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Wendebourg MJ, Weigel M, Weidensteiner C, Sander L, Kesenheimer E, Naumann N, Haas T, Madoerin P, Braun N, Neuwirth C, Weber M, Jahn K, Kappos L, Granziera C, Schweikert K, Sinnreich M, Bieri O, Schlaeger R. Cervical and thoracic spinal cord gray matter atrophy is associated with disability in patients with amyotrophic lateral sclerosis. Eur J Neurol 2024; 31:e16268. [PMID: 38465478 DOI: 10.1111/ene.16268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 01/24/2024] [Accepted: 02/14/2024] [Indexed: 03/12/2024]
Abstract
BACKGROUND AND PURPOSE In amyotrophic lateral sclerosis (ALS), there is an unmet need for more precise patient characterization through quantitative, ideally operator-independent, assessments of disease extent and severity. Radially sampled averaged magnetization inversion recovery acquisitions (rAMIRA) magnetic resonance imaging enables gray matter (GM) and white matter (WM) area quantitation in the cervical and thoracic spinal cord (SC) with optimized contrast. We aimed to investigate rAMIRA-derived SC GM and SC WM areas and their association with clinical phenotype and disability in ALS. METHODS A total of 36 patients with ALS (mean [SD] age 61.7 [12.6] years, 14 women) and 36 healthy, age- and sex-matched controls (HCs; mean [SD] age 63.1 [12.1] years, 14 women) underwent two-dimensional axial rAMIRA imaging at the inter-vertebral disc levels C2/3-C5/C6 and the lumbar enlargement level Tmax. ALS Functional Rating Scale-revised (ALSFRS-R) score, muscle strength, and sniff nasal inspiratory pressure (SNIP) were assessed. RESULTS Compared to HCs, GM and WM areas were reduced in patients at all cervical levels (p < 0.0001). GM area (p = 0.0001), but not WM area, was reduced at Tmax. Patients with King's Stage 3 showed significant GM atrophy at all levels, while patients with King's Stage 1 showed significant GM atrophy selectively at Tmax. SC GM area was significantly associated with muscle force at corresponding myotomes. GM area at C3/C4 was associated with ALSFRS-R (p < 0.001) and SNIP (p = 0.0016). CONCLUSION Patients with ALS assessed by rAMIRA imaging show significant cervical and thoracic SC GM and SC WM atrophy. SC GM area correlates with muscle strength and clinical disability. GM area reduction at Tmax may be an early disease sign. Longitudinal studies are warranted.
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Affiliation(s)
- Maria Janina Wendebourg
- Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
- Department of Biomedical Engineering, Translational Imaging in Neurology (ThINk), University of Basel, Basel, Switzerland
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University of Basel, Basel, Switzerland
| | - Matthias Weigel
- Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
- Department of Biomedical Engineering, Translational Imaging in Neurology (ThINk), University of Basel, Basel, Switzerland
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University of Basel, Basel, Switzerland
- Division of Radiological Physics, Department of Radiology, University Hospital Basel, Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Claudia Weidensteiner
- Division of Radiological Physics, Department of Radiology, University Hospital Basel, Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Laura Sander
- Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
- Department of Biomedical Engineering, Translational Imaging in Neurology (ThINk), University of Basel, Basel, Switzerland
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University of Basel, Basel, Switzerland
| | - Eva Kesenheimer
- Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
- Department of Biomedical Engineering, Translational Imaging in Neurology (ThINk), University of Basel, Basel, Switzerland
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University of Basel, Basel, Switzerland
| | - Nicole Naumann
- Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Tanja Haas
- Division of Radiological Physics, Department of Radiology, University Hospital Basel, Basel, Switzerland
| | - Philipp Madoerin
- Division of Radiological Physics, Department of Radiology, University Hospital Basel, Basel, Switzerland
| | - Nathalie Braun
- Neuromuscular Diseases Unit/ALS Clinic, Kantonsspital Sankt Gallen, St. Gallen, Switzerland
| | - Christoph Neuwirth
- Neuromuscular Diseases Unit/ALS Clinic, Kantonsspital Sankt Gallen, St. Gallen, Switzerland
| | - Markus Weber
- Neuromuscular Diseases Unit/ALS Clinic, Kantonsspital Sankt Gallen, St. Gallen, Switzerland
| | - Kathleen Jahn
- Clinics of Respiratory Medicine, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Ludwig Kappos
- Department of Biomedical Engineering, Translational Imaging in Neurology (ThINk), University of Basel, Basel, Switzerland
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University of Basel, Basel, Switzerland
| | - Cristina Granziera
- Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
- Department of Biomedical Engineering, Translational Imaging in Neurology (ThINk), University of Basel, Basel, Switzerland
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University of Basel, Basel, Switzerland
| | - Kathi Schweikert
- Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Michael Sinnreich
- Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Biomedicine (DBE), University of Basel, Basel, Switzerland
| | - Oliver Bieri
- Division of Radiological Physics, Department of Radiology, University Hospital Basel, Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Regina Schlaeger
- Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
- Department of Biomedical Engineering, Translational Imaging in Neurology (ThINk), University of Basel, Basel, Switzerland
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University of Basel, Basel, Switzerland
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Longitudinal assessment of cervical spinal cord compartments in multiple sclerosis. Mult Scler Relat Disord 2023; 71:104545. [PMID: 36758461 DOI: 10.1016/j.msard.2023.104545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 01/21/2023] [Accepted: 01/31/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND Although cervical spinal cord (cSC) area is an established biomarker in MS, there is currently a lack of longitudinal assessments of cSC gray and white matter areas. OBJECTIVE We conducted an explorative analysis of longitudinal changes of cSC gray and white matter areas in MS patients. METHODS 65 MS patients (33 relapsing-remitting; 20 secondary progressive and 12 primary progressive) and 20 healthy controls (HC) received clinical and upper cSC MRI assessments over 1.10±0.28 years. cSC compartments were quantified on MRI using the novel averaged magnetization inversion recovery acquisitions sequence (in-plane resolution=0.67 × 0.67mm2), and in-house developed post-processing methods. Patients were stratified regarding clinical progression. RESULTS Patients with clinical progression showed faster reduction of cSC areas over time at the level of cSC enlargement (approximate vertebral level C4-C5) compared to stable patients (p<0.05). In addition, when compared to the rostral-cSC (approximate vertebral level C2-C3), a preferential reduction of cSC and white matter areas over time at the level of cSC enlargement (p<0.05 and p<0.01, respectively) was demonstrated only in patients with clinical progression, but not in stable MS patients and HC. Compared to HC, MS patients showed comparable changes over time in all cSC compartments. CONCLUSIONS MS patients with clinical disease progression demonstrate subtle signs of a more pronounced tissue loss at the level of cSC enlargement. Future studies should consider larger sample sizes and more extended observation periods.
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Tsagkas C, Horvath-Huck A, Haas T, Amann M, Todea A, Altermatt A, Müller J, Cagol A, Leimbacher M, Barakovic M, Weigel M, Pezold S, Sprenger T, Kappos L, Bieri O, Granziera C, Cattin P, Parmar K. Fully Automatic Method for Reliable Spinal Cord Compartment Segmentation in Multiple Sclerosis. AJNR Am J Neuroradiol 2023; 44:218-227. [PMID: 36702504 PMCID: PMC9891337 DOI: 10.3174/ajnr.a7756] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 12/05/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND AND PURPOSE Fully automatic quantification methods of spinal cord compartments are needed to study pathologic changes of the spinal cord GM and WM in MS in vivo. We propose a novel method for automatic spinal cord compartment segmentation (SCORE) in patients with MS. MATERIALS AND METHODS The cervical spinal cords of 24 patients with MS and 24 sex- and age-matched healthy controls were scanned on a 3T MR imaging system, including an averaged magnetization inversion recovery acquisition sequence. Three experienced raters manually segmented the spinal cord GM and WM, anterior and posterior horns, gray commissure, and MS lesions. Subsequently, manual segmentations were used to train neural segmentation networks of spinal cord compartments with multidimensional gated recurrent units in a 3-fold cross-validation fashion. Total intracranial volumes were quantified using FreeSurfer. RESULTS The intra- and intersession reproducibility of SCORE was high in all spinal cord compartments (eg, mean relative SD of GM and WM: ≤ 3.50% and ≤1.47%, respectively) and was better than manual segmentations (all P < .001). The accuracy of SCORE compared with manual segmentations was excellent, both in healthy controls and in patients with MS (Dice similarity coefficients of GM and WM: ≥ 0.84 and ≥0.92, respectively). Patients with MS had lower total WM areas (P < .05), and total anterior horn areas (P < .01 respectively), as measured with SCORE. CONCLUSIONS We demonstrate a novel, reliable quantification method for spinal cord tissue segmentation in healthy controls and patients with MS and other neurologic disorders affecting the spinal cord. Patients with MS have reduced areas in specific spinal cord tissue compartments, which may be used as MS biomarkers.
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Affiliation(s)
- C Tsagkas
- From the Neurologic Clinic and Policlinic, Departments of Medicine (C.T., M.A., J.M., M.W., T.S., L.K., C.G., K.P.), Clinical Research and Biomedical Engineering
- Translational Imaging in Neurology Basel (C.T., A.T., J.M., A.C., M.B., M.W., C.G., K.P.)
| | - A Horvath-Huck
- Department of Biomedical Engineering (A.H.-H., M.A., A.C., M.B., M.W., S.P., O.B., C.G., P.C.), University of Basel, Allschwil, Switzerland
| | - T Haas
- Department of Medicine and Biomedical Engineering; Division of Radiological Physics (T.H., M.W., O.B.)
| | - M Amann
- From the Neurologic Clinic and Policlinic, Departments of Medicine (C.T., M.A., J.M., M.W., T.S., L.K., C.G., K.P.), Clinical Research and Biomedical Engineering
- Department of Biomedical Engineering (A.H.-H., M.A., A.C., M.B., M.W., S.P., O.B., C.G., P.C.), University of Basel, Allschwil, Switzerland
- Medical Image Analysis Center AG (M.A., A.A.), Basel, Switzerland
| | - A Todea
- Translational Imaging in Neurology Basel (C.T., A.T., J.M., A.C., M.B., M.W., C.G., K.P.)
- Department of Radiology; Department of Neuroradiology (A.T.), Clinic for Radiology & Nuclear Medicine; and Research Center for Clinical Neuroimmunology
| | - A Altermatt
- Medical Image Analysis Center AG (M.A., A.A.), Basel, Switzerland
| | - J Müller
- From the Neurologic Clinic and Policlinic, Departments of Medicine (C.T., M.A., J.M., M.W., T.S., L.K., C.G., K.P.), Clinical Research and Biomedical Engineering
- Translational Imaging in Neurology Basel (C.T., A.T., J.M., A.C., M.B., M.W., C.G., K.P.)
| | - A Cagol
- Translational Imaging in Neurology Basel (C.T., A.T., J.M., A.C., M.B., M.W., C.G., K.P.)
- Department of Biomedical Engineering (A.H.-H., M.A., A.C., M.B., M.W., S.P., O.B., C.G., P.C.), University of Basel, Allschwil, Switzerland
| | - M Leimbacher
- Medical Faculty (M.L., P.C.), University of Basel, Basel, Switzerland
| | - M Barakovic
- Translational Imaging in Neurology Basel (C.T., A.T., J.M., A.C., M.B., M.W., C.G., K.P.)
- Department of Biomedical Engineering (A.H.-H., M.A., A.C., M.B., M.W., S.P., O.B., C.G., P.C.), University of Basel, Allschwil, Switzerland
| | - M Weigel
- From the Neurologic Clinic and Policlinic, Departments of Medicine (C.T., M.A., J.M., M.W., T.S., L.K., C.G., K.P.), Clinical Research and Biomedical Engineering
- Translational Imaging in Neurology Basel (C.T., A.T., J.M., A.C., M.B., M.W., C.G., K.P.)
- Department of Medicine and Biomedical Engineering; Division of Radiological Physics (T.H., M.W., O.B.)
- Department of Biomedical Engineering (A.H.-H., M.A., A.C., M.B., M.W., S.P., O.B., C.G., P.C.), University of Basel, Allschwil, Switzerland
| | - S Pezold
- Department of Biomedical Engineering (A.H.-H., M.A., A.C., M.B., M.W., S.P., O.B., C.G., P.C.), University of Basel, Allschwil, Switzerland
| | - T Sprenger
- From the Neurologic Clinic and Policlinic, Departments of Medicine (C.T., M.A., J.M., M.W., T.S., L.K., C.G., K.P.), Clinical Research and Biomedical Engineering
- Department of Neurology (T.S.), DKD Helios Klinik Wiesbaden, Wiesbaden, Germany
| | - L Kappos
- From the Neurologic Clinic and Policlinic, Departments of Medicine (C.T., M.A., J.M., M.W., T.S., L.K., C.G., K.P.), Clinical Research and Biomedical Engineering
- Neuroscience Basel (RC2NB) (L.K.), Departments of Medicine, Clinical Research, and Biomedical Imaging, University Hospital Basel and University of Basel, Basel, Switzerland
| | - O Bieri
- Department of Medicine and Biomedical Engineering; Division of Radiological Physics (T.H., M.W., O.B.)
- Department of Biomedical Engineering (A.H.-H., M.A., A.C., M.B., M.W., S.P., O.B., C.G., P.C.), University of Basel, Allschwil, Switzerland
| | - C Granziera
- From the Neurologic Clinic and Policlinic, Departments of Medicine (C.T., M.A., J.M., M.W., T.S., L.K., C.G., K.P.), Clinical Research and Biomedical Engineering
- Translational Imaging in Neurology Basel (C.T., A.T., J.M., A.C., M.B., M.W., C.G., K.P.)
- Department of Biomedical Engineering (A.H.-H., M.A., A.C., M.B., M.W., S.P., O.B., C.G., P.C.), University of Basel, Allschwil, Switzerland
| | - P Cattin
- Department of Biomedical Engineering (A.H.-H., M.A., A.C., M.B., M.W., S.P., O.B., C.G., P.C.), University of Basel, Allschwil, Switzerland
- Medical Faculty (M.L., P.C.), University of Basel, Basel, Switzerland
| | - K Parmar
- From the Neurologic Clinic and Policlinic, Departments of Medicine (C.T., M.A., J.M., M.W., T.S., L.K., C.G., K.P.), Clinical Research and Biomedical Engineering
- Translational Imaging in Neurology Basel (C.T., A.T., J.M., A.C., M.B., M.W., C.G., K.P.)
- Reha Rheinfelden (K.P.), Rheinfelden, Switzerland
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Tsagkas C, Huck-Horvath A, Cagol A, Haas T, Barakovic M, Amann M, Ruberte E, Melie-Garcia L, Weigel M, Pezold S, Schlaeger R, Kuhle J, Sprenger T, Kappos L, Bieri O, Cattin P, Granziera C, Parmar K. Anterior horn atrophy in the cervical spinal cord: A new biomarker in progressive multiple sclerosis. Mult Scler 2022; 29:702-718. [PMID: 36550626 DOI: 10.1177/13524585221139152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Spinal cord (SC) gray and white matter pathology plays a central role in multiple sclerosis (MS). OBJECTIVE We aimed to investigate the extent, pattern, and clinical relevance of SC gray and white matter atrophy in vivo. METHODS 39 relapsing-remitting patients (RRMS), 40 progressive MS patients (PMS), and 24 healthy controls (HC) were imaged at 3T using the averaged magnetization inversion recovery acquisitions sequence. Total and lesional cervical gray and white matter, and posterior (SCPH) and anterior horn (SCAH) areas were automatically quantified. Clinical assessment included the expanded disability status scale, timed 25-foot walk test, nine-hole peg test, and the 12-item MS walking scale. RESULTS PMS patients had significantly reduced cervical SCAH - but not SCPH - areas compared with HC and RRMS (both p < 0.001). In RRMS and PMS, the cervical SCAH areas increased significantly less in the region of cervical SC enlargement compared with HC (all p < 0.001). This reduction was more pronounced in PMS compared with RRMS (both p < 0.001). In PMS, a lower cervical SCAH area was the most important magnetic resonance imaging (MRI)-variable for higher disability scores. CONCLUSION MS patients show clinically relevant cervical SCAH atrophy, which is more pronounced in PMS and at the level of cervical SC enlargement.
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Affiliation(s)
- Charidimos Tsagkas
- Neurologic Clinic and Policlinic, Departments of Head, Spine and Neuromedicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland/Translational Imaging in Neurology (ThINk) Basel, Departments of Head, Spine and Neuromedicine and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Antal Huck-Horvath
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Alessandro Cagol
- Translational Imaging in Neurology (ThINk) Basel, Departments of Head, Spine and Neuromedicine and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland/Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Tanja Haas
- Division of Radiological Physics, Department of Radiology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Muhamed Barakovic
- Translational Imaging in Neurology (ThINk) Basel, Departments of Head, Spine and Neuromedicine and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland/Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Michael Amann
- Neurologic Clinic and Policlinic, Departments of Head, Spine and Neuromedicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland/Department of Biomedical Engineering, University of Basel, Basel, Switzerland; Medical Image Analysis Center AG, Basel, Switzerland
| | - Esther Ruberte
- Translational Imaging in Neurology (ThINk) Basel, Departments of Head, Spine and Neuromedicine and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland/Medical Image Analysis Center AG, Basel, Switzerland
| | - Lester Melie-Garcia
- Neurologic Clinic and Policlinic, Departments of Head, Spine and Neuromedicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland/Translational Imaging in Neurology (ThINk) Basel, Departments of Head, Spine and Neuromedicine and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Matthias Weigel
- Neurologic Clinic and Policlinic, Departments of Head, Spine and Neuromedicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland/Translational Imaging in Neurology (ThINk) Basel, Departments of Head, Spine and Neuromedicine and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland/Department of Biomedical Engineering, University of Basel, Basel, Switzerland/Division of Radiological Physics, Department of Radiology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Simon Pezold
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Regina Schlaeger
- Neurologic Clinic and Policlinic, Departments of Head, Spine and Neuromedicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland/Translational Imaging in Neurology (ThINk) Basel, Departments of Head, Spine and Neuromedicine and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Jens Kuhle
- Neurologic Clinic and Policlinic, Departments of Head, Spine and Neuromedicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Till Sprenger
- Neurologic Clinic and Policlinic, Departments of Head, Spine and Neuromedicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland/Department of Neurology, DKD HELIOS Klinik Wiesbaden, Wiesbaden, Germany
| | - Ludwig Kappos
- Neurologic Clinic and Policlinic, Departments of Head, Spine and Neuromedicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland/Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), Departments of Head, Spine and Neuromedicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Oliver Bieri
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland/Division of Radiological Physics, Department of Radiology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Philippe Cattin
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Cristina Granziera
- Neurologic Clinic and Policlinic, Departments of Head, Spine and Neuromedicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland/Translational Imaging in Neurology (ThINk) Basel, Departments of Head, Spine and Neuromedicine and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland; Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Katrin Parmar
- Neurologic Clinic and Policlinic, Departments of Head, Spine and Neuromedicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland/Translational Imaging in Neurology (ThINk) Basel, Departments of Head, Spine and Neuromedicine and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland; Reha Rheinfelden, Rheinfelden, Switzerland
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5
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Wendebourg MJ, Weigel M, Richter L, Gocheva V, Hafner P, Orsini AL, Crepulja V, Schmidt S, Huck A, Oechtering J, Blatow M, Haas T, Granziera C, Kappos L, Cattin P, Bieri O, Fischer D, Schlaeger R. Spinal Cord Gray Matter Atrophy is associated with functional decline in Post-Polio Syndrome. Eur J Neurol 2022; 29:1435-1445. [PMID: 35102676 PMCID: PMC9310958 DOI: 10.1111/ene.15261] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 12/30/2021] [Accepted: 01/20/2022] [Indexed: 11/29/2022]
Abstract
Objective To determine if patients with post‐polio syndrome (PPS) show spinal cord gray matter (SCGM) atrophy and to assess associations between SCGM atrophy, muscle strength and patient‐reported functional decline. Methods Twenty patients diagnosed with PPS (March of Dimes criteria) and 20 age‐ and sex‐matched healthy controls (HC) underwent 3T axial 2D‐rAMIRA magnetic resonance imaging at the intervertebral disc levels C2/C3–C6/C7, T9/T10 and the lumbar enlargement level (Tmax) (0.5 × 0.5 mm2 in‐plane resolution). SCGM areas were segmented manually by two independent raters. Muscle strength, self‐reported fatigue, depression and pain measures were assessed. Results Post‐polio syndrome patients showed significantly and preferentially reduced SCGM areas at C2/C3 (p = 0.048), C3/C4 (p = 0.001), C4/C5 (p < 0.001), C5/C6 (p = 0.004) and Tmax (p = 0.041) compared to HC. SCGM areas were significantly associated with muscle strength in corresponding myotomes even after adjustment for fatigue, pain and depression. SCGM areaTmax together with age and sex explained 68% of ankle dorsiflexion strength variance. No associations were found with age at or time since infection. Patients reporting PPS‐related decline in arm function showed significant cervical SCGM atrophy compared to stable patients adjusted for initial disease severity. Conclusions Patients with PPS show significant SCGM atrophy that correlates with muscle strength and is associated with PPS‐related functional decline. Our findings suggest a secondary neurodegenerative process underlying SCGM atrophy in PPS that is not explained by aging or residua of the initial infection alone. Confirmation by longitudinal studies is needed. The described imaging methodology is promising for developing novel imaging surrogates for SCGM diseases.
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Affiliation(s)
- Maria Janina Wendebourg
- Neurology Clinic and Policlinic, Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland.,ThINK Basel, Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Matthias Weigel
- Neurology Clinic and Policlinic, Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland.,ThINK Basel, Department of Biomedical Engineering, University of Basel, Basel, Switzerland.,Division of Radiological Physics, Department of Radiology, University Hospital Basel, Basel, Switzerland.,Department of Biomedical Engineering, University of Basel, Basel, Switzerland.,MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
| | - Laura Richter
- Neurology Clinic and Policlinic, Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Vanya Gocheva
- Division of Paediatric Neurology, University of Basel Children's Hospital, Basel, Switzerland
| | - Patricia Hafner
- Division of Paediatric Neurology, University of Basel Children's Hospital, Basel, Switzerland
| | - Anna-Lena Orsini
- Division of Paediatric Neurology, University of Basel Children's Hospital, Basel, Switzerland
| | - Valentina Crepulja
- Neurology Clinic and Policlinic, Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland.,ThINK Basel, Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Simone Schmidt
- Division of Paediatric Neurology, University of Basel Children's Hospital, Basel, Switzerland
| | - Antal Huck
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Johanna Oechtering
- Neurology Clinic and Policlinic, Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Maria Blatow
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Tanja Haas
- Division of Radiological Physics, Department of Radiology, University Hospital Basel, Basel, Switzerland.,Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Cristina Granziera
- Neurology Clinic and Policlinic, Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland.,ThINK Basel, Department of Biomedical Engineering, University of Basel, Basel, Switzerland.,MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
| | - Ludwig Kappos
- Neurology Clinic and Policlinic, Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland.,ThINK Basel, Department of Biomedical Engineering, University of Basel, Basel, Switzerland.,MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
| | - Philippe Cattin
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Oliver Bieri
- Division of Radiological Physics, Department of Radiology, University Hospital Basel, Basel, Switzerland.,Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Dirk Fischer
- Division of Paediatric Neurology, University of Basel Children's Hospital, Basel, Switzerland
| | - Regina Schlaeger
- Neurology Clinic and Policlinic, Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland.,ThINK Basel, Department of Biomedical Engineering, University of Basel, Basel, Switzerland.,MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
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6
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Kesenheimer EM, Wendebourg MJ, Weigel M, Weidensteiner C, Haas T, Richter L, Sander L, Horvath A, Barakovic M, Cattin P, Granziera C, Bieri O, Schlaeger R. Normalization of Spinal Cord Total Cross-Sectional and Gray Matter Areas as Quantified With Radially Sampled Averaged Magnetization Inversion Recovery Acquisitions. Front Neurol 2021; 12:637198. [PMID: 33841307 PMCID: PMC8027254 DOI: 10.3389/fneur.2021.637198] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 02/05/2021] [Indexed: 11/19/2022] Open
Abstract
Background: MR imaging of the spinal cord (SC) gray matter (GM) at the cervical and lumbar enlargements' level may be particularly informative in lower motor neuron disorders, e. g., spinal muscular atrophy, but also in other neurodegenerative or autoimmune diseases affecting the SC. Radially sampled averaged magnetization inversion recovery acquisition (rAMIRA) is a novel approach to perform SC imaging in clinical settings with favorable contrast and is well-suited for SC GM quantitation. However, before applying rAMIRA in clinical studies, it is important to understand (i) the sources of inter-subject variability of total SC cross-sectional areas (TCA) and GM area (GMA) measurements in healthy subjects and (ii) their relation to age and sex to facilitate the detection of pathology-associated changes. In this study, we aimed to develop normalization strategies for rAMIRA-derived SC metrics using skull and spine-based metrics to reduce anatomical variability. Methods: Sixty-one healthy subjects (age range 11–93 years, 37.7% women) were investigated with axial two-dimensional rAMIRA imaging at 3T MRI. Cervical and thoracic levels including the level of the cervical (C4/C5) and lumbar enlargements (Tmax) were examined. SC T2-weighted sagittal images and high-resolution 3D whole-brain T1-weighted images were acquired. TCA and GMAs were quantified. Anatomical variables with associations of |r| > 0.30 in univariate association with SC areas, and age and sex were used to construct normalization models using backward selection with TCAC4/C5 as outcome. The effect of the normalization was assessed by % relative standard deviation (RSD) reductions. Results: Mean inter-individual variability and the SD of the SC area metrics were considerable: TCAC4/5: 8.1%/9.0; TCATmax: 8.9%/6.5; GMAC4/C5: 8.6%/2.2; GMATmax: 12.2%/3.8. Normalization based on sex, brain WM volume, and spinal canal area resulted in RSD reductions of 23.7% for TCAs and 12.0% for GM areas at C4/C5. Normalizations based on the area of spinal canal alone resulted in RSD reductions of 10.2% for TCAs and 9.6% for GM areas at C4/C5, respectively. Discussion: Anatomic inter-individual variability of SC areas is substantial. This study identified effective normalization models for inter-subject variability reduction in TCA and SC GMA in healthy subjects based on rAMIRA imaging.
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Affiliation(s)
- Eva M Kesenheimer
- Neurologic Clinic and Policlinic, University Hospital Basel, Basel, Switzerland.,Department of Clinical Research, University of Basel, Basel, Switzerland.,Translational Imaging in Neurology (ThINK) Basel, Department of Medicine and Biomedical Engineering, Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
| | - Maria Janina Wendebourg
- Neurologic Clinic and Policlinic, University Hospital Basel, Basel, Switzerland.,Department of Clinical Research, University of Basel, Basel, Switzerland.,Translational Imaging in Neurology (ThINK) Basel, Department of Medicine and Biomedical Engineering, Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
| | - Matthias Weigel
- Neurologic Clinic and Policlinic, University Hospital Basel, Basel, Switzerland.,Translational Imaging in Neurology (ThINK) Basel, Department of Medicine and Biomedical Engineering, Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland.,Division of Radiological Physics, Department of Radiology, University Hospital Basel, Basel, Switzerland
| | - Claudia Weidensteiner
- Division of Radiological Physics, Department of Radiology, University Hospital Basel, Basel, Switzerland.,Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland
| | - Tanja Haas
- Division of Radiological Physics, Department of Radiology, University Hospital Basel, Basel, Switzerland
| | - Laura Richter
- Neurologic Clinic and Policlinic, University Hospital Basel, Basel, Switzerland.,Department of Clinical Research, University of Basel, Basel, Switzerland.,Translational Imaging in Neurology (ThINK) Basel, Department of Medicine and Biomedical Engineering, Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
| | - Laura Sander
- Neurologic Clinic and Policlinic, University Hospital Basel, Basel, Switzerland.,Department of Clinical Research, University of Basel, Basel, Switzerland.,Translational Imaging in Neurology (ThINK) Basel, Department of Medicine and Biomedical Engineering, Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
| | - Antal Horvath
- Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland
| | - Muhamed Barakovic
- Translational Imaging in Neurology (ThINK) Basel, Department of Medicine and Biomedical Engineering, Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland.,Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland
| | - Philippe Cattin
- Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland
| | - Cristina Granziera
- Neurologic Clinic and Policlinic, University Hospital Basel, Basel, Switzerland.,Translational Imaging in Neurology (ThINK) Basel, Department of Medicine and Biomedical Engineering, Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland.,Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland
| | - Oliver Bieri
- Division of Radiological Physics, Department of Radiology, University Hospital Basel, Basel, Switzerland.,Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland
| | - Regina Schlaeger
- Neurologic Clinic and Policlinic, University Hospital Basel, Basel, Switzerland.,Department of Clinical Research, University of Basel, Basel, Switzerland.,Translational Imaging in Neurology (ThINK) Basel, Department of Medicine and Biomedical Engineering, Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
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7
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Geldschläger O, Bosch D, Avdievich NI, Henning A. Ultrahigh-resolution quantitative spinal cord MRI at 9.4T. Magn Reson Med 2020; 85:1013-1027. [PMID: 32789980 DOI: 10.1002/mrm.28455] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 07/06/2020] [Accepted: 07/10/2020] [Indexed: 11/08/2022]
Abstract
PURPOSE To present the results of the first human spinal cord in vivo MRI scans at 9.4T. METHODS A human brain coil was used to image the human spinal cord at 9.4T. All anatomical images were acquired with a T2 *-weighted gradient-echo sequence. A comparison of the influence of four different B0 shimming routines on the image quality was performed. Intrinsic signal-to-noise-ratio maps were determined using a pseudo-multiple replica approach. Measurements with different echo times were compared and processed to one multiecho data image combination image. Based on the multiecho acquisitions, T2 *-relaxation time maps were calculated. Algorithmic spinal cord detection and gray matter/white matter segmentation were tested. RESULTS An echo time between 9 and 13.8 ms compromised best between gray matter/white matter contrast and image quality. A maximum in-plane resolution of 0.15 × 0.15 mm2 was achieved for anatomical images. These images offered excellent image quality and made small structures of the spinal cord visible. The scanner vendor implemented B0 shimming routine performed best during this work. Intrinsic signal-to-noise-ratio values of between 6600 and 8060 at the upper cervical spinal cord were achieved. Detection and segmentation worked reliably. An average T2 *-time of 24.88 ms ± 6.68 ms for gray matter and 19.37 ms ± 8.66 ms for white matter was calculated. CONCLUSION The proposed human brain coil can be used to image the spinal cord. The maximum in-plane resolution in this work was higher compared with the 7T results from the literature. The 9.4T acquisitions made the small structures of the spinal cord clearly visible.
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Affiliation(s)
- Ole Geldschläger
- High-Field Magnetic Resonance Center, Max Planck Institute for Biological Cybernetics, Tübingen, Germany
| | - Dario Bosch
- High-Field Magnetic Resonance Center, Max Planck Institute for Biological Cybernetics, Tübingen, Germany.,Biomedical Magnetic Resonance, University Hospital Tübingen, Tübingen, Germany
| | - Nikolai I Avdievich
- High-Field Magnetic Resonance Center, Max Planck Institute for Biological Cybernetics, Tübingen, Germany
| | - Anke Henning
- High-Field Magnetic Resonance Center, Max Planck Institute for Biological Cybernetics, Tübingen, Germany.,Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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8
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Weigel M, Haas T, Wendebourg MJ, Schlaeger R, Bieri O. Imaging of the thoracic spinal cord using radially sampled averaged magnetization inversion recovery acquisitions. J Neurosci Methods 2020; 343:108825. [PMID: 32580062 DOI: 10.1016/j.jneumeth.2020.108825] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 06/18/2020] [Accepted: 06/19/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Spinal cord (SC) gray and white matter atrophy quantification by advanced morphometric MRI can help to better characterize the course of neurodegenerative diseases in vivo, such as e.g. lower motor neuron disorders. Imaging the lower thoracic cord - containing those motor neurons that control leg function - could be particularly informative, however, is challenging due to tissue composition, physiological motion and large field of views. NEW METHOD An "averaged magnetization inversion recovery acquisitions" (AMIRA) approach with a radial k-space acquisition scheme was developed. The method is designed for morphometric SC imaging with a focus on the thoracic SC. RESULTS In a typical setting, radial AMIRA acquires transverse slices with a high 0.50 × 0.50mm2 in-plane resolution and a pronounced positive contrast between thoracic gray and white matter, within typically 2:39 min. Additional proof-of-concept measurements in patients demonstrate that such contrast and resolving capability is indeed necessary to assess potential atrophy of the anterior horns. COMPARISON WITH EXISTING METHOD(S) Radial AMIRA utilizes two benefits of radial MRI techniques: being generally less prone to motion effects and that fold over artifacts can manifest less intrusively. These benefits are united with the original AMIRA approach which allows the contrast to be 'tuned' and improved based on the combination of five simultaneously acquired images of different tissue contrast. CONCLUSIONS Radial AMIRA is a promising approach for in vivo SC gray and white matter atrophy visualization and quantification in lower motor neuron diseases and other autoimmune or genetic diseases involving the entire (not only cervical) spinal cord.
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Affiliation(s)
- Matthias Weigel
- Division of Radiological Physics, Department of Radiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland; Translational Imaging in Neurology (ThINk) Basel, Department of Medicine and Biomedical Engineering, University Hospital Basel and University of Basel, Petersgraben 4, 4031 Basel, Switzerland; Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Petersgraben 4, 4031 Basel, Switzerland.
| | - Tanja Haas
- Division of Radiological Physics, Department of Radiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Maria Janina Wendebourg
- Translational Imaging in Neurology (ThINk) Basel, Department of Medicine and Biomedical Engineering, University Hospital Basel and University of Basel, Petersgraben 4, 4031 Basel, Switzerland; Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Regina Schlaeger
- Translational Imaging in Neurology (ThINk) Basel, Department of Medicine and Biomedical Engineering, University Hospital Basel and University of Basel, Petersgraben 4, 4031 Basel, Switzerland; Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Oliver Bieri
- Division of Radiological Physics, Department of Radiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland; Department of Biomedical Engineering, University of Basel, Gewerbestrasse 14, 4123 Allschwil, Switzerland
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9
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Ma YJ, Fan S, Shao H, Du J, Szeverenyi NM, Young IR, Bydder GM. Use of Multiplied, Added, Subtracted and/or FiTted Inversion Recovery (MASTIR) pulse sequences. Quant Imaging Med Surg 2020; 10:1334-1369. [PMID: 32550142 DOI: 10.21037/qims-20-568] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
The group of Multiplied, Added, Subtracted and/or fiTted Inversion Recovery (MASTIR) pulse sequences in which usually two or more inversion recovery (IR) images of different types are combined is described, and uses for this type of sequence are outlined. IR sequences of different types can be multiplied, added, subtracted, and/or fitted together to produce variants of the MASTIR sequence. The sequences provide a range of options for increasing image contrast, demonstrating specific tissues and fluids of interest, and suppressing unwanted signals. A formalism using the concept of pulse sequences as tissue property filters is used to explain the signal, contrast and weighting of the pulse sequences with both univariate and multivariate filter models. Subtraction of one magnitude reconstructed IR image from another with a shorter TI can produce very high T1 dependent positive contrast from small increases in T1. The reverse subtracted IR sequence can provide high positive contrast enhancement with gadolinium chelates and iron deposition which decrease T1. Additional contrast to that arising from increases in T1 can be produced by supplementing this with contrast arising from concurrent increases in ρm and T2, as well as increases or decreases in diffusion using subtraction IR with echo subtraction and/or diffusion subtraction. Phase images may show 180º differences as a result of rotating into the transverse plane both positive and negative longitudinal magnetization. Phase images with contrast arising in this way, or other ways, can be multiplied by magnitude IR images to increase the contrast of the latter. Magnetization Transfer (MT) and susceptibility can be used with IR sequences to improve contrast. Selective images of white and brown adipose tissue lipid and water components can be produced using different TIs and in and out-of-phase TEs. Selective images of ultrashort and short T2 tissue components can be produced by nulling long T2 tissue components with an inversion pulse and subtraction of images with longer TEs from images with ultrashort TEs. The Double Echo Sliding IR (DESIRE) sequence provides images with a wide range of TIs from which it is possible to choose values of TI to achieve particular types of tissue and/or fluid contrast (e.g., for subtraction with different TIs, as described above, and for long T2 tissue signal nulling with UTE sequences). Unwanted tissue and fluid signals can be suppressed by addition and subtraction of phase-sensitive (ps) and magnitude reconstructed images. The sequence also offers options for synergistic use of the changes in blood and tissue ρm, T1, T2/T2*, D* and perfusion that can be seen with fMRI of the brain. In-vivo and ex-vivo illustrative examples of normal brain, cartilage, multiple sclerosis, Alzheimer's disease, and peripheral nerve imaged with different forms of the MASTIR sequence are included.
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Affiliation(s)
- Ya-Jun Ma
- Department of Radiology, University of California, San Diego, San Diego, CA, USA
| | - Shujuan Fan
- Department of Radiology, University of California, San Diego, San Diego, CA, USA
| | - Hongda Shao
- Department of Radiology, University of California, San Diego, San Diego, CA, USA
| | - Jiang Du
- Department of Radiology, University of California, San Diego, San Diego, CA, USA
| | | | - Ian R Young
- Formerly Department of Electrical Engineering, Imperial College, London, UK
| | - Graeme M Bydder
- Department of Radiology, University of California, San Diego, San Diego, CA, USA
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10
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Tsagkas C, Horvath A, Altermatt A, Pezold S, Weigel M, Haas T, Amann M, Kappos L, Sprenger T, Bieri O, Cattin P, Parmar K. Automatic Spinal Cord Gray Matter Quantification: A Novel Approach. AJNR Am J Neuroradiol 2019; 40:1592-1600. [PMID: 31439628 DOI: 10.3174/ajnr.a6157] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 06/25/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND PURPOSE Currently, accurate and reproducible spinal cord GM segmentation remains challenging and a noninvasive broadly accepted reference standard for spinal cord GM measurements is still a matter of ongoing discussion. Our aim was to assess the reproducibility and accuracy of cervical spinal cord GM and WM cross-sectional area measurements using averaged magnetization inversion recovery acquisitions images and a fully-automatic postprocessing segmentation algorithm. MATERIALS AND METHODS The cervical spinal cord of 24 healthy subjects (14 women; mean age, 40 ± 11 years) was scanned in a test-retest fashion on a 3T MR imaging system. Twelve axial averaged magnetization inversion recovery acquisitions slices were acquired over a 48-mm cord segment. GM and WM were both manually segmented by 2 experienced readers and compared with an automatic variational segmentation algorithm with a shape prior modified for 3D data with a slice similarity prior. Precision and accuracy of the automatic method were evaluated using coefficients of variation and Dice similarity coefficients. RESULTS The mean GM area was 17.20 ± 2.28 mm2 and the mean WM area was 72.71 ± 7.55 mm2 using the automatic method. Reproducibility was high for both methods, while being better for the automatic approach (all mean automatic coefficients of variation, ≤4.77%; all differences, P < .001). The accuracy of the automatic method compared with the manual reference standard was excellent (mean Dice similarity coefficients: 0.86 ± 0.04 for GM and 0.90 ± 0.03 for WM). The automatic approach demonstrated similar coefficients of variation between intra- and intersession reproducibility as well as among all acquired spinal cord slices. CONCLUSIONS Our novel approach including the averaged magnetization inversion recovery acquisitions sequence and a fully-automated postprocessing segmentation algorithm demonstrated an accurate and reproducible spinal cord GM and WM segmentation. This pipeline is promising for both the exploration of longitudinal structural GM changes and application in clinical settings in disorders affecting the spinal cord.
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Affiliation(s)
- C Tsagkas
- From the Neurologic Clinic and Policlinic (C.T., M.A., L.K., T.S., K.P.), Department of Medicine and Biomedical Engineering.,Translational Imaging in Neurology Basel (C.T., A.A., M.A., M.W., L.K., K.P.), Department of Medicine and Biomedical Engineering.,Medical Image Analysis Center (C.T., A.A., M.A.), Basel, Switzerland
| | - A Horvath
- Department of Biomedical Engineering (A.H., A.A., S.P., M.W., O.B., P.C.), University of Basel, Allschwil, Switzerland
| | - A Altermatt
- Translational Imaging in Neurology Basel (C.T., A.A., M.A., M.W., L.K., K.P.), Department of Medicine and Biomedical Engineering.,Medical Image Analysis Center (C.T., A.A., M.A.), Basel, Switzerland.,Department of Biomedical Engineering (A.H., A.A., S.P., M.W., O.B., P.C.), University of Basel, Allschwil, Switzerland
| | - S Pezold
- Department of Biomedical Engineering (A.H., A.A., S.P., M.W., O.B., P.C.), University of Basel, Allschwil, Switzerland
| | - M Weigel
- Translational Imaging in Neurology Basel (C.T., A.A., M.A., M.W., L.K., K.P.), Department of Medicine and Biomedical Engineering.,Division of Radiological Physics (M.W., T.H., O.B.), Department of Radiology.,Department of Biomedical Engineering (A.H., A.A., S.P., M.W., O.B., P.C.), University of Basel, Allschwil, Switzerland
| | - T Haas
- Division of Radiological Physics (M.W., T.H., O.B.), Department of Radiology
| | - M Amann
- From the Neurologic Clinic and Policlinic (C.T., M.A., L.K., T.S., K.P.), Department of Medicine and Biomedical Engineering.,Translational Imaging in Neurology Basel (C.T., A.A., M.A., M.W., L.K., K.P.), Department of Medicine and Biomedical Engineering.,Division of Diagnostic and Interventional Neuroradiology (M.A.), Department of Radiology, University Hospital Basel, University of Basel, Basel, Switzerland.,Medical Image Analysis Center (C.T., A.A., M.A.), Basel, Switzerland
| | - L Kappos
- From the Neurologic Clinic and Policlinic (C.T., M.A., L.K., T.S., K.P.), Department of Medicine and Biomedical Engineering.,Translational Imaging in Neurology Basel (C.T., A.A., M.A., M.W., L.K., K.P.), Department of Medicine and Biomedical Engineering
| | - T Sprenger
- From the Neurologic Clinic and Policlinic (C.T., M.A., L.K., T.S., K.P.), Department of Medicine and Biomedical Engineering.,Department of Neurology (T.S.), DKD HELIOS Klinik, Wiesbaden, Germany
| | - O Bieri
- Division of Radiological Physics (M.W., T.H., O.B.), Department of Radiology.,Department of Biomedical Engineering (A.H., A.A., S.P., M.W., O.B., P.C.), University of Basel, Allschwil, Switzerland
| | - P Cattin
- Department of Biomedical Engineering (A.H., A.A., S.P., M.W., O.B., P.C.), University of Basel, Allschwil, Switzerland
| | - K Parmar
- From the Neurologic Clinic and Policlinic (C.T., M.A., L.K., T.S., K.P.), Department of Medicine and Biomedical Engineering .,Translational Imaging in Neurology Basel (C.T., A.A., M.A., M.W., L.K., K.P.), Department of Medicine and Biomedical Engineering
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11
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Magnetic resonance imaging in immune-mediated myelopathies. J Neurol 2019; 267:1233-1244. [PMID: 30694379 DOI: 10.1007/s00415-019-09206-2] [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] [Received: 09/29/2018] [Revised: 01/15/2019] [Accepted: 01/18/2019] [Indexed: 10/27/2022]
Abstract
Immune-mediated myelopathies are a heterogeneous group of inflammatory spinal cord disorders including autoimmune disorders with known antibodies, e.g. aquaporin-4 IgG channelopathy or anti-myelin oligodendrocyte glycoprotein-associated myelitis, myelopathies in the context of multiple sclerosis and systemic autoimmune disorders with myelopathy, as well as post-infectious and paraneoplastic myelopathies. Although magnetic resonance imaging of the spinal cord is still challenging due to the small dimension of the cord cross-section and frequent movement and susceptibility artifacts, recent methodological advances have led to improved diagnostic evaluation and characterization of immune-mediated myelopathies. Topography, length and width of the lesion, gadolinium enhancement pattern, and changes in morphology over time help in narrowing the broad differential diagnosis. In this review, we give an overview of recent advances in magnetic resonance imaging of immune-mediated myelopathies and its role in the differential diagnosis and monitoring of this heterogeneous group of disorders.
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12
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Sinnecker T, Granziera C, Wuerfel J, Schlaeger R. Future Brain and Spinal Cord Volumetric Imaging in the Clinic for Monitoring Treatment Response in MS. Curr Treat Options Neurol 2018; 20:17. [PMID: 29679165 DOI: 10.1007/s11940-018-0504-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE OF REVIEW Volumetric analysis of brain imaging has emerged as a standard approach used in clinical research, e.g., in the field of multiple sclerosis (MS), but its application in individual disease course monitoring is still hampered by biological and technical limitations. This review summarizes novel developments in volumetric imaging on the road towards clinical application to eventually monitor treatment response in patients with MS. RECENT FINDINGS In addition to the assessment of whole-brain volume changes, recent work was focused on the volumetry of specific compartments and substructures of the central nervous system (CNS) in MS. This included volumetric imaging of the deep brain structures and of the spinal cord white and gray matter. Volume changes of the latter indeed independently correlate with clinical outcome measures especially in progressive MS. Ultrahigh field MRI and quantitative MRI added to this trend by providing a better visualization of small compartments on highly resolving MR images as well as microstructural information. New developments in volumetric imaging have the potential to improve sensitivity as well as specificity in detecting and hence monitoring disease-related CNS volume changes in MS.
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Affiliation(s)
- Tim Sinnecker
- Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Petersgraben 4, 4031, Basel, Switzerland
- Translational Imaging in Neurology (ThINK) Basel, Department of Medicine and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland
- Medical Image Analysis Center Basel AG, Basel, Switzerland
- NeuroCure Clinical Research Center, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Cristina Granziera
- Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Petersgraben 4, 4031, Basel, Switzerland
- Translational Imaging in Neurology (ThINK) Basel, Department of Medicine and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Jens Wuerfel
- Medical Image Analysis Center Basel AG, Basel, Switzerland
- NeuroCure Clinical Research Center, Charité Universitätsmedizin Berlin, Berlin, Germany
- Berlin Ultrahigh Field Facility, Max Delbrück Center for Molecular Medicine, Berlin, Germany
| | - Regina Schlaeger
- Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Petersgraben 4, 4031, Basel, Switzerland.
- Translational Imaging in Neurology (ThINK) Basel, Department of Medicine and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland.
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