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Vlahovic L, McDonald J, Hinman J, Tomczak A, Lock C, Palmer CA, Cook LJ, Yeaman MR, Burnett MK, Deutsch GK, Nelson LM, Han MH. Prevalence, Demographic, and Clinical Factors Associated With Cognitive Dysfunction in Patients With Neuromyelitis Optica Spectrum Disorder. Neurology 2024; 102:e207965. [PMID: 38165361 PMCID: PMC10834131 DOI: 10.1212/wnl.0000000000207965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 09/11/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Neuromyelitis optica spectrum disorder (NMOSD) is a chronic CNS demyelinating autoimmune disorder targeting the astrocyte antigen aquaporin-4 (AQP4), typically presenting with optic neuritis, transverse myelitis, and brain syndromes. Cognitive dysfunction (CD) in NMOSD is under-recognized and poorly understood. The purpose of this study was to evaluate the prevalence and clinical variables associated with CD in NMOSD. METHODS This observational retrospective study with longitudinal follow-up describes a clinical cohort seen in the Collaborative International Research in Clinical and Longitudinal Experience Study in NMOSD. Serial Montreal Cognitive Assessments (MoCAs) were performed upon enrollment and at 6-month intervals to evaluate longitudinal cognitive function relative to demographic and disease-related factors. We used 2-tailed t test, analysis of variance, the χ2 test, linear regression for univariable and adjusted analyses and simultaneous linear regression and mixed-effects model for multivariable analyses. RESULTS Thirty-four percent (75/219) of patients met criteria for CD (MoCA <26); 29% (64/219) showed mild dysfunction (MoCA 20-26/30), and 5% (11/219) showed moderate (MoCA <20/30) dysfunction. Patients with less neurologic disability and lower pain scores had higher MoCA scores (95% CI 0.24-0.65 and 95% CI 0.09-0.42, respectively). Patients with at least high school education scored higher on the MoCA (95% CI 2.2-5). When comparing patients dichotomized for CD, patients never on rituximab scored higher than patients only treated with rituximab (p < 0.029). There was no significant association between annualized relapse rate, age, sex, disease duration, AQP4 serostatus or brain lesions, and CD. CD was more pronounced among Black than White patients (95% CI -2.7 to -0.7). Multivariable analysis of serial MoCA did not indicate change (p = 0.715). Descriptive analysis of serial MoCA showed 30% (45/150) of patients with worsening MoCA performance had impaired language and verbal recall. DISCUSSION To our knowledge, this is the largest study of diverse cohort to investigate CD in patients with NMOSD. Our findings demonstrate 34% of patients with NMOSD experience mild-to-moderate CD, while 30% of patients demonstrated decline on serial testing. The substantial prevalence of CD in this pilot report highlights the need for improved and validated screening tools and comprehensive measures to investigate CD in NMOSD.
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Affiliation(s)
- Luka Vlahovic
- From the Providence Multiple Sclerosis Center (L.V.), Providence Brain and Spine Institute, Portland, OR; Departments of Neurology and Neurological Sciences (J.M., A.T., C.L., G.D., M.H.H.), and Epidemiology and Population Health (J.H., L.M.N.), Stanford University School of Medicine; Sparta Science (J.H.), Menlo Park, CA; Department of Pediatrics (C.P., L.J.C.), Data Coordinating Center, University of Utah School of Medicine, Salt Lake City; Department of Medicine (M.R.Y.), Geffen School of Medicine, University of California, Los Angeles; Division of Molecular Medicine (M.R.Y.), and The Lundquist Institute for Infection & Immunity, Harbor-UCLA Medical Center (M.R.Y.), Torrance, CA; and Department of Neurology (M.B.), Creighton University School of Medicine, Omaha, NE
| | - Jamie McDonald
- From the Providence Multiple Sclerosis Center (L.V.), Providence Brain and Spine Institute, Portland, OR; Departments of Neurology and Neurological Sciences (J.M., A.T., C.L., G.D., M.H.H.), and Epidemiology and Population Health (J.H., L.M.N.), Stanford University School of Medicine; Sparta Science (J.H.), Menlo Park, CA; Department of Pediatrics (C.P., L.J.C.), Data Coordinating Center, University of Utah School of Medicine, Salt Lake City; Department of Medicine (M.R.Y.), Geffen School of Medicine, University of California, Los Angeles; Division of Molecular Medicine (M.R.Y.), and The Lundquist Institute for Infection & Immunity, Harbor-UCLA Medical Center (M.R.Y.), Torrance, CA; and Department of Neurology (M.B.), Creighton University School of Medicine, Omaha, NE
| | - Jessica Hinman
- From the Providence Multiple Sclerosis Center (L.V.), Providence Brain and Spine Institute, Portland, OR; Departments of Neurology and Neurological Sciences (J.M., A.T., C.L., G.D., M.H.H.), and Epidemiology and Population Health (J.H., L.M.N.), Stanford University School of Medicine; Sparta Science (J.H.), Menlo Park, CA; Department of Pediatrics (C.P., L.J.C.), Data Coordinating Center, University of Utah School of Medicine, Salt Lake City; Department of Medicine (M.R.Y.), Geffen School of Medicine, University of California, Los Angeles; Division of Molecular Medicine (M.R.Y.), and The Lundquist Institute for Infection & Immunity, Harbor-UCLA Medical Center (M.R.Y.), Torrance, CA; and Department of Neurology (M.B.), Creighton University School of Medicine, Omaha, NE
| | - Anna Tomczak
- From the Providence Multiple Sclerosis Center (L.V.), Providence Brain and Spine Institute, Portland, OR; Departments of Neurology and Neurological Sciences (J.M., A.T., C.L., G.D., M.H.H.), and Epidemiology and Population Health (J.H., L.M.N.), Stanford University School of Medicine; Sparta Science (J.H.), Menlo Park, CA; Department of Pediatrics (C.P., L.J.C.), Data Coordinating Center, University of Utah School of Medicine, Salt Lake City; Department of Medicine (M.R.Y.), Geffen School of Medicine, University of California, Los Angeles; Division of Molecular Medicine (M.R.Y.), and The Lundquist Institute for Infection & Immunity, Harbor-UCLA Medical Center (M.R.Y.), Torrance, CA; and Department of Neurology (M.B.), Creighton University School of Medicine, Omaha, NE
| | - Christopher Lock
- From the Providence Multiple Sclerosis Center (L.V.), Providence Brain and Spine Institute, Portland, OR; Departments of Neurology and Neurological Sciences (J.M., A.T., C.L., G.D., M.H.H.), and Epidemiology and Population Health (J.H., L.M.N.), Stanford University School of Medicine; Sparta Science (J.H.), Menlo Park, CA; Department of Pediatrics (C.P., L.J.C.), Data Coordinating Center, University of Utah School of Medicine, Salt Lake City; Department of Medicine (M.R.Y.), Geffen School of Medicine, University of California, Los Angeles; Division of Molecular Medicine (M.R.Y.), and The Lundquist Institute for Infection & Immunity, Harbor-UCLA Medical Center (M.R.Y.), Torrance, CA; and Department of Neurology (M.B.), Creighton University School of Medicine, Omaha, NE
| | - Chella A Palmer
- From the Providence Multiple Sclerosis Center (L.V.), Providence Brain and Spine Institute, Portland, OR; Departments of Neurology and Neurological Sciences (J.M., A.T., C.L., G.D., M.H.H.), and Epidemiology and Population Health (J.H., L.M.N.), Stanford University School of Medicine; Sparta Science (J.H.), Menlo Park, CA; Department of Pediatrics (C.P., L.J.C.), Data Coordinating Center, University of Utah School of Medicine, Salt Lake City; Department of Medicine (M.R.Y.), Geffen School of Medicine, University of California, Los Angeles; Division of Molecular Medicine (M.R.Y.), and The Lundquist Institute for Infection & Immunity, Harbor-UCLA Medical Center (M.R.Y.), Torrance, CA; and Department of Neurology (M.B.), Creighton University School of Medicine, Omaha, NE
| | - Lawrence J Cook
- From the Providence Multiple Sclerosis Center (L.V.), Providence Brain and Spine Institute, Portland, OR; Departments of Neurology and Neurological Sciences (J.M., A.T., C.L., G.D., M.H.H.), and Epidemiology and Population Health (J.H., L.M.N.), Stanford University School of Medicine; Sparta Science (J.H.), Menlo Park, CA; Department of Pediatrics (C.P., L.J.C.), Data Coordinating Center, University of Utah School of Medicine, Salt Lake City; Department of Medicine (M.R.Y.), Geffen School of Medicine, University of California, Los Angeles; Division of Molecular Medicine (M.R.Y.), and The Lundquist Institute for Infection & Immunity, Harbor-UCLA Medical Center (M.R.Y.), Torrance, CA; and Department of Neurology (M.B.), Creighton University School of Medicine, Omaha, NE
| | - Michael R Yeaman
- From the Providence Multiple Sclerosis Center (L.V.), Providence Brain and Spine Institute, Portland, OR; Departments of Neurology and Neurological Sciences (J.M., A.T., C.L., G.D., M.H.H.), and Epidemiology and Population Health (J.H., L.M.N.), Stanford University School of Medicine; Sparta Science (J.H.), Menlo Park, CA; Department of Pediatrics (C.P., L.J.C.), Data Coordinating Center, University of Utah School of Medicine, Salt Lake City; Department of Medicine (M.R.Y.), Geffen School of Medicine, University of California, Los Angeles; Division of Molecular Medicine (M.R.Y.), and The Lundquist Institute for Infection & Immunity, Harbor-UCLA Medical Center (M.R.Y.), Torrance, CA; and Department of Neurology (M.B.), Creighton University School of Medicine, Omaha, NE
| | - Melinda K Burnett
- From the Providence Multiple Sclerosis Center (L.V.), Providence Brain and Spine Institute, Portland, OR; Departments of Neurology and Neurological Sciences (J.M., A.T., C.L., G.D., M.H.H.), and Epidemiology and Population Health (J.H., L.M.N.), Stanford University School of Medicine; Sparta Science (J.H.), Menlo Park, CA; Department of Pediatrics (C.P., L.J.C.), Data Coordinating Center, University of Utah School of Medicine, Salt Lake City; Department of Medicine (M.R.Y.), Geffen School of Medicine, University of California, Los Angeles; Division of Molecular Medicine (M.R.Y.), and The Lundquist Institute for Infection & Immunity, Harbor-UCLA Medical Center (M.R.Y.), Torrance, CA; and Department of Neurology (M.B.), Creighton University School of Medicine, Omaha, NE
| | - Gayle K Deutsch
- From the Providence Multiple Sclerosis Center (L.V.), Providence Brain and Spine Institute, Portland, OR; Departments of Neurology and Neurological Sciences (J.M., A.T., C.L., G.D., M.H.H.), and Epidemiology and Population Health (J.H., L.M.N.), Stanford University School of Medicine; Sparta Science (J.H.), Menlo Park, CA; Department of Pediatrics (C.P., L.J.C.), Data Coordinating Center, University of Utah School of Medicine, Salt Lake City; Department of Medicine (M.R.Y.), Geffen School of Medicine, University of California, Los Angeles; Division of Molecular Medicine (M.R.Y.), and The Lundquist Institute for Infection & Immunity, Harbor-UCLA Medical Center (M.R.Y.), Torrance, CA; and Department of Neurology (M.B.), Creighton University School of Medicine, Omaha, NE
| | - Lorene M Nelson
- From the Providence Multiple Sclerosis Center (L.V.), Providence Brain and Spine Institute, Portland, OR; Departments of Neurology and Neurological Sciences (J.M., A.T., C.L., G.D., M.H.H.), and Epidemiology and Population Health (J.H., L.M.N.), Stanford University School of Medicine; Sparta Science (J.H.), Menlo Park, CA; Department of Pediatrics (C.P., L.J.C.), Data Coordinating Center, University of Utah School of Medicine, Salt Lake City; Department of Medicine (M.R.Y.), Geffen School of Medicine, University of California, Los Angeles; Division of Molecular Medicine (M.R.Y.), and The Lundquist Institute for Infection & Immunity, Harbor-UCLA Medical Center (M.R.Y.), Torrance, CA; and Department of Neurology (M.B.), Creighton University School of Medicine, Omaha, NE
| | - May H Han
- From the Providence Multiple Sclerosis Center (L.V.), Providence Brain and Spine Institute, Portland, OR; Departments of Neurology and Neurological Sciences (J.M., A.T., C.L., G.D., M.H.H.), and Epidemiology and Population Health (J.H., L.M.N.), Stanford University School of Medicine; Sparta Science (J.H.), Menlo Park, CA; Department of Pediatrics (C.P., L.J.C.), Data Coordinating Center, University of Utah School of Medicine, Salt Lake City; Department of Medicine (M.R.Y.), Geffen School of Medicine, University of California, Los Angeles; Division of Molecular Medicine (M.R.Y.), and The Lundquist Institute for Infection & Immunity, Harbor-UCLA Medical Center (M.R.Y.), Torrance, CA; and Department of Neurology (M.B.), Creighton University School of Medicine, Omaha, NE
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Chen X, Roberts N, Zheng Q, Peng Y, Han Y, Luo Q, Feng J, Luo T, Li Y. Comparison of diffusion tensor imaging (DTI) tissue characterization parameters in white matter tracts of patients with multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD). Eur Radiol 2024:10.1007/s00330-023-10550-1. [PMID: 38175221 DOI: 10.1007/s00330-023-10550-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 09/25/2023] [Accepted: 11/11/2023] [Indexed: 01/05/2024]
Abstract
OBJECTIVE To investigate the microstructural properties of T2 lesion and normal-appearing white matter (NAWM) in 20 white matter tracts between multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD) and correlations between the tissue damage and clinical variables. METHODS The white matter (WM) compartment of the brain was segmented for 56 healthy controls (HC), 48 patients with MS, and 38 patients with NMOSD, and for the patients further subdivided into T2 lesion and NAWM. Subsequently, the diffusion tensor imaging (DTI) tissue characterization parameters of fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) were compared for 20 principal white matter tracts. The correlation between tissue damage and clinical variables was also investigated. RESULTS The higher T2 lesion volumes of 14 fibers were shown in MS compared to NMOSD. MS showed more microstructure damage in 13 fibers of T2 lesion, but similar microstructure in seven fibers compared to NMOSD. MS and NMOSD had microstructure damage of NAWM in 20 fibers compared to WM in HC, with more damage in 20 fibers in MS compared to NMOSD. MS patients showed higher correlation between the microstructure of T2 lesion areas and NAWM. The T2 lesion microstructure damage was correlated with duration and impaired cognition in MS. CONCLUSIONS Patients with MS and NMOSD show different patterns of microstructural damage in T2 lesion and NAWM areas. The prolonged disease course of MS may aggravate the microstructural damage, and the degree of microstructural damage is further related to cognitive impairment. CLINICAL RELEVANCE STATEMENT Microstructure differences between T2 lesion areas and normal-appearing white matter help distinguish multiple sclerosis and neuromyelitis optica spectrum disorder. In multiple sclerosis, lesions rather than normal-appearing white matter should be a concern, because the degree of lesion severity correlated both with normal-appearing white matter damage and cognitive impairment. KEY POINTS • Multiple sclerosis and neuromyelitis optica spectrum disorder have different damage patterns in T2 lesion and normal-appearing white matter areas. • The microstructure damage of normal-appearing white matter is correlated with the microstructure of T2 lesion in multiple sclerosis and neuromyelitis optica spectrum disorder. • The microstructure damage of T2 lesion in multiple sclerosis is correlated with duration and cognitive impairment.
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Affiliation(s)
- Xiaoya Chen
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Neil Roberts
- Edinburgh Imaging Facility QMRI, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Qiao Zheng
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Yuling Peng
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Yongliang Han
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Qi Luo
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Jinzhou Feng
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Tianyou Luo
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
| | - Yongmei Li
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
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Masuda H, Mori M, Hirano S, Uzawa A, Uchida T, Muto M, Ohtani R, Aoki R, Hirano Y, Kuwabara S. Higher longitudinal brain white matter atrophy rate in aquaporin-4 IgG-positive NMOSD compared with healthy controls. Sci Rep 2023; 13:12631. [PMID: 37537208 PMCID: PMC10400628 DOI: 10.1038/s41598-023-38893-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 07/17/2023] [Indexed: 08/05/2023] Open
Abstract
We aimed to compare longitudinal brain atrophy in patients with neuromyelitis optica spectrum disorder (NMOSD) with healthy controls (HCs). The atrophy rate in patients with anti-aquaporin-4 antibody-positive NMOSD (AQP4 + NMOSD) was compared with age-sex-matched HCs recruited from the Japanese Alzheimer's Disease Neuroimaging Initiative study and another study performed at Chiba University. Twenty-nine patients with AQP4 + NMOSD and 29 HCs were enrolled in the study. The time between magnetic resonance imaging (MRI) scans was longer in the AQP4 + NMOSD group compared with the HCs (median; 3.2 vs. 2.9 years, P = 0.009). The annualized normalized white matter volume (NWV) atrophy rate was higher in the AQP4 + NMOSD group compared with the HCs (median; 0.37 vs. - 0.14, P = 0.018). The maximum spinal cord lesion length negatively correlated with NWV at baseline MRI in patients with AQP4 + NMOSD (Spearman's rho = - 0.41, P = 0.027). The annualized NWV atrophy rate negatively correlated with the time between initiation of persistent prednisolone usage and baseline MRI in patients with AQP4 + NMOSD (Spearman's rho = - 0.43, P = 0.019). Patients with AQP4 + NMOSD had a greater annualized NWV atrophy rate than HCs. Suppressing disease activity may prevent brain atrophy in patients with AQP4 + NMOSD.
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Affiliation(s)
- Hiroki Masuda
- Department of Neurology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-Ku, Chiba, 260-8670, Japan.
| | - Masahiro Mori
- Department of Neurology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-Ku, Chiba, 260-8670, Japan
| | - Shigeki Hirano
- Department of Neurology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-Ku, Chiba, 260-8670, Japan
| | - Akiyuki Uzawa
- Department of Neurology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-Ku, Chiba, 260-8670, Japan
| | - Tomohiko Uchida
- Department of Neurology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-Ku, Chiba, 260-8670, Japan
| | - Mayumi Muto
- Department of Neurology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-Ku, Chiba, 260-8670, Japan
- Department of Neurology, Chiba Rosai Hospital, 2-16, Tatsumidai-Higashi, Ichihara, 290-0003, Japan
| | - Ryohei Ohtani
- Department of Neurology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-Ku, Chiba, 260-8670, Japan
- Department of Neurology, Kimitsu Chuo Hospital, 1010, Sakurai, Kisarazu-Shi, Chiba, 292-8535, Japan
| | - Reiji Aoki
- Department of Neurology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-Ku, Chiba, 260-8670, Japan
| | - Yoshiyuki Hirano
- Research Center for Child Mental Development, Chiba University, 1-8-1, Inohana, Chuo-Ku, Chiba, 260-8670, Japan
| | - Satoshi Kuwabara
- Department of Neurology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-Ku, Chiba, 260-8670, Japan
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Chen X, Peng Y, Zheng Q, Luo D, Han Y, Luo Q, Zhu Q, Luo T, Li Y. The different damage patterns of short-, middle- and long-range connections between patients with relapse-remitting multiple sclerosis and neuromyelitis optica spectrum disorder. Front Immunol 2022; 13:1007335. [PMID: 36532033 PMCID: PMC9755727 DOI: 10.3389/fimmu.2022.1007335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 11/16/2022] [Indexed: 12/04/2022] Open
Abstract
Objective To investigate the differences in short-, middle- and long-range connections between patients with relapse-remitting multiple sclerosis (RRMS) and neuromyelitis optica spectrum disorder (NMOSD), and their correlation with brain tissue volume, structural and functional network parameters. Methods A total of 51 RRMS, 42 NMOSD and 56 health controls (HC) were recruited. Of these 25 RRMS (median: 1.37 years) and 20 NMOSD (median: 1.25 years) patients were also studied at follow-up. The whole-brain fiber connection was divided into three groups according to the trisected lengths of the tract in HC group, including short-, middle- and long-range connections. The brain tissue features (including total brain tissue and deep grey matter volumes) and parameters of DTI and functional networks (including the shortest path, clustering coefficient, local efficiency and global efficiency) were calculated. The differences in fiber number (FN) and average fractional anisotropy (FA) were compared between RRMS and NMOSD by the One-way ANOVA and post hoc tests. The correlation between the FN or FA and the brain tissue volume, DTI and functional network parameters were further analyzed by Pearson analysis. Results Compared to HC and NMOSD, the total number of fibers in RRMS was decreased, including the reduced FN of middle- and long-range connections, but increased FN of short-range connections. Compared to HC, the FA of three fibers in RRMS and NMOSD were reduced significantly, and the decrease of FA in RRMS was greater than in NMOSD. There were correlations between the FN of short-, and long-range connections and the atrophy of whole brain tissue in two diseases and structural network topological parameters in RRMS. Additionally, there was no significant difference of FN and FA in short-, middle- and long-range connections between the baseline and follow-up in two diseases. Conclusions RRMS and NMOSD patients have different patterns of fiber connection damage. The FN of different lengths in RRMS and NMOSD patients may be associated with brain atrophy. The FN and FA of different lengths may explain the decreased efficiency of the structural network in RRMS patients. In the short-term follow-up, neither has worsened damage of different fibers in two diseases.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Yongmei Li
- *Correspondence: Tianyou Luo, ; Yongmei Li,
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Yan Z, Wang X, Zhu Q, Shi Z, Chen X, Han Y, Zheng Q, Wei Y, Wang J, Li Y. Alterations in White Matter Fiber Tracts Characterized by Automated Fiber-Tract Quantification and Their Correlations With Cognitive Impairment in Neuromyelitis Optica Spectrum Disorder Patients. Front Neurosci 2022; 16:904309. [PMID: 35844220 PMCID: PMC9283762 DOI: 10.3389/fnins.2022.904309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 05/30/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives To investigate whether patients with neuromyelitis optica spectrum disorder (NMOSD) have tract-specific alterations in the white matter (WM) and the correlations between the alterations and cognitive impairment. Materials and Methods In total, 40 patients with NMOSD and 20 healthy controls (HCs) who underwent diffusion tensor imaging (DTI) scan and neuropsychological scale assessments were enrolled. Automated fiber-tract quantification (AFQ) was applied to identify and quantify 100 equally spaced nodes of 18 specific WM fiber tracts for each participant. Then the group comparisons in DTI metrics and correlations between different DTI metrics and neuropsychological scales were performed. Results Regardless of the entire or pointwise level in WM fiber tracts, patients with NMOSD exhibited a decreased fractional anisotropy (FA) in the left inferior fronto-occipital fasciculus (L_IFOF) and widespread increased mean diffusion (MD), axial diffusivity (AD), and radial diffusivity (RD), especially for the thalamic radiation (TR), corticospinal tract (CST), IFOF, inferior longitudinal fasciculus (ILF), superior longitudinal fasciculus (SLF) [p < 0.05, false discovery rate (FDR) correction], and the pointwise analyses performed more sensitive. Furthermore, the negative correlations among MD, AD, RD, and symbol digit modalities test (SDMT) scores in the left TR (L_TR) were found in NMOSD. Conclusion Patients with NMOSD exhibited the specific nodes of WM fiber tract damage, which can enhance our understanding of WM microstructural abnormalities in NMOSD. In addition, the altered DTI metrics were correlated with cognitive impairment, which can be used as imaging markers for the early identification of NMOSD cognitive impairment.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Kato S, Hagiwara A, Yokoyama K, Andica C, Tomizawa Y, Hoshino Y, Uchida W, Nishimura Y, Fujita S, Kamagata K, Hori M, Hattori N, Abe O, Aoki S. Microstructural white matter abnormalities in multiple sclerosis and neuromyelitis optica spectrum disorders: Evaluation by advanced diffusion imaging. J Neurol Sci 2022. [DOI: 10.1016/j.jns.2022.120205] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 01/29/2022] [Accepted: 02/20/2022] [Indexed: 12/19/2022]
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Kim M, Choi KS, Hyun RC, Hwang I, Yun TJ, Kim SM, Kim JH. Free-water diffusion tensor imaging detects occult periependymal abnormality in the AQP4-IgG-seropositive neuromyelitis optica spectrum disorder. Sci Rep 2022; 12:512. [PMID: 35017589 PMCID: PMC8752776 DOI: 10.1038/s41598-021-04490-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 12/22/2021] [Indexed: 11/23/2022] Open
Abstract
To compare free-water corrected diffusion tensor imaging (DTI) measures in the normal-appearing periependymal area between AQP4-IgG-seropositive NMOSD and multiple sclerosis (MS) to investigate occult pathophysiology.
This prospective study included 44 patients (mean age, 39.52 ± 11.90 years; 14 men) with AQP4-IgG-seropositive NMOSD (n = 20) and MS (n = 24) who underwent DTI between April 2014 and April 2020. Based on free-water corrected DTI measures obtained from normal-appearing periependymal voxels of (1) lateral ventricles and (2) the 3rd and 4th ventricles as dependent variables, MANCOVA was conducted to compare the two groups, using clinical variables as covariates. A significant difference was found between AQP4-IgG-seropositive NMOSD and MS in the 3rd and 4th periependymal voxels (λ = 0.462, P = 0.001). Fractional anisotropy, axial diffusivity was significantly decreased and radial diffusivity was increased in AQP4-IgG-seropositive NMOSD in post-hoc analysis, compared with MS (F = 27.616, P < 0.001, F = 7.336, P = 0.011, and F = 5.800, P = 0.022, respectively). Free-water corrected DTI measures differ in the periependymal area surrounding the diencephalon and brain stem/cerebellum between MS and NMOSD, which may suggest occult white matter injury in areas with distribution of AQP-4 in NMOSD.
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Affiliation(s)
- Minchul Kim
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyu Sung Choi
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ryoo Chang Hyun
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Inpyeong Hwang
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Tae Jin Yun
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sung Min Kim
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
| | - Ji-Hoon Kim
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
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9
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Cortese R, Giorgio A, Severa G, De Stefano N. MRI Prognostic Factors in Multiple Sclerosis, Neuromyelitis Optica Spectrum Disorder, and Myelin Oligodendrocyte Antibody Disease. Front Neurol 2021; 12:679881. [PMID: 34867701 PMCID: PMC8636325 DOI: 10.3389/fneur.2021.679881] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 10/08/2021] [Indexed: 11/25/2022] Open
Abstract
Several MRI measures have been developed in the last couple of decades, providing a number of imaging biomarkers that can capture the complexity of the pathological processes occurring in multiple sclerosis (MS) brains. Such measures have provided more specific information on the heterogeneous pathologic substrate of MS-related tissue damage, being able to detect, and quantify the evolution of structural changes both within and outside focal lesions. In clinical practise, MRI is increasingly used in the MS field to help to assess patients during follow-up, guide treatment decisions and, importantly, predict the disease course. Moreover, the process of identifying new effective therapies for MS patients has been supported by the use of serial MRI examinations in order to sensitively detect the sub-clinical effects of disease-modifying treatments at an earlier stage than is possible using measures based on clinical disease activity. However, despite this has been largely demonstrated in the relapsing forms of MS, a poor understanding of the underlying pathologic mechanisms leading to either progression or tissue repair in MS as well as the lack of sensitive outcome measures for the progressive phases of the disease and repair therapies makes the development of effective treatments a big challenge. Finally, the role of MRI biomarkers in the monitoring of disease activity and the assessment of treatment response in other inflammatory demyelinating diseases of the central nervous system, such as neuromyelitis optica spectrum disorder (NMOSD) and myelin oligodendrocyte antibody disease (MOGAD) is still marginal, and advanced MRI studies have shown conflicting results. Against this background, this review focused on recently developed MRI measures, which were sensitive to pathological changes, and that could best contribute in the future to provide prognostic information and monitor patients with MS and other inflammatory demyelinating diseases, in particular, NMOSD and MOGAD.
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Affiliation(s)
- Rosa Cortese
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Antonio Giorgio
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Gianmarco Severa
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Nicola De Stefano
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
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Homos MD. Can white matter lesion burden predict involvement of normal appearing thalami in multiple sclerosis? Study using 3D FLAIR and DTI. Egypt J Radiol Nucl Med 2021. [DOI: 10.1186/s43055-021-00406-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Multiple sclerosis is a chronic demyelinating disease that affects the white and grey matter. The thalamus is responsible for many neurological functions, and it is liable to damage in multiple sclerosis in the absence of MRI-detectable thalamic lesions. Standardized imaging protocol for multiple sclerosis includes 3D FLAIR sequence that is highly sensitive in detecting white matter lesions. Owing to the thalamic functional importance, we aim in this study to show to what extent the standardized imaging protocol (3D FLAIR) can predict microscopic damage of normal appearing thalami, depending on DTI metrics (ADC and FA) as indicators of the microscopic damage.
Results
We examined 42 multiple sclerosis patients, 16 males and 26 females, with mean age 29 ± 6 years using 3D FLAIR sequence to delineate the white matter lesions and calculate their total areas and using DTI to calculate the average ADC and FA values of the thalami. Spearman’s correlation coefficient (r) was used to correlate between the white matter lesion burden and the thalamic diffusivity (ADC and FA).
Moderate correlation was found between average ADC values of the thalami and the total white matter lesion areas (r = 0.5, p = 0.03).
Very weak correlation was found between average FA values of the thalami and the total white matter lesion areas (r = − 0.1, p = 0.6)
Conclusion
White matter lesion burden detected using the highly sensitive 3D FLAIR sequence does not always correlate with the microstructural damage in normal appearing thalami. DTI needs to be added to the examination protocol if damage of normal appearing thalami is of concern.
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Molazadeh N, Filippatou AG, Vasileiou ES, Levy M, Sotirchos ES. Evidence for and against subclinical disease activity and progressive disease in MOG antibody disease and neuromyelitis optica spectrum disorder. J Neuroimmunol 2021; 360:577702. [PMID: 34547512 DOI: 10.1016/j.jneuroim.2021.577702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 08/18/2021] [Accepted: 08/23/2021] [Indexed: 10/20/2022]
Abstract
Myelin oligodendrocyte glycoprotein antibody disease (MOGAD) and aquaporin-4 IgG seropositive neuromyelitis optica spectrum disorder (AQP4-IgG+ NMOSD) are generally considered to be relapsing disorders, without clinical progression or subclinical disease activity outside of clinical relapses, in contrast to multiple sclerosis (MS). With advances in the diagnosis and treatment of these conditions, prolonged periods of remission without relapses can be achieved, and the question of whether progressive disease courses can occur has re-emerged. In this review, we focus on studies exploring evidence for and against relapse-independent clinical progression and/or subclinical disease activity in patients with MOGAD and AQP4-IgG+ NMOSD.
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Affiliation(s)
- Negar Molazadeh
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
| | | | - Eleni S Vasileiou
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA.
| | - Michael Levy
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
| | - Elias S Sotirchos
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA.
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12
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Liu C, Shi M, Zhu M, Chu F, Jin T, Zhu J. Comparisons of clinical phenotype, radiological and laboratory features, and therapy of neuromyelitis optica spectrum disorder by regions: update and challenges. Autoimmun Rev 2021; 21:102921. [PMID: 34384938 DOI: 10.1016/j.autrev.2021.102921] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 08/08/2021] [Indexed: 11/26/2022]
Abstract
Neuromyelitis optica spectrum disorder (NMOSD) is an inflammatory demyelinating disease of the central nervous system (CNS) associated with autoantibody (ab) to aquaporin-4 (AQP4). There is obvious variation between regions and countries in the epidemiology, clinical features and management in NMOSD. Based on published population-based observation and cohort studies, the different clinical pattern of NMOSD has been seen in several geographical regions and some of these patients with NMOSD-like features do not fully meet the current diagnostic criteria, which is needed to consider the value of recently revised diagnostic criteria. At present, all treatments applied in NMOSD have made great progress, however, these treatments failed in AQP4 ab negative and refractory patients. Therefore, it is necessary to turn into an innovative idea and to open a new era of NMOSD treatment to develop novel and diverse targets and effective therapeutic drugs in NMOSD and to conduct the trails in large clinical samples and case-control studies to confirm their therapeutic effects on NMOSD in the future, which still remain a challenge.
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Affiliation(s)
- Caiyun Liu
- Neuroscience Center, Department of Neurology, The First Hospital of Jilin University, Changchun, China.
| | - Mingchao Shi
- Neuroscience Center, Department of Neurology, The First Hospital of Jilin University, Changchun, China.
| | - Mingqin Zhu
- Neuroscience Center, Department of Neurology, The First Hospital of Jilin University, Changchun, China.
| | - Fengna Chu
- Neuroscience Center, Department of Neurology, The First Hospital of Jilin University, Changchun, China.
| | - Tao Jin
- Neuroscience Center, Department of Neurology, The First Hospital of Jilin University, Changchun, China.
| | - Jie Zhu
- Neuroscience Center, Department of Neurology, The First Hospital of Jilin University, Changchun, China; Department of Neurobiology, Care Sciences & Society, Division of Neurogeriatrcs, Karolinska Institutet, Karolinska University Hospital Solna, Stockholm, Sweden.
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13
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Chen X, Roberts N, Zheng Q, Peng Y, Han Y, Luo Q, Zeng C, Wang J, Luo T, Li Y. Progressive brain microstructural damage in patients with multiple sclerosis but not in patients with neuromyelitis optica spectrum disorder: A cross-sectional and follow-up tract-based spatial statistics study. Mult Scler Relat Disord 2021; 55:103178. [PMID: 34384989 DOI: 10.1016/j.msard.2021.103178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 07/20/2021] [Accepted: 07/25/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Neuromyelitis optica spectrum disorder (NMOSD) may sometimes be misdiagnosed as multiple sclerosis (MS) because both disorders have similar clinical presentations and commonly show white matter damage in the brain. Diffusion tensor imaging (DTI) is an advanced MRI technique to assess the microstructural organization of white matter and provides greater pathological specificity than conventional MRI. In the present combined cross-sectional and longitudinal study, the novel DTI technique of Track-Based Spatial Statistics (TBSS) was used to investigate the difference of DTI parameter abnormalities between NMOSD and MS. METHODS A total of 42 patients with NMOSD, 51 patients with MS and 56 health controls (HC) were recruited and of these 14 patients with NMOSD and 13 patients with MS were also studied at follow-up after an average interval of approximately one year. Measurements of fractional anisotropy (FA), mean diffusion (MD), axial diffusivity (AD) and radial diffusivity (RD) were compared at baseline and follow-up in patients with NMOSD and MS. RESULTS Significant reduction in FA, increase in MD, AD and RD were observed in patients with MS (p < 0.05) and reduced FA was shown in NMOSD (p < 0.05) compared to HC, with all the effects, together with lesion load on T1WI and T2WI, being greater in patients with MS than in patients with NMOSD (p < 0.05). There was no significant difference in the time interval to follow-up in patients with MS (1.37 years) and NMOSD (1.25 years) (p > 0.05), during which there were significant changes in EDSS score between baseline and follow-up in NMOSD and MS patients (p < 0.05). There was a significantly reduced FA, and increased MD and RD in patients with MS (p < 0.05), but no significant changes in patients with NMOSD (p > 0.05). CONCLUSIONS Both MS and NMOSD have microstructure damage in white matter, while the progressive change in brain microstructural properties is observed in patients with MS but may not in patients with NMOSD in a short-term follow-up.
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Affiliation(s)
- Xiaoya Chen
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Neil Roberts
- Edinburgh Imaging facility QMRI, Queen's Medical Research Institute University of Edinburgh, Edinburgh, United Kingdom
| | - Qiao Zheng
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Yuling Peng
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Yongliang Han
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Qi Luo
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Chun Zeng
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Jingjie Wang
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Tianyou Luo
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
| | - Yongmei Li
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
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Messina S, Mariano R, Roca-Fernandez A, Cavey A, Jurynczyk M, Leite MI, Calabrese M, Jenkinson M, Palace J. Contrasting the brain imaging features of MOG-antibody disease, with AQP4-antibody NMOSD and multiple sclerosis. Mult Scler 2021; 28:217-227. [PMID: 34048323 PMCID: PMC8795219 DOI: 10.1177/13524585211018987] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background: Identifying magnetic resonance imaging (MRI) markers in myelin-oligodendrocytes-glycoprotein antibody-associated disease (MOGAD), neuromyelitis optica spectrum disorder-aquaporin-4 positive (NMOSD-AQP4) and multiple sclerosis (MS) is essential for establishing objective outcome measures. Objectives: To quantify imaging patterns of central nervous system (CNS) damage in MOGAD during the remission stage, and to compare it with NMOSD-AQP4 and MS. Methods: 20 MOGAD, 19 NMOSD-AQP4, 18 MS in remission with brain or spinal cord involvement and 18 healthy controls (HC) were recruited. Volumetrics, lesions and cortical lesions, diffusion-imaging measures, were analysed. Results: Deep grey matter volumes were lower in MOGAD (p = 0.02) and MS (p = 0.0001), compared to HC and were strongly correlated with current lesion volume (MOGAD R = −0.93, p < 0.001, MS R = −0.65, p = 0.0034). Cortical/juxtacortical lesions were seen in a minority of MOGAD, in a majority of MS and in none of NMOSD-AQP4. Non-lesional tissue fractional anisotropy (FA) was only reduced in MS (p = 0.01), although focal reductions were noted in NMOSD-AQP4, reflecting mainly optic nerve and corticospinal tract pathways. Conclusion: MOGAD patients are left with grey matter damage, and this may be related to persistent white matter lesions. NMOSD-AQP4 patients showed a relative sparing of deep grey matter volumes, but reduced non-lesional tissue FA. Observations from our study can be used to identify new markers of damage for future multicentre studies.
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Affiliation(s)
- Silvia Messina
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK/Oxford University Hospital NHS Foundation Trust, Oxford, UK
| | - Romina Mariano
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Adriana Roca-Fernandez
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Ana Cavey
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Maciej Jurynczyk
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK/Laboratory of Brain Imaging, Nencki Institute of Experimental Biology, Polish Academy of Sciences, Warsaw, Poland
| | - Maria Isabel Leite
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK/Oxford University Hospital NHS Foundation Trust, Oxford, UK
| | - Massimiliano Calabrese
- Multiple Sclerosis Centre, Neurology Department of Neurosciences, Biomedicine and Movement, University Hospital of Verona, Verona, Italy
| | - Mark Jenkinson
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK/University of Adelaide, Adelaide, SA, Australia
| | - Jacqueline Palace
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK/Oxford University Hospital NHS Foundation Trust, Oxford, UK
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15
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Zheng Q, Chen X, Xie M, Fu J, Han Y, Wang J, Zeng C, Li Y. Altered structural networks in neuromyelitis optica spectrum disorder related with cognition impairment and clinical features. Mult Scler Relat Disord 2020; 48:102714. [PMID: 33422915 DOI: 10.1016/j.msard.2020.102714] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 11/19/2020] [Accepted: 12/19/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To investigate the topological properties alterations of white matter (WM) network in neuromyelitis optica spectrum disorder (NMOSD) patients and its correlation with clinical and cognitive performance. METHODS Forty-eight NMOSD patients and fifty healthy controls (HC) underwent DTI and 3D-T1 scan on a 3.0 T MRI and clinical data and cognitive scales were collected. Structural networks were constructed and analyzed by using graph theory. The network metrics between-group comparisons were examined by using GRETNA. Differences in network parameters between two groups and grouped patients according to disease duration (DD) were compared to examine the impact of DD on WM network. The relationships between the network characteristics and clinical data and cognitive performances were also analyzed by partial correlation analysis. RESULTS The NMOSD patients exhibited decreased global and local network efficiency and increased characteristic path length, which were pronounced more in long DD patients. Furthermore, altered nodal efficiencies were observed in several brain regions, which were mainly distributed in default mode and visual systems. The Expanded Disability Status Scale was positively related to nodal shortest path. NMOSD patients showed decreased cognitive performance in attention, short-term memory and verbal memory, which were associated with significantly decreased degree centrality, nodal efficiency and increased nodal shortest path of several brain regions (all p<0.05). CONCLUSIONS This study illustrated the relationship between WM disruption and cognitive impairment in NMOSD patients, which advance the understanding of disrupted WM networks and provide insight into subtle WM pathology to cognitive impairment in NMOSD.
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Affiliation(s)
- Qiao Zheng
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing 400016, China
| | - Xiaoya Chen
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing 400016, China
| | - Min Xie
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing 400016, China
| | - Jialiang Fu
- Department of Radiology, Chongqing Health Center for Women and Children, 120 Longshan Road, Yubei District, Chongqing 401120, China
| | - Yongliang Han
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing 400016, China
| | - Jingjie Wang
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing 400016, China
| | - Chun Zeng
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing 400016, China.
| | - Yongmei Li
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing 400016, China.
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Lee MY, Yong KP, Hyun JW, Kim SH, Lee SH, Kim HJ. Incidence of interattack asymptomatic brain lesions in NMO spectrum disorder. Neurology 2020; 95:e3124-e3128. [PMID: 32928976 DOI: 10.1212/wnl.0000000000010847] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 07/22/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine whether aquaporin-4 (AQP4) antibody-seropositive patients with neuromyelitis optica spectrum disorder (NMOSD) develop new asymptomatic brain lesions during the interattack period. METHODS Of 296 consecutive AQP4 antibody-seropositive patients in the NMOSD database of the National Cancer Center from May 2005 to November 2019, 145 patients, who had serial brain MRI scans over an interval of at least 1 year during relapse-free period after immunosuppressive therapy, with 370 longitudinally assessed brain MRI scans were included in this study. We retrospectively analyzed them for presence of new subclinical brain lesions during the relapse-free period. RESULTS Five of 145 patients (3.4%) had detectable new, asymptomatic brain lesions in the deep white matter over a total observed relapse-free period of 708 person-years. All the lesions were smaller than 6 mm and assessed to be nonspecific. No brain lesion characteristic of NMOSD or gadolinium-enhancing lesion was identified. CONCLUSIONS Asymptomatic brain lesions are rarely observed on conventional MRI in clinically stable AQP4 antibody-seropositive patients with NMOSD after immunosuppressive therapy and brain MRI lesions characteristic of NMOSD are not seen in the relapse-free period. These findings may provide further insight regarding currently known diagnostic and disease-monitoring strategies in NMOSD.
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Affiliation(s)
- Min Young Lee
- From the Departments of Neurology (M.Y.L., J.-W.H., S.-H.K., H.J.K.) and Radiology (S.-H.L.), Research Institute and Hospital of National Cancer Center, Goyang, Korea; and Department of Neurology (K.P.Y.), National Neuroscience Institute, Singapore
| | - Kok Pin Yong
- From the Departments of Neurology (M.Y.L., J.-W.H., S.-H.K., H.J.K.) and Radiology (S.-H.L.), Research Institute and Hospital of National Cancer Center, Goyang, Korea; and Department of Neurology (K.P.Y.), National Neuroscience Institute, Singapore
| | - Jae-Won Hyun
- From the Departments of Neurology (M.Y.L., J.-W.H., S.-H.K., H.J.K.) and Radiology (S.-H.L.), Research Institute and Hospital of National Cancer Center, Goyang, Korea; and Department of Neurology (K.P.Y.), National Neuroscience Institute, Singapore
| | - Su-Hyun Kim
- From the Departments of Neurology (M.Y.L., J.-W.H., S.-H.K., H.J.K.) and Radiology (S.-H.L.), Research Institute and Hospital of National Cancer Center, Goyang, Korea; and Department of Neurology (K.P.Y.), National Neuroscience Institute, Singapore.
| | - Sang-Hyun Lee
- From the Departments of Neurology (M.Y.L., J.-W.H., S.-H.K., H.J.K.) and Radiology (S.-H.L.), Research Institute and Hospital of National Cancer Center, Goyang, Korea; and Department of Neurology (K.P.Y.), National Neuroscience Institute, Singapore
| | - Ho Jin Kim
- From the Departments of Neurology (M.Y.L., J.-W.H., S.-H.K., H.J.K.) and Radiology (S.-H.L.), Research Institute and Hospital of National Cancer Center, Goyang, Korea; and Department of Neurology (K.P.Y.), National Neuroscience Institute, Singapore.
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Kuchling J, Paul F. Visualizing the Central Nervous System: Imaging Tools for Multiple Sclerosis and Neuromyelitis Optica Spectrum Disorders. Front Neurol 2020; 11:450. [PMID: 32625158 PMCID: PMC7311777 DOI: 10.3389/fneur.2020.00450] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 04/28/2020] [Indexed: 12/12/2022] Open
Abstract
Multiple sclerosis (MS) and neuromyelitis optica spectrum disorders (NMOSD) are autoimmune central nervous system conditions with increasing incidence and prevalence. While MS is the most frequent inflammatory CNS disorder in young adults, NMOSD is a rare disease, that is pathogenetically distinct from MS, and accounts for approximately 1% of demyelinating disorders, with the relative proportion within the demyelinating CNS diseases varying widely among different races and regions. Most immunomodulatory drugs used in MS are inefficacious or even harmful in NMOSD, emphasizing the need for a timely and accurate diagnosis and distinction from MS. Despite distinct immunopathology and differences in disease course and severity there might be considerable overlap in clinical and imaging findings, posing a diagnostic challenge for managing neurologists. Differential diagnosis is facilitated by positive serology for AQP4-antibodies (AQP4-ab) in NMOSD, but might be difficult in seronegative cases. Imaging of the brain, optic nerve, retina and spinal cord is of paramount importance when managing patients with autoimmune CNS conditions. Once a diagnosis has been established, imaging techniques are often deployed at regular intervals over the disease course as surrogate measures for disease activity and progression and to surveil treatment effects. While the application of some imaging modalities for monitoring of disease course was established decades ago in MS, the situation is unclear in NMOSD where work on longitudinal imaging findings and their association with clinical disability is scant. Moreover, as long-term disability is mostly attack-related in NMOSD and does not stem from insidious progression as in MS, regular follow-up imaging might not be useful in the absence of clinical events. However, with accumulating evidence for covert tissue alteration in NMOSD and with the advent of approved immunotherapies the role of imaging in the management of NMOSD may be reconsidered. By contrast, MS management still faces the challenge of implementing imaging techniques that are capable of monitoring progressive tissue loss in clinical trials and cohort studies into treatment algorithms for individual patients. This article reviews the current status of imaging research in MS and NMOSD with an emphasis on emerging modalities that have the potential to be implemented in clinical practice.
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Affiliation(s)
- Joseph Kuchling
- Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt–Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- NeuroCure Clinical Research Center, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt–Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Department of Neurology, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt–Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
| | - Friedemann Paul
- Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt–Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- NeuroCure Clinical Research Center, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt–Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Department of Neurology, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt–Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
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Cho MK, Jang SH. Diffusion Tensor Imaging Studies on Spontaneous Subarachnoid Hemorrhage-Related Brain Injury: A Mini-Review. Front Neurol 2020; 11:283. [PMID: 32411076 PMCID: PMC7198780 DOI: 10.3389/fneur.2020.00283] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Accepted: 03/25/2020] [Indexed: 11/13/2022] Open
Abstract
Accurate diagnosis of the presence and severity of neural injury in patients with subarachnoid hemorrhage (SAH) is important in neurorehabilitation because it is essential for establishing appropriate therapeutic strategies and developing a prognosis. Diffusion tensor imaging has a unique advantage in the identification of microstructural white matter abnormalities which are not usually detectable on conventional brain magnetic resonance imaging. In this mini-review article, 12 diffusion tensor imaging studies on SAH-related brain injury were reviewed. These studies have demonstrated SAH-related brain injuries in various neural tracts or structures including the cingulum, fornix, hippocampus, dorsolateral prefrontal region, corticospinal tract, mamillothalamic tract, corticoreticular pathway, ascending reticular activating system, Papez circuit, optic radiation, and subcortical white matter. We believe that these reviewed studies provide information that would be helpful in science-based neurorehabilitation of patients with SAH. Furthermore, the results of these reviewed studies would also be useful for clarification of the pathophysiological mechanisms associated with SAH-related brain injury. However, considering the large number of neural tracts or neural structures in the brain, more research on SAH-related brain injury in other neural tracts or structures should be encouraged.
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Affiliation(s)
- Min Kyeong Cho
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daegu, South Korea
| | - Sung Ho Jang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daegu, South Korea
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Backner Y, Ben-Shalom I, Kuchling J, Siebert N, Scheel M, Ruprecht K, Brandt A, Paul F, Levin N. Cortical topological network changes following optic neuritis. Neurol Neuroimmunol Neuroinflamm 2020; 7:7/3/e687. [PMID: 32123044 PMCID: PMC7136064 DOI: 10.1212/nxi.0000000000000687] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 01/10/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To differentiate between visual cortical network topology changes following optic neuritis (ON) stemming from different inflammatory disease types, we used mathematical graph theory-based tools to analyze functional imaging data. METHODS Sixty-two patients were recruited into this cross-sectional study, 23 of whom had neuromyelitis optica spectrum disorder (NMOSD) with ON, 18 with clinically isolated syndrome (CIS)-ON, and 21 with other CIS episodes. Twenty-six healthy controls (HCs) were also recruited. All participants underwent resting-state functional MRI. Visual networks were defined using 50 visual regions of interest. Analysis included graph theory metrics, including degree, density, modularity, and local and global efficiency. RESULTS Visual network density shows decreased connectivity in all patient groups compared with controls. A higher degree of connections is seen in both ON groups (CIS and NMOSD) compared with the the non-ON group. This pattern is most pronounced in dorsal-lateral regions. Information transfer efficiency and modularity were reduced in both CIS groups, but not in the NMOSD group, compared with the HC group. CONCLUSIONS Visual network density appears affected by the neurologic deficit sustained (ON), and connectivity changes are more evident in dorsal-lateral regions. Efficiency and modularity appear to be associated with the specific disease type (CIS vs NMOSD). Thus, topological cortical changes in the visual system are associated with the type of neurologic deficit within the limits set on them by the underlying pathophysiology. We suggest that cortical patterns of activity should be considered in the outcome of the patients despite the localized nature of ON.
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Affiliation(s)
- Yael Backner
- From the fMRI Unit (Y.B., I.B.-S., N.L.), Neurology Department, Hadassah-Hebrew University Medical Center, Jerusalem, Israel; Experimental and Clinical Research Center (J.K., N.S., A.B., F.P.), Max Delbrueck Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, Germany; NeuroCure Clinical Research Center (J.K., N.S., M.S., A.B., F.P.), Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Department of Neurology (J.K., K.R., F.P.), Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany; Department of Neuroradiology (M.S.), Charité-Universitätsmedizin Berlin, Germany; and Department of Neurology (A.B.), University of California, Irvine
| | - Ido Ben-Shalom
- From the fMRI Unit (Y.B., I.B.-S., N.L.), Neurology Department, Hadassah-Hebrew University Medical Center, Jerusalem, Israel; Experimental and Clinical Research Center (J.K., N.S., A.B., F.P.), Max Delbrueck Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, Germany; NeuroCure Clinical Research Center (J.K., N.S., M.S., A.B., F.P.), Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Department of Neurology (J.K., K.R., F.P.), Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany; Department of Neuroradiology (M.S.), Charité-Universitätsmedizin Berlin, Germany; and Department of Neurology (A.B.), University of California, Irvine
| | - Joseph Kuchling
- From the fMRI Unit (Y.B., I.B.-S., N.L.), Neurology Department, Hadassah-Hebrew University Medical Center, Jerusalem, Israel; Experimental and Clinical Research Center (J.K., N.S., A.B., F.P.), Max Delbrueck Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, Germany; NeuroCure Clinical Research Center (J.K., N.S., M.S., A.B., F.P.), Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Department of Neurology (J.K., K.R., F.P.), Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany; Department of Neuroradiology (M.S.), Charité-Universitätsmedizin Berlin, Germany; and Department of Neurology (A.B.), University of California, Irvine
| | - Nadja Siebert
- From the fMRI Unit (Y.B., I.B.-S., N.L.), Neurology Department, Hadassah-Hebrew University Medical Center, Jerusalem, Israel; Experimental and Clinical Research Center (J.K., N.S., A.B., F.P.), Max Delbrueck Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, Germany; NeuroCure Clinical Research Center (J.K., N.S., M.S., A.B., F.P.), Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Department of Neurology (J.K., K.R., F.P.), Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany; Department of Neuroradiology (M.S.), Charité-Universitätsmedizin Berlin, Germany; and Department of Neurology (A.B.), University of California, Irvine
| | - Michael Scheel
- From the fMRI Unit (Y.B., I.B.-S., N.L.), Neurology Department, Hadassah-Hebrew University Medical Center, Jerusalem, Israel; Experimental and Clinical Research Center (J.K., N.S., A.B., F.P.), Max Delbrueck Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, Germany; NeuroCure Clinical Research Center (J.K., N.S., M.S., A.B., F.P.), Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Department of Neurology (J.K., K.R., F.P.), Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany; Department of Neuroradiology (M.S.), Charité-Universitätsmedizin Berlin, Germany; and Department of Neurology (A.B.), University of California, Irvine
| | - Klemens Ruprecht
- From the fMRI Unit (Y.B., I.B.-S., N.L.), Neurology Department, Hadassah-Hebrew University Medical Center, Jerusalem, Israel; Experimental and Clinical Research Center (J.K., N.S., A.B., F.P.), Max Delbrueck Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, Germany; NeuroCure Clinical Research Center (J.K., N.S., M.S., A.B., F.P.), Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Department of Neurology (J.K., K.R., F.P.), Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany; Department of Neuroradiology (M.S.), Charité-Universitätsmedizin Berlin, Germany; and Department of Neurology (A.B.), University of California, Irvine
| | - Alexander Brandt
- From the fMRI Unit (Y.B., I.B.-S., N.L.), Neurology Department, Hadassah-Hebrew University Medical Center, Jerusalem, Israel; Experimental and Clinical Research Center (J.K., N.S., A.B., F.P.), Max Delbrueck Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, Germany; NeuroCure Clinical Research Center (J.K., N.S., M.S., A.B., F.P.), Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Department of Neurology (J.K., K.R., F.P.), Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany; Department of Neuroradiology (M.S.), Charité-Universitätsmedizin Berlin, Germany; and Department of Neurology (A.B.), University of California, Irvine
| | - Friedemann Paul
- From the fMRI Unit (Y.B., I.B.-S., N.L.), Neurology Department, Hadassah-Hebrew University Medical Center, Jerusalem, Israel; Experimental and Clinical Research Center (J.K., N.S., A.B., F.P.), Max Delbrueck Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, Germany; NeuroCure Clinical Research Center (J.K., N.S., M.S., A.B., F.P.), Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Department of Neurology (J.K., K.R., F.P.), Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany; Department of Neuroradiology (M.S.), Charité-Universitätsmedizin Berlin, Germany; and Department of Neurology (A.B.), University of California, Irvine
| | - Netta Levin
- From the fMRI Unit (Y.B., I.B.-S., N.L.), Neurology Department, Hadassah-Hebrew University Medical Center, Jerusalem, Israel; Experimental and Clinical Research Center (J.K., N.S., A.B., F.P.), Max Delbrueck Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, Germany; NeuroCure Clinical Research Center (J.K., N.S., M.S., A.B., F.P.), Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Department of Neurology (J.K., K.R., F.P.), Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany; Department of Neuroradiology (M.S.), Charité-Universitätsmedizin Berlin, Germany; and Department of Neurology (A.B.), University of California, Irvine.
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Zhang N, Sun J, Wang Q, Qin W, Zhang X, Qi Y, Yang L, Shi FD, Yu C. Differentiate aquaporin-4 antibody negative neuromyelitis optica spectrum disorders from multiple sclerosis by multimodal advanced MRI techniques. Mult Scler Relat Disord 2020; 41:102035. [PMID: 32200338 DOI: 10.1016/j.msard.2020.102035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 02/23/2020] [Accepted: 02/29/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND It is clinically essential to distinguish aquaporin-4 antibody (AQP4-Ab) negative neuromyelitis optica spectrum disorders (NMOSD) and multiple sclerosis (MS) because of different therapeutic strategies. Since clinical and lesion features may not allow the distinction, we aimed to identify advanced imaging features that could improve the distinction between two disorders. METHODS Multimodal imaging measures included fractional anisotropy, mean, axial, radial diffusivity (MD, AD, RD) and kurtosis (MK, AK, RK) from diffusion kurtosis imaging; functional connectivity strength (FCS) and density, regional homogeneity, amplitude of low frequency fluctuations from resting-state functional MRI; gray matter volume from structural MRI; and cerebral blood flow from arterial spin labeling imaging. Voxel-wise comparisons were performed to identify inter-group differences in imaging measures, and the performance of differentiating these two disorders was estimated by receiver operating characteristic curves. RESULTS Compared to MS, patients with AQP4-Ab negative NMOSD showed decreased MD and AD but increased MK and AK in white matter regions; and reduced FCS in the occipital cortex (P < 0.05, FWE corrected). The joint-use of these five imaging measures distinguished the two disorders with an accuracy of 94% (P < 0.001, 95%CI = 0.84-0.98). Other imaging measures showed no significant differences between the two patient groups. CONCLUSIONS The study showed less white matter damage and a more severe functional disconnection of the occipital cortex in patients with AQP4-Ab negative NMOSD compared to MS. The combined use of diffusion and functional connectivity could facilitate a better distinction between NMO and MS with seronegative AQP4-Ab in clinical management.
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Affiliation(s)
- Ningnannan Zhang
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Jie Sun
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Qiuhui Wang
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Wen Qin
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Xue Zhang
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Yuan Qi
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Li Yang
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Fu-Dong Shi
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Chunshui Yu
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, 300052, China.
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Chou IJ, Tanasescu R, Mougin OE, Gowland PA, Tench CR, Whitehouse WP, Gran B, Nikfekr E, Sharrack B, Mazibrada G, Constantinescu CS. Reduced Myelin Signal in Normal-appearing White Matter in Neuromyelitis Optica Measured by 7T Magnetic Resonance Imaging. Sci Rep 2019; 9:14378. [PMID: 31591424 DOI: 10.1038/s41598-019-50928-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 09/18/2019] [Indexed: 12/22/2022] Open
Abstract
Whether the integrity of normal-appearing white matter (NAWM) is preserved in neuromyelitis optica spectrum disorders (NMOSD) is open to debate. To examine whether the tissue integrity of NAWM in NMOSD is compromised compared to that in healthy controls and patients with multiple sclerosis (MS), we prospectively enrolled 14 patients with NMOSD, 12 patients with MS, and 10 controls for clinical functional assessments and quantitative imaging, including T1 relaxation time (T1) and magnetization transfer ratio (MTR) at 7 Tesla. Cognitive performance on the Paced Auditory Serial Addition Test with a 3-second interstimulus interval (PASAT-3) was significantly lower in the NMOSD compared to the MS group (mean number of correct answers, 34.1 vs. 47.6; p = 0.006), but there were no differences in disease duration or disability. Histograms of T1 and MTR maps of NAWM demonstrated a decreased peak height in patients with NMOSD compared to the healthy controls, but not compared to patients with MS. Using 7T quantitative magnetic resonance imaging (MRI), this study showed that the NAWM in patients with NMOSD is abnormal, with reduced myelin signal; this was not previously observed using MRI at a lower field strength.
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Pisa M, Ratti F, Vabanesi M, Radaelli M, Guerrieri S, Moiola L, Martinelli V, Comi G, Leocani L. Subclinical neurodegeneration in multiple sclerosis and neuromyelitis optica spectrum disorder revealed by optical coherence tomography. Mult Scler 2019; 26:1197-1206. [PMID: 31392924 DOI: 10.1177/1352458519861603] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Neuroretinal atrophy is associated with whole-brain atrophy and disease activity in multiple sclerosis (MS). Recent findings support that subclinical visual pathway involvement might also occur in neuromyelitis optica spectrum disorders (NMOSDs). OBJECTIVE The objective of this study is to assess retinal thinning in MS and NMOSD and its association with disease activity. METHODS In total, 27 NMOSD and 54 propensity-score-matched MS patients underwent optical coherence tomography, visual acuity, and visual-evoked potentials at 2.4 years apart, in addition to routine clinical and magnetic resonance imaging (MRI) assessment. We excluded eyes with acute optic neuritis. RESULTS In NMOSD, we detected peripapillary retinal nerve fiber layer (pRNFL) thinning in patients with disease activity during follow-up (-0.494 µm/year), but not in stable patients (-0.012 µm/year). Macular ganglion cell-inner plexiform layer (GCIPL) thinning occurred instead in all patients (-0.279 µm/year). Relapsing-remitting multiple sclerosis (RRMS) meeting NEDA-3 criteria had no pRNFL or GCIPL thinning during follow-up. Active-disease RRMS and progressive MS, both active and stable, displayed pRNFL (-0.724, -0.586, -0.556 µm/year, respectively) and GCIPL loss. CONCLUSION In MS, neuroretinal atrophy was associated with disease activity but occurred in progressive MS even when achieving NEDA-3 criteria. In NMOSD, pRNFL thinning was associated with non-ocular relapses due to a spreading of inflammatory activity. GCIPL thinning was found in all patients, supporting a primary retinal pathology targeting AQP4-rich structures.
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Affiliation(s)
- Marco Pisa
- University Vita-Salute San Raffaele, Milan, Italy
| | | | | | | | | | - Lucia Moiola
- Department of Neurology, Hospital San Raffaele, Milan, Italy/Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute, Milan, Italy
| | - Vittorio Martinelli
- Department of Neurology, Hospital San Raffaele, Milan, Italy/Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute, Milan, Italy
| | - Giancarlo Comi
- Department of Clinical Neurophysiology, Hospital San Raffaele, Milan, Italy/ Department of Neurorehabilitation, Hospital San Raffaele, Milan, Italy/ Department of Neurology, Hospital San Raffaele, Milan, Italy/ Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute, Milan, Italy/ University Vita-Salute San Raffaele, Milan, Italy
| | - Letizia Leocani
- Department of Neurorehabilitation and Department of Clinical Neurophysiology, Hospital San Raffaele, Milan, Italy/ INSPE, Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute, Milan, Italy/ University Vita-Salute San Raffaele, Milan, Italy
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Wang C, Barnett MH, Yiannikas C, Barton J, Parratt J, You Y, Graham SL, Klistorner A. Lesion activity and chronic demyelination are the major determinants of brain atrophy in MS. Neurol Neuroimmunol Neuroinflamm 2019; 6:6/5/e593. [PMID: 31454773 PMCID: PMC6705629 DOI: 10.1212/nxi.0000000000000593] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 05/07/2019] [Indexed: 01/26/2023]
Abstract
Objective To evaluate the combined effect of lesion activity and pathologic processes occurring in both chronically demyelinated lesions and normal-appearing white matter (NAWM) on brain atrophy in MS. Methods Pre- and post-gadolinium T1, fluid attenuation inversion recovery, and diffusion tensor imaging images were acquired from 50 consecutive patients with relapsing-remitting MS (all, but one, on disease-modifying therapy) at baseline and 5 years. Brain atrophy was measured using structural image evaluation, using normalization of atrophy percent brain volume change (PBVC) analysis. Results During follow-up, brain volume diminished by 2.0% ± 1.1%. PBVC was not associated with patient age, disease duration, sex, or type of treatment. PBVC moderately correlated with baseline lesion load (r = −0.38, p = 0.016), but demonstrated strong association with new lesion activity (r = −0.63, p < 0.001). Brain atrophy was also strongly linked to the increase of water diffusion within chronic MS lesions (r = −0.62, p < 0.001). In normal-appearing white matter (NAWM), PBVC demonstrated a significant correlation with both baseline and longitudinal increase of demyelination as measured by radial diffusivity (RD, r = −0.44, p = 0.005 and r = −0.35, p = 0.026, respectively). Linear regression analysis explained 62% of the variance in PBVC. It confirmed the major role of new lesion activity (p = 0.002, standardized beta-coefficient −0.42), whereas change in diffusivity inside chronic lesions and NAWM RD at baseline also contributed significantly (p = 0.04 and 0.02, standardized beta-coefficient −0.31 and −0.29, respectively), increasing predictive power of the model by 55%. Conclusion In addition to new lesion activity, progressive loss of demyelinated axons in chronic lesions and the degree of demyelination in NAWM significantly contribute to accelerated loss of brain tissue in patients with MS receiving immunomodulatory therapy.
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Affiliation(s)
- Chenyu Wang
- From the Brain and Mind Centre (C.W., M.H.B., J.B.), Sydney Medical School, University of Sydney; Sydney Neuroimaging Analysis Centre (C.W., M.H.B.); Royal North Shore Hospital (C.Y., J.P.); Save Sight Institute (Y.Y., A.K.), Sydney Medical School, University of Sydney; and Faculty of Medicine and Health Sciences (S.L.G., A.K.), Macquarie University, Sydney, NSW, Australia
| | - Michael H Barnett
- From the Brain and Mind Centre (C.W., M.H.B., J.B.), Sydney Medical School, University of Sydney; Sydney Neuroimaging Analysis Centre (C.W., M.H.B.); Royal North Shore Hospital (C.Y., J.P.); Save Sight Institute (Y.Y., A.K.), Sydney Medical School, University of Sydney; and Faculty of Medicine and Health Sciences (S.L.G., A.K.), Macquarie University, Sydney, NSW, Australia
| | - Con Yiannikas
- From the Brain and Mind Centre (C.W., M.H.B., J.B.), Sydney Medical School, University of Sydney; Sydney Neuroimaging Analysis Centre (C.W., M.H.B.); Royal North Shore Hospital (C.Y., J.P.); Save Sight Institute (Y.Y., A.K.), Sydney Medical School, University of Sydney; and Faculty of Medicine and Health Sciences (S.L.G., A.K.), Macquarie University, Sydney, NSW, Australia
| | - Joshua Barton
- From the Brain and Mind Centre (C.W., M.H.B., J.B.), Sydney Medical School, University of Sydney; Sydney Neuroimaging Analysis Centre (C.W., M.H.B.); Royal North Shore Hospital (C.Y., J.P.); Save Sight Institute (Y.Y., A.K.), Sydney Medical School, University of Sydney; and Faculty of Medicine and Health Sciences (S.L.G., A.K.), Macquarie University, Sydney, NSW, Australia
| | - John Parratt
- From the Brain and Mind Centre (C.W., M.H.B., J.B.), Sydney Medical School, University of Sydney; Sydney Neuroimaging Analysis Centre (C.W., M.H.B.); Royal North Shore Hospital (C.Y., J.P.); Save Sight Institute (Y.Y., A.K.), Sydney Medical School, University of Sydney; and Faculty of Medicine and Health Sciences (S.L.G., A.K.), Macquarie University, Sydney, NSW, Australia
| | - Yuyi You
- From the Brain and Mind Centre (C.W., M.H.B., J.B.), Sydney Medical School, University of Sydney; Sydney Neuroimaging Analysis Centre (C.W., M.H.B.); Royal North Shore Hospital (C.Y., J.P.); Save Sight Institute (Y.Y., A.K.), Sydney Medical School, University of Sydney; and Faculty of Medicine and Health Sciences (S.L.G., A.K.), Macquarie University, Sydney, NSW, Australia
| | - Stuart L Graham
- From the Brain and Mind Centre (C.W., M.H.B., J.B.), Sydney Medical School, University of Sydney; Sydney Neuroimaging Analysis Centre (C.W., M.H.B.); Royal North Shore Hospital (C.Y., J.P.); Save Sight Institute (Y.Y., A.K.), Sydney Medical School, University of Sydney; and Faculty of Medicine and Health Sciences (S.L.G., A.K.), Macquarie University, Sydney, NSW, Australia
| | - Alexander Klistorner
- From the Brain and Mind Centre (C.W., M.H.B., J.B.), Sydney Medical School, University of Sydney; Sydney Neuroimaging Analysis Centre (C.W., M.H.B.); Royal North Shore Hospital (C.Y., J.P.); Save Sight Institute (Y.Y., A.K.), Sydney Medical School, University of Sydney; and Faculty of Medicine and Health Sciences (S.L.G., A.K.), Macquarie University, Sydney, NSW, Australia.
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Kor D, Birkl C, Ropele S, Doucette J, Xu T, Wiggermann V, Hernández-Torres E, Hametner S, Rauscher A. The role of iron and myelin in orientation dependent R 2* of white matter. NMR Biomed 2019; 32:e4092. [PMID: 31038240 DOI: 10.1002/nbm.4092] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 02/05/2019] [Accepted: 02/17/2019] [Indexed: 06/09/2023]
Abstract
Brain myelin and iron content are important parameters in neurodegenerative diseases such as multiple sclerosis (MS). Both myelin and iron content influence the brain's R2* relaxation rate. However, their quantification based on R2* maps requires a realistic tissue model that can be fitted to the measured data. In structures with low myelin content, such as deep gray matter, R2* shows a linear increase with increasing iron content. In white matter, R2* is not only affected by iron and myelin but also by the orientation of the myelinated axons with respect to the external magnetic field. Here, we propose a numerical model which incorporates iron and myelin, as well as fibre orientation, to simulate R2* decay in white matter. Applying our model to fibre orientation-dependent in vivo R2* data, we are able to determine a unique solution of myelin and iron content in global white matter. We determine an averaged myelin volume fraction of 16.02 ± 2.07% in non-lesional white matter of patients with MS, 17.32 ± 2.20% in matched healthy controls, and 18.19 ± 2.98% in healthy siblings of patients with MS. Averaged iron content was 35.6 ± 8.9 mg/kg tissue in patients, 43.1 ± 8.3 mg/kg in controls, and 47.8 ± 8.2 mg/kg in siblings. All differences in iron content between groups were significant, while the difference in myelin content between MS patients and the siblings of MS patients was significant. In conclusion, we demonstrate that a model that combines myelin-induced orientation-dependent and iron-induced orientation-independent components is able to fit in vivo R2* data.
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Affiliation(s)
- Daniel Kor
- Department of Physics & Astronomy, University of British Columbia, Vancouver, BC, Canada
- UBC MRI Research Centre, University of British Columbia, Vancouver, BC, Canada
| | - Christoph Birkl
- UBC MRI Research Centre, University of British Columbia, Vancouver, BC, Canada
- Department of Pediatrics (Division of Neurology), University of British Columbia, Vancouver, BC, Canada
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Stefan Ropele
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Jonathan Doucette
- Department of Physics & Astronomy, University of British Columbia, Vancouver, BC, Canada
- UBC MRI Research Centre, University of British Columbia, Vancouver, BC, Canada
- Department of Pediatrics (Division of Neurology), University of British Columbia, Vancouver, BC, Canada
| | - Tianyou Xu
- Oxford Centre for Functional MRI of the Brain, University of Oxford, Oxford, UK
| | - Vanessa Wiggermann
- Department of Physics & Astronomy, University of British Columbia, Vancouver, BC, Canada
- UBC MRI Research Centre, University of British Columbia, Vancouver, BC, Canada
- Department of Pediatrics (Division of Neurology), University of British Columbia, Vancouver, BC, Canada
| | - Enedino Hernández-Torres
- UBC MRI Research Centre, University of British Columbia, Vancouver, BC, Canada
- Department of Pediatrics (Division of Neurology), University of British Columbia, Vancouver, BC, Canada
| | - Simon Hametner
- Institute of Neuropathology, University Medical Center Göttingen, Göttingen, Germany
| | - Alexander Rauscher
- Department of Physics & Astronomy, University of British Columbia, Vancouver, BC, Canada
- UBC MRI Research Centre, University of British Columbia, Vancouver, BC, Canada
- Department of Pediatrics (Division of Neurology), University of British Columbia, Vancouver, BC, Canada
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
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25
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Pasquier B, Borisow N, Rasche L, Bellmann-Strobl J, Ruprecht K, Niendorf T, Derfuss TJ, Wuerfel J, Paul F, Sinnecker T. Quantitative 7T MRI does not detect occult brain damage in neuromyelitis optica. Neurol Neuroimmunol Neuroinflamm 2019; 6:e541. [PMID: 30882018 PMCID: PMC6410932 DOI: 10.1212/nxi.0000000000000541] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 11/26/2018] [Indexed: 12/19/2022]
Abstract
Objective To investigate and compare occult damages in aquaporin-4 (AQP4)-rich periependymal regions in patients with neuromyelitis optica spectrum disorder (NMOSD) vs healthy controls (HCs) and patients with multiple sclerosis (MS) applying quantitative T1 mapping at 7 Tesla (T) in a cross-sectional study. Methods Eleven patients with NMOSD (median Expanded Disability Status Scale [EDSS] score 3.5, disease duration 9.3 years, age 43.7 years, and 11 female) seropositive for anti-AQP4 antibodies, 7 patients with MS (median EDSS score 1.5, disease duration 3.6, age 30.2 years, and 4 female), and 10 HCs underwent 7T MRI. The imaging protocol included T2*-weighted (w) imaging and an MP2RAGE sequence yielding 3D T1w images and quantitative T1 maps. We semiautomatically marked the lesion-free periependymal area around the cerebral aqueduct and the lateral, third, and fourth ventricles to finally measure and compare the T1 relaxation time within these areas. Results We did not observe any differences in the T1 relaxation time between patients with NMOSD and HCs (all p > 0.05). Contrarily, the T1 relaxation time was longer in patients with MS vs patients with NMOSD (lateral ventricle p = 0.056, third ventricle p = 0.173, fourth ventricle p = 0.016, and cerebral aqueduct p = 0.048) and vs HCs (third ventricle p = 0.027, fourth ventricle p = 0.013, lateral ventricle p = 0.043, and cerebral aqueduct p = 0.005). Conclusion Unlike in MS, we did not observe subtle T1 changes in lesion-free periependymal regions in NMOSD, which supports the hypothesis of a rather focal than diffuse brain pathology in NMOSD.
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Affiliation(s)
- Baptiste Pasquier
- Neurologic Clinic and Policlinic (B.P., T.J.D., T.S.), Departments of Medicine, Clinical Research and Biomedical Engineering, University Hospital and University of Basel, Basel, Switzerland; NeuroCure Clinical Research Center (N.B., L.R., J.B.-S., F.P., T.S.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Department of Neurology (N.B., J.B.-S., K.R., F.P.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Experimental and Clinical Research Center (F.P.), Charité-Universitätsmedizin Berlin and Max Delbrück Center for Molecular Medicine; Clinical and Experimental Multiple Sclerosis Research Center (K.R., F.P.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Berlin Ultrahigh Field Facility (T.N.), Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Germany; Medical Image Analysis Center AG (J.W., T.S.); and qbig (J.W.), Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Nadja Borisow
- Neurologic Clinic and Policlinic (B.P., T.J.D., T.S.), Departments of Medicine, Clinical Research and Biomedical Engineering, University Hospital and University of Basel, Basel, Switzerland; NeuroCure Clinical Research Center (N.B., L.R., J.B.-S., F.P., T.S.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Department of Neurology (N.B., J.B.-S., K.R., F.P.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Experimental and Clinical Research Center (F.P.), Charité-Universitätsmedizin Berlin and Max Delbrück Center for Molecular Medicine; Clinical and Experimental Multiple Sclerosis Research Center (K.R., F.P.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Berlin Ultrahigh Field Facility (T.N.), Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Germany; Medical Image Analysis Center AG (J.W., T.S.); and qbig (J.W.), Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Ludwig Rasche
- Neurologic Clinic and Policlinic (B.P., T.J.D., T.S.), Departments of Medicine, Clinical Research and Biomedical Engineering, University Hospital and University of Basel, Basel, Switzerland; NeuroCure Clinical Research Center (N.B., L.R., J.B.-S., F.P., T.S.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Department of Neurology (N.B., J.B.-S., K.R., F.P.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Experimental and Clinical Research Center (F.P.), Charité-Universitätsmedizin Berlin and Max Delbrück Center for Molecular Medicine; Clinical and Experimental Multiple Sclerosis Research Center (K.R., F.P.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Berlin Ultrahigh Field Facility (T.N.), Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Germany; Medical Image Analysis Center AG (J.W., T.S.); and qbig (J.W.), Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Judith Bellmann-Strobl
- Neurologic Clinic and Policlinic (B.P., T.J.D., T.S.), Departments of Medicine, Clinical Research and Biomedical Engineering, University Hospital and University of Basel, Basel, Switzerland; NeuroCure Clinical Research Center (N.B., L.R., J.B.-S., F.P., T.S.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Department of Neurology (N.B., J.B.-S., K.R., F.P.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Experimental and Clinical Research Center (F.P.), Charité-Universitätsmedizin Berlin and Max Delbrück Center for Molecular Medicine; Clinical and Experimental Multiple Sclerosis Research Center (K.R., F.P.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Berlin Ultrahigh Field Facility (T.N.), Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Germany; Medical Image Analysis Center AG (J.W., T.S.); and qbig (J.W.), Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Klemens Ruprecht
- Neurologic Clinic and Policlinic (B.P., T.J.D., T.S.), Departments of Medicine, Clinical Research and Biomedical Engineering, University Hospital and University of Basel, Basel, Switzerland; NeuroCure Clinical Research Center (N.B., L.R., J.B.-S., F.P., T.S.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Department of Neurology (N.B., J.B.-S., K.R., F.P.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Experimental and Clinical Research Center (F.P.), Charité-Universitätsmedizin Berlin and Max Delbrück Center for Molecular Medicine; Clinical and Experimental Multiple Sclerosis Research Center (K.R., F.P.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Berlin Ultrahigh Field Facility (T.N.), Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Germany; Medical Image Analysis Center AG (J.W., T.S.); and qbig (J.W.), Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Thoralf Niendorf
- Neurologic Clinic and Policlinic (B.P., T.J.D., T.S.), Departments of Medicine, Clinical Research and Biomedical Engineering, University Hospital and University of Basel, Basel, Switzerland; NeuroCure Clinical Research Center (N.B., L.R., J.B.-S., F.P., T.S.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Department of Neurology (N.B., J.B.-S., K.R., F.P.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Experimental and Clinical Research Center (F.P.), Charité-Universitätsmedizin Berlin and Max Delbrück Center for Molecular Medicine; Clinical and Experimental Multiple Sclerosis Research Center (K.R., F.P.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Berlin Ultrahigh Field Facility (T.N.), Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Germany; Medical Image Analysis Center AG (J.W., T.S.); and qbig (J.W.), Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Tobias J Derfuss
- Neurologic Clinic and Policlinic (B.P., T.J.D., T.S.), Departments of Medicine, Clinical Research and Biomedical Engineering, University Hospital and University of Basel, Basel, Switzerland; NeuroCure Clinical Research Center (N.B., L.R., J.B.-S., F.P., T.S.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Department of Neurology (N.B., J.B.-S., K.R., F.P.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Experimental and Clinical Research Center (F.P.), Charité-Universitätsmedizin Berlin and Max Delbrück Center for Molecular Medicine; Clinical and Experimental Multiple Sclerosis Research Center (K.R., F.P.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Berlin Ultrahigh Field Facility (T.N.), Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Germany; Medical Image Analysis Center AG (J.W., T.S.); and qbig (J.W.), Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Jens Wuerfel
- Neurologic Clinic and Policlinic (B.P., T.J.D., T.S.), Departments of Medicine, Clinical Research and Biomedical Engineering, University Hospital and University of Basel, Basel, Switzerland; NeuroCure Clinical Research Center (N.B., L.R., J.B.-S., F.P., T.S.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Department of Neurology (N.B., J.B.-S., K.R., F.P.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Experimental and Clinical Research Center (F.P.), Charité-Universitätsmedizin Berlin and Max Delbrück Center for Molecular Medicine; Clinical and Experimental Multiple Sclerosis Research Center (K.R., F.P.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Berlin Ultrahigh Field Facility (T.N.), Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Germany; Medical Image Analysis Center AG (J.W., T.S.); and qbig (J.W.), Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Friedemann Paul
- Neurologic Clinic and Policlinic (B.P., T.J.D., T.S.), Departments of Medicine, Clinical Research and Biomedical Engineering, University Hospital and University of Basel, Basel, Switzerland; NeuroCure Clinical Research Center (N.B., L.R., J.B.-S., F.P., T.S.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Department of Neurology (N.B., J.B.-S., K.R., F.P.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Experimental and Clinical Research Center (F.P.), Charité-Universitätsmedizin Berlin and Max Delbrück Center for Molecular Medicine; Clinical and Experimental Multiple Sclerosis Research Center (K.R., F.P.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Berlin Ultrahigh Field Facility (T.N.), Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Germany; Medical Image Analysis Center AG (J.W., T.S.); and qbig (J.W.), Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Tim Sinnecker
- Neurologic Clinic and Policlinic (B.P., T.J.D., T.S.), Departments of Medicine, Clinical Research and Biomedical Engineering, University Hospital and University of Basel, Basel, Switzerland; NeuroCure Clinical Research Center (N.B., L.R., J.B.-S., F.P., T.S.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Department of Neurology (N.B., J.B.-S., K.R., F.P.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Experimental and Clinical Research Center (F.P.), Charité-Universitätsmedizin Berlin and Max Delbrück Center for Molecular Medicine; Clinical and Experimental Multiple Sclerosis Research Center (K.R., F.P.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Berlin Ultrahigh Field Facility (T.N.), Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Germany; Medical Image Analysis Center AG (J.W., T.S.); and qbig (J.W.), Department of Biomedical Engineering, University of Basel, Basel, Switzerland
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Pérez CA, Garcia-Tarodo S, Troxell R. MRI-Negative Myelitis Associated With Myelin Oligodendrocyte Glycoprotein Antibody Spectrum Demyelinating Disease. Child Neurol Open 2019; 6:2329048X19830475. [PMID: 30800700 PMCID: PMC6379793 DOI: 10.1177/2329048x19830475] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 01/20/2019] [Accepted: 01/21/2019] [Indexed: 11/16/2022] Open
Abstract
Myelin oligodendrocyte glycoprotein is expressed in the central nervous system on the
surface of oligodendrocytes and is associated with a broad range of adult and pediatric
demyelinating phenotypes. The entire spectrum of clinical and radiologic features of
myelin oligodendrocyte glycoprotein antibody spectrum disorder remains to be fully
elucidated. We describe the case of a 9-year-old boy with immune-mediated myelitis
undetectable by conventional magnetic resonance imaging in the context of relapsing
anti-myelin oligodendrocyte glycoprotein spectrum disorder. Despite the severe clinical
presentation, his symptoms improved significantly following treatment with
corticosteroids. Because timely diagnosis and treatment is imperative to prevent disease
recurrence and reduce long-term morbidity, serum anti-myelin oligodendrocyte glycoprotein
antibody testing should be considered in all children with acute demyelinating syndromes
and unusual clinical presentations—including seizures—both at presentation and at
follow-up.
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Affiliation(s)
- Carlos A Pérez
- Division of Child and Adolescent Neurology, Department of Pediatrics, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Stephanie Garcia-Tarodo
- Division of Child and Adolescent Neurology, Department of Pediatrics, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Regina Troxell
- Division of Child and Adolescent Neurology, Department of Pediatrics, University of Texas Health Science Center at Houston, Houston, TX, USA
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Chen X, Fu J, Luo Q, Han Y, Zheng Q, Xie M, Li Y. Altered volume and microstructural integrity of hippocampus in NMOSD. Mult Scler Relat Disord 2019; 28:132-7. [DOI: 10.1016/j.msard.2018.12.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 11/26/2018] [Accepted: 12/07/2018] [Indexed: 11/23/2022]
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28
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Schapira AHV. Progress in neurology 2017-2018. Eur J Neurol 2018; 25:1389-1397. [DOI: 10.1111/ene.13846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- A. H. V. Schapira
- Department of Clinical and Movement Neurosciences; UCL Queen Square Institute of Neurology; London UK
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