1
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Ritson M, Wheeler-Jones CPD, Stolp HB. Endothelial dysfunction in neurodegenerative disease: Is endothelial inflammation an overlooked druggable target? J Neuroimmunol 2024; 391:578363. [PMID: 38728929 DOI: 10.1016/j.jneuroim.2024.578363] [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: 12/21/2023] [Revised: 03/29/2024] [Accepted: 05/02/2024] [Indexed: 05/12/2024]
Abstract
Neurological diseases with a neurodegenerative component have been associated with alterations in the cerebrovasculature. At the anatomical level, these are centred around changes in cerebral blood flow and vessel organisation. At the molecular level, there is extensive expression of cellular adhesion molecules and increased release of pro-inflammatory mediators. Together, these has been found to negatively impact blood-brain barrier integrity. Systemic inflammation has been found to accelerate and exacerbate endothelial dysfunction, neuroinflammation and degeneration. Here, we review the role of cerebrovasculature dysfunction in neurodegenerative disease and discuss the potential contribution of intermittent pro-inflammatory systemic disease in causing endothelial pathology, highlighting a possible mechanism that may allow broad-spectrum therapeutic targeting in the future.
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Affiliation(s)
- Megan Ritson
- Department of Comparative Biomedical Sciences, Royal Veterinary College, London NW1 0TU, UK
| | | | - Helen B Stolp
- Department of Comparative Biomedical Sciences, Royal Veterinary College, London NW1 0TU, UK.
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2
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Gloor M, Andelova M, Gaetano L, Papadopoulou A, Burguet Villena F, Sprenger T, Radue EW, Kappos L, Bieri O, Garcia M. Longitudinal analysis of new multiple sclerosis lesions with magnetization transfer and diffusion tensor imaging. Eur Radiol 2024; 34:1680-1691. [PMID: 37658894 PMCID: PMC10873225 DOI: 10.1007/s00330-023-10173-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 07/02/2023] [Accepted: 07/12/2023] [Indexed: 09/05/2023]
Abstract
OBJECTIVE The potential of magnetization transfer imaging (MTI) and diffusion tensor imaging (DTI) for the detection and evolution of new multiple sclerosis (MS) lesions was analyzed. METHODS Nineteen patients with MS obtained conventional MRI, MTI, and DTI examinations bimonthly for 12 months and again after 24 months at 1.5 T MRI. MTI was acquired with balanced steady-state free precession (bSSFP) in 10 min (1.3 mm3 isotropic resolution) yielding both magnetization transfer ratio (MTR) and quantitative magnetization transfer (qMT) parameters (pool size ratio (F), exchange rate (kf), and relaxation times (T1/T2)). DTI provided fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD). RESULTS At the time of their appearance on MRI, the 21 newly detected MS lesions showed significantly reduced MTR/F/kf and prolonged T1/T2 parameters, as well as significantly reduced FA and increased AD/MD/RD. Significant differences were already observed for MTR 4 months and for qMT parameters 2 months prior to lesions' detection on MRI. DTI did not show any significant pre-lesional differences. Slightly reversed trends were observed for most lesions up to 8 months after their detection for qMT and less pronounced for MTR and three diffusion parameters, while appearing unchanged on MRI. CONCLUSIONS MTI provides more information than DTI in MS lesions and detects tissue changes 2 to 4 months prior to their appearance on MRI. After lesions' detection, qMT parameter changes promise to be more sensitive than MTR for the lesions' evolutional assessment. Overall, bSSFP-based MTI adumbrates to be more sensitive than MRI and DTI for the early detection and follow-up assessment of MS lesions. CLINICAL RELEVANCE STATEMENT When additionally acquired in routine MRI, fast bSSFP-based MTI can complement the MRI/DTI longitudinal lesion assessment by detecting MS lesions 2-4 months earlier than with MRI, which could implicate earlier clinical decisions and better follow-up/treatment assessment in MS patients. KEY POINTS • Magnetization transfer imaging provides more information than DTI in multiple sclerosis lesions and can detect tissue changes 2 to 4 months prior to their appearance on MRI. • After lesions' detection, quantitative magnetization transfer changes are more pronounced than magnetization transfer ratio changes and therefore promise to be more sensitive for the lesions' evolutional assessment. • Balanced steady-state free precession-based magnetization transfer imaging is more sensitive than MRI and DTI for the early detection and follow-up assessment of multiple sclerosis lesions.
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Affiliation(s)
- Monika Gloor
- Division of Radiological Physics, Department of Radiology, University Hospital Basel, Basel, Switzerland
| | - Michaela Andelova
- Department of Neurology, University Hospital Basel, Basel, Switzerland
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Laura Gaetano
- Department of Neurology, University Hospital Basel, Basel, Switzerland
- Medical Image Analysis Center (MIAC) AG, Basel, Switzerland
- Novartis Institutes for BioMedical Research Basel, Basel, Switzerland
| | - Athina Papadopoulou
- Department of Neurology, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, Faculty of Medicine, University Hospital Basel, Basel, Switzerland
| | - Federico Burguet Villena
- Department of Neurology, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, Faculty of Medicine, University Hospital Basel, Basel, Switzerland
| | - Till Sprenger
- Department of Neurology, University Hospital Basel, Basel, Switzerland
- University Hospital Zürich, Zurich, Switzerland
| | | | - Ludwig Kappos
- Department of Neurology, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, Faculty of Medicine, University Hospital Basel, Basel, Switzerland
| | - Oliver Bieri
- Division of Radiological Physics, Department of Radiology, University Hospital Basel, Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland
| | - Meritxell Garcia
- Division of Neuroradiology, Department of Radiology, University Hospital Basel, Basel, Switzerland.
- Department of Neuroradiology, University Hospital Zürich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland.
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3
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Eid K, Bjørk MH, Gilhus NE, Torkildsen Ø. Adverse Childhood Experiences and the Risk of Multiple Sclerosis Development: A Review of Potential Mechanisms. Int J Mol Sci 2024; 25:1520. [PMID: 38338799 PMCID: PMC10855716 DOI: 10.3390/ijms25031520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/16/2024] [Accepted: 01/24/2024] [Indexed: 02/12/2024] Open
Abstract
Adverse childhood experiences (ACEs), such as abuse, neglect, and household dysfunction, contribute to long-term systemic toxic stress and inflammation that may last well into adulthood. Such early-life stressors have been associated with increased susceptibility to multiple sclerosis (MS) in observational studies and with the development of experimental autoimmune encephalomyelitis in animal models. In this review, we summarize the evidence for an ACE-mediated increase in MS risk, as well as the potential mechanisms for this association. ACEs dysregulate neurodevelopment, stress responses, and immune reactivity; they also alter the interplay between the immune system and neural networks. All of this may be relevant for MS risk. We further discuss how ACEs induce epigenetic changes and how the toxic stress caused by ACEs may reactivate the Epstein-Barr Virus (EBV), a key risk factor for MS. We conclude by suggesting new initiatives to obtain further insights into this topic.
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Affiliation(s)
- Karine Eid
- Department of Neurology, Haukeland University Hospital, Jonas Lies vei 71, 5053 Bergen, Norway; (M.-H.B.); (N.E.G.)
- Department of Clinical Medicine, University of Bergen, 5021 Bergen, Norway;
| | - Marte-Helene Bjørk
- Department of Neurology, Haukeland University Hospital, Jonas Lies vei 71, 5053 Bergen, Norway; (M.-H.B.); (N.E.G.)
- Department of Clinical Medicine, University of Bergen, 5021 Bergen, Norway;
- NorHead, Norwegian Center for Headache Research, 5021 Bergen, Norway
| | - Nils Erik Gilhus
- Department of Neurology, Haukeland University Hospital, Jonas Lies vei 71, 5053 Bergen, Norway; (M.-H.B.); (N.E.G.)
- Department of Clinical Medicine, University of Bergen, 5021 Bergen, Norway;
| | - Øivind Torkildsen
- Department of Clinical Medicine, University of Bergen, 5021 Bergen, Norway;
- Neuro-SysMed, Department of Neurology, Haukeland University Hospital, 5021 Bergen, Norway
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4
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Cacciaguerra L, Rocca MA, Filippi M. Understanding the Pathophysiology and Magnetic Resonance Imaging of Multiple Sclerosis and Neuromyelitis Optica Spectrum Disorders. Korean J Radiol 2023; 24:1260-1283. [PMID: 38016685 DOI: 10.3348/kjr.2023.0360] [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: 04/26/2023] [Revised: 08/09/2023] [Accepted: 08/21/2023] [Indexed: 11/30/2023] Open
Abstract
Magnetic resonance imaging (MRI) has been extensively applied in the study of multiple sclerosis (MS), substantially contributing to diagnosis, differential diagnosis, and disease monitoring. MRI studies have significantly contributed to the understanding of MS through the characterization of typical radiological features and their clinical or prognostic implications using conventional MRI pulse sequences and further with the application of advanced imaging techniques sensitive to microstructural damage. Interpretation of results has often been validated by MRI-pathology studies. However, the application of MRI techniques in the study of neuromyelitis optica spectrum disorders (NMOSD) remains an emerging field, and MRI studies have focused on radiological correlates of NMOSD and its pathophysiology to aid in diagnosis, improve monitoring, and identify relevant prognostic factors. In this review, we discuss the main contributions of MRI to the understanding of MS and NMOSD, focusing on the most novel discoveries to clarify differences in the pathophysiology of focal inflammation initiation and perpetuation, involvement of normal-appearing tissue, potential entry routes of pathogenic elements into the CNS, and existence of primary or secondary mechanisms of neurodegeneration.
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Affiliation(s)
- Laura Cacciaguerra
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Maria A Rocca
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milano, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy
- Vita-Salute San Raffaele University, Milano, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milano, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy
- Vita-Salute San Raffaele University, Milano, Italy
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milano, Italy.
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5
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Ćirović M, Jeličić L, Maksimović S, Fatić S, Marisavljević M, Bošković Matić T, Subotić M. EEG Correlates of Cognitive Functions in a Child with ASD and White Matter Signal Abnormalities: A Case Report with Two-and-a-Half-Year Follow-Up. Diagnostics (Basel) 2023; 13:2878. [PMID: 37761245 PMCID: PMC10529253 DOI: 10.3390/diagnostics13182878] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 08/21/2023] [Accepted: 08/31/2023] [Indexed: 09/29/2023] Open
Abstract
This research aimed to examine the EEG correlates of different stimuli processing instances in a child with ASD and white matter signal abnormalities and to investigate their relationship to the results of behavioral tests. The prospective case study reports two and a half years of follow-up data from a child aged 38 to 66 months. Cognitive, speech-language, sensory, and EEG correlates of auditory-verbal and auditory-visual-verbal information processing were recorded during five test periods, and their mutual interrelation was analyzed. EEG findings revealed no functional theta frequency range redistribution in the frontal regions favoring the left hemisphere during speech processing. The results pointed to a positive linear trend in the relative theta frequency range and a negative linear trend in the relative alpha frequency range when listening to and watching the cartoon. There was a statistically significant correlation between EEG signals and behavioral test results. Based on the obtained results, it may be concluded that EEG signals and their association with the results of behavioral tests should be evaluated with certain restraints considering the characteristics of the stimuli during EEG recording.
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Affiliation(s)
- Milica Ćirović
- Cognitive Neuroscience Department, Research and Development Institute “Life Activities Advancement Institute”, 11000 Belgrade, Serbia; (M.Ć.); (S.M.); (S.F.); (M.M.); (M.S.)
- Department of Speech, Language and Hearing Sciences, Institute for Experimental Phonetics and Speech Pathology, 11000 Belgrade, Serbia
| | - Ljiljana Jeličić
- Cognitive Neuroscience Department, Research and Development Institute “Life Activities Advancement Institute”, 11000 Belgrade, Serbia; (M.Ć.); (S.M.); (S.F.); (M.M.); (M.S.)
- Department of Speech, Language and Hearing Sciences, Institute for Experimental Phonetics and Speech Pathology, 11000 Belgrade, Serbia
| | - Slavica Maksimović
- Cognitive Neuroscience Department, Research and Development Institute “Life Activities Advancement Institute”, 11000 Belgrade, Serbia; (M.Ć.); (S.M.); (S.F.); (M.M.); (M.S.)
- Department of Speech, Language and Hearing Sciences, Institute for Experimental Phonetics and Speech Pathology, 11000 Belgrade, Serbia
| | - Saška Fatić
- Cognitive Neuroscience Department, Research and Development Institute “Life Activities Advancement Institute”, 11000 Belgrade, Serbia; (M.Ć.); (S.M.); (S.F.); (M.M.); (M.S.)
- Department of Speech, Language and Hearing Sciences, Institute for Experimental Phonetics and Speech Pathology, 11000 Belgrade, Serbia
| | - Maša Marisavljević
- Cognitive Neuroscience Department, Research and Development Institute “Life Activities Advancement Institute”, 11000 Belgrade, Serbia; (M.Ć.); (S.M.); (S.F.); (M.M.); (M.S.)
- Department of Speech, Language and Hearing Sciences, Institute for Experimental Phonetics and Speech Pathology, 11000 Belgrade, Serbia
| | - Tatjana Bošković Matić
- Department of Neurology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia;
- Clinic of Neurology, University Clinical Centre of Kragujevac, 34000 Kragujevac, Serbia
| | - Miško Subotić
- Cognitive Neuroscience Department, Research and Development Institute “Life Activities Advancement Institute”, 11000 Belgrade, Serbia; (M.Ć.); (S.M.); (S.F.); (M.M.); (M.S.)
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Pernet V, Joly S, Spiegel S, Meli I, Idriss S, Maigler F, Mdzomba JB, Roenneke AK, Franceschini A, Silvestri L, Pavone FS, Calamai M, Schindowski K, Chan A. Nogo-A antibody delivery through the olfactory mucosa mitigates experimental autoimmune encephalomyelitis in the mouse CNS. Cell Death Discov 2023; 9:290. [PMID: 37558696 PMCID: PMC10412545 DOI: 10.1038/s41420-023-01588-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 07/18/2023] [Accepted: 07/28/2023] [Indexed: 08/11/2023] Open
Abstract
Systemic administration of Nogo-A-neutralizing antibody ameliorates experimental autoimmune encephalomyelitis (EAE), an animal model of multiple sclerosis. However, the blood-brain barrier (BBB) is a major obstacle limiting the passage of systemically applied antibody to the CNS. To bypass the BBB, in the present study we tested the intranasal route of administration by targeting the olfactory mucosa with the Nogo-A-blocking antibody 11C7 mAb in myelin oligodendrocyte glycoprotein-induced EAE. Antibodies were specifically administered onto the olfactory mucosa using a microcatheter. Antibody distribution was examined in the CNS by ELISA and light-sheet microscopy. The effects of 11C7 mAb on Nogo-A signaling were assessed by Western blotting. EAE-induced deficits were monitored daily. Demyelination was observed on spinal cord histological sections. Gene expression changes were followed by trancriptomic analyses. A sensitive capture ELISA revealed a rapid and widespread distribution of 11C7 mAb in the CNS, including the olfactory bulb, the cerebellum and the lumbar spinal cord, but not in the CSF. Light-sheet microscopy allowed to observe antibody accumulation in the parenchyma, thus demonstrating nose-to-brain transfer of IgG. At the functional level, the widespread penetration of 11C7 mAb in the CNS, including the thoracolumbar spinal cord, resulted in the improvement of motor symptoms and in the preservation of myelin in the spinal cord of EAE mice. This was accompanied by Nogo-A signaling downregulation, as reflected by the decreased level of phosphorylated cofilin observed by Western blotting in the cerebellum. In the brain of EAE score-matched animals, 11C7 modified the expression of genes that can influence neurotransmission and cognitive functions, independently of the demyelination phenotype in the spinal cord. In conclusion, our data show the feasibility of olfactory mucosa-directed administration for the delivery of therapeutic antibodies targeting CNS antigens in EAE mice.
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Affiliation(s)
- Vincent Pernet
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
- Center for experimental neurology (ZEN), Bern University Hospital, University of Bern, Bern, Switzerland.
- Centre de recherche du CHU de Québec-Université Laval and Department of Molecular Medicine, Faculté de médecine, Université Laval, Québec, Québec, Canada.
| | - Sandrine Joly
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Center for experimental neurology (ZEN), Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sebastian Spiegel
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Center for experimental neurology (ZEN), Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Applied Biotechnology, Biberach University of Applied Science, Hubertus-Liebrecht-Strasse 35, Biberach, Germany
- Department of Biomedical Research, University of Bern, Bern, Switzerland
- Graduate School for Cellular and Biomedical Sciences, University of Bern, Bern, Switzerland
| | - Ivo Meli
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Center for experimental neurology (ZEN), Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sherif Idriss
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Center for experimental neurology (ZEN), Bern University Hospital, University of Bern, Bern, Switzerland
| | - Frank Maigler
- Institute of Applied Biotechnology, Biberach University of Applied Science, Hubertus-Liebrecht-Strasse 35, Biberach, Germany
| | - Julius Baya Mdzomba
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Center for experimental neurology (ZEN), Bern University Hospital, University of Bern, Bern, Switzerland
| | - Anna K Roenneke
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Center for experimental neurology (ZEN), Bern University Hospital, University of Bern, Bern, Switzerland
| | - Alessandra Franceschini
- LENS- European Laboratory for Non-Linear Spectroscopy, University of Florence, Sesto-Fiorentino (Firenze), Italy
| | - Ludovico Silvestri
- LENS- European Laboratory for Non-Linear Spectroscopy, University of Florence, Sesto-Fiorentino (Firenze), Italy
| | - Francesco S Pavone
- LENS- European Laboratory for Non-Linear Spectroscopy, University of Florence, Sesto-Fiorentino (Firenze), Italy
| | - Martino Calamai
- LENS- European Laboratory for Non-Linear Spectroscopy, University of Florence, Sesto-Fiorentino (Firenze), Italy
- National Institute of Optics - National Research Council (CNR-INO), Sesto Fiorentino, Italy
| | - Katharina Schindowski
- Institute of Applied Biotechnology, Biberach University of Applied Science, Hubertus-Liebrecht-Strasse 35, Biberach, Germany
| | - Andrew Chan
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
- Center for experimental neurology (ZEN), Bern University Hospital, University of Bern, Bern, Switzerland.
- Department of Biomedical Research, University of Bern, Bern, Switzerland.
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7
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Oost W, Huitema AJ, Kats K, Giepmans BNG, Kooistra SM, Eggen BJL, Baron W. Pathological ultrastructural alterations of myelinated axons in normal appearing white matter in progressive multiple sclerosis. Acta Neuropathol Commun 2023; 11:100. [PMID: 37340488 DOI: 10.1186/s40478-023-01598-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 06/02/2023] [Indexed: 06/22/2023] Open
Abstract
Multiple sclerosis (MS) pathophysiology includes inflammation, demyelination and neurodegeneration, but the exact mechanisms of disease initiation and progression are unknown. A major feature of lesions is lack of myelin, which increases axonal energy demand and requires adaptation in number and size of mitochondria. Outside lesions, subtle and diffuse alterations are observed in normal appearing white matter (NAWM) and normal appearing grey matter (NAGM), including increased oxidative stress, reduced axon density and changes in myelin composition and morphology. On an ultrastructural level, only limited data is available on alterations in myelinated axons. We generated large scale 2D scanning transmission electron microscopy images ('nanotomy') of non-demyelinated brain tissue of control and progressive MS donors, accessible via an open-access online repository. We observed a reduced density of myelinated axons in NAWM, without a decrease in cross-sectional axon area. Small myelinated axons were less frequently and large myelinated axons were more frequently present in NAWM, while the g-ratio was similar. The correlation between axonal mitochondrial radius and g-ratio was lost in NAWM, but not in NAGM. Myelinated axons in control GM and NAGM had a similar g-ratio and radius distribution. We hypothesize that axonal loss in NAWM is likely compensated by swelling of the remaining myelinated axons and subsequent adjustment of myelin thickness to maintain their g-ratio. Failure of axonal mitochondria to adjust their size and fine-tuning of myelin thickness may render NAWM axons and their myelin more susceptible to injury.
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Affiliation(s)
- Wendy Oost
- Department of Biomedical Sciences of Cells and Systems, Section Molecular Neurobiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- MS Center Noord Nederland, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Allard J Huitema
- Department of Biomedical Sciences of Cells and Systems, Section Molecular Neurobiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- MS Center Noord Nederland, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Kim Kats
- Department of Biomedical Sciences of Cells and Systems, Section Molecular Neurobiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Ben N G Giepmans
- Department of Biomedical Sciences of Cells and Systems, Section Molecular Neurobiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Susanne M Kooistra
- Department of Biomedical Sciences of Cells and Systems, Section Molecular Neurobiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- MS Center Noord Nederland, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Bart J L Eggen
- Department of Biomedical Sciences of Cells and Systems, Section Molecular Neurobiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- MS Center Noord Nederland, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Wia Baron
- Department of Biomedical Sciences of Cells and Systems, Section Molecular Neurobiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
- MS Center Noord Nederland, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
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8
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Nishihara H, Perriot S, Gastfriend BD, Steinfort M, Cibien C, Soldati S, Matsuo K, Guimbal S, Mathias A, Palecek SP, Shusta EV, Pasquier RD, Engelhardt B. Intrinsic blood-brain barrier dysfunction contributes to multiple sclerosis pathogenesis. Brain 2022; 145:4334-4348. [PMID: 35085379 PMCID: PMC10200307 DOI: 10.1093/brain/awac019] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 12/17/2021] [Accepted: 12/20/2021] [Indexed: 07/20/2023] Open
Abstract
Blood-brain barrier (BBB) breakdown and immune cell infiltration into the CNS are early hallmarks of multiple sclerosis (MS). The mechanisms leading to BBB dysfunction are incompletely understood and generally thought to be a consequence of neuroinflammation. Here, we have challenged this view and asked if intrinsic alterations in the BBB of MS patients contribute to MS pathogenesis. To this end, we made use of human induced pluripotent stem cells derived from healthy controls and MS patients and differentiated them into brain microvascular endothelial cell (BMEC)-like cells as in vitro model of the BBB. MS-derived BMEC-like cells showed impaired junctional integrity, barrier properties and efflux pump activity when compared to healthy controls. Also, MS-derived BMEC-like cells displayed an inflammatory phenotype with increased adhesion molecule expression and immune cell interactions. Activation of Wnt/β-catenin signalling in MS-derived endothelial progenitor cells enhanced barrier characteristics and reduced the inflammatory phenotype. Our study provides evidence for an intrinsic impairment of BBB function in MS patients that can be modelled in vitro. Human iPSC-derived BMEC-like cells are thus suitable to explore the molecular underpinnings of BBB dysfunction in MS and will assist in the identification of potential novel therapeutic targets for BBB stabilization.
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Affiliation(s)
- Hideaki Nishihara
- Theodor Kocher Institute, University of Bern, 3012 Bern, Switzerland
| | - Sylvain Perriot
- Laboratory of Neuroimmunology, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Benjamin D Gastfriend
- Department of Chemical and Biological Engineering, University of Wisconsin-Madison, Madison, WI, USA
| | - Marel Steinfort
- Theodor Kocher Institute, University of Bern, 3012 Bern, Switzerland
| | - Celine Cibien
- Theodor Kocher Institute, University of Bern, 3012 Bern, Switzerland
| | - Sasha Soldati
- Theodor Kocher Institute, University of Bern, 3012 Bern, Switzerland
| | - Kinya Matsuo
- Theodor Kocher Institute, University of Bern, 3012 Bern, Switzerland
| | - Sarah Guimbal
- Theodor Kocher Institute, University of Bern, 3012 Bern, Switzerland
| | - Amandine Mathias
- Laboratory of Neuroimmunology, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Sean P Palecek
- Department of Chemical and Biological Engineering, University of Wisconsin-Madison, Madison, WI, USA
| | - Eric V Shusta
- Department of Chemical and Biological Engineering, University of Wisconsin-Madison, Madison, WI, USA
- Department of Neurological Surgery, University of Wisconsin-Madison, Madison, WI, USA
| | - Renaud Du Pasquier
- Laboratory of Neuroimmunology, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Britta Engelhardt
- Theodor Kocher Institute, University of Bern, 3012 Bern, Switzerland
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9
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McCloskey MC, Zhang VZ, Ahmad SD, Walker S, Romanick SS, Awad HA, McGrath JL. Sourcing cells for in vitro models of human vascular barriers of inflammation. FRONTIERS IN MEDICAL TECHNOLOGY 2022; 4:979768. [PMID: 36483299 PMCID: PMC9724237 DOI: 10.3389/fmedt.2022.979768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 09/29/2022] [Indexed: 07/20/2023] Open
Abstract
The vascular system plays a critical role in the progression and resolution of inflammation. The contributions of the vascular endothelium to these processes, however, vary with tissue and disease state. Recently, tissue chip models have emerged as promising tools to understand human disease and for the development of personalized medicine approaches. Inclusion of a vascular component within these platforms is critical for properly evaluating most diseases, but many models to date use "generic" endothelial cells, which can preclude the identification of biomedically meaningful pathways and mechanisms. As the knowledge of vascular heterogeneity and immune cell trafficking throughout the body advances, tissue chip models should also advance to incorporate tissue-specific cells where possible. Here, we discuss the known heterogeneity of leukocyte trafficking in vascular beds of some commonly modeled tissues. We comment on the availability of different tissue-specific cell sources for endothelial cells and pericytes, with a focus on stem cell sources for the full realization of personalized medicine. We discuss sources available for the immune cells needed to model inflammatory processes and the findings of tissue chip models that have used the cells to studying transmigration.
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Affiliation(s)
- Molly C. McCloskey
- Department of Biomedical Engineering, University of Rochester, Rochester, NY, United States
| | - Victor Z. Zhang
- Department of Biomedical Engineering, University of Rochester, Rochester, NY, United States
- Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, NY, United States
| | - S. Danial Ahmad
- Department of Biomedical Engineering, University of Rochester, Rochester, NY, United States
| | - Samuel Walker
- Department of Biomedical Engineering, University of Rochester, Rochester, NY, United States
| | - Samantha S. Romanick
- Department of Biomedical Engineering, University of Rochester, Rochester, NY, United States
| | - Hani A. Awad
- Department of Biomedical Engineering, University of Rochester, Rochester, NY, United States
- Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, NY, United States
- Department of Orthopaedics, University of Rochester Medical Center, Rochester, NY, United States
| | - James L. McGrath
- Department of Biomedical Engineering, University of Rochester, Rochester, NY, United States
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10
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Tagge IJ, Leppert IR, Fetco D, Campbell JS, Rudko DA, Brown RA, Stikov N, Pike GB, Giacomini PS, Arnold DL, Narayanan S. Permanent tissue damage in multiple sclerosis lesions is associated with reduced pre-lesion myelin and axon volume fractions. Mult Scler 2022; 28:2027-2037. [PMID: 35903888 PMCID: PMC9574230 DOI: 10.1177/13524585221110585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The use of advanced magnetic resonance imaging (MRI) techniques in MS research has led to new insights in lesion evolution and disease outcomes. It has not yet been determined if, or how, pre-lesional abnormalities in normal-appearing white matter (NAWM) relate to the long-term evolution of new lesions. OBJECTIVE To investigate the relationship between abnormalities in MRI measures of axonal and myelin volume fractions (AVF and MVF) in NAWM preceding development of black-hole (BH) and non-BH lesions in people with MS. METHODS We obtained magnetization transfer and diffusion MRI at 6-month intervals in patients with MS to estimate MVF and AVF during lesion evolution. Lesions were classified as either BH or non-BH on the final imaging visit using T1 maps. RESULTS Longitudinal data from 97 new T2 lesions from 9 participants were analyzed; 25 lesions in 8 participants were classified as BH 6-12 months after initial appearance. Pre-lesion MVF, AVF, and MVF/AVF were significantly lower, and T1 was significantly higher, in the lesions that later became BHs (p < 0.001) compared to those that did not. No significant pre-lesion abnormalities were found in non-BH lesions (p > 0.05). CONCLUSION The present work demonstrated that pre-lesion abnormalities are associated with worse long-term lesion-level outcome.
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Affiliation(s)
- Ian J Tagge
- McConnell Brain Imaging Center, Montreal Neurological Institute & Hospital, Montreal, QC, Canada
| | - Ilana R Leppert
- McConnell Brain Imaging Center, Montreal Neurological Institute & Hospital, Montreal, QC, Canada
| | - Dumitru Fetco
- McConnell Brain Imaging Center, Montreal Neurological Institute & Hospital, Montreal, QC, Canada
| | - Jennifer Sw Campbell
- McConnell Brain Imaging Center, Montreal Neurological Institute & Hospital, Montreal, QC, Canada
| | - David A Rudko
- McConnell Brain Imaging Center, Montreal Neurological Institute & Hospital, Montreal, QC, Canada
| | - Robert A Brown
- McConnell Brain Imaging Center, Montreal Neurological Institute & Hospital, Montreal, QC, Canada
| | - Nikola Stikov
- Electrical Engineering, Polytechnique Montreal, Montreal, QC, Canada
| | - G Bruce Pike
- Departments of Radiology and Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Paul S Giacomini
- Neurology and Neurosurgery, Montreal Neurological Institute & Hospital, Montreal, QC, Canada
| | - Douglas L Arnold
- McConnell Brain Imaging Center, Montreal Neurological Institute & Hospital, Montreal, QC, Canada
| | - Sridar Narayanan
- McConnell Brain Imaging Center, Montreal Neurological Institute & Hospital, Montreal, QC, Canada
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11
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Chylińska M, Karaszewski B, Komendziński J, Wyszomirski A, Sabisz A, Halas M, Szurowska E. Skeletonized mean diffusivity and neuropsychological performance in relapsing-remitting multiple sclerosis. Brain Behav 2022; 12:e2591. [PMID: 35560868 PMCID: PMC9226842 DOI: 10.1002/brb3.2591] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 01/18/2022] [Accepted: 04/10/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Peak width of Skeletonized Mean Diffusivity (PSMD), as a novel marker of white matter (WM) microstructure damage, is associated with cognitive decline in several WM pathologies (i.e., small vessel disorders). We hypothesized that markers combining alterations in whole WM could be associated with cognitive dysfunction in relapsing-remitting multiple sclerosis (RRMS) patients. METHODS We used PSMD based on tract-based spatial statistics (TBSS) of diffusion tensor imaging (DTI) magnetic resonance (MR) scans. We investigated RRMS patients (n = 73) undergoing interferon beta (IFN-β) therapy. In this cross-sectional study, we investigated the association between neuropsychological data and clinical and MRI variables: PSMD, WM hypointensities, and normalized brain volume (NBV). RESULTS In our cohort, 37 (50.7%) patients were recognized as cognitively impaired (CI) and 36 (49.3%) patients were cognitively normal (CN). In regression analysis, PSMD was a statistically significant contributor in the California Verbal Learning Test (CVLT) list A (p = 0.04) and semantic fluency (p = 0.036). PSMD (p < 0.001, r2 = 0.35), NBV (p = 0.002, r2 = 2.6) and WM hypointensities (p < 0.001, r2 = 0.40) were major contributors to upper extremity disability (9HPT) in the CN subgroup. A significant contributor in the majority of neuropsychological measures was education attainment. CONCLUSION We investigated PSMD as a new parameter of WM microstructure damage that is a contributor in complex cognitive tasks, CVLT performance, and semantic fluency. PSMD was a statistically significant contributor to upper extremity disability (9HPT) together with WM hypointensities and NBV. Education attainment proved to be relevant in the majority of cognitive domains. Further studies are needed to estimate PSMD relevance as a marker of CI in MS.
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Affiliation(s)
- Magdalena Chylińska
- Department of Adult NeurologyMedical University of Gdańsk, Faculty of MedicineGdańskPoland
| | - Bartosz Karaszewski
- Department of Adult NeurologyMedical University of Gdańsk, Faculty of MedicineGdańskPoland
| | - Jakub Komendziński
- Department of Adult NeurologyMedical University of Gdańsk, Faculty of MedicineGdańskPoland
| | - Adam Wyszomirski
- Department of Adult NeurologyMedical University of Gdańsk, Faculty of MedicineGdańskPoland
| | - Agnieszka Sabisz
- 2nd Department of RadiologyMedical University of Gdańsk, Faculty of MedicineGdańskPoland
| | - Marek Halas
- Department of Adult NeurologyMedical University of Gdańsk, Faculty of MedicineGdańskPoland
| | - Edyta Szurowska
- 2nd Department of RadiologyMedical University of Gdańsk, Faculty of MedicineGdańskPoland
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12
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Engelhardt B, Comabella M, Chan A. Multiple sclerosis: Immunopathological heterogeneity and its implications. Eur J Immunol 2022; 52:869-881. [PMID: 35476319 PMCID: PMC9324211 DOI: 10.1002/eji.202149757] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 04/22/2022] [Accepted: 04/25/2022] [Indexed: 01/13/2023]
Abstract
MS is the most common autoimmune demyelinating disease of the CNS. For the past decades, several immunomodulatory disease-modifying treatments with multiple presumed mechanisms of action have been developed, but MS remains an incurable disease. Whereas high efficacy, at least in early disease, corroborates underlying immunopathophysiology, there is profound heterogeneity in clinical presentation as well as immunophenotypes that may also vary over time. In addition, functional plasticity in the immune system as well as in the inflamed CNS further contributes to disease heterogeneity. In this review, we will highlight immune-pathophysiological and associated clinical heterogeneity that may have an implication for more precise immunomodulatory therapeutic strategies in MS.
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Affiliation(s)
| | - Manuel Comabella
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Institut de Recerca Vall d'Hebron (VHIR), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Andrew Chan
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Department for BioMedical Research (DBMR), University of Bern, Bern, Switzerland
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13
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Bao J, Tu H, Li Y, Sun J, Hu Z, Zhang F, Li J. Diffusion Tensor Imaging Revealed Microstructural Changes in Normal-Appearing White Matter Regions in Relapsing–Remitting Multiple Sclerosis. Front Neurosci 2022; 16:837452. [PMID: 35310094 PMCID: PMC8924457 DOI: 10.3389/fnins.2022.837452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 01/27/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundAxons and myelin sheaths are the physical foundation for white matter (WM) to perform normal functions. Our previous study found the metabolite abnormalities in frontal, parietal, and occipital normal-appearing white matter (NAWM) regions in relapsing–remitting multiple sclerosis (RRMS) patients by applying a 2D 1H magnetic resonance spectroscopic imaging method. Since the metabolite changes may associate with the microstructure changes, we used the diffusion tensor imaging (DTI) method to assess the integrity of NAWM in this study.MethodDiffusion tensor imaging scan was performed on 17 clinically definite RRMS patients and 21 age-matched healthy controls on a 3.0-T scanner. DTI metrics including fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) were extracted from 19 predefined regions of interest (ROIs), which were generated by removing a mask of manually drawn probabilistic lesion map from the Johns Hopkins University white-matter atlas. The mean values of FA, MD, AD, and RD were compared between different groups in the same ROIs.ResultsA probabilistic lesion map was successfully generated, and the lesion regions were eliminated from the WM atlas. We found that the RRMS patients had significantly lower FA in the entire corpus callosum (CC), bilateral of anterior corona radiata, and right posterior thalamic radiation (PTR). At the same time, RRMS patients showed significantly higher MD in the bilateral anterior corona radiata and superior corona radiata. Moreover, all AD values increased, and the bilateral external capsule, PTR, and left tapetum NAWM show statistical significance. What is more, all NAWM tracts showed increasing RD values in RRMS patients, and the bilateral superior corona radiata, the anterior corona radiata, right PTR, and the genu CC reach statistical significance.ConclusionOur study revealed widespread microstructure changes in NAWM in RRMS patients through a ready-made WM atlas and probabilistic lesion map. These findings support the hypothesis of demyelination, accumulation of inflammatory cells, and axonal injury in NAWM for RRMS. The DTI-based metrics could be considered as potential non-invasive biomarkers of disease severity.
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Affiliation(s)
- Jianfeng Bao
- College of Medical Technology and Engineering, Henan University of Science and Technology, Luoyang, China
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China
| | - Hui Tu
- College of Medical Technology and Engineering, Henan University of Science and Technology, Luoyang, China
| | - Yijia Li
- College of Medical Technology and Engineering, Henan University of Science and Technology, Luoyang, China
| | - Jubao Sun
- MRI Center, The First Affiliated Hospital of Henan University of Science and Technology, Luoyang, China
| | - Zhigang Hu
- College of Medical Technology and Engineering, Henan University of Science and Technology, Luoyang, China
| | - Fengshou Zhang
- College of Medical Technology and Engineering, Henan University of Science and Technology, Luoyang, China
- *Correspondence: Fengshou Zhang,
| | - Jinghua Li
- College of Medical Technology and Engineering, Henan University of Science and Technology, Luoyang, China
- Jinghua Li,
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14
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Kular L, Ewing E, Needhamsen M, Pahlevan Kakhki M, Covacu R, Gomez-Cabrero D, Brundin L, Jagodic M. DNA methylation changes in glial cells of the normal-appearing white matter in Multiple Sclerosis patients. Epigenetics 2022; 17:1311-1330. [PMID: 35094644 PMCID: PMC9586622 DOI: 10.1080/15592294.2021.2020436] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Multiple Sclerosis (MS), the leading cause of non-traumatic neurological disability in young adults, is a chronic inflammatory and neurodegenerative disease of the central nervous system (CNS). Due to the poor accessibility to the target organ, CNS-confined processes underpinning the later progressive form of MS remain elusive thereby limiting treatment options. We aimed to examine DNA methylation, a stable epigenetic mark of genome activity, in glial cells to capture relevant molecular changes underlying MS neuropathology. We profiled DNA methylation in nuclei of non-neuronal cells, isolated from 38 post-mortem normal-appearing white matter (NAWM) specimens of MS patients (n = 8) in comparison to white matter of control individuals (n = 14), using Infinium MethylationEPIC BeadChip. We identified 1,226 significant (genome-wide adjusted P-value < 0.05) differentially methylated positions (DMPs) between MS patients and controls. Functional annotation of the altered DMP-genes uncovered alterations of processes related to cellular motility, cytoskeleton dynamics, metabolic processes, synaptic support, neuroinflammation and signaling, such as Wnt and TGF-β pathways. A fraction of the affected genes displayed transcriptional differences in the brain of MS patients, as reported by publically available transcriptomic data. Cell type-restricted annotation of DMP-genes attributed alterations of cytoskeleton rearrangement and extracellular matrix remodelling to all glial cell types, while some processes, including ion transport, Wnt/TGF-β signaling and immune processes were more specifically linked to oligodendrocytes, astrocytes and microglial cells, respectively. Our findings strongly suggest that NAWM glial cells are highly altered, even in the absence of lesional insult, collectively exhibiting a multicellular reaction in response to diffuse inflammation.
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Affiliation(s)
- Lara Kular
- Department of Clinical Neuroscience, Center for Molecular Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Ewoud Ewing
- Department of Clinical Neuroscience, Center for Molecular Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Maria Needhamsen
- Department of Clinical Neuroscience, Center for Molecular Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Majid Pahlevan Kakhki
- Department of Clinical Neuroscience, Center for Molecular Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Ruxandra Covacu
- Department of Clinical Neuroscience, Center for Molecular Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - David Gomez-Cabrero
- Department of Medicine, Unit of Computational Medicine, Center for Molecular Medicine, Karolinska Institutet, Solna, Sweden
- Mucosal and Salivary Biology Division, King’s College London Dental Institute, London, UK
- Translational Bioinformatics Unit, Navarrabiomed, Complejo Hospitalario de Navarra (Chn), Universidad Pública de Navarra (Upna), IdiSNA, Pamplona, Spain
- Biological & Environmental Sciences & Engineering Division, King Abdullah University of Science & Technology, Thuwal, Kingdom of Saudi Arabia
| | - Lou Brundin
- Department of Clinical Neuroscience, Center for Molecular Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - Maja Jagodic
- Department of Clinical Neuroscience, Center for Molecular Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
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15
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Weber CE, Wittayer M, Kraemer M, Dabringhaus A, Bail K, Platten M, Schirmer L, Gass A, Eisele P. Long-term dynamics of multiple sclerosis iron rim lesions. Mult Scler Relat Disord 2022; 57:103340. [PMID: 35158450 DOI: 10.1016/j.msard.2021.103340] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/08/2021] [Accepted: 10/17/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Several studies have pointed out that seemingly chronic multiple sclerosis (MS) lesions may also be in inflammatory states. In pathological studies, up to 40% of chronic MS lesions are characterized as "chronic active" or "smoldering" lesions that are characterized by a rim of iron-laden proinflammatory macrophages/microglial cells at the lesion edge with low-grade continuous myelin breakdown. In vivo, these lesions can be visualized as "iron rim lesions" (IRLs) on susceptibility-weighted imaging (SWI). The aim of this study was to investigate the long-term dynamics of IRLs in vivo for a more detailed evolution of dynamic lesion volume changes occurring over time. METHODS We retrospectively identified patients with MS who were followed for at least 36 months (up to 72 months) and underwent at least an annual MRI on the same 3 Tsystem. Using Voxel-Guided Morphometry (VGM) we investigated regional volume changes within lesions and correlated these findings with SWI for the presence of a characteristic hypointense lesion rim. To estimate tissue damage, apparent diffusion coefficient (ADC) values for every lesion at baseline and follow-up MRIs were determined. RESULTS Forty-three patients were included in the study. Overall, we identified 302 supratentorial non-confluent MS lesions (52 persistent IRLs, nine transient IRLs, 228 non-IRLs and 13 acute contrast-enhancing lesions). During follow-up, persistent IRLs significantly enlarged, whereas non-IRLs showed a tendency to shrink. At baseline MRI, ADC values were significantly higher in persistent IRLs (1.23 × 10-3 mm/s2) compared to non-IRLs (1.01 × 10-3 mm/s2; p < 0.001), but not compared to transient IRLs (1.06 × 10-3 mm/s2; p = 0.15) and contrast-enhancing lesions (1.15 × 10-3 mm/s2; p = 1.0). During follow-up, ADC values significantly increased more often in persistent IRLs compared to all other lesion types (p < 0.0001). CONCLUSIONS Our long-term data demonstrate that persistent IRLs enlarge during disease duration, whereas non-IRLs show a tendency to shrink. Furthermore, IRLs are associated with sustained tissue damage, supporting the notion that IRLs could represent a new imaging biomarker in MS.
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Affiliation(s)
- Claudia E Weber
- Department of Neurology, Medical Faculty Mannheim and Mannheim Center of Translational Neurosciences (MCTN), Heidelberg University, Theodor-Kutzer-Ufer 1 - 3, 68167 Mannheim, Germany.
| | - Matthias Wittayer
- Department of Neurology, Medical Faculty Mannheim and Mannheim Center of Translational Neurosciences (MCTN), Heidelberg University, Theodor-Kutzer-Ufer 1 - 3, 68167 Mannheim, Germany.
| | - Matthias Kraemer
- VGMorph GmbH, Waterloostr. 32, 45472 Mülheim an der Ruhr, Germany; Neurocentrum, Am Ziegelkamp 1f, 41515 Grevenbroich, Germany.
| | | | - Kathrin Bail
- Department of Neurology, Medical Faculty Mannheim and Mannheim Center of Translational Neurosciences (MCTN), Heidelberg University, Theodor-Kutzer-Ufer 1 - 3, 68167 Mannheim, Germany.
| | - Michael Platten
- Department of Neurology, Medical Faculty Mannheim and Mannheim Center of Translational Neurosciences (MCTN), Heidelberg University, Theodor-Kutzer-Ufer 1 - 3, 68167 Mannheim, Germany; Institute for Innate Immunoscience, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
| | - Lucas Schirmer
- Department of Neurology, Medical Faculty Mannheim and Mannheim Center of Translational Neurosciences (MCTN), Heidelberg University, Theodor-Kutzer-Ufer 1 - 3, 68167 Mannheim, Germany; Institute for Innate Immunoscience, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; Interdisciplinary Center for Neurosciences, Heidelberg University, Heidelberg, Germany.
| | - Achim Gass
- Department of Neurology, Medical Faculty Mannheim and Mannheim Center of Translational Neurosciences (MCTN), Heidelberg University, Theodor-Kutzer-Ufer 1 - 3, 68167 Mannheim, Germany.
| | - Philipp Eisele
- Department of Neurology, Medical Faculty Mannheim and Mannheim Center of Translational Neurosciences (MCTN), Heidelberg University, Theodor-Kutzer-Ufer 1 - 3, 68167 Mannheim, Germany.
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16
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Buyukturkoglu K, Vergara C, Fuentealba V, Tozlu C, Dahan JB, Carroll BE, Kuceyeski A, Riley CS, Sumowski JF, Guevara Oliva C, Sitaram R, Guevara P, Leavitt VM. Machine learning to investigate superficial white matter integrity in early multiple sclerosis. J Neuroimaging 2022; 32:36-47. [PMID: 34532924 PMCID: PMC8752496 DOI: 10.1111/jon.12934] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 09/01/2021] [Accepted: 09/03/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND AND PURPOSE This study aims todetermine the sensitivity of superficial white matter (SWM) integrity as a metric to distinguish early multiple sclerosis (MS) patients from healthy controls (HC). METHODS Fractional anisotropy and mean diffusivity (MD) values from SWM bundles across the cortex and major deep white matter (DWM) tracts were extracted from 29 early MS patients and 31 age- and sex-matched HC. Thickness of 68 cortical regions and resting-state functional-connectivity (RSFC) among them were calculated. The distribution of structural and functional metrics between groups were compared using Wilcoxon rank-sum test. Utilizing a machine learning method (adaptive boosting), 6 models were built based on: 1-SWM, 2-DWM, 3-SWM and DWM, 4-cortical thickness, or 5-RSFC measures. In model 6, all features from previous models were incorporated. The models were trained with nested 5-folds cross-validation. Area under the receiver operating characteristic curve (AUCroc ) values were calculated to evaluate classification performance of each model. Permutation tests were used to compare the AUCroc values. RESULTS Patients had higher MD in SWM bundles including insula, inferior frontal, orbitofrontal, superior and medial temporal, and pre- and post-central cortices (p < .05). No group differences were found for any other MRI metric. The model incorporating SWM and DWM features provided the best classification (AUCroc = 0.75). The SWM model provided higher AUCroc (0.74), compared to DWM (0.63), cortical thickness (0.67), RSFC (0.63), and all-features (0.68) models (p < .001 for all). CONCLUSION Our results reveal a non-random pattern of SWM abnormalities at early stages of MS even before pronounced structural and functional alterations emerge.
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Affiliation(s)
- Korhan Buyukturkoglu
- Columbia University Irving Medical Center, Department of Neurology. New York, NY. USA
| | | | | | - Ceren Tozlu
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA
| | - Jacob B. Dahan
- Columbia University Irving Medical Center, Department of Neurology. New York, NY. USA
| | - Britta E. Carroll
- Columbia University Irving Medical Center, Department of Neurology. New York, NY. USA
| | - Amy Kuceyeski
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA
| | - Claire S. Riley
- Multiple Sclerosis Center, Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - James F. Sumowski
- Corinne Goldsmith Dickinson Center for Multiple Sclerosis, Mount Sinai Hospital, New York, NY. USA
| | | | - Ranganatha Sitaram
- Diagnostic Imaging Department, St. Jude Children’s Research Hospital, Memphis TN. USA
| | | | - Victoria M. Leavitt
- Columbia University Irving Medical Center, Department of Neurology. New York, NY. USA
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17
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Elliott C, Momayyezsiahkal P, Arnold DL, Liu D, Ke J, Zhu L, Zhu B, George IC, Bradley DP, Fisher E, Cahir-McFarland E, Stys PK, Geurts JJG, Franchimont N, Gafson A, Belachew S. Abnormalities in normal-appearing white matter from which multiple sclerosis lesions arise. Brain Commun 2021; 3:fcab176. [PMID: 34557664 PMCID: PMC8453433 DOI: 10.1093/braincomms/fcab176] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 06/08/2021] [Accepted: 06/09/2021] [Indexed: 11/24/2022] Open
Abstract
Normal-appearing white matter is far from normal in multiple sclerosis; little is known about the precise pathology or spatial pattern of this alteration and its relation to subsequent lesion formation. This study was undertaken to evaluate normal-appearing white matter abnormalities in brain areas where multiple sclerosis lesions subsequently form, and to investigate the spatial distribution of normal-appearing white matter abnormalities in persons with multiple sclerosis. Brain MRIs of pre-lesion normal-appearing white matter were analysed in participants with new T2 lesions, pooled from three clinical trials: SYNERGY (NCT01864148; n = 85 with relapsing multiple sclerosis) was the test data set; ASCEND (NCT01416181; n = 154 with secondary progressive multiple sclerosis) and ADVANCE (NCT00906399; n = 261 with relapsing-remitting multiple sclerosis) were used as validation data sets. Focal normal-appearing white matter tissue state was analysed prior to lesion formation in areas where new T2 lesions later formed (pre-lesion normal-appearing white matter) using normalized magnetization transfer ratio and T2-weighted (nT2) intensities, and compared with overall normal-appearing white matter and spatially matched contralateral normal-appearing white matter. Each outcome was analysed using linear mixed-effects models. Follow-up time (as a categorical variable), patient-level characteristics (including treatment group) and other baseline variables were treated as fixed effects. In SYNERGY, nT2 intensity was significantly higher, and normalized magnetization transfer ratio was lower in pre-lesion normal-appearing white matter versus overall and contralateral normal-appearing white matter at all time points up to 24 weeks before new T2 lesion onset. In ASCEND and ADVANCE (for which normalized magnetization transfer ratio was not available), nT2 intensity in pre-lesion normal-appearing white matter was significantly higher compared to both overall and contralateral normal-appearing white matter at all pre-lesion time points extending up to 2 years prior to lesion formation. In all trials, nT2 intensity in the contralateral normal-appearing white matter was also significantly higher at all pre-lesion time points compared to overall normal-appearing white matter. Brain atlases of normal-appearing white matter abnormalities were generated using measures of voxel-wise differences in normalized magnetization transfer ratio of normal-appearing white matter in persons with multiple sclerosis compared to scanner-matched healthy controls. We observed that overall spatial distribution of normal-appearing white matter abnormalities in persons with multiple sclerosis largely recapitulated the anatomical distribution of probabilities of T2 hyperintense lesions. Overall, these findings suggest that intrinsic spatial properties and/or longstanding precursory abnormalities of normal-appearing white matter tissue may contribute to the risk of autoimmune acute demyelination in multiple sclerosis.
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Affiliation(s)
| | - Parya Momayyezsiahkal
- NeuroRx Research, Montreal, QC H2X 3P9, Canada.,McGill University, Montreal, QC H3A 0G4, Canada
| | - Douglas L Arnold
- NeuroRx Research, Montreal, QC H2X 3P9, Canada.,McGill University, Montreal, QC H3A 0G4, Canada
| | - Dawei Liu
- Biogen Digital Health, Biogen, Cambridge, MA 02142, USA
| | - Jun Ke
- Biogen, Cambridge, MA 02142, USA
| | - Li Zhu
- Biogen, Cambridge, MA 02142, USA
| | - Bing Zhu
- Biogen, Cambridge, MA 02142, USA
| | - Ilena C George
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA
| | | | | | | | - Peter K Stys
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Jeroen J G Geurts
- Department of Anatomy and Neurosciences, Amsterdam UMC, 1081 HV Amsterdam, Netherlands
| | | | - Arie Gafson
- Biogen Digital Health, Biogen, Cambridge, MA 02142, USA
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18
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Tackley G, Kong Y, Minne R, Messina S, Winkler A, Cavey A, Everett R, DeLuca GC, Weir A, Craner M, Tracey I, Palace J, Stagg CJ, Emir U. An In-vivo 1H-MRS short-echo time technique at 7T: Quantification of metabolites in chronic multiple sclerosis and neuromyelitis optica brain lesions and normal appearing brain tissue. Neuroimage 2021; 238:118225. [PMID: 34062267 PMCID: PMC7611458 DOI: 10.1016/j.neuroimage.2021.118225] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 03/09/2021] [Accepted: 05/29/2021] [Indexed: 11/05/2022] Open
Abstract
Magnetic Resonance Spectroscopy (MRS) allows for the non-invasive quantification of neurochemicals and has the potential to differentiate between the pathologically distinct diseases, multiple sclerosis (MS) and AQP4Ab-positive neuromyelitis optica spectrum disorder (AQP4Ab-NMOSD). In this study we characterised the metabolite profiles of brain lesions in 11 MS and 4 AQP4Ab-NMOSD patients using an optimised MRS methodology at ultra-high field strength (7T) incorporating correction for T2 water relaxation differences between lesioned and normal tissue. MS metabolite results were in keeping with the existing literature: total N-acetylaspartate (NAA) was lower in lesions compared to normal appearing brain white matter (NAWM) with reciprocal findings for myo-Inositol. An unexpected subtlety revealed by our technique was that total NAA differences were likely driven by NAA-glutamate (NAAG), a ubiquitous CNS molecule with functions quite distinct from NAA though commonly quantified together with NAA in MRS studies as total NAA. Surprisingly, AQP4Ab-NMOSD showed no significant differences for total NAA, NAA, NAAG or myo-Inositol between lesion and NAWM sites, nor were there any differences between MS and AQP4Ab-NMOSD for a priori hypotheses. Post-hoc testing revealed a significant correlation between NAWM Ins:NAA and disability (as measured by EDSS) for disease groups combined, driven by the AP4Ab-NMOSD group. Utilising an optimised MRS methodology, our study highlights some under-explored subtleties in MRS profiles, such as the absence of myo-Inositol concentration differences in AQP4Ab-NMOSD brain lesions versus NAWM and the potential influence of NAAG differences between lesions and normal appearing white matter in MS.
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Affiliation(s)
- George Tackley
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DU, United Kingdom; Cardiff University Brain Research Imaging Centre (CUBRIC), Cardiff University, CF24 4HQ, United Kingdom.
| | - Yazhuo Kong
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DU, United Kingdom; CAS Key Laboratory of Behavioural Science, Institute of Psychology, Chinese Academy of Sciences, Beijing 100101, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Rachel Minne
- School of Health Sciences, Purdue University, 550 Stadium Mall Drive, West Lafayette, IN 47907, (765) 494-1419, United States
| | - Silvia Messina
- Division of Clinical Neurology, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DU, United Kingdom
| | - Anderson Winkler
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DU, United Kingdom; National Institute of Mental Health (NIMH), National Institutes of Health (NIH), Bethesda, MD, United States
| | - Ana Cavey
- Division of Clinical Neurology, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DU, United Kingdom
| | - Rosie Everett
- Division of Clinical Neurology, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DU, United Kingdom
| | - Gabriele C DeLuca
- Division of Clinical Neurology, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DU, United Kingdom
| | - Andrew Weir
- Division of Clinical Neurology, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DU, United Kingdom
| | - Matthew Craner
- Division of Clinical Neurology, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DU, United Kingdom
| | - Irene Tracey
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DU, United Kingdom
| | - Jacqueline Palace
- Division of Clinical Neurology, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DU, United Kingdom
| | - Charlotte J Stagg
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DU, United Kingdom; MRC Brain Network Dynamics Unit, University of Oxford, Oxford, OX1 3TH, United Kingdom
| | - Uzay Emir
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DU, United Kingdom; School of Health Sciences, Purdue University, 550 Stadium Mall Drive, West Lafayette, IN 47907, (765) 494-1419, United States; Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, United States
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Greiner T, Kipp M. What Guides Peripheral Immune Cells into the Central Nervous System? Cells 2021; 10:cells10082041. [PMID: 34440810 PMCID: PMC8392645 DOI: 10.3390/cells10082041] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 08/05/2021] [Accepted: 08/06/2021] [Indexed: 11/16/2022] Open
Abstract
Multiple sclerosis (MS), an immune-mediated demyelinating disease of the central nervous system (CNS), initially presents with a relapsing-remitting disease course. During this early stage of the disease, leukocytes cross the blood–brain barrier to drive the formation of focal demyelinating plaques. Disease-modifying agents that modulate or suppress the peripheral immune system provide a therapeutic benefit during relapsing-remitting MS (RRMS). The majority of individuals with RRMS ultimately enter a secondary progressive disease stage with a progressive accumulation of neurologic deficits. The cellular and molecular basis for this transition is unclear and the role of inflammation during the secondary progressive disease stage is a subject of intense and controversial debate. In this review article, we discuss the following main hypothesis: during both disease stages, peripheral immune cells are triggered by CNS-intrinsic stimuli to invade the brain parenchyma. Furthermore, we outline the different neuroanatomical routes by which peripheral immune cells might migrate from the periphery into the CNS.
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20
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Granziera C, Wuerfel J, Barkhof F, Calabrese M, De Stefano N, Enzinger C, Evangelou N, Filippi M, Geurts JJG, Reich DS, Rocca MA, Ropele S, Rovira À, Sati P, Toosy AT, Vrenken H, Gandini Wheeler-Kingshott CAM, Kappos L. Quantitative magnetic resonance imaging towards clinical application in multiple sclerosis. Brain 2021; 144:1296-1311. [PMID: 33970206 PMCID: PMC8219362 DOI: 10.1093/brain/awab029] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 10/25/2020] [Accepted: 11/16/2020] [Indexed: 12/11/2022] Open
Abstract
Quantitative MRI provides biophysical measures of the microstructural integrity of the CNS, which can be compared across CNS regions, patients, and centres. In patients with multiple sclerosis, quantitative MRI techniques such as relaxometry, myelin imaging, magnetization transfer, diffusion MRI, quantitative susceptibility mapping, and perfusion MRI, complement conventional MRI techniques by providing insight into disease mechanisms. These include: (i) presence and extent of diffuse damage in CNS tissue outside lesions (normal-appearing tissue); (ii) heterogeneity of damage and repair in focal lesions; and (iii) specific damage to CNS tissue components. This review summarizes recent technical advances in quantitative MRI, existing pathological validation of quantitative MRI techniques, and emerging applications of quantitative MRI to patients with multiple sclerosis in both research and clinical settings. The current level of clinical maturity of each quantitative MRI technique, especially regarding its integration into clinical routine, is discussed. We aim to provide a better understanding of how quantitative MRI may help clinical practice by improving stratification of patients with multiple sclerosis, and assessment of disease progression, and evaluation of treatment response.
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Affiliation(s)
- Cristina Granziera
- Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland
- Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Jens Wuerfel
- Medical Image Analysis Center, Basel, Switzerland
- Quantitative Biomedical Imaging Group (qbig), Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, multiple sclerosis Center Amsterdam, Amsterdam University Medical Center, Amsterdam, The Netherlands
- UCL Institutes of Healthcare Engineering and Neurology, London, UK
| | - Massimiliano Calabrese
- Neurology B, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Nicola De Stefano
- Neurology, Department of Medicine, Surgery and Neuroscience, University of Siena, Italy
| | - Christian Enzinger
- Department of Neurology and Division of Neuroradiology, Medical University of Graz, Graz, Austria
| | - Nikos Evangelou
- Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - Massimo Filippi
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, and Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Jeroen J G Geurts
- Department of Anatomy and Neurosciences, multiple sclerosis Center Amsterdam, Neuroscience Amsterdam, Amsterdam University Medical Centers, location VUmc, Amsterdam, The Netherlands
| | - Daniel S Reich
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD, USA
| | - Maria A Rocca
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, and Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Stefan Ropele
- Neuroimaging Research Unit, Department of Neurology, Medical University of Graz, Graz, Austria
| | - Àlex Rovira
- Section of Neuroradiology (Department of Radiology), Vall d'Hebron University Hospital and Research Institute, Barcelona, Spain
| | - Pascal Sati
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD, USA
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Ahmed T Toosy
- Queen Square multiple sclerosis Centre, Department of Neuroinflammation, Queen Square Institute of Neurology, University College London, London, UK
| | - Hugo Vrenken
- Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, multiple sclerosis Center Amsterdam, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Claudia A M Gandini Wheeler-Kingshott
- Queen Square multiple sclerosis Centre, Department of Neuroinflammation, Queen Square Institute of Neurology, University College London, London, UK
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
- Brain MRI 3T Research Centre, IRCCS Mondino Foundation, Pavia, Italy
| | - Ludwig Kappos
- Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland
- Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland
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21
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Loizou CP, Pantzaris M, Pattichis CS. Normal appearing brain white matter changes in relapsing multiple sclerosis: Texture image and classification analysis in serial MRI scans. Magn Reson Imaging 2020; 73:192-202. [PMID: 32890673 DOI: 10.1016/j.mri.2020.08.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 08/20/2020] [Accepted: 08/27/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE There is a clinical interest in identifying normal appearing white matter (NAWM) areas in brain T2-weighted (T2W) MRI scans in multiple sclerosis (MS) subjects. These areas are susceptible to disease development and areas need to be studied in order to find potential associations between texture feature changes and disease progression. METHODS The subjects investigated had a first demyelinating event (Clinically Isolated Syndrome-CIS) at baseline (Time0), and the NAWM0 (i.e. NAWM at Time0) of the brain tissue was subsequently converted to demyelinating plaques (as evaluated in a follow up MRI at Time6-12). 38 untreated subjects that had developed a CIS, had brain MRI scans within an interval of 6-12 months (Time6-12 at follow-up). An experienced MS neurologist manually delineated the demyelinating lesions at Time0 (L0) and at Time6-12 (L6-12). Areas in the Time6-12 MRI scans, where new lesions had been developed, were mapped back to their corresponding NAWM areas on the Time0 MR scans (ROIS0). In addition, contralateral ROIs of similar size and shape were segmented on the same images at Time0 (ROISC0) to form an intra-subject control group. Following that, texture features were extracted from all prescribed areas and MS lesions. RESULTS Texture features were used as input into Support Vector Machine (SVM) models to differentiate between the following: NAWM0 vs ROISC0, NAWM0 vs NAWM6-12, NAWM0 vs L0, NAWM6-12 vs L6-12, ROIS0 vs L0, ROIS0 vs L6-12 and ROIS0 vs ROISC0, where the corresponding % correct classifications scores were 89%, 95%, 98%, 92%, 85%, 90% and 65% respectively. CONCLUSIONS Texture features may provide complementary information for following up the development and progression of MS disease. Future work will investigate the proposed method on more subjects.
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Affiliation(s)
- Christos P Loizou
- Faculty of Engineering & Technology, Department of Electrical Engineering and Computer Engineering and Informatics, Cyprus University of Technology, 30 Arch. Kyprianos Str., Limassol CY-3036, Cyprus.
| | - Marios Pantzaris
- Cyprus School of Molecular Medicine, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus.
| | - Constandinos S Pattichis
- Departement of Computer Science, University of Cyprus, Nicosia, Cyprus; Research Centre on Interactive Media, Smart Systems and Emerging Technologies (RISE CoE), Nicosia, Cyprus.
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22
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Häring DA, Kropshofer H, Kappos L, Cohen JA, Shah A, Meinert R, Leppert D, Tomic D, Kuhle J. Long-term prognostic value of longitudinal measurements of blood neurofilament levels. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2020; 7:e856. [PMID: 32817406 PMCID: PMC7428358 DOI: 10.1212/nxi.0000000000000856] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 06/19/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To assess the long-term prognostic value of an integral of longitudinal measurements of plasma neurofilament light chain levels (NfLlong) over 12 and 24 months vs single neurofilament light chain (NfL) measurements in patients with relapsing-remitting MS (RRMS) and its additional value when combined with clinical and MRI measures. METHODS This analysis included continuously fingolimod-treated patients with RRMS from the 24-month FTY720 Research Evaluating Effects of Daily Oral therapy in Multiple Sclerosis (FREEDOMS)/12-month Trial Assessing Injectable Interferon vs FTY720 Oral in Relapsing-Remitting Multiple Sclerosis (TRANSFORMS) phase 3 trials and their long-term extension, LONGTERMS. Patients were classified into high (≥30 pg/mL, n = 110) and low (<30 pg/mL, n = 164) NfL categories based on the baseline (BL) NfL value or the geometric mean NfLlong calculated over 12 and 24 months to predict disability-related outcomes and brain volume loss (BVL). The additional prognostic value of NfL was quantified using the area under the receiver operating characteristic (ROC) curve. RESULTS A single high (vs low) NfL measure at BL was prognostic of a higher risk of reaching Expanded Disability Status Scale (EDSS) score ≥4 earlier (hazard ratio [HR] = 2.19; 95% CI = 1.21-3.97) and higher BVL over 120 months (difference: -1.12%; 95% CI = -2.07 to -0.17). When NfLlong was measured over 24 months, high NfL was associated with a higher risk of reaching EDSS score ≥4 (HR = 7.91; 95% CI = 2.99-20.92), accelerated 6-month confirmed disability worsening (HR = 3.14; 95% CI = 1.38-7.11), and 20% worsening in the Timed 25-Foot Walk Test (HR = 3.05; 95% CI = 1.38-6.70). Area under the ROC curve was consistently highest in models combining NfL with clinical and MRI measures. CONCLUSIONS NfLlong had a higher prognostic value than single NfL assessments on long-term outcomes in RRMS. Combining it with clinical and MRI measures increased sensitivity and specificity to predict long-term disease outcomes. CLASSIFICATION OF EVIDENCE This study provides Class I evidence that NfLlong was more strongly associated with long-term outcomes than single NfL assessments in patients with RRMS.
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Affiliation(s)
- Dieter A Häring
- From the Novartis Pharma AG (D.A.H., H.K., D.T.), Basel; Research Center for Clinical Neuroimmunology and Neuroscience Basel (L.K., D.L., J.K.), Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering, University Hospital and University of Basel, Switzerland; Department of Neurology (J.A.C.), Mellen MS Center, Neurological Institute, Cleveland Clinic, OH; Novartis Healthcare Pvt. Ltd. (A.S.), Hyderabad, India; and DATAMAP GmbH (R.M.), Freiburg, Germany
| | - Harald Kropshofer
- From the Novartis Pharma AG (D.A.H., H.K., D.T.), Basel; Research Center for Clinical Neuroimmunology and Neuroscience Basel (L.K., D.L., J.K.), Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering, University Hospital and University of Basel, Switzerland; Department of Neurology (J.A.C.), Mellen MS Center, Neurological Institute, Cleveland Clinic, OH; Novartis Healthcare Pvt. Ltd. (A.S.), Hyderabad, India; and DATAMAP GmbH (R.M.), Freiburg, Germany
| | - Ludwig Kappos
- From the Novartis Pharma AG (D.A.H., H.K., D.T.), Basel; Research Center for Clinical Neuroimmunology and Neuroscience Basel (L.K., D.L., J.K.), Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering, University Hospital and University of Basel, Switzerland; Department of Neurology (J.A.C.), Mellen MS Center, Neurological Institute, Cleveland Clinic, OH; Novartis Healthcare Pvt. Ltd. (A.S.), Hyderabad, India; and DATAMAP GmbH (R.M.), Freiburg, Germany
| | - Jeffrey A Cohen
- From the Novartis Pharma AG (D.A.H., H.K., D.T.), Basel; Research Center for Clinical Neuroimmunology and Neuroscience Basel (L.K., D.L., J.K.), Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering, University Hospital and University of Basel, Switzerland; Department of Neurology (J.A.C.), Mellen MS Center, Neurological Institute, Cleveland Clinic, OH; Novartis Healthcare Pvt. Ltd. (A.S.), Hyderabad, India; and DATAMAP GmbH (R.M.), Freiburg, Germany
| | - Anuja Shah
- From the Novartis Pharma AG (D.A.H., H.K., D.T.), Basel; Research Center for Clinical Neuroimmunology and Neuroscience Basel (L.K., D.L., J.K.), Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering, University Hospital and University of Basel, Switzerland; Department of Neurology (J.A.C.), Mellen MS Center, Neurological Institute, Cleveland Clinic, OH; Novartis Healthcare Pvt. Ltd. (A.S.), Hyderabad, India; and DATAMAP GmbH (R.M.), Freiburg, Germany
| | - Rolf Meinert
- From the Novartis Pharma AG (D.A.H., H.K., D.T.), Basel; Research Center for Clinical Neuroimmunology and Neuroscience Basel (L.K., D.L., J.K.), Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering, University Hospital and University of Basel, Switzerland; Department of Neurology (J.A.C.), Mellen MS Center, Neurological Institute, Cleveland Clinic, OH; Novartis Healthcare Pvt. Ltd. (A.S.), Hyderabad, India; and DATAMAP GmbH (R.M.), Freiburg, Germany
| | - David Leppert
- From the Novartis Pharma AG (D.A.H., H.K., D.T.), Basel; Research Center for Clinical Neuroimmunology and Neuroscience Basel (L.K., D.L., J.K.), Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering, University Hospital and University of Basel, Switzerland; Department of Neurology (J.A.C.), Mellen MS Center, Neurological Institute, Cleveland Clinic, OH; Novartis Healthcare Pvt. Ltd. (A.S.), Hyderabad, India; and DATAMAP GmbH (R.M.), Freiburg, Germany
| | - Davorka Tomic
- From the Novartis Pharma AG (D.A.H., H.K., D.T.), Basel; Research Center for Clinical Neuroimmunology and Neuroscience Basel (L.K., D.L., J.K.), Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering, University Hospital and University of Basel, Switzerland; Department of Neurology (J.A.C.), Mellen MS Center, Neurological Institute, Cleveland Clinic, OH; Novartis Healthcare Pvt. Ltd. (A.S.), Hyderabad, India; and DATAMAP GmbH (R.M.), Freiburg, Germany
| | - Jens Kuhle
- From the Novartis Pharma AG (D.A.H., H.K., D.T.), Basel; Research Center for Clinical Neuroimmunology and Neuroscience Basel (L.K., D.L., J.K.), Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering, University Hospital and University of Basel, Switzerland; Department of Neurology (J.A.C.), Mellen MS Center, Neurological Institute, Cleveland Clinic, OH; Novartis Healthcare Pvt. Ltd. (A.S.), Hyderabad, India; and DATAMAP GmbH (R.M.), Freiburg, Germany.
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Zacharzewska-Gondek A, Pokryszko-Dragan A, Budrewicz S, Sąsiadek M, Trybek G, Bladowska J. The role of ADC values within the normal-appearing brain in the prognosis of multiple sclerosis activity during interferon-β therapy in the 3-year follow-up: a preliminary report. Sci Rep 2020; 10:12828. [PMID: 32732968 PMCID: PMC7393067 DOI: 10.1038/s41598-020-69383-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Accepted: 07/03/2020] [Indexed: 11/17/2022] Open
Abstract
Predictors of multiple sclerosis (MS) activity during disease-modifying treatment are being extensively investigated. The aim of this study was to assess the prognosis of NEDA (no evidence of disease activity) status during IFN-β (interferon-β) treatment, using apparent diffusion coefficient (ADC) measurements obtained at initial MRI (magnetic resonance imaging). In 87 MS patients treated with IFN-β, ADC values were calculated for 13 regions of normal-appearing white and grey matter (NAWM, NAGM) based on MRI performed with a 1.5 T magnet before (MS0, n = 45) or after one year of therapy (MS1, n = 42). Associations were evaluated between ADC, conventional MRI findings, demographic and clinical factors and NEDA status within the following 3 years using logistic, Cox and multinomial logistic regression models. NEDA rates in the MS0 group were 64.4%, 46.5% and 33.3% after the 1st, 2nd and 3rd year of treatment, respectively and in MS1 patients 71.4% and 48.7% for the periods 1st–2nd and 1st–3rd years of treatment, respectively. ADC values in the NAWM regions contributed to loss of NEDA and its clinical and radiological components, with a 1–3% increase in the risk of NEDA loss (p = 0.0001–0.0489) in both groups. ADC measurements may have an additional prognostic value with regard to NEDA status.
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Affiliation(s)
- Anna Zacharzewska-Gondek
- Department of General and Interventional Radiology and Neuroradiology, Wroclaw Medical University, 213 Borowska Street, 50-556, Wroclaw, Poland.
| | - Anna Pokryszko-Dragan
- Department and Clinic of Neurology, Wroclaw Medical University, 213 Borowska Street, 50-556, Wroclaw, Poland
| | - Sławomir Budrewicz
- Department and Clinic of Neurology, Wroclaw Medical University, 213 Borowska Street, 50-556, Wroclaw, Poland
| | - Marek Sąsiadek
- Department of General and Interventional Radiology and Neuroradiology, Wroclaw Medical University, 213 Borowska Street, 50-556, Wroclaw, Poland
| | - Grzegorz Trybek
- Department of Oral Surgery, Pomeranian Medical University, 72 Powstańców Wielkopolskich Street, 70-111, Szczecin, Poland
| | - Joanna Bladowska
- Department of General and Interventional Radiology and Neuroradiology, Wroclaw Medical University, 213 Borowska Street, 50-556, Wroclaw, Poland
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24
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Dietary Fructose Intake and Hippocampal Structure and Connectivity during Childhood. Nutrients 2020; 12:nu12040909. [PMID: 32224933 PMCID: PMC7230400 DOI: 10.3390/nu12040909] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 03/21/2020] [Accepted: 03/24/2020] [Indexed: 01/06/2023] Open
Abstract
In rodent literature, there is evidence that excessive fructose consumption during development has a detrimental impact on hippocampal structure and function. In this study of 103 children ages 7–11 years old, we investigated whether dietary fructose intake was related to alterations in hippocampal volume and connectivity in humans. To examine if these associations were specific to fructose or were related to dietary sugars intake in general, we explored relationships between dietary intake of added sugars and the monosaccharide, glucose, on the same brain measures. We found that increased dietary intake of fructose, measured as a percentage of total calories, was associated with both an increase in the volume of the CA2/3 subfield of the right hippocampus and increased axial, radial, and mean diffusivity in the prefrontal connections of the right cingulum. These findings are consistent with the idea that increased fructose consumption during childhood may be associated with an inflammatory process, and/or decreases or delays in myelination and/or pruning. Increased habitual consumption of glucose or added sugar in general were associated with an increased volume of right CA2/3, but not with any changes in the connectivity of the hippocampus. These findings support animal data suggesting that higher dietary intake of added sugars, particularly fructose, are associated with alterations in hippocampal structure and connectivity during childhood.
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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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Filip P, Svatkova A, Carpenter AF, Eberly LE, Nestrasil I, Nissi MJ, Michaeli S, Mangia S. Rotating frame MRI relaxations as markers of diffuse white matter abnormalities in multiple sclerosis. NEUROIMAGE-CLINICAL 2020; 26:102234. [PMID: 32272373 PMCID: PMC7139162 DOI: 10.1016/j.nicl.2020.102234] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 02/16/2020] [Accepted: 02/29/2020] [Indexed: 01/04/2023]
Abstract
T1ρ and RAFF4 - MRI protocols sensitive to slow motional regimes – are able to detect changes in T2w-defined normally appearing white matter of patients with multiple sclerosis. RAFF4, T1ρ and T2ρ showed differences in hippocampus in patients with multiple sclerosis despite the absence of alterations in resting-state functional MRI metrics. Hence, RAFF4, T1ρ and T2ρ hold promise as potential non-invasive tools for monitoring MS activity and eventually for the evaluation of therapeutic effects.
Even though MRI visualization of white matter lesions is pivotal for the diagnosis and management of multiple sclerosis (MS), the issue of detecting diffuse brain tissue damage beyond the apparent T2-hyperintense lesions continues to spark considerable interest. Motivated by the notion that rotating frame MRI methods are sensitive to slow motional regimes critical for tissue characterization, here we utilized novel imaging protocols of rotating frame MRI on a clinical 3 Tesla platform, including adiabatic longitudinal, T1ρ, and transverse, T2ρ, relaxation methods, and Relaxation Along a Fictitious Field (RAFF) in the rotating frame of rank 4 (RAFF4), in 10 relapsing-remitting multiple sclerosis patients and 10 sex- and age-matched healthy controls. T1ρ, T2ρ and RAFF4 relaxograms extracted from the whole white matter exhibited a significant shift towards longer relaxation time constants in MS patients as compared to controls. T1ρ and RAFF4 detected alterations even when considering only regions of normally appearing white matter (NAWM), while other MRI metrics such as T1w/T2w ratio and diffusion tensor imaging measures failed to find group differences. In addition, RAFF4, T2ρ and, to a lesser extent, T1ρ showed differences in subcortical grey matter structures, mainly hippocampus, whereas no functional changes in this region were detected in resting-state functional MRI metrics. We conclude that rotating frame MRI techniques are exceptionally sensitive methods for the detection of subtle abnormalities not only in NAWM, but also in deep grey matter in MS, where they surpass even highly sensitive measures of functional changes, which are often suggested to precede detectable structural alterations. Such abnormalities are consistent with a wide spectrum of different, but interconnected pathological features of MS, including the loss of neuronal cells and their axons, decreased levels of myelin even in NAWM, and altered iron content.
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Affiliation(s)
- Pavel Filip
- First Department of Neurology, Faculty of Medicine, Masaryk University and University Hospital of St. Anne, Brno, Czech Republic; Department of Radiology, Center for Magnetic Resonance Research (CMRR), University of Minnesota, Minneapolis, MN, USA
| | - Alena Svatkova
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA; Department of Medicine III, Clinical Division of Endocrinology and Metabolism, Medical University of Vienna, Vienna, Austria
| | - Adam F Carpenter
- Department of Neurology, School of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Lynn E Eberly
- Department of Radiology, Center for Magnetic Resonance Research (CMRR), University of Minnesota, Minneapolis, MN, USA; Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Igor Nestrasil
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - Mikko J Nissi
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Shalom Michaeli
- Department of Radiology, Center for Magnetic Resonance Research (CMRR), University of Minnesota, Minneapolis, MN, USA
| | - Silvia Mangia
- Department of Radiology, Center for Magnetic Resonance Research (CMRR), University of Minnesota, Minneapolis, MN, USA.
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Unal S, Peker E, Erdogan S, Erden MI. Is It Possible to Discriminate Active MS Lesions with Diffusion Weighted Imaging? Eurasian J Med 2019; 51:219-223. [PMID: 31692763 DOI: 10.5152/eurasianjmed.2019.18473] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective Patients with multiple sclerosis (MS) are at a risk of gadolinium deposition because of multiple control imaging. Therefore, it is important to determine biomarkers that can differentiate active and chronic lesions without using contrast agent. This study aimed to assess mean apparent diffusion coefficient (ADC) values and signal intensities (SI) on diffusion weighted imaging (DWI) values of active and nonactive lesions. Materials and Methods We included 25 patients in this study. We measured mean ADC values and SI on DWI of the randomly selected active and nonactive lesions and normal appearing white matter (NAWM) for all patients with MS. SI on DWI and ADC values were normalized to the SI of the CSF. We compared all of the measurements between active and nonactive lesions, active lesions and NAWM, and nonactive lesions and NAWM. SI on DWI and mean ADC values of normal healthy white matter (NHWM) of control group were measured. A comparison was made between NHWM and NAWM. Results For patients with active lesions, the mean nADC value was 0.35±0.06 for active lesions and 0.30±0.07 for nonactive lesions (p>0.050). The mean nDWI-SI value was 3.69±0.68 for active lesions was 3.39±0.68 for nonactive lesions (p<0.050). When patients with and without active lesions were compared, both nDWI values and nADC values for active and nonactive lesions were statistically insignificant (p>0.050). Discussion In MS lesions, diffusion alternations can be quantitatively evaluated with ADC mapping. Lesions seen in patients with MS have higher mean ADC values than NAWM and NHWM.
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Affiliation(s)
- Sena Unal
- Department of Radiology, Ankara University School of Medicine, Ankara, Turkey
| | - Elif Peker
- Department of Radiology, Ankara University School of Medicine, Ankara, Turkey
| | - Seyda Erdogan
- Department of Neurology, Ankara University School of Medicine, Ankara, Turkey
| | - Memet Ilhan Erden
- Department of Radiology, Ankara University School of Medicine, Ankara, Turkey
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Liu T, Chen Y, Thomas AM, Song X. CEST MRI with distribution-based analysis for assessment of early stage disease activity in a mouse model of multiple sclerosis: An initial study. NMR IN BIOMEDICINE 2019; 32:e4139. [PMID: 31342587 DOI: 10.1002/nbm.4139] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 06/14/2019] [Accepted: 06/14/2019] [Indexed: 06/10/2023]
Abstract
Imaging biomarkers that can detect pathological changes at an early stage of multiple sclerosis (MS) may allow earlier therapeutic intervention with an improved outcome. Using a mouse model of MS, termed as experimental autoimmune encephalomyelitis (EAE), we performed chemical exchange saturation transfer (CEST) MRI at a very early stage before symptom onset (6 days post-induction) for assessment of changes in tissues that appear "normal" with conventional MRI. The collected CEST Z-spectra signals (Ssat /S0 ) were analyzed using a histogram-guided method to determine the contributions from various offset frequencies. Histogram analysis showed that EAE mice exhibit a more heterogeneous distribution with lower peak heights in the hindbrain compared with naïve mice at saturation offsets of 1 and 2 ppm. At these two offsets, both the mean Ssat /S0 and the mean MTRasym values in the cerebellum and brain stem are significantly different between EAE and naïve mice (P < 0.05). Immunofluorescent staining validated the presence of neuroinflammation, with IBA1-positive cells detected throughout the hindbrain including the cerebellum and brain stem. Follow-up MRI at the symptom onset (score = 1.5-2.5, 13 days post-induction) confirmed gadolinium-enhanced periventricular lesions. CEST Z-spectra signals also changed by this time. The proposed three-level histogram-oriented analysis is simple to execute and robust for detecting subtle changes in Z-spectra signals, which does not require a priori knowledge of damage locations or contributing offset components. CEST MRI signals at 1 and 2 ppm were sensitive to the subtle pathological changes at an early stage in EAE mice, and have potential as novel imaging biomarkers complementary to functional and physiological MRI measures.
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Affiliation(s)
- Tao Liu
- Russell H. Morgan Dept. of Radiology and Radiological Science, Division of MR Research, The Johns Hopkins University School of Medicine, Baltimore, Maryland
- Dept. of Neurology, Hainan General Hospital, Haikou, Hainan, China
- Cellular Imaging Section and Vascular Biology Program, Institute for Cell Engineering, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Yanrong Chen
- Russell H. Morgan Dept. of Radiology and Radiological Science, Division of MR Research, The Johns Hopkins University School of Medicine, Baltimore, Maryland
- Cellular Imaging Section and Vascular Biology Program, Institute for Cell Engineering, The Johns Hopkins University School of Medicine, Baltimore, Maryland
- Dept. of Information Sciences and Technology, Northwest University, Xi'an, Shaanxi, China
| | - Aline M Thomas
- Russell H. Morgan Dept. of Radiology and Radiological Science, Division of MR Research, The Johns Hopkins University School of Medicine, Baltimore, Maryland
- Cellular Imaging Section and Vascular Biology Program, Institute for Cell Engineering, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Xiaolei Song
- Russell H. Morgan Dept. of Radiology and Radiological Science, Division of MR Research, The Johns Hopkins University School of Medicine, Baltimore, Maryland
- Cellular Imaging Section and Vascular Biology Program, Institute for Cell Engineering, The Johns Hopkins University School of Medicine, Baltimore, Maryland
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ElSayed MEKA, El-Toukhy MMB, Asaad RE, El-Serafy OA. Diffusion tensor imaging for assessment of normally appearing white matter of the brain and spinal cord in cases of multiple sclerosis: a multi-parametric correlation in view of patient’s clinical status. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2019. [DOI: 10.1186/s43055-019-0031-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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30
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Lampinen B, Szczepankiewicz F, Novén M, van Westen D, Hansson O, Englund E, Mårtensson J, Westin C, Nilsson M. Searching for the neurite density with diffusion MRI: Challenges for biophysical modeling. Hum Brain Mapp 2019; 40:2529-2545. [PMID: 30802367 PMCID: PMC6503974 DOI: 10.1002/hbm.24542] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 01/17/2019] [Accepted: 02/03/2019] [Indexed: 12/19/2022] Open
Abstract
In vivo mapping of the neurite density with diffusion MRI (dMRI) is a high but challenging aim. First, it is unknown whether all neurites exhibit completely anisotropic ("stick-like") diffusion. Second, the "density" of tissue components may be confounded by non-diffusion properties such as T2 relaxation. Third, the domain of validity for the estimated parameters to serve as indices of neurite density is incompletely explored. We investigated these challenges by acquiring data with "b-tensor encoding" and multiple echo times in brain regions with low orientation coherence and in white matter lesions. Results showed that microscopic anisotropy from b-tensor data is associated with myelinated axons but not with dendrites. Furthermore, b-tensor data together with data acquired for multiple echo times showed that unbiased density estimates in white matter lesions require data-driven estimates of compartment-specific T2 values. Finally, the "stick" fractions of different biophysical models could generally not serve as neurite density indices across the healthy brain and white matter lesions, where outcomes of comparisons depended on the choice of constraints. In particular, constraining compartment-specific T2 values was ambiguous in the healthy brain and had a large impact on estimated values. In summary, estimating neurite density generally requires accounting for different diffusion and/or T2 properties between axons and dendrites. Constrained "index" parameters could be valid within limited domains that should be delineated by future studies.
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Affiliation(s)
- Björn Lampinen
- Clinical Sciences Lund, Medical Radiation PhysicsLund UniversityLundSweden
| | - Filip Szczepankiewicz
- Clinical Sciences Lund, Medical Radiation PhysicsLund UniversityLundSweden
- Brigham and Women's HospitalHarvard Medical SchoolBostonMassachusettsUS
| | - Mikael Novén
- Centre for Languages and LiteratureLund UniversityLundSweden
| | | | - Oskar Hansson
- Clinical Sciences Malmö, Clinical Memory Research UnitLund UniversityLundSweden
| | - Elisabet Englund
- Clinical Sciences Lund, Oncology and PathologyLund UniversityLundSweden
| | - Johan Mårtensson
- Clinical Sciences Lund, Department of Logopedics, Phoniatrics and AudiologyLund UniversityLundSweden
| | | | - Markus Nilsson
- Clinical Sciences Lund, RadiologyLund UniversityLundSweden
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Eisele P, Szabo K, Ebert A, Radbruch A, Platten M, Schoenberg SO, Gass A. Diffusion-weighted imaging of the dentate nucleus after repeated application of gadolinium-based contrast agents in multiple sclerosis. Magn Reson Imaging 2019; 58:1-5. [DOI: 10.1016/j.mri.2019.01.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 01/06/2019] [Accepted: 01/06/2019] [Indexed: 12/31/2022]
Affiliation(s)
- Philipp Eisele
- Department of Neurology, Universitätsmedizin Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1 - 3, 68167 Mannheim, Germany.
| | - Kristina Szabo
- Department of Neurology, Universitätsmedizin Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1 - 3, 68167 Mannheim, Germany
| | - Anne Ebert
- Department of Neurology, Universitätsmedizin Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1 - 3, 68167 Mannheim, Germany
| | - Alexander Radbruch
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Huefelandstrasse 55, 45147 Essen, Germany; German Cancer Research Center (DKFZ), Department of Radiology, INF280, 69120 Heidelberg, Germany
| | - Michael Platten
- Department of Neurology, Universitätsmedizin Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1 - 3, 68167 Mannheim, Germany
| | - Stefan O Schoenberg
- Institute of Clinical Radiology and Nuclear Medicine, Universitätsmedizin Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1 - 3, 68167 Mannheim, Germany
| | - Achim Gass
- Department of Neurology, Universitätsmedizin Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1 - 3, 68167 Mannheim, Germany
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32
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Eisele P, Konstandin S, Szabo K, Ebert A, Roßmanith C, Paschke N, Kerschensteiner M, Platten M, Schoenberg SO, Schad LR, Gass A. Temporal evolution of acute multiple sclerosis lesions on serial sodium (23Na) MRI. Mult Scler Relat Disord 2019; 29:48-54. [DOI: 10.1016/j.msard.2019.01.027] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 01/11/2019] [Accepted: 01/16/2019] [Indexed: 10/27/2022]
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Zacharzewska-Gondek A, Pokryszko-Dragan A, Gondek TM, Kołtowska A, Gruszka E, Budrewicz S, Sąsiadek M, Bladowska J. Apparent diffusion coefficient measurements in normal appearing white matter may support the differential diagnosis between multiple sclerosis lesions and other white matter hyperintensities. J Neurol Sci 2019; 397:24-30. [DOI: 10.1016/j.jns.2018.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 11/30/2018] [Accepted: 12/13/2018] [Indexed: 10/27/2022]
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Toschi N, De Santis S, Granberg T, Ouellette R, Treaba CA, Herranz E, Mainero C. Evidence for Progressive Microstructural Damage in Early Multiple Sclerosis by Multi-Shell Diffusion Magnetic Resonance Imaging. Neuroscience 2019; 403:27-34. [PMID: 30708049 DOI: 10.1016/j.neuroscience.2019.01.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Revised: 01/12/2019] [Accepted: 01/14/2019] [Indexed: 12/21/2022]
Abstract
In multiple sclerosis (MS), it would be of clinical value to be able to track the progression of axonal pathology, especially before the manifestation of clinical disability. However, non-invasive evaluation of short-term longitudinal progression of white matter integrity is challenging. This study aims at assessing longitudinal changes in the restricted (i.e. intracellular) diffusion signal fraction (FR) in early-stage MS by using ultra-high gradient strength multi-shell diffusion magnetic resonance imaging. In 11 early MS subjects (disease duration ≤5 years), FR was obtained at two timepoints (one year apart) through the Composite Hindered and Restricted Model of Diffusion, along with conventional Diffusion Tensor Imaging metrics. At follow-up, no statistically significant change was detected in clinical variables, while all imaging metrics showed statistically significant longitudinal changes (p < 0.01, corrected for multiple comparisons) in widespread regions in normal-appearing white matter (NAWM). The most extensive longitudinal changes were observed in FR, including areas known to include a large fraction of crossing fibers. Furthermore, FR was also the only metric showing significant longitudinal changes in lesions that were present at both time points (p = 0.007), with no significant differences found for conventional diffusion metrics. Finally, FR was the only diffusion metric (as compared to Diffusion Tensor Imaging) that revealed pre-lesional changes already present at baseline. Taken together, our data provide evidence for progressive microstructural damage in the NAWM of early MS cases detectable already at 1-year follow-up. Our study highlights the value of multi-shell diffusion imaging for sensitive tracking of disease evolution in MS before any clinical changes are observed. This article is part of a Special Issue entitled: SI: MRI and Neuroinflammation.
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Affiliation(s)
- Nicola Toschi
- Athinoula A. Martinos Center for Biomedical Imaging and Harvard Medical School, Boston, MA, USA; Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.
| | - Silvia De Santis
- Instituto de Neurociencias de Alicante (CSIC-UMH), San Juan de Alicante, Spain; Cardiff University Brain Research Imaging Centre (CUBRIC), Cardiff University, Cardiff, UK
| | - Tobias Granberg
- Athinoula A. Martinos Center for Biomedical Imaging and Harvard Medical School, Boston, MA, USA; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Radiology, Karolinska University Hospital, Stockholm, Sweden
| | - Russell Ouellette
- Athinoula A. Martinos Center for Biomedical Imaging and Harvard Medical School, Boston, MA, USA; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Constantina A Treaba
- Athinoula A. Martinos Center for Biomedical Imaging and Harvard Medical School, Boston, MA, USA
| | - Elena Herranz
- Athinoula A. Martinos Center for Biomedical Imaging and Harvard Medical School, Boston, MA, USA
| | - Caterina Mainero
- Athinoula A. Martinos Center for Biomedical Imaging and Harvard Medical School, Boston, MA, USA
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Choi JY, Jeong IH, Oh S, Oh C, Park NY, Kim HJ, Lee J. Evaluation of Normal‐Appearing White Matter in Multiple Sclerosis Using Direct Visualization of Short Transverse Relaxation Time Component (ViSTa) Myelin Water Imaging and Gradient Echo and Spin Echo (GRASE) Myelin Water Imaging. J Magn Reson Imaging 2018; 49:1091-1098. [DOI: 10.1002/jmri.26278] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 07/13/2018] [Indexed: 11/09/2022] Open
Affiliation(s)
- Joon Yul Choi
- Laboratory for Imaging Science and Technology, Department of Electrical and Computer EngineeringSeoul National University Seoul Republic of Korea
| | - In Hye Jeong
- Department of NeurologyResearch Institute and Hospital of National Cancer Center Gyeonggi‐do Republic of Korea
| | - Se‐Hong Oh
- Department of Biomedical EngineeringHankuk University of Foreign Studies Gyeonggi‐do Republic of Korea
| | - Chang‐Hyun Oh
- Department of Electronics and Information EngineeringKorea University Sejong Republic of Korea
| | - Na Young Park
- Department of NeurologyResearch Institute and Hospital of National Cancer Center Gyeonggi‐do Republic of Korea
| | - Ho Jin Kim
- Department of NeurologyResearch Institute and Hospital of National Cancer Center Gyeonggi‐do Republic of Korea
| | - Jongho Lee
- Laboratory for Imaging Science and Technology, Department of Electrical and Computer EngineeringSeoul National University Seoul Republic of Korea
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Diffusion tensor imaging findings in the multiple sclerosis patients and their relationships to various aspects of disability. J Neurol Sci 2018; 391:127-133. [DOI: 10.1016/j.jns.2018.06.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 05/22/2018] [Accepted: 06/12/2018] [Indexed: 11/19/2022]
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Abstract
Since its technical development in the early 1980s, magnetic resonance imaging (MRI) has quickly been adopted as an essential tool in supporting the diagnosis, longitudinal monitoring, evaluation of therapeutic response, and scientific investigations in multiple sclerosis (MS). The clinical usage of MRI has increased in parallel with technical innovations in the technique itself; the widespread adoption of clinically routine MRI at 1.5T has allowed sensitive qualitative and quantitative assessments of macroscopic central nervous system (CNS) inflammatory demyelinating lesions and tissue atrophy. However, conventional MRI lesion measures lack specificity for the underlying MS pathology and only weakly correlate with clinical status. Higher field strength units and newer, advanced MRI techniques offer increased sensitivity and specificity in the detection of disease activity and disease severity. This review summarizes the current status and future prospects regarding the role of MRI in the characterization of MS-related brain and spinal cord involvement.
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Affiliation(s)
- Christopher C Hemond
- Laboratory for Neuroimaging Research, Partners Multiple Sclerosis Center, Ann Romney Center for Neurologic Diseases, Departments of Neurology and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115
| | - Rohit Bakshi
- Laboratory for Neuroimaging Research, Partners Multiple Sclerosis Center, Ann Romney Center for Neurologic Diseases, Departments of Neurology and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115
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Rissanen E, Tuisku J, Vahlberg T, Sucksdorff M, Paavilainen T, Parkkola R, Rokka J, Gerhard A, Hinz R, Talbot PS, Rinne JO, Airas L. Microglial activation, white matter tract damage, and disability in MS. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2018. [PMID: 29520366 PMCID: PMC5840890 DOI: 10.1212/nxi.0000000000000443] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Objective To investigate the relationship of in vivo microglial activation to clinical and MRI parameters in MS. Methods Patients with secondary progressive MS (n = 10) or relapsing-remitting MS (n = 10) and age-matched healthy controls (n = 17) were studied. Microglial activation was measured using PET and radioligand [11C](R)-PK11195. Clinical assessment and structural and quantitative MRI including diffusion tensor imaging (DTI) were performed for comparison. Results [11C](R)-PK11195 binding was significantly higher in the normal-appearing white matter (NAWM) of patients with secondary progressive vs relapsing MS and healthy controls, in the thalami of patients with secondary progressive MS vs controls, and in the perilesional area among the progressive compared with relapsing patients. Higher binding in the NAWM was associated with higher clinical disability and reduced white matter (WM) structural integrity, as shown by lower fractional anisotropy, higher mean diffusivity, and increased WM lesion load. Increasing age contributed to higher microglial activation in the NAWM among patients with MS but not in healthy controls. Conclusions PET can be used to quantitate microglial activation, which associates with MS progression. This study demonstrates that increased microglial activity in the NAWM correlates closely with impaired WM structural integrity and thus offers one rational pathologic correlate to diffusion tensor imaging (DTI) parameters.
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Affiliation(s)
- Eero Rissanen
- Turku PET Centre (E.R., J.T., M.S., J.R., J.O.R.), Division of Clinical Neurosciences (E.R., M.S., J.O.R., L.A.), Department of Biostatistics (T.V.), and Medical Imaging Centre of Southwest Finland (T.P., R.P.), Turku University Hospital and University of Turku, Finland; Division of Neuroscience and Experimental Psychology (A.G.), University of Manchester, United Kingdom; Department of Nuclear Medicine and Geriatric Medicine (A.G.), University Hospital Essen, Germany; and Wolfson Molecular Imaging Centre (R.H., P.S.T.), University of Manchester, United Kingdom
| | - Jouni Tuisku
- Turku PET Centre (E.R., J.T., M.S., J.R., J.O.R.), Division of Clinical Neurosciences (E.R., M.S., J.O.R., L.A.), Department of Biostatistics (T.V.), and Medical Imaging Centre of Southwest Finland (T.P., R.P.), Turku University Hospital and University of Turku, Finland; Division of Neuroscience and Experimental Psychology (A.G.), University of Manchester, United Kingdom; Department of Nuclear Medicine and Geriatric Medicine (A.G.), University Hospital Essen, Germany; and Wolfson Molecular Imaging Centre (R.H., P.S.T.), University of Manchester, United Kingdom
| | - Tero Vahlberg
- Turku PET Centre (E.R., J.T., M.S., J.R., J.O.R.), Division of Clinical Neurosciences (E.R., M.S., J.O.R., L.A.), Department of Biostatistics (T.V.), and Medical Imaging Centre of Southwest Finland (T.P., R.P.), Turku University Hospital and University of Turku, Finland; Division of Neuroscience and Experimental Psychology (A.G.), University of Manchester, United Kingdom; Department of Nuclear Medicine and Geriatric Medicine (A.G.), University Hospital Essen, Germany; and Wolfson Molecular Imaging Centre (R.H., P.S.T.), University of Manchester, United Kingdom
| | - Marcus Sucksdorff
- Turku PET Centre (E.R., J.T., M.S., J.R., J.O.R.), Division of Clinical Neurosciences (E.R., M.S., J.O.R., L.A.), Department of Biostatistics (T.V.), and Medical Imaging Centre of Southwest Finland (T.P., R.P.), Turku University Hospital and University of Turku, Finland; Division of Neuroscience and Experimental Psychology (A.G.), University of Manchester, United Kingdom; Department of Nuclear Medicine and Geriatric Medicine (A.G.), University Hospital Essen, Germany; and Wolfson Molecular Imaging Centre (R.H., P.S.T.), University of Manchester, United Kingdom
| | - Teemu Paavilainen
- Turku PET Centre (E.R., J.T., M.S., J.R., J.O.R.), Division of Clinical Neurosciences (E.R., M.S., J.O.R., L.A.), Department of Biostatistics (T.V.), and Medical Imaging Centre of Southwest Finland (T.P., R.P.), Turku University Hospital and University of Turku, Finland; Division of Neuroscience and Experimental Psychology (A.G.), University of Manchester, United Kingdom; Department of Nuclear Medicine and Geriatric Medicine (A.G.), University Hospital Essen, Germany; and Wolfson Molecular Imaging Centre (R.H., P.S.T.), University of Manchester, United Kingdom
| | - Riitta Parkkola
- Turku PET Centre (E.R., J.T., M.S., J.R., J.O.R.), Division of Clinical Neurosciences (E.R., M.S., J.O.R., L.A.), Department of Biostatistics (T.V.), and Medical Imaging Centre of Southwest Finland (T.P., R.P.), Turku University Hospital and University of Turku, Finland; Division of Neuroscience and Experimental Psychology (A.G.), University of Manchester, United Kingdom; Department of Nuclear Medicine and Geriatric Medicine (A.G.), University Hospital Essen, Germany; and Wolfson Molecular Imaging Centre (R.H., P.S.T.), University of Manchester, United Kingdom
| | - Johanna Rokka
- Turku PET Centre (E.R., J.T., M.S., J.R., J.O.R.), Division of Clinical Neurosciences (E.R., M.S., J.O.R., L.A.), Department of Biostatistics (T.V.), and Medical Imaging Centre of Southwest Finland (T.P., R.P.), Turku University Hospital and University of Turku, Finland; Division of Neuroscience and Experimental Psychology (A.G.), University of Manchester, United Kingdom; Department of Nuclear Medicine and Geriatric Medicine (A.G.), University Hospital Essen, Germany; and Wolfson Molecular Imaging Centre (R.H., P.S.T.), University of Manchester, United Kingdom
| | - Alexander Gerhard
- Turku PET Centre (E.R., J.T., M.S., J.R., J.O.R.), Division of Clinical Neurosciences (E.R., M.S., J.O.R., L.A.), Department of Biostatistics (T.V.), and Medical Imaging Centre of Southwest Finland (T.P., R.P.), Turku University Hospital and University of Turku, Finland; Division of Neuroscience and Experimental Psychology (A.G.), University of Manchester, United Kingdom; Department of Nuclear Medicine and Geriatric Medicine (A.G.), University Hospital Essen, Germany; and Wolfson Molecular Imaging Centre (R.H., P.S.T.), University of Manchester, United Kingdom
| | - Rainer Hinz
- Turku PET Centre (E.R., J.T., M.S., J.R., J.O.R.), Division of Clinical Neurosciences (E.R., M.S., J.O.R., L.A.), Department of Biostatistics (T.V.), and Medical Imaging Centre of Southwest Finland (T.P., R.P.), Turku University Hospital and University of Turku, Finland; Division of Neuroscience and Experimental Psychology (A.G.), University of Manchester, United Kingdom; Department of Nuclear Medicine and Geriatric Medicine (A.G.), University Hospital Essen, Germany; and Wolfson Molecular Imaging Centre (R.H., P.S.T.), University of Manchester, United Kingdom
| | - Peter S Talbot
- Turku PET Centre (E.R., J.T., M.S., J.R., J.O.R.), Division of Clinical Neurosciences (E.R., M.S., J.O.R., L.A.), Department of Biostatistics (T.V.), and Medical Imaging Centre of Southwest Finland (T.P., R.P.), Turku University Hospital and University of Turku, Finland; Division of Neuroscience and Experimental Psychology (A.G.), University of Manchester, United Kingdom; Department of Nuclear Medicine and Geriatric Medicine (A.G.), University Hospital Essen, Germany; and Wolfson Molecular Imaging Centre (R.H., P.S.T.), University of Manchester, United Kingdom
| | - Juha O Rinne
- Turku PET Centre (E.R., J.T., M.S., J.R., J.O.R.), Division of Clinical Neurosciences (E.R., M.S., J.O.R., L.A.), Department of Biostatistics (T.V.), and Medical Imaging Centre of Southwest Finland (T.P., R.P.), Turku University Hospital and University of Turku, Finland; Division of Neuroscience and Experimental Psychology (A.G.), University of Manchester, United Kingdom; Department of Nuclear Medicine and Geriatric Medicine (A.G.), University Hospital Essen, Germany; and Wolfson Molecular Imaging Centre (R.H., P.S.T.), University of Manchester, United Kingdom
| | - Laura Airas
- Turku PET Centre (E.R., J.T., M.S., J.R., J.O.R.), Division of Clinical Neurosciences (E.R., M.S., J.O.R., L.A.), Department of Biostatistics (T.V.), and Medical Imaging Centre of Southwest Finland (T.P., R.P.), Turku University Hospital and University of Turku, Finland; Division of Neuroscience and Experimental Psychology (A.G.), University of Manchester, United Kingdom; Department of Nuclear Medicine and Geriatric Medicine (A.G.), University Hospital Essen, Germany; and Wolfson Molecular Imaging Centre (R.H., P.S.T.), University of Manchester, United Kingdom
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Harada K, Ikuta T, Nakashima M, Watanuki T, Hirotsu M, Matsubara T, Yamagata H, Watanabe Y, Matsuo K. Altered Connectivity of the Anterior Cingulate and the Posterior Superior Temporal Gyrus in a Longitudinal Study of Later-life Depression. Front Aging Neurosci 2018; 10:31. [PMID: 29472854 PMCID: PMC5809471 DOI: 10.3389/fnagi.2018.00031] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 01/26/2018] [Indexed: 12/12/2022] Open
Abstract
Patients with later-life depression (LLD) show abnormal gray matter (GM) volume, white matter (WM) integrity and functional connectivity in the anterior cingulate cortex (ACC) and posterior superior temporal gyrus (pSTG), but it remains unclear whether these abnormalities persist over time. We examined whether structural and functional abnormalities in these two regions are present within the same subjects during depressed vs. remitted phases. Sixteen patients with LLD and 30 healthy subjects were studied over a period of 1.5 years. Brain images obtained with a 3-Tesla magnetic resonance imaging (MRI) system were analyzed by voxel-based morphometry of the GM volume, and diffusion tensor imaging (DTI) and resting-state functional MRI were used to assess ACC–pSTG connectivity. Patients with LLD in the depressed and remitted phases showed significantly smaller GM volume in the left ACC and left pSTG than healthy subjects. Both patients with LLD in the depressed and remitted phases had significantly higher diffusivities in the WM tract of the left ACC–pSTG than healthy subjects. Remitted patients with LLD showed lower functional ACC–pSTG connectivity compared to healthy subjects. No difference was found in the two regions between depressed and remitted patients in GM volume, structural or functional connectivity. Functional ACC–pSTG connectivity was positively correlated with lower global function during remission. Our preliminary data show that structural and functional abnormalities of the ACC and pSTG occur during LLD remission. Our findings tentatively reveal the brain pathophysiology involved in LLD and may aid in developing neuroanatomical biomarkers for this condition.
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Affiliation(s)
- Kenichiro Harada
- Division of Neuropsychiatry, Department of Neuroscience, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Toshikazu Ikuta
- Department of Communication Sciences and Disorders, School of Applied Sciences, University of Mississippi, Jackson, MS, United States
| | - Mami Nakashima
- Division of Neuropsychiatry, Department of Neuroscience, Yamaguchi University Graduate School of Medicine, Ube, Japan.,Nagato-Ichinomiya Hospital, Shimonoseki, Japan
| | - Toshio Watanuki
- Division of Neuropsychiatry, Department of Neuroscience, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Masako Hirotsu
- Division of Neuropsychiatry, Department of Neuroscience, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Toshio Matsubara
- Division of Neuropsychiatry, Department of Neuroscience, Yamaguchi University Graduate School of Medicine, Ube, Japan.,Health Administration Center, Yamaguchi University Organization for University Education, Yamaguchi, Japan
| | - Hirotaka Yamagata
- Division of Neuropsychiatry, Department of Neuroscience, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Yoshifumi Watanabe
- Division of Neuropsychiatry, Department of Neuroscience, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Koji Matsuo
- Division of Neuropsychiatry, Department of Neuroscience, Yamaguchi University Graduate School of Medicine, Ube, Japan
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40
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Berghoff SA, Düking T, Spieth L, Winchenbach J, Stumpf SK, Gerndt N, Kusch K, Ruhwedel T, Möbius W, Saher G. Blood-brain barrier hyperpermeability precedes demyelination in the cuprizone model. Acta Neuropathol Commun 2017; 5:94. [PMID: 29195512 PMCID: PMC5710130 DOI: 10.1186/s40478-017-0497-6] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 11/17/2017] [Indexed: 11/10/2022] Open
Abstract
In neuroinflammatory disorders such as multiple sclerosis, the physiological function of the blood-brain barrier (BBB) is perturbed, particularly in demyelinating lesions and supposedly secondary to acute demyelinating pathology. Using the toxic non-inflammatory cuprizone model of demyelination, we demonstrate, however, that the onset of persistent BBB impairment precedes demyelination. In addition to a direct effect of cuprizone on endothelial cells, a plethora of inflammatory mediators, which are mainly of astroglial origin during the initial disease phase, likely contribute to the destabilization of endothelial barrier function in vivo. Our study reveals that, at different time points of pathology and in different CNS regions, the level of gliosis correlates with the extent of BBB hyperpermeability and edema. Furthermore, in mutant mice with abolished type 3 CXC chemokine receptor (CXCR3) signaling, inflammatory responses are dampened and BBB dysfunction ameliorated. Together, these data have implications for understanding the role of BBB permeability in the pathogenesis of demyelinating disease.
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41
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Pawlitzki M, Neumann J, Kaufmann J, Heidel J, Stadler E, Sweeney-Reed C, Sailer M, Schreiber S. Loss of corticospinal tract integrity in early MS disease stages. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2017; 4:e399. [PMID: 28959706 PMCID: PMC5614727 DOI: 10.1212/nxi.0000000000000399] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Accepted: 08/08/2017] [Indexed: 11/17/2022]
Abstract
Objective: We investigated corticospinal tract (CST) integrity in the absence of white matter (WM) lesions using diffusion tensor imaging (DTI) in early MS disease stages. Methods: Our study comprised 19 patients with clinically isolated syndrome (CIS), 11 patients with relapsing-remitting MS (RRMS), and 32 age- and sex-matched healthy controls, for whom MRI measures of CST integrity (fractional anisotropy [FA], mean diffusivity [MD]), T1- and T2-based lesion load, and brain volumes were available. The mean (SD) disease duration was 3.5 (2.1) months, and disability score was low (median Expanded Disability Status Scale 1.5) at the time of the study. Results: Patients with CIS and RRMS had significantly lower CST FA and higher CST MD values compared with controls. These findings were present, irrespective of whether WM lesions affected the CST. However, no group differences in the overall gray or WM volume were identified. Conclusions: In early MS disease stages, CST integrity is already affected in the absence of WM lesions or brain atrophy.
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Affiliation(s)
- Marc Pawlitzki
- Department of Neurology (M.P., J.N., J.K., J.H., E.S., C.S.-R., S.S.), Otto von Guericke University; MEDIAN Klinik NRZ Magdeburg (M.S.), Affiliated Institute for Neurorehabilitation of the Otto von Guericke University; and German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association (S.S.), Magdeburg, Germany
| | - Jens Neumann
- Department of Neurology (M.P., J.N., J.K., J.H., E.S., C.S.-R., S.S.), Otto von Guericke University; MEDIAN Klinik NRZ Magdeburg (M.S.), Affiliated Institute for Neurorehabilitation of the Otto von Guericke University; and German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association (S.S.), Magdeburg, Germany
| | - Jörn Kaufmann
- Department of Neurology (M.P., J.N., J.K., J.H., E.S., C.S.-R., S.S.), Otto von Guericke University; MEDIAN Klinik NRZ Magdeburg (M.S.), Affiliated Institute for Neurorehabilitation of the Otto von Guericke University; and German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association (S.S.), Magdeburg, Germany
| | - Jan Heidel
- Department of Neurology (M.P., J.N., J.K., J.H., E.S., C.S.-R., S.S.), Otto von Guericke University; MEDIAN Klinik NRZ Magdeburg (M.S.), Affiliated Institute for Neurorehabilitation of the Otto von Guericke University; and German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association (S.S.), Magdeburg, Germany
| | - Erhard Stadler
- Department of Neurology (M.P., J.N., J.K., J.H., E.S., C.S.-R., S.S.), Otto von Guericke University; MEDIAN Klinik NRZ Magdeburg (M.S.), Affiliated Institute for Neurorehabilitation of the Otto von Guericke University; and German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association (S.S.), Magdeburg, Germany
| | - Catherine Sweeney-Reed
- Department of Neurology (M.P., J.N., J.K., J.H., E.S., C.S.-R., S.S.), Otto von Guericke University; MEDIAN Klinik NRZ Magdeburg (M.S.), Affiliated Institute for Neurorehabilitation of the Otto von Guericke University; and German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association (S.S.), Magdeburg, Germany
| | - Michael Sailer
- Department of Neurology (M.P., J.N., J.K., J.H., E.S., C.S.-R., S.S.), Otto von Guericke University; MEDIAN Klinik NRZ Magdeburg (M.S.), Affiliated Institute for Neurorehabilitation of the Otto von Guericke University; and German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association (S.S.), Magdeburg, Germany
| | - Stefanie Schreiber
- Department of Neurology (M.P., J.N., J.K., J.H., E.S., C.S.-R., S.S.), Otto von Guericke University; MEDIAN Klinik NRZ Magdeburg (M.S.), Affiliated Institute for Neurorehabilitation of the Otto von Guericke University; and German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association (S.S.), Magdeburg, Germany
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42
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Ferizi U, Scherrer B, Schneider T, Alipoor M, Eufracio O, Fick RH, Deriche R, Nilsson M, Loya‐Olivas AK, Rivera M, Poot DH, Ramirez‐Manzanares A, Marroquin JL, Rokem A, Pötter C, Dougherty RF, Sakaie K, Wheeler‐Kingshott C, Warfield SK, Witzel T, Wald LL, Raya JG, Alexander DC. Diffusion MRI microstructure models with in vivo human brain Connectome data: results from a multi-group comparison. NMR IN BIOMEDICINE 2017. [PMID: 28643354 PMCID: PMC5563694 DOI: 10.1002/nbm.3734] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
A large number of mathematical models have been proposed to describe the measured signal in diffusion-weighted (DW) magnetic resonance imaging (MRI). However, model comparison to date focuses only on specific subclasses, e.g. compartment models or signal models, and little or no information is available in the literature on how performance varies among the different types of models. To address this deficiency, we organized the 'White Matter Modeling Challenge' during the International Symposium on Biomedical Imaging (ISBI) 2015 conference. This competition aimed to compare a range of different kinds of models in their ability to explain a large range of measurable in vivo DW human brain data. Specifically, we assessed the ability of models to predict the DW signal accurately for new diffusion gradients and b values. We did not evaluate the accuracy of estimated model parameters, as a ground truth is hard to obtain. We used the Connectome scanner at the Massachusetts General Hospital, using gradient strengths of up to 300 mT/m and a broad set of diffusion times. We focused on assessing the DW signal prediction in two regions: the genu in the corpus callosum, where the fibres are relatively straight and parallel, and the fornix, where the configuration of fibres is more complex. The challenge participants had access to three-quarters of the dataset and their models were ranked on their ability to predict the remaining unseen quarter of the data. The challenge provided a unique opportunity for a quantitative comparison of diverse methods from multiple groups worldwide. The comparison of the challenge entries reveals interesting trends that could potentially influence the next generation of diffusion-based quantitative MRI techniques. The first is that signal models do not necessarily outperform tissue models; in fact, of those tested, tissue models rank highest on average. The second is that assuming a non-Gaussian (rather than purely Gaussian) noise model provides little improvement in prediction of unseen data, although it is possible that this may still have a beneficial effect on estimated parameter values. The third is that preprocessing the training data, here by omitting signal outliers, and using signal-predicting strategies, such as bootstrapping or cross-validation, could benefit the model fitting. The analysis in this study provides a benchmark for other models and the data remain available to build up a more complete comparison in the future.
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Affiliation(s)
- Uran Ferizi
- Centre for Medical Image ComputingDepartment of Computer Science, University College LondonUK
- Department of RadiologyNew York University School of MedicineUSA
- Department of Neuroinflammation, Institute of NeurologyUniversity College LondonUK
| | - Benoit Scherrer
- Computational Radiology Laboratory, Boston Children's Hosp.Harvard UniversityUSA
| | - Torben Schneider
- Department of Neuroinflammation, Institute of NeurologyUniversity College LondonUK
- Philips HealthcareGuildfordSurreyUK
| | | | - Odin Eufracio
- Centro de Investigacion en Matematicas ACGuanajuatoMexico
| | | | - Rachid Deriche
- Athena Project‐TeamINRIA Sophia Antipolis ‐ MéditerranéeFrance
| | | | | | - Mariano Rivera
- Centro de Investigacion en Matematicas ACGuanajuatoMexico
| | - Dirk H.J. Poot
- Erasmus Medical Center and Delft University of Technologythe Netherlands
| | | | | | - Ariel Rokem
- eScience InstituteUniversity of WashingtonUSA
- Center for Cognitive and Neurobiological ImagingStanford UniversityUSA
| | - Christian Pötter
- Center for Cognitive and Neurobiological ImagingStanford UniversityUSA
| | | | - Ken Sakaie
- Imaging InstituteThe Cleveland ClinicClevelandUSA
| | | | - Simon K. Warfield
- Computational Radiology Laboratory, Boston Children's Hosp.Harvard UniversityUSA
| | - Thomas Witzel
- A.A. Martinos Center for Biomedical Imaging, MGHHarvard UniversityUSA
| | - Lawrence L. Wald
- A.A. Martinos Center for Biomedical Imaging, MGHHarvard UniversityUSA
| | - José G. Raya
- Department of RadiologyNew York University School of MedicineUSA
| | - Daniel C. Alexander
- Centre for Medical Image ComputingDepartment of Computer Science, University College LondonUK
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McNamara C, Sugrue G, Murray B, MacMahon PJ. Current and Emerging Therapies in Multiple Sclerosis: Implications for the Radiologist, Part 2-Surveillance for Treatment Complications and Disease Progression. AJNR Am J Neuroradiol 2017; 38:1672-1680. [PMID: 28428206 DOI: 10.3174/ajnr.a5148] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
An understanding of the new generation of MS drugs in conjunction with the key role MR imaging plays in the detection of disease progression, opportunistic infections, and drug-related adverse effects is of vital importance to the neuroradiologist. Part 1 of this review outlined the current treatment options available for MS and examined the mechanisms of action of the various medications. It also covered specific complications associated with each form of therapy. Part 2, in turn deals with the subject of pharmacovigilance and the optimal frequency of MRI monitoring for each individual patient, depending on his or her unique risk profile. Special attention is given to the diagnosing of progressive multifocal leukoencephalopathy in patients treated with natalizumab as this is a key area in which neuroradiologists can contribute to improved patient outcomes. This article also outlines the aims of treatment and reviews the possibility of "no evidence of disease activity" becoming a treatment goal with the availability of more effective therapies. Potential future areas and technologies including image subtraction, brain volume measurement and advanced imaging techniques such as double inversion recovery are also reviewed. It is anticipated that such advancements in this rapidly developing field will improve the accuracy of monitoring an individual patient's response to treatment.
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Affiliation(s)
- C McNamara
- From the Departments of Radiology (C.M., G.S., P.J.M.)
| | - G Sugrue
- From the Departments of Radiology (C.M., G.S., P.J.M.)
| | - B Murray
- Neurology (B.M.), Mater Misericordiae University Hospital, Dublin, Ireland
| | - P J MacMahon
- From the Departments of Radiology (C.M., G.S., P.J.M.)
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44
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Luo J, Shen Z, Chen G, Wang D, Yu X. Pontine Changes in Metabolites and Axonal Fibres of Rats Following Four-week Alcohol Exposure: In Vivo Diffusion Tensor Imaging and 1h-magnetic Resonance Spectroscopy Study at 7.0 T. Alcohol Alcohol 2017; 52:145-150. [PMID: 28182205 DOI: 10.1093/alcalc/agw087] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 11/14/2016] [Indexed: 02/05/2023] Open
Affiliation(s)
- Jianming Luo
- Department of Neurosurgery, The Second Affiliated Hospital, Shantou University Medical College, Shantou City, Guangdong Prov., China
| | - Zhiwei Shen
- Department of Radiology, The Second Affiliated Hospital, Shantou University Medical College, Shantou City, Guangdong Prov. , China
| | - Guang Chen
- Department of Basic Medical Sciences, Southern Medical University, Guangzhou City, Guangdong Prov. , China
| | - Dian Wang
- Department of Forensic Medicine, Shantou University Medical College, Shantou City, Guangdong Prov. , China
| | - Xiaojun Yu
- Department of Forensic Medicine, Shantou University Medical College, Shantou City, Guangdong Prov. , China
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45
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Berghoff SA, Gerndt N, Winchenbach J, Stumpf SK, Hosang L, Odoardi F, Ruhwedel T, Böhler C, Barrette B, Stassart R, Liebetanz D, Dibaj P, Möbius W, Edgar JM, Saher G. Dietary cholesterol promotes repair of demyelinated lesions in the adult brain. Nat Commun 2017; 8:14241. [PMID: 28117328 PMCID: PMC5286209 DOI: 10.1038/ncomms14241] [Citation(s) in RCA: 91] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 12/12/2016] [Indexed: 12/15/2022] Open
Abstract
Multiple Sclerosis (MS) is an inflammatory demyelinating disorder in which remyelination failure contributes to persistent disability. Cholesterol is rate-limiting for myelin biogenesis in the developing CNS; however, whether cholesterol insufficiency contributes to remyelination failure in MS, is unclear. Here, we show the relationship between cholesterol, myelination and neurological parameters in mouse models of demyelination and remyelination. In the cuprizone model, acute disease reduces serum cholesterol levels that can be restored by dietary cholesterol. Concomitant with blood-brain barrier impairment, supplemented cholesterol directly supports oligodendrocyte precursor proliferation and differentiation, and restores the balance of growth factors, creating a permissive environment for repair. This leads to attenuated axon damage, enhanced remyelination and improved motor learning. Remarkably, in experimental autoimmune encephalomyelitis, cholesterol supplementation does not exacerbate disease expression. These findings emphasize the safety of dietary cholesterol in inflammatory diseases and point to a previously unrecognized role of cholesterol in promoting repair after demyelinating episodes. Cholesterol is important for axonal myelination during development. Here the authors show that cholesterol levels are reduced in a cuprizone mouse model of multiple sclerosis and that dietary cholesterol supplementation enhances remyelination and recovery.
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Affiliation(s)
- Stefan A Berghoff
- Department of Neurogenetics, Max Planck Institute of Experimental Medicine, Hermann-Rein-Str. 3, 37075 Göttingen, Germany
| | - Nina Gerndt
- Department of Neurogenetics, Max Planck Institute of Experimental Medicine, Hermann-Rein-Str. 3, 37075 Göttingen, Germany
| | - Jan Winchenbach
- Department of Neurogenetics, Max Planck Institute of Experimental Medicine, Hermann-Rein-Str. 3, 37075 Göttingen, Germany
| | - Sina K Stumpf
- Department of Neurogenetics, Max Planck Institute of Experimental Medicine, Hermann-Rein-Str. 3, 37075 Göttingen, Germany
| | - Leon Hosang
- Institute of Neuroimmunology and Institute for Multiple Sclerosis Research, University Medical Centre Göttingen, Waldweg 33, 37073 Göttingen, Germany
| | - Francesca Odoardi
- Institute of Neuroimmunology and Institute for Multiple Sclerosis Research, University Medical Centre Göttingen, Waldweg 33, 37073 Göttingen, Germany
| | - Torben Ruhwedel
- Department of Neurogenetics, Max Planck Institute of Experimental Medicine, Hermann-Rein-Str. 3, 37075 Göttingen, Germany
| | - Carolin Böhler
- Department of Neurogenetics, Max Planck Institute of Experimental Medicine, Hermann-Rein-Str. 3, 37075 Göttingen, Germany
| | - Benoit Barrette
- Department of Neurogenetics, Max Planck Institute of Experimental Medicine, Hermann-Rein-Str. 3, 37075 Göttingen, Germany
| | - Ruth Stassart
- Department of Neurogenetics, Max Planck Institute of Experimental Medicine, Hermann-Rein-Str. 3, 37075 Göttingen, Germany.,Department of Neuropathology, University Medical Center, Georg-August-University, Robert Koch Str. 40, 37075 Göttingen, Germany
| | - David Liebetanz
- Department of Clinical Neurophysiology, Georg-August University, Robert Koch Str. 40, 37075 Göttingen, Germany
| | - Payam Dibaj
- Department of Neurogenetics, Max Planck Institute of Experimental Medicine, Hermann-Rein-Str. 3, 37075 Göttingen, Germany
| | - Wiebke Möbius
- Department of Neurogenetics, Max Planck Institute of Experimental Medicine, Hermann-Rein-Str. 3, 37075 Göttingen, Germany.,Center Nanoscale Microscopy and Molecular Physiology of the Brain (CNMPB), Wilhelmsplatz 1, 37073 Göttingen, Germany
| | - Julia M Edgar
- Department of Neurogenetics, Max Planck Institute of Experimental Medicine, Hermann-Rein-Str. 3, 37075 Göttingen, Germany.,Applied Neurobiology Group, Institute of Infection, Immunity and Inflammation, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow G12-8TA, UK
| | - Gesine Saher
- Department of Neurogenetics, Max Planck Institute of Experimental Medicine, Hermann-Rein-Str. 3, 37075 Göttingen, Germany
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Ikram MA, Vernooij MW, Roshchupkin GV, Hofman A, van Duijn CM, Uitterlinden AG, Niessen WJ, Hintzen RQ, Adams HH. Genetic susceptibility to multiple sclerosis: Brain structure and cognitive function in the general population. Mult Scler 2016; 23:1697-1706. [PMID: 28273768 DOI: 10.1177/1352458516682104] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) affects brain structure and cognitive function and has a heritable component. Over a 100 common genetic risk variants have been identified, but most carriers do not develop MS. For other neurodegenerative diseases, risk variants have effects outside patient populations, but this remains uninvestigated for MS. OBJECTIVES To study the effect of MS-associated genetic variants on brain structure and cognitive function in the general population. METHODS We studied middle-aged and elderly individuals (mean age = 65.7 years) from the population-based Rotterdam Study. We determined 107 MS variants and additionally created a risk score combining all variants. Magnetic resonance imaging ( N = 4710) was performed to obtain measures of brain macrostructure, white matter microstructure, and gray matter voxel-based morphometry. A cognitive test battery ( N = 7556) was used to test a variety of cognitive domains. RESULTS The MS risk score was associated with smaller gray matter volume over the whole brain (βstandardized = -0.016; p = 0.044), but region-specific analyses did not survive multiple testing correction. Similarly, no significant associations with brain structure were observed for individual variants. For cognition, rs2283792 was significantly associated with poorer memory (β = -0.064; p = 3.4 × 10-5). CONCLUSION Increased genetic susceptibility to MS may affect brain structure and cognition in persons without disease, pointing to a "hidden burden" of MS.
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Affiliation(s)
- Mohammad Arfan Ikram
- Department of Epidemiology, Erasmus University Medical Center (Erasmus MC), Rotterdam, The Netherlands/Department of Radiology, Erasmus University Medical Center (Erasmus MC), Rotterdam, The Netherlands/Department of Neurology, Erasmus University Medical Center (Erasmus MC), Rotterdam, The Netherlands
| | - Meike W Vernooij
- Department of Epidemiology, Erasmus University Medical Center (Erasmus MC), Rotterdam, The Netherlands/Department of Radiology, Erasmus University Medical Center (Erasmus MC), Rotterdam, The Netherlands
| | - Gennady V Roshchupkin
- Department of Radiology, Erasmus University Medical Center (Erasmus MC), Rotterdam, The Netherlands/Department of Medical Informatics, Erasmus University Medical Center (Erasmus MC), Rotterdam, The Netherlands
| | - Albert Hofman
- Department of Epidemiology, Erasmus University Medical Center (Erasmus MC), Rotterdam, The Netherlands/Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Cornelia M van Duijn
- Department of Epidemiology, Erasmus University Medical Center (Erasmus MC), Rotterdam, The Netherlands
| | - André G Uitterlinden
- Department of Internal Medicine, Erasmus University Medical Center (Erasmus MC), Rotterdam, The Netherlands
| | - Wiro J Niessen
- Department of Radiology, Erasmus University Medical Center (Erasmus MC), Rotterdam, The Netherlands/Department of Neurology, Erasmus University Medical Center (Erasmus MC), Rotterdam, The Netherlands/Faculty of Applied Sciences, Delft University of Technology, Delft, The Netherlands
| | - Rogier Q Hintzen
- Department of Neurology, Erasmus University Medical Center (Erasmus MC), Rotterdam, The Netherlands
| | - Hieab Hh Adams
- Department of Epidemiology, Erasmus University Medical Center (Erasmus MC), Rotterdam, The Netherlands/Department of Radiology, Erasmus University Medical Center (Erasmus MC), Rotterdam, The Netherlands
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Abdoli M, Chakraborty S, MacLean HJ, Freedman MS. The evaluation of MRI diffusion values of active demyelinating lesions in multiple sclerosis. Mult Scler Relat Disord 2016; 10:97-102. [PMID: 27919508 DOI: 10.1016/j.msard.2016.09.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 08/21/2016] [Accepted: 09/24/2016] [Indexed: 01/18/2023]
Abstract
BACKGROUND Gadolinium (Gd) enhancement of lesions is the main radiologic marker for detection of activity in Multiple Sclerosis (MS). This study compares Diffusion weighted imaging (DWI) characteristics and enhancement to determine whether DWI can be used as an alternative to Gd administration. METHODS A retrospective study of 72 patients who had MRI with Gd and DWI. Visual assessment and comparison of the Apparent Diffusion Coefficient (ADC) values on Gd+ lesions, all lesions showing restricted diffusion, 2 Gd- lesions and 1 area of normal-appearing white matter (NAWM) in each MRI were performed. RESULTS DWI values were measured on 275 T2 lesions, 68 Gd+ and 207 Gd- lesions, as well as 104 NAWM. 34 Gd+ lesions showed restricted diffusion. The median ADC-minimum of Gd+ lesions was significantly lower than NAWM and even lower than Gd- lesions. Most DWI restricted lesions were also Gd+(specificity≥94%), however many Gd+ lesions did not show visually detectable restriction in DWI (sensitivity≤34%). The median ADC-minimum of symptomatic lesions was lower than asymptomatic lesions. CONCLUSION While Gd+ lesions have lower ADC-minimum, visual DWI assessment cannot replace Gd administration for identifying active lesions. Gd+ lesions showing restricted diffusion are clinically important as they are more likely associated with neurological symptoms.
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Affiliation(s)
| | - Santanu Chakraborty
- Department of Radiology, University of Ottawa, Department of Medical Imaging, The Ottawa Hospital, Canada.
| | | | - Mark S Freedman
- The Ottawa Hospital Research Institute and the University of Ottawa, Canada.
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B7-H1 shapes T-cell-mediated brain endothelial cell dysfunction and regional encephalitogenicity in spontaneous CNS autoimmunity. Proc Natl Acad Sci U S A 2016; 113:E6182-E6191. [PMID: 27671636 DOI: 10.1073/pnas.1601350113] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Molecular mechanisms that determine lesion localization or phenotype variation in multiple sclerosis are mostly unidentified. Although transmigration of activated encephalitogenic T cells across the blood-brain barrier (BBB) is a crucial step in the disease pathogenesis of CNS autoimmunity, the consequences on brain endothelial barrier integrity upon interaction with such T cells and subsequent lesion formation and distribution are largely unknown. We made use of a transgenic spontaneous mouse model of CNS autoimmunity characterized by inflammatory demyelinating lesions confined to optic nerves and spinal cord (OSE mice). Genetic ablation of a single immune-regulatory molecule in this model [i.e., B7-homolog 1 (B7-H1, PD-L1)] not only significantly increased incidence of spontaneous CNS autoimmunity and aggravated disease course, especially in the later stages of disease, but also importantly resulted in encephalitogenic T-cell infiltration and lesion formation in normally unaffected brain regions, such as the cerebrum and cerebellum. Interestingly, B7-H1 ablation on myelin oligodendrocyte glycoprotein-specific CD4+ T cells, but not on antigen-presenting cells, amplified T-cell effector functions, such as IFN-γ and granzyme B production. Therefore, these T cells were rendered more capable of eliciting cell contact-dependent brain endothelial cell dysfunction and increased barrier permeability in an in vitro model of the BBB. Our findings suggest that a single immune-regulatory molecule on T cells can be ultimately responsible for localized BBB breakdown, and thus substantial changes in lesion topography in the context of CNS autoimmunity.
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Ontaneda D, Sakaie K, Lin J, Wang XF, Lowe MJ, Phillips MD, Fox RJ. Measuring Brain Tissue Integrity during 4 Years Using Diffusion Tensor Imaging. AJNR Am J Neuroradiol 2016; 38:31-38. [PMID: 27659189 DOI: 10.3174/ajnr.a4946] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 07/26/2016] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND PURPOSE DTI is an MR imaging measure of brain tissue integrity. Little is known regarding the long-term longitudinal evolution of lesional and nonlesional tissue DTI parameters in multiple sclerosis and the present study examines DTI evolution over 4 years. MATERIALS AND METHODS Twenty-one patients with multiple sclerosis were imaged for up to 48 months after starting natalizumab therapy. Gadolinium-enhancing lesions at baseline, chronic T2 lesions, and normal-appearing white matter were followed longitudinally. T2 lesions were subclassified as black holes and non-black holes. Within each ROI, the average values of DTI metrics were derived by using Analysis of Functional Neuro Images software. The longitudinal trend in DTI metrics was estimated by using a mixed-model regression analysis. RESULTS A significant increase was observed for axial diffusivity (P < .001) in gadolinium-enhancing lesions and chronic T2 lesions during 4 years. No significant change in radial diffusivity either in normal-appearing white matter or lesional tissue was observed. The evolution of axial diffusivity was different in gadolinium-enhancing lesions (P < .001) and chronic T2 lesions (P = .02) compared with normal-appearing white matter. CONCLUSIONS An increase in axial diffusion in both gadolinium-enhancing lesions and T2 lesions may relate to the complex evolution of chronically demyelinated brain tissue. Pathologic changes in normal-appearing white matter are likely more subtle than in lesional tissue and may explain the stability of these measures with DTI.
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Affiliation(s)
- D Ontaneda
- From the Department of Neurology (D.O., R.J.F.), Neurological Institute, Mellen Center for Multiple Sclerosis Treatment and Research
| | - K Sakaie
- Imaging Institute (K.S., J.L., M.J.L., M.D.P.)
| | - J Lin
- Imaging Institute (K.S., J.L., M.J.L., M.D.P.)
| | - X-F Wang
- Department of Quantitative Health Sciences (X.-F.W.), Cleveland Clinic Foundation, Cleveland, Ohio
| | - M J Lowe
- Imaging Institute (K.S., J.L., M.J.L., M.D.P.)
| | | | - R J Fox
- From the Department of Neurology (D.O., R.J.F.), Neurological Institute, Mellen Center for Multiple Sclerosis Treatment and Research
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Cassol E, Ranjeva JP, Ibarrola D, Mékies C, Manelfe C, Clanet M, Berry I. Diffusion tensor imaging in multiple sclerosis: a tool for monitoring changes in normal-appearing white matter. Mult Scler 2016; 10:188-96. [PMID: 15124766 DOI: 10.1191/1352458504ms997oa] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Our objectives were to determine the reproducibility of diffusion tensor imaging (DTI) in volunteers and to evaluate the ability of the method to monitor longitudinal changes occurring in the normal-appearing white matter (NAWM) of patients with multiple sclerosis (MS). DTI was performed three-mo nthly for one year in seven MS patients: three relapsing-remitting (RRMS), three secondary progressive (SPMS) and one relapsing SP. They were selected with a limited cerebral lesion load. Seven age- and sex-matched controls also underwent monthly examinations for three months. Diffusivity and anisotropy were quantified over the segmented whole supratentorial white matter, with the indices of trace (Tr) and fractional anisotropy (FA). Results obtained in volunteers show the reproducibility of the method. Patients had higher trace and lower anisotropy than matched controls (P B-0.0001). O ver the follow-up, both Tr and FA indicated a recovery after the acute phase in RRMS and a progressive shift towards abnormal values in SPMS. A lthough this result is not statistically significant, it suggests that DTI is sensitive to microscopic changes occurring in tissue of normal appearance in conventional images and could be useful for monitoring the course of the disease, even though it was unable to clearly distinguish between the various physiopathological processes involved.
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Affiliation(s)
- Emmanuelle Cassol
- Department of Biophysics and Multimodality Imaging, University Paul Sabatier, Toulouse-Rangueil, France
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