physics and Astronomy, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Radiation Medicine and Applied Sciences, University of California, San Diego, California, USA
| | - Shannon H Kolind
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada.,International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, British Columbia, Canada.,Department of Medicine, Division of Neurology, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Physics and Astronomy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alexander Rauscher
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Physics and Astronomy, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - David K B Li
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Medicine, Division of Neurology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Anthony Traboulsee
- Department of Medicine, Division of Neurology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alex L MacKay
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Physics and Astronomy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Cornelia Laule
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada.,International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, British Columbia, Canada.,Department of Physics and Astronomy, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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13
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Salter A, Fox RJ, Newsome SD, Halper J, Li DKB, Kanellis P, Costello K, Bebo B, Rammohan K, Cutter GR, Cross AH. Outcomes and Risk Factors Associated With SARS-CoV-2 Infection in a North American Registry of Patients With Multiple Sclerosis. JAMA Neurol 2021; 78:699-708. [PMID: 33739362 PMCID: PMC7980147 DOI: 10.1001/jamaneurol.2021.0688] [Citation(s) in RCA: 188] [Impact Index Per Article: 62.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Importance Emergence of SARS-CoV-2 causing COVID-19 prompted the need to gather information on clinical outcomes and risk factors associated with morbidity and mortality in patients with multiple sclerosis (MS) and concomitant SARS-CoV-2 infections. Objective To examine outcomes and risk factors associated with COVID-19 clinical severity in a large, diverse cohort of North American patients with MS. Design, Setting, and Participants This analysis used deidentified, cross-sectional data on patients with MS and SARS-CoV-2 infection reported by health care professionals in North American academic and community practices between April 1, 2020, and December 12, 2020, in the COVID-19 Infections in MS Registry. Health care professionals were asked to report patients after a minimum of 7 days from initial symptom onset and after sufficient time had passed to observe the COVID-19 disease course through resolution of acute illness or death. Data collection began April 1, 2020, and is ongoing. Exposures Laboratory-positive SARS-CoV-2 infection or highly suspected COVID-19. Main Outcomes and Measures Clinical outcome with 4 levels of increasing severity: not hospitalized, hospitalization only, admission to the intensive care unit and/or required ventilator support, and death. Results Of 1626 patients, most had laboratory-positive SARS-CoV-2 infection (1345 [82.7%]), were female (1202 [74.0%]), and had relapsing-remitting MS (1255 [80.4%]). A total of 996 patients (61.5%) were non-Hispanic White, 337 (20.8%) were Black, and 190 (11.7%) were Hispanic/Latinx. The mean (SD) age was 47.7 (13.2) years, and 797 (49.5%) had 1 or more comorbidity. The overall mortality rate was 3.3% (95% CI, 2.5%-4.3%). Ambulatory disability and older age were each independently associated with increased odds of all clinical severity levels compared with those not hospitalized after adjusting for other risk factors (nonambulatory: hospitalization only, odds ratio [OR], 2.8 [95% CI, 1.6-4.8]; intensive care unit/required ventilator support, OR, 3.5 [95% CI, 1.6-7.8]; death, OR, 25.4 [95% CI, 9.3-69.1]; age [every 10 years]: hospitalization only, OR, 1.3 [95% CI, 1.1-1.6]; intensive care unit/required ventilator support, OR, 1.3 [95% CI, 0.99-1.7]; death, OR, 1.8 [95% CI, 1.2-2.6]). Conclusions and Relevance In this registry-based cross-sectional study, increased disability was independently associated with worse clinical severity including death from COVID-19. Other risk factors for worse outcomes included older age, Black race, cardiovascular comorbidities, and recent treatment with corticosteroids. Knowledge of these risk factors may improve the treatment of patients with MS and COVID-19 by helping clinicians identify patients requiring more intense monitoring or COVID-19 treatment.
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Affiliation(s)
- Amber Salter
- Washington University School of Medicine in St Louis, St Louis, Missouri
| | | | - Scott D Newsome
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - June Halper
- Consortium of MS Centers, Hackensack, New Jersey
| | - David K B Li
- The University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | - Bruce Bebo
- National Multiple Sclerosis Society, Chicago, Illinois
| | | | | | - Anne H Cross
- Washington University School of Medicine in St Louis, St Louis, Missouri
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14
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Holmes RD, Vavasour IM, Greenfield J, Zhao G, Lee JS, Moore GRW, Tam R, Metz LM, Trablousee A, Li DKB, Laule C. Nonlesional diffusely abnormal appearing white matter in clinically isolated syndrome: Prevalence, association with clinical and MRI features, and risk for conversion to multiple sclerosis. J Neuroimaging 2021; 31:981-994. [PMID: 34128576 DOI: 10.1111/jon.12900] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 05/26/2021] [Accepted: 05/28/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND AND PURPOSE While diffusely abnormal white matter (DAWM) is a nonlesional MRI abnormality identified in ∼25% of patients with multiple sclerosis (MS), it has yet to be investigated in patients at an earlier disease stage, namely clinically isolated syndrome (CIS). The goals of this study were to (1) determine the prevalence of DAWM in patients with a CIS suggestive of MS, (2) evaluate the association between DAWM and demographic, clinical, and MRI features, and (3) evaluate the prognostic significance of DAWM on conversion from CIS to MS. METHODS One hundred and forty-two CIS participants were categorized into DAWM and non-DAWM groups at baseline and followed for up to 24 months or until MS diagnosis. The primary outcome was conversion to MS (2005 McDonald criteria) within 6 months. RESULTS DAWM was present in 27.5% of participants, and was positively associated with brainstem symptom onset, receiving corticosteroids, dissemination in space, and T2 lesion volume. DAWM was associated with an increased risk of conversion to MS over 6 months after adjustment for age and disability (hazard ratio [HR] = 2.24, p = 0.004). This association remained at a trend-level after adjustment for high-risk imaging features (HR = 1.68, p = 0.10). CONCLUSIONS DAWM is present in a similar proportion of patients with CIS and clinically definite MS, and it is associated with increased risk of conversion to MS over 6 months.
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Affiliation(s)
- R Davis Holmes
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Irene M Vavasour
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jamie Greenfield
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Guojun Zhao
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada.,UBC MS/MRI Research Group, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jimmy S Lee
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - G R Wayne Moore
- Department of Pathology & Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, British Columbia, Canada
| | - Roger Tam
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada.,UBC MS/MRI Research Group, University of British Columbia, Vancouver, British Columbia, Canada.,School of Biomedical Engineering, University of British Columbia, Vancouver, British Columbia, Canada
| | - Luanne M Metz
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Anthony Trablousee
- UBC MS/MRI Research Group, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Medicine (Neurology), University of British Columbia, Vancouver, British Columbia, Canada
| | - David K B Li
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada.,UBC MS/MRI Research Group, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Medicine (Neurology), University of British Columbia, Vancouver, British Columbia, Canada
| | - Cornelia Laule
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Pathology & Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, British Columbia, Canada.,Department of Physics & Astronomy, University of British Columbia, Vancouver, British Columbia, Canada
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15
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Wattjes MP, Ciccarelli O, Reich DS, Banwell B, de Stefano N, Enzinger C, Fazekas F, Filippi M, Frederiksen J, Gasperini C, Hacohen Y, Kappos L, Li DKB, Mankad K, Montalban X, Newsome SD, Oh J, Palace J, Rocca MA, Sastre-Garriga J, Tintoré M, Traboulsee A, Vrenken H, Yousry T, Barkhof F, Rovira À. 2021 MAGNIMS-CMSC-NAIMS consensus recommendations on the use of MRI in patients with multiple sclerosis. Lancet Neurol 2021; 20:653-670. [PMID: 34139157 DOI: 10.1016/s1474-4422(21)00095-8] [Citation(s) in RCA: 255] [Impact Index Per Article: 85.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 02/15/2021] [Accepted: 03/12/2021] [Indexed: 12/11/2022]
Abstract
The 2015 Magnetic Resonance Imaging in Multiple Sclerosis and 2016 Consortium of Multiple Sclerosis Centres guidelines on the use of MRI in diagnosis and monitoring of multiple sclerosis made an important step towards appropriate use of MRI in routine clinical practice. Since their promulgation, there have been substantial relevant advances in knowledge, including the 2017 revisions of the McDonald diagnostic criteria, renewed safety concerns regarding intravenous gadolinium-based contrast agents, and the value of spinal cord MRI for diagnostic, prognostic, and monitoring purposes. These developments suggest a changing role of MRI for the management of patients with multiple sclerosis. This 2021 revision of the previous guidelines on MRI use for patients with multiple sclerosis merges recommendations from the Magnetic Resonance Imaging in Multiple Sclerosis study group, Consortium of Multiple Sclerosis Centres, and North American Imaging in Multiple Sclerosis Cooperative, and translates research findings into clinical practice to improve the use of MRI for diagnosis, prognosis, and monitoring of individuals with multiple sclerosis. We recommend changes in MRI acquisition protocols, such as emphasising the value of three dimensional-fluid-attenuated inversion recovery as the core brain pulse sequence to improve diagnostic accuracy and ability to identify new lesions to monitor treatment effectiveness, and we provide recommendations for the judicious use of gadolinium-based contrast agents for specific clinical purposes. Additionally, we extend the recommendations to the use of MRI in patients with multiple sclerosis in childhood, during pregnancy, and in the post-partum period. Finally, we discuss promising MRI approaches that might deserve introduction into clinical practice in the near future.
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Affiliation(s)
- Mike P Wattjes
- Department of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany; Department of Radiology and Nuclear Medicine, Amsterdam UMC, Amsterdam, Netherlands
| | - Olga Ciccarelli
- Faculty of Brain Sciences, University College London Queen Square Institute of Neurology, University College London, London, UK; National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, UK
| | - Daniel S Reich
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Brenda Banwell
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Nicola de Stefano
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Christian Enzinger
- Department of Neurology, Medical University of Graz, Graz, Austria; Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Franz Fazekas
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Massimo Filippi
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Neurophysiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Jette Frederiksen
- Department of Neurology, Rigshospitalet Glostrup, University Hospital of Copenhagen, Glostrup, Denmark
| | - Claudio Gasperini
- Department of Neurology, San Camillo-Forlanini Hospital, Roma, Italy
| | - Yael Hacohen
- Faculty of Brain Sciences, University College London Queen Square Institute of Neurology, University College London, London, UK; Department of Paediatric Neurology, Great Ormond Street Hospital for Children, London, UK
| | - Ludwig Kappos
- Department of Neurology and Research Center for Clinical Neuroimmunology and Neuroscience, University Hospital of Basel and University of Basel, Basel, Switzerland
| | - David K B Li
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Kshitij Mankad
- Department of Neuroradiology, Great Ormond Street Hospital for Children, London, UK
| | - Xavier Montalban
- Multiple Sclerosis Centre of Catalonia, Department of Neurology-Neuroimmunology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain; Division of Neurology, St Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Scott D Newsome
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Jiwon Oh
- Division of Neurology, St Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | | | - Maria A Rocca
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Jaume Sastre-Garriga
- Multiple Sclerosis Centre of Catalonia, Department of Neurology-Neuroimmunology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Mar Tintoré
- Multiple Sclerosis Centre of Catalonia, Department of Neurology-Neuroimmunology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Anthony Traboulsee
- Division of Neurology, University of British Columbia, Vancouver, BC, Canada
| | - Hugo Vrenken
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Amsterdam, Netherlands
| | - Tarek Yousry
- Lysholm Department of Neuroradiology, UCLH National Hospital for Neurology and Neurosurgery, London, UK; Neuroradiological Academic Unit, University College London Queen Square Institute of Neurology, University College London, London, UK
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Amsterdam, Netherlands; Faculty of Brain Sciences, University College London Queen Square Institute of Neurology, University College London, London, UK; National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, UK
| | - Àlex Rovira
- Section of Neuroradiology, Department of Radiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
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16
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Camara-Lemarroy CR, Silva C, Metz LM, Cerchiaro G, Greenfield J, Dowlatabadi R, Vogel HJ, Lee CH, Giuliani F, Nakhaei-Nejad M, Li DKB, Traboulsee A, Yong VW. Multimodal peripheral fluid biomarker analysis in clinically isolated syndrome and early multiple sclerosis. Mult Scler Relat Disord 2021; 50:102809. [PMID: 33581614 DOI: 10.1016/j.msard.2021.102809] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 08/19/2020] [Revised: 01/06/2021] [Accepted: 01/31/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Increasing evidence suggests that various inflammatory, immunological and metabolic pathways are altered in the clinically isolated syndrome (CIS) of multiple sclerosis (MS). Moreover, recent diagnostic criteria have made possible the very early diagnosis of MS. We evaluated multiple fluid biomarkers in people with early MS and CIS. METHODS We measured blood levels of cytokines, matrix metalloproteinases (MMPs), serum metabolomics and immune cell immunophenotyping in participants in the Trial of Minocycline in a Clinically Isolated Syndrome of Multiple Sclerosis. RESULTS When compared with healthy controls, people with early MS/CIS had higher levels of eotaxin, MCP-3, IL-1 receptor antagonist, IL-1β, IL-9 and IP-10, as well as MMPs 1, 8 and 9. In metabolomics analysis, the alanine, aspartate and glutamate metabolism and the synthesis and degradation of ketone bodies pathways were altered compared to healthy controls. There were no differences in lymphocyte subpopulation numbers. Out of all these biomarkers, only MMP-1 was able to differentiate between early MS and CIS, and was found to correlate with lesion volume and gadolinium enhancing lesions on MRI. CONCLUSION The immunological and metabolic profile of CIS and early MS is remarkably similar, supporting that these are a continuum of a common underlying pathophysiological process.
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Affiliation(s)
- Carlos R Camara-Lemarroy
- Departments of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
| | - Claudia Silva
- Departments of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Luanne M Metz
- Departments of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Graziela Cerchiaro
- Departments of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jamie Greenfield
- Departments of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Reza Dowlatabadi
- Department of Biological Science, Bio-NMR-metabolomics Research center, University of Calgary, Calgary, Canada
| | - Hans J Vogel
- Department of Biological Science, Bio-NMR-metabolomics Research center, University of Calgary, Calgary, Canada
| | - Chieh-Hsin Lee
- Department of Medicine, University of Alberta, Alberta, Canada
| | | | | | - David K B Li
- Department of Medicine, University of British Columbia, Canada
| | | | - V Wee Yong
- Departments of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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17
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Dvorak AV, Ljungberg E, Vavasour IM, Lee LE, Abel S, Li DKB, Traboulsee A, MacKay AL, Kolind SH. Comparison of multi echo T 2 relaxation and steady state approaches for myelin imaging in the central nervous system. Sci Rep 2021; 11:1369. [PMID: 33446710 PMCID: PMC7809349 DOI: 10.1038/s41598-020-80585-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 09/07/2020] [Accepted: 12/22/2020] [Indexed: 12/11/2022] Open
Abstract
The traditional approach for measuring myelin-associated water with quantitative magnetic resonance imaging (MRI) uses multi-echo T2 relaxation data to calculate the myelin water fraction (MWF). A fundamentally different approach, abbreviated “mcDESPOT”, uses a more efficient steady-state acquisition to generate an equivalent metric (fM). Although previous studies have demonstrated inherent instability and bias in the complex mcDESPOT analysis procedure, fM has often been used as a surrogate for MWF. We produced and compared multivariate atlases of MWF and fM in healthy human brain and cervical spinal cord (available online) and compared their ability to detect multiple sclerosis pathology. A significant bias was found in all regions (p < 10–5), albeit reversed for spinal cord (fM-MWF = − 3.4%) compared to brain (+ 6.2%). MWF and fM followed an approximately linear relationship for regions with MWF < ~ 10%. For MWF > ~ 10%, the relationship broke down and fM no longer increased in tandem with MWF. For multiple sclerosis patients, MWF and fM Z score maps showed overlapping areas of low Z score and similar trends between patients and brain regions, although those of fM generally had greater spatial extent and magnitude of severity. These results will guide future choice of myelin-sensitive quantitative MRI and improve interpretation of studies using either myelin imaging approach.
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Affiliation(s)
- Adam V Dvorak
- Physics and Astronomy, University of British Columbia, Vancouver, BC, Canada. .,International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada.
| | - Emil Ljungberg
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Irene M Vavasour
- Physics and Astronomy, University of British Columbia, Vancouver, BC, Canada.,Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Lisa Eunyoung Lee
- Medicine (Neurology), University of British Columbia, Vancouver, BC, Canada
| | - Shawna Abel
- Medicine (Neurology), University of British Columbia, Vancouver, BC, Canada
| | - David K B Li
- Radiology, University of British Columbia, Vancouver, BC, Canada.,Medicine (Neurology), University of British Columbia, Vancouver, BC, Canada
| | - Anthony Traboulsee
- Medicine (Neurology), University of British Columbia, Vancouver, BC, Canada
| | - Alex L MacKay
- Physics and Astronomy, University of British Columbia, Vancouver, BC, Canada.,Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Shannon H Kolind
- Physics and Astronomy, University of British Columbia, Vancouver, BC, Canada.,International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada.,Radiology, University of British Columbia, Vancouver, BC, Canada.,Medicine (Neurology), University of British Columbia, Vancouver, BC, Canada
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18
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Dvorak AV, Swift-LaPointe T, Vavasour IM, Lee LE, Abel S, Russell-Schulz B, Graf C, Wurl A, Liu H, Laule C, Li DKB, Traboulsee A, Tam R, Boyd LA, MacKay AL, Kolind SH. An atlas for human brain myelin content throughout the adult life span. Sci Rep 2021; 11:269. [PMID: 33431990 PMCID: PMC7801525 DOI: 10.1038/s41598-020-79540-3] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 12/09/2020] [Indexed: 12/11/2022] Open
Abstract
Myelin water imaging is a quantitative neuroimaging technique that provides the myelin water fraction (MWF), a metric highly specific to myelin content, and the intra-/extra-cellular T2 (IET2), which is related to water and iron content. We coupled high-resolution data from 100 adults with gold-standard methodology to create an optimized anatomical brain template and accompanying MWF and IET2 atlases. We then used the MWF atlas to characterize how myelin content relates to demographic factors. In most brain regions, myelin content followed a quadratic pattern of increase during the third decade of life, plateau at a maximum around the fifth decade, then decrease during later decades. The ranking of mean myelin content between brain regions remained consistent across age groups. These openly available normative atlases can facilitate evaluation of myelin imaging results on an individual basis and elucidate the distribution of myelin content between brain regions and in the context of aging.
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Affiliation(s)
- Adam V Dvorak
- Physics and Astronomy, University of British Columbia, Vancouver, BC, Canada. .,International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada.
| | | | - Irene M Vavasour
- Physics and Astronomy, University of British Columbia, Vancouver, BC, Canada.,Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Lisa Eunyoung Lee
- Medicine (Neurology), University of British Columbia, Vancouver, BC, Canada
| | - Shawna Abel
- Medicine (Neurology), University of British Columbia, Vancouver, BC, Canada
| | | | - Carina Graf
- Physics and Astronomy, University of British Columbia, Vancouver, BC, Canada.,International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada
| | - Anika Wurl
- Physics and Astronomy, University of British Columbia, Vancouver, BC, Canada
| | - Hanwen Liu
- Physics and Astronomy, University of British Columbia, Vancouver, BC, Canada.,International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada
| | - Cornelia Laule
- Physics and Astronomy, University of British Columbia, Vancouver, BC, Canada.,International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada.,Radiology, University of British Columbia, Vancouver, BC, Canada.,Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - David K B Li
- Radiology, University of British Columbia, Vancouver, BC, Canada.,Medicine (Neurology), University of British Columbia, Vancouver, BC, Canada
| | - Anthony Traboulsee
- Medicine (Neurology), University of British Columbia, Vancouver, BC, Canada
| | - Roger Tam
- Radiology, University of British Columbia, Vancouver, BC, Canada.,Biomedical Engineering, University of British Columbia, Vancouver, BC, Canada
| | - Lara A Boyd
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Alex L MacKay
- Physics and Astronomy, University of British Columbia, Vancouver, BC, Canada.,Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Shannon H Kolind
- Physics and Astronomy, University of British Columbia, Vancouver, BC, Canada.,International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada.,Radiology, University of British Columbia, Vancouver, BC, Canada.,Medicine (Neurology), University of British Columbia, Vancouver, BC, Canada
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19
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Saslow L, Li DKB, Halper J, Banwell B, Barkhof F, Barlow L, Costello K, Damiri P, Dunn J, Giri S, Maes M, Morrow SA, Newsome SD, Oh J, Paul F, Quarterman P, Reich DS, Shewchuk JR, Shinohara RT, Van Hecke W, van de Ven K, Wallin MT, Wolinsky JS, Traboulsee A. An International Standardized Magnetic Resonance Imaging Protocol for Diagnosis and Follow-up of Patients with Multiple Sclerosis: Advocacy, Dissemination, and Implementation Strategies. Int J MS Care 2020; 22:226-232. [PMID: 33177959 DOI: 10.7224/1537-2073.2020-094] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Standardized magnetic resonance imaging (MRI) protocols are important for the diagnosis and monitoring of patients with multiple sclerosis (MS). The Consortium of Multiple Sclerosis Centers (CMSC) convened an international panel of MRI experts to review and update the current guidelines. The objective was to update the standardized MRI protocol and clinical guidelines for diagnosis and follow-up of MS and develop strategies for advocacy, dissemination, and implementation. Conference attendees included neurologists, radiologists, technologists, and imaging scientists with expertise in MS. Representatives from the CMSC, Magnetic Resonance Imaging in MS (MAGNIMS), North American Imaging in Multiple Sclerosis Cooperative, US Department of Veteran Affairs, National Multiple Sclerosis Society, Multiple Sclerosis Association of America, MRI manufacturers, and commercial image analysis companies were present. Before the meeting, CMSC members were surveyed about standardized MRI protocols, gadolinium use, need for diffusion-weighted imaging, and the central vein sign. The panel worked to make the CMSC and MAGNIMS MRI protocols similar so that the updated guidelines could ultimately be accepted by international consensus. Advocacy efforts will promote the importance of standardized MS MRI protocols. Dissemination will include publications, meeting abstracts, educational programming, webinars, "meet the expert" teleconferences, and examination cards. Implementation will require comprehensive and coordinated efforts to make the protocol easy to access and use. The ultimate vision, and goal, is for the guidelines to be universally useful, usable, and used as the standard of care for patients with MS.
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20
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Abel S, Vavasour I, Lee LE, Johnson P, Ristow S, Ackermans N, Chan J, Cross H, Laule C, Dvorak A, Schabas A, Hernández-Torres E, Tam R, Kuan AJ, Morrow SA, Wilken J, Rauscher A, Bhan V, Sayao AL, Devonshire V, Li DKB, Carruthers R, Traboulsee A, Kolind SH. Associations Between Findings From Myelin Water Imaging and Cognitive Performance Among Individuals With Multiple Sclerosis. JAMA Netw Open 2020; 3:e2014220. [PMID: 32990740 PMCID: PMC7525360 DOI: 10.1001/jamanetworkopen.2020.14220] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Cognitive impairment is a debilitating symptom of multiple sclerosis (MS) that affects up to 70% of patients. An improved understanding of the underlying pathology of MS-related cognitive impairment would provide considerable benefit to patients and clinicians. OBJECTIVE To determine whether there is an association between myelin damage in tissue that appears completely normal on standard clinical imaging, but can be detected by myelin water imaging (MWI), with cognitive performance in MS. DESIGN, SETTING, AND PARTICIPANTS In this cross-sectional study, participants with MS and controls underwent cognitive testing and magnetic resonance imaging (MRI) from August 23, 2017, to February 20, 2019. Participants were recruited through the University of British Columbia Hospital MS clinic and via online recruitment advertisements on local health authority websites. Cognitive testing was performed in the MS clinic, and MRI was performed at the adjacent academic research neuroimaging center. Seventy-three participants with clinically definite MS fulfilling the 2017 revised McDonald criteria for diagnosis and 22 age-, sex-, and education-matched healthy volunteers without neurological disease were included in the study. Data analysis was performed from March to November 2019. EXPOSURES MWI was performed at 3 T with a 48-echo, 3-dimensional, gradient and spin-echo (GRASE) sequence. Cognitive testing was performed with assessments drawn from cognitive batteries validated for use in MS. MAIN OUTCOMES AND MEASURES The association between myelin water measures, a measurement of the T2 relaxation signal from water in the myelin bilayers providing a specific marker for myelin, and cognitive test scores was assessed using Pearson correlation. Three white matter regions of interest-the cingulum, superior longitudinal fasciculus (SLF), and corpus callosum-were selected a priori according to their known involvement in MS-related cognitive impairment. RESULTS For the 95 total participants, the mean (SD) age was 49.33 (11.44) years. The mean (SD) age was 50.2 (10.7) years for the 73 participants with MS and 46.4 (13.5) for the 22 controls. Forty-eight participants with MS (66%) and 14 controls (64%) were women. The mean (SD) years of education were 14.7 (2.2) for patients and 15.8 (2.5) years for controls. In MS, significant associations were observed between myelin water measures and scores on the Symbol Digit Modalities Test (SLF, r = -0.490; 95% CI, -0.697 to -0.284; P < .001; corpus callosum, r = -0.471; 95% CI, -0.680 to -0.262; P < .001; and cingulum, r = -0.419; 95% CI, -0.634 to -0.205; P < .001), Selective Reminding Test (SLF, r = -0.444; 95% CI, -0.660 to -0.217; P < .001; corpus callosum, r = -0.411; 95% CI, -0.630 to -0.181; P = .001; and cingulum, r = -0.361; 95% CI, -0.602 to -0.130; P = .003), and Controlled Oral Word Association Test (SLF, r = -0.317; 95% CI, -0.549 to -0.078; P = .01; and cingulum, r = -0.335; 95% CI, -0.658 to -0.113; P = .006). No significant associations were found in controls. CONCLUSIONS AND RELEVANCE This study used MWI to demonstrate that otherwise normal-appearing brain tissue is diffusely damaged in MS, and the findings suggest that myelin water measures are associated with cognitive performance. MWI offers an in vivo biomarker feasible for use in clinical trials investigating cognition, providing a means for monitoring changes in myelination and its association with symptom worsening or improvement.
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Affiliation(s)
- Shawna Abel
- Department of Medicine (Neurology), The University of British Columbia, Vancouver, British Columbia, Canada
| | - Irene Vavasour
- Department of Radiology, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Lisa Eunyoung Lee
- Department of Medicine (Neurology), The University of British Columbia, Vancouver, British Columbia, Canada
| | - Poljanka Johnson
- Department of Medicine (Neurology), The University of British Columbia, Vancouver, British Columbia, Canada
| | - Stephen Ristow
- Department of Medicine (Neurology), The University of British Columbia, Vancouver, British Columbia, Canada
| | - Nathalie Ackermans
- Department of Medicine (Neurology), The University of British Columbia, Vancouver, British Columbia, Canada
| | - Jillian Chan
- Department of Medicine (Neurology), The University of British Columbia, Vancouver, British Columbia, Canada
| | - Helen Cross
- Department of Medicine (Neurology), The University of British Columbia, Vancouver, British Columbia, Canada
| | - Cornelia Laule
- Department of Radiology, The University of British Columbia, Vancouver, British Columbia, Canada
- Department of Pathology & Laboratory Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
- Department of Physics & Astronomy, The University of British Columbia, Vancouver, British Columbia, Canada
- International Collaboration on Repair Discoveries, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Adam Dvorak
- Department of Physics & Astronomy, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Alice Schabas
- Department of Medicine (Neurology), The University of British Columbia, Vancouver, British Columbia, Canada
| | - Enedino Hernández-Torres
- Department of Medicine (Neurology), The University of British Columbia, Vancouver, British Columbia, Canada
| | - Roger Tam
- Department of Radiology, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Annie J. Kuan
- Department of Psychiatry, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Sarah A. Morrow
- Department of Clinical Neurological Sciences, Western University, London, Ontario, Canada
| | - Jeffrey Wilken
- Department of Neurology, Georgetown University Hospital, Washington, DC
- Washington Neuropsychology Research Group LLC, Fairfax, Virginia
| | - Alexander Rauscher
- Department of Radiology, The University of British Columbia, Vancouver, British Columbia, Canada
- Department of Physics & Astronomy, The University of British Columbia, Vancouver, British Columbia, Canada
- Department of Pediatrics, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Virender Bhan
- Department of Medicine (Neurology), The University of British Columbia, Vancouver, British Columbia, Canada
| | - Ana-Luiza Sayao
- Department of Medicine (Neurology), The University of British Columbia, Vancouver, British Columbia, Canada
| | - Virginia Devonshire
- Department of Medicine (Neurology), The University of British Columbia, Vancouver, British Columbia, Canada
| | - David K. B. Li
- Department of Medicine (Neurology), The University of British Columbia, Vancouver, British Columbia, Canada
- Department of Radiology, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Robert Carruthers
- Department of Medicine (Neurology), The University of British Columbia, Vancouver, British Columbia, Canada
| | - Anthony Traboulsee
- Department of Medicine (Neurology), The University of British Columbia, Vancouver, British Columbia, Canada
| | - Shannon H. Kolind
- Department of Medicine (Neurology), The University of British Columbia, Vancouver, British Columbia, Canada
- Department of Radiology, The University of British Columbia, Vancouver, British Columbia, Canada
- Department of Physics & Astronomy, The University of British Columbia, Vancouver, British Columbia, Canada
- International Collaboration on Repair Discoveries, The University of British Columbia, Vancouver, British Columbia, Canada
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21
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Morris SR, Holmes RD, Dvorak AV, Liu H, Yoo Y, Vavasour IM, Mazabel S, Mädler B, Kolind SH, Li DKB, Siegel L, Beaulieu C, MacKay AL, Laule C. Brain Myelin Water Fraction and Diffusion Tensor Imaging Atlases for 9-10 Year-Old Children. J Neuroimaging 2020; 30:150-160. [PMID: 32064721 DOI: 10.1111/jon.12689] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 09/17/2019] [Revised: 12/18/2019] [Accepted: 01/17/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND AND PURPOSE Myelin water imaging (MWI) and diffusion tensor imaging (DTI) provide information about myelin and axon-related brain microstructure, which can be useful for investigating normal brain development and many childhood brain disorders. While pediatric DTI atlases exist, there are no pediatric MWI atlases available for the 9-10 years old age group. As myelination and structural development occurs throughout childhood and adolescence, studies of pediatric brain pathologies must use age-specific MWI and DTI healthy control data. We created atlases of myelin water fraction (MWF) and DTI metrics for healthy children aged 9-10 years for use as normative data in pediatric neuroimaging studies. METHODS 3D-T1 , DTI, and MWI scans were acquired from 20 healthy children (mean age: 9.6 years, range: 9.2-10.3 years, 4 females). ANTs and FSL registration were used to create quantitative MWF and DTI atlases. Region of interest (ROI) analysis in nine white matter regions was used to compare pediatric MWF with adult MWF values from a recent study and to investigate the correlation between pediatric MWF and DTI metrics. RESULTS Adults had significantly higher MWF than the pediatric cohort in seven of the nine white matter ROIs, but not in the genu of the corpus callosum or the cingulum. In the pediatric data, MWF correlated significantly with mean diffusivity, but not with axial diffusivity, radial diffusivity, or fractional anisotropy. CONCLUSIONS Normative MWF and DTI metrics from a group of 9-10 year old healthy children provide a resource for comparison to pathologies. The age-specific atlases are ready for use in pediatric neuroimaging research and can be accessed: https://sourceforge.net/projects/pediatric-mri-myelin-diffusion/.
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Affiliation(s)
- Sarah R Morris
- Department of Physics and Astronomy, University of British Columbia, Vancouver, BC, Canada.,International Collaboration on Repair Discoveries, Vancouver, BC, Canada.,Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | | | - Adam V Dvorak
- Department of Physics and Astronomy, University of British Columbia, Vancouver, BC, Canada.,International Collaboration on Repair Discoveries, Vancouver, BC, Canada
| | - Hanwen Liu
- Department of Physics and Astronomy, University of British Columbia, Vancouver, BC, Canada.,International Collaboration on Repair Discoveries, Vancouver, BC, Canada
| | - Youngjin Yoo
- Medical Imaging Technologies, Siemens Healthineers, Princeton, NJ
| | - Irene M Vavasour
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Silvia Mazabel
- Educational and Counseling Psychology, and Special Education, University of British Columbia, Vancouver, BC, Canada
| | | | - Shannon H Kolind
- Department of Physics and Astronomy, University of British Columbia, Vancouver, BC, Canada.,International Collaboration on Repair Discoveries, Vancouver, BC, Canada.,Department of Radiology, University of British Columbia, Vancouver, BC, Canada.,Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - David K B Li
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada.,Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Linda Siegel
- Educational and Counseling Psychology, and Special Education, University of British Columbia, Vancouver, BC, Canada
| | - Christian Beaulieu
- Department of Biomedical Engineering, University of Alberta, Edmonton, AB, Canada
| | - Alex L MacKay
- Department of Physics and Astronomy, University of British Columbia, Vancouver, BC, Canada.,Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Cornelia Laule
- Department of Physics and Astronomy, University of British Columbia, Vancouver, BC, Canada.,International Collaboration on Repair Discoveries, Vancouver, BC, Canada.,Department of Radiology, University of British Columbia, Vancouver, BC, Canada.,Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
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Liu H, Xiang QS, Tam R, Dvorak AV, MacKay AL, Kolind SH, Traboulsee A, Vavasour IM, Li DKB, Kramer JK, Laule C. Myelin water imaging data analysis in less than one minute. Neuroimage 2020; 210:116551. [PMID: 31978542 DOI: 10.1016/j.neuroimage.2020.116551] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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: 06/01/2019] [Revised: 12/21/2019] [Accepted: 01/14/2020] [Indexed: 12/11/2022] Open
Abstract
PURPOSE Based on a deep learning neural network (NN) algorithm, a super fast and easy to implement data analysis method was proposed for myelin water imaging (MWI) to calculate the myelin water fraction (MWF). METHODS A NN was constructed and trained on MWI data acquired by a 32-echo 3D gradient and spin echo (GRASE) sequence. Ground truth labels were created by regularized non-negative least squares (NNLS) with stimulated echo corrections. Voxel-wise GRASE data from 5 brains (4 healthy, 1 multiple sclerosis (MS)) were used for NN training. The trained NN was tested on 2 healthy brains, 1 MS brain with segmented lesions, 1 healthy spinal cord, and 1 healthy brain acquired from a different scanner. RESULTS Production of whole brain MWF maps in approximately 33 s can be achieved by a trained NN without graphics card acceleration. For all testing regions, no visual differences between NN and NNLS MWF maps were observed, and no obvious regional biases were found. Quantitatively, all voxels exhibited excellent agreement between NN and NNLS (all R2>0.98, p < 0.001, mean absolute error <0.01). CONCLUSION The time for accurate MWF calculation can be dramatically reduced to less than 1 min by the proposed NN, addressing one of the barriers facing future clinical feasibility of MWI.
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Affiliation(s)
- Hanwen Liu
- Physics & Astronomy, University of British Columbia, Canada; International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Canada
| | - Qing-San Xiang
- Physics & Astronomy, University of British Columbia, Canada; Radiology, University of British Columbia, Canada
| | - Roger Tam
- Radiology, University of British Columbia, Canada; Biomedical Engineering, University of British Columbia, Canada
| | - Adam V Dvorak
- Physics & Astronomy, University of British Columbia, Canada; International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Canada
| | - Alex L MacKay
- Physics & Astronomy, University of British Columbia, Canada; Radiology, University of British Columbia, Canada
| | - Shannon H Kolind
- Physics & Astronomy, University of British Columbia, Canada; International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Canada; Radiology, University of British Columbia, Canada; Medicine, University of British Columbia, Canada
| | | | - Irene M Vavasour
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Canada; Radiology, University of British Columbia, Canada
| | - David K B Li
- Radiology, University of British Columbia, Canada; Medicine, University of British Columbia, Canada
| | - John K Kramer
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Canada; Kinesiology, University of British Columbia, Canada
| | - Cornelia Laule
- Physics & Astronomy, University of British Columbia, Canada; International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Canada; Radiology, University of British Columbia, Canada; Pathology & Laboratory Medicine, University of British Columbia, Canada.
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23
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Barkhof F, Kappos L, Wolinsky JS, Li DKB, Bar-Or A, Hartung HP, Belachew S, Han J, Julian L, Sauter A, Napieralski J, Koendgen H, Hauser SL. Onset of clinical and MRI efficacy of ocrelizumab in relapsing multiple sclerosis. Neurology 2019; 93:e1778-e1786. [PMID: 31484710 PMCID: PMC6946481 DOI: 10.1212/wnl.0000000000008189] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [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: 11/05/2018] [Accepted: 05/30/2019] [Indexed: 01/21/2023] Open
Abstract
Objective To assess the onset of ocrelizumab efficacy on brain MRI measures of disease activity in the phase II study in relapsing-remitting multiple sclerosis (RRMS), and relapse rate in the pooled phase III studies in relapsing multiple sclerosis (RMS). Methods Brain MRI activity was determined in the phase II trial at monthly intervals in patients with RRMS receiving placebo, ocrelizumab (600 mg), or intramuscular interferon (IFN) β-1a (30 μg). Annualized relapse rate (ARR; over various epochs) and time to first relapse were analyzed in the pooled population of the phase III OPERA (A Study of Ocrelizumab in Comparison With Interferon Beta-1a [Rebif] in Participants With Relapsing Multiple Sclerosis) I and OPERA II trials in patients with RMS receiving ocrelizumab (600 mg) or subcutaneous IFN-β-1a (44 μg). Results In patients with RRMS, ocrelizumab reduced the number of new T1 gadolinium-enhancing lesions by week 4 vs placebo (p = 0.042) and by week 8 vs intramuscular IFN-β-1a (p < 0.001). Ocrelizumab also reduced the number of new or enlarging T2 lesions appearing between weeks 4 and 8 vs both placebo and IFN-β-1a (both p < 0.001). In patients with RMS, ocrelizumab significantly reduced ARR (p = 0.005) and the probability of time to first protocol-defined relapse (p = 0.014) vs subcutaneous IFN-β-1a within the first 8 weeks. Conclusion Epoch analysis of MRI-measured lesion activity in the phase II study and relapse rate in the phase III studies consistently revealed a rapid suppression of acute MRI and clinical disease activity following treatment initiation with ocrelizumab in patients with RRMS and RMS, respectively. Classification of evidence This study provides Class II evidence that for patients with RRMS and RMS, ocrelizumab suppressed MRI activity within 4 weeks and clinical disease activity within 8 weeks.
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Affiliation(s)
- Frederik Barkhof
- From the Department of Radiology and Nuclear Medicine (F.B.), VU University Medical Centre, Amsterdam, the Netherlands; UCL Institutes of Healthcare Engineering and Neurology (F.B.), London, UK; Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering (L.K.), University Hospital Basel, University of Basel, Switzerland; Department of Neurology (J.S.W.), McGovern Medical School, UTHealth, Houston, TX; Department of Radiology (D.K.B.L.), University of British Columbia, Vancouver, Canada; Department of Neurology and Center for Neuroinflammation and Experimental Therapeutics (A.B.-O.), University of Pennsylvania, Philadelphia; Department of Neurology, Medical Faculty (H.-P.H.), Heinrich-Heine University Düsseldorf, Germany; F. Hoffmann-La Roche Ltd. (S.B., A.S., J.N., H.K.), Basel, Switzerland; Genentech, Inc. (J.H., L.J.), South San Francisco; and Department of Neurology (S.L.H.), University of California, San Francisco. During completion of the work related to this article, S. Belachew was an employee of F. Hoffmann-La Roche Ltd.; his current affiliation is Biogen, Cambridge, MA.
| | - Ludwig Kappos
- From the Department of Radiology and Nuclear Medicine (F.B.), VU University Medical Centre, Amsterdam, the Netherlands; UCL Institutes of Healthcare Engineering and Neurology (F.B.), London, UK; Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering (L.K.), University Hospital Basel, University of Basel, Switzerland; Department of Neurology (J.S.W.), McGovern Medical School, UTHealth, Houston, TX; Department of Radiology (D.K.B.L.), University of British Columbia, Vancouver, Canada; Department of Neurology and Center for Neuroinflammation and Experimental Therapeutics (A.B.-O.), University of Pennsylvania, Philadelphia; Department of Neurology, Medical Faculty (H.-P.H.), Heinrich-Heine University Düsseldorf, Germany; F. Hoffmann-La Roche Ltd. (S.B., A.S., J.N., H.K.), Basel, Switzerland; Genentech, Inc. (J.H., L.J.), South San Francisco; and Department of Neurology (S.L.H.), University of California, San Francisco. During completion of the work related to this article, S. Belachew was an employee of F. Hoffmann-La Roche Ltd.; his current affiliation is Biogen, Cambridge, MA
| | - Jerry S Wolinsky
- From the Department of Radiology and Nuclear Medicine (F.B.), VU University Medical Centre, Amsterdam, the Netherlands; UCL Institutes of Healthcare Engineering and Neurology (F.B.), London, UK; Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering (L.K.), University Hospital Basel, University of Basel, Switzerland; Department of Neurology (J.S.W.), McGovern Medical School, UTHealth, Houston, TX; Department of Radiology (D.K.B.L.), University of British Columbia, Vancouver, Canada; Department of Neurology and Center for Neuroinflammation and Experimental Therapeutics (A.B.-O.), University of Pennsylvania, Philadelphia; Department of Neurology, Medical Faculty (H.-P.H.), Heinrich-Heine University Düsseldorf, Germany; F. Hoffmann-La Roche Ltd. (S.B., A.S., J.N., H.K.), Basel, Switzerland; Genentech, Inc. (J.H., L.J.), South San Francisco; and Department of Neurology (S.L.H.), University of California, San Francisco. During completion of the work related to this article, S. Belachew was an employee of F. Hoffmann-La Roche Ltd.; his current affiliation is Biogen, Cambridge, MA
| | - David K B Li
- From the Department of Radiology and Nuclear Medicine (F.B.), VU University Medical Centre, Amsterdam, the Netherlands; UCL Institutes of Healthcare Engineering and Neurology (F.B.), London, UK; Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering (L.K.), University Hospital Basel, University of Basel, Switzerland; Department of Neurology (J.S.W.), McGovern Medical School, UTHealth, Houston, TX; Department of Radiology (D.K.B.L.), University of British Columbia, Vancouver, Canada; Department of Neurology and Center for Neuroinflammation and Experimental Therapeutics (A.B.-O.), University of Pennsylvania, Philadelphia; Department of Neurology, Medical Faculty (H.-P.H.), Heinrich-Heine University Düsseldorf, Germany; F. Hoffmann-La Roche Ltd. (S.B., A.S., J.N., H.K.), Basel, Switzerland; Genentech, Inc. (J.H., L.J.), South San Francisco; and Department of Neurology (S.L.H.), University of California, San Francisco. During completion of the work related to this article, S. Belachew was an employee of F. Hoffmann-La Roche Ltd.; his current affiliation is Biogen, Cambridge, MA
| | - Amit Bar-Or
- From the Department of Radiology and Nuclear Medicine (F.B.), VU University Medical Centre, Amsterdam, the Netherlands; UCL Institutes of Healthcare Engineering and Neurology (F.B.), London, UK; Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering (L.K.), University Hospital Basel, University of Basel, Switzerland; Department of Neurology (J.S.W.), McGovern Medical School, UTHealth, Houston, TX; Department of Radiology (D.K.B.L.), University of British Columbia, Vancouver, Canada; Department of Neurology and Center for Neuroinflammation and Experimental Therapeutics (A.B.-O.), University of Pennsylvania, Philadelphia; Department of Neurology, Medical Faculty (H.-P.H.), Heinrich-Heine University Düsseldorf, Germany; F. Hoffmann-La Roche Ltd. (S.B., A.S., J.N., H.K.), Basel, Switzerland; Genentech, Inc. (J.H., L.J.), South San Francisco; and Department of Neurology (S.L.H.), University of California, San Francisco. During completion of the work related to this article, S. Belachew was an employee of F. Hoffmann-La Roche Ltd.; his current affiliation is Biogen, Cambridge, MA
| | - Hans-Peter Hartung
- From the Department of Radiology and Nuclear Medicine (F.B.), VU University Medical Centre, Amsterdam, the Netherlands; UCL Institutes of Healthcare Engineering and Neurology (F.B.), London, UK; Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering (L.K.), University Hospital Basel, University of Basel, Switzerland; Department of Neurology (J.S.W.), McGovern Medical School, UTHealth, Houston, TX; Department of Radiology (D.K.B.L.), University of British Columbia, Vancouver, Canada; Department of Neurology and Center for Neuroinflammation and Experimental Therapeutics (A.B.-O.), University of Pennsylvania, Philadelphia; Department of Neurology, Medical Faculty (H.-P.H.), Heinrich-Heine University Düsseldorf, Germany; F. Hoffmann-La Roche Ltd. (S.B., A.S., J.N., H.K.), Basel, Switzerland; Genentech, Inc. (J.H., L.J.), South San Francisco; and Department of Neurology (S.L.H.), University of California, San Francisco. During completion of the work related to this article, S. Belachew was an employee of F. Hoffmann-La Roche Ltd.; his current affiliation is Biogen, Cambridge, MA
| | - Shibeshih Belachew
- From the Department of Radiology and Nuclear Medicine (F.B.), VU University Medical Centre, Amsterdam, the Netherlands; UCL Institutes of Healthcare Engineering and Neurology (F.B.), London, UK; Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering (L.K.), University Hospital Basel, University of Basel, Switzerland; Department of Neurology (J.S.W.), McGovern Medical School, UTHealth, Houston, TX; Department of Radiology (D.K.B.L.), University of British Columbia, Vancouver, Canada; Department of Neurology and Center for Neuroinflammation and Experimental Therapeutics (A.B.-O.), University of Pennsylvania, Philadelphia; Department of Neurology, Medical Faculty (H.-P.H.), Heinrich-Heine University Düsseldorf, Germany; F. Hoffmann-La Roche Ltd. (S.B., A.S., J.N., H.K.), Basel, Switzerland; Genentech, Inc. (J.H., L.J.), South San Francisco; and Department of Neurology (S.L.H.), University of California, San Francisco. During completion of the work related to this article, S. Belachew was an employee of F. Hoffmann-La Roche Ltd.; his current affiliation is Biogen, Cambridge, MA
| | - Jian Han
- From the Department of Radiology and Nuclear Medicine (F.B.), VU University Medical Centre, Amsterdam, the Netherlands; UCL Institutes of Healthcare Engineering and Neurology (F.B.), London, UK; Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering (L.K.), University Hospital Basel, University of Basel, Switzerland; Department of Neurology (J.S.W.), McGovern Medical School, UTHealth, Houston, TX; Department of Radiology (D.K.B.L.), University of British Columbia, Vancouver, Canada; Department of Neurology and Center for Neuroinflammation and Experimental Therapeutics (A.B.-O.), University of Pennsylvania, Philadelphia; Department of Neurology, Medical Faculty (H.-P.H.), Heinrich-Heine University Düsseldorf, Germany; F. Hoffmann-La Roche Ltd. (S.B., A.S., J.N., H.K.), Basel, Switzerland; Genentech, Inc. (J.H., L.J.), South San Francisco; and Department of Neurology (S.L.H.), University of California, San Francisco. During completion of the work related to this article, S. Belachew was an employee of F. Hoffmann-La Roche Ltd.; his current affiliation is Biogen, Cambridge, MA
| | - Laura Julian
- From the Department of Radiology and Nuclear Medicine (F.B.), VU University Medical Centre, Amsterdam, the Netherlands; UCL Institutes of Healthcare Engineering and Neurology (F.B.), London, UK; Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering (L.K.), University Hospital Basel, University of Basel, Switzerland; Department of Neurology (J.S.W.), McGovern Medical School, UTHealth, Houston, TX; Department of Radiology (D.K.B.L.), University of British Columbia, Vancouver, Canada; Department of Neurology and Center for Neuroinflammation and Experimental Therapeutics (A.B.-O.), University of Pennsylvania, Philadelphia; Department of Neurology, Medical Faculty (H.-P.H.), Heinrich-Heine University Düsseldorf, Germany; F. Hoffmann-La Roche Ltd. (S.B., A.S., J.N., H.K.), Basel, Switzerland; Genentech, Inc. (J.H., L.J.), South San Francisco; and Department of Neurology (S.L.H.), University of California, San Francisco. During completion of the work related to this article, S. Belachew was an employee of F. Hoffmann-La Roche Ltd.; his current affiliation is Biogen, Cambridge, MA
| | - Annette Sauter
- From the Department of Radiology and Nuclear Medicine (F.B.), VU University Medical Centre, Amsterdam, the Netherlands; UCL Institutes of Healthcare Engineering and Neurology (F.B.), London, UK; Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering (L.K.), University Hospital Basel, University of Basel, Switzerland; Department of Neurology (J.S.W.), McGovern Medical School, UTHealth, Houston, TX; Department of Radiology (D.K.B.L.), University of British Columbia, Vancouver, Canada; Department of Neurology and Center for Neuroinflammation and Experimental Therapeutics (A.B.-O.), University of Pennsylvania, Philadelphia; Department of Neurology, Medical Faculty (H.-P.H.), Heinrich-Heine University Düsseldorf, Germany; F. Hoffmann-La Roche Ltd. (S.B., A.S., J.N., H.K.), Basel, Switzerland; Genentech, Inc. (J.H., L.J.), South San Francisco; and Department of Neurology (S.L.H.), University of California, San Francisco. During completion of the work related to this article, S. Belachew was an employee of F. Hoffmann-La Roche Ltd.; his current affiliation is Biogen, Cambridge, MA
| | - Julie Napieralski
- From the Department of Radiology and Nuclear Medicine (F.B.), VU University Medical Centre, Amsterdam, the Netherlands; UCL Institutes of Healthcare Engineering and Neurology (F.B.), London, UK; Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering (L.K.), University Hospital Basel, University of Basel, Switzerland; Department of Neurology (J.S.W.), McGovern Medical School, UTHealth, Houston, TX; Department of Radiology (D.K.B.L.), University of British Columbia, Vancouver, Canada; Department of Neurology and Center for Neuroinflammation and Experimental Therapeutics (A.B.-O.), University of Pennsylvania, Philadelphia; Department of Neurology, Medical Faculty (H.-P.H.), Heinrich-Heine University Düsseldorf, Germany; F. Hoffmann-La Roche Ltd. (S.B., A.S., J.N., H.K.), Basel, Switzerland; Genentech, Inc. (J.H., L.J.), South San Francisco; and Department of Neurology (S.L.H.), University of California, San Francisco. During completion of the work related to this article, S. Belachew was an employee of F. Hoffmann-La Roche Ltd.; his current affiliation is Biogen, Cambridge, MA
| | - Harold Koendgen
- From the Department of Radiology and Nuclear Medicine (F.B.), VU University Medical Centre, Amsterdam, the Netherlands; UCL Institutes of Healthcare Engineering and Neurology (F.B.), London, UK; Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering (L.K.), University Hospital Basel, University of Basel, Switzerland; Department of Neurology (J.S.W.), McGovern Medical School, UTHealth, Houston, TX; Department of Radiology (D.K.B.L.), University of British Columbia, Vancouver, Canada; Department of Neurology and Center for Neuroinflammation and Experimental Therapeutics (A.B.-O.), University of Pennsylvania, Philadelphia; Department of Neurology, Medical Faculty (H.-P.H.), Heinrich-Heine University Düsseldorf, Germany; F. Hoffmann-La Roche Ltd. (S.B., A.S., J.N., H.K.), Basel, Switzerland; Genentech, Inc. (J.H., L.J.), South San Francisco; and Department of Neurology (S.L.H.), University of California, San Francisco. During completion of the work related to this article, S. Belachew was an employee of F. Hoffmann-La Roche Ltd.; his current affiliation is Biogen, Cambridge, MA
| | - Stephen L Hauser
- From the Department of Radiology and Nuclear Medicine (F.B.), VU University Medical Centre, Amsterdam, the Netherlands; UCL Institutes of Healthcare Engineering and Neurology (F.B.), London, UK; Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering (L.K.), University Hospital Basel, University of Basel, Switzerland; Department of Neurology (J.S.W.), McGovern Medical School, UTHealth, Houston, TX; Department of Radiology (D.K.B.L.), University of British Columbia, Vancouver, Canada; Department of Neurology and Center for Neuroinflammation and Experimental Therapeutics (A.B.-O.), University of Pennsylvania, Philadelphia; Department of Neurology, Medical Faculty (H.-P.H.), Heinrich-Heine University Düsseldorf, Germany; F. Hoffmann-La Roche Ltd. (S.B., A.S., J.N., H.K.), Basel, Switzerland; Genentech, Inc. (J.H., L.J.), South San Francisco; and Department of Neurology (S.L.H.), University of California, San Francisco. During completion of the work related to this article, S. Belachew was an employee of F. Hoffmann-La Roche Ltd.; his current affiliation is Biogen, Cambridge, MA
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Liu H, Ljungberg E, Dvorak AV, Lee LE, Yik JT, MacMillan EL, Barlow L, Li DKB, Traboulsee A, Kolind SH, Kramer JLK, Laule C. Myelin Water Fraction and Intra/Extracellular Water Geometric Mean T 2 Normative Atlases for the Cervical Spinal Cord from 3T MRI. J Neuroimaging 2019; 30:50-57. [PMID: 31407400 DOI: 10.1111/jon.12659] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 05/30/2019] [Revised: 07/19/2019] [Accepted: 07/23/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND AND PURPOSE Acquiring and interpreting quantitative myelin-specific MRI data at an individual level is challenging because of technical difficulties and natural myelin variation in the population. To overcome these challenges, we used multiecho T2 myelin water imaging (MWI) to create T2 metric healthy population atlases that depict the mean and variation of myelin water fraction (MWF), and intra- and extracellular water mobility as described by geometric mean T2 (IEGMT2 ). METHODS Cervical cord MWI was performed at 3T on 20 healthy individuals (10M/10F, mean age: 36 years) and 3 relapsing remitting multiple sclerosis (RRMS) participants (1M/2F, age: 39/42/37 years). Anatomical data were collected for the purpose of image segmentation and registration. Atlases were created by coregistering and averaging T2 metrics from all controls. Voxel-wise z-score maps from 3 RRMS participants were produced to demonstrate the preliminary utility of the MWF and IEGMT2 atlases. RESULTS The average MWF atlas provides a representation of myelin in the spinal cord consistent with well-known spinal cord anatomical characteristics. The IEGMT2 atlas also depicted structural variations in the spinal cord. Z-score analysis illustrated distinct abnormalities in MWF and IEGMT2 in the 3 RRMS cases. CONCLUSIONS Our findings highlight the potential for using a quantitative T2 relaxation metric atlas to visualize and detect pathology in spinal cord. Our MWF and IEGMT2 atlases (URL: https://sourceforge.net/projects/mwi-spinal-cord-atlases/) can serve as normative references in the cervical spinal cord for other studies.
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Affiliation(s)
- Hanwen Liu
- Department of Physics & Astronomy, University of British Columbia, Vancouver, Canada.,International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, Canada
| | - Emil Ljungberg
- Department of Neuroimaging, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Adam V Dvorak
- Department of Physics & Astronomy, University of British Columbia, Vancouver, Canada.,International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, Canada
| | - Lisa Eunyoung Lee
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Jackie T Yik
- Department of Physics & Astronomy, University of British Columbia, Vancouver, Canada.,International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, Canada
| | - Erin L MacMillan
- Philips, Markham, Canada.,School of Mechatronic Systems Engineering, Simon Fraser University, Canada.,Department of Radiology, University of British Columbia, Vancouver, Canada
| | | | - David K B Li
- Department of Medicine, University of British Columbia, Vancouver, Canada.,Department of Radiology, University of British Columbia, Vancouver, Canada
| | - Anthony Traboulsee
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Shannon H Kolind
- Department of Physics & Astronomy, University of British Columbia, Vancouver, Canada.,International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, Canada.,Department of Medicine, University of British Columbia, Vancouver, Canada.,Department of Radiology, University of British Columbia, Vancouver, Canada
| | - John L K Kramer
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, Canada.,School of Kinesiology, University of British Columbia, Vancouver, Canada
| | - Cornelia Laule
- Department of Physics & Astronomy, University of British Columbia, Vancouver, Canada.,International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, Canada.,Department of Radiology, University of British Columbia, Vancouver, Canada.,Pathology & Laboratory Medicine, University of British Columbia, Vancouver, Canada
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25
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Liu H, Rubino C, Dvorak AV, Jarrett M, Ljungberg E, Vavasour IM, Lee LE, Kolind SH, MacMillan EL, Traboulsee A, Lang DJ, Rauscher A, Li DKB, MacKay AL, Boyd LA, Kramer JLK, Laule C. Myelin Water Atlas: A Template for Myelin Distribution in the Brain. J Neuroimaging 2019; 29:699-706. [PMID: 31347238 DOI: 10.1111/jon.12657] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [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: 04/07/2019] [Revised: 06/28/2019] [Accepted: 07/06/2019] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND AND PURPOSE Myelin water imaging (MWI) is a magnetic resonance imaging technique that quantifies myelin in-vivo. Although MWI has been extensively applied to study myelin-related diseases in groups, clinical use in individual patients is challenging mainly due to population heterogeneity. The purpose of this study was twofold: (1) create a normative brain myelin water atlas depicting the population mean and regional variability of myelin content; and (2) apply the myelin atlas to assess the degree of demyelination in individuals with multiple sclerosis (MS). METHODS 3T MWI was performed on 50 healthy adults (25 M/25 F, mean age 25 years [range 17-42 years]). The myelin water atlas was created by averaging coregistered myelin water fraction (MWF) maps from all healthy individuals. To illustrate the preliminary utility of the atlas, white matter (WM) regional MWF variations were evaluated and voxel-wise z-score maps (z < -1.96) from the MWI of three MS participants were produced to assess individually the degree of demyelination. RESULTS The myelin water atlas demonstrated significant MWF variation across control WM. No significant MWF differences were found between male and female healthy participants. MS z-score maps revealed diffuse regions of demyelination in the two participants with Expanded Disability Status Scale (EDSS) = 2.0 but not in the participant with EDSS = 0. CONCLUSIONS The myelin water atlas can be used as a reference (URL: https://sourceforge.net/projects/myelin-water-atlas/) to demonstrate areas of demyelination in individual MS participants. Future studies will expand the atlas age range, account for education, and other variables that may affect myelination.
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Affiliation(s)
- Hanwen Liu
- Department of Physics and Astronomy, University of British Columbia, Vancouver, British Columbia, Canada.,International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, British Columbia, Canada
| | - Cristina Rubino
- Rehabilitation Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Adam V Dvorak
- Department of Physics and Astronomy, University of British Columbia, Vancouver, British Columbia, Canada.,International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, British Columbia, Canada
| | - Michael Jarrett
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada.,UBC MRI Research Centre, University of British Columbia, Vancouver, British Columbia, Canada
| | - Emil Ljungberg
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Irene M Vavasour
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lisa Eunyoung Lee
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Shannon H Kolind
- Department of Physics and Astronomy, University of British Columbia, Vancouver, British Columbia, Canada.,International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Erin L MacMillan
- UBC MRI Research Centre, University of British Columbia, Vancouver, British Columbia, Canada.,MR Clinical Science, Philips Healthcare Canada, Markham, Ontario, Canada.,ImageTech Lab, Simon Fraser University, Surrey, British Columbia, Canada
| | - Anthony Traboulsee
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Donna J Lang
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alexander Rauscher
- Department of Physics and Astronomy, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada.,UBC MRI Research Centre, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - David K B Li
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alexander L MacKay
- Department of Physics and Astronomy, University of British Columbia, Vancouver, British Columbia, Canada.,UBC MRI Research Centre, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lara A Boyd
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - John L K Kramer
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Cornelia Laule
- Department of Physics and Astronomy, University of British Columbia, Vancouver, British Columbia, Canada.,International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Pathology & Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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Le M, Tang LYW, Hernández-Torres E, Jarrett M, Brosch T, Metz L, Li DKB, Traboulsee A, Tam RC, Rauscher A, Wiggermann V. FLAIR 2 improves LesionTOADS automatic segmentation of multiple sclerosis lesions in non-homogenized, multi-center, 2D clinical magnetic resonance images. Neuroimage Clin 2019; 23:101918. [PMID: 31491827 PMCID: PMC6646743 DOI: 10.1016/j.nicl.2019.101918] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 06/18/2019] [Accepted: 06/30/2019] [Indexed: 11/05/2022]
Abstract
Background Accurate segmentation of MS lesions on MRI is difficult and, if performed manually, time consuming. Automatic segmentations rely strongly on the image contrast and signal-to-noise ratio. Literature examining segmentation tool performances in real-world multi-site data acquisition settings is scarce. Objective FLAIR2, a combination of T2-weighted and fluid attenuated inversion recovery (FLAIR) images, improves tissue contrast while suppressing CSF. We compared the use of FLAIR and FLAIR2 in LesionTOADS, OASIS and the lesion segmentation toolbox (LST) when applied to non-homogenized, multi-center 2D-imaging data. Methods Lesions were segmented on 47 MS patient data sets obtained from 34 sites using LesionTOADS, OASIS and LST, and compared to a semi-automatically generated reference. The performance of FLAIR and FLAIR2 was assessed using the relative lesion volume difference (LVD), Dice coefficient (DSC), sensitivity (SEN) and symmetric surface distance (SSD). Performance improvements related to lesion volumes (LVs) were evaluated for all tools. For comparison, LesionTOADS was also used to segment lesions from 3 T single-center MR data of 40 clinically isolated syndrome (CIS) patients. Results Compared to FLAIR, the use of FLAIR2 in LesionTOADS led to improvements of 31.6% (LVD), 14.0% (DSC), 25.1% (SEN), and 47.0% (SSD) in the multi-center study. DSC and SSD significantly improved for larger LVs, while LVD and SEN were enhanced independent of LV. OASIS showed little difference between FLAIR and FLAIR2, likely due to its inherent use of T2w and FLAIR. LST replicated the benefits of FLAIR2 only in part, indicating that further optimization, particularly at low LVs is needed. In the CIS study, LesionTOADS did not benefit from the use of FLAIR2 as the segmentation performance for both FLAIR and FLAIR2 was heterogeneous. Conclusions In this real-world, multi-center experiment, FLAIR2 outperformed FLAIR in its ability to segment MS lesions with LesionTOADS. The computation of FLAIR2 enhanced lesion detection, at minimally increased computational time or cost, even retrospectively. Further work is needed to determine how LesionTOADS and other tools, such as LST, can optimally benefit from the improved FLAIR2 contrast. FLAIR2 improves automatic MS lesion segmentation with LesionTOADS compared to FLAIR. Segmentation similarity improves for higher lesion volumes, particularly for FLAIR2. FLAIR2 provides greater sensitivity independent of lesion volume than FLAIR alone. Other segmentation tools need further optimization to fully benefit from FLAIR2. FLAIR2 provides immediate benefits at 1.5 T and visually improves segmentation at 3 T.
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Affiliation(s)
- M Le
- MS/MRI Research Group (Division of Neurology), University of British Columbia, Vancouver, BC, Canada
| | - L Y W Tang
- MS/MRI Research Group (Division of Neurology), University of British Columbia, Vancouver, BC, Canada; Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - E Hernández-Torres
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada; UBC MRI Research Centre, University of British Columbia, Vancouver, BC, Canada; Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - M Jarrett
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada; Population Data BC, Vancouver, BC, Canada
| | - T Brosch
- MS/MRI Research Group (Division of Neurology), University of British Columbia, Vancouver, BC, Canada; Department of Electrical and Computer Engineering, University of British Columbia, Vancouver, BC, Canada; Philips Medical Innovative Technologies, Hamburg, Germany
| | - L Metz
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - D K B Li
- MS/MRI Research Group (Division of Neurology), University of British Columbia, Vancouver, BC, Canada; Department of Radiology, University of British Columbia, Vancouver, BC, Canada; UBC MRI Research Centre, University of British Columbia, Vancouver, BC, Canada
| | - A Traboulsee
- Department of Neurology (Division of Medicine), University of British Columbia, Vancouver, BC, Canada
| | - R C Tam
- MS/MRI Research Group (Division of Neurology), University of British Columbia, Vancouver, BC, Canada; Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - A Rauscher
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada; BC Children's Hospital Research Institute, Canada; Department of Physics and Astronomy, University of British Columbia, Vancouver, BC, Canada
| | - V Wiggermann
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada; UBC MRI Research Centre, University of British Columbia, Vancouver, BC, Canada; Department of Physics and Astronomy, University of British Columbia, Vancouver, BC, Canada.
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Baumeister TR, Lin SJ, Vavasour I, Kolind S, Kosaka B, Li DKB, Traboulsee A, MacKay A, McKeown MJ. Data fusion detects consistent relations between non-lesional white matter myelin, executive function, and clinical characteristics in multiple sclerosis. Neuroimage Clin 2019; 24:101926. [PMID: 31412310 PMCID: PMC6704047 DOI: 10.1016/j.nicl.2019.101926] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 11/23/2018] [Revised: 05/29/2019] [Accepted: 06/30/2019] [Indexed: 01/11/2023]
Abstract
We examined the influence of dysfunctional, non-lesional white matter on cognitive performance in multiple sclerosis (MS). Forty-six MS subjects were assessed using MRI-based myelin water imaging (MWI), and average myelin water fraction (MWF) values across 20 white matter regions of interest (ROIs) were determined. A data-fusion method, multiset canonical correlation analysis (MCCA), was used to investigate the multivariate, deterministic joint relations between MWF, executive function, and demographic and clinical characteristics. MCCA revealed one significant component (p = 0.009) which consisted of three linked profiles, with a pairwise correlation between the MWF and cognitive profiles of r = 0.37, a correlation between MWF and demographics profiles of r = 0.31, and between cognitive and demographics profiles r = 0.64. White matter ROIs representing long-range intra-hemispheric tracts and ROIs connecting the two hemispheres were positively related through their individual profiles to overall cognitive performance, education and female gender, while age, EDSS, and disease duration were related negatively. Surprisingly, lesions within the ROIs had a negligible effect on overall relations between imaging, cognitive, and demographic variables. These findings indicate that there is a strong association between a pattern of MWF values and cognitive performance in MS, which is modulated by age, education, and disease severity. Moreover, this consistent relation involves multiple white matter regions and is separate from the influence of lesions. White matter myelination, cognitive performance, and demographic and clinical variables are all consistently linked in MS. Multivariate approach links imaging, cognitive, and clinical features in joint analysis. Education promotes cognitive performance and myelin content. Age and disease severity are negatively associated with myelination and cognitive performance. Demyelination in lesions had minimal impact on overall relation between imaging, cognitive, and demographic characteristic.
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Affiliation(s)
- Tobias R Baumeister
- School of Biomedical Engineering, The University of British Columbia, Canada
| | - Sue-Jin Lin
- Graduate Program in Neuroscience, The University of British Columbia, Canada
| | - Irene Vavasour
- Department of Radiology, The University of British Columbia, Canada
| | - Shannon Kolind
- Department of Radiology, The University of British Columbia, Canada; Faculty of Medicine, Division of Neurology, The University of British Columbia, Canada; Department of Physics and Astronomy, The University of British Columbia, Canada
| | - Brenda Kosaka
- Department of Psychiatry, The University of British Columbia, Canada
| | - David K B Li
- Department of Radiology, The University of British Columbia, Canada
| | - Anthony Traboulsee
- Department of Radiology, The University of British Columbia, Canada; Faculty of Medicine, Division of Neurology, The University of British Columbia, Canada
| | - Alex MacKay
- Department of Radiology, The University of British Columbia, Canada; Department of Physics and Astronomy, The University of British Columbia, Canada
| | - Martin J McKeown
- Faculty of Medicine, Division of Neurology, The University of British Columbia, Canada.
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Dvorak AV, Ljungberg E, Vavasour IM, Liu H, Johnson P, Rauscher A, Kramer JLK, Tam R, Li DKB, Laule C, Barlow L, Briemberg H, MacKay AL, Traboulsee A, Kozlowski P, Cashman N, Kolind SH. Rapid myelin water imaging for the assessment of cervical spinal cord myelin damage. Neuroimage Clin 2019; 23:101896. [PMID: 31276928 PMCID: PMC6611998 DOI: 10.1016/j.nicl.2019.101896] [Citation(s) in RCA: 15] [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] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 06/08/2019] [Accepted: 06/11/2019] [Indexed: 12/13/2022]
Abstract
Background Rapid myelin water imaging (MWI) using a combined gradient and spin echo (GRASE) sequence can produce myelin specific metrics for the human brain. Spinal cord MWI could be similarly useful, but technical challenges have hindered routine application. GRASE rapid MWI was recently successfully implemented for imaging of healthy cervical spinal cord and may complement other advanced imaging methods, such as diffusion tensor imaging (DTI) and quantitative T1 (qT1). Objective To demonstrate the feasibility of cervical cord GRASE rapid MWI in multiple sclerosis (MS), primary lateral sclerosis (PLS) and neuromyelitis optica spectrum disorder (NMO), with comparison to DTI and qT1 metrics. Methods GRASE MWI, DTI and qT1 data were acquired in 2 PLS, 1 relapsing-remitting MS (RRMS), 1 primary-progressive MS (PPMS) and 2 NMO subjects, as well as 6 age (±3 yrs) and sex matched healthy controls (HC). Internal cord structure guided template registrations, used for region of interest (ROI) analysis. Z score maps were calculated for the difference between disease subject and mean HC metric values. Results PLS subjects had low myelin water fraction (MWF) in the lateral funiculi compared to HC. RRMS subject MWF was heterogeneous within the cord. The PPMS subject showed no trends in ROI results but had a region of low MWF Z score corresponding to a focal lesion. The NMO subject with a longitudinally extensive transverse myelitis lesion had low values for whole cord mean MWF of 12.8% compared to 24.3% (standard deviation 2.2%) for HC. The NMO subject without lesions also had low MWF compared to HC. DTI and qT1 metrics showed similar trends, corroborating the MWF results and providing complementary information. Conclusion GRASE is sufficiently sensitive to detect decreased myelin within MS spinal cord plaques, NMO lesions, and PLS diffuse spinal cord injury. Decreased MWF in PLS is consistent with demyelination secondary to motor neuron degeneration. GRASE MWI is a feasible method for rapid assessment of myelin content in the cervical spinal cord and provides complementary information to that of DTI and qT1 measures. Downstream myelin changes in motor tracts of primary lateral sclerosis spinal cord. Low myelin water fraction in multiple sclerosis and neuromyelitis optica cord lesions. Diffuse demyelination evidence in neuromyelitis optica normal-appearing white matter. Myelin water imaging provides complementary information to diffusion and T1 metrics.
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Affiliation(s)
- Adam V Dvorak
- Physics and Astronomy, University of British Columbia, 6224 Agricultural Road, Vancouver, BC V6T 1Z1, Canada; International Collaboration on Repair Discoveries, University of British Columbia, 818 West 10th Avenue, Vancouver, BC V5Z 1M9, Canada.
| | - Emil Ljungberg
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park PO89, London SE5 8AF, United Kingdom
| | - Irene M Vavasour
- Radiology, University of British Columbia, 2775 Laurel Street, Vancouver, BC V5Z 1M9, Canada
| | - Hanwen Liu
- Physics and Astronomy, University of British Columbia, 6224 Agricultural Road, Vancouver, BC V6T 1Z1, Canada; International Collaboration on Repair Discoveries, University of British Columbia, 818 West 10th Avenue, Vancouver, BC V5Z 1M9, Canada
| | - Poljanka Johnson
- Physics and Astronomy, University of British Columbia, 6224 Agricultural Road, Vancouver, BC V6T 1Z1, Canada
| | - Alexander Rauscher
- Physics and Astronomy, University of British Columbia, 6224 Agricultural Road, Vancouver, BC V6T 1Z1, Canada; Radiology, University of British Columbia, 2775 Laurel Street, Vancouver, BC V5Z 1M9, Canada; Pediatrics, University of British Columbia, 4480 Oak Street BC Children's Hospital Vancouver, BC V6H 3V4, Canada; UBC MRI Research Centre, University of British Columbia, 2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada
| | - John L K Kramer
- International Collaboration on Repair Discoveries, University of British Columbia, 818 West 10th Avenue, Vancouver, BC V5Z 1M9, Canada; School of Kinesiology, University of British Columbia, 210-6081 University Boulevard, Vancouver, BC V6T 1Z1, Canada
| | - Roger Tam
- Radiology, University of British Columbia, 2775 Laurel Street, Vancouver, BC V5Z 1M9, Canada; School of Biomedical Engineering, University of British Columbia, 2222 Health Sciences Mall, Vancouver, BC V6T 1Z3, Canada
| | - David K B Li
- Radiology, University of British Columbia, 2775 Laurel Street, Vancouver, BC V5Z 1M9, Canada; Medicine (Neurology), University of British Columbia, 2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada; UBC MRI Research Centre, University of British Columbia, 2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada
| | - Cornelia Laule
- Physics and Astronomy, University of British Columbia, 6224 Agricultural Road, Vancouver, BC V6T 1Z1, Canada; Radiology, University of British Columbia, 2775 Laurel Street, Vancouver, BC V5Z 1M9, Canada; International Collaboration on Repair Discoveries, University of British Columbia, 818 West 10th Avenue, Vancouver, BC V5Z 1M9, Canada; Pathology & Laboratory Medicine, University of British Columbia, 2211 Wesbrook Mall, Vancouver, BC V6T 2B5, Canada
| | - Laura Barlow
- Radiology, University of British Columbia, 2775 Laurel Street, Vancouver, BC V5Z 1M9, Canada; UBC MRI Research Centre, University of British Columbia, 2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada
| | - Hannah Briemberg
- Medicine (Neurology), University of British Columbia, 2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada
| | - Alex L MacKay
- Physics and Astronomy, University of British Columbia, 6224 Agricultural Road, Vancouver, BC V6T 1Z1, Canada; Radiology, University of British Columbia, 2775 Laurel Street, Vancouver, BC V5Z 1M9, Canada
| | - Anthony Traboulsee
- Medicine (Neurology), University of British Columbia, 2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada
| | - Piotr Kozlowski
- Physics and Astronomy, University of British Columbia, 6224 Agricultural Road, Vancouver, BC V6T 1Z1, Canada; Radiology, University of British Columbia, 2775 Laurel Street, Vancouver, BC V5Z 1M9, Canada; International Collaboration on Repair Discoveries, University of British Columbia, 818 West 10th Avenue, Vancouver, BC V5Z 1M9, Canada; UBC MRI Research Centre, University of British Columbia, 2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada
| | - Neil Cashman
- Medicine (Neurology), University of British Columbia, 2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada
| | - Shannon H Kolind
- Physics and Astronomy, University of British Columbia, 6224 Agricultural Road, Vancouver, BC V6T 1Z1, Canada; Radiology, University of British Columbia, 2775 Laurel Street, Vancouver, BC V5Z 1M9, Canada; International Collaboration on Repair Discoveries, University of British Columbia, 818 West 10th Avenue, Vancouver, BC V5Z 1M9, Canada; Medicine (Neurology), University of British Columbia, 2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada
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Graf C, MacMillan EL, Fu E, Harris T, Traboulsee A, Vavasour IM, MacKay AL, Mädler B, Li DKB, Laule C. Intra- and inter-site reproducibility of human brain single-voxel proton MRS at 3 T. NMR Biomed 2019; 32:e4083. [PMID: 30889311 DOI: 10.1002/nbm.4083] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 01/24/2019] [Accepted: 01/28/2019] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Clinical trials that involve participants from multiple sites necessitate standardized and reliable quantitative MRI outcomes to detect significant group differences over time. Metabolite concentrations measured by proton MRS (1 H-MRS) provide valuable information about in vivo metabolism of the central nervous system, but can vary based on the acquisition and quantitation methods used by different MR sites. Therefore, we investigated the intra- and inter-site reproducibility of metabolite concentrations measured by 1 H-MRS on MRI scanners from a single manufacturer across six sites. METHODS Five healthy controls were scanned twice within 24 h at six participating 3 T MR sites with large single-voxel PRESS (TE/TR/NSA = 36 ms/4000 ms/56) and anatomical images for voxel positioning and correction of partial volume relaxation. Absolute metabolite concentrations were calculated relative to the T1 and T2 relaxation corrected signal from water. Intra- and inter-site reproducibility was assessed using Bland-Altman plots and intra- and inter-site coefficient of variation (CoV) as well as intra- and inter-site intra-class correlation coefficient. RESULTS The median intra-site CoVs for the five major metabolite concentrations ([NAA], [tCr], [Glu], [tCho] and [Ins]) were between 2.5 and 5.3%. Inter-site CoVs were also low, with the median CoVs for all metabolites between 3.7 and 6.4%. Metabolite concentrations were robust to small inconsistencies in voxel placement and site was not the driving factor in the variance of the measurement of any metabolite concentration. Between-subject differences accounted for the majority of the concentration variability for creatine, choline and myo-inositol (42-65% of the variance). CONCLUSION A large single-voxel 1 H-MRS acquisition from a single manufacturer's MRI scanner is highly reproducible and reliable for multi-site clinical trials.
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Affiliation(s)
- Carina Graf
- Physics & Astronomy, University of British Columbia, Vancouver, British Columbia, Canada
- International Collaboration on Repair Discoveries (ICORD), Vancouver, British Columbia, Canada
| | - Erin L MacMillan
- MR Clinical Science, Philips Canada, Markham, Ontario, Canada
- UBC MRI Research Centre, University of British Columbia, Vancouver, British Columbia, Canada
- ImageTech Lab, Simon Fraser University, Surrey, British Columbia, Canada
| | - Eric Fu
- Statistics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Trudy Harris
- UBC MRI Research Centre, University of British Columbia, Vancouver, British Columbia, Canada
- Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Anthony Traboulsee
- Medicine (Neurology), University of British Columbia, Vancouver, British Columbia, Canada
| | - Irene M Vavasour
- UBC MRI Research Centre, University of British Columbia, Vancouver, British Columbia, Canada
- Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alex L MacKay
- Physics & Astronomy, University of British Columbia, Vancouver, British Columbia, Canada
- UBC MRI Research Centre, University of British Columbia, Vancouver, British Columbia, Canada
- Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - David K B Li
- UBC MRI Research Centre, University of British Columbia, Vancouver, British Columbia, Canada
- Radiology, University of British Columbia, Vancouver, British Columbia, Canada
- Medicine (Neurology), University of British Columbia, Vancouver, British Columbia, Canada
| | - Cornelia Laule
- Physics & Astronomy, University of British Columbia, Vancouver, British Columbia, Canada
- International Collaboration on Repair Discoveries (ICORD), Vancouver, British Columbia, Canada
- Radiology, University of British Columbia, Vancouver, British Columbia, Canada
- Pathology & Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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Oh J, Ontaneda D, Azevedo C, Klawiter EC, Absinta M, Arnold DL, Bakshi R, Calabresi PA, Crainiceanu C, Dewey B, Freeman L, Gauthier S, Henry R, Inglese M, Kolind S, Li DKB, Mainero C, Menon RS, Nair G, Narayanan S, Nelson F, Pelletier D, Rauscher A, Rooney W, Sati P, Schwartz D, Shinohara RT, Tagge I, Traboulsee A, Wang Y, Yoo Y, Yousry T, Zhang Y, Robert Z, Sicotte NL, Reich DS. Imaging outcome measures of neuroprotection and repair in MS: A consensus statement from NAIMS. Neurology 2019; 92:519-533. [PMID: 30787160 PMCID: PMC6511106 DOI: 10.1212/wnl.0000000000007099] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [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: 06/05/2018] [Accepted: 11/29/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To summarize current and emerging imaging techniques that can be used to assess neuroprotection and repair in multiple sclerosis (MS), and to provide a consensus opinion on the potential utility of each technique in clinical trial settings. METHODS Clinicians and scientists with expertise in the use of MRI in MS convened in Toronto, Canada, in November 2016 at a North American Imaging in Multiple Sclerosis (NAIMS) Cooperative workshop meeting. The discussion was compiled into a manuscript and circulated to all NAIMS members in attendance. Edits and feedback were incorporated until all authors were in agreement. RESULTS A wide spectrum of imaging techniques and analysis methods in the context of specific study designs were discussed, with a focus on the utility and limitations of applying each technique to assess neuroprotection and repair. Techniques were discussed under specific themes, and included conventional imaging, magnetization transfer ratio, diffusion tensor imaging, susceptibility-weighted imaging, imaging cortical lesions, magnetic resonance spectroscopy, PET, advanced diffusion imaging, sodium imaging, multimodal techniques, imaging of special regions, statistical considerations, and study design. CONCLUSIONS Imaging biomarkers of neuroprotection and repair are an unmet need in MS. There are a number of promising techniques with different strengths and limitations, and selection of a specific technique will depend on a number of factors, notably the question the trial seeks to answer. Ongoing collaborative efforts will enable further refinement and improved methods to image the effect of novel therapeutic agents that exert benefit in MS predominately through neuroprotective and reparative mechanisms.
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Affiliation(s)
- Jiwon Oh
- From the Division of Neurology (J.O.), St. Michael's Hospital, University of Toronto, Canada; Department of Neurology (J.O., P.A.C., B.D., D.S.R.), Johns Hopkins University, Baltimore, MD; Mellen Center for Multiple Sclerosis (D.O.), Cleveland Clinic, OH; Department of Neurology (C.A., D.P.), University of Southern California, Los Angeles; Department of Neurology (E.C.K.), Massachusetts General Hospital, Harvard Medical School, Boston; Translational Neuroradiology Unit (M.A., G.N., P.S., D.S.R.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Brain Imaging Centre (D.L.A., S.N.), Montreal Neurological Institute, McGill University, Canada; Departments of Neurology (R.B.) and Radiology (R.B.), Brigham and Women's Hospital, Harvard Medical School, Boston; Department of Biostatistics (C.C.), Johns Hopkins School of Public Health, Baltimore, MD; Department of Neurology (L.F.), University of Texas Health Science Center at Houston; Department of Neurology (S.G., Y.W.), Weill Cornell Medical College, Cornell University, Ithaca, NY; Department of Neurology (R.H.), University of California at San Francisco; Department of Neurology (M.I., A.T.), Mount Sinai Hospital, New York, NY; Division of Neurology, Department of Medicine (S.K., D.K.B.L.), Department of Radiology (S.K., D.K.B.L., A.R.), Department of Physics and Astronomy (S.K., A.R., A.T., Y.Y.), MS/MRI Research Group (S.K., D.K.B.L., A.T., Y.Y.), MRI Research Centre (S.K., D.K.B.L., A.R.), and Department of Pediatrics (A.R.), University of British Columbia, Vancouver, Canada; A. A. Martinos Center for Biomedical Imaging (C.M.), Department of Radiology, Massachusetts General Hospital, Boston; Centre for Functional and Metabolic Mapping (R.S.M.), Robarts Research Institute, Western University, London, CA; Department of Neurology (F.N.), University of Minnesota, Minneapolis; Advanced Imaging Research Center (W.R., D.S., I.T.), Oregon Health & Science University, Portland; Department of Biostatistics, Epidemiology, and Informatics (R.T.S.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Division of Neuroradiology and Neurophysics (T.Y.), University College London Institute of Neurology, UK; Department of Radiology (Y.Z.) and Department of Clinical Neurosciences and Hotchkiss Brain Institute (Y.Z.), University of Calgary, Canada; and Department of Neurology (N.L.S.), Cedars-Sinai Medical Center, Los Angeles, CA.
| | - Daniel Ontaneda
- From the Division of Neurology (J.O.), St. Michael's Hospital, University of Toronto, Canada; Department of Neurology (J.O., P.A.C., B.D., D.S.R.), Johns Hopkins University, Baltimore, MD; Mellen Center for Multiple Sclerosis (D.O.), Cleveland Clinic, OH; Department of Neurology (C.A., D.P.), University of Southern California, Los Angeles; Department of Neurology (E.C.K.), Massachusetts General Hospital, Harvard Medical School, Boston; Translational Neuroradiology Unit (M.A., G.N., P.S., D.S.R.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Brain Imaging Centre (D.L.A., S.N.), Montreal Neurological Institute, McGill University, Canada; Departments of Neurology (R.B.) and Radiology (R.B.), Brigham and Women's Hospital, Harvard Medical School, Boston; Department of Biostatistics (C.C.), Johns Hopkins School of Public Health, Baltimore, MD; Department of Neurology (L.F.), University of Texas Health Science Center at Houston; Department of Neurology (S.G., Y.W.), Weill Cornell Medical College, Cornell University, Ithaca, NY; Department of Neurology (R.H.), University of California at San Francisco; Department of Neurology (M.I., A.T.), Mount Sinai Hospital, New York, NY; Division of Neurology, Department of Medicine (S.K., D.K.B.L.), Department of Radiology (S.K., D.K.B.L., A.R.), Department of Physics and Astronomy (S.K., A.R., A.T., Y.Y.), MS/MRI Research Group (S.K., D.K.B.L., A.T., Y.Y.), MRI Research Centre (S.K., D.K.B.L., A.R.), and Department of Pediatrics (A.R.), University of British Columbia, Vancouver, Canada; A. A. Martinos Center for Biomedical Imaging (C.M.), Department of Radiology, Massachusetts General Hospital, Boston; Centre for Functional and Metabolic Mapping (R.S.M.), Robarts Research Institute, Western University, London, CA; Department of Neurology (F.N.), University of Minnesota, Minneapolis; Advanced Imaging Research Center (W.R., D.S., I.T.), Oregon Health & Science University, Portland; Department of Biostatistics, Epidemiology, and Informatics (R.T.S.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Division of Neuroradiology and Neurophysics (T.Y.), University College London Institute of Neurology, UK; Department of Radiology (Y.Z.) and Department of Clinical Neurosciences and Hotchkiss Brain Institute (Y.Z.), University of Calgary, Canada; and Department of Neurology (N.L.S.), Cedars-Sinai Medical Center, Los Angeles, CA
| | - Christina Azevedo
- From the Division of Neurology (J.O.), St. Michael's Hospital, University of Toronto, Canada; Department of Neurology (J.O., P.A.C., B.D., D.S.R.), Johns Hopkins University, Baltimore, MD; Mellen Center for Multiple Sclerosis (D.O.), Cleveland Clinic, OH; Department of Neurology (C.A., D.P.), University of Southern California, Los Angeles; Department of Neurology (E.C.K.), Massachusetts General Hospital, Harvard Medical School, Boston; Translational Neuroradiology Unit (M.A., G.N., P.S., D.S.R.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Brain Imaging Centre (D.L.A., S.N.), Montreal Neurological Institute, McGill University, Canada; Departments of Neurology (R.B.) and Radiology (R.B.), Brigham and Women's Hospital, Harvard Medical School, Boston; Department of Biostatistics (C.C.), Johns Hopkins School of Public Health, Baltimore, MD; Department of Neurology (L.F.), University of Texas Health Science Center at Houston; Department of Neurology (S.G., Y.W.), Weill Cornell Medical College, Cornell University, Ithaca, NY; Department of Neurology (R.H.), University of California at San Francisco; Department of Neurology (M.I., A.T.), Mount Sinai Hospital, New York, NY; Division of Neurology, Department of Medicine (S.K., D.K.B.L.), Department of Radiology (S.K., D.K.B.L., A.R.), Department of Physics and Astronomy (S.K., A.R., A.T., Y.Y.), MS/MRI Research Group (S.K., D.K.B.L., A.T., Y.Y.), MRI Research Centre (S.K., D.K.B.L., A.R.), and Department of Pediatrics (A.R.), University of British Columbia, Vancouver, Canada; A. A. Martinos Center for Biomedical Imaging (C.M.), Department of Radiology, Massachusetts General Hospital, Boston; Centre for Functional and Metabolic Mapping (R.S.M.), Robarts Research Institute, Western University, London, CA; Department of Neurology (F.N.), University of Minnesota, Minneapolis; Advanced Imaging Research Center (W.R., D.S., I.T.), Oregon Health & Science University, Portland; Department of Biostatistics, Epidemiology, and Informatics (R.T.S.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Division of Neuroradiology and Neurophysics (T.Y.), University College London Institute of Neurology, UK; Department of Radiology (Y.Z.) and Department of Clinical Neurosciences and Hotchkiss Brain Institute (Y.Z.), University of Calgary, Canada; and Department of Neurology (N.L.S.), Cedars-Sinai Medical Center, Los Angeles, CA
| | - Eric C Klawiter
- From the Division of Neurology (J.O.), St. Michael's Hospital, University of Toronto, Canada; Department of Neurology (J.O., P.A.C., B.D., D.S.R.), Johns Hopkins University, Baltimore, MD; Mellen Center for Multiple Sclerosis (D.O.), Cleveland Clinic, OH; Department of Neurology (C.A., D.P.), University of Southern California, Los Angeles; Department of Neurology (E.C.K.), Massachusetts General Hospital, Harvard Medical School, Boston; Translational Neuroradiology Unit (M.A., G.N., P.S., D.S.R.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Brain Imaging Centre (D.L.A., S.N.), Montreal Neurological Institute, McGill University, Canada; Departments of Neurology (R.B.) and Radiology (R.B.), Brigham and Women's Hospital, Harvard Medical School, Boston; Department of Biostatistics (C.C.), Johns Hopkins School of Public Health, Baltimore, MD; Department of Neurology (L.F.), University of Texas Health Science Center at Houston; Department of Neurology (S.G., Y.W.), Weill Cornell Medical College, Cornell University, Ithaca, NY; Department of Neurology (R.H.), University of California at San Francisco; Department of Neurology (M.I., A.T.), Mount Sinai Hospital, New York, NY; Division of Neurology, Department of Medicine (S.K., D.K.B.L.), Department of Radiology (S.K., D.K.B.L., A.R.), Department of Physics and Astronomy (S.K., A.R., A.T., Y.Y.), MS/MRI Research Group (S.K., D.K.B.L., A.T., Y.Y.), MRI Research Centre (S.K., D.K.B.L., A.R.), and Department of Pediatrics (A.R.), University of British Columbia, Vancouver, Canada; A. A. Martinos Center for Biomedical Imaging (C.M.), Department of Radiology, Massachusetts General Hospital, Boston; Centre for Functional and Metabolic Mapping (R.S.M.), Robarts Research Institute, Western University, London, CA; Department of Neurology (F.N.), University of Minnesota, Minneapolis; Advanced Imaging Research Center (W.R., D.S., I.T.), Oregon Health & Science University, Portland; Department of Biostatistics, Epidemiology, and Informatics (R.T.S.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Division of Neuroradiology and Neurophysics (T.Y.), University College London Institute of Neurology, UK; Department of Radiology (Y.Z.) and Department of Clinical Neurosciences and Hotchkiss Brain Institute (Y.Z.), University of Calgary, Canada; and Department of Neurology (N.L.S.), Cedars-Sinai Medical Center, Los Angeles, CA
| | - Martina Absinta
- From the Division of Neurology (J.O.), St. Michael's Hospital, University of Toronto, Canada; Department of Neurology (J.O., P.A.C., B.D., D.S.R.), Johns Hopkins University, Baltimore, MD; Mellen Center for Multiple Sclerosis (D.O.), Cleveland Clinic, OH; Department of Neurology (C.A., D.P.), University of Southern California, Los Angeles; Department of Neurology (E.C.K.), Massachusetts General Hospital, Harvard Medical School, Boston; Translational Neuroradiology Unit (M.A., G.N., P.S., D.S.R.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Brain Imaging Centre (D.L.A., S.N.), Montreal Neurological Institute, McGill University, Canada; Departments of Neurology (R.B.) and Radiology (R.B.), Brigham and Women's Hospital, Harvard Medical School, Boston; Department of Biostatistics (C.C.), Johns Hopkins School of Public Health, Baltimore, MD; Department of Neurology (L.F.), University of Texas Health Science Center at Houston; Department of Neurology (S.G., Y.W.), Weill Cornell Medical College, Cornell University, Ithaca, NY; Department of Neurology (R.H.), University of California at San Francisco; Department of Neurology (M.I., A.T.), Mount Sinai Hospital, New York, NY; Division of Neurology, Department of Medicine (S.K., D.K.B.L.), Department of Radiology (S.K., D.K.B.L., A.R.), Department of Physics and Astronomy (S.K., A.R., A.T., Y.Y.), MS/MRI Research Group (S.K., D.K.B.L., A.T., Y.Y.), MRI Research Centre (S.K., D.K.B.L., A.R.), and Department of Pediatrics (A.R.), University of British Columbia, Vancouver, Canada; A. A. Martinos Center for Biomedical Imaging (C.M.), Department of Radiology, Massachusetts General Hospital, Boston; Centre for Functional and Metabolic Mapping (R.S.M.), Robarts Research Institute, Western University, London, CA; Department of Neurology (F.N.), University of Minnesota, Minneapolis; Advanced Imaging Research Center (W.R., D.S., I.T.), Oregon Health & Science University, Portland; Department of Biostatistics, Epidemiology, and Informatics (R.T.S.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Division of Neuroradiology and Neurophysics (T.Y.), University College London Institute of Neurology, UK; Department of Radiology (Y.Z.) and Department of Clinical Neurosciences and Hotchkiss Brain Institute (Y.Z.), University of Calgary, Canada; and Department of Neurology (N.L.S.), Cedars-Sinai Medical Center, Los Angeles, CA
| | - Douglas L Arnold
- From the Division of Neurology (J.O.), St. Michael's Hospital, University of Toronto, Canada; Department of Neurology (J.O., P.A.C., B.D., D.S.R.), Johns Hopkins University, Baltimore, MD; Mellen Center for Multiple Sclerosis (D.O.), Cleveland Clinic, OH; Department of Neurology (C.A., D.P.), University of Southern California, Los Angeles; Department of Neurology (E.C.K.), Massachusetts General Hospital, Harvard Medical School, Boston; Translational Neuroradiology Unit (M.A., G.N., P.S., D.S.R.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Brain Imaging Centre (D.L.A., S.N.), Montreal Neurological Institute, McGill University, Canada; Departments of Neurology (R.B.) and Radiology (R.B.), Brigham and Women's Hospital, Harvard Medical School, Boston; Department of Biostatistics (C.C.), Johns Hopkins School of Public Health, Baltimore, MD; Department of Neurology (L.F.), University of Texas Health Science Center at Houston; Department of Neurology (S.G., Y.W.), Weill Cornell Medical College, Cornell University, Ithaca, NY; Department of Neurology (R.H.), University of California at San Francisco; Department of Neurology (M.I., A.T.), Mount Sinai Hospital, New York, NY; Division of Neurology, Department of Medicine (S.K., D.K.B.L.), Department of Radiology (S.K., D.K.B.L., A.R.), Department of Physics and Astronomy (S.K., A.R., A.T., Y.Y.), MS/MRI Research Group (S.K., D.K.B.L., A.T., Y.Y.), MRI Research Centre (S.K., D.K.B.L., A.R.), and Department of Pediatrics (A.R.), University of British Columbia, Vancouver, Canada; A. A. Martinos Center for Biomedical Imaging (C.M.), Department of Radiology, Massachusetts General Hospital, Boston; Centre for Functional and Metabolic Mapping (R.S.M.), Robarts Research Institute, Western University, London, CA; Department of Neurology (F.N.), University of Minnesota, Minneapolis; Advanced Imaging Research Center (W.R., D.S., I.T.), Oregon Health & Science University, Portland; Department of Biostatistics, Epidemiology, and Informatics (R.T.S.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Division of Neuroradiology and Neurophysics (T.Y.), University College London Institute of Neurology, UK; Department of Radiology (Y.Z.) and Department of Clinical Neurosciences and Hotchkiss Brain Institute (Y.Z.), University of Calgary, Canada; and Department of Neurology (N.L.S.), Cedars-Sinai Medical Center, Los Angeles, CA
| | - Rohit Bakshi
- From the Division of Neurology (J.O.), St. Michael's Hospital, University of Toronto, Canada; Department of Neurology (J.O., P.A.C., B.D., D.S.R.), Johns Hopkins University, Baltimore, MD; Mellen Center for Multiple Sclerosis (D.O.), Cleveland Clinic, OH; Department of Neurology (C.A., D.P.), University of Southern California, Los Angeles; Department of Neurology (E.C.K.), Massachusetts General Hospital, Harvard Medical School, Boston; Translational Neuroradiology Unit (M.A., G.N., P.S., D.S.R.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Brain Imaging Centre (D.L.A., S.N.), Montreal Neurological Institute, McGill University, Canada; Departments of Neurology (R.B.) and Radiology (R.B.), Brigham and Women's Hospital, Harvard Medical School, Boston; Department of Biostatistics (C.C.), Johns Hopkins School of Public Health, Baltimore, MD; Department of Neurology (L.F.), University of Texas Health Science Center at Houston; Department of Neurology (S.G., Y.W.), Weill Cornell Medical College, Cornell University, Ithaca, NY; Department of Neurology (R.H.), University of California at San Francisco; Department of Neurology (M.I., A.T.), Mount Sinai Hospital, New York, NY; Division of Neurology, Department of Medicine (S.K., D.K.B.L.), Department of Radiology (S.K., D.K.B.L., A.R.), Department of Physics and Astronomy (S.K., A.R., A.T., Y.Y.), MS/MRI Research Group (S.K., D.K.B.L., A.T., Y.Y.), MRI Research Centre (S.K., D.K.B.L., A.R.), and Department of Pediatrics (A.R.), University of British Columbia, Vancouver, Canada; A. A. Martinos Center for Biomedical Imaging (C.M.), Department of Radiology, Massachusetts General Hospital, Boston; Centre for Functional and Metabolic Mapping (R.S.M.), Robarts Research Institute, Western University, London, CA; Department of Neurology (F.N.), University of Minnesota, Minneapolis; Advanced Imaging Research Center (W.R., D.S., I.T.), Oregon Health & Science University, Portland; Department of Biostatistics, Epidemiology, and Informatics (R.T.S.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Division of Neuroradiology and Neurophysics (T.Y.), University College London Institute of Neurology, UK; Department of Radiology (Y.Z.) and Department of Clinical Neurosciences and Hotchkiss Brain Institute (Y.Z.), University of Calgary, Canada; and Department of Neurology (N.L.S.), Cedars-Sinai Medical Center, Los Angeles, CA
| | - Peter A Calabresi
- From the Division of Neurology (J.O.), St. Michael's Hospital, University of Toronto, Canada; Department of Neurology (J.O., P.A.C., B.D., D.S.R.), Johns Hopkins University, Baltimore, MD; Mellen Center for Multiple Sclerosis (D.O.), Cleveland Clinic, OH; Department of Neurology (C.A., D.P.), University of Southern California, Los Angeles; Department of Neurology (E.C.K.), Massachusetts General Hospital, Harvard Medical School, Boston; Translational Neuroradiology Unit (M.A., G.N., P.S., D.S.R.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Brain Imaging Centre (D.L.A., S.N.), Montreal Neurological Institute, McGill University, Canada; Departments of Neurology (R.B.) and Radiology (R.B.), Brigham and Women's Hospital, Harvard Medical School, Boston; Department of Biostatistics (C.C.), Johns Hopkins School of Public Health, Baltimore, MD; Department of Neurology (L.F.), University of Texas Health Science Center at Houston; Department of Neurology (S.G., Y.W.), Weill Cornell Medical College, Cornell University, Ithaca, NY; Department of Neurology (R.H.), University of California at San Francisco; Department of Neurology (M.I., A.T.), Mount Sinai Hospital, New York, NY; Division of Neurology, Department of Medicine (S.K., D.K.B.L.), Department of Radiology (S.K., D.K.B.L., A.R.), Department of Physics and Astronomy (S.K., A.R., A.T., Y.Y.), MS/MRI Research Group (S.K., D.K.B.L., A.T., Y.Y.), MRI Research Centre (S.K., D.K.B.L., A.R.), and Department of Pediatrics (A.R.), University of British Columbia, Vancouver, Canada; A. A. Martinos Center for Biomedical Imaging (C.M.), Department of Radiology, Massachusetts General Hospital, Boston; Centre for Functional and Metabolic Mapping (R.S.M.), Robarts Research Institute, Western University, London, CA; Department of Neurology (F.N.), University of Minnesota, Minneapolis; Advanced Imaging Research Center (W.R., D.S., I.T.), Oregon Health & Science University, Portland; Department of Biostatistics, Epidemiology, and Informatics (R.T.S.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Division of Neuroradiology and Neurophysics (T.Y.), University College London Institute of Neurology, UK; Department of Radiology (Y.Z.) and Department of Clinical Neurosciences and Hotchkiss Brain Institute (Y.Z.), University of Calgary, Canada; and Department of Neurology (N.L.S.), Cedars-Sinai Medical Center, Los Angeles, CA
| | - Ciprian Crainiceanu
- From the Division of Neurology (J.O.), St. Michael's Hospital, University of Toronto, Canada; Department of Neurology (J.O., P.A.C., B.D., D.S.R.), Johns Hopkins University, Baltimore, MD; Mellen Center for Multiple Sclerosis (D.O.), Cleveland Clinic, OH; Department of Neurology (C.A., D.P.), University of Southern California, Los Angeles; Department of Neurology (E.C.K.), Massachusetts General Hospital, Harvard Medical School, Boston; Translational Neuroradiology Unit (M.A., G.N., P.S., D.S.R.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Brain Imaging Centre (D.L.A., S.N.), Montreal Neurological Institute, McGill University, Canada; Departments of Neurology (R.B.) and Radiology (R.B.), Brigham and Women's Hospital, Harvard Medical School, Boston; Department of Biostatistics (C.C.), Johns Hopkins School of Public Health, Baltimore, MD; Department of Neurology (L.F.), University of Texas Health Science Center at Houston; Department of Neurology (S.G., Y.W.), Weill Cornell Medical College, Cornell University, Ithaca, NY; Department of Neurology (R.H.), University of California at San Francisco; Department of Neurology (M.I., A.T.), Mount Sinai Hospital, New York, NY; Division of Neurology, Department of Medicine (S.K., D.K.B.L.), Department of Radiology (S.K., D.K.B.L., A.R.), Department of Physics and Astronomy (S.K., A.R., A.T., Y.Y.), MS/MRI Research Group (S.K., D.K.B.L., A.T., Y.Y.), MRI Research Centre (S.K., D.K.B.L., A.R.), and Department of Pediatrics (A.R.), University of British Columbia, Vancouver, Canada; A. A. Martinos Center for Biomedical Imaging (C.M.), Department of Radiology, Massachusetts General Hospital, Boston; Centre for Functional and Metabolic Mapping (R.S.M.), Robarts Research Institute, Western University, London, CA; Department of Neurology (F.N.), University of Minnesota, Minneapolis; Advanced Imaging Research Center (W.R., D.S., I.T.), Oregon Health & Science University, Portland; Department of Biostatistics, Epidemiology, and Informatics (R.T.S.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Division of Neuroradiology and Neurophysics (T.Y.), University College London Institute of Neurology, UK; Department of Radiology (Y.Z.) and Department of Clinical Neurosciences and Hotchkiss Brain Institute (Y.Z.), University of Calgary, Canada; and Department of Neurology (N.L.S.), Cedars-Sinai Medical Center, Los Angeles, CA
| | - Blake Dewey
- From the Division of Neurology (J.O.), St. Michael's Hospital, University of Toronto, Canada; Department of Neurology (J.O., P.A.C., B.D., D.S.R.), Johns Hopkins University, Baltimore, MD; Mellen Center for Multiple Sclerosis (D.O.), Cleveland Clinic, OH; Department of Neurology (C.A., D.P.), University of Southern California, Los Angeles; Department of Neurology (E.C.K.), Massachusetts General Hospital, Harvard Medical School, Boston; Translational Neuroradiology Unit (M.A., G.N., P.S., D.S.R.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Brain Imaging Centre (D.L.A., S.N.), Montreal Neurological Institute, McGill University, Canada; Departments of Neurology (R.B.) and Radiology (R.B.), Brigham and Women's Hospital, Harvard Medical School, Boston; Department of Biostatistics (C.C.), Johns Hopkins School of Public Health, Baltimore, MD; Department of Neurology (L.F.), University of Texas Health Science Center at Houston; Department of Neurology (S.G., Y.W.), Weill Cornell Medical College, Cornell University, Ithaca, NY; Department of Neurology (R.H.), University of California at San Francisco; Department of Neurology (M.I., A.T.), Mount Sinai Hospital, New York, NY; Division of Neurology, Department of Medicine (S.K., D.K.B.L.), Department of Radiology (S.K., D.K.B.L., A.R.), Department of Physics and Astronomy (S.K., A.R., A.T., Y.Y.), MS/MRI Research Group (S.K., D.K.B.L., A.T., Y.Y.), MRI Research Centre (S.K., D.K.B.L., A.R.), and Department of Pediatrics (A.R.), University of British Columbia, Vancouver, Canada; A. A. Martinos Center for Biomedical Imaging (C.M.), Department of Radiology, Massachusetts General Hospital, Boston; Centre for Functional and Metabolic Mapping (R.S.M.), Robarts Research Institute, Western University, London, CA; Department of Neurology (F.N.), University of Minnesota, Minneapolis; Advanced Imaging Research Center (W.R., D.S., I.T.), Oregon Health & Science University, Portland; Department of Biostatistics, Epidemiology, and Informatics (R.T.S.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Division of Neuroradiology and Neurophysics (T.Y.), University College London Institute of Neurology, UK; Department of Radiology (Y.Z.) and Department of Clinical Neurosciences and Hotchkiss Brain Institute (Y.Z.), University of Calgary, Canada; and Department of Neurology (N.L.S.), Cedars-Sinai Medical Center, Los Angeles, CA
| | - Leorah Freeman
- From the Division of Neurology (J.O.), St. Michael's Hospital, University of Toronto, Canada; Department of Neurology (J.O., P.A.C., B.D., D.S.R.), Johns Hopkins University, Baltimore, MD; Mellen Center for Multiple Sclerosis (D.O.), Cleveland Clinic, OH; Department of Neurology (C.A., D.P.), University of Southern California, Los Angeles; Department of Neurology (E.C.K.), Massachusetts General Hospital, Harvard Medical School, Boston; Translational Neuroradiology Unit (M.A., G.N., P.S., D.S.R.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Brain Imaging Centre (D.L.A., S.N.), Montreal Neurological Institute, McGill University, Canada; Departments of Neurology (R.B.) and Radiology (R.B.), Brigham and Women's Hospital, Harvard Medical School, Boston; Department of Biostatistics (C.C.), Johns Hopkins School of Public Health, Baltimore, MD; Department of Neurology (L.F.), University of Texas Health Science Center at Houston; Department of Neurology (S.G., Y.W.), Weill Cornell Medical College, Cornell University, Ithaca, NY; Department of Neurology (R.H.), University of California at San Francisco; Department of Neurology (M.I., A.T.), Mount Sinai Hospital, New York, NY; Division of Neurology, Department of Medicine (S.K., D.K.B.L.), Department of Radiology (S.K., D.K.B.L., A.R.), Department of Physics and Astronomy (S.K., A.R., A.T., Y.Y.), MS/MRI Research Group (S.K., D.K.B.L., A.T., Y.Y.), MRI Research Centre (S.K., D.K.B.L., A.R.), and Department of Pediatrics (A.R.), University of British Columbia, Vancouver, Canada; A. A. Martinos Center for Biomedical Imaging (C.M.), Department of Radiology, Massachusetts General Hospital, Boston; Centre for Functional and Metabolic Mapping (R.S.M.), Robarts Research Institute, Western University, London, CA; Department of Neurology (F.N.), University of Minnesota, Minneapolis; Advanced Imaging Research Center (W.R., D.S., I.T.), Oregon Health & Science University, Portland; Department of Biostatistics, Epidemiology, and Informatics (R.T.S.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Division of Neuroradiology and Neurophysics (T.Y.), University College London Institute of Neurology, UK; Department of Radiology (Y.Z.) and Department of Clinical Neurosciences and Hotchkiss Brain Institute (Y.Z.), University of Calgary, Canada; and Department of Neurology (N.L.S.), Cedars-Sinai Medical Center, Los Angeles, CA
| | - Susan Gauthier
- From the Division of Neurology (J.O.), St. Michael's Hospital, University of Toronto, Canada; Department of Neurology (J.O., P.A.C., B.D., D.S.R.), Johns Hopkins University, Baltimore, MD; Mellen Center for Multiple Sclerosis (D.O.), Cleveland Clinic, OH; Department of Neurology (C.A., D.P.), University of Southern California, Los Angeles; Department of Neurology (E.C.K.), Massachusetts General Hospital, Harvard Medical School, Boston; Translational Neuroradiology Unit (M.A., G.N., P.S., D.S.R.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Brain Imaging Centre (D.L.A., S.N.), Montreal Neurological Institute, McGill University, Canada; Departments of Neurology (R.B.) and Radiology (R.B.), Brigham and Women's Hospital, Harvard Medical School, Boston; Department of Biostatistics (C.C.), Johns Hopkins School of Public Health, Baltimore, MD; Department of Neurology (L.F.), University of Texas Health Science Center at Houston; Department of Neurology (S.G., Y.W.), Weill Cornell Medical College, Cornell University, Ithaca, NY; Department of Neurology (R.H.), University of California at San Francisco; Department of Neurology (M.I., A.T.), Mount Sinai Hospital, New York, NY; Division of Neurology, Department of Medicine (S.K., D.K.B.L.), Department of Radiology (S.K., D.K.B.L., A.R.), Department of Physics and Astronomy (S.K., A.R., A.T., Y.Y.), MS/MRI Research Group (S.K., D.K.B.L., A.T., Y.Y.), MRI Research Centre (S.K., D.K.B.L., A.R.), and Department of Pediatrics (A.R.), University of British Columbia, Vancouver, Canada; A. A. Martinos Center for Biomedical Imaging (C.M.), Department of Radiology, Massachusetts General Hospital, Boston; Centre for Functional and Metabolic Mapping (R.S.M.), Robarts Research Institute, Western University, London, CA; Department of Neurology (F.N.), University of Minnesota, Minneapolis; Advanced Imaging Research Center (W.R., D.S., I.T.), Oregon Health & Science University, Portland; Department of Biostatistics, Epidemiology, and Informatics (R.T.S.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Division of Neuroradiology and Neurophysics (T.Y.), University College London Institute of Neurology, UK; Department of Radiology (Y.Z.) and Department of Clinical Neurosciences and Hotchkiss Brain Institute (Y.Z.), University of Calgary, Canada; and Department of Neurology (N.L.S.), Cedars-Sinai Medical Center, Los Angeles, CA
| | - Roland Henry
- From the Division of Neurology (J.O.), St. Michael's Hospital, University of Toronto, Canada; Department of Neurology (J.O., P.A.C., B.D., D.S.R.), Johns Hopkins University, Baltimore, MD; Mellen Center for Multiple Sclerosis (D.O.), Cleveland Clinic, OH; Department of Neurology (C.A., D.P.), University of Southern California, Los Angeles; Department of Neurology (E.C.K.), Massachusetts General Hospital, Harvard Medical School, Boston; Translational Neuroradiology Unit (M.A., G.N., P.S., D.S.R.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Brain Imaging Centre (D.L.A., S.N.), Montreal Neurological Institute, McGill University, Canada; Departments of Neurology (R.B.) and Radiology (R.B.), Brigham and Women's Hospital, Harvard Medical School, Boston; Department of Biostatistics (C.C.), Johns Hopkins School of Public Health, Baltimore, MD; Department of Neurology (L.F.), University of Texas Health Science Center at Houston; Department of Neurology (S.G., Y.W.), Weill Cornell Medical College, Cornell University, Ithaca, NY; Department of Neurology (R.H.), University of California at San Francisco; Department of Neurology (M.I., A.T.), Mount Sinai Hospital, New York, NY; Division of Neurology, Department of Medicine (S.K., D.K.B.L.), Department of Radiology (S.K., D.K.B.L., A.R.), Department of Physics and Astronomy (S.K., A.R., A.T., Y.Y.), MS/MRI Research Group (S.K., D.K.B.L., A.T., Y.Y.), MRI Research Centre (S.K., D.K.B.L., A.R.), and Department of Pediatrics (A.R.), University of British Columbia, Vancouver, Canada; A. A. Martinos Center for Biomedical Imaging (C.M.), Department of Radiology, Massachusetts General Hospital, Boston; Centre for Functional and Metabolic Mapping (R.S.M.), Robarts Research Institute, Western University, London, CA; Department of Neurology (F.N.), University of Minnesota, Minneapolis; Advanced Imaging Research Center (W.R., D.S., I.T.), Oregon Health & Science University, Portland; Department of Biostatistics, Epidemiology, and Informatics (R.T.S.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Division of Neuroradiology and Neurophysics (T.Y.), University College London Institute of Neurology, UK; Department of Radiology (Y.Z.) and Department of Clinical Neurosciences and Hotchkiss Brain Institute (Y.Z.), University of Calgary, Canada; and Department of Neurology (N.L.S.), Cedars-Sinai Medical Center, Los Angeles, CA
| | - Mathilde Inglese
- From the Division of Neurology (J.O.), St. Michael's Hospital, University of Toronto, Canada; Department of Neurology (J.O., P.A.C., B.D., D.S.R.), Johns Hopkins University, Baltimore, MD; Mellen Center for Multiple Sclerosis (D.O.), Cleveland Clinic, OH; Department of Neurology (C.A., D.P.), University of Southern California, Los Angeles; Department of Neurology (E.C.K.), Massachusetts General Hospital, Harvard Medical School, Boston; Translational Neuroradiology Unit (M.A., G.N., P.S., D.S.R.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Brain Imaging Centre (D.L.A., S.N.), Montreal Neurological Institute, McGill University, Canada; Departments of Neurology (R.B.) and Radiology (R.B.), Brigham and Women's Hospital, Harvard Medical School, Boston; Department of Biostatistics (C.C.), Johns Hopkins School of Public Health, Baltimore, MD; Department of Neurology (L.F.), University of Texas Health Science Center at Houston; Department of Neurology (S.G., Y.W.), Weill Cornell Medical College, Cornell University, Ithaca, NY; Department of Neurology (R.H.), University of California at San Francisco; Department of Neurology (M.I., A.T.), Mount Sinai Hospital, New York, NY; Division of Neurology, Department of Medicine (S.K., D.K.B.L.), Department of Radiology (S.K., D.K.B.L., A.R.), Department of Physics and Astronomy (S.K., A.R., A.T., Y.Y.), MS/MRI Research Group (S.K., D.K.B.L., A.T., Y.Y.), MRI Research Centre (S.K., D.K.B.L., A.R.), and Department of Pediatrics (A.R.), University of British Columbia, Vancouver, Canada; A. A. Martinos Center for Biomedical Imaging (C.M.), Department of Radiology, Massachusetts General Hospital, Boston; Centre for Functional and Metabolic Mapping (R.S.M.), Robarts Research Institute, Western University, London, CA; Department of Neurology (F.N.), University of Minnesota, Minneapolis; Advanced Imaging Research Center (W.R., D.S., I.T.), Oregon Health & Science University, Portland; Department of Biostatistics, Epidemiology, and Informatics (R.T.S.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Division of Neuroradiology and Neurophysics (T.Y.), University College London Institute of Neurology, UK; Department of Radiology (Y.Z.) and Department of Clinical Neurosciences and Hotchkiss Brain Institute (Y.Z.), University of Calgary, Canada; and Department of Neurology (N.L.S.), Cedars-Sinai Medical Center, Los Angeles, CA
| | - Shannon Kolind
- From the Division of Neurology (J.O.), St. Michael's Hospital, University of Toronto, Canada; Department of Neurology (J.O., P.A.C., B.D., D.S.R.), Johns Hopkins University, Baltimore, MD; Mellen Center for Multiple Sclerosis (D.O.), Cleveland Clinic, OH; Department of Neurology (C.A., D.P.), University of Southern California, Los Angeles; Department of Neurology (E.C.K.), Massachusetts General Hospital, Harvard Medical School, Boston; Translational Neuroradiology Unit (M.A., G.N., P.S., D.S.R.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Brain Imaging Centre (D.L.A., S.N.), Montreal Neurological Institute, McGill University, Canada; Departments of Neurology (R.B.) and Radiology (R.B.), Brigham and Women's Hospital, Harvard Medical School, Boston; Department of Biostatistics (C.C.), Johns Hopkins School of Public Health, Baltimore, MD; Department of Neurology (L.F.), University of Texas Health Science Center at Houston; Department of Neurology (S.G., Y.W.), Weill Cornell Medical College, Cornell University, Ithaca, NY; Department of Neurology (R.H.), University of California at San Francisco; Department of Neurology (M.I., A.T.), Mount Sinai Hospital, New York, NY; Division of Neurology, Department of Medicine (S.K., D.K.B.L.), Department of Radiology (S.K., D.K.B.L., A.R.), Department of Physics and Astronomy (S.K., A.R., A.T., Y.Y.), MS/MRI Research Group (S.K., D.K.B.L., A.T., Y.Y.), MRI Research Centre (S.K., D.K.B.L., A.R.), and Department of Pediatrics (A.R.), University of British Columbia, Vancouver, Canada; A. A. Martinos Center for Biomedical Imaging (C.M.), Department of Radiology, Massachusetts General Hospital, Boston; Centre for Functional and Metabolic Mapping (R.S.M.), Robarts Research Institute, Western University, London, CA; Department of Neurology (F.N.), University of Minnesota, Minneapolis; Advanced Imaging Research Center (W.R., D.S., I.T.), Oregon Health & Science University, Portland; Department of Biostatistics, Epidemiology, and Informatics (R.T.S.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Division of Neuroradiology and Neurophysics (T.Y.), University College London Institute of Neurology, UK; Department of Radiology (Y.Z.) and Department of Clinical Neurosciences and Hotchkiss Brain Institute (Y.Z.), University of Calgary, Canada; and Department of Neurology (N.L.S.), Cedars-Sinai Medical Center, Los Angeles, CA
| | - David K B Li
- From the Division of Neurology (J.O.), St. Michael's Hospital, University of Toronto, Canada; Department of Neurology (J.O., P.A.C., B.D., D.S.R.), Johns Hopkins University, Baltimore, MD; Mellen Center for Multiple Sclerosis (D.O.), Cleveland Clinic, OH; Department of Neurology (C.A., D.P.), University of Southern California, Los Angeles; Department of Neurology (E.C.K.), Massachusetts General Hospital, Harvard Medical School, Boston; Translational Neuroradiology Unit (M.A., G.N., P.S., D.S.R.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Brain Imaging Centre (D.L.A., S.N.), Montreal Neurological Institute, McGill University, Canada; Departments of Neurology (R.B.) and Radiology (R.B.), Brigham and Women's Hospital, Harvard Medical School, Boston; Department of Biostatistics (C.C.), Johns Hopkins School of Public Health, Baltimore, MD; Department of Neurology (L.F.), University of Texas Health Science Center at Houston; Department of Neurology (S.G., Y.W.), Weill Cornell Medical College, Cornell University, Ithaca, NY; Department of Neurology (R.H.), University of California at San Francisco; Department of Neurology (M.I., A.T.), Mount Sinai Hospital, New York, NY; Division of Neurology, Department of Medicine (S.K., D.K.B.L.), Department of Radiology (S.K., D.K.B.L., A.R.), Department of Physics and Astronomy (S.K., A.R., A.T., Y.Y.), MS/MRI Research Group (S.K., D.K.B.L., A.T., Y.Y.), MRI Research Centre (S.K., D.K.B.L., A.R.), and Department of Pediatrics (A.R.), University of British Columbia, Vancouver, Canada; A. A. Martinos Center for Biomedical Imaging (C.M.), Department of Radiology, Massachusetts General Hospital, Boston; Centre for Functional and Metabolic Mapping (R.S.M.), Robarts Research Institute, Western University, London, CA; Department of Neurology (F.N.), University of Minnesota, Minneapolis; Advanced Imaging Research Center (W.R., D.S., I.T.), Oregon Health & Science University, Portland; Department of Biostatistics, Epidemiology, and Informatics (R.T.S.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Division of Neuroradiology and Neurophysics (T.Y.), University College London Institute of Neurology, UK; Department of Radiology (Y.Z.) and Department of Clinical Neurosciences and Hotchkiss Brain Institute (Y.Z.), University of Calgary, Canada; and Department of Neurology (N.L.S.), Cedars-Sinai Medical Center, Los Angeles, CA
| | - Caterina Mainero
- From the Division of Neurology (J.O.), St. Michael's Hospital, University of Toronto, Canada; Department of Neurology (J.O., P.A.C., B.D., D.S.R.), Johns Hopkins University, Baltimore, MD; Mellen Center for Multiple Sclerosis (D.O.), Cleveland Clinic, OH; Department of Neurology (C.A., D.P.), University of Southern California, Los Angeles; Department of Neurology (E.C.K.), Massachusetts General Hospital, Harvard Medical School, Boston; Translational Neuroradiology Unit (M.A., G.N., P.S., D.S.R.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Brain Imaging Centre (D.L.A., S.N.), Montreal Neurological Institute, McGill University, Canada; Departments of Neurology (R.B.) and Radiology (R.B.), Brigham and Women's Hospital, Harvard Medical School, Boston; Department of Biostatistics (C.C.), Johns Hopkins School of Public Health, Baltimore, MD; Department of Neurology (L.F.), University of Texas Health Science Center at Houston; Department of Neurology (S.G., Y.W.), Weill Cornell Medical College, Cornell University, Ithaca, NY; Department of Neurology (R.H.), University of California at San Francisco; Department of Neurology (M.I., A.T.), Mount Sinai Hospital, New York, NY; Division of Neurology, Department of Medicine (S.K., D.K.B.L.), Department of Radiology (S.K., D.K.B.L., A.R.), Department of Physics and Astronomy (S.K., A.R., A.T., Y.Y.), MS/MRI Research Group (S.K., D.K.B.L., A.T., Y.Y.), MRI Research Centre (S.K., D.K.B.L., A.R.), and Department of Pediatrics (A.R.), University of British Columbia, Vancouver, Canada; A. A. Martinos Center for Biomedical Imaging (C.M.), Department of Radiology, Massachusetts General Hospital, Boston; Centre for Functional and Metabolic Mapping (R.S.M.), Robarts Research Institute, Western University, London, CA; Department of Neurology (F.N.), University of Minnesota, Minneapolis; Advanced Imaging Research Center (W.R., D.S., I.T.), Oregon Health & Science University, Portland; Department of Biostatistics, Epidemiology, and Informatics (R.T.S.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Division of Neuroradiology and Neurophysics (T.Y.), University College London Institute of Neurology, UK; Department of Radiology (Y.Z.) and Department of Clinical Neurosciences and Hotchkiss Brain Institute (Y.Z.), University of Calgary, Canada; and Department of Neurology (N.L.S.), Cedars-Sinai Medical Center, Los Angeles, CA
| | - Ravi S Menon
- From the Division of Neurology (J.O.), St. Michael's Hospital, University of Toronto, Canada; Department of Neurology (J.O., P.A.C., B.D., D.S.R.), Johns Hopkins University, Baltimore, MD; Mellen Center for Multiple Sclerosis (D.O.), Cleveland Clinic, OH; Department of Neurology (C.A., D.P.), University of Southern California, Los Angeles; Department of Neurology (E.C.K.), Massachusetts General Hospital, Harvard Medical School, Boston; Translational Neuroradiology Unit (M.A., G.N., P.S., D.S.R.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Brain Imaging Centre (D.L.A., S.N.), Montreal Neurological Institute, McGill University, Canada; Departments of Neurology (R.B.) and Radiology (R.B.), Brigham and Women's Hospital, Harvard Medical School, Boston; Department of Biostatistics (C.C.), Johns Hopkins School of Public Health, Baltimore, MD; Department of Neurology (L.F.), University of Texas Health Science Center at Houston; Department of Neurology (S.G., Y.W.), Weill Cornell Medical College, Cornell University, Ithaca, NY; Department of Neurology (R.H.), University of California at San Francisco; Department of Neurology (M.I., A.T.), Mount Sinai Hospital, New York, NY; Division of Neurology, Department of Medicine (S.K., D.K.B.L.), Department of Radiology (S.K., D.K.B.L., A.R.), Department of Physics and Astronomy (S.K., A.R., A.T., Y.Y.), MS/MRI Research Group (S.K., D.K.B.L., A.T., Y.Y.), MRI Research Centre (S.K., D.K.B.L., A.R.), and Department of Pediatrics (A.R.), University of British Columbia, Vancouver, Canada; A. A. Martinos Center for Biomedical Imaging (C.M.), Department of Radiology, Massachusetts General Hospital, Boston; Centre for Functional and Metabolic Mapping (R.S.M.), Robarts Research Institute, Western University, London, CA; Department of Neurology (F.N.), University of Minnesota, Minneapolis; Advanced Imaging Research Center (W.R., D.S., I.T.), Oregon Health & Science University, Portland; Department of Biostatistics, Epidemiology, and Informatics (R.T.S.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Division of Neuroradiology and Neurophysics (T.Y.), University College London Institute of Neurology, UK; Department of Radiology (Y.Z.) and Department of Clinical Neurosciences and Hotchkiss Brain Institute (Y.Z.), University of Calgary, Canada; and Department of Neurology (N.L.S.), Cedars-Sinai Medical Center, Los Angeles, CA
| | - Govind Nair
- From the Division of Neurology (J.O.), St. Michael's Hospital, University of Toronto, Canada; Department of Neurology (J.O., P.A.C., B.D., D.S.R.), Johns Hopkins University, Baltimore, MD; Mellen Center for Multiple Sclerosis (D.O.), Cleveland Clinic, OH; Department of Neurology (C.A., D.P.), University of Southern California, Los Angeles; Department of Neurology (E.C.K.), Massachusetts General Hospital, Harvard Medical School, Boston; Translational Neuroradiology Unit (M.A., G.N., P.S., D.S.R.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Brain Imaging Centre (D.L.A., S.N.), Montreal Neurological Institute, McGill University, Canada; Departments of Neurology (R.B.) and Radiology (R.B.), Brigham and Women's Hospital, Harvard Medical School, Boston; Department of Biostatistics (C.C.), Johns Hopkins School of Public Health, Baltimore, MD; Department of Neurology (L.F.), University of Texas Health Science Center at Houston; Department of Neurology (S.G., Y.W.), Weill Cornell Medical College, Cornell University, Ithaca, NY; Department of Neurology (R.H.), University of California at San Francisco; Department of Neurology (M.I., A.T.), Mount Sinai Hospital, New York, NY; Division of Neurology, Department of Medicine (S.K., D.K.B.L.), Department of Radiology (S.K., D.K.B.L., A.R.), Department of Physics and Astronomy (S.K., A.R., A.T., Y.Y.), MS/MRI Research Group (S.K., D.K.B.L., A.T., Y.Y.), MRI Research Centre (S.K., D.K.B.L., A.R.), and Department of Pediatrics (A.R.), University of British Columbia, Vancouver, Canada; A. A. Martinos Center for Biomedical Imaging (C.M.), Department of Radiology, Massachusetts General Hospital, Boston; Centre for Functional and Metabolic Mapping (R.S.M.), Robarts Research Institute, Western University, London, CA; Department of Neurology (F.N.), University of Minnesota, Minneapolis; Advanced Imaging Research Center (W.R., D.S., I.T.), Oregon Health & Science University, Portland; Department of Biostatistics, Epidemiology, and Informatics (R.T.S.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Division of Neuroradiology and Neurophysics (T.Y.), University College London Institute of Neurology, UK; Department of Radiology (Y.Z.) and Department of Clinical Neurosciences and Hotchkiss Brain Institute (Y.Z.), University of Calgary, Canada; and Department of Neurology (N.L.S.), Cedars-Sinai Medical Center, Los Angeles, CA
| | - Sridar Narayanan
- From the Division of Neurology (J.O.), St. Michael's Hospital, University of Toronto, Canada; Department of Neurology (J.O., P.A.C., B.D., D.S.R.), Johns Hopkins University, Baltimore, MD; Mellen Center for Multiple Sclerosis (D.O.), Cleveland Clinic, OH; Department of Neurology (C.A., D.P.), University of Southern California, Los Angeles; Department of Neurology (E.C.K.), Massachusetts General Hospital, Harvard Medical School, Boston; Translational Neuroradiology Unit (M.A., G.N., P.S., D.S.R.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Brain Imaging Centre (D.L.A., S.N.), Montreal Neurological Institute, McGill University, Canada; Departments of Neurology (R.B.) and Radiology (R.B.), Brigham and Women's Hospital, Harvard Medical School, Boston; Department of Biostatistics (C.C.), Johns Hopkins School of Public Health, Baltimore, MD; Department of Neurology (L.F.), University of Texas Health Science Center at Houston; Department of Neurology (S.G., Y.W.), Weill Cornell Medical College, Cornell University, Ithaca, NY; Department of Neurology (R.H.), University of California at San Francisco; Department of Neurology (M.I., A.T.), Mount Sinai Hospital, New York, NY; Division of Neurology, Department of Medicine (S.K., D.K.B.L.), Department of Radiology (S.K., D.K.B.L., A.R.), Department of Physics and Astronomy (S.K., A.R., A.T., Y.Y.), MS/MRI Research Group (S.K., D.K.B.L., A.T., Y.Y.), MRI Research Centre (S.K., D.K.B.L., A.R.), and Department of Pediatrics (A.R.), University of British Columbia, Vancouver, Canada; A. A. Martinos Center for Biomedical Imaging (C.M.), Department of Radiology, Massachusetts General Hospital, Boston; Centre for Functional and Metabolic Mapping (R.S.M.), Robarts Research Institute, Western University, London, CA; Department of Neurology (F.N.), University of Minnesota, Minneapolis; Advanced Imaging Research Center (W.R., D.S., I.T.), Oregon Health & Science University, Portland; Department of Biostatistics, Epidemiology, and Informatics (R.T.S.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Division of Neuroradiology and Neurophysics (T.Y.), University College London Institute of Neurology, UK; Department of Radiology (Y.Z.) and Department of Clinical Neurosciences and Hotchkiss Brain Institute (Y.Z.), University of Calgary, Canada; and Department of Neurology (N.L.S.), Cedars-Sinai Medical Center, Los Angeles, CA
| | - Flavia Nelson
- From the Division of Neurology (J.O.), St. Michael's Hospital, University of Toronto, Canada; Department of Neurology (J.O., P.A.C., B.D., D.S.R.), Johns Hopkins University, Baltimore, MD; Mellen Center for Multiple Sclerosis (D.O.), Cleveland Clinic, OH; Department of Neurology (C.A., D.P.), University of Southern California, Los Angeles; Department of Neurology (E.C.K.), Massachusetts General Hospital, Harvard Medical School, Boston; Translational Neuroradiology Unit (M.A., G.N., P.S., D.S.R.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Brain Imaging Centre (D.L.A., S.N.), Montreal Neurological Institute, McGill University, Canada; Departments of Neurology (R.B.) and Radiology (R.B.), Brigham and Women's Hospital, Harvard Medical School, Boston; Department of Biostatistics (C.C.), Johns Hopkins School of Public Health, Baltimore, MD; Department of Neurology (L.F.), University of Texas Health Science Center at Houston; Department of Neurology (S.G., Y.W.), Weill Cornell Medical College, Cornell University, Ithaca, NY; Department of Neurology (R.H.), University of California at San Francisco; Department of Neurology (M.I., A.T.), Mount Sinai Hospital, New York, NY; Division of Neurology, Department of Medicine (S.K., D.K.B.L.), Department of Radiology (S.K., D.K.B.L., A.R.), Department of Physics and Astronomy (S.K., A.R., A.T., Y.Y.), MS/MRI Research Group (S.K., D.K.B.L., A.T., Y.Y.), MRI Research Centre (S.K., D.K.B.L., A.R.), and Department of Pediatrics (A.R.), University of British Columbia, Vancouver, Canada; A. A. Martinos Center for Biomedical Imaging (C.M.), Department of Radiology, Massachusetts General Hospital, Boston; Centre for Functional and Metabolic Mapping (R.S.M.), Robarts Research Institute, Western University, London, CA; Department of Neurology (F.N.), University of Minnesota, Minneapolis; Advanced Imaging Research Center (W.R., D.S., I.T.), Oregon Health & Science University, Portland; Department of Biostatistics, Epidemiology, and Informatics (R.T.S.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Division of Neuroradiology and Neurophysics (T.Y.), University College London Institute of Neurology, UK; Department of Radiology (Y.Z.) and Department of Clinical Neurosciences and Hotchkiss Brain Institute (Y.Z.), University of Calgary, Canada; and Department of Neurology (N.L.S.), Cedars-Sinai Medical Center, Los Angeles, CA
| | - Daniel Pelletier
- From the Division of Neurology (J.O.), St. Michael's Hospital, University of Toronto, Canada; Department of Neurology (J.O., P.A.C., B.D., D.S.R.), Johns Hopkins University, Baltimore, MD; Mellen Center for Multiple Sclerosis (D.O.), Cleveland Clinic, OH; Department of Neurology (C.A., D.P.), University of Southern California, Los Angeles; Department of Neurology (E.C.K.), Massachusetts General Hospital, Harvard Medical School, Boston; Translational Neuroradiology Unit (M.A., G.N., P.S., D.S.R.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Brain Imaging Centre (D.L.A., S.N.), Montreal Neurological Institute, McGill University, Canada; Departments of Neurology (R.B.) and Radiology (R.B.), Brigham and Women's Hospital, Harvard Medical School, Boston; Department of Biostatistics (C.C.), Johns Hopkins School of Public Health, Baltimore, MD; Department of Neurology (L.F.), University of Texas Health Science Center at Houston; Department of Neurology (S.G., Y.W.), Weill Cornell Medical College, Cornell University, Ithaca, NY; Department of Neurology (R.H.), University of California at San Francisco; Department of Neurology (M.I., A.T.), Mount Sinai Hospital, New York, NY; Division of Neurology, Department of Medicine (S.K., D.K.B.L.), Department of Radiology (S.K., D.K.B.L., A.R.), Department of Physics and Astronomy (S.K., A.R., A.T., Y.Y.), MS/MRI Research Group (S.K., D.K.B.L., A.T., Y.Y.), MRI Research Centre (S.K., D.K.B.L., A.R.), and Department of Pediatrics (A.R.), University of British Columbia, Vancouver, Canada; A. A. Martinos Center for Biomedical Imaging (C.M.), Department of Radiology, Massachusetts General Hospital, Boston; Centre for Functional and Metabolic Mapping (R.S.M.), Robarts Research Institute, Western University, London, CA; Department of Neurology (F.N.), University of Minnesota, Minneapolis; Advanced Imaging Research Center (W.R., D.S., I.T.), Oregon Health & Science University, Portland; Department of Biostatistics, Epidemiology, and Informatics (R.T.S.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Division of Neuroradiology and Neurophysics (T.Y.), University College London Institute of Neurology, UK; Department of Radiology (Y.Z.) and Department of Clinical Neurosciences and Hotchkiss Brain Institute (Y.Z.), University of Calgary, Canada; and Department of Neurology (N.L.S.), Cedars-Sinai Medical Center, Los Angeles, CA
| | - Alexander Rauscher
- From the Division of Neurology (J.O.), St. Michael's Hospital, University of Toronto, Canada; Department of Neurology (J.O., P.A.C., B.D., D.S.R.), Johns Hopkins University, Baltimore, MD; Mellen Center for Multiple Sclerosis (D.O.), Cleveland Clinic, OH; Department of Neurology (C.A., D.P.), University of Southern California, Los Angeles; Department of Neurology (E.C.K.), Massachusetts General Hospital, Harvard Medical School, Boston; Translational Neuroradiology Unit (M.A., G.N., P.S., D.S.R.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Brain Imaging Centre (D.L.A., S.N.), Montreal Neurological Institute, McGill University, Canada; Departments of Neurology (R.B.) and Radiology (R.B.), Brigham and Women's Hospital, Harvard Medical School, Boston; Department of Biostatistics (C.C.), Johns Hopkins School of Public Health, Baltimore, MD; Department of Neurology (L.F.), University of Texas Health Science Center at Houston; Department of Neurology (S.G., Y.W.), Weill Cornell Medical College, Cornell University, Ithaca, NY; Department of Neurology (R.H.), University of California at San Francisco; Department of Neurology (M.I., A.T.), Mount Sinai Hospital, New York, NY; Division of Neurology, Department of Medicine (S.K., D.K.B.L.), Department of Radiology (S.K., D.K.B.L., A.R.), Department of Physics and Astronomy (S.K., A.R., A.T., Y.Y.), MS/MRI Research Group (S.K., D.K.B.L., A.T., Y.Y.), MRI Research Centre (S.K., D.K.B.L., A.R.), and Department of Pediatrics (A.R.), University of British Columbia, Vancouver, Canada; A. A. Martinos Center for Biomedical Imaging (C.M.), Department of Radiology, Massachusetts General Hospital, Boston; Centre for Functional and Metabolic Mapping (R.S.M.), Robarts Research Institute, Western University, London, CA; Department of Neurology (F.N.), University of Minnesota, Minneapolis; Advanced Imaging Research Center (W.R., D.S., I.T.), Oregon Health & Science University, Portland; Department of Biostatistics, Epidemiology, and Informatics (R.T.S.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Division of Neuroradiology and Neurophysics (T.Y.), University College London Institute of Neurology, UK; Department of Radiology (Y.Z.) and Department of Clinical Neurosciences and Hotchkiss Brain Institute (Y.Z.), University of Calgary, Canada; and Department of Neurology (N.L.S.), Cedars-Sinai Medical Center, Los Angeles, CA
| | - William Rooney
- From the Division of Neurology (J.O.), St. Michael's Hospital, University of Toronto, Canada; Department of Neurology (J.O., P.A.C., B.D., D.S.R.), Johns Hopkins University, Baltimore, MD; Mellen Center for Multiple Sclerosis (D.O.), Cleveland Clinic, OH; Department of Neurology (C.A., D.P.), University of Southern California, Los Angeles; Department of Neurology (E.C.K.), Massachusetts General Hospital, Harvard Medical School, Boston; Translational Neuroradiology Unit (M.A., G.N., P.S., D.S.R.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Brain Imaging Centre (D.L.A., S.N.), Montreal Neurological Institute, McGill University, Canada; Departments of Neurology (R.B.) and Radiology (R.B.), Brigham and Women's Hospital, Harvard Medical School, Boston; Department of Biostatistics (C.C.), Johns Hopkins School of Public Health, Baltimore, MD; Department of Neurology (L.F.), University of Texas Health Science Center at Houston; Department of Neurology (S.G., Y.W.), Weill Cornell Medical College, Cornell University, Ithaca, NY; Department of Neurology (R.H.), University of California at San Francisco; Department of Neurology (M.I., A.T.), Mount Sinai Hospital, New York, NY; Division of Neurology, Department of Medicine (S.K., D.K.B.L.), Department of Radiology (S.K., D.K.B.L., A.R.), Department of Physics and Astronomy (S.K., A.R., A.T., Y.Y.), MS/MRI Research Group (S.K., D.K.B.L., A.T., Y.Y.), MRI Research Centre (S.K., D.K.B.L., A.R.), and Department of Pediatrics (A.R.), University of British Columbia, Vancouver, Canada; A. A. Martinos Center for Biomedical Imaging (C.M.), Department of Radiology, Massachusetts General Hospital, Boston; Centre for Functional and Metabolic Mapping (R.S.M.), Robarts Research Institute, Western University, London, CA; Department of Neurology (F.N.), University of Minnesota, Minneapolis; Advanced Imaging Research Center (W.R., D.S., I.T.), Oregon Health & Science University, Portland; Department of Biostatistics, Epidemiology, and Informatics (R.T.S.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Division of Neuroradiology and Neurophysics (T.Y.), University College London Institute of Neurology, UK; Department of Radiology (Y.Z.) and Department of Clinical Neurosciences and Hotchkiss Brain Institute (Y.Z.), University of Calgary, Canada; and Department of Neurology (N.L.S.), Cedars-Sinai Medical Center, Los Angeles, CA
| | - Pascal Sati
- From the Division of Neurology (J.O.), St. Michael's Hospital, University of Toronto, Canada; Department of Neurology (J.O., P.A.C., B.D., D.S.R.), Johns Hopkins University, Baltimore, MD; Mellen Center for Multiple Sclerosis (D.O.), Cleveland Clinic, OH; Department of Neurology (C.A., D.P.), University of Southern California, Los Angeles; Department of Neurology (E.C.K.), Massachusetts General Hospital, Harvard Medical School, Boston; Translational Neuroradiology Unit (M.A., G.N., P.S., D.S.R.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Brain Imaging Centre (D.L.A., S.N.), Montreal Neurological Institute, McGill University, Canada; Departments of Neurology (R.B.) and Radiology (R.B.), Brigham and Women's Hospital, Harvard Medical School, Boston; Department of Biostatistics (C.C.), Johns Hopkins School of Public Health, Baltimore, MD; Department of Neurology (L.F.), University of Texas Health Science Center at Houston; Department of Neurology (S.G., Y.W.), Weill Cornell Medical College, Cornell University, Ithaca, NY; Department of Neurology (R.H.), University of California at San Francisco; Department of Neurology (M.I., A.T.), Mount Sinai Hospital, New York, NY; Division of Neurology, Department of Medicine (S.K., D.K.B.L.), Department of Radiology (S.K., D.K.B.L., A.R.), Department of Physics and Astronomy (S.K., A.R., A.T., Y.Y.), MS/MRI Research Group (S.K., D.K.B.L., A.T., Y.Y.), MRI Research Centre (S.K., D.K.B.L., A.R.), and Department of Pediatrics (A.R.), University of British Columbia, Vancouver, Canada; A. A. Martinos Center for Biomedical Imaging (C.M.), Department of Radiology, Massachusetts General Hospital, Boston; Centre for Functional and Metabolic Mapping (R.S.M.), Robarts Research Institute, Western University, London, CA; Department of Neurology (F.N.), University of Minnesota, Minneapolis; Advanced Imaging Research Center (W.R., D.S., I.T.), Oregon Health & Science University, Portland; Department of Biostatistics, Epidemiology, and Informatics (R.T.S.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Division of Neuroradiology and Neurophysics (T.Y.), University College London Institute of Neurology, UK; Department of Radiology (Y.Z.) and Department of Clinical Neurosciences and Hotchkiss Brain Institute (Y.Z.), University of Calgary, Canada; and Department of Neurology (N.L.S.), Cedars-Sinai Medical Center, Los Angeles, CA
| | - Daniel Schwartz
- From the Division of Neurology (J.O.), St. Michael's Hospital, University of Toronto, Canada; Department of Neurology (J.O., P.A.C., B.D., D.S.R.), Johns Hopkins University, Baltimore, MD; Mellen Center for Multiple Sclerosis (D.O.), Cleveland Clinic, OH; Department of Neurology (C.A., D.P.), University of Southern California, Los Angeles; Department of Neurology (E.C.K.), Massachusetts General Hospital, Harvard Medical School, Boston; Translational Neuroradiology Unit (M.A., G.N., P.S., D.S.R.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Brain Imaging Centre (D.L.A., S.N.), Montreal Neurological Institute, McGill University, Canada; Departments of Neurology (R.B.) and Radiology (R.B.), Brigham and Women's Hospital, Harvard Medical School, Boston; Department of Biostatistics (C.C.), Johns Hopkins School of Public Health, Baltimore, MD; Department of Neurology (L.F.), University of Texas Health Science Center at Houston; Department of Neurology (S.G., Y.W.), Weill Cornell Medical College, Cornell University, Ithaca, NY; Department of Neurology (R.H.), University of California at San Francisco; Department of Neurology (M.I., A.T.), Mount Sinai Hospital, New York, NY; Division of Neurology, Department of Medicine (S.K., D.K.B.L.), Department of Radiology (S.K., D.K.B.L., A.R.), Department of Physics and Astronomy (S.K., A.R., A.T., Y.Y.), MS/MRI Research Group (S.K., D.K.B.L., A.T., Y.Y.), MRI Research Centre (S.K., D.K.B.L., A.R.), and Department of Pediatrics (A.R.), University of British Columbia, Vancouver, Canada; A. A. Martinos Center for Biomedical Imaging (C.M.), Department of Radiology, Massachusetts General Hospital, Boston; Centre for Functional and Metabolic Mapping (R.S.M.), Robarts Research Institute, Western University, London, CA; Department of Neurology (F.N.), University of Minnesota, Minneapolis; Advanced Imaging Research Center (W.R., D.S., I.T.), Oregon Health & Science University, Portland; Department of Biostatistics, Epidemiology, and Informatics (R.T.S.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Division of Neuroradiology and Neurophysics (T.Y.), University College London Institute of Neurology, UK; Department of Radiology (Y.Z.) and Department of Clinical Neurosciences and Hotchkiss Brain Institute (Y.Z.), University of Calgary, Canada; and Department of Neurology (N.L.S.), Cedars-Sinai Medical Center, Los Angeles, CA
| | - Russell T Shinohara
- From the Division of Neurology (J.O.), St. Michael's Hospital, University of Toronto, Canada; Department of Neurology (J.O., P.A.C., B.D., D.S.R.), Johns Hopkins University, Baltimore, MD; Mellen Center for Multiple Sclerosis (D.O.), Cleveland Clinic, OH; Department of Neurology (C.A., D.P.), University of Southern California, Los Angeles; Department of Neurology (E.C.K.), Massachusetts General Hospital, Harvard Medical School, Boston; Translational Neuroradiology Unit (M.A., G.N., P.S., D.S.R.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Brain Imaging Centre (D.L.A., S.N.), Montreal Neurological Institute, McGill University, Canada; Departments of Neurology (R.B.) and Radiology (R.B.), Brigham and Women's Hospital, Harvard Medical School, Boston; Department of Biostatistics (C.C.), Johns Hopkins School of Public Health, Baltimore, MD; Department of Neurology (L.F.), University of Texas Health Science Center at Houston; Department of Neurology (S.G., Y.W.), Weill Cornell Medical College, Cornell University, Ithaca, NY; Department of Neurology (R.H.), University of California at San Francisco; Department of Neurology (M.I., A.T.), Mount Sinai Hospital, New York, NY; Division of Neurology, Department of Medicine (S.K., D.K.B.L.), Department of Radiology (S.K., D.K.B.L., A.R.), Department of Physics and Astronomy (S.K., A.R., A.T., Y.Y.), MS/MRI Research Group (S.K., D.K.B.L., A.T., Y.Y.), MRI Research Centre (S.K., D.K.B.L., A.R.), and Department of Pediatrics (A.R.), University of British Columbia, Vancouver, Canada; A. A. Martinos Center for Biomedical Imaging (C.M.), Department of Radiology, Massachusetts General Hospital, Boston; Centre for Functional and Metabolic Mapping (R.S.M.), Robarts Research Institute, Western University, London, CA; Department of Neurology (F.N.), University of Minnesota, Minneapolis; Advanced Imaging Research Center (W.R., D.S., I.T.), Oregon Health & Science University, Portland; Department of Biostatistics, Epidemiology, and Informatics (R.T.S.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Division of Neuroradiology and Neurophysics (T.Y.), University College London Institute of Neurology, UK; Department of Radiology (Y.Z.) and Department of Clinical Neurosciences and Hotchkiss Brain Institute (Y.Z.), University of Calgary, Canada; and Department of Neurology (N.L.S.), Cedars-Sinai Medical Center, Los Angeles, CA
| | - Ian Tagge
- From the Division of Neurology (J.O.), St. Michael's Hospital, University of Toronto, Canada; Department of Neurology (J.O., P.A.C., B.D., D.S.R.), Johns Hopkins University, Baltimore, MD; Mellen Center for Multiple Sclerosis (D.O.), Cleveland Clinic, OH; Department of Neurology (C.A., D.P.), University of Southern California, Los Angeles; Department of Neurology (E.C.K.), Massachusetts General Hospital, Harvard Medical School, Boston; Translational Neuroradiology Unit (M.A., G.N., P.S., D.S.R.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Brain Imaging Centre (D.L.A., S.N.), Montreal Neurological Institute, McGill University, Canada; Departments of Neurology (R.B.) and Radiology (R.B.), Brigham and Women's Hospital, Harvard Medical School, Boston; Department of Biostatistics (C.C.), Johns Hopkins School of Public Health, Baltimore, MD; Department of Neurology (L.F.), University of Texas Health Science Center at Houston; Department of Neurology (S.G., Y.W.), Weill Cornell Medical College, Cornell University, Ithaca, NY; Department of Neurology (R.H.), University of California at San Francisco; Department of Neurology (M.I., A.T.), Mount Sinai Hospital, New York, NY; Division of Neurology, Department of Medicine (S.K., D.K.B.L.), Department of Radiology (S.K., D.K.B.L., A.R.), Department of Physics and Astronomy (S.K., A.R., A.T., Y.Y.), MS/MRI Research Group (S.K., D.K.B.L., A.T., Y.Y.), MRI Research Centre (S.K., D.K.B.L., A.R.), and Department of Pediatrics (A.R.), University of British Columbia, Vancouver, Canada; A. A. Martinos Center for Biomedical Imaging (C.M.), Department of Radiology, Massachusetts General Hospital, Boston; Centre for Functional and Metabolic Mapping (R.S.M.), Robarts Research Institute, Western University, London, CA; Department of Neurology (F.N.), University of Minnesota, Minneapolis; Advanced Imaging Research Center (W.R., D.S., I.T.), Oregon Health & Science University, Portland; Department of Biostatistics, Epidemiology, and Informatics (R.T.S.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Division of Neuroradiology and Neurophysics (T.Y.), University College London Institute of Neurology, UK; Department of Radiology (Y.Z.) and Department of Clinical Neurosciences and Hotchkiss Brain Institute (Y.Z.), University of Calgary, Canada; and Department of Neurology (N.L.S.), Cedars-Sinai Medical Center, Los Angeles, CA
| | - Anthony Traboulsee
- From the Division of Neurology (J.O.), St. Michael's Hospital, University of Toronto, Canada; Department of Neurology (J.O., P.A.C., B.D., D.S.R.), Johns Hopkins University, Baltimore, MD; Mellen Center for Multiple Sclerosis (D.O.), Cleveland Clinic, OH; Department of Neurology (C.A., D.P.), University of Southern California, Los Angeles; Department of Neurology (E.C.K.), Massachusetts General Hospital, Harvard Medical School, Boston; Translational Neuroradiology Unit (M.A., G.N., P.S., D.S.R.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Brain Imaging Centre (D.L.A., S.N.), Montreal Neurological Institute, McGill University, Canada; Departments of Neurology (R.B.) and Radiology (R.B.), Brigham and Women's Hospital, Harvard Medical School, Boston; Department of Biostatistics (C.C.), Johns Hopkins School of Public Health, Baltimore, MD; Department of Neurology (L.F.), University of Texas Health Science Center at Houston; Department of Neurology (S.G., Y.W.), Weill Cornell Medical College, Cornell University, Ithaca, NY; Department of Neurology (R.H.), University of California at San Francisco; Department of Neurology (M.I., A.T.), Mount Sinai Hospital, New York, NY; Division of Neurology, Department of Medicine (S.K., D.K.B.L.), Department of Radiology (S.K., D.K.B.L., A.R.), Department of Physics and Astronomy (S.K., A.R., A.T., Y.Y.), MS/MRI Research Group (S.K., D.K.B.L., A.T., Y.Y.), MRI Research Centre (S.K., D.K.B.L., A.R.), and Department of Pediatrics (A.R.), University of British Columbia, Vancouver, Canada; A. A. Martinos Center for Biomedical Imaging (C.M.), Department of Radiology, Massachusetts General Hospital, Boston; Centre for Functional and Metabolic Mapping (R.S.M.), Robarts Research Institute, Western University, London, CA; Department of Neurology (F.N.), University of Minnesota, Minneapolis; Advanced Imaging Research Center (W.R., D.S., I.T.), Oregon Health & Science University, Portland; Department of Biostatistics, Epidemiology, and Informatics (R.T.S.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Division of Neuroradiology and Neurophysics (T.Y.), University College London Institute of Neurology, UK; Department of Radiology (Y.Z.) and Department of Clinical Neurosciences and Hotchkiss Brain Institute (Y.Z.), University of Calgary, Canada; and Department of Neurology (N.L.S.), Cedars-Sinai Medical Center, Los Angeles, CA
| | - Yi Wang
- From the Division of Neurology (J.O.), St. Michael's Hospital, University of Toronto, Canada; Department of Neurology (J.O., P.A.C., B.D., D.S.R.), Johns Hopkins University, Baltimore, MD; Mellen Center for Multiple Sclerosis (D.O.), Cleveland Clinic, OH; Department of Neurology (C.A., D.P.), University of Southern California, Los Angeles; Department of Neurology (E.C.K.), Massachusetts General Hospital, Harvard Medical School, Boston; Translational Neuroradiology Unit (M.A., G.N., P.S., D.S.R.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Brain Imaging Centre (D.L.A., S.N.), Montreal Neurological Institute, McGill University, Canada; Departments of Neurology (R.B.) and Radiology (R.B.), Brigham and Women's Hospital, Harvard Medical School, Boston; Department of Biostatistics (C.C.), Johns Hopkins School of Public Health, Baltimore, MD; Department of Neurology (L.F.), University of Texas Health Science Center at Houston; Department of Neurology (S.G., Y.W.), Weill Cornell Medical College, Cornell University, Ithaca, NY; Department of Neurology (R.H.), University of California at San Francisco; Department of Neurology (M.I., A.T.), Mount Sinai Hospital, New York, NY; Division of Neurology, Department of Medicine (S.K., D.K.B.L.), Department of Radiology (S.K., D.K.B.L., A.R.), Department of Physics and Astronomy (S.K., A.R., A.T., Y.Y.), MS/MRI Research Group (S.K., D.K.B.L., A.T., Y.Y.), MRI Research Centre (S.K., D.K.B.L., A.R.), and Department of Pediatrics (A.R.), University of British Columbia, Vancouver, Canada; A. A. Martinos Center for Biomedical Imaging (C.M.), Department of Radiology, Massachusetts General Hospital, Boston; Centre for Functional and Metabolic Mapping (R.S.M.), Robarts Research Institute, Western University, London, CA; Department of Neurology (F.N.), University of Minnesota, Minneapolis; Advanced Imaging Research Center (W.R., D.S., I.T.), Oregon Health & Science University, Portland; Department of Biostatistics, Epidemiology, and Informatics (R.T.S.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Division of Neuroradiology and Neurophysics (T.Y.), University College London Institute of Neurology, UK; Department of Radiology (Y.Z.) and Department of Clinical Neurosciences and Hotchkiss Brain Institute (Y.Z.), University of Calgary, Canada; and Department of Neurology (N.L.S.), Cedars-Sinai Medical Center, Los Angeles, CA
| | - Youngjin Yoo
- From the Division of Neurology (J.O.), St. Michael's Hospital, University of Toronto, Canada; Department of Neurology (J.O., P.A.C., B.D., D.S.R.), Johns Hopkins University, Baltimore, MD; Mellen Center for Multiple Sclerosis (D.O.), Cleveland Clinic, OH; Department of Neurology (C.A., D.P.), University of Southern California, Los Angeles; Department of Neurology (E.C.K.), Massachusetts General Hospital, Harvard Medical School, Boston; Translational Neuroradiology Unit (M.A., G.N., P.S., D.S.R.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Brain Imaging Centre (D.L.A., S.N.), Montreal Neurological Institute, McGill University, Canada; Departments of Neurology (R.B.) and Radiology (R.B.), Brigham and Women's Hospital, Harvard Medical School, Boston; Department of Biostatistics (C.C.), Johns Hopkins School of Public Health, Baltimore, MD; Department of Neurology (L.F.), University of Texas Health Science Center at Houston; Department of Neurology (S.G., Y.W.), Weill Cornell Medical College, Cornell University, Ithaca, NY; Department of Neurology (R.H.), University of California at San Francisco; Department of Neurology (M.I., A.T.), Mount Sinai Hospital, New York, NY; Division of Neurology, Department of Medicine (S.K., D.K.B.L.), Department of Radiology (S.K., D.K.B.L., A.R.), Department of Physics and Astronomy (S.K., A.R., A.T., Y.Y.), MS/MRI Research Group (S.K., D.K.B.L., A.T., Y.Y.), MRI Research Centre (S.K., D.K.B.L., A.R.), and Department of Pediatrics (A.R.), University of British Columbia, Vancouver, Canada; A. A. Martinos Center for Biomedical Imaging (C.M.), Department of Radiology, Massachusetts General Hospital, Boston; Centre for Functional and Metabolic Mapping (R.S.M.), Robarts Research Institute, Western University, London, CA; Department of Neurology (F.N.), University of Minnesota, Minneapolis; Advanced Imaging Research Center (W.R., D.S., I.T.), Oregon Health & Science University, Portland; Department of Biostatistics, Epidemiology, and Informatics (R.T.S.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Division of Neuroradiology and Neurophysics (T.Y.), University College London Institute of Neurology, UK; Department of Radiology (Y.Z.) and Department of Clinical Neurosciences and Hotchkiss Brain Institute (Y.Z.), University of Calgary, Canada; and Department of Neurology (N.L.S.), Cedars-Sinai Medical Center, Los Angeles, CA
| | - Tarek Yousry
- From the Division of Neurology (J.O.), St. Michael's Hospital, University of Toronto, Canada; Department of Neurology (J.O., P.A.C., B.D., D.S.R.), Johns Hopkins University, Baltimore, MD; Mellen Center for Multiple Sclerosis (D.O.), Cleveland Clinic, OH; Department of Neurology (C.A., D.P.), University of Southern California, Los Angeles; Department of Neurology (E.C.K.), Massachusetts General Hospital, Harvard Medical School, Boston; Translational Neuroradiology Unit (M.A., G.N., P.S., D.S.R.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Brain Imaging Centre (D.L.A., S.N.), Montreal Neurological Institute, McGill University, Canada; Departments of Neurology (R.B.) and Radiology (R.B.), Brigham and Women's Hospital, Harvard Medical School, Boston; Department of Biostatistics (C.C.), Johns Hopkins School of Public Health, Baltimore, MD; Department of Neurology (L.F.), University of Texas Health Science Center at Houston; Department of Neurology (S.G., Y.W.), Weill Cornell Medical College, Cornell University, Ithaca, NY; Department of Neurology (R.H.), University of California at San Francisco; Department of Neurology (M.I., A.T.), Mount Sinai Hospital, New York, NY; Division of Neurology, Department of Medicine (S.K., D.K.B.L.), Department of Radiology (S.K., D.K.B.L., A.R.), Department of Physics and Astronomy (S.K., A.R., A.T., Y.Y.), MS/MRI Research Group (S.K., D.K.B.L., A.T., Y.Y.), MRI Research Centre (S.K., D.K.B.L., A.R.), and Department of Pediatrics (A.R.), University of British Columbia, Vancouver, Canada; A. A. Martinos Center for Biomedical Imaging (C.M.), Department of Radiology, Massachusetts General Hospital, Boston; Centre for Functional and Metabolic Mapping (R.S.M.), Robarts Research Institute, Western University, London, CA; Department of Neurology (F.N.), University of Minnesota, Minneapolis; Advanced Imaging Research Center (W.R., D.S., I.T.), Oregon Health & Science University, Portland; Department of Biostatistics, Epidemiology, and Informatics (R.T.S.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Division of Neuroradiology and Neurophysics (T.Y.), University College London Institute of Neurology, UK; Department of Radiology (Y.Z.) and Department of Clinical Neurosciences and Hotchkiss Brain Institute (Y.Z.), University of Calgary, Canada; and Department of Neurology (N.L.S.), Cedars-Sinai Medical Center, Los Angeles, CA
| | - Yunyan Zhang
- From the Division of Neurology (J.O.), St. Michael's Hospital, University of Toronto, Canada; Department of Neurology (J.O., P.A.C., B.D., D.S.R.), Johns Hopkins University, Baltimore, MD; Mellen Center for Multiple Sclerosis (D.O.), Cleveland Clinic, OH; Department of Neurology (C.A., D.P.), University of Southern California, Los Angeles; Department of Neurology (E.C.K.), Massachusetts General Hospital, Harvard Medical School, Boston; Translational Neuroradiology Unit (M.A., G.N., P.S., D.S.R.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Brain Imaging Centre (D.L.A., S.N.), Montreal Neurological Institute, McGill University, Canada; Departments of Neurology (R.B.) and Radiology (R.B.), Brigham and Women's Hospital, Harvard Medical School, Boston; Department of Biostatistics (C.C.), Johns Hopkins School of Public Health, Baltimore, MD; Department of Neurology (L.F.), University of Texas Health Science Center at Houston; Department of Neurology (S.G., Y.W.), Weill Cornell Medical College, Cornell University, Ithaca, NY; Department of Neurology (R.H.), University of California at San Francisco; Department of Neurology (M.I., A.T.), Mount Sinai Hospital, New York, NY; Division of Neurology, Department of Medicine (S.K., D.K.B.L.), Department of Radiology (S.K., D.K.B.L., A.R.), Department of Physics and Astronomy (S.K., A.R., A.T., Y.Y.), MS/MRI Research Group (S.K., D.K.B.L., A.T., Y.Y.), MRI Research Centre (S.K., D.K.B.L., A.R.), and Department of Pediatrics (A.R.), University of British Columbia, Vancouver, Canada; A. A. Martinos Center for Biomedical Imaging (C.M.), Department of Radiology, Massachusetts General Hospital, Boston; Centre for Functional and Metabolic Mapping (R.S.M.), Robarts Research Institute, Western University, London, CA; Department of Neurology (F.N.), University of Minnesota, Minneapolis; Advanced Imaging Research Center (W.R., D.S., I.T.), Oregon Health & Science University, Portland; Department of Biostatistics, Epidemiology, and Informatics (R.T.S.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Division of Neuroradiology and Neurophysics (T.Y.), University College London Institute of Neurology, UK; Department of Radiology (Y.Z.) and Department of Clinical Neurosciences and Hotchkiss Brain Institute (Y.Z.), University of Calgary, Canada; and Department of Neurology (N.L.S.), Cedars-Sinai Medical Center, Los Angeles, CA
| | - Zivadinov Robert
- From the Division of Neurology (J.O.), St. Michael's Hospital, University of Toronto, Canada; Department of Neurology (J.O., P.A.C., B.D., D.S.R.), Johns Hopkins University, Baltimore, MD; Mellen Center for Multiple Sclerosis (D.O.), Cleveland Clinic, OH; Department of Neurology (C.A., D.P.), University of Southern California, Los Angeles; Department of Neurology (E.C.K.), Massachusetts General Hospital, Harvard Medical School, Boston; Translational Neuroradiology Unit (M.A., G.N., P.S., D.S.R.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Brain Imaging Centre (D.L.A., S.N.), Montreal Neurological Institute, McGill University, Canada; Departments of Neurology (R.B.) and Radiology (R.B.), Brigham and Women's Hospital, Harvard Medical School, Boston; Department of Biostatistics (C.C.), Johns Hopkins School of Public Health, Baltimore, MD; Department of Neurology (L.F.), University of Texas Health Science Center at Houston; Department of Neurology (S.G., Y.W.), Weill Cornell Medical College, Cornell University, Ithaca, NY; Department of Neurology (R.H.), University of California at San Francisco; Department of Neurology (M.I., A.T.), Mount Sinai Hospital, New York, NY; Division of Neurology, Department of Medicine (S.K., D.K.B.L.), Department of Radiology (S.K., D.K.B.L., A.R.), Department of Physics and Astronomy (S.K., A.R., A.T., Y.Y.), MS/MRI Research Group (S.K., D.K.B.L., A.T., Y.Y.), MRI Research Centre (S.K., D.K.B.L., A.R.), and Department of Pediatrics (A.R.), University of British Columbia, Vancouver, Canada; A. A. Martinos Center for Biomedical Imaging (C.M.), Department of Radiology, Massachusetts General Hospital, Boston; Centre for Functional and Metabolic Mapping (R.S.M.), Robarts Research Institute, Western University, London, CA; Department of Neurology (F.N.), University of Minnesota, Minneapolis; Advanced Imaging Research Center (W.R., D.S., I.T.), Oregon Health & Science University, Portland; Department of Biostatistics, Epidemiology, and Informatics (R.T.S.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Division of Neuroradiology and Neurophysics (T.Y.), University College London Institute of Neurology, UK; Department of Radiology (Y.Z.) and Department of Clinical Neurosciences and Hotchkiss Brain Institute (Y.Z.), University of Calgary, Canada; and Department of Neurology (N.L.S.), Cedars-Sinai Medical Center, Los Angeles, CA
| | - Nancy L Sicotte
- From the Division of Neurology (J.O.), St. Michael's Hospital, University of Toronto, Canada; Department of Neurology (J.O., P.A.C., B.D., D.S.R.), Johns Hopkins University, Baltimore, MD; Mellen Center for Multiple Sclerosis (D.O.), Cleveland Clinic, OH; Department of Neurology (C.A., D.P.), University of Southern California, Los Angeles; Department of Neurology (E.C.K.), Massachusetts General Hospital, Harvard Medical School, Boston; Translational Neuroradiology Unit (M.A., G.N., P.S., D.S.R.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Brain Imaging Centre (D.L.A., S.N.), Montreal Neurological Institute, McGill University, Canada; Departments of Neurology (R.B.) and Radiology (R.B.), Brigham and Women's Hospital, Harvard Medical School, Boston; Department of Biostatistics (C.C.), Johns Hopkins School of Public Health, Baltimore, MD; Department of Neurology (L.F.), University of Texas Health Science Center at Houston; Department of Neurology (S.G., Y.W.), Weill Cornell Medical College, Cornell University, Ithaca, NY; Department of Neurology (R.H.), University of California at San Francisco; Department of Neurology (M.I., A.T.), Mount Sinai Hospital, New York, NY; Division of Neurology, Department of Medicine (S.K., D.K.B.L.), Department of Radiology (S.K., D.K.B.L., A.R.), Department of Physics and Astronomy (S.K., A.R., A.T., Y.Y.), MS/MRI Research Group (S.K., D.K.B.L., A.T., Y.Y.), MRI Research Centre (S.K., D.K.B.L., A.R.), and Department of Pediatrics (A.R.), University of British Columbia, Vancouver, Canada; A. A. Martinos Center for Biomedical Imaging (C.M.), Department of Radiology, Massachusetts General Hospital, Boston; Centre for Functional and Metabolic Mapping (R.S.M.), Robarts Research Institute, Western University, London, CA; Department of Neurology (F.N.), University of Minnesota, Minneapolis; Advanced Imaging Research Center (W.R., D.S., I.T.), Oregon Health & Science University, Portland; Department of Biostatistics, Epidemiology, and Informatics (R.T.S.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Division of Neuroradiology and Neurophysics (T.Y.), University College London Institute of Neurology, UK; Department of Radiology (Y.Z.) and Department of Clinical Neurosciences and Hotchkiss Brain Institute (Y.Z.), University of Calgary, Canada; and Department of Neurology (N.L.S.), Cedars-Sinai Medical Center, Los Angeles, CA
| | - Daniel S Reich
- From the Division of Neurology (J.O.), St. Michael's Hospital, University of Toronto, Canada; Department of Neurology (J.O., P.A.C., B.D., D.S.R.), Johns Hopkins University, Baltimore, MD; Mellen Center for Multiple Sclerosis (D.O.), Cleveland Clinic, OH; Department of Neurology (C.A., D.P.), University of Southern California, Los Angeles; Department of Neurology (E.C.K.), Massachusetts General Hospital, Harvard Medical School, Boston; Translational Neuroradiology Unit (M.A., G.N., P.S., D.S.R.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; Brain Imaging Centre (D.L.A., S.N.), Montreal Neurological Institute, McGill University, Canada; Departments of Neurology (R.B.) and Radiology (R.B.), Brigham and Women's Hospital, Harvard Medical School, Boston; Department of Biostatistics (C.C.), Johns Hopkins School of Public Health, Baltimore, MD; Department of Neurology (L.F.), University of Texas Health Science Center at Houston; Department of Neurology (S.G., Y.W.), Weill Cornell Medical College, Cornell University, Ithaca, NY; Department of Neurology (R.H.), University of California at San Francisco; Department of Neurology (M.I., A.T.), Mount Sinai Hospital, New York, NY; Division of Neurology, Department of Medicine (S.K., D.K.B.L.), Department of Radiology (S.K., D.K.B.L., A.R.), Department of Physics and Astronomy (S.K., A.R., A.T., Y.Y.), MS/MRI Research Group (S.K., D.K.B.L., A.T., Y.Y.), MRI Research Centre (S.K., D.K.B.L., A.R.), and Department of Pediatrics (A.R.), University of British Columbia, Vancouver, Canada; A. A. Martinos Center for Biomedical Imaging (C.M.), Department of Radiology, Massachusetts General Hospital, Boston; Centre for Functional and Metabolic Mapping (R.S.M.), Robarts Research Institute, Western University, London, CA; Department of Neurology (F.N.), University of Minnesota, Minneapolis; Advanced Imaging Research Center (W.R., D.S., I.T.), Oregon Health & Science University, Portland; Department of Biostatistics, Epidemiology, and Informatics (R.T.S.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Division of Neuroradiology and Neurophysics (T.Y.), University College London Institute of Neurology, UK; Department of Radiology (Y.Z.) and Department of Clinical Neurosciences and Hotchkiss Brain Institute (Y.Z.), University of Calgary, Canada; and Department of Neurology (N.L.S.), Cedars-Sinai Medical Center, Los Angeles, CA
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31
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O'Muircheartaigh J, Vavasour I, Ljungberg E, Li DKB, Rauscher A, Levesque V, Garren H, Clayton D, Tam R, Traboulsee A, Kolind S. Quantitative neuroimaging measures of myelin in the healthy brain and in multiple sclerosis. Hum Brain Mapp 2019; 40:2104-2116. [PMID: 30648315 PMCID: PMC6590140 DOI: 10.1002/hbm.24510] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [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: 06/20/2018] [Revised: 12/28/2018] [Accepted: 01/02/2019] [Indexed: 12/25/2022] Open
Abstract
Quantitative magnetic resonance imaging (MRI) techniques have been developed as imaging biomarkers, aiming to improve the specificity of MRI to underlying pathology compared to conventional weighted MRI. For assessing the integrity of white matter (WM), myelin, in particular, several techniques have been proposed and investigated individually. However, comparisons between these methods are lacking. In this study, we compared four established myelin‐sensitive MRI techniques in 56 patients with relapsing–remitting multiple sclerosis (MS) and 38 healthy controls. We used T2‐relaxation with combined GRadient And Spin Echoes (GRASE) to measure myelin water fraction (MWF‐G), multi‐component driven equilibrium single pulse observation of T1 and T2 (mcDESPOT) to measure MWF‐D, magnetization‐transfer imaging to measure magnetization‐transfer ratio (MTR), and T1 relaxation to measure quantitative T1 (qT1). Using voxelwise Spearman correlations, we tested the correspondence of methods throughout the brain. All four methods showed associations that varied across tissue types; the highest correlations were found between MWF‐D and qT1 (median ρ across tissue classes 0.8) and MWF‐G and MWF‐D (median ρ = 0.59). In eight WM tracts, all measures showed differences (p < 0.05) between MS normal‐appearing WM and healthy control WM, with qT1 showing the highest number of different regions (8), followed by MWF‐D and MTR (6), and MWF‐G (n = 4). Comparing the methods in terms of their statistical sensitivity to MS lesions in WM, MWF‐D demonstrated the best accuracy (p < 0.05, after multiple comparison correction). To aid future power analysis, we provide the average and standard deviation volumes of the four techniques, estimated from the healthy control sample.
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Affiliation(s)
- Jonathan O'Muircheartaigh
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, United Kingdom.,Centre for the Developing Brain, Department of Perinatal Imaging and Health, St. Thomas' Hospital, King's College London, London, United Kingdom.,Department of Neuroimaging, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, United Kingdom.,MRC Centre for Neurodevelopmental Disorders, King's College London, London, United Kingdom
| | - Irene Vavasour
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Emil Ljungberg
- Department of Neuroimaging, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, United Kingdom
| | - David K B Li
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada.,MS/MRI Research Group, Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alexander Rauscher
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Physics and Astronomy, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | - Roger Tam
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada.,MS/MRI Research Group, Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada.,School of Biomedical Engineering, University of British Columbia, Vancouver, British Columbia, Canada
| | - Anthony Traboulsee
- MS/MRI Research Group, Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada.,Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Shannon Kolind
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada.,MS/MRI Research Group, Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Physics and Astronomy, University of British Columbia, Vancouver, British Columbia, Canada.,Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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32
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Sharma S, Laule C, Moore GRW, Li DKB, Zhang Y. Correlating new directional measures of myelin and axonal integrity in T2-weighted MRI with quantitative histology in multiple sclerosis. J Neurosci Methods 2019; 311:369-376. [PMID: 30240805 DOI: 10.1016/j.jneumeth.2018.09.020] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 09/17/2018] [Accepted: 09/17/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Imaging measurement of structure alignment has shown increasing importance in determining tissue properties. It is not known if a similar ability for characterizing neuropathology exists. NEW METHODS This study aimed to validate a new alignment-assessing method for measuring myelin and axonal properties using quantitative histological metrics. The new method involved analysis of the Fourier transform (FT) power spectrum in standard magnetic resonance imaging (MRI). T2-weighted MRI were collected from 10 post-mortem multiple sclerosis (MS) brain samples. Three tissue types were examined: lesions, diffusely abnormal white matter, and normal appearing white matter. MRI analysis included computing the FT power spectrum; extracting alignment histograms; and calculating dominant orientation and alignment complexity (angular entropy). Post MRI, the brain samples were processed for myelin and axonal staining, and the stained images were used to derive quantitative orientation measures using structure tensor analysis for MRI comparison. RESULTS There were significant differences in orientation metrics between tissue types in both MRI and histology, and MRI measurements correlated strongly with histological indices. Moreover, the joint effect of myelin and axonal entropy explained over 95% of the variance of MRI angular entropy. COMPARISON WITH EXISTING METHOD There is no established method for characterizing myelin and axonal pathology using standard MRI. Advanced MRI methods have the potential to do this but are still in research development and are not yet routinely acquired in clinical practice. CONCLUSIONS Alignment measurement using clinical MRI scans may become a valuable new method for characterizing myelin and axonal properties in MS patients.
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Affiliation(s)
- Shrushrita Sharma
- Department of Radiology, University of Calgary, Alberta, Canada; Department of Clinical Neurosciences, University of Calgary, Alberta, Canada; Hotchkiss Brain Institute, University of Calgary, Alberta, Canada
| | - Cornelia Laule
- Department of Radiology, University of British Columbia, British Columbia, Canada; Department of Pathology and Laboratory Medicine, University of British Columbia, British Columbia, Canada; International Collaboration on Repair Discoveries (ICORD), University of British Columbia, British Columbia, Canada; Department of Physics & Astronomy, University of British Columbia, British Columbia, Canada
| | - G R Wayne Moore
- Department of Pathology and Laboratory Medicine, University of British Columbia, British Columbia, Canada; International Collaboration on Repair Discoveries (ICORD), University of British Columbia, British Columbia, Canada
| | - David K B Li
- Department of Radiology, University of British Columbia, British Columbia, Canada
| | - Yunyan Zhang
- Department of Radiology, University of Calgary, Alberta, Canada; Department of Clinical Neurosciences, University of Calgary, Alberta, Canada; Hotchkiss Brain Institute, University of Calgary, Alberta, Canada.
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33
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Wiggermann V, Lapointe E, Litvin L, Graf C, Hernández-Torres E, McKenzie M, Vavasour IM, Laule C, MacMillan EL, Li DKB, Kolind SH, Rauscher A, Traboulsee AL. Longitudinal advanced MRI case report of white matter radiation necrosis. Ann Clin Transl Neurol 2018; 6:379-385. [PMID: 30847370 PMCID: PMC6389755 DOI: 10.1002/acn3.704] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 08/15/2018] [Revised: 10/09/2018] [Accepted: 10/31/2018] [Indexed: 11/11/2022] Open
Abstract
Radiation necrosis mostly occurs in and near the radiation field. We used magnetic resonance imaging to study radiation-induced necrosis of atypical onset, severity, and extent following stereotactic radiosurgery for a symptomatic arteriovenous malformation. Susceptibility-sensitive imaging, T1-relaxation, myelin water imaging, and magnetic resonance spectroscopy were acquired three times up to 52 months postradiosurgery. Increasing water content outside the radiation field, contralateral neuronal loss, and gliosis were detected over time. Our findings suggest that radiation-induced vasculopathic changes spread more diffusely than previously described. An autoimmune response to brain antigens could underlie white matter changes outside the initial radiation field.
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Affiliation(s)
- Vanessa Wiggermann
- Department of Physics and Astronomy University of British Columbia Vancouver British Columbia Canada.,Department of Pediatrics University of British Columbia Vancouver British Columbia Canada.,UBC MRI Research Centre University of British Columbia Vancouver British Columbia Canada
| | - Emmanuelle Lapointe
- Department of Medicine Division of Neurology University of British Columbia Vancouver British Columbia Canada
| | - Ludmila Litvin
- Department of Radiology University of British Columbia Vancouver British Columbia Canada
| | - Carina Graf
- Department of Physics and Astronomy University of British Columbia Vancouver British Columbia Canada.,International Collaboration on Repair Discoveries (ICORD) University of British Columbia Vancouver British Columbia Canada
| | - Enedino Hernández-Torres
- Department of Pediatrics University of British Columbia Vancouver British Columbia Canada.,UBC MRI Research Centre University of British Columbia Vancouver British Columbia Canada
| | - Michael McKenzie
- Department of Surgery Division of Radiation Oncology and Developmental Radiotherapeutics University of British Columbia Vancouver British Columbia Canada
| | - Irene M Vavasour
- UBC MRI Research Centre University of British Columbia Vancouver British Columbia Canada.,Department of Radiology University of British Columbia Vancouver British Columbia Canada
| | - Cornelia Laule
- Department of Physics and Astronomy University of British Columbia Vancouver British Columbia Canada.,Department of Radiology University of British Columbia Vancouver British Columbia Canada.,International Collaboration on Repair Discoveries (ICORD) University of British Columbia Vancouver British Columbia Canada.,Department of Pathology & Laboratory Medicine University of British Columbia Vancouver British Columbia Canada
| | - Erin L MacMillan
- UBC MRI Research Centre University of British Columbia Vancouver British Columbia Canada.,Department of Radiology University of British Columbia Vancouver British Columbia Canada.,Philips Markham Ontario Canada
| | - David K B Li
- Department of Medicine Division of Neurology University of British Columbia Vancouver British Columbia Canada.,Department of Radiology University of British Columbia Vancouver British Columbia Canada
| | - Shannon H Kolind
- Department of Physics and Astronomy University of British Columbia Vancouver British Columbia Canada.,Department of Medicine Division of Neurology University of British Columbia Vancouver British Columbia Canada.,Department of Radiology University of British Columbia Vancouver British Columbia Canada
| | - Alexander Rauscher
- Department of Physics and Astronomy University of British Columbia Vancouver British Columbia Canada.,Department of Pediatrics University of British Columbia Vancouver British Columbia Canada.,UBC MRI Research Centre University of British Columbia Vancouver British Columbia Canada.,Department of Radiology University of British Columbia Vancouver British Columbia Canada
| | - Anthony L Traboulsee
- Department of Medicine Division of Neurology University of British Columbia Vancouver British Columbia Canada
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34
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Lin S, Vavasour I, Kosaka B, Li DKB, Traboulsee A, MacKay A, McKeown MJ. Education, and the balance between dynamic and stationary functional connectivity jointly support executive functions in relapsing-remitting multiple sclerosis. Hum Brain Mapp 2018; 39:5039-5049. [PMID: 30240533 PMCID: PMC6866468 DOI: 10.1002/hbm.24343] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [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: 04/09/2018] [Revised: 07/18/2018] [Accepted: 07/24/2018] [Indexed: 01/20/2023] Open
Abstract
Graphical network characteristics and nonstationary functional connectivity features, both derived from resting-state functional magnetic resonance imaging (rsfMRI) data, have been associated with cognitive performance in healthy subjects. How these features jointly relate to cognition in diseased states has not been investigated. In this study, 46 relapsing-remitting multiple sclerosis subjects underwent rsfMRI scans and a focused cognitive battery. With a sliding window approach, we examined six dynamic network features that indicated how connectivity changed over time as well as six measures derived from graph theory to reflect static network characteristics. Multiset canonical correlation analysis (MCCA) was then carried out to investigate the relations between dynamic network features, stationary network characteristics, cognitive testing, demographic, disease severity, and mood. Multiple sclerosis (MS) subjects demonstrated weaker connectivity strength, decreased network density, reduced global changes, but increased changes in interhemispheric connectivity compared to controls. The MCCA model determined that executive functions and processing speed ability measured by Wechsler Adult Intelligence Scale IV (WAIS-IV) Working Memory Index, WAIS-IV Processing Speed Index, and the Verbal Fluency Test were positively correlated with education, dynamic connectivity, and static connectivity strength; while poor task switching was correlated with disease severity, psychiatric comorbidities such as depression, anxiety, and fatigue, and static network density. Taken together, our results suggest that better executive functioning in MS requires maintenance of a continued coordination between stationary and dynamic functional connectivity as well as the support of education, and dynamic functional connectivity may provide an additional cognitive biomarker of disease severity in the MS population.
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Affiliation(s)
- Sue‐Jin Lin
- Graduate Program in NeuroscienceUniversity of British ColumbiaVancouverBritish ColumbiaCanada
- Pacific Parkinson's Research CentreUniversity of British Columbia HospitalVancouverBritish ColumbiaCanada
| | - Irene Vavasour
- Department of RadiologyUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Brenda Kosaka
- Department of PsychiatryUniversity of British Columbia HospitalVancouverBritish ColumbiaCanada
| | - David K. B. Li
- Department of RadiologyUniversity of British ColumbiaVancouverBritish ColumbiaCanada
- Faculty of Medicine, NeurologyUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Anthony Traboulsee
- Faculty of Medicine, NeurologyUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Alex MacKay
- Department of RadiologyUniversity of British ColumbiaVancouverBritish ColumbiaCanada
- Department of Physics and AstronomyUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Martin J. McKeown
- Graduate Program in NeuroscienceUniversity of British ColumbiaVancouverBritish ColumbiaCanada
- Pacific Parkinson's Research CentreUniversity of British Columbia HospitalVancouverBritish ColumbiaCanada
- Faculty of Medicine, NeurologyUniversity of British ColumbiaVancouverBritish ColumbiaCanada
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35
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Lee LE, Ljungberg E, Shin D, Figley CR, Vavasour IM, Rauscher A, Cohen-Adad J, Li DKB, Traboulsee AL, MacKay AL, Lee J, Kolind SH. Inter-Vendor Reproducibility of Myelin Water Imaging Using a 3D Gradient and Spin Echo Sequence. Front Neurosci 2018; 12:854. [PMID: 30519158 PMCID: PMC6258882 DOI: 10.3389/fnins.2018.00854] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [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: 08/02/2018] [Accepted: 11/01/2018] [Indexed: 01/22/2023] Open
Abstract
Myelin water imaging can be achieved using multicomponent T2 relaxation analysis to quantify in vivo measurement of myelin content, termed the myelin water fraction (MWF). Therefore, myelin water imaging can be a valuable tool to better understand the underlying white matter pathology in demyelinating diseases, such as multiple sclerosis. To apply myelin water imaging in multisite studies and clinical applications, it must be acquired in a clinically feasible scan time (less than 15 min) and be reproducible across sites and scanner vendors. Here, we assessed the reproducibility of MWF measurements in regional and global white matter in 10 healthy human brains across two sites with two different 3 T magnetic resonance imaging scanner vendors (Philips and Siemens), using a 32-echo gradient and spin echo (GRASE) sequence. A strong correlation was found between the MWF measurements in the global white matter (Pearson's r = 0.91; p < 0.001) for all participants across the two sites. The mean intersite MWF coefficient of variation across participants was 2.77% in the global white matter and ranged from 4.47% (splenium of the corpus callosum) to 17.89% (genu of the corpus callosum) in white matter regions of interest. Bland-Altman analysis showed a good agreement in MWF measurements between the two sites with small bias of 0.002. Overall, MWF estimates were in good agreement across the two sites and scanner vendors. Our findings support the use of quantitative multi-echo T2 relaxation metrics, such as the MWF, in multicenter studies and clinical trials to gain deeper understanding about the pathological processes resulting from the underlying disease progression in neurodegenerative diseases.
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Affiliation(s)
- Lisa Eunyoung Lee
- Department of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Emil Ljungberg
- Department of Medicine, The University of British Columbia, Vancouver, BC, Canada.,Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Dongmyung Shin
- Department of Electrical and Computer Engineering, Seoul National University, Seoul, South Korea
| | - Chase R Figley
- Department of Radiology, University of Manitoba, Winnipeg, MB, Canada
| | - Irene M Vavasour
- Department of Radiology, The University of British Columbia, Vancouver, BC, Canada
| | - Alexander Rauscher
- Department of Radiology, The University of British Columbia, Vancouver, BC, Canada.,Department of Pediatrics, The University of British Columbia, Vancouver, BC, Canada.,Department of Physics and Astronomy, The University of British Columbia, Vancouver, BC, Canada
| | - Julien Cohen-Adad
- NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montreal, Montreal, QC, Canada.,Functional Neuroimaging Unit, CRIUGM, Université de Montréal, Montreal, QC, Canada
| | - David K B Li
- Department of Radiology, The University of British Columbia, Vancouver, BC, Canada
| | - Anthony L Traboulsee
- Department of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Alex L MacKay
- Department of Radiology, The University of British Columbia, Vancouver, BC, Canada.,Department of Physics and Astronomy, The University of British Columbia, Vancouver, BC, Canada
| | - Jongho Lee
- Department of Electrical and Computer Engineering, Seoul National University, Seoul, South Korea
| | - Shannon H Kolind
- Department of Medicine, The University of British Columbia, Vancouver, BC, Canada.,Department of Radiology, The University of British Columbia, Vancouver, BC, Canada.,Department of Physics and Astronomy, The University of British Columbia, Vancouver, BC, Canada
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36
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Traboulsee A, Li DKB, Cascione M, Fang J, Dangond F, Miller A. Effect of interferon beta-1a subcutaneously three times weekly on clinical and radiological measures and no evidence of disease activity status in patients with relapsing-remitting multiple sclerosis at year 1. BMC Neurol 2018; 18:143. [PMID: 30217172 PMCID: PMC6137887 DOI: 10.1186/s12883-018-1145-x] [Citation(s) in RCA: 12] [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: 03/21/2017] [Accepted: 08/30/2018] [Indexed: 11/29/2022] Open
Abstract
Background In the PRISMS study, interferon beta-1a subcutaneously (IFN β-1a SC) reduced clinical and radiological disease burden at 2 years in patients with relapsing–remitting multiple sclerosis. The study aimed to characterize efficacy of IFN β-1a SC 44 μg and 22 μg three times weekly (tiw) at Year 1. Methods Exploratory endpoints included annualized relapse rate (ARR), 3-month confirmed disability progression (1-point Expanded Disability Status Scale increase if baseline was < 6.0 [0.5-point if baseline was ≥6.0]), active T2 lesions, and no evidence of disease activity (NEDA; defined as no relapses [subanalyzed by relapse severity], 3-month confirmed progression, or active T2 lesions). Effect of IFN β-1a SC in prespecified patient subgroups was also assessed. Results Patients were randomized to IFN β-1a 22 μg (n = 189), 44 μg (n = 184), or placebo (n = 187). At 1 year, IFN β-1a SC tiw reduced ARR (p < 0.001), risk of disability progression (p ≤ 0.029), and mean number of active T2 lesions per patients per scan (p < 0.001) versus placebo. Clinical and radiological benefits were seen as early as Month 2 and 3. Outcomes in subgroups were consistent with those in the overall population. More patients treated with IFN β-1a SC tiw achieved NEDA status, versus placebo, regardless of relapse severity (p ≤ 0.006). Conclusion Clinical, radiological, and NEDA outcomes at Year 1 were consistent with Year 2 results. Treatment efficacy was consistent in pre-specified patient subgroups. Electronic supplementary material The online version of this article (10.1186/s12883-018-1145-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anthony Traboulsee
- University of British Columbia, S113-2211 Wesbrook Mall, Vancouver, BC, V6T 1Z7, Canada.
| | - David K B Li
- University of British Columbia, S113-2211 Wesbrook Mall, Vancouver, BC, V6T 1Z7, Canada
| | - Mark Cascione
- Tampa Neurology Associates, South Tampa Multiple Sclerosis Center, 2919 W. Swann Avenue, Suite 401, South Tampa, FL, 33609, USA
| | - Juanzhi Fang
- EMD Serono, Inc., One Technology Place, Rockland, MA, 02370, USA
| | | | - Aaron Miller
- Mount Sinai Hospital, 5 East 98th Street, 1st Floor, New York, NY, 10029, USA
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37
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Kang H, Hii M, Le M, Tam R, Riddehough A, Traboulsee A, Kolind S, Freedman MS, Li DKB. Gadolinium Deposition in Deep Brain Structures: Relationship with Dose and Ionization of Linear Gadolinium-Based Contrast Agents. AJNR Am J Neuroradiol 2018; 39:1597-1603. [PMID: 30139752 DOI: 10.3174/ajnr.a5751] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Accepted: 06/20/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Dose-dependent association between hyperintensity in deep brain structures on unenhanced T1WIs and gadolinium-based contrast agent administrations has been demonstrated with subsequent histopathological confirmation of gadolinium deposition. Our aim was to determine whether greater exposure to linear gadolinium-based contrast agent administration is associated with higher signal intensity in deep brain structures on unenhanced T1-weighted MR imaging. Secondary objective was to compare signal intensity differences between ionic and nonionic linear gadolinium-based contrast agents. MATERIALS AND METHODS Subjects with secondary-progressive MS originally enrolled in a multicenter clinical trial were studied retrospectively. Eighty subjects (high-exposure cohort) received 9 linear gadolinium-based contrast agent administrations (30 nonionic/50 ionic) between week -4 and year 1 and a tenth administration by year 2. One hundred fifteen subjects (low-exposure cohort) received 2 administrations (40 nonionic/75 ionic) between week -4 and year 1 and a third administration by year 2. Signal intensities were measured on unenhanced T1WIs by placing sample-points on the dentate nucleus, globus pallidus, caudate, thalamus, pons, and white matter, and they were normalized using the following ratios: dentate/pons, globus pallidus/white matter, caudate/white matter, and thalamus/white matter. RESULTS Between week -4 and year 1, subjects in the high-exposure cohort showed increased signal intensity ratios in all regions (P < .01), while the low-exposure cohort showed only an increase in the dentate nucleus (P = .003). Between years 1 and 2, when both cohorts received only 1 additional gadolinium-based contrast agent, no significant changes were observed. In the high-exposure cohort, significantly higher changes in signal intensity ratios were observed in subjects receiving linear nonionic than in those receiving linear ionic gadolinium-based contrast agents. CONCLUSIONS Hyperintensity in deep brain structures from gadolinium deposition is related to the number of doses and the type of linear gadolinium-based contrast agent (nonionic greater than ionic) administration.
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Affiliation(s)
- H Kang
- From the Department of Radiology (H.K., M.L., R.T., S.K., D.K.B.L.)
| | - M Hii
- University of British Columbia MS/MRI Research Group (M.H., R.T., A.R., A.T., S.K., D.K.B.L.)
| | - M Le
- From the Department of Radiology (H.K., M.L., R.T., S.K., D.K.B.L.)
| | - R Tam
- From the Department of Radiology (H.K., M.L., R.T., S.K., D.K.B.L.).,University of British Columbia MS/MRI Research Group (M.H., R.T., A.R., A.T., S.K., D.K.B.L.)
| | - A Riddehough
- University of British Columbia MS/MRI Research Group (M.H., R.T., A.R., A.T., S.K., D.K.B.L.)
| | - A Traboulsee
- University of British Columbia MS/MRI Research Group (M.H., R.T., A.R., A.T., S.K., D.K.B.L.).,Department of Medicine and Division of Neurology (A.T., S.K., D.K.B.L.)
| | - S Kolind
- From the Department of Radiology (H.K., M.L., R.T., S.K., D.K.B.L.).,University of British Columbia MS/MRI Research Group (M.H., R.T., A.R., A.T., S.K., D.K.B.L.).,Department of Medicine and Division of Neurology (A.T., S.K., D.K.B.L.).,Department of Physics and Astronomy (S.K.), University of British Columbia, Vancouver, British Columbia, Canada
| | - M S Freedman
- Department of Medicine and Division of Neurology (M.S.F.), University of Ottawa and the Ottawa Hospital Research Institute, Ottawa, Canada
| | - D K B Li
- From the Department of Radiology (H.K., M.L., R.T., S.K., D.K.B.L.).,University of British Columbia MS/MRI Research Group (M.H., R.T., A.R., A.T., S.K., D.K.B.L.).,Department of Medicine and Division of Neurology (A.T., S.K., D.K.B.L.)
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Weber AM, Pukropski A, Kames C, Jarrett M, Dadachanji S, Taunton J, Li DKB, Rauscher A. Pathological Insights From Quantitative Susceptibility Mapping and Diffusion Tensor Imaging in Ice Hockey Players Pre and Post-concussion. Front Neurol 2018; 9:575. [PMID: 30131752 PMCID: PMC6091605 DOI: 10.3389/fneur.2018.00575] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 02/09/2018] [Accepted: 06/26/2018] [Indexed: 01/27/2023] Open
Abstract
Myelin sensitive MRI techniques, such as diffusion tensor imaging and myelin water imaging, have previously been used to reveal changes in myelin after sports-related concussions. What is not clear from these studies, however, is how myelin is affected: whether it becomes degraded and possibly removed, or whether the myelin sheath loosens and becomes “decompacted”. Previously, our team revealed myelin specific changes in ice hockey players 2 weeks post-concussion using myelin water imaging. In that study, 45 subjects underwent a pre-season baseline scan, 11 of which sustained a concussion during play and received follow-up scans: eight were scanned within 3 days, 10 were scanned at 14 days, and nine were scanned at 60 days. In the current retrospective analysis, we used quantitative susceptibility mapping, along with the diffusion tensor imaging measures axial diffusivity and radial diffusivity, to investigate this myelin disruption. If sports-related concussive hits lead to myelin fragmentation in regions of lowered MWF, this should result in a measurable increase in magnetic susceptibility, due to the anisotropic myelin fragmenting into isotropic myelin debris, and the diamagnetic myelin tissue being removed, while no such changes should be expected if the myelin sheath simply loosens and becomes decompacted. An increase in radial diffusivity would likewise reveal myelin fragmentation, as myelin sheaths block water diffusion out of the axon, with little to no changes expected for myelin sheath loosening. Statistical analysis of the same voxels-of-interest that were found to have reduced myelin water fraction 2 weeks post-concussion, revealed no statistically significant changes in magnetic susceptibility, axial diffusivity, or radial diffusivity at any time-point post-concussion. This suggests that myelin water fraction changes are likely due to a loosening of the myelin sheath structure, as opposed to fragmentation and removal of myelin debris.
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Affiliation(s)
- Alexander M Weber
- Division of Neurology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada.,UBC MRI Research Centre, University of British Columbia, Vancouver, BC, Canada
| | - Anna Pukropski
- Program of Cognitive Science, University of Osnabrueck, Osnabrueck, Germany
| | - Christian Kames
- UBC MRI Research Centre, University of British Columbia, Vancouver, BC, Canada.,Department of Physics and Astronomy, University of British Columbia, Vancouver, BC, Canada
| | - Michael Jarrett
- Division of Neurology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada.,UBC MRI Research Centre, University of British Columbia, Vancouver, BC, Canada
| | - Shiroy Dadachanji
- Division of Sports Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Jack Taunton
- Division of Sports Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - David K B Li
- UBC MRI Research Centre, University of British Columbia, Vancouver, BC, Canada.,Department of Radiology, University of British Columbia, Vancouver, BC, Canada.,MS/MRI Research Group, University of British Columbia, Vancouver, BC, Canada
| | - Alexander Rauscher
- Division of Neurology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada.,UBC MRI Research Centre, University of British Columbia, Vancouver, BC, Canada.,Department of Radiology, University of British Columbia, Vancouver, BC, Canada
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Traboulsee A, Li DKB, Cascione M, Fang J, Dangond F, Miller A. Predictive value of early magnetic resonance imaging measures is differentially affected by the dose of interferon beta-1a given subcutaneously three times a week: an exploratory analysis of the PRISMS study. BMC Neurol 2018; 18:68. [PMID: 29751787 PMCID: PMC5946401 DOI: 10.1186/s12883-018-1066-8] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 05/01/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND On-treatment magnetic resonance imaging lesions may predict long-term clinical outcomes in patients receiving interferon β-1a. This study aimed to assess the effect of active T2 and T1 gadolinium-enhancing (Gd+) lesions on relapses and 3-month confirmed Expanded Disability Status Scale (EDSS) progression in the PRISMS clinical trial. METHODS Exploratory analyses assessed whether active T2 and T1 Gd + lesions at Month 6, or active T2 lesions at Month 12, predicted clinical outcomes over 4 years in PRISMS. RESULTS Mean active T2 lesion number at Month 6 was significantly lower with interferon beta-1a given subcutaneously (IFN β-1a SC) 44 μg and 22 μg 3×/week (tiw) than with placebo (p < 0.0001). The presence of ≥4 versus 0 active T2 lesions predicted disability progression at Years 3-4 in the IFN β-1a SC 22 μg group only (p < 0.05), whereas the presence of ≥2 versus 0-1 active T2 lesions predicted disability progression in the placebo/delayed treatment (DTx) (Years 2-4; p < 0.05) and IFN β-1a SC 22 μg groups (Years 3-4; p < 0.05). Greater active T2 lesion number at 6 months predicted relapses in the placebo/DTx group only (≥4 vs. 0, Years 1-4; ≥2 vs. 0-1, Years 2-4; p < 0.05), and the presence of T1 Gd + lesions at 6 months predicted disability progression in the IFN β-1a SC 44 μg group only (Year 1; p < 0.05). The presence of ≥2 versus 0-1 active T2 lesions at 12 months predicted disability progression over 3 and 4 years in the IFN β-1a SC 44 μg group. CONCLUSION Active T2 lesions at 6 months predicted clinical outcomes in patients receiving placebo or IFN β-1a SC 22 μg, but not in those receiving IFN β-1a SC 44 μg. Active T2 lesions at 12 months may predict outcomes in those receiving IFN β-1a SC 44 μg and are possibly more suggestive of poor response to therapy than T2 results at 6 months.
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Affiliation(s)
- Anthony Traboulsee
- University of British Columbia, S113-2211 Wesbrook Mall, Vancouver, BC, V6T 1Z7, Canada.
| | - David K B Li
- University of British Columbia, S113-2211 Wesbrook Mall, Vancouver, BC, V6T 1Z7, Canada
| | - Mark Cascione
- Tampa Neurology Associates, South Tampa Multiple Sclerosis Center, 2919 W. Swann Avenue, Suite 401, South Tampa, FL, 33609, USA
| | - Juanzhi Fang
- EMD Serono, Inc., One Technology Place, Rockland, MA, 02370, USA
| | - Fernando Dangond
- EMD Serono, Inc., 45A Middlesex Turnpike, Billerica, MA, 01821, USA
| | - Aaron Miller
- Mount Sinai Hospital, 5 East 98th Street, 1st Floor, New York, NY, 10029, USA
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Laule C, Vavasour IM, Shahinfard E, Mädler B, Zhang J, Li DKB, MacKay AL, Sirrs SM. Hematopoietic Stem Cell Transplantation in Late‐Onset Krabbe Disease: No Evidence of Worsening Demyelination and Axonal Loss 4 Years Post‐allograft. J Neuroimaging 2018; 28:252-255. [DOI: 10.1111/jon.12502] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 01/16/2018] [Indexed: 11/30/2022] Open
Affiliation(s)
- Cornelia Laule
- Department of RadiologyUniversity of British Columbia Vancouver Canada
- Department of Pathology & Laboratory MedicineUniversity of British Columbia Vancouver Canada
- International Collaboration on Repair Discoveries (ICORD)University of British Columbia Vancouver Canada
- Department of Physics & AstronomyUniversity of British Columbia Vancouver Canada
| | - Irene M. Vavasour
- Department of RadiologyUniversity of British Columbia Vancouver Canada
| | - Elham Shahinfard
- Department of RadiologyUniversity of British Columbia Vancouver Canada
| | | | - Jing Zhang
- Department of RadiologyUniversity of British Columbia Vancouver Canada
| | - David K. B. Li
- Department of RadiologyUniversity of British Columbia Vancouver Canada
- Department of Medicine (Neurology)University of British Columbia Vancouver Canada
| | - Alex L. MacKay
- Department of RadiologyUniversity of British Columbia Vancouver Canada
- Department of Physics & AstronomyUniversity of British Columbia Vancouver Canada
| | - Sandra M. Sirrs
- Department of Medicine (Endocrinology)University of British Columbia Vancouver Canada
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Abstract
Using MR imaging, perfusion can be assessed either by dynamic susceptibility contrast MR imaging or arterial spin-labeling. Alterations of cerebral perfusion have repeatedly been described in multiple sclerosis compared with healthy controls. Acute lesions exhibit relative hyperperfusion in comparison with normal-appearing white matter, a finding mostly attributed to inflammation in this stage of lesion development. In contrast, normal-appearing white and gray matter of patients with MS has been mostly found to be hypoperfused compared with controls, and correlations with cognitive impairment as well as fatigue in multiple sclerosis have been described. Mitochondrial failure, axonal degeneration, and vascular dysfunction have been hypothesized to underlie the perfusion MR imaging findings. Clinically, perfusion MR imaging could allow earlier detection of the acute focal inflammatory changes underlying relapses and new lesions, and could constitute a marker for cognitive dysfunction in MS. Nevertheless, the clinical relevance and pathogenesis of the brain perfusion changes in MS remain to be clarified.
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Affiliation(s)
- E Lapointe
- From the Division of Neurology (E.L., A.L.T.) .,Department of Medicine (E.L., A.L.T.)
| | - D K B Li
- Radiology (D.K.B.L.), University of British Columbia, Djavad Mowafaghian Center for Brain Health, Vancouver, British Columbia, Canada
| | - A L Traboulsee
- From the Division of Neurology (E.L., A.L.T.).,Department of Medicine (E.L., A.L.T.)
| | - A Rauscher
- MRI Research Center (A.R.).,Departments of Pediatrics (A.R.)
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Lin SJ, Lam J, Beveridge S, Vavasour I, Traboulsee A, Li DKB, MacKay A, McKeown M, Kosaka B. Cognitive Performance in Subjects With Multiple Sclerosis Is Robustly Influenced by Gender in Canonical-Correlation Analysis. J Neuropsychiatry Clin Neurosci 2017; 29:119-127. [PMID: 27899053 DOI: 10.1176/appi.neuropsych.16040083] [Citation(s) in RCA: 10] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The authors explored the relations between clinical/demographic characteristics and performance on a neuropsychological battery (eight tests) in a cohort (N=46) of multiple sclerosis (MS) subjects. Findings resulted from a secondary analysis of a study examining the relationships between imaging biomarkers in MS and cognitive tasks of executive functioning. The objective was to determine whether the overlapping test results could be judiciously combined and associated with clinical/demographic variables. Canonical-correlation analysis (CCA) was utilized, and it was found that differences between performance on untimed tests, and the sum of performance on timed Trail-Making Tests, Parts A and B, best matched clinical/demographic variables, and gender was the most important feature.
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Affiliation(s)
- Sue-Jin Lin
- From the Graduate Program in Neuroscience, University of British Columbia (S-JL, MM); the Department of Statistics, University of British Columbia (JL); the Graduate Program in Counselling Psychology, University of British Columbia (SB); the Department of Radiology, University of British Columbia (IV, AM); the Department of Neurology, Faculty of Medicine, University of British Columbia (AT, DL, MM); the Department of Physics and Astronomy, University of British Columbia (AM); and the Department of Psychiatry, University of British Columbia Hospital (BK)
| | - Janet Lam
- From the Graduate Program in Neuroscience, University of British Columbia (S-JL, MM); the Department of Statistics, University of British Columbia (JL); the Graduate Program in Counselling Psychology, University of British Columbia (SB); the Department of Radiology, University of British Columbia (IV, AM); the Department of Neurology, Faculty of Medicine, University of British Columbia (AT, DL, MM); the Department of Physics and Astronomy, University of British Columbia (AM); and the Department of Psychiatry, University of British Columbia Hospital (BK)
| | - Samantha Beveridge
- From the Graduate Program in Neuroscience, University of British Columbia (S-JL, MM); the Department of Statistics, University of British Columbia (JL); the Graduate Program in Counselling Psychology, University of British Columbia (SB); the Department of Radiology, University of British Columbia (IV, AM); the Department of Neurology, Faculty of Medicine, University of British Columbia (AT, DL, MM); the Department of Physics and Astronomy, University of British Columbia (AM); and the Department of Psychiatry, University of British Columbia Hospital (BK)
| | - Irene Vavasour
- From the Graduate Program in Neuroscience, University of British Columbia (S-JL, MM); the Department of Statistics, University of British Columbia (JL); the Graduate Program in Counselling Psychology, University of British Columbia (SB); the Department of Radiology, University of British Columbia (IV, AM); the Department of Neurology, Faculty of Medicine, University of British Columbia (AT, DL, MM); the Department of Physics and Astronomy, University of British Columbia (AM); and the Department of Psychiatry, University of British Columbia Hospital (BK)
| | - Anthony Traboulsee
- From the Graduate Program in Neuroscience, University of British Columbia (S-JL, MM); the Department of Statistics, University of British Columbia (JL); the Graduate Program in Counselling Psychology, University of British Columbia (SB); the Department of Radiology, University of British Columbia (IV, AM); the Department of Neurology, Faculty of Medicine, University of British Columbia (AT, DL, MM); the Department of Physics and Astronomy, University of British Columbia (AM); and the Department of Psychiatry, University of British Columbia Hospital (BK)
| | - David K B Li
- From the Graduate Program in Neuroscience, University of British Columbia (S-JL, MM); the Department of Statistics, University of British Columbia (JL); the Graduate Program in Counselling Psychology, University of British Columbia (SB); the Department of Radiology, University of British Columbia (IV, AM); the Department of Neurology, Faculty of Medicine, University of British Columbia (AT, DL, MM); the Department of Physics and Astronomy, University of British Columbia (AM); and the Department of Psychiatry, University of British Columbia Hospital (BK)
| | - Alex MacKay
- From the Graduate Program in Neuroscience, University of British Columbia (S-JL, MM); the Department of Statistics, University of British Columbia (JL); the Graduate Program in Counselling Psychology, University of British Columbia (SB); the Department of Radiology, University of British Columbia (IV, AM); the Department of Neurology, Faculty of Medicine, University of British Columbia (AT, DL, MM); the Department of Physics and Astronomy, University of British Columbia (AM); and the Department of Psychiatry, University of British Columbia Hospital (BK)
| | - Martin McKeown
- From the Graduate Program in Neuroscience, University of British Columbia (S-JL, MM); the Department of Statistics, University of British Columbia (JL); the Graduate Program in Counselling Psychology, University of British Columbia (SB); the Department of Radiology, University of British Columbia (IV, AM); the Department of Neurology, Faculty of Medicine, University of British Columbia (AT, DL, MM); the Department of Physics and Astronomy, University of British Columbia (AM); and the Department of Psychiatry, University of British Columbia Hospital (BK)
| | - Brenda Kosaka
- From the Graduate Program in Neuroscience, University of British Columbia (S-JL, MM); the Department of Statistics, University of British Columbia (JL); the Graduate Program in Counselling Psychology, University of British Columbia (SB); the Department of Radiology, University of British Columbia (IV, AM); the Department of Neurology, Faculty of Medicine, University of British Columbia (AT, DL, MM); the Department of Physics and Astronomy, University of British Columbia (AM); and the Department of Psychiatry, University of British Columbia Hospital (BK)
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Yoo Y, Tang LYW, Li DKB, Metz L, Kolind S, Traboulsee AL, Tam RC. Deep learning of brain lesion patterns and user-defined clinical and MRI features for predicting conversion to multiple sclerosis from clinically isolated syndrome. Computer Methods in Biomechanics and Biomedical Engineering: Imaging & Visualization 2017. [DOI: 10.1080/21681163.2017.1356750] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Youngjin Yoo
- Department of Electrical and Computer Engineering, University of British Columbia , Vancouver, Canada
- Biomedical Engineering Program, University of British Columbia , Vancouver, Canada
- MS/MRI Research Group, University of British Columbia , Vancouver, Canada
| | - Lisa Y. W. Tang
- Department of Radiology, University of British Columbia , Vancouver, Canada
- MS/MRI Research Group, University of British Columbia , Vancouver, Canada
| | - David K. B. Li
- Department of Radiology, University of British Columbia , Vancouver, Canada
- MS/MRI Research Group, University of British Columbia , Vancouver, Canada
| | - Luanne Metz
- Division of Neurology, University of Calgary , Calgary, Canada
| | - Shannon Kolind
- Division of Neurology, University of British Columbia , Vancouver, Canada
| | - Anthony L. Traboulsee
- Division of Neurology, University of British Columbia , Vancouver, Canada
- MS/MRI Research Group, University of British Columbia , Vancouver, Canada
| | - Roger C. Tam
- Biomedical Engineering Program, University of British Columbia , Vancouver, Canada
- Department of Radiology, University of British Columbia , Vancouver, Canada
- MS/MRI Research Group, University of British Columbia , Vancouver, Canada
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Liu H, MacMillan EL, Jutzeler CR, Ljungberg E, MacKay AL, Kolind SH, Mädler B, Li DKB, Dvorak MF, Curt A, Laule C, Kramer JLK. Assessing structure and function of myelin in cervical spondylotic myelopathy: Evidence of demyelination. Neurology 2017; 89:602-610. [PMID: 28701500 PMCID: PMC5562959 DOI: 10.1212/wnl.0000000000004197] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [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: 10/11/2016] [Accepted: 05/12/2017] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To assess the extent of demyelination in cervical spondylotic myelopathy (CSM) using myelin water imaging (MWI) and electrophysiologic techniques. METHODS Somatosensory evoked potentials (SSEPs) and MWI were acquired in 14 patients with CSM and 18 age-matched healthy controls. MWI was performed on a 3.0T whole body magnetic resonance scanner. Myelin water fraction (MWF) was extracted for the dorsal columns and whole cord. SSEPs and MWF were also compared with conventional MRI outcomes, including T2 signal intensity, compression ratio, maximum spinal cord compression (MSCC), and maximum canal compromise (MCC). RESULTS Group analysis showed marked differences in T2 signal intensity, compression ratio, MSCC, and MCC between healthy controls and patients with CSM. There were no group differences in MWF and SSEP latencies. However, patients with CSM with pathologic SSEPs exhibited reduction in MWF (p < 0.05). MWF was also correlated with SSEP latencies. CONCLUSION Our findings provide evidence of decreased myelin content in the spinal cord associated with impaired spinal cord conduction in patients with CSM. While conventional MRI are of great value to define the extent of cord compression, they show a limited correlation with functional deficits (i.e., delayed SSEPs). MWI provides independent and complementary readouts to spinal cord compression, with a high specificity to detect impaired conduction.
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Affiliation(s)
- Hanwen Liu
- From Physics and Astronomy (H.L., A.L.M., B.M.), ICORD (H.L., C.R.J., M.F.D., C.L., J.L.K.K.), Medicine (Neurology) (E.L.M., E.L., S.H.K., D.K.B.L.), Radiology (A.L.M., D.K.B.L., C.L.), Orthopaedics (M.F.D.), Pathology & Laboratory Medicine (C.L.), and School of Kinesiology (J.L.K.K.), University of British Columbia, Vancouver, Canada; Spinal Cord Injury Center (C.R.J., A.C.), University Hospital Balgrist, University of Zurich, Switzerland; and Philips Healthcare (B.M.), Hamburg, Germany.
| | - Erin L MacMillan
- From Physics and Astronomy (H.L., A.L.M., B.M.), ICORD (H.L., C.R.J., M.F.D., C.L., J.L.K.K.), Medicine (Neurology) (E.L.M., E.L., S.H.K., D.K.B.L.), Radiology (A.L.M., D.K.B.L., C.L.), Orthopaedics (M.F.D.), Pathology & Laboratory Medicine (C.L.), and School of Kinesiology (J.L.K.K.), University of British Columbia, Vancouver, Canada; Spinal Cord Injury Center (C.R.J., A.C.), University Hospital Balgrist, University of Zurich, Switzerland; and Philips Healthcare (B.M.), Hamburg, Germany
| | - Catherine R Jutzeler
- From Physics and Astronomy (H.L., A.L.M., B.M.), ICORD (H.L., C.R.J., M.F.D., C.L., J.L.K.K.), Medicine (Neurology) (E.L.M., E.L., S.H.K., D.K.B.L.), Radiology (A.L.M., D.K.B.L., C.L.), Orthopaedics (M.F.D.), Pathology & Laboratory Medicine (C.L.), and School of Kinesiology (J.L.K.K.), University of British Columbia, Vancouver, Canada; Spinal Cord Injury Center (C.R.J., A.C.), University Hospital Balgrist, University of Zurich, Switzerland; and Philips Healthcare (B.M.), Hamburg, Germany
| | - Emil Ljungberg
- From Physics and Astronomy (H.L., A.L.M., B.M.), ICORD (H.L., C.R.J., M.F.D., C.L., J.L.K.K.), Medicine (Neurology) (E.L.M., E.L., S.H.K., D.K.B.L.), Radiology (A.L.M., D.K.B.L., C.L.), Orthopaedics (M.F.D.), Pathology & Laboratory Medicine (C.L.), and School of Kinesiology (J.L.K.K.), University of British Columbia, Vancouver, Canada; Spinal Cord Injury Center (C.R.J., A.C.), University Hospital Balgrist, University of Zurich, Switzerland; and Philips Healthcare (B.M.), Hamburg, Germany
| | - Alex L MacKay
- From Physics and Astronomy (H.L., A.L.M., B.M.), ICORD (H.L., C.R.J., M.F.D., C.L., J.L.K.K.), Medicine (Neurology) (E.L.M., E.L., S.H.K., D.K.B.L.), Radiology (A.L.M., D.K.B.L., C.L.), Orthopaedics (M.F.D.), Pathology & Laboratory Medicine (C.L.), and School of Kinesiology (J.L.K.K.), University of British Columbia, Vancouver, Canada; Spinal Cord Injury Center (C.R.J., A.C.), University Hospital Balgrist, University of Zurich, Switzerland; and Philips Healthcare (B.M.), Hamburg, Germany
| | - Shannon H Kolind
- From Physics and Astronomy (H.L., A.L.M., B.M.), ICORD (H.L., C.R.J., M.F.D., C.L., J.L.K.K.), Medicine (Neurology) (E.L.M., E.L., S.H.K., D.K.B.L.), Radiology (A.L.M., D.K.B.L., C.L.), Orthopaedics (M.F.D.), Pathology & Laboratory Medicine (C.L.), and School of Kinesiology (J.L.K.K.), University of British Columbia, Vancouver, Canada; Spinal Cord Injury Center (C.R.J., A.C.), University Hospital Balgrist, University of Zurich, Switzerland; and Philips Healthcare (B.M.), Hamburg, Germany
| | - Burkhard Mädler
- From Physics and Astronomy (H.L., A.L.M., B.M.), ICORD (H.L., C.R.J., M.F.D., C.L., J.L.K.K.), Medicine (Neurology) (E.L.M., E.L., S.H.K., D.K.B.L.), Radiology (A.L.M., D.K.B.L., C.L.), Orthopaedics (M.F.D.), Pathology & Laboratory Medicine (C.L.), and School of Kinesiology (J.L.K.K.), University of British Columbia, Vancouver, Canada; Spinal Cord Injury Center (C.R.J., A.C.), University Hospital Balgrist, University of Zurich, Switzerland; and Philips Healthcare (B.M.), Hamburg, Germany
| | - David K B Li
- From Physics and Astronomy (H.L., A.L.M., B.M.), ICORD (H.L., C.R.J., M.F.D., C.L., J.L.K.K.), Medicine (Neurology) (E.L.M., E.L., S.H.K., D.K.B.L.), Radiology (A.L.M., D.K.B.L., C.L.), Orthopaedics (M.F.D.), Pathology & Laboratory Medicine (C.L.), and School of Kinesiology (J.L.K.K.), University of British Columbia, Vancouver, Canada; Spinal Cord Injury Center (C.R.J., A.C.), University Hospital Balgrist, University of Zurich, Switzerland; and Philips Healthcare (B.M.), Hamburg, Germany
| | - Marcel F Dvorak
- From Physics and Astronomy (H.L., A.L.M., B.M.), ICORD (H.L., C.R.J., M.F.D., C.L., J.L.K.K.), Medicine (Neurology) (E.L.M., E.L., S.H.K., D.K.B.L.), Radiology (A.L.M., D.K.B.L., C.L.), Orthopaedics (M.F.D.), Pathology & Laboratory Medicine (C.L.), and School of Kinesiology (J.L.K.K.), University of British Columbia, Vancouver, Canada; Spinal Cord Injury Center (C.R.J., A.C.), University Hospital Balgrist, University of Zurich, Switzerland; and Philips Healthcare (B.M.), Hamburg, Germany
| | - Armin Curt
- From Physics and Astronomy (H.L., A.L.M., B.M.), ICORD (H.L., C.R.J., M.F.D., C.L., J.L.K.K.), Medicine (Neurology) (E.L.M., E.L., S.H.K., D.K.B.L.), Radiology (A.L.M., D.K.B.L., C.L.), Orthopaedics (M.F.D.), Pathology & Laboratory Medicine (C.L.), and School of Kinesiology (J.L.K.K.), University of British Columbia, Vancouver, Canada; Spinal Cord Injury Center (C.R.J., A.C.), University Hospital Balgrist, University of Zurich, Switzerland; and Philips Healthcare (B.M.), Hamburg, Germany
| | - Cornelia Laule
- From Physics and Astronomy (H.L., A.L.M., B.M.), ICORD (H.L., C.R.J., M.F.D., C.L., J.L.K.K.), Medicine (Neurology) (E.L.M., E.L., S.H.K., D.K.B.L.), Radiology (A.L.M., D.K.B.L., C.L.), Orthopaedics (M.F.D.), Pathology & Laboratory Medicine (C.L.), and School of Kinesiology (J.L.K.K.), University of British Columbia, Vancouver, Canada; Spinal Cord Injury Center (C.R.J., A.C.), University Hospital Balgrist, University of Zurich, Switzerland; and Philips Healthcare (B.M.), Hamburg, Germany
| | - John L K Kramer
- From Physics and Astronomy (H.L., A.L.M., B.M.), ICORD (H.L., C.R.J., M.F.D., C.L., J.L.K.K.), Medicine (Neurology) (E.L.M., E.L., S.H.K., D.K.B.L.), Radiology (A.L.M., D.K.B.L., C.L.), Orthopaedics (M.F.D.), Pathology & Laboratory Medicine (C.L.), and School of Kinesiology (J.L.K.K.), University of British Columbia, Vancouver, Canada; Spinal Cord Injury Center (C.R.J., A.C.), University Hospital Balgrist, University of Zurich, Switzerland; and Philips Healthcare (B.M.), Hamburg, Germany
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Wiggermann V, Hametner S, Hernández-Torres E, Kames C, Endmayr V, Kasprian G, Höftberger R, Li DKB, Traboulsee A, Rauscher A. Susceptibility-sensitive MRI of multiple sclerosis lesions and the impact of normal-appearing white matter changes. NMR Biomed 2017; 30:e3727. [PMID: 28470768 DOI: 10.1002/nbm.3727] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 02/24/2017] [Accepted: 03/01/2017] [Indexed: 06/07/2023]
Abstract
Susceptibility-sensitive magnetic resonance imaging (MRI) has gained importance in multiple sclerosis (MS) research because of its versatility, high resolution and excellent sensitivity to changes in tissue structure and composition. In particular, mapping of the resonance frequency of the MR signal and quantitative susceptibility mapping (QSM) have been explored for the description of MS lesions. Many current studies utilizing these techniques attribute increases in the MR frequency or QSM to elevated tissue iron content, in addition to myelin loss. However, this common interpretation is inconsistent with recent histopathological studies. Here, we investigate the nature of MR frequency shifts related to MS lesions by comparing post-mortem MRI data with histology, and contrast them with numerical simulations of the MR signal. We demonstrate that iron accumulation is not the driving source of the MR frequency or QSM image contrast in our sample; rather, most chronic MS lesions are characterized by advanced loss of both myelin and iron. Moreover, our results suggest that the appearance of MS lesions on MR frequency maps and QSM depends on changes in the non-lesional white matter surrounding the lesions. Understanding and accounting for these changes is essential for the quantitative interpretation of MR frequency or QSM data in white matter.
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Affiliation(s)
- Vanessa Wiggermann
- Department of Physics and Astronomy, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Pediatrics (Division of Neurology), University of British Columbia, Vancouver, British Columbia, Canada
- UBC MRI Research Centre, University of British Columbia, Vancouver, British Columbia, Canada
| | - Simon Hametner
- Center for Brain Research, Medical University of Vienna, Vienna, Austria
| | - Enedino Hernández-Torres
- Department of Pediatrics (Division of Neurology), University of British Columbia, Vancouver, British Columbia, Canada
- UBC MRI Research Centre, University of British Columbia, Vancouver, British Columbia, Canada
| | - Christian Kames
- UBC MRI Research Centre, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Engineering Physics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Verena Endmayr
- Center for Brain Research, Medical University of Vienna, Vienna, Austria
| | - Gregor Kasprian
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Romana Höftberger
- Institute of Neurology, Medical University of Vienna, Vienna, Austria
| | - David K B Li
- UBC MRI Research Centre, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
- Faculty of Medicine (Division of Neurology), University of British Columbia, Vancouver, British Columbia, Canada
| | - Anthony Traboulsee
- Faculty of Medicine (Division of Neurology), University of British Columbia, Vancouver, British Columbia, Canada
| | - Alexander Rauscher
- Department of Physics and Astronomy, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Pediatrics (Division of Neurology), University of British Columbia, Vancouver, British Columbia, Canada
- UBC MRI Research Centre, University of British Columbia, Vancouver, British Columbia, Canada
- Child and Family Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
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Metz LM, Li DKB, Traboulsee AL, Duquette P, Eliasziw M, Cerchiaro G, Greenfield J, Riddehough A, Yeung M, Kremenchutzky M, Vorobeychik G, Freedman MS, Bhan V, Blevins G, Marriott JJ, Grand'Maison F, Lee L, Thibault M, Hill MD, Yong VW. Trial of Minocycline in a Clinically Isolated Syndrome of Multiple Sclerosis. N Engl J Med 2017; 376:2122-2133. [PMID: 28564557 DOI: 10.1056/nejmoa1608889] [Citation(s) in RCA: 127] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND On the basis of encouraging preliminary results, we conducted a randomized, controlled trial to determine whether minocycline reduces the risk of conversion from a first demyelinating event (also known as a clinically isolated syndrome) to multiple sclerosis. METHODS During the period from January 2009 through July 2013, we randomly assigned participants who had had their first demyelinating symptoms within the previous 180 days to receive either 100 mg of minocycline, administered orally twice daily, or placebo. Administration of minocycline or placebo was continued until a diagnosis of multiple sclerosis was established or until 24 months after randomization, whichever came first. The primary outcome was conversion to multiple sclerosis (diagnosed on the basis of the 2005 McDonald criteria) within 6 months after randomization. Secondary outcomes included conversion to multiple sclerosis within 24 months after randomization and changes on magnetic resonance imaging (MRI) at 6 months and 24 months (change in lesion volume on T2-weighted MRI, cumulative number of new lesions enhanced on T1-weighted MRI ["enhancing lesions"], and cumulative combined number of unique lesions [new enhancing lesions on T1-weighted MRI plus new and newly enlarged lesions on T2-weighted MRI]). RESULTS A total of 142 eligible participants underwent randomization at 12 Canadian multiple sclerosis clinics; 72 participants were assigned to the minocycline group and 70 to the placebo group. The mean age of the participants was 35.8 years, and 68.3% were women. The unadjusted risk of conversion to multiple sclerosis within 6 months after randomization was 61.0% in the placebo group and 33.4% in the minocycline group, a difference of 27.6 percentage points (95% confidence interval [CI], 11.4 to 43.9; P=0.001). After adjustment for the number of enhancing lesions at baseline, the difference in the risk of conversion to multiple sclerosis within 6 months after randomization was 18.5 percentage points (95% CI, 3.7 to 33.3; P=0.01); the unadjusted risk difference was not significant at the 24-month secondary outcome time point (P=0.06). All secondary MRI outcomes favored minocycline over placebo at 6 months but not at 24 months. Trial withdrawals and adverse events of rash, dizziness, and dental discoloration were more frequent among participants who received minocycline than among those who received placebo. CONCLUSIONS The risk of conversion from a clinically isolated syndrome to multiple sclerosis was significantly lower with minocycline than with placebo over 6 months but not over 24 months. (Funded by the Multiple Sclerosis Society of Canada; ClinicalTrials.gov number, NCT00666887 .).
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Affiliation(s)
- Luanne M Metz
- From the Cumming School of Medicine and the Hotchkiss Brain Institute, Calgary, AB (L.M.M., G.C., J.G., M.Y., M.D.H., V.W.Y.), the University of British Columbia, Vancouver (D.K.B.L., A.L.T., A.R.), the University of Montreal, Montreal (P.D.), Western University, London, ON (M.K.), Fraser Health MS Clinic, Burnaby, BC (G.V.), the University of Ottawa and the Ottawa Hospital Research Institute, Ottawa (M.S.F.), Dalhousie University, Halifax, NS (V.B.), the University of Alberta, Edmonton (G.B.), the University of Manitoba, Winnipeg (J.J.M.), Clinique Neuro Rive-Sud, Greenfield Park, QC (F.G.), the University of Toronto, Toronto (L.L.), and CHA-Hôpital Enfant-Jésus, Quebec, QC (M.T.) - all in Canada; and Tufts University, Boston (M.E.)
| | - David K B Li
- From the Cumming School of Medicine and the Hotchkiss Brain Institute, Calgary, AB (L.M.M., G.C., J.G., M.Y., M.D.H., V.W.Y.), the University of British Columbia, Vancouver (D.K.B.L., A.L.T., A.R.), the University of Montreal, Montreal (P.D.), Western University, London, ON (M.K.), Fraser Health MS Clinic, Burnaby, BC (G.V.), the University of Ottawa and the Ottawa Hospital Research Institute, Ottawa (M.S.F.), Dalhousie University, Halifax, NS (V.B.), the University of Alberta, Edmonton (G.B.), the University of Manitoba, Winnipeg (J.J.M.), Clinique Neuro Rive-Sud, Greenfield Park, QC (F.G.), the University of Toronto, Toronto (L.L.), and CHA-Hôpital Enfant-Jésus, Quebec, QC (M.T.) - all in Canada; and Tufts University, Boston (M.E.)
| | - Anthony L Traboulsee
- From the Cumming School of Medicine and the Hotchkiss Brain Institute, Calgary, AB (L.M.M., G.C., J.G., M.Y., M.D.H., V.W.Y.), the University of British Columbia, Vancouver (D.K.B.L., A.L.T., A.R.), the University of Montreal, Montreal (P.D.), Western University, London, ON (M.K.), Fraser Health MS Clinic, Burnaby, BC (G.V.), the University of Ottawa and the Ottawa Hospital Research Institute, Ottawa (M.S.F.), Dalhousie University, Halifax, NS (V.B.), the University of Alberta, Edmonton (G.B.), the University of Manitoba, Winnipeg (J.J.M.), Clinique Neuro Rive-Sud, Greenfield Park, QC (F.G.), the University of Toronto, Toronto (L.L.), and CHA-Hôpital Enfant-Jésus, Quebec, QC (M.T.) - all in Canada; and Tufts University, Boston (M.E.)
| | - Pierre Duquette
- From the Cumming School of Medicine and the Hotchkiss Brain Institute, Calgary, AB (L.M.M., G.C., J.G., M.Y., M.D.H., V.W.Y.), the University of British Columbia, Vancouver (D.K.B.L., A.L.T., A.R.), the University of Montreal, Montreal (P.D.), Western University, London, ON (M.K.), Fraser Health MS Clinic, Burnaby, BC (G.V.), the University of Ottawa and the Ottawa Hospital Research Institute, Ottawa (M.S.F.), Dalhousie University, Halifax, NS (V.B.), the University of Alberta, Edmonton (G.B.), the University of Manitoba, Winnipeg (J.J.M.), Clinique Neuro Rive-Sud, Greenfield Park, QC (F.G.), the University of Toronto, Toronto (L.L.), and CHA-Hôpital Enfant-Jésus, Quebec, QC (M.T.) - all in Canada; and Tufts University, Boston (M.E.)
| | - Misha Eliasziw
- From the Cumming School of Medicine and the Hotchkiss Brain Institute, Calgary, AB (L.M.M., G.C., J.G., M.Y., M.D.H., V.W.Y.), the University of British Columbia, Vancouver (D.K.B.L., A.L.T., A.R.), the University of Montreal, Montreal (P.D.), Western University, London, ON (M.K.), Fraser Health MS Clinic, Burnaby, BC (G.V.), the University of Ottawa and the Ottawa Hospital Research Institute, Ottawa (M.S.F.), Dalhousie University, Halifax, NS (V.B.), the University of Alberta, Edmonton (G.B.), the University of Manitoba, Winnipeg (J.J.M.), Clinique Neuro Rive-Sud, Greenfield Park, QC (F.G.), the University of Toronto, Toronto (L.L.), and CHA-Hôpital Enfant-Jésus, Quebec, QC (M.T.) - all in Canada; and Tufts University, Boston (M.E.)
| | - Graziela Cerchiaro
- From the Cumming School of Medicine and the Hotchkiss Brain Institute, Calgary, AB (L.M.M., G.C., J.G., M.Y., M.D.H., V.W.Y.), the University of British Columbia, Vancouver (D.K.B.L., A.L.T., A.R.), the University of Montreal, Montreal (P.D.), Western University, London, ON (M.K.), Fraser Health MS Clinic, Burnaby, BC (G.V.), the University of Ottawa and the Ottawa Hospital Research Institute, Ottawa (M.S.F.), Dalhousie University, Halifax, NS (V.B.), the University of Alberta, Edmonton (G.B.), the University of Manitoba, Winnipeg (J.J.M.), Clinique Neuro Rive-Sud, Greenfield Park, QC (F.G.), the University of Toronto, Toronto (L.L.), and CHA-Hôpital Enfant-Jésus, Quebec, QC (M.T.) - all in Canada; and Tufts University, Boston (M.E.)
| | - Jamie Greenfield
- From the Cumming School of Medicine and the Hotchkiss Brain Institute, Calgary, AB (L.M.M., G.C., J.G., M.Y., M.D.H., V.W.Y.), the University of British Columbia, Vancouver (D.K.B.L., A.L.T., A.R.), the University of Montreal, Montreal (P.D.), Western University, London, ON (M.K.), Fraser Health MS Clinic, Burnaby, BC (G.V.), the University of Ottawa and the Ottawa Hospital Research Institute, Ottawa (M.S.F.), Dalhousie University, Halifax, NS (V.B.), the University of Alberta, Edmonton (G.B.), the University of Manitoba, Winnipeg (J.J.M.), Clinique Neuro Rive-Sud, Greenfield Park, QC (F.G.), the University of Toronto, Toronto (L.L.), and CHA-Hôpital Enfant-Jésus, Quebec, QC (M.T.) - all in Canada; and Tufts University, Boston (M.E.)
| | - Andrew Riddehough
- From the Cumming School of Medicine and the Hotchkiss Brain Institute, Calgary, AB (L.M.M., G.C., J.G., M.Y., M.D.H., V.W.Y.), the University of British Columbia, Vancouver (D.K.B.L., A.L.T., A.R.), the University of Montreal, Montreal (P.D.), Western University, London, ON (M.K.), Fraser Health MS Clinic, Burnaby, BC (G.V.), the University of Ottawa and the Ottawa Hospital Research Institute, Ottawa (M.S.F.), Dalhousie University, Halifax, NS (V.B.), the University of Alberta, Edmonton (G.B.), the University of Manitoba, Winnipeg (J.J.M.), Clinique Neuro Rive-Sud, Greenfield Park, QC (F.G.), the University of Toronto, Toronto (L.L.), and CHA-Hôpital Enfant-Jésus, Quebec, QC (M.T.) - all in Canada; and Tufts University, Boston (M.E.)
| | - Michael Yeung
- From the Cumming School of Medicine and the Hotchkiss Brain Institute, Calgary, AB (L.M.M., G.C., J.G., M.Y., M.D.H., V.W.Y.), the University of British Columbia, Vancouver (D.K.B.L., A.L.T., A.R.), the University of Montreal, Montreal (P.D.), Western University, London, ON (M.K.), Fraser Health MS Clinic, Burnaby, BC (G.V.), the University of Ottawa and the Ottawa Hospital Research Institute, Ottawa (M.S.F.), Dalhousie University, Halifax, NS (V.B.), the University of Alberta, Edmonton (G.B.), the University of Manitoba, Winnipeg (J.J.M.), Clinique Neuro Rive-Sud, Greenfield Park, QC (F.G.), the University of Toronto, Toronto (L.L.), and CHA-Hôpital Enfant-Jésus, Quebec, QC (M.T.) - all in Canada; and Tufts University, Boston (M.E.)
| | - Marcelo Kremenchutzky
- From the Cumming School of Medicine and the Hotchkiss Brain Institute, Calgary, AB (L.M.M., G.C., J.G., M.Y., M.D.H., V.W.Y.), the University of British Columbia, Vancouver (D.K.B.L., A.L.T., A.R.), the University of Montreal, Montreal (P.D.), Western University, London, ON (M.K.), Fraser Health MS Clinic, Burnaby, BC (G.V.), the University of Ottawa and the Ottawa Hospital Research Institute, Ottawa (M.S.F.), Dalhousie University, Halifax, NS (V.B.), the University of Alberta, Edmonton (G.B.), the University of Manitoba, Winnipeg (J.J.M.), Clinique Neuro Rive-Sud, Greenfield Park, QC (F.G.), the University of Toronto, Toronto (L.L.), and CHA-Hôpital Enfant-Jésus, Quebec, QC (M.T.) - all in Canada; and Tufts University, Boston (M.E.)
| | - Galina Vorobeychik
- From the Cumming School of Medicine and the Hotchkiss Brain Institute, Calgary, AB (L.M.M., G.C., J.G., M.Y., M.D.H., V.W.Y.), the University of British Columbia, Vancouver (D.K.B.L., A.L.T., A.R.), the University of Montreal, Montreal (P.D.), Western University, London, ON (M.K.), Fraser Health MS Clinic, Burnaby, BC (G.V.), the University of Ottawa and the Ottawa Hospital Research Institute, Ottawa (M.S.F.), Dalhousie University, Halifax, NS (V.B.), the University of Alberta, Edmonton (G.B.), the University of Manitoba, Winnipeg (J.J.M.), Clinique Neuro Rive-Sud, Greenfield Park, QC (F.G.), the University of Toronto, Toronto (L.L.), and CHA-Hôpital Enfant-Jésus, Quebec, QC (M.T.) - all in Canada; and Tufts University, Boston (M.E.)
| | - Mark S Freedman
- From the Cumming School of Medicine and the Hotchkiss Brain Institute, Calgary, AB (L.M.M., G.C., J.G., M.Y., M.D.H., V.W.Y.), the University of British Columbia, Vancouver (D.K.B.L., A.L.T., A.R.), the University of Montreal, Montreal (P.D.), Western University, London, ON (M.K.), Fraser Health MS Clinic, Burnaby, BC (G.V.), the University of Ottawa and the Ottawa Hospital Research Institute, Ottawa (M.S.F.), Dalhousie University, Halifax, NS (V.B.), the University of Alberta, Edmonton (G.B.), the University of Manitoba, Winnipeg (J.J.M.), Clinique Neuro Rive-Sud, Greenfield Park, QC (F.G.), the University of Toronto, Toronto (L.L.), and CHA-Hôpital Enfant-Jésus, Quebec, QC (M.T.) - all in Canada; and Tufts University, Boston (M.E.)
| | - Virender Bhan
- From the Cumming School of Medicine and the Hotchkiss Brain Institute, Calgary, AB (L.M.M., G.C., J.G., M.Y., M.D.H., V.W.Y.), the University of British Columbia, Vancouver (D.K.B.L., A.L.T., A.R.), the University of Montreal, Montreal (P.D.), Western University, London, ON (M.K.), Fraser Health MS Clinic, Burnaby, BC (G.V.), the University of Ottawa and the Ottawa Hospital Research Institute, Ottawa (M.S.F.), Dalhousie University, Halifax, NS (V.B.), the University of Alberta, Edmonton (G.B.), the University of Manitoba, Winnipeg (J.J.M.), Clinique Neuro Rive-Sud, Greenfield Park, QC (F.G.), the University of Toronto, Toronto (L.L.), and CHA-Hôpital Enfant-Jésus, Quebec, QC (M.T.) - all in Canada; and Tufts University, Boston (M.E.)
| | - Gregg Blevins
- From the Cumming School of Medicine and the Hotchkiss Brain Institute, Calgary, AB (L.M.M., G.C., J.G., M.Y., M.D.H., V.W.Y.), the University of British Columbia, Vancouver (D.K.B.L., A.L.T., A.R.), the University of Montreal, Montreal (P.D.), Western University, London, ON (M.K.), Fraser Health MS Clinic, Burnaby, BC (G.V.), the University of Ottawa and the Ottawa Hospital Research Institute, Ottawa (M.S.F.), Dalhousie University, Halifax, NS (V.B.), the University of Alberta, Edmonton (G.B.), the University of Manitoba, Winnipeg (J.J.M.), Clinique Neuro Rive-Sud, Greenfield Park, QC (F.G.), the University of Toronto, Toronto (L.L.), and CHA-Hôpital Enfant-Jésus, Quebec, QC (M.T.) - all in Canada; and Tufts University, Boston (M.E.)
| | - James J Marriott
- From the Cumming School of Medicine and the Hotchkiss Brain Institute, Calgary, AB (L.M.M., G.C., J.G., M.Y., M.D.H., V.W.Y.), the University of British Columbia, Vancouver (D.K.B.L., A.L.T., A.R.), the University of Montreal, Montreal (P.D.), Western University, London, ON (M.K.), Fraser Health MS Clinic, Burnaby, BC (G.V.), the University of Ottawa and the Ottawa Hospital Research Institute, Ottawa (M.S.F.), Dalhousie University, Halifax, NS (V.B.), the University of Alberta, Edmonton (G.B.), the University of Manitoba, Winnipeg (J.J.M.), Clinique Neuro Rive-Sud, Greenfield Park, QC (F.G.), the University of Toronto, Toronto (L.L.), and CHA-Hôpital Enfant-Jésus, Quebec, QC (M.T.) - all in Canada; and Tufts University, Boston (M.E.)
| | - Francois Grand'Maison
- From the Cumming School of Medicine and the Hotchkiss Brain Institute, Calgary, AB (L.M.M., G.C., J.G., M.Y., M.D.H., V.W.Y.), the University of British Columbia, Vancouver (D.K.B.L., A.L.T., A.R.), the University of Montreal, Montreal (P.D.), Western University, London, ON (M.K.), Fraser Health MS Clinic, Burnaby, BC (G.V.), the University of Ottawa and the Ottawa Hospital Research Institute, Ottawa (M.S.F.), Dalhousie University, Halifax, NS (V.B.), the University of Alberta, Edmonton (G.B.), the University of Manitoba, Winnipeg (J.J.M.), Clinique Neuro Rive-Sud, Greenfield Park, QC (F.G.), the University of Toronto, Toronto (L.L.), and CHA-Hôpital Enfant-Jésus, Quebec, QC (M.T.) - all in Canada; and Tufts University, Boston (M.E.)
| | - Liesly Lee
- From the Cumming School of Medicine and the Hotchkiss Brain Institute, Calgary, AB (L.M.M., G.C., J.G., M.Y., M.D.H., V.W.Y.), the University of British Columbia, Vancouver (D.K.B.L., A.L.T., A.R.), the University of Montreal, Montreal (P.D.), Western University, London, ON (M.K.), Fraser Health MS Clinic, Burnaby, BC (G.V.), the University of Ottawa and the Ottawa Hospital Research Institute, Ottawa (M.S.F.), Dalhousie University, Halifax, NS (V.B.), the University of Alberta, Edmonton (G.B.), the University of Manitoba, Winnipeg (J.J.M.), Clinique Neuro Rive-Sud, Greenfield Park, QC (F.G.), the University of Toronto, Toronto (L.L.), and CHA-Hôpital Enfant-Jésus, Quebec, QC (M.T.) - all in Canada; and Tufts University, Boston (M.E.)
| | - Manon Thibault
- From the Cumming School of Medicine and the Hotchkiss Brain Institute, Calgary, AB (L.M.M., G.C., J.G., M.Y., M.D.H., V.W.Y.), the University of British Columbia, Vancouver (D.K.B.L., A.L.T., A.R.), the University of Montreal, Montreal (P.D.), Western University, London, ON (M.K.), Fraser Health MS Clinic, Burnaby, BC (G.V.), the University of Ottawa and the Ottawa Hospital Research Institute, Ottawa (M.S.F.), Dalhousie University, Halifax, NS (V.B.), the University of Alberta, Edmonton (G.B.), the University of Manitoba, Winnipeg (J.J.M.), Clinique Neuro Rive-Sud, Greenfield Park, QC (F.G.), the University of Toronto, Toronto (L.L.), and CHA-Hôpital Enfant-Jésus, Quebec, QC (M.T.) - all in Canada; and Tufts University, Boston (M.E.)
| | - Michael D Hill
- From the Cumming School of Medicine and the Hotchkiss Brain Institute, Calgary, AB (L.M.M., G.C., J.G., M.Y., M.D.H., V.W.Y.), the University of British Columbia, Vancouver (D.K.B.L., A.L.T., A.R.), the University of Montreal, Montreal (P.D.), Western University, London, ON (M.K.), Fraser Health MS Clinic, Burnaby, BC (G.V.), the University of Ottawa and the Ottawa Hospital Research Institute, Ottawa (M.S.F.), Dalhousie University, Halifax, NS (V.B.), the University of Alberta, Edmonton (G.B.), the University of Manitoba, Winnipeg (J.J.M.), Clinique Neuro Rive-Sud, Greenfield Park, QC (F.G.), the University of Toronto, Toronto (L.L.), and CHA-Hôpital Enfant-Jésus, Quebec, QC (M.T.) - all in Canada; and Tufts University, Boston (M.E.)
| | - V Wee Yong
- From the Cumming School of Medicine and the Hotchkiss Brain Institute, Calgary, AB (L.M.M., G.C., J.G., M.Y., M.D.H., V.W.Y.), the University of British Columbia, Vancouver (D.K.B.L., A.L.T., A.R.), the University of Montreal, Montreal (P.D.), Western University, London, ON (M.K.), Fraser Health MS Clinic, Burnaby, BC (G.V.), the University of Ottawa and the Ottawa Hospital Research Institute, Ottawa (M.S.F.), Dalhousie University, Halifax, NS (V.B.), the University of Alberta, Edmonton (G.B.), the University of Manitoba, Winnipeg (J.J.M.), Clinique Neuro Rive-Sud, Greenfield Park, QC (F.G.), the University of Toronto, Toronto (L.L.), and CHA-Hôpital Enfant-Jésus, Quebec, QC (M.T.) - all in Canada; and Tufts University, Boston (M.E.)
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Kappos L, Li DKB, Stüve O, Hartung HP, Freedman MS, Hemmer B, Rieckmann P, Montalban X, Ziemssen T, Hunter B, Arnould S, Wallström E, Selmaj K. Safety and Efficacy of Siponimod (BAF312) in Patients With Relapsing-Remitting Multiple Sclerosis: Dose-Blinded, Randomized Extension of the Phase 2 BOLD Study. JAMA Neurol 2017; 73:1089-98. [PMID: 27380540 DOI: 10.1001/jamaneurol.2016.1451] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE This dose-blinded extension of the phase 2 BOLD (BAF312 on MRI Lesion Given Once Daily) Study in relapsing-remitting multiple sclerosis provides evidence on disease activity and safety of a range of siponimod doses for up to 24 months. OBJECTIVE To assess the safety and efficacy of siponimod for up to 24 months during the dose-blinded extension of the BOLD Study. DESIGN, SETTING, AND PARTICIPANTS At extension baseline in a randomized clinical trial, patients taking siponimod continued at the originally assigned dose and patients taking placebo were rerandomized to the 5 siponimod doses. Initial treatment was titrated over 10 days. A total of 252 eligible patients were treated at specialized multiple sclerosis centers for this study conducted from August 30, 2010, through June 3, 2013. INTERVENTIONS Siponimod at 10-mg, 2-mg, 1.25-mg, 0.5-mg, and 0.25-mg doses. MAIN OUTCOMES AND MEASURES Safety assessment included blood tests, documentation of adverse events at regular scheduled visits and Holter monitoring; key efficacy measures were annualized relapse rate and magnetic resonance imaging lesion activity. RESULTS Among the 252 eligible patients, the mean (SD) ages were 37.2 (8.4) years, 35.2 (9.1) years, 34.0 (7.6) years, 35.1 (9.2) years, and 36.8 (9.1) years in the 0.25-mg, 0.5-mg, 1.25-mg, 2-mg, and 10-mg groups. Of the 252 patients, 184 (73%) entered the extension and received siponimod (10 mg: n = 33; 2 mg: n = 29; 1.25 mg: n = 43; 0.5 mg: n = 29; and 0.25 mg: n = 50); 159 (86.4%) completed the dose-blinded extension. The incidence of adverse events was similar across treatment groups (10 mg: 87.9%; 2 mg: 89.7%; 1.25 mg: 88.4%; 0.5 mg: 96.6%; and 0.25 mg: 84.0%). Nine patients reported serious adverse events (2 mg: 3/29 [10.3%], 1.25 mg: 1/43 [2.3%], 0.5 mg: 4/29 [13.8%], and 0.25 mg: 1/50 [2.0%]; no serious adverse event was reported for more than 1 patient and no new safety signals occurred compared with the BOLD Study. Dose titration mitigated symptomatic bradycardic events. Reductions in mean (95% CI) gadolinium-enhancing T1 lesion counts from the last BOLD assessment were sustained in the 10-mg, 2-mg, 1.25-mg, and 0.5-mg dose groups (0 [0-0], 0.1 [0-1.9], 0.1 [0-2.6], and 0.1 [0-2.8] at month 24, respectively). At the 3 highest vs 2 lowest doses, the estimated new/newly enlarging T2 lesion counts (95% CIs) were lower during months 6 to 12 (0.5 [0.2-1.3], 0.4 [0.2-1.1], and 0.2 [0.1-0.6] vs 1.3 [0.6-2.8] and 1.4 [0.7-2.7]), months 12 to 18 (0.4 [0.1-1.1], 0.4 [0.1-1.3], and 0.4 [0.2-1.0] vs 1.0 [0.4-2.6] and 3.6 [1.7-7.6]), and months 18 to 24 (0 [0-not estimable], 0.9 [0.1-7.6], and 0.1 [0-1.7] vs 1.6 [0.3-7.7] and 2.0 [0.4-9.5]). Annualized relapse rates (95% CIs) up to month 24 were similarly lower for the 3 highest doses: 0.22 (0.12-0.40) for 10 mg, 0.20 (0.10-0.38) for 2 mg, and 0.14 (0.08-0.26) for 1.25 mg vs 0.33 (0.19-0.56) for 0.5 mg and 0.33 (0.21-0.50) for 0.25 mg. CONCLUSIONS AND RELEVANCE For up to 24 months of siponimod treatment, multiple sclerosis disease activity was low and there were no new safety signals; investigation in phase 3 trials is encouraged. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01185821.
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Affiliation(s)
- Ludwig Kappos
- Neurologic Clinic and Policlinic, Department of Medicine, University Hospital Basel, Basel, Switzerland2Department of Clinical Research, University Hospital Basel, Basel, Switzerland3Department of Biomedicine and Biomedical Engineering, University Hospital Basel, Basel, Switzerland
| | - David K B Li
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada5Department of Medicine (Neurology), University of British Columbia, Vancouver, British Columbia, Canada
| | - Olaf Stüve
- University of Texas Southwestern Medical Center, Dallas
| | - Hans-Peter Hartung
- Department of Neurology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Mark S Freedman
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | | | | | - Xavier Montalban
- MS Centre of Catalonia, Vall d´Hebron University Hospital, Barcelona, Spain
| | - Tjalf Ziemssen
- Center of Clinical Neuroscience, University of Technology Dresden, Dresden, Germany
| | | | | | | | - Krzysztof Selmaj
- Department of Neurology, Medical University of Lodz, Lodz, Poland
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Brosch T, Tang LYW, Li DKB, Traboulsee A, Tam R. Deep 3D Convolutional Encoder Networks With Shortcuts for Multiscale Feature Integration Applied to Multiple Sclerosis Lesion Segmentation. IEEE Trans Med Imaging 2016; 35:1229-1239. [PMID: 26886978 DOI: 10.1109/tmi.2016.2528821] [Citation(s) in RCA: 204] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
We propose a novel segmentation approach based on deep 3D convolutional encoder networks with shortcut connections and apply it to the segmentation of multiple sclerosis (MS) lesions in magnetic resonance images. Our model is a neural network that consists of two interconnected pathways, a convolutional pathway, which learns increasingly more abstract and higher-level image features, and a deconvolutional pathway, which predicts the final segmentation at the voxel level. The joint training of the feature extraction and prediction pathways allows for the automatic learning of features at different scales that are optimized for accuracy for any given combination of image types and segmentation task. In addition, shortcut connections between the two pathways allow high- and low-level features to be integrated, which enables the segmentation of lesions across a wide range of sizes. We have evaluated our method on two publicly available data sets (MICCAI 2008 and ISBI 2015 challenges) with the results showing that our method performs comparably to the top-ranked state-of-the-art methods, even when only relatively small data sets are available for training. In addition, we have compared our method with five freely available and widely used MS lesion segmentation methods (EMS, LST-LPA, LST-LGA, Lesion-TOADS, and SLS) on a large data set from an MS clinical trial. The results show that our method consistently outperforms these other methods across a wide range of lesion sizes.
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Jarrett M, Tam R, Hernández-Torres E, Martin N, Perera W, Zhao Y, Shahinfard E, Dadachanji S, Taunton J, Li DKB, Rauscher A. A Prospective Pilot Investigation of Brain Volume, White Matter Hyperintensities, and Hemorrhagic Lesions after Mild Traumatic Brain Injury. Front Neurol 2016; 7:11. [PMID: 26903944 PMCID: PMC4751255 DOI: 10.3389/fneur.2016.00011] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 01/22/2016] [Indexed: 12/14/2022] Open
Abstract
Traumatic brain injury (TBI) is among the most common neurological disorders. Hemorrhagic lesions and white matter hyperintensities (WMH) are radiological features associated with moderate and severe TBI. Brain volume reductions have also been observed during the months following injury. In concussion, no signs of injury are observed on conventional magnetic resonance imaging (MRI), which may be a true feature of concussion or merely due to the limited sensitivity of imaging techniques used so far. Moreover, it is not known whether volume reductions are due to the resolution of trauma-related edema or a true volume loss. Forty-five collegiate-level ice hockey players (20 females) and 15 controls (9 females), 40 players underwent 3-T MRI for hemorrhages [multi-echo susceptibility-weighted imaging (SWI)], WMH (three-dimensional fluid-attenuated inversion recovery), and brain volume at the beginning and the end of the hockey season. Concussed athletes underwent additional imaging and neuropsychological testing at 3 days, 2 weeks, and 2 months after injury. At the end of the hockey season, brain volume was reduced compared to controls by 0.32% (p < 0.034) in the whole cohort and by 0.26% (p < 0.09) in the concussed athletes. Two weeks and 2 months after concussion, brain volume was reduced by −0.08% (p = 0.027) and −0.23% (p = 0.035), respectively. In athletes, the WMH were significantly closer to the interface between gray matter and white matter compared to controls. No significant changes in the number of WMH over the duration of the study were found in athletes. No microhemorrhages were detected as a result of concussion or playing a season of ice hockey. We conclude that mild TBI does not lead to transient increases in brain volume and no new microbleeds or WMH are detectable after concussion. Brain volume reductions appear by 2 weeks after concussion and persist until at least 2 months after concussion. Brain volume is reduced between the beginning and the end of the ice hockey season.
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Affiliation(s)
- Michael Jarrett
- UBC MRI Research Centre, University of British Columbia , Vancouver, BC , Canada
| | - Roger Tam
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada; Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | | | - Nancy Martin
- Department of Radiology, Richmond Hospital, Richmond, BC, Canada; Department of Radiology, Burnaby Hospital, Burnaby, BC, Canada; Department of Radiology, Delta Hospital, Delta, BC, Canada
| | - Warren Perera
- Medical Imaging Department, St Vincent's Hospital , Melbourne, VIC , Australia
| | - Yinshan Zhao
- Division of Neurology, Department of Medicine, University of British Columbia , Vancouver, BC , Canada
| | - Elham Shahinfard
- Division of Neurology, Department of Medicine, University of British Columbia , Vancouver, BC , Canada
| | - Shiroy Dadachanji
- Division of Sports Medicine, Faculty of Medicine, University of British Columbia , Vancouver, BC , Canada
| | - Jack Taunton
- Division of Sports Medicine, Faculty of Medicine, University of British Columbia , Vancouver, BC , Canada
| | - David K B Li
- UBC MRI Research Centre, University of British Columbia, Vancouver, BC, Canada; Department of Radiology, University of British Columbia, Vancouver, BC, Canada; MS/MRI Research Group, University of British Columbia, Vancouver, BC, Canada
| | - Alexander Rauscher
- UBC MRI Research Centre, University of British Columbia, Vancouver, BC, Canada; Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada; Division of Neurology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
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50
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Wiggermann V, Hernández-Torres E, Traboulsee A, Li DKB, Rauscher A. FLAIR2: A Combination of FLAIR and T2 for Improved MS Lesion Detection. AJNR Am J Neuroradiol 2016; 37:259-65. [PMID: 26450539 DOI: 10.3174/ajnr.a4514] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [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: 05/04/2015] [Accepted: 06/21/2015] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND PURPOSE FLAIR and double inversion recovery are important MR imaging scans for MS. The suppression of signal from CSF in FLAIR and the additional suppression of WM signal in double inversion recovery improve contrast between lesions, WM and GM, albeit at a reduced SNR. However, whether the acquisition of double inversion recovery is necessary is still debated. Here, we present an approach that allows obtaining CSF-suppressed images with improved contrast between lesions, WM and GM without strongly penalizing SNR. MATERIALS AND METHODS 3D T2-weighted and 3D-FLAIR data acquired from September 2014 to April 2015 in healthy volunteers (23.4 ± 2.4 years of age; female/male ratio, 3:2) and patients (44.1 ± 14.0 years of age; female/male ratio, 4:5) with MS were coregistered and multiplied (FLAIR(2)). SNR and contrast-to-noise measurements were performed for focal lesions and GM and WM. Furthermore, data from 24 subjects with relapsing-remitting and progressive MS were analyzed retrospectively (52.7 ± 8.1 years of age; female/male ratio, 14:10). RESULTS The GM-WM contrast-to-noise ratio was by 133% higher in FLAIR(2) than in FLAIR and improved between lesions and WM by 31%, 93%, and 158% compared with T2, DIR, and FLAIR, respectively. Cortical and juxtacortical lesions were more conspicuous in FLAIR(2). Furthermore, the 3D nature of FLAIR(2) allowed reliable visualization of callosal and infratentorial lesions. CONCLUSIONS We present a simple approach for obtaining CSF suppression with an improved contrast-to-noise ratio compared with conventional FLAIR and double inversion recovery without the acquisition of additional data. FLAIR(2) can be computed retrospectively if T2 and FLAIR scans are available.
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Affiliation(s)
- V Wiggermann
- From the Departments of Physics and Astronomy (V.W.) Pediatrics (V.W., E.H.T., A.R.) University of British Columbia MRI Research Centre (V.W., E.H.T., A.R.)
| | - E Hernández-Torres
- Pediatrics (V.W., E.H.T., A.R.) University of British Columbia MRI Research Centre (V.W., E.H.T., A.R.)
| | | | - D K B Li
- Medicine (Neurology) (A.T., D.K.B.L.) Radiology (D.K.B.L.) Centre for Brain Health (D.K.B.L., A.R.)
| | - A Rauscher
- Pediatrics (V.W., E.H.T., A.R.) University of British Columbia MRI Research Centre (V.W., E.H.T., A.R.) Centre for Brain Health (D.K.B.L., A.R.) Child and Family Research Institute (A.R.), University of British Columbia, Vancouver, British Columbia, Canada.
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