1
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Kang B, Kim B, Park H, Heo HY. Learning-based optimization of acquisition schedule for magnetization transfer contrast MR fingerprinting. NMR IN BIOMEDICINE 2022; 35:e4662. [PMID: 34939236 PMCID: PMC9761585 DOI: 10.1002/nbm.4662] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 11/12/2021] [Accepted: 11/16/2021] [Indexed: 05/03/2023]
Abstract
Magnetization transfer contrast MR fingerprinting (MTC-MRF) is a novel quantitative imaging method that simultaneously quantifies free bulk water and semisolid macromolecule parameters using pseudo-randomized scan parameters. To improve acquisition efficiency and reconstruction accuracy, the optimization of MRF sequence design has been of recent interest in the MRF field, but has been challenging due to the large number of degrees of freedom to be optimized in the sequence. Herein, we propose a framework for learning-based optimization of the acquisition schedule (LOAS), which optimizes RF saturation-encoded MRF acquisitions with a minimal number of scan parameters for tissue parameter determination. In a supervised learning framework, scan parameters were subsequently updated to minimize a predefined loss function that can directly represent tissue quantification errors. We evaluated the performance of the proposed approach with a numerical phantom and in in vivo experiments. For validation, MRF images were synthesized using the tissue parameters estimated from a fully connected neural network framework and compared with references. Our results showed that LOAS outperformed existing indirect optimization methods with regard to quantification accuracy and acquisition efficiency. The proposed LOAS method could be a powerful optimization tool in the design of MRF pulse sequences.
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Affiliation(s)
- Beomgu Kang
- Department of Electrical Engineering, Korea Advanced
Institute of Science and Technology, Guseong-dong, Yuseong-gu, Daejeon, Republic of
Korea
| | - Byungjai Kim
- Department of Electrical Engineering, Korea Advanced
Institute of Science and Technology, Guseong-dong, Yuseong-gu, Daejeon, Republic of
Korea
- Divison of MR Research, Department of Radiology, Johns
Hopkins University, Baltimore, Maryland, USA
| | - HyunWook Park
- Department of Electrical Engineering, Korea Advanced
Institute of Science and Technology, Guseong-dong, Yuseong-gu, Daejeon, Republic of
Korea
| | - Hye-Young Heo
- Divison of MR Research, Department of Radiology, Johns
Hopkins University, Baltimore, Maryland, USA
- F.M. Kirby Research Center for Functional Brain Imaging,
Kennedy Krieger Institute, Baltimore, Maryland, USA
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2
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Lampinen B, Szczepankiewicz F, Mårtensson J, van Westen D, Hansson O, Westin CF, Nilsson M. Towards unconstrained compartment modeling in white matter using diffusion-relaxation MRI with tensor-valued diffusion encoding. Magn Reson Med 2020; 84:1605-1623. [PMID: 32141131 DOI: 10.1002/mrm.28216] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 01/27/2020] [Accepted: 01/28/2020] [Indexed: 01/05/2023]
Abstract
PURPOSE To optimize diffusion-relaxation MRI with tensor-valued diffusion encoding for precise estimation of compartment-specific fractions, diffusivities, and T2 values within a two-compartment model of white matter, and to explore the approach in vivo. METHODS Sampling protocols featuring different b-values (b), b-tensor shapes (bΔ ), and echo times (TE) were optimized using Cramér-Rao lower bounds (CRLB). Whole-brain data were acquired in children, adults, and elderly with white matter lesions. Compartment fractions, diffusivities, and T2 values were estimated in a model featuring two microstructural compartments represented by a "stick" and a "zeppelin." RESULTS Precise parameter estimates were enabled by sampling protocols featuring seven or more "shells" with unique b/bΔ /TE-combinations. Acquisition times were approximately 15 minutes. In white matter of adults, the "stick" compartment had a fraction of approximately 0.5 and, compared with the "zeppelin" compartment, featured lower isotropic diffusivities (0.6 vs. 1.3 μm2 /ms) but higher T2 values (85 vs. 65 ms). Children featured lower "stick" fractions (0.4). White matter lesions exhibited high "zeppelin" isotropic diffusivities (1.7 μm2 /ms) and T2 values (150 ms). CONCLUSIONS Diffusion-relaxation MRI with tensor-valued diffusion encoding expands the set of microstructure parameters that can be precisely estimated and therefore increases their specificity to biological quantities.
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Affiliation(s)
- Björn Lampinen
- Clinical Sciences Lund, Medical Radiation Physics, Lund University, Lund, Sweden
| | - Filip Szczepankiewicz
- Clinical Sciences Lund, Radiology, Lund University, Lund, Sweden.,Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Johan Mårtensson
- Clinical Sciences Lund, Department of Logopedics, Phoniatrics and Audiology, Lund University, Lund, Sweden
| | | | - Oskar Hansson
- Clinical Sciences Malmö, Clinical Memory Research Unit, Lund University, Lund, Sweden
| | - Carl-Fredrik Westin
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Markus Nilsson
- Clinical Sciences Lund, Radiology, Lund University, Lund, Sweden
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3
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Etherton MR, Wu O, Giese AK, Rost NS. Normal-appearing white matter microstructural injury is associated with white matter hyperintensity burden in acute ischemic stroke. Int J Stroke 2019; 16:184-191. [PMID: 31847795 DOI: 10.1177/1747493019895707] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND White matter hyperintensity of presumed vascular origin is a risk factor for poor stroke outcomes. In patients with acute ischemic stroke, however, the in vivo mechanisms of white matter microstructural injury are less clear. AIMS To characterize the directional diffusivity components in normal-appearing white matter and white matter hyperintensity in acute ischemic stroke patients. METHODS A retrospective analysis was performed on a cohort of patients with acute ischemic stroke and brain magnetic resonance imaging with diffusion tensor imaging sequences acquired within 48 h of admission. White matter hyperintensity volume was measured in a semi-automated manner. Median fractional anisotropy, mean diffusivity, radial diffusivity, and axial diffusivity values were calculated within normal-appearing white matter and white matter hyperintensity in the hemisphere contralateral to the acute infarct. Linear regression analysis was performed to evaluate predictors of white matter hyperintensity volume and normal-appearing white matter diffusivity metrics. RESULTS In 319 patients, mean age was 64.9 ± 15.9 years. White matter hyperintensity volume was 6.33 cm3 (interquartile range 3.0-12.6 cm3). Axial and radial diffusivity were significantly increased in white matter hyperintensity compared to normal-appearing white matter. In multivariable linear regression, age (β = 0.20, P = 0.003) and normal-appearing white matter axial diffusivity (β = 37.9, P < 0.001) were independently associated with white matter hyperintensity volume. Subsequent analysis demonstrated that increasing age (β = 0.004, P < 0.001) and admission diastolic blood pressure (β = 0.001, P = 0.02) were independent predictors of normal-appearing white matter axial diffusivity in multivariable linear regression. CONCLUSIONS Normal-appearing white matter axial diffusivity increases with age and is an independent predictor of white matter hyperintensity volume in acute ischemic stroke.
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Affiliation(s)
- Mark R Etherton
- Department of Neurology, J. Philip Kistler Stroke Research Center, 2348Massachusetts General Hospital and Harvard Medical School, Boston, USA
| | - Ona Wu
- Department of Neurology, J. Philip Kistler Stroke Research Center, 2348Massachusetts General Hospital and Harvard Medical School, Boston, USA.,Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, 2348Massachusetts General Hospital, Boston, USA
| | - Anne-Katrin Giese
- Department of Neurology, J. Philip Kistler Stroke Research Center, 2348Massachusetts General Hospital and Harvard Medical School, Boston, USA
| | - Natalia S Rost
- Department of Neurology, J. Philip Kistler Stroke Research Center, 2348Massachusetts General Hospital and Harvard Medical School, Boston, USA
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4
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Zhao Y, Ke Z, He W, Cai Z. Volume of white matter hyperintensities increases with blood pressure in patients with hypertension. J Int Med Res 2019; 47:3681-3689. [PMID: 31242795 PMCID: PMC6726811 DOI: 10.1177/0300060519858023] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Objective Hypertension is a risk factor for development of white matter hyperintensities (WMHs). However, the relationship between hypertension and WMHs remains obscure. We sought to clarify this relationship using clinical data from different regions of China. Methods We analyzed the data of 333 patients with WMHs in this study. All included patients underwent conventional magnetic resonance imaging (MRI) examination. A primary diagnosis of WMHs was made according to MRI findings. The volume burden of WMHs was investigated using the Fazekas scale, which is widely used to rate the degree of WMHs. We conducted retrospective clinical analysis of the data in this study. Results Our findings showed that WMHs in patients with hypertension were associated with diabetes, cardiovascular diseases, history of cerebral infarct, and plasma glucose and triglyceride levels. Fazekas scale scores for WMHs increased with increased blood pressure values in patients with hypertension. Conclusion This analysis indicates that hypertension is an independent contributor to the prevalence and severity of WMHs.
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Affiliation(s)
- Yu Zhao
- 1 Department of Neurology, the Fourth Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Zunyu Ke
- 2 Department of Neurology, Renmin Hospital, Hubei University of Medicine, Shiyan Renmin Hospital, Shiyan, Hubei Province, China
| | - Wenbo He
- 2 Department of Neurology, Renmin Hospital, Hubei University of Medicine, Shiyan Renmin Hospital, Shiyan, Hubei Province, China
| | - Zhiyou Cai
- 3 Department of Neurology, Chongqing General Hospital, University of Chinese Academy of Sciences, Chongqing, Chongqing, China.,4 Chongqing Key Laboratory of Neurodegenerative Diseases, Chongqing, Chongqing, China
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5
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Wu X, Ge X, Du J, Wang Y, Sun Y, Han X, Ding W, Cao M, Xu Q, Zhou Y. Characterizing the Penumbras of White Matter Hyperintensities and Their Associations With Cognitive Function in Patients With Subcortical Vascular Mild Cognitive Impairment. Front Neurol 2019; 10:348. [PMID: 31031687 PMCID: PMC6474292 DOI: 10.3389/fneur.2019.00348] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 03/21/2019] [Indexed: 11/13/2022] Open
Abstract
Normal-appearing white matter (NAWM) surrounding white matter hyperintensities (WMHs), frequently known as the WMH penumbra, is associated with subtle white matter injury and has a high risk for future conversion to WMHs. The goal of this study was to define WMH penumbras and to further explore whether the diffusion and perfusion parameters of these penumbras could better reflect cognitive function alterations than WMHs in subjects with subcortical vascular mild cognitive impairment (svMCI). Seventy-three svMCI subjects underwent neuropsychological assessments and 3T MRI scans, including diffusion tensor imaging (DTI) and arterial spin labeling (ASL). To determine the extent of cerebral blood flow (CBF) and DTI penumbras. A NAWM layer mask was generated for periventricular WMHs (PVWMHs) and deep WMHs (DWMHs) separately. Mean values of CBF, fractional anisotropy (FA), mean diffusivity (MD) within the WMHs and their corresponding NAWM layer masks were computed and compared using paired t-tests. Pearson's partial correlations were used to assess the relations of the mean CBF, FA, and MD values within the corresponding penumbras with composite z-scores of global cognition and four cognitive domains controlling for age, sex, and education. For both PVWMHs and DWMHs, the CBF penumbras were wider than the DTI penumbras. Only the mean FA value of the PVWMH-FA penumbra was correlated with the composite z-scores of global cognition before correction (r = 0.268, p = 0.024), but that correlation did not survive after correcting the p-value for multiple comparisons. Our findings showed extensive white matter perfusion disturbances including white matter tissue, both with and without microstructural alterations. The imaging parameters investigated, however, did not correlate to cognition.
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Affiliation(s)
- Xiaowei Wu
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xin Ge
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jing Du
- Department of Neurology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yao Wang
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yawen Sun
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xu Han
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Weina Ding
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Mengqiu Cao
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Qun Xu
- Department of Neurology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yan Zhou
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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6
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Raja R, Rosenberg G, Caprihan A. Review of diffusion MRI studies in chronic white matter diseases. Neurosci Lett 2019; 694:198-207. [PMID: 30528980 PMCID: PMC6380179 DOI: 10.1016/j.neulet.2018.12.007] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 12/03/2018] [Accepted: 12/04/2018] [Indexed: 02/07/2023]
Abstract
Diffusion MRI studies characterizing the changes in white matter (WM) due to vascular cognitive impairment, which includes all forms of small vessel disease are reviewed. We reviewed the usefulness of diffusion methods in discriminating the affected WM regions and its relation to cognitive impairment. These studies were categorized based on the diffusion MRI techniques used. The most common method was the diffusion tensor imaging, whereas other methods included diffusion weighted imaging, diffusion kurtosis imaging, intravoxel incoherent motion, and studies based on diffusion tractography. The diffusion measures showed correlation with cognitive scores and disease progression, with mean diffusivity being the most robust parameter. Future studies should focus on incorporating multi-compartment and higher order diffusion models, which can handle the presence of multiple and crossing fibers inside a voxel.
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Affiliation(s)
- Rajikha Raja
- The MIND Research Network, Albuquerque, NM, United States.
| | - Gary Rosenberg
- Department of Neurology, University of New Mexico Health Sciences Center, Albuquerque, NM, United States
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7
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Sartor J, Bettecken K, Bernhard FP, Hofmann M, Gladow T, Lindig T, Ciliz M, Ten Kate M, Geritz J, Heinzel S, Benedictus M, Scheltens P, Hobert MA, Maetzler W. White Matter Changes-Related Gait and Executive Function Deficits: Associations with Age and Parkinson's Disease. Front Aging Neurosci 2017; 9:213. [PMID: 28713264 PMCID: PMC5491602 DOI: 10.3389/fnagi.2017.00213] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 06/16/2017] [Indexed: 01/22/2023] Open
Abstract
Background: White matter changes (WMC) are a common finding among older adults and patients with Parkinson's disease (PD), and have been associated with, e.g., gait deficits and executive dysfunction. How the factors age and PD influence WMC-related deficits is, to our best knowledge, not investigated to date. We hypothesized that advanced age and presence of PD leads to WMC-related symptoms while practicing tasks with a low complexity level, and low age and absence of PD leads to WMC-related symptoms while practicing tasks with a high complexity level. Methods: Hundred and thirty-eight participants [65 young persons without PD (50–69 years, yPn), 22 young PD patients (50–69 years, yPD), 36 old persons without PD (70–89 years, oPn) and 15 old PD patients (70–89 years, oPD)] were included. Presence and severity of WMC were determined with the modified Fazekas score. Velocity of walking under single and dual tasking conditions and the Trail Making Test (TMT) were used as gait and executive function parameters. Correlations between presence and severity of WMC, and gait and executive function parameters were tested in yPn, yPD, oPn, and oPD using Spearman's rank correlation, and significance between groups was evaluated with Fisher's z-transformed correlation coefficient. Results: yPn and yPD, as well as oPn and oPD did not differ regarding demographic and clinical parameters. Severity of WMC was not significantly different between groups. yPn and yPD displayed significant correlations of WMC with executive function parameters at low levels of task complexity, oPn at intermediate, and oPD at high complexity levels. Conclusion: This study argues for a relevant association of age and PD-related brain pathology with WMC-related gait and executive function deficits.
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Affiliation(s)
- Jennifer Sartor
- Department of Neurodegeneration, Center for Neurology and Hertie Institute for Clinical Brain Research, University of TuebingenTuebingen, Germany.,German Center for Neurodegenerative Diseases (DZNE)Tuebingen, Germany
| | - Kristina Bettecken
- Department of Neurodegeneration, Center for Neurology and Hertie Institute for Clinical Brain Research, University of TuebingenTuebingen, Germany.,German Center for Neurodegenerative Diseases (DZNE)Tuebingen, Germany
| | - Felix P Bernhard
- Department of Neurodegeneration, Center for Neurology and Hertie Institute for Clinical Brain Research, University of TuebingenTuebingen, Germany.,German Center for Neurodegenerative Diseases (DZNE)Tuebingen, Germany
| | | | | | - Tobias Lindig
- Department of Diagnostic and Interventional Neuroradiology, University of TuebingenTuebingen, Germany
| | - Meltem Ciliz
- Department of Neurodegeneration, Center for Neurology and Hertie Institute for Clinical Brain Research, University of TuebingenTuebingen, Germany.,German Center for Neurodegenerative Diseases (DZNE)Tuebingen, Germany
| | - Mara Ten Kate
- Alzheimer Center and Department of Neurology, Neuroscience Campus Amsterdam, VU University Medical CenterAmsterdam, Netherlands
| | - Johanna Geritz
- Department of Neurology, Christian-Albrechts-University of KielKiel, Germany
| | - Sebastian Heinzel
- Department of Neurology, Christian-Albrechts-University of KielKiel, Germany
| | - Marije Benedictus
- Alzheimer Center and Department of Neurology, Neuroscience Campus Amsterdam, VU University Medical CenterAmsterdam, Netherlands
| | - Philip Scheltens
- Alzheimer Center and Department of Neurology, Neuroscience Campus Amsterdam, VU University Medical CenterAmsterdam, Netherlands
| | - Markus A Hobert
- Department of Neurodegeneration, Center for Neurology and Hertie Institute for Clinical Brain Research, University of TuebingenTuebingen, Germany.,German Center for Neurodegenerative Diseases (DZNE)Tuebingen, Germany.,Department of Neurology, Christian-Albrechts-University of KielKiel, Germany
| | - Walter Maetzler
- Department of Neurodegeneration, Center for Neurology and Hertie Institute for Clinical Brain Research, University of TuebingenTuebingen, Germany.,German Center for Neurodegenerative Diseases (DZNE)Tuebingen, Germany.,Department of Neurology, Christian-Albrechts-University of KielKiel, Germany
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8
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Lyoubi-Idrissi AL, Jouvent E, Poupon C, Chabriat H. Diffusion magnetic resonance imaging in cerebral small vessel disease. Rev Neurol (Paris) 2017; 173:201-210. [PMID: 28392060 DOI: 10.1016/j.neurol.2017.03.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Revised: 12/04/2016] [Accepted: 03/09/2017] [Indexed: 01/13/2023]
Abstract
Cerebral small vessel disease (SVD) is frequent in the elderly, and accounts for a wide spectrum of clinical and radiological manifestations. This report summarizes the most important findings obtained using diffusion MRI (DWI) in SVD. With DWI and apparent diffusion coefficient (ADC) maps, recent ischemic lesions can easily be detected after acute stroke in SVD, while even multiple simultaneous lesions may be observed. Microstructural changes are frequent in SVD, with increases in diffusivity and decreases in anisotropy being the most reliable findings observed, mainly in white matter. These tissue changes are associated with clinical severity and especially executive dysfunction. They can also precede the usual MRI markers of SVD, such as white matter hyperintensities, microbleeds and lacunes. Thus, DWI may reveal surrogate markers of SVD progression and offer a better understanding of their underlying mechanisms.
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Affiliation(s)
- A L Lyoubi-Idrissi
- Department of Neurology, université de Paris Denis Didérot, DHU NeuroVasc Sorbonne Paris-Cité, GH Saint-Louis-Lariboisière, Assistance publique-Hôpitaux de Paris, Paris, France; CEA, Neurospin, 91191 Gif-sur-Yvette, France.
| | - E Jouvent
- Department of Neurology, université de Paris Denis Didérot, DHU NeuroVasc Sorbonne Paris-Cité, GH Saint-Louis-Lariboisière, Assistance publique-Hôpitaux de Paris, Paris, France; CEA, Neurospin, 91191 Gif-sur-Yvette, France; Inserm UMR 1161, faculté de médecine, Villemin, 75010 Paris, France
| | - C Poupon
- CEA, Neurospin, 91191 Gif-sur-Yvette, France
| | - H Chabriat
- Department of Neurology, université de Paris Denis Didérot, DHU NeuroVasc Sorbonne Paris-Cité, GH Saint-Louis-Lariboisière, Assistance publique-Hôpitaux de Paris, Paris, France; CEA, Neurospin, 91191 Gif-sur-Yvette, France; Inserm UMR 1161, faculté de médecine, Villemin, 75010 Paris, France
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9
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Pinter D, Ritchie SJ, Doubal F, Gattringer T, Morris Z, Bastin ME, del C. Valdés Hernández M, Royle NA, Corley J, Muñoz Maniega S, Pattie A, Dickie DA, Staals J, Gow AJ, Starr JM, Deary IJ, Enzinger C, Fazekas F, Wardlaw J. Impact of small vessel disease in the brain on gait and balance. Sci Rep 2017; 7:41637. [PMID: 28134332 PMCID: PMC5278543 DOI: 10.1038/srep41637] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 12/22/2016] [Indexed: 11/09/2022] Open
Abstract
Gait and balance impairment is highly prevalent in older people. We aimed to assess whether and how single markers of small vessel disease (SVD) or a combination thereof explain gait and balance function in the elderly. We analysed 678 community-dwelling healthy subjects from the Lothian Birth Cohort 1936 at the age of 71-74 years who had undergone comprehensive risk factor assessment, gait and balance assessment as well as brain MRI. We investigated the impact of individual SVD markers (white matter hyperintensity - WMH, microbleeds, lacunes, enlarged perivascular spaces, brain atrophy) as seen on structural brain MRI and of a global SVD score on the patients' performance. A regression model revealed that age, sex, and hypertension significantly explained gait speed. Among SVD markers white matter hyperintensity (WMH) score or volume were additional significant and independent predictors of gait speed in the regression model. A similar association was seen with the global SVD score. Our study confirms a negative impact of SVD-related morphologic brain changes on gait speed in addition to age, sex and hypertension independent from brain atrophy. The presence of WMH seems to be the major driving force for SVD on gait impairment in healthy elderly subjects.
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Affiliation(s)
- Daniela Pinter
- Department of Neurology, Medical University of Graz, Graz, 8036, Austria
| | - Stuart J. Ritchie
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, EH8 9YL, UK
- Department of Psychology, University of Edinburgh, Edinburgh, EH8 9YL, UK
| | - Fergus Doubal
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, EH8 9YL, UK
- Brain Research Imaging Centre, University of Edinburgh, Edinburgh, EH4 2XU, UK
| | - Thomas Gattringer
- Department of Neurology, Medical University of Graz, Graz, 8036, Austria
| | - Zoe Morris
- Brain Research Imaging Centre, University of Edinburgh, Edinburgh, EH4 2XU, UK
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, EH4 2XU, UK
| | - Mark E. Bastin
- Brain Research Imaging Centre, University of Edinburgh, Edinburgh, EH4 2XU, UK
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, EH4 2XU, UK
| | - Maria del C. Valdés Hernández
- Brain Research Imaging Centre, University of Edinburgh, Edinburgh, EH4 2XU, UK
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, EH4 2XU, UK
| | - Natalie A. Royle
- Brain Research Imaging Centre, University of Edinburgh, Edinburgh, EH4 2XU, UK
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, EH4 2XU, UK
| | - Janie Corley
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, EH8 9YL, UK
- Department of Psychology, University of Edinburgh, Edinburgh, EH8 9YL, UK
| | - Susana Muñoz Maniega
- Brain Research Imaging Centre, University of Edinburgh, Edinburgh, EH4 2XU, UK
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, EH4 2XU, UK
| | - Alison Pattie
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, EH8 9YL, UK
- Department of Psychology, University of Edinburgh, Edinburgh, EH8 9YL, UK
| | - David A. Dickie
- Brain Research Imaging Centre, University of Edinburgh, Edinburgh, EH4 2XU, UK
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, EH4 2XU, UK
| | - Julie Staals
- Department of Neurology, Maastricht University Medical Centre, Maastricht, 6211, Netherlands
| | - Alan J. Gow
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, EH8 9YL, UK
- Department of Psychology, Heriot-Watt University, Edinburgh, EH14 4AS, UK
| | - John M. Starr
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, EH8 9YL, UK
- Alzheimer Scotland Dementia Research Centre, Department of Psychology, University of Edinburgh, Edinburgh, EH8 9YL, UK
| | - Ian J. Deary
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, EH8 9YL, UK
- Department of Psychology, University of Edinburgh, Edinburgh, EH8 9YL, UK
| | - Christian Enzinger
- Department of Neurology, Medical University of Graz, Graz, 8036, Austria
- Division of Neuroradiology, Vascular and Interventional Neuroradiology, Department of Radiology, Medical University of Graz, Graz, 8036, Austria
| | - Franz Fazekas
- Department of Neurology, Medical University of Graz, Graz, 8036, Austria
| | - Joanna Wardlaw
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, EH8 9YL, UK
- Brain Research Imaging Centre, University of Edinburgh, Edinburgh, EH4 2XU, UK
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, EH4 2XU, UK
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10
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Moonen JEF, Foster-Dingley JC, van den Berg-Huijsmans AA, de Ruijter W, de Craen AJM, van der Grond J, van der Mast RC. Influence of Small Vessel Disease and Microstructural Integrity on Neurocognitive Functioning in Older Individuals: The DANTE Study Leiden. AJNR Am J Neuroradiol 2017; 38:25-30. [PMID: 27659190 DOI: 10.3174/ajnr.a4934] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 07/20/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Small vessel disease is a major cause of neurocognitive dysfunction in the elderly. Small vessel disease may manifest as white matter hyperintensities, lacunar infarcts, cerebral microbleeds, and atrophy, all of which are visible on conventional MR imaging or as microstructural changes determined by diffusion tensor imaging. This study investigated whether microstructural integrity is associated with neurocognitive dysfunction in older individuals, irrespective of the conventional features of small vessel disease. MATERIALS AND METHODS The study included 195 participants (75 years of age or older) who underwent conventional 3T MR imaging with DTI to assess fractional anisotropy, mean diffusivity, axial diffusivity, and radial diffusivity. Cognitive tests were administered to assess cognitive domains, and the Geriatric Depression Scale-15 and Apathy Scale of Starkstein were used to assess symptoms of depression and apathy, respectively. The association between DTI measures and neurocognitive function was analyzed by using linear regression models. RESULTS In gray matter, a lower fractional anisotropy and higher mean diffusivity, axial diffusivity, and radial diffusivity were associated with worse executive function, psychomotor speed, and overall cognition and, in white matter, also with memory. Findings were independent of white matter hyperintensities, lacunar infarcts, and cerebral microbleeds. However, after additional adjustment for normalized brain volume, only lower fractional anisotropy in white and gray matter and higher gray matter radial diffusivity remained associated with executive functioning. DTI measures were not associated with scores on the Geriatric Depression Scale-15 or the Apathy Scale of Starkstein. CONCLUSIONS Microstructural integrity was associated with cognitive but not psychological dysfunction. Associations were independent of the conventional features of small vessel disease but attenuated after adjusting for brain volume.
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Affiliation(s)
- J E F Moonen
- From the Departments of Psychiatry (J.E.F.M., J.C.F.-D., R.C.v.d.M.)
| | | | | | | | - A J M de Craen
- Gerontology and Geriatrics (A.J.M.d.C.), Leiden University Medical Center, Leiden, the Netherlands
| | | | - R C van der Mast
- From the Departments of Psychiatry (J.E.F.M., J.C.F.-D., R.C.v.d.M.)
- Department of Psychiatry (R.C.v.d.M.), Collaborative Antwerp Psychiatric Research Institute, University of Antwerp, Antwerp, Belgium
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11
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Tomimoto H. White matter integrity and cognitive dysfunction: Radiological and neuropsychological correlations. Geriatr Gerontol Int 2015; 15 Suppl 1:3-9. [DOI: 10.1111/ggi.12661] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2015] [Indexed: 12/30/2022]
Affiliation(s)
- Hidekazu Tomimoto
- Department of Neurology; Graduate School of Medicine; Mie University; Mie Japan
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12
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Sahin N, Solak A, Genc B, Akpinar MB, Kulu U, Cengiz H. Brain diffusion changes in unilateral carotid artery stenosis with non-shunt endarterectomy: Correlation with white matter lesions. Clin Neurol Neurosurg 2015; 133:24-9. [PMID: 25837237 DOI: 10.1016/j.clineuro.2015.03.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Revised: 12/26/2014] [Accepted: 03/02/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Carotid stenosis is associated with hemodynamic cerebral ischemia. Diffusion-weighted MR imaging allows for the assessment of changes related to alterations in tissue integrity. The aim of this study was to investigate (a) whether white matter lesions (WML) and apparent diffusion coefficient (ADC) values differ between ipsilateral and contralateral hemispheres, (b) whether ADC values are related to WMLs and common vascular risk factors, and (c) whether ADC values differ after carotid endarterectomy (CEA) without a shunt in patients with unilateral internal carotid artery stenosis (ICAS). METHODS Twenty-five patients (16 men, 9 women; mean age of 68 years) with unilateral ICAS (≥ 70% carotid stenosis) were assessed with brain MRI before and after CEA, prospectively. Two experienced radiologists scored the WMLs. Bilateral ADC values in anterior and posterior periventricular WM, occipital WM, and thalamus were evaluated on preoperative and postoperative MRI. Differences in ADC values and WML scores between the two hemispheres were assessed and associations between ADC values, WML scores, and explanatory variables (e.g., age, sex, vascular risk factors) were analyzed. RESULTS WMLs were significantly greater and ADC values were elevated in the ipsilateral cerebral WM. After CEA, ADC values rapidly decreased but remained higher than within the contralateral hemisphere. Ipsilateral hemispheric ADC values were associated with basal ganglia WMLs. No association between ADC values and vascular risk factors was found. CONCLUSION ICAS is associated with increased diffusion in normal-appearing WM in comparison to more prominent chronic ischemic lesions. CEA has a partial effect on diffusion. These cerebral changes may be related to chronic low-grade ischemic damage that is induced by ICAS.
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Affiliation(s)
- Neslin Sahin
- Department of Radiology, Sifa University School of Medicine, Fevzipasa Boulevard No. 172/2, 35240 Basmane Izmir, Turkey.
| | - Aynur Solak
- Department of Radiology, Sifa University School of Medicine, Fevzipasa Boulevard No. 172/2, 35240 Basmane Izmir, Turkey
| | - Berhan Genc
- Department of Radiology, Sifa University School of Medicine, Fevzipasa Boulevard No. 172/2, 35240 Basmane Izmir, Turkey
| | - Mehmet Besir Akpinar
- Department of Cardiovascular and Thoracic Surgery, Sifa University School of Medicine, Fevzipasa Boulevard No. 172/2, 35240 Basmane Izmir, Turkey
| | - Ugur Kulu
- Department of Neurology, Sifa University School of Medicine, Fevzipasa Boulevard No. 172/2, 35240 Basmane Izmir, Turkey
| | - Hakan Cengiz
- Sifa University, Department of Biostatistics & Medical Informatics, Ankara Cd, 35100 İzmir, Turkey
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13
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Viehweger A, Riffert T, Dhital B, Knösche TR, Anwander A, Stepan H, Sorge I, Hirsch W. The Gini coefficient: a methodological pilot study to assess fetal brain development employing postmortem diffusion MRI. Pediatr Radiol 2014; 44:1290-301. [PMID: 24816372 DOI: 10.1007/s00247-014-3002-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2013] [Revised: 02/20/2014] [Accepted: 04/09/2014] [Indexed: 12/19/2022]
Abstract
BACKGROUND Diffusion-weighted imaging (DWI) is important in the assessment of fetal brain development. However, it is clinically challenging and time-consuming to prepare neuromorphological examinations to assess real brain age and to detect abnormalities. OBJECTIVE To demonstrate that the Gini coefficient can be a simple, intuitive parameter for modelling fetal brain development. MATERIALS AND METHODS Postmortem fetal specimens(n = 28) were evaluated by diffusion-weighted imaging (DWI) on a 3-T MRI scanner using 60 directions, 0.7-mm isotropic voxels and b-values of 0, 150, 1,600 s/mm(2). Constrained spherical deconvolution (CSD) was used as the local diffusion model. Fractional anisotropy (FA), apparent diffusion coefficient (ADC) and complexity (CX) maps were generated. CX was defined as a novel diffusion metric. On the basis of those three parameters, the Gini coefficient was calculated. RESULTS Study of fetal brain development in postmortem specimens was feasible using DWI. The Gini coefficient could be calculated for the combination of the three diffusion parameters. This multidimensional Gini coefficient correlated well with age (Adjusted R(2) = 0.59) between the ages of 17 and 26 gestational weeks. CONCLUSIONS We propose a new method that uses an economics concept, the Gini coefficient, to describe the whole brain with one simple and intuitive measure, which can be used to assess the brain's developmental state.
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Affiliation(s)
- Adrian Viehweger
- Department of Pediatric Radiology, University Hospital Leipzig, Liebigstraße 20a, 04103, Leipzig, Germany,
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14
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Kliper E, Ben Assayag E, Tarrasch R, Artzi M, Korczyn AD, Shenhar-Tsarfaty S, Aizenstein O, Hallevi H, Mike A, Shopin L, Bornstein NM, Ben Bashat D. Cognitive state following stroke: the predominant role of preexisting white matter lesions. PLoS One 2014; 9:e105461. [PMID: 25153800 PMCID: PMC4143274 DOI: 10.1371/journal.pone.0105461] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Accepted: 07/24/2014] [Indexed: 11/25/2022] Open
Abstract
Background and purpose Stroke is a major cause of cognitive impairment and dementia in adults, however the role of the ischemic lesions themselves, on top of other risk factors known in the elderly, remains controversial. This study used structural equation modeling to determine the respective impact of the new ischemic lesions' volume, preexisting white matter lesions and white matter integrity on post stroke cognitive state. Methods Consecutive first ever mild to moderate stroke or transient ischemic attack patients recruited into the ongoing prospective TABASCO study underwent magnetic resonance imaging scans within seven days of stroke onset and were cognitively assessed one year after the event using a computerized neuropsychological battery. The volumes of both ischemic lesions and preexisting white matter lesions and the integrity of the normal appearing white matter tissue were measured and their contribution to cognitive state was assessed using structural equation modeling path analysis taking into account demographic parameters. Two models were hypothesized, differing by the role of ischemic lesions' volume. Results Structural equation modeling analysis of 142 patients confirmed the predominant role of white matter lesion volume (standardized path coefficient β = −0.231) and normal appearing white matter integrity (β = −0.176) on the global cognitive score, while ischemic lesions' volume showed no such effect (β = 0.038). The model excluding the ischemic lesion presented better fit to the data (comparative fit index 0.9 versus 0.092). Conclusions Mild to moderate stroke patients with preexisting white matter lesions are more vulnerable to cognitive impairment regardless of their new ischemic lesions. Thus, these patients can serve as a target group for studies on cognitive rehabilitation and neuro-protective therapies which may, in turn, slow their cognitive deterioration.
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Affiliation(s)
- Efrat Kliper
- Functional Brain Center, The Wohl Institute for Advanced Imaging, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Neurology Department, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Einor Ben Assayag
- Neurology Department, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Ricardo Tarrasch
- Jaime and Joan Constantiner School of Education, Tel Aviv University, Tel Aviv, Israel; Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Moran Artzi
- Functional Brain Center, The Wohl Institute for Advanced Imaging, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amos D Korczyn
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Orna Aizenstein
- Functional Brain Center, The Wohl Institute for Advanced Imaging, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Hen Hallevi
- Neurology Department, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Anat Mike
- Neurology Department, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Ludmila Shopin
- Neurology Department, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Natan M Bornstein
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Neurology Department, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Dafna Ben Bashat
- Functional Brain Center, The Wohl Institute for Advanced Imaging, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
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15
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Quattrocchi CC, Errante Y, Mallio CA, Santini D, Tonini G, Zobel BB. Brain metastatic volume and white matter lesions in advanced cancer patients. J Neurooncol 2013; 113:451-8. [DOI: 10.1007/s11060-013-1137-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Accepted: 04/27/2013] [Indexed: 12/15/2022]
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16
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de Groot M, Verhaaren BFJ, de Boer R, Klein S, Hofman A, van der Lugt A, Ikram MA, Niessen WJ, Vernooij MW. Changes in normal-appearing white matter precede development of white matter lesions. Stroke 2013; 44:1037-42. [PMID: 23429507 DOI: 10.1161/strokeaha.112.680223] [Citation(s) in RCA: 183] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE It is unknown whether white matter lesions (WML) develop abruptly in previously normal brain areas, or whether tissue changes are already present before WML become apparent on MRI. We therefore investigated whether development of WML is preceded by quantifiable changes in normal-appearing white matter (NAWM). METHODS In 689 participants from the general population (mean age 67 years), we performed 2 MRI scans (including diffusion tensor imaging and Fluid Attenuation Inversion Recovery [FLAIR] sequences) 3.5 years apart using the same 1.5-T scanner. Using automated tissue segmentation, we identified NAWM at baseline. We assessed which NAWM regions converted into WML during follow-up and differentiated new WML into regions of WML growth and de novo WML. Fractional anisotropy, mean diffusivity, and FLAIR intensity of regions converting to WML and regions of persistent NAWM were compared using 3 approaches: a whole-brain analysis, a regionally matched approach, and a voxel-wise approach. RESULTS All 3 approaches showed that low fractional anisotropy, high mean diffusivity, and relatively high FLAIR intensity at baseline were associated with WML development during follow-up. Compared with persistent NAWM regions, NAWM regions converting to WML had significantly lower fractional anisotropy (0.337 vs 0.387; P<0.001), higher mean diffusivity (0.910 × 10(-3) mm(2)/s vs 0.729 × 10(-3) mm(2)/s; P<0.001), and relatively higher normalized FLAIR intensity (1.233 vs -0.340; P<0.001). This applied to both NAWM developing into growing and de novo WML. CONCLUSIONS White matter changes in NAWM are present and can be quantified on diffusion tensor imaging and FLAIR before WML develop. This suggests that WML develop gradually, and that visually appreciable WML are only the tip of the iceberg of white matter pathology.
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Affiliation(s)
- Marius de Groot
- Department of Radiology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
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17
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18
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Jokinen H, Schmidt R, Ropele S, Fazekas F, Gouw AA, Barkhof F, Scheltens P, Madureira S, Verdelho A, Ferro JM, Wallin A, Poggesi A, Inzitari D, Pantoni L, Erkinjuntti T. Diffusion changes predict cognitive and functional outcome: the LADIS study. Ann Neurol 2013; 73:576-83. [PMID: 23423951 DOI: 10.1002/ana.23802] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Revised: 09/14/2012] [Accepted: 10/26/2012] [Indexed: 11/10/2022]
Abstract
OBJECTIVE A study was undertaken to determine whether diffusion-weighted imaging (DWI) abnormalities in normal-appearing brain tissue (NABT) and in white matter hyperintensities (WMH) predict longitudinal cognitive decline and disability in older individuals independently of the concomitant magnetic resonance imaging (MRI) findings. METHODS A total of 340 LADIS (Leukoaraiosis and Disability Study) participants, aged 65 to 84 years, underwent brain MRI including DWI at baseline. Neuropsychological and functional assessments were carried out at study entry and repeated annually over a 3-year observational period. Linear mixed models and Cox regression survival analysis adjusted for demographics, WMH volume, lacunes, and brain atrophy were used to evaluate the independent effect of the DWI measures on change in cognitive performance and functional abilities. RESULTS The mean global apparent diffusion coefficient (ADC) and the relative peak height and peak position of the ADC histogram in NABT predicted faster rate of decline in a composite score for speed and motor control. Higher mean ADC and lower peak height were also related to deterioration in executive functions and memory (specifically working memory), with peak height also being related to more rapid transition to disability and higher rate of mortality. Mean ADC in WMH had less pronounced effects on cognitive and functional outcomes. INTERPRETATION DWI microstructural changes in NABT predict faster decline in psychomotor speed, executive functions, and working memory regardless of conventional MRI findings. Moreover, these changes are related to functional disability and higher mortality.
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Affiliation(s)
- Hanna Jokinen
- Department of Neurology, Helsinki University Central Hospital and Department of Neurological Sciences, University of Helsinki, Finland.
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Jonsson M, Zetterberg H, Rolstad S, Edman A, Gouw AA, Bjerke M, Lind K, Blennow K, Pantoni L, Inzitari D, Wallin A. Low cerebrospinal fluid sulfatide predicts progression of white matter lesions: The LADIS study. Dement Geriatr Cogn Disord 2013; 34:61-7. [PMID: 22922641 DOI: 10.1159/000341576] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/18/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Demyelination and axonal degeneration are the hallmarks of established white matter lesions (WML). The neurochemistry of ongoing WML is only partially known. We explored cerebrospinal fluid (CSF) substances as markers of brain tissue damage in relation to progression of WML rated on magnetic resonance imaging. METHODS CSF from elderly individuals with WML was analyzed for amyloid markers, total τ, hyperphosphorylated τ, neurofilament protein light subunit, sulfatide and CSF/serum-albumin ratio. After 3 years, a follow-up magnetic resonance imaging was performed. Progression of WML was rated using the Rotterdam Progression Scale (RPS). RESULTS 37 subjects (age 73.6 ± 4.6 years) were included. Subjects with more pronounced progression (RPS > 2; n = 15) had lower mean sulfatide concentration at baseline as compared to subjects with no or minimal progression (RPS 0-2; n = 22) according to univariate analyses (p = 0.009). Sulfatide was the only biomarker that predicted the RPS score according to regression analysis, explaining 18.9% of the total variance (r = 0.38, p = 0.015). CONCLUSION The correlation of CSF sulfatide levels and RPS scores may reflect a remyelination response to the demyelination process associated with WML. Furthermore, the results strengthen the notion that WML pathology is different from that of Alzheimer's disease.
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Affiliation(s)
- Michael Jonsson
- Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, The Sahlgrenska Academy at University of Gothenburg, Sweden.
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Poggesi A, Pantoni L, Inzitari D, Fazekas F, Ferro J, O'Brien J, Hennerici M, Scheltens P, Erkinjuntti T, Visser M, Langhorne P, Chabriat H, Waldemar G, Wallin A, Wahlund A. 2001-2011: A Decade of the LADIS (Leukoaraiosis And DISability) Study: What Have We Learned about White Matter Changes and Small-Vessel Disease? Cerebrovasc Dis 2011; 32:577-88. [PMID: 22277351 DOI: 10.1159/000334498] [Citation(s) in RCA: 208] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2011] [Accepted: 10/18/2011] [Indexed: 11/19/2022] Open
Abstract
Over the last 20 years, evidence about the clinical correlates of cerebral white matter changes (WMC; also called leukoaraiosis) has been accumulating. WMC are now listed among the neuroimaging expressions of cerebral small-vessel disease and are no longer considered an innocuous finding because they are associated, in cross-sectional surveys, with various disturbances and, in follow-up studies, with poor prognosis. The Leukoaraiosis And DISability (LADIS) study has contributed substantially to this body of knowledge. LADIS is a European multicenter collaboration that was started in 2001 with the aim of assessing the independent role of WMC in predicting disability in subjects aged 65-84. The main results of the LADIS study have been released in 2009 with the demonstration that severe WMC more than double the risk of transition from an autonomous to a dependent status after 3 years of follow-up. The LADIS study has also contributed more focused substudies assessing the possible role of WMC in the decline of cognitive and motor performances, depressive symptoms associated with aging and cerebrovascular diseases, urinary disturbances, and also the role of other brain lesions (lacunar infarcts, cerebral atrophy, and corpus callosum morphology). The LADIS study provides a good example of harmonization of instruments (MRI protocol, clinical, neuropsychological, and functional scales) within an international collaboration. Currently, the LADIS study is providing data about the natural history of WMC. In this paper, we review the background and the main results of the LADIS study. This review puts forward some considerations for future studies in the field.
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Heterogeneity in age-related white matter changes. Acta Neuropathol 2011; 122:171-85. [PMID: 21706175 DOI: 10.1007/s00401-011-0851-x] [Citation(s) in RCA: 220] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2011] [Revised: 06/15/2011] [Accepted: 06/16/2011] [Indexed: 10/18/2022]
Abstract
White matter changes occur endemically in routine magnetic resonance imaging (MRI) scans of elderly persons. MRI appearance and histopathological correlates of white matter changes are heterogeneous. Smooth periventricular hyperintensities, including caps around the ventricular horns, periventricular lining and halos are likely to be of non-vascular origin. They relate to a disruption of the ependymal lining with subependymal widening of the extracellular space and have to be differentiated from subcortical and deep white matter abnormalities. For the latter a distinction needs to be made between punctate, early confluent and confluent types. Although punctate white matter lesions often represent widened perivascular spaces without substantial ischemic tissue damage, early confluent and confluent lesions correspond to incomplete ischemic destruction. Punctate abnormalities on MRI show a low tendency for progression, while early confluent and confluent changes progress rapidly. The causative and modifying pathways involved in the occurrence of sporadic age-related white matter changes are still incompletely understood, but recent microarray and genome-wide association approaches increased the notion of pathways that might be considered as targets for therapeutic intervention. The majority of differentially regulated transcripts in white matter lesions encode genes associated with immune function, cell cycle, proteolysis, and ion transport. Genome-wide association studies identified six SNPs mapping to a locus on chromosome 17q25 to be related to white matter lesion load in the general population. We also report first and preliminary data that demonstrate apolipoprotein E (ApoE) immunoreactivity in white matter lesions and support epidemiological findings indicating that ApoE is another factor possibly related to white matter lesion occurrence. Further insights come from modern MRI techniques, such as diffusion tensor and magnetization transfer imaging, as they provide tools for the characterization of normal-appearing brain tissue beyond what can be expected from standard MRI scans. There is a need for additional pre- and postmortem studies in humans, including these new imaging techniques.
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MRI-detected white matter lesions: do they really matter? J Neural Transm (Vienna) 2011; 118:673-81. [DOI: 10.1007/s00702-011-0594-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2010] [Accepted: 01/27/2011] [Indexed: 10/18/2022]
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Gloor M, Scheffler K, Bieri O. Intrascanner and interscanner variability of magnetization transfer-sensitized balanced steady-state free precession imaging. Magn Reson Med 2010; 65:1112-7. [DOI: 10.1002/mrm.22694] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2010] [Revised: 07/26/2010] [Accepted: 09/24/2010] [Indexed: 11/11/2022]
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Taki Y, Kinomura S, Sato K, Goto R, Wu K, Kawashima R, Fukuda H. Correlation between degree of white matter hyperintensities and global gray matter volume decline rate. Neuroradiology 2010; 53:397-403. [PMID: 20625706 DOI: 10.1007/s00234-010-0746-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2010] [Accepted: 06/28/2010] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Whether the degree of white matter hyperintensities (WMHs) shows a significant correlation with the rate of global gray matter volume decline over a period following initial baseline measurement remains unclear. The purpose of the present study was to reveal the relationship between the degree of WMHs at baseline and the rate of global gray matter volume decline by applying a longitudinal design. METHODS Using a 6-year longitudinal design and magnetic resonance images of the brains of 160 healthy individuals aged over 50 years and living in the community, we analyzed the correlation between degree of WMHs using Fazekas scaling at baseline and rate of global gray matter volume decline 6 years later. To obtain the rate of global gray matter volume decline, we calculated global gray matter volume and intracranial volume at baseline and at follow-up using a fully automated method. RESULTS The annual percentage change in the gray matter ratio (GMR, APC(GMR)), in which GMR represents the percentage of gray matter volume in the intracranial volume, showed a significant positive correlation with the degree of deep WMHs and periventricular WMHs at baseline, after adjusting for age, gender, present history of hypertension, and diabetes mellitus. CONCLUSION Our results suggest that degree of WMHs at baseline predicts the rate of gray matter volume decline 6 years later and that simple visual scaling of WMHs could contribute to predicting the rate of global gray matter volume decline.
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Affiliation(s)
- Yasuyuki Taki
- Division of Developmental Cognitive Neuroscience, Institute of Development, Aging and Cancer, Tohoku University, Aobaku, Sendai, Japan.
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Schmidt R, Ropele S, Ferro J, Madureira S, Verdelho A, Petrovic K, Gouw A, van der Flier WM, Enzinger C, Pantoni L, Inzitari D, Erkinjuntti T, Scheltens P, Wahlund LO, Waldemar G, Rostrup E, Wallin A, Barkhof F, Fazekas F. Diffusion-Weighted Imaging and Cognition in the Leukoariosis and Disability in the Elderly Study. Stroke 2010; 41:e402-8. [DOI: 10.1161/strokeaha.109.576629] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
The mechanisms by which leukoariosis impacts on clinical and cognitive functions are not yet fully understood. We hypothesized that ultrastructural abnormalities of the normal-appearing brain tissue (NABT) assessed by diffusion-weighted imaging played a major and independent role.
Methods—
In addition to a comprehensive clinical, neuropsychologic, and imaging work-up, diffusion-weighted imaging was performed in 340 participants of the multicenter leukoariosis and disability study examining the impact of white matter hyperintensities (WMH) on 65- to 85-year old individuals without previous disability. WMH severity was rated according to the Fazekas score. Multivariate regression analysis served to assess correlations of histogram metrics of the apparent diffusion coefficient (ADC) of whole-brain tissue, NABT, and of the mean ADC of WMH with cognitive functions.
Results—
Increasing WMH scores were associated with a higher frequency of hypertension, a greater WMH volume, more brain atrophy, worse overall cognitive performance, and changes in ADC. We found strong associations between the peak height of the ADC histogram of whole-brain tissue and NABT with memory performance, executive dysfunction, and speed, which remained after adjustment for WMH lesion volume and brain atrophy and were consistent among centers. No such association was seen with the mean ADC of WMH.
Conclusions—
Ultrastructural abnormalities of NABT increase with WMH severity and have a strong and independent effect on cognitive functions, whereas diffusion-weighted imaging metrics within WMH have no direct impact. This should be considered when defining outcome measures for trials that attempt to ameliorate the consequences of WMH progression.
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Affiliation(s)
- Reinhold Schmidt
- From Department of Neurology (R.S., S.R., K.P., C.E., F.F.), Medical University of Graz, Graz, Austria; Serviço de Neurologia (J.F., S.M., A.V., F.B.), Centro de Estudos Egas Moniz, Hospital de Santa Maria, Lisboa, Portugal; Department of Neurology (A.G., W.v.d.F., P.S., F.B.), Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Department of Neurological and Psychiatric Sciences (A.G., L.P., D.I.), University of Florence, Florence, Italy; Memory Research Unit (T.E.), Department of
| | - Stefan Ropele
- From Department of Neurology (R.S., S.R., K.P., C.E., F.F.), Medical University of Graz, Graz, Austria; Serviço de Neurologia (J.F., S.M., A.V., F.B.), Centro de Estudos Egas Moniz, Hospital de Santa Maria, Lisboa, Portugal; Department of Neurology (A.G., W.v.d.F., P.S., F.B.), Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Department of Neurological and Psychiatric Sciences (A.G., L.P., D.I.), University of Florence, Florence, Italy; Memory Research Unit (T.E.), Department of
| | - José Ferro
- From Department of Neurology (R.S., S.R., K.P., C.E., F.F.), Medical University of Graz, Graz, Austria; Serviço de Neurologia (J.F., S.M., A.V., F.B.), Centro de Estudos Egas Moniz, Hospital de Santa Maria, Lisboa, Portugal; Department of Neurology (A.G., W.v.d.F., P.S., F.B.), Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Department of Neurological and Psychiatric Sciences (A.G., L.P., D.I.), University of Florence, Florence, Italy; Memory Research Unit (T.E.), Department of
| | - Sofia Madureira
- From Department of Neurology (R.S., S.R., K.P., C.E., F.F.), Medical University of Graz, Graz, Austria; Serviço de Neurologia (J.F., S.M., A.V., F.B.), Centro de Estudos Egas Moniz, Hospital de Santa Maria, Lisboa, Portugal; Department of Neurology (A.G., W.v.d.F., P.S., F.B.), Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Department of Neurological and Psychiatric Sciences (A.G., L.P., D.I.), University of Florence, Florence, Italy; Memory Research Unit (T.E.), Department of
| | - Ana Verdelho
- From Department of Neurology (R.S., S.R., K.P., C.E., F.F.), Medical University of Graz, Graz, Austria; Serviço de Neurologia (J.F., S.M., A.V., F.B.), Centro de Estudos Egas Moniz, Hospital de Santa Maria, Lisboa, Portugal; Department of Neurology (A.G., W.v.d.F., P.S., F.B.), Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Department of Neurological and Psychiatric Sciences (A.G., L.P., D.I.), University of Florence, Florence, Italy; Memory Research Unit (T.E.), Department of
| | - Katja Petrovic
- From Department of Neurology (R.S., S.R., K.P., C.E., F.F.), Medical University of Graz, Graz, Austria; Serviço de Neurologia (J.F., S.M., A.V., F.B.), Centro de Estudos Egas Moniz, Hospital de Santa Maria, Lisboa, Portugal; Department of Neurology (A.G., W.v.d.F., P.S., F.B.), Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Department of Neurological and Psychiatric Sciences (A.G., L.P., D.I.), University of Florence, Florence, Italy; Memory Research Unit (T.E.), Department of
| | - Alida Gouw
- From Department of Neurology (R.S., S.R., K.P., C.E., F.F.), Medical University of Graz, Graz, Austria; Serviço de Neurologia (J.F., S.M., A.V., F.B.), Centro de Estudos Egas Moniz, Hospital de Santa Maria, Lisboa, Portugal; Department of Neurology (A.G., W.v.d.F., P.S., F.B.), Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Department of Neurological and Psychiatric Sciences (A.G., L.P., D.I.), University of Florence, Florence, Italy; Memory Research Unit (T.E.), Department of
| | - Wiesje M. van der Flier
- From Department of Neurology (R.S., S.R., K.P., C.E., F.F.), Medical University of Graz, Graz, Austria; Serviço de Neurologia (J.F., S.M., A.V., F.B.), Centro de Estudos Egas Moniz, Hospital de Santa Maria, Lisboa, Portugal; Department of Neurology (A.G., W.v.d.F., P.S., F.B.), Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Department of Neurological and Psychiatric Sciences (A.G., L.P., D.I.), University of Florence, Florence, Italy; Memory Research Unit (T.E.), Department of
| | - Christian Enzinger
- From Department of Neurology (R.S., S.R., K.P., C.E., F.F.), Medical University of Graz, Graz, Austria; Serviço de Neurologia (J.F., S.M., A.V., F.B.), Centro de Estudos Egas Moniz, Hospital de Santa Maria, Lisboa, Portugal; Department of Neurology (A.G., W.v.d.F., P.S., F.B.), Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Department of Neurological and Psychiatric Sciences (A.G., L.P., D.I.), University of Florence, Florence, Italy; Memory Research Unit (T.E.), Department of
| | - Leonardo Pantoni
- From Department of Neurology (R.S., S.R., K.P., C.E., F.F.), Medical University of Graz, Graz, Austria; Serviço de Neurologia (J.F., S.M., A.V., F.B.), Centro de Estudos Egas Moniz, Hospital de Santa Maria, Lisboa, Portugal; Department of Neurology (A.G., W.v.d.F., P.S., F.B.), Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Department of Neurological and Psychiatric Sciences (A.G., L.P., D.I.), University of Florence, Florence, Italy; Memory Research Unit (T.E.), Department of
| | - Domenico Inzitari
- From Department of Neurology (R.S., S.R., K.P., C.E., F.F.), Medical University of Graz, Graz, Austria; Serviço de Neurologia (J.F., S.M., A.V., F.B.), Centro de Estudos Egas Moniz, Hospital de Santa Maria, Lisboa, Portugal; Department of Neurology (A.G., W.v.d.F., P.S., F.B.), Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Department of Neurological and Psychiatric Sciences (A.G., L.P., D.I.), University of Florence, Florence, Italy; Memory Research Unit (T.E.), Department of
| | - Timo Erkinjuntti
- From Department of Neurology (R.S., S.R., K.P., C.E., F.F.), Medical University of Graz, Graz, Austria; Serviço de Neurologia (J.F., S.M., A.V., F.B.), Centro de Estudos Egas Moniz, Hospital de Santa Maria, Lisboa, Portugal; Department of Neurology (A.G., W.v.d.F., P.S., F.B.), Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Department of Neurological and Psychiatric Sciences (A.G., L.P., D.I.), University of Florence, Florence, Italy; Memory Research Unit (T.E.), Department of
| | - Philip Scheltens
- From Department of Neurology (R.S., S.R., K.P., C.E., F.F.), Medical University of Graz, Graz, Austria; Serviço de Neurologia (J.F., S.M., A.V., F.B.), Centro de Estudos Egas Moniz, Hospital de Santa Maria, Lisboa, Portugal; Department of Neurology (A.G., W.v.d.F., P.S., F.B.), Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Department of Neurological and Psychiatric Sciences (A.G., L.P., D.I.), University of Florence, Florence, Italy; Memory Research Unit (T.E.), Department of
| | - Lars O. Wahlund
- From Department of Neurology (R.S., S.R., K.P., C.E., F.F.), Medical University of Graz, Graz, Austria; Serviço de Neurologia (J.F., S.M., A.V., F.B.), Centro de Estudos Egas Moniz, Hospital de Santa Maria, Lisboa, Portugal; Department of Neurology (A.G., W.v.d.F., P.S., F.B.), Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Department of Neurological and Psychiatric Sciences (A.G., L.P., D.I.), University of Florence, Florence, Italy; Memory Research Unit (T.E.), Department of
| | - Gunhild Waldemar
- From Department of Neurology (R.S., S.R., K.P., C.E., F.F.), Medical University of Graz, Graz, Austria; Serviço de Neurologia (J.F., S.M., A.V., F.B.), Centro de Estudos Egas Moniz, Hospital de Santa Maria, Lisboa, Portugal; Department of Neurology (A.G., W.v.d.F., P.S., F.B.), Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Department of Neurological and Psychiatric Sciences (A.G., L.P., D.I.), University of Florence, Florence, Italy; Memory Research Unit (T.E.), Department of
| | - Egill Rostrup
- From Department of Neurology (R.S., S.R., K.P., C.E., F.F.), Medical University of Graz, Graz, Austria; Serviço de Neurologia (J.F., S.M., A.V., F.B.), Centro de Estudos Egas Moniz, Hospital de Santa Maria, Lisboa, Portugal; Department of Neurology (A.G., W.v.d.F., P.S., F.B.), Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Department of Neurological and Psychiatric Sciences (A.G., L.P., D.I.), University of Florence, Florence, Italy; Memory Research Unit (T.E.), Department of
| | - Anders Wallin
- From Department of Neurology (R.S., S.R., K.P., C.E., F.F.), Medical University of Graz, Graz, Austria; Serviço de Neurologia (J.F., S.M., A.V., F.B.), Centro de Estudos Egas Moniz, Hospital de Santa Maria, Lisboa, Portugal; Department of Neurology (A.G., W.v.d.F., P.S., F.B.), Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Department of Neurological and Psychiatric Sciences (A.G., L.P., D.I.), University of Florence, Florence, Italy; Memory Research Unit (T.E.), Department of
| | - Frederik Barkhof
- From Department of Neurology (R.S., S.R., K.P., C.E., F.F.), Medical University of Graz, Graz, Austria; Serviço de Neurologia (J.F., S.M., A.V., F.B.), Centro de Estudos Egas Moniz, Hospital de Santa Maria, Lisboa, Portugal; Department of Neurology (A.G., W.v.d.F., P.S., F.B.), Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Department of Neurological and Psychiatric Sciences (A.G., L.P., D.I.), University of Florence, Florence, Italy; Memory Research Unit (T.E.), Department of
| | - Franz Fazekas
- From Department of Neurology (R.S., S.R., K.P., C.E., F.F.), Medical University of Graz, Graz, Austria; Serviço de Neurologia (J.F., S.M., A.V., F.B.), Centro de Estudos Egas Moniz, Hospital de Santa Maria, Lisboa, Portugal; Department of Neurology (A.G., W.v.d.F., P.S., F.B.), Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Department of Neurological and Psychiatric Sciences (A.G., L.P., D.I.), University of Florence, Florence, Italy; Memory Research Unit (T.E.), Department of
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26
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Ropele S, Enzinger C, Söllinger M, Langkammer C, Wallner-Blazek M, Schmidt R, Fazekas F. The impact of sex and vascular risk factors on brain tissue changes with aging: magnetization transfer imaging results of the Austrian stroke prevention study. AJNR Am J Neuroradiol 2010; 31:1297-301. [PMID: 20223888 DOI: 10.3174/ajnr.a2042] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Quantitative MR imaging techniques allow detection of subtle tissue changes that occur with brain aging beyond the accumulation of WMH and brain atrophy. To what extent sex and cerebrovascular risk factors impact these changes is largely unknown. We attempted to study these risk factors in the context of the community-based ASPS. MATERIAL AND METHODS We performed MTI in 328 neurologically asymptomatic ASPS participants (age range, 52-87 years). FLAIR was used to delineate WMH and to define NABT. The MTR was measured globally in NABT by using a histogram analysis technique and focally in WMH. Associations of MTR metrics with sex and a large battery of different cerebrovascular risk factors (age, arterial hypertension, diabetes mellitus, smoking, body mass index, cholesterol and triglyceride levels, glycated hemoglobin, and the presence of cardiac disease) were assessed with univariate and multiple regression analysis. RESULTS Age was seen to affect all MTR histogram metrics of NABT, and a faster decrease of the MTR peak height occurred in men. Independent associations with MTR metrics were found for arterial hypertension and diabetes mellitus. Besides lesion grade, arterial hypertension was also significantly associated with a lower MTR in WMH. CONCLUSIONS Microstructural tissue changes of NABT increase with aging and may be more extensive in men. Diabetes mellitus and hypertension appear to add to tissue destruction. The exact mechanisms involved await further clarification.
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Affiliation(s)
- Stefan Ropele
- Department of Neurology, Medical University of Graz, Graz, Austria.
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27
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Shimony JS, Sheline YI, D’Angelo G, Epstein AA, Benzinger TL, Mintun MA, McKinstry RC, Snyder AZ. Diffuse microstructural abnormalities of normal-appearing white matter in late life depression: a diffusion tensor imaging study. Biol Psychiatry 2009; 66:245-52. [PMID: 19375071 PMCID: PMC2804471 DOI: 10.1016/j.biopsych.2009.02.032] [Citation(s) in RCA: 109] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2008] [Revised: 02/12/2009] [Accepted: 02/27/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND Many recent studies have identified white matter abnormalities in late life depression (LLD). These abnormalities include an increased volume of discrete white matter hyperintensities on T2-weighted imaging (WMH) and changes in the diffusion tensor properties of water. However, no study of LLD to date has examined the integrity of white matter outside of WMH (i.e., in normal-appearing white matter). METHODS We performed T1- and T2-weighted imaging as well as diffusion tensor imaging (DTI) in depressed elderly subjects (n = 73) and nondepressed control subjects (n = 23) matched for age and cerebrovascular risk factors. The structural images were segmented into white matter, gray matter, cerebrospinal fluid, and WMH. The DTI parameters were calculated in white matter regions of interest after excluding the WMH. RESULTS Compared with control subjects, in the LLD group there were widespread abnormalities in DTI parameters, particularly in prefrontal regions. From a comprehensive neuropsychological battery, the strongest correlations were observed between cognitive processing speed and DTI abnormalities. CONCLUSIONS These results suggest that further investigation is warranted to determine potential reversibility and/or prognosis in LLD.
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Affiliation(s)
- Joshua S. Shimony
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO 63110
| | - Yvette I. Sheline
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO 63110, Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110
| | - Gina D’Angelo
- Division of Biostatistics, Washington University School of Medicine, St. Louis, MO 63110
| | - Adrian A. Epstein
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO 63110
| | - Tammie L.S. Benzinger
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO 63110
| | - Mark A. Mintun
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO 63110, Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110
| | - Robert C. McKinstry
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO 63110
| | - Abraham Z. Snyder
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO 63110, Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110
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