1
|
Lomer NB, Asalemi KA, Saberi A, Sarlak K. Predictors of multiple sclerosis progression: A systematic review of conventional magnetic resonance imaging studies. PLoS One 2024; 19:e0300415. [PMID: 38626023 PMCID: PMC11020451 DOI: 10.1371/journal.pone.0300415] [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: 10/17/2023] [Accepted: 02/26/2024] [Indexed: 04/18/2024] Open
Abstract
INTRODUCTION Multiple Sclerosis (MS) is a chronic neurodegenerative disorder that affects the central nervous system (CNS) and results in progressive clinical disability and cognitive decline. Currently, there are no specific imaging parameters available for the prediction of longitudinal disability in MS patients. Magnetic resonance imaging (MRI) has linked imaging anomalies to clinical and cognitive deficits in MS. In this study, we aimed to evaluate the effectiveness of MRI in predicting disability, clinical progression, and cognitive decline in MS. METHODS In this study, according to PRISMA guidelines, we comprehensively searched the Web of Science, PubMed, and Embase databases to identify pertinent articles that employed conventional MRI in the context of Relapsing-Remitting and progressive forms of MS. Following a rigorous screening process, studies that met the predefined inclusion criteria were selected for data extraction and evaluated for potential sources of bias. RESULTS A total of 3028 records were retrieved from database searching. After a rigorous screening, 53 records met the criteria and were included in this study. Lesions and alterations in CNS structures like white matter, gray matter, corpus callosum, thalamus, and spinal cord, may be used to anticipate disability progression. Several prognostic factors associated with the progression of MS, including presence of cortical lesions, changes in gray matter volume, whole brain atrophy, the corpus callosum index, alterations in thalamic volume, and lesions or alterations in cross-sectional area of the spinal cord. For cognitive impairment in MS patients, reliable predictors include cortical gray matter volume, brain atrophy, lesion characteristics (T2-lesion load, temporal, frontal, and cerebellar lesions), white matter lesion volume, thalamic volume, and corpus callosum density. CONCLUSION This study indicates that MRI can be used to predict the cognitive decline, disability progression, and disease progression in MS patients over time.
Collapse
Affiliation(s)
| | | | - Alia Saberi
- Department of Neurology, Poursina Hospital, Faculty of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Kasra Sarlak
- Faculty of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| |
Collapse
|
2
|
Meng Y, Wang S, Zhu W, Wang T, Liu D, Wang M, Pi J, Liu Y, Zhuo Z, Pan Y, Wang Y. Association of Mean Upper Cervical Spinal Cord Cross-Sectional Area With Cerebral Small Vessel Disease: A Community-Based Cohort Study. Stroke 2024; 55:687-695. [PMID: 38269540 DOI: 10.1161/strokeaha.123.044666] [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: 07/29/2023] [Accepted: 12/13/2023] [Indexed: 01/26/2024]
Abstract
BACKGROUND The purpose of this study was to investigate the association between the mean upper cervical spinal cord cross-sectional area (MUCCA) and the risk and severity of cerebral small vessel disease (CSVD). METHODS Community-dwelling residents in Lishui City, China, from the cross-sectional survey in the PRECISE cohort study (Polyvascular Evaluation for Cognitive Impairment and Vascular Events) conducted from 2017 to 2019. We included 1644 of 3067 community-dwelling adults in the PRECISE study after excluding those with incorrect, incomplete, insufficient, or missing clinical or imaging data. Total and modified total CSVD scores, as well as magnetic resonance imaging features, including white matter hyperintensity, lacunes, cerebral microbleeds, enlarged perivascular spaces, and brain atrophy, were assessed at the baseline. The Spinal Cord Toolbox was used to measure the upper cervical spinal cord cross-sectional area of the C1 to C3 segments of the spinal cord and its average value was taken as MUCCA. Participants were divided into 4 groups according to quartiles of MUCCA. Associations were analyzed using linear regression models adjusted for age, sex, current smoking and drinking, medical history, intracranial volume, and total cortical volume. RESULTS The means±SD age of the participants was 61.4±6.5 years, and 635 of 1644 participants (38.6%) were men. The MUCCA was smaller in patients with CSVD than those without CSVD. Using the total CSVD score as a criterion, the MUCCA was 61.78±6.12 cm2 in 504 of 1644 participants with CSVD and 62.74±5.94 cm2 in 1140 of 1644 participants without CSVD. Using the modified total CSVD score, the MUCCA was 61.81±6.04 cm2 in 699 of 1644 participants with CSVD and 62.91±5.94 cm2 in 945 of 1644 without CSVD. There were statistical differences between the 2 groups after adjusting for covariates in 3 models. The MUCCA was negatively associated with the total and modified total CSVD scores (adjusted β value, -0.009 [95% CI, -0.01 to -0.003] and -0.007 [95% CI, -0.01 to -0.0006]) after adjustment for covariates. Furthermore, the MUCCA was negatively associated with the white matter hyperintensity burden (adjusted β value, -0.01 [95% CI, -0.02 to -0.003]), enlarged perivascular spaces in the basal ganglia (adjusted β value, -0.005 [95% CI, -0.009 to -0.001]), lacunes (adjusted β value, -0.004 [95% CI, -0.007 to -0.0007]), and brain atrophy (adjusted β value, -0.009 [95% CI, -0.01 to -0.004]). CONCLUSIONS The MUCCA and CSVD were correlated. Spinal cord atrophy may serve as an imaging marker for CSVD; thus, small vessel disease may involve the spinal cord in addition to being intracranial.
Collapse
Affiliation(s)
- Yufei Meng
- Department of Neurology, Beijing Tiantan Hospital (Y.M., W.Z., T.W., D.L., M.W., J.P., Y.L., Z.Z., Y.P., Y.W.), Capital Medical University, China
- Dongzhimen Hospital, Beijing University of Chinese Medicine, China (Y.M.)
| | - Suying Wang
- Department of Neurology and Cerebrovascular Research Laboratory, Lishui Central Hospital and Fifth Affiliated Hospital of Wenzhou Medical University, Zhejiang, China (S.W.)
| | - Wanlin Zhu
- Department of Neurology, Beijing Tiantan Hospital (Y.M., W.Z., T.W., D.L., M.W., J.P., Y.L., Z.Z., Y.P., Y.W.), Capital Medical University, China
| | - Tingting Wang
- Department of Neurology, Beijing Tiantan Hospital (Y.M., W.Z., T.W., D.L., M.W., J.P., Y.L., Z.Z., Y.P., Y.W.), Capital Medical University, China
- China National Clinical Research Center for Neurological Diseases, Beijing (T.W., D.L., M.W., Y.P., Y.W.)
| | - Dandan Liu
- Department of Neurology, Beijing Tiantan Hospital (Y.M., W.Z., T.W., D.L., M.W., J.P., Y.L., Z.Z., Y.P., Y.W.), Capital Medical University, China
- China National Clinical Research Center for Neurological Diseases, Beijing (T.W., D.L., M.W., Y.P., Y.W.)
| | - Mengxing Wang
- Department of Neurology, Beijing Tiantan Hospital (Y.M., W.Z., T.W., D.L., M.W., J.P., Y.L., Z.Z., Y.P., Y.W.), Capital Medical University, China
- China National Clinical Research Center for Neurological Diseases, Beijing (T.W., D.L., M.W., Y.P., Y.W.)
| | - Jingtao Pi
- Department of Neurology, Beijing Tiantan Hospital (Y.M., W.Z., T.W., D.L., M.W., J.P., Y.L., Z.Z., Y.P., Y.W.), Capital Medical University, China
| | - Yaou Liu
- Department of Neurology, Beijing Tiantan Hospital (Y.M., W.Z., T.W., D.L., M.W., J.P., Y.L., Z.Z., Y.P., Y.W.), Capital Medical University, China
| | - Zhizheng Zhuo
- Department of Neurology, Beijing Tiantan Hospital (Y.M., W.Z., T.W., D.L., M.W., J.P., Y.L., Z.Z., Y.P., Y.W.), Capital Medical University, China
| | - Yuesong Pan
- Department of Neurology, Beijing Tiantan Hospital (Y.M., W.Z., T.W., D.L., M.W., J.P., Y.L., Z.Z., Y.P., Y.W.), Capital Medical University, China
- China National Clinical Research Center for Neurological Diseases, Beijing (T.W., D.L., M.W., Y.P., Y.W.)
| | - Yilong Wang
- Department of Neurology, Beijing Tiantan Hospital (Y.M., W.Z., T.W., D.L., M.W., J.P., Y.L., Z.Z., Y.P., Y.W.), Capital Medical University, China
- Advanced Innovation Center for Human Brain Protection (Y.W.), Capital Medical University, China
- Beijing Laboratory of Oral Health (Y.W.), Capital Medical University, China
- Chinese Institute for Brain Research, Beijing, China (Y.W.)
- National Center for Neurological Diseases, Beijing, China (Y.W.)
- China National Clinical Research Center for Neurological Diseases, Beijing (T.W., D.L., M.W., Y.P., Y.W.)
| |
Collapse
|
3
|
Chertcoff A, Schneider R, Azevedo CJ, Sicotte N, Oh J. Recent Advances in Diagnostic, Prognostic, and Disease-Monitoring Biomarkers in Multiple Sclerosis. Neurol Clin 2024; 42:15-38. [PMID: 37980112 DOI: 10.1016/j.ncl.2023.06.008] [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] [Indexed: 11/20/2023]
Abstract
Multiple sclerosis (MS) is a highly heterogeneous disease. Currently, a combination of clinical features, MRI, and cerebrospinal fluid markers are used in clinical practice for diagnosis and treatment decisions. In recent years, there has been considerable effort to develop novel biomarkers that better reflect the pathologic substrates of the disease to aid in diagnosis and early prognosis, evaluation of ongoing inflammatory activity, detection and monitoring of disease progression, prediction of treatment response, and monitoring of disease-modifying treatment safety. In this review, the authors provide an overview of promising recent developments in diagnostic, prognostic, and disease-monitoring/treatment-response biomarkers in MS.
Collapse
Affiliation(s)
- Anibal Chertcoff
- Division of Neurology, Department of Medicine, St. Michael's Hospital, University of Toronto, 30 Bond Street, PGT 17-742, Toronto, Ontario M5B 1W8, Canada
| | - Raphael Schneider
- Division of Neurology, Department of Medicine, St. Michael's Hospital, University of Toronto, 30 Bond Street, PGT 17-742, Toronto, Ontario M5B 1W8, Canada
| | - Christina J Azevedo
- Department of Neurology, Keck School of Medicine, University of Southern California, HCT 1520 San Pablo Street, Health Sciences Campus, Los Angeles, CA 90033, USA
| | - Nancy Sicotte
- Department of Neurology, Cedars-Sinai Medical Center, 127 S San Vicente Boulevard, 6th floor, Suite A6600, Los Angeles, CA 90048, USA
| | - Jiwon Oh
- Division of Neurology, Department of Medicine, St. Michael's Hospital, University of Toronto, 30 Bond Street, PGT 17-742, Toronto, Ontario M5B 1W8, Canada; Department of Neurology, Johns Hopkins University, Baltimore, MD, USA.
| |
Collapse
|
4
|
Kreiter D, Postma AA, Hupperts R, Gerlach O. Hallmarks of spinal cord pathology in multiple sclerosis. J Neurol Sci 2024; 456:122846. [PMID: 38142540 DOI: 10.1016/j.jns.2023.122846] [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: 10/19/2023] [Accepted: 12/13/2023] [Indexed: 12/26/2023]
Abstract
A disparity exists between spinal cord and brain involvement in multiple sclerosis (MS), each independently contributing to disability. Underlying differences between brain and cord are not just anatomical in nature (volume, white/grey matter organization, vascularization), but also in barrier functions (differences in function and composition of the blood-spinal cord barrier compared to blood-brain barrier) and possibly in repair mechanisms. Also, immunological phenotypes seem to influence localization of inflammatory activity. Whereas the brain has gained a lot of attention in MS research, the spinal cord lags behind. Advanced imaging techniques and biomarkers are improving and providing us with tools to uncover the mechanisms of spinal cord pathology in MS. In the present review, we elaborate on the underlying anatomical and physiological factors driving differences between brain and cord involvement in MS and review current literature on pathophysiology of spinal cord involvement in MS and the observed differences to brain involvement.
Collapse
Affiliation(s)
- Daniel Kreiter
- Academic MS Center Zuyd, Department of Neurology, Zuyderland MC, Sittard-Geleen, the Netherlands; School for Mental Health and Neuroscience, Department of Neurology, Maastricht University Medical Center, Maastricht, the Netherlands.
| | - Alida A Postma
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands; School for Mental Health and Neuroscience, Department of Neurology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Raymond Hupperts
- Academic MS Center Zuyd, Department of Neurology, Zuyderland MC, Sittard-Geleen, the Netherlands; School for Mental Health and Neuroscience, Department of Neurology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Oliver Gerlach
- Academic MS Center Zuyd, Department of Neurology, Zuyderland MC, Sittard-Geleen, the Netherlands; School for Mental Health and Neuroscience, Department of Neurology, Maastricht University Medical Center, Maastricht, the Netherlands
| |
Collapse
|
5
|
Cagol A, Benkert P, Melie-Garcia L, Schaedelin SA, Leber S, Tsagkas C, Barakovic M, Galbusera R, Lu PJ, Weigel M, Ruberte E, Radue EW, Yaldizli Ö, Oechtering J, Lorscheider J, D'Souza M, Fischer-Barnicol B, Müller S, Achtnichts L, Vehoff J, Disanto G, Findling O, Chan A, Salmen A, Pot C, Bridel C, Zecca C, Derfuss T, Lieb JM, Remonda L, Wagner F, Vargas MI, Du Pasquier RA, Lalive PH, Pravatà E, Weber J, Cattin PC, Absinta M, Gobbi C, Leppert D, Kappos L, Kuhle J, Granziera C. Association of Spinal Cord Atrophy and Brain Paramagnetic Rim Lesions With Progression Independent of Relapse Activity in People With MS. Neurology 2024; 102:e207768. [PMID: 38165377 PMCID: PMC10834139 DOI: 10.1212/wnl.0000000000207768] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 06/08/2023] [Accepted: 09/18/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Progression independent of relapse activity (PIRA) is a crucial determinant of overall disability accumulation in multiple sclerosis (MS). Accelerated brain atrophy has been shown in patients experiencing PIRA. In this study, we assessed the relation between PIRA and neurodegenerative processes reflected by (1) longitudinal spinal cord atrophy and (2) brain paramagnetic rim lesions (PRLs). Besides, the same relationship was investigated in progressive MS (PMS). Last, we explored the value of cross-sectional brain and spinal cord volumetric measurements in predicting PIRA. METHODS From an ongoing multicentric cohort study, we selected patients with MS with (1) availability of a susceptibility-based MRI scan and (2) regular clinical and conventional MRI follow-up in the 4 years before the susceptibility-based MRI. Comparisons in spinal cord atrophy rates (explored with linear mixed-effect models) and PRL count (explored with negative binomial regression models) were performed between: (1) relapsing-remitting (RRMS) and PMS phenotypes and (2) patients experiencing PIRA and patients without confirmed disability accumulation (CDA) during follow-up (both considering the entire cohort and the subgroup of patients with RRMS). Associations between baseline MRI volumetric measurements and time to PIRA were explored with multivariable Cox regression analyses. RESULTS In total, 445 patients with MS (64.9% female; mean [SD] age at baseline 45.0 [11.4] years; 11.2% with PMS) were enrolled. Compared with patients with RRMS, those with PMS had accelerated cervical cord atrophy (mean difference in annual percentage volume change [MD-APC] -1.41; p = 0.004) and higher PRL load (incidence rate ratio [IRR] 1.93; p = 0.005). Increased spinal cord atrophy (MD-APC -1.39; p = 0.0008) and PRL burden (IRR 1.95; p = 0.0008) were measured in patients with PIRA compared with patients without CDA; such differences were also confirmed when restricting the analysis to patients with RRMS. Baseline volumetric measurements of the cervical cord, whole brain, and cerebral cortex significantly predicted time to PIRA (all p ≤ 0.002). DISCUSSION Our results show that PIRA is associated with both increased spinal cord atrophy and PRL burden, and this association is evident also in patients with RRMS. These findings further point to the need to develop targeted treatment strategies for PIRA to prevent irreversible neuroaxonal loss and optimize long-term outcomes of patients with MS.
Collapse
Affiliation(s)
- Alessandro Cagol
- From Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine (A. Cagol, L.M.-G., S.L., C.T., M.B., R.G., P.-J.L., M.W., E.R., E.-W.R., Ö.Y., L.K., C. Granziera), Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (A. Cagol, L.M.-G., C.T., M.B., R.G., P.-J.L., M.W., E.R.,O.Y., J.O., J.L., M.D.S., B.F.-B., T.D., D.L., L.K., J.K., C. Granziera), Department of Clinical Research (P.B., S.A.S.), Division of Radiological Physics, Department of Radiology (M.W.), and Division of Diagnostic and Interventional Neuroradiology, Clinic for Radiology and Nuclear Medicine (J.M.L.), University Hospital Basel, University of Basel, Switzerland; Translational Neuroradiology Section (C.T), National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD; Medical Image Analysis Center (MIAC) and Quantitative Biomedical Imaging Group (qbig), Department of Biomedical Engineering (E.R., P.C.C.), University Basel; Departments of Neurology (S.M., J.V.) and Radiology (J.W.), Cantonal Hospital St. Gallen; Departments of Neurology (L.A., O.F.) and Radiology (L.R.), Cantonal Hospital Aarau; Departments of Neurology (G.D., C.Z., C.G.) and Neuroradiology (E.P.), Neurocenter of Southern Switzerland, Lugano; Departments of Neurology, Inselspital (A. Chan, A.S.), and Diagnostic and Interventional Neuroradiology, Inselspital (F.W.) Bern University Hospital and University of Bern; Departments of Clinical Neurosciences, Division of Neurology (C.P., R.A.D.P.), and Radiology (R.A.D.P.) Lausanne University Hospital and University of Lausanne; Department of Clinical Neurosciences, Division of Neurology (C.B., P.H.L.), and Radiology (M.I.V.) Geneva University Hospitals and Faculty of Medicine; Faculty of Biomedical Sciences (C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Institute of Experimental Neurology, Division of Neuroscience (M.A.); Vita-Salute San Raffaele University and Hospital, Milan, Italy
| | - Pascal Benkert
- From Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine (A. Cagol, L.M.-G., S.L., C.T., M.B., R.G., P.-J.L., M.W., E.R., E.-W.R., Ö.Y., L.K., C. Granziera), Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (A. Cagol, L.M.-G., C.T., M.B., R.G., P.-J.L., M.W., E.R.,O.Y., J.O., J.L., M.D.S., B.F.-B., T.D., D.L., L.K., J.K., C. Granziera), Department of Clinical Research (P.B., S.A.S.), Division of Radiological Physics, Department of Radiology (M.W.), and Division of Diagnostic and Interventional Neuroradiology, Clinic for Radiology and Nuclear Medicine (J.M.L.), University Hospital Basel, University of Basel, Switzerland; Translational Neuroradiology Section (C.T), National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD; Medical Image Analysis Center (MIAC) and Quantitative Biomedical Imaging Group (qbig), Department of Biomedical Engineering (E.R., P.C.C.), University Basel; Departments of Neurology (S.M., J.V.) and Radiology (J.W.), Cantonal Hospital St. Gallen; Departments of Neurology (L.A., O.F.) and Radiology (L.R.), Cantonal Hospital Aarau; Departments of Neurology (G.D., C.Z., C.G.) and Neuroradiology (E.P.), Neurocenter of Southern Switzerland, Lugano; Departments of Neurology, Inselspital (A. Chan, A.S.), and Diagnostic and Interventional Neuroradiology, Inselspital (F.W.) Bern University Hospital and University of Bern; Departments of Clinical Neurosciences, Division of Neurology (C.P., R.A.D.P.), and Radiology (R.A.D.P.) Lausanne University Hospital and University of Lausanne; Department of Clinical Neurosciences, Division of Neurology (C.B., P.H.L.), and Radiology (M.I.V.) Geneva University Hospitals and Faculty of Medicine; Faculty of Biomedical Sciences (C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Institute of Experimental Neurology, Division of Neuroscience (M.A.); Vita-Salute San Raffaele University and Hospital, Milan, Italy
| | - Lester Melie-Garcia
- From Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine (A. Cagol, L.M.-G., S.L., C.T., M.B., R.G., P.-J.L., M.W., E.R., E.-W.R., Ö.Y., L.K., C. Granziera), Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (A. Cagol, L.M.-G., C.T., M.B., R.G., P.-J.L., M.W., E.R.,O.Y., J.O., J.L., M.D.S., B.F.-B., T.D., D.L., L.K., J.K., C. Granziera), Department of Clinical Research (P.B., S.A.S.), Division of Radiological Physics, Department of Radiology (M.W.), and Division of Diagnostic and Interventional Neuroradiology, Clinic for Radiology and Nuclear Medicine (J.M.L.), University Hospital Basel, University of Basel, Switzerland; Translational Neuroradiology Section (C.T), National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD; Medical Image Analysis Center (MIAC) and Quantitative Biomedical Imaging Group (qbig), Department of Biomedical Engineering (E.R., P.C.C.), University Basel; Departments of Neurology (S.M., J.V.) and Radiology (J.W.), Cantonal Hospital St. Gallen; Departments of Neurology (L.A., O.F.) and Radiology (L.R.), Cantonal Hospital Aarau; Departments of Neurology (G.D., C.Z., C.G.) and Neuroradiology (E.P.), Neurocenter of Southern Switzerland, Lugano; Departments of Neurology, Inselspital (A. Chan, A.S.), and Diagnostic and Interventional Neuroradiology, Inselspital (F.W.) Bern University Hospital and University of Bern; Departments of Clinical Neurosciences, Division of Neurology (C.P., R.A.D.P.), and Radiology (R.A.D.P.) Lausanne University Hospital and University of Lausanne; Department of Clinical Neurosciences, Division of Neurology (C.B., P.H.L.), and Radiology (M.I.V.) Geneva University Hospitals and Faculty of Medicine; Faculty of Biomedical Sciences (C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Institute of Experimental Neurology, Division of Neuroscience (M.A.); Vita-Salute San Raffaele University and Hospital, Milan, Italy
| | - Sabine A Schaedelin
- From Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine (A. Cagol, L.M.-G., S.L., C.T., M.B., R.G., P.-J.L., M.W., E.R., E.-W.R., Ö.Y., L.K., C. Granziera), Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (A. Cagol, L.M.-G., C.T., M.B., R.G., P.-J.L., M.W., E.R.,O.Y., J.O., J.L., M.D.S., B.F.-B., T.D., D.L., L.K., J.K., C. Granziera), Department of Clinical Research (P.B., S.A.S.), Division of Radiological Physics, Department of Radiology (M.W.), and Division of Diagnostic and Interventional Neuroradiology, Clinic for Radiology and Nuclear Medicine (J.M.L.), University Hospital Basel, University of Basel, Switzerland; Translational Neuroradiology Section (C.T), National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD; Medical Image Analysis Center (MIAC) and Quantitative Biomedical Imaging Group (qbig), Department of Biomedical Engineering (E.R., P.C.C.), University Basel; Departments of Neurology (S.M., J.V.) and Radiology (J.W.), Cantonal Hospital St. Gallen; Departments of Neurology (L.A., O.F.) and Radiology (L.R.), Cantonal Hospital Aarau; Departments of Neurology (G.D., C.Z., C.G.) and Neuroradiology (E.P.), Neurocenter of Southern Switzerland, Lugano; Departments of Neurology, Inselspital (A. Chan, A.S.), and Diagnostic and Interventional Neuroradiology, Inselspital (F.W.) Bern University Hospital and University of Bern; Departments of Clinical Neurosciences, Division of Neurology (C.P., R.A.D.P.), and Radiology (R.A.D.P.) Lausanne University Hospital and University of Lausanne; Department of Clinical Neurosciences, Division of Neurology (C.B., P.H.L.), and Radiology (M.I.V.) Geneva University Hospitals and Faculty of Medicine; Faculty of Biomedical Sciences (C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Institute of Experimental Neurology, Division of Neuroscience (M.A.); Vita-Salute San Raffaele University and Hospital, Milan, Italy
| | - Selina Leber
- From Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine (A. Cagol, L.M.-G., S.L., C.T., M.B., R.G., P.-J.L., M.W., E.R., E.-W.R., Ö.Y., L.K., C. Granziera), Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (A. Cagol, L.M.-G., C.T., M.B., R.G., P.-J.L., M.W., E.R.,O.Y., J.O., J.L., M.D.S., B.F.-B., T.D., D.L., L.K., J.K., C. Granziera), Department of Clinical Research (P.B., S.A.S.), Division of Radiological Physics, Department of Radiology (M.W.), and Division of Diagnostic and Interventional Neuroradiology, Clinic for Radiology and Nuclear Medicine (J.M.L.), University Hospital Basel, University of Basel, Switzerland; Translational Neuroradiology Section (C.T), National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD; Medical Image Analysis Center (MIAC) and Quantitative Biomedical Imaging Group (qbig), Department of Biomedical Engineering (E.R., P.C.C.), University Basel; Departments of Neurology (S.M., J.V.) and Radiology (J.W.), Cantonal Hospital St. Gallen; Departments of Neurology (L.A., O.F.) and Radiology (L.R.), Cantonal Hospital Aarau; Departments of Neurology (G.D., C.Z., C.G.) and Neuroradiology (E.P.), Neurocenter of Southern Switzerland, Lugano; Departments of Neurology, Inselspital (A. Chan, A.S.), and Diagnostic and Interventional Neuroradiology, Inselspital (F.W.) Bern University Hospital and University of Bern; Departments of Clinical Neurosciences, Division of Neurology (C.P., R.A.D.P.), and Radiology (R.A.D.P.) Lausanne University Hospital and University of Lausanne; Department of Clinical Neurosciences, Division of Neurology (C.B., P.H.L.), and Radiology (M.I.V.) Geneva University Hospitals and Faculty of Medicine; Faculty of Biomedical Sciences (C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Institute of Experimental Neurology, Division of Neuroscience (M.A.); Vita-Salute San Raffaele University and Hospital, Milan, Italy
| | - Charidimos Tsagkas
- From Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine (A. Cagol, L.M.-G., S.L., C.T., M.B., R.G., P.-J.L., M.W., E.R., E.-W.R., Ö.Y., L.K., C. Granziera), Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (A. Cagol, L.M.-G., C.T., M.B., R.G., P.-J.L., M.W., E.R.,O.Y., J.O., J.L., M.D.S., B.F.-B., T.D., D.L., L.K., J.K., C. Granziera), Department of Clinical Research (P.B., S.A.S.), Division of Radiological Physics, Department of Radiology (M.W.), and Division of Diagnostic and Interventional Neuroradiology, Clinic for Radiology and Nuclear Medicine (J.M.L.), University Hospital Basel, University of Basel, Switzerland; Translational Neuroradiology Section (C.T), National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD; Medical Image Analysis Center (MIAC) and Quantitative Biomedical Imaging Group (qbig), Department of Biomedical Engineering (E.R., P.C.C.), University Basel; Departments of Neurology (S.M., J.V.) and Radiology (J.W.), Cantonal Hospital St. Gallen; Departments of Neurology (L.A., O.F.) and Radiology (L.R.), Cantonal Hospital Aarau; Departments of Neurology (G.D., C.Z., C.G.) and Neuroradiology (E.P.), Neurocenter of Southern Switzerland, Lugano; Departments of Neurology, Inselspital (A. Chan, A.S.), and Diagnostic and Interventional Neuroradiology, Inselspital (F.W.) Bern University Hospital and University of Bern; Departments of Clinical Neurosciences, Division of Neurology (C.P., R.A.D.P.), and Radiology (R.A.D.P.) Lausanne University Hospital and University of Lausanne; Department of Clinical Neurosciences, Division of Neurology (C.B., P.H.L.), and Radiology (M.I.V.) Geneva University Hospitals and Faculty of Medicine; Faculty of Biomedical Sciences (C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Institute of Experimental Neurology, Division of Neuroscience (M.A.); Vita-Salute San Raffaele University and Hospital, Milan, Italy
| | - Muhamed Barakovic
- From Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine (A. Cagol, L.M.-G., S.L., C.T., M.B., R.G., P.-J.L., M.W., E.R., E.-W.R., Ö.Y., L.K., C. Granziera), Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (A. Cagol, L.M.-G., C.T., M.B., R.G., P.-J.L., M.W., E.R.,O.Y., J.O., J.L., M.D.S., B.F.-B., T.D., D.L., L.K., J.K., C. Granziera), Department of Clinical Research (P.B., S.A.S.), Division of Radiological Physics, Department of Radiology (M.W.), and Division of Diagnostic and Interventional Neuroradiology, Clinic for Radiology and Nuclear Medicine (J.M.L.), University Hospital Basel, University of Basel, Switzerland; Translational Neuroradiology Section (C.T), National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD; Medical Image Analysis Center (MIAC) and Quantitative Biomedical Imaging Group (qbig), Department of Biomedical Engineering (E.R., P.C.C.), University Basel; Departments of Neurology (S.M., J.V.) and Radiology (J.W.), Cantonal Hospital St. Gallen; Departments of Neurology (L.A., O.F.) and Radiology (L.R.), Cantonal Hospital Aarau; Departments of Neurology (G.D., C.Z., C.G.) and Neuroradiology (E.P.), Neurocenter of Southern Switzerland, Lugano; Departments of Neurology, Inselspital (A. Chan, A.S.), and Diagnostic and Interventional Neuroradiology, Inselspital (F.W.) Bern University Hospital and University of Bern; Departments of Clinical Neurosciences, Division of Neurology (C.P., R.A.D.P.), and Radiology (R.A.D.P.) Lausanne University Hospital and University of Lausanne; Department of Clinical Neurosciences, Division of Neurology (C.B., P.H.L.), and Radiology (M.I.V.) Geneva University Hospitals and Faculty of Medicine; Faculty of Biomedical Sciences (C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Institute of Experimental Neurology, Division of Neuroscience (M.A.); Vita-Salute San Raffaele University and Hospital, Milan, Italy
| | - Riccardo Galbusera
- From Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine (A. Cagol, L.M.-G., S.L., C.T., M.B., R.G., P.-J.L., M.W., E.R., E.-W.R., Ö.Y., L.K., C. Granziera), Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (A. Cagol, L.M.-G., C.T., M.B., R.G., P.-J.L., M.W., E.R.,O.Y., J.O., J.L., M.D.S., B.F.-B., T.D., D.L., L.K., J.K., C. Granziera), Department of Clinical Research (P.B., S.A.S.), Division of Radiological Physics, Department of Radiology (M.W.), and Division of Diagnostic and Interventional Neuroradiology, Clinic for Radiology and Nuclear Medicine (J.M.L.), University Hospital Basel, University of Basel, Switzerland; Translational Neuroradiology Section (C.T), National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD; Medical Image Analysis Center (MIAC) and Quantitative Biomedical Imaging Group (qbig), Department of Biomedical Engineering (E.R., P.C.C.), University Basel; Departments of Neurology (S.M., J.V.) and Radiology (J.W.), Cantonal Hospital St. Gallen; Departments of Neurology (L.A., O.F.) and Radiology (L.R.), Cantonal Hospital Aarau; Departments of Neurology (G.D., C.Z., C.G.) and Neuroradiology (E.P.), Neurocenter of Southern Switzerland, Lugano; Departments of Neurology, Inselspital (A. Chan, A.S.), and Diagnostic and Interventional Neuroradiology, Inselspital (F.W.) Bern University Hospital and University of Bern; Departments of Clinical Neurosciences, Division of Neurology (C.P., R.A.D.P.), and Radiology (R.A.D.P.) Lausanne University Hospital and University of Lausanne; Department of Clinical Neurosciences, Division of Neurology (C.B., P.H.L.), and Radiology (M.I.V.) Geneva University Hospitals and Faculty of Medicine; Faculty of Biomedical Sciences (C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Institute of Experimental Neurology, Division of Neuroscience (M.A.); Vita-Salute San Raffaele University and Hospital, Milan, Italy
| | - Po-Jui Lu
- From Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine (A. Cagol, L.M.-G., S.L., C.T., M.B., R.G., P.-J.L., M.W., E.R., E.-W.R., Ö.Y., L.K., C. Granziera), Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (A. Cagol, L.M.-G., C.T., M.B., R.G., P.-J.L., M.W., E.R.,O.Y., J.O., J.L., M.D.S., B.F.-B., T.D., D.L., L.K., J.K., C. Granziera), Department of Clinical Research (P.B., S.A.S.), Division of Radiological Physics, Department of Radiology (M.W.), and Division of Diagnostic and Interventional Neuroradiology, Clinic for Radiology and Nuclear Medicine (J.M.L.), University Hospital Basel, University of Basel, Switzerland; Translational Neuroradiology Section (C.T), National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD; Medical Image Analysis Center (MIAC) and Quantitative Biomedical Imaging Group (qbig), Department of Biomedical Engineering (E.R., P.C.C.), University Basel; Departments of Neurology (S.M., J.V.) and Radiology (J.W.), Cantonal Hospital St. Gallen; Departments of Neurology (L.A., O.F.) and Radiology (L.R.), Cantonal Hospital Aarau; Departments of Neurology (G.D., C.Z., C.G.) and Neuroradiology (E.P.), Neurocenter of Southern Switzerland, Lugano; Departments of Neurology, Inselspital (A. Chan, A.S.), and Diagnostic and Interventional Neuroradiology, Inselspital (F.W.) Bern University Hospital and University of Bern; Departments of Clinical Neurosciences, Division of Neurology (C.P., R.A.D.P.), and Radiology (R.A.D.P.) Lausanne University Hospital and University of Lausanne; Department of Clinical Neurosciences, Division of Neurology (C.B., P.H.L.), and Radiology (M.I.V.) Geneva University Hospitals and Faculty of Medicine; Faculty of Biomedical Sciences (C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Institute of Experimental Neurology, Division of Neuroscience (M.A.); Vita-Salute San Raffaele University and Hospital, Milan, Italy
| | - Matthias Weigel
- From Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine (A. Cagol, L.M.-G., S.L., C.T., M.B., R.G., P.-J.L., M.W., E.R., E.-W.R., Ö.Y., L.K., C. Granziera), Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (A. Cagol, L.M.-G., C.T., M.B., R.G., P.-J.L., M.W., E.R.,O.Y., J.O., J.L., M.D.S., B.F.-B., T.D., D.L., L.K., J.K., C. Granziera), Department of Clinical Research (P.B., S.A.S.), Division of Radiological Physics, Department of Radiology (M.W.), and Division of Diagnostic and Interventional Neuroradiology, Clinic for Radiology and Nuclear Medicine (J.M.L.), University Hospital Basel, University of Basel, Switzerland; Translational Neuroradiology Section (C.T), National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD; Medical Image Analysis Center (MIAC) and Quantitative Biomedical Imaging Group (qbig), Department of Biomedical Engineering (E.R., P.C.C.), University Basel; Departments of Neurology (S.M., J.V.) and Radiology (J.W.), Cantonal Hospital St. Gallen; Departments of Neurology (L.A., O.F.) and Radiology (L.R.), Cantonal Hospital Aarau; Departments of Neurology (G.D., C.Z., C.G.) and Neuroradiology (E.P.), Neurocenter of Southern Switzerland, Lugano; Departments of Neurology, Inselspital (A. Chan, A.S.), and Diagnostic and Interventional Neuroradiology, Inselspital (F.W.) Bern University Hospital and University of Bern; Departments of Clinical Neurosciences, Division of Neurology (C.P., R.A.D.P.), and Radiology (R.A.D.P.) Lausanne University Hospital and University of Lausanne; Department of Clinical Neurosciences, Division of Neurology (C.B., P.H.L.), and Radiology (M.I.V.) Geneva University Hospitals and Faculty of Medicine; Faculty of Biomedical Sciences (C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Institute of Experimental Neurology, Division of Neuroscience (M.A.); Vita-Salute San Raffaele University and Hospital, Milan, Italy
| | - Esther Ruberte
- From Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine (A. Cagol, L.M.-G., S.L., C.T., M.B., R.G., P.-J.L., M.W., E.R., E.-W.R., Ö.Y., L.K., C. Granziera), Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (A. Cagol, L.M.-G., C.T., M.B., R.G., P.-J.L., M.W., E.R.,O.Y., J.O., J.L., M.D.S., B.F.-B., T.D., D.L., L.K., J.K., C. Granziera), Department of Clinical Research (P.B., S.A.S.), Division of Radiological Physics, Department of Radiology (M.W.), and Division of Diagnostic and Interventional Neuroradiology, Clinic for Radiology and Nuclear Medicine (J.M.L.), University Hospital Basel, University of Basel, Switzerland; Translational Neuroradiology Section (C.T), National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD; Medical Image Analysis Center (MIAC) and Quantitative Biomedical Imaging Group (qbig), Department of Biomedical Engineering (E.R., P.C.C.), University Basel; Departments of Neurology (S.M., J.V.) and Radiology (J.W.), Cantonal Hospital St. Gallen; Departments of Neurology (L.A., O.F.) and Radiology (L.R.), Cantonal Hospital Aarau; Departments of Neurology (G.D., C.Z., C.G.) and Neuroradiology (E.P.), Neurocenter of Southern Switzerland, Lugano; Departments of Neurology, Inselspital (A. Chan, A.S.), and Diagnostic and Interventional Neuroradiology, Inselspital (F.W.) Bern University Hospital and University of Bern; Departments of Clinical Neurosciences, Division of Neurology (C.P., R.A.D.P.), and Radiology (R.A.D.P.) Lausanne University Hospital and University of Lausanne; Department of Clinical Neurosciences, Division of Neurology (C.B., P.H.L.), and Radiology (M.I.V.) Geneva University Hospitals and Faculty of Medicine; Faculty of Biomedical Sciences (C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Institute of Experimental Neurology, Division of Neuroscience (M.A.); Vita-Salute San Raffaele University and Hospital, Milan, Italy
| | - Ernst-Wilhelm Radue
- From Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine (A. Cagol, L.M.-G., S.L., C.T., M.B., R.G., P.-J.L., M.W., E.R., E.-W.R., Ö.Y., L.K., C. Granziera), Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (A. Cagol, L.M.-G., C.T., M.B., R.G., P.-J.L., M.W., E.R.,O.Y., J.O., J.L., M.D.S., B.F.-B., T.D., D.L., L.K., J.K., C. Granziera), Department of Clinical Research (P.B., S.A.S.), Division of Radiological Physics, Department of Radiology (M.W.), and Division of Diagnostic and Interventional Neuroradiology, Clinic for Radiology and Nuclear Medicine (J.M.L.), University Hospital Basel, University of Basel, Switzerland; Translational Neuroradiology Section (C.T), National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD; Medical Image Analysis Center (MIAC) and Quantitative Biomedical Imaging Group (qbig), Department of Biomedical Engineering (E.R., P.C.C.), University Basel; Departments of Neurology (S.M., J.V.) and Radiology (J.W.), Cantonal Hospital St. Gallen; Departments of Neurology (L.A., O.F.) and Radiology (L.R.), Cantonal Hospital Aarau; Departments of Neurology (G.D., C.Z., C.G.) and Neuroradiology (E.P.), Neurocenter of Southern Switzerland, Lugano; Departments of Neurology, Inselspital (A. Chan, A.S.), and Diagnostic and Interventional Neuroradiology, Inselspital (F.W.) Bern University Hospital and University of Bern; Departments of Clinical Neurosciences, Division of Neurology (C.P., R.A.D.P.), and Radiology (R.A.D.P.) Lausanne University Hospital and University of Lausanne; Department of Clinical Neurosciences, Division of Neurology (C.B., P.H.L.), and Radiology (M.I.V.) Geneva University Hospitals and Faculty of Medicine; Faculty of Biomedical Sciences (C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Institute of Experimental Neurology, Division of Neuroscience (M.A.); Vita-Salute San Raffaele University and Hospital, Milan, Italy
| | - Özgür Yaldizli
- From Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine (A. Cagol, L.M.-G., S.L., C.T., M.B., R.G., P.-J.L., M.W., E.R., E.-W.R., Ö.Y., L.K., C. Granziera), Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (A. Cagol, L.M.-G., C.T., M.B., R.G., P.-J.L., M.W., E.R.,O.Y., J.O., J.L., M.D.S., B.F.-B., T.D., D.L., L.K., J.K., C. Granziera), Department of Clinical Research (P.B., S.A.S.), Division of Radiological Physics, Department of Radiology (M.W.), and Division of Diagnostic and Interventional Neuroradiology, Clinic for Radiology and Nuclear Medicine (J.M.L.), University Hospital Basel, University of Basel, Switzerland; Translational Neuroradiology Section (C.T), National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD; Medical Image Analysis Center (MIAC) and Quantitative Biomedical Imaging Group (qbig), Department of Biomedical Engineering (E.R., P.C.C.), University Basel; Departments of Neurology (S.M., J.V.) and Radiology (J.W.), Cantonal Hospital St. Gallen; Departments of Neurology (L.A., O.F.) and Radiology (L.R.), Cantonal Hospital Aarau; Departments of Neurology (G.D., C.Z., C.G.) and Neuroradiology (E.P.), Neurocenter of Southern Switzerland, Lugano; Departments of Neurology, Inselspital (A. Chan, A.S.), and Diagnostic and Interventional Neuroradiology, Inselspital (F.W.) Bern University Hospital and University of Bern; Departments of Clinical Neurosciences, Division of Neurology (C.P., R.A.D.P.), and Radiology (R.A.D.P.) Lausanne University Hospital and University of Lausanne; Department of Clinical Neurosciences, Division of Neurology (C.B., P.H.L.), and Radiology (M.I.V.) Geneva University Hospitals and Faculty of Medicine; Faculty of Biomedical Sciences (C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Institute of Experimental Neurology, Division of Neuroscience (M.A.); Vita-Salute San Raffaele University and Hospital, Milan, Italy
| | - Johanna Oechtering
- From Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine (A. Cagol, L.M.-G., S.L., C.T., M.B., R.G., P.-J.L., M.W., E.R., E.-W.R., Ö.Y., L.K., C. Granziera), Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (A. Cagol, L.M.-G., C.T., M.B., R.G., P.-J.L., M.W., E.R.,O.Y., J.O., J.L., M.D.S., B.F.-B., T.D., D.L., L.K., J.K., C. Granziera), Department of Clinical Research (P.B., S.A.S.), Division of Radiological Physics, Department of Radiology (M.W.), and Division of Diagnostic and Interventional Neuroradiology, Clinic for Radiology and Nuclear Medicine (J.M.L.), University Hospital Basel, University of Basel, Switzerland; Translational Neuroradiology Section (C.T), National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD; Medical Image Analysis Center (MIAC) and Quantitative Biomedical Imaging Group (qbig), Department of Biomedical Engineering (E.R., P.C.C.), University Basel; Departments of Neurology (S.M., J.V.) and Radiology (J.W.), Cantonal Hospital St. Gallen; Departments of Neurology (L.A., O.F.) and Radiology (L.R.), Cantonal Hospital Aarau; Departments of Neurology (G.D., C.Z., C.G.) and Neuroradiology (E.P.), Neurocenter of Southern Switzerland, Lugano; Departments of Neurology, Inselspital (A. Chan, A.S.), and Diagnostic and Interventional Neuroradiology, Inselspital (F.W.) Bern University Hospital and University of Bern; Departments of Clinical Neurosciences, Division of Neurology (C.P., R.A.D.P.), and Radiology (R.A.D.P.) Lausanne University Hospital and University of Lausanne; Department of Clinical Neurosciences, Division of Neurology (C.B., P.H.L.), and Radiology (M.I.V.) Geneva University Hospitals and Faculty of Medicine; Faculty of Biomedical Sciences (C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Institute of Experimental Neurology, Division of Neuroscience (M.A.); Vita-Salute San Raffaele University and Hospital, Milan, Italy
| | - Johannes Lorscheider
- From Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine (A. Cagol, L.M.-G., S.L., C.T., M.B., R.G., P.-J.L., M.W., E.R., E.-W.R., Ö.Y., L.K., C. Granziera), Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (A. Cagol, L.M.-G., C.T., M.B., R.G., P.-J.L., M.W., E.R.,O.Y., J.O., J.L., M.D.S., B.F.-B., T.D., D.L., L.K., J.K., C. Granziera), Department of Clinical Research (P.B., S.A.S.), Division of Radiological Physics, Department of Radiology (M.W.), and Division of Diagnostic and Interventional Neuroradiology, Clinic for Radiology and Nuclear Medicine (J.M.L.), University Hospital Basel, University of Basel, Switzerland; Translational Neuroradiology Section (C.T), National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD; Medical Image Analysis Center (MIAC) and Quantitative Biomedical Imaging Group (qbig), Department of Biomedical Engineering (E.R., P.C.C.), University Basel; Departments of Neurology (S.M., J.V.) and Radiology (J.W.), Cantonal Hospital St. Gallen; Departments of Neurology (L.A., O.F.) and Radiology (L.R.), Cantonal Hospital Aarau; Departments of Neurology (G.D., C.Z., C.G.) and Neuroradiology (E.P.), Neurocenter of Southern Switzerland, Lugano; Departments of Neurology, Inselspital (A. Chan, A.S.), and Diagnostic and Interventional Neuroradiology, Inselspital (F.W.) Bern University Hospital and University of Bern; Departments of Clinical Neurosciences, Division of Neurology (C.P., R.A.D.P.), and Radiology (R.A.D.P.) Lausanne University Hospital and University of Lausanne; Department of Clinical Neurosciences, Division of Neurology (C.B., P.H.L.), and Radiology (M.I.V.) Geneva University Hospitals and Faculty of Medicine; Faculty of Biomedical Sciences (C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Institute of Experimental Neurology, Division of Neuroscience (M.A.); Vita-Salute San Raffaele University and Hospital, Milan, Italy
| | - Marcus D'Souza
- From Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine (A. Cagol, L.M.-G., S.L., C.T., M.B., R.G., P.-J.L., M.W., E.R., E.-W.R., Ö.Y., L.K., C. Granziera), Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (A. Cagol, L.M.-G., C.T., M.B., R.G., P.-J.L., M.W., E.R.,O.Y., J.O., J.L., M.D.S., B.F.-B., T.D., D.L., L.K., J.K., C. Granziera), Department of Clinical Research (P.B., S.A.S.), Division of Radiological Physics, Department of Radiology (M.W.), and Division of Diagnostic and Interventional Neuroradiology, Clinic for Radiology and Nuclear Medicine (J.M.L.), University Hospital Basel, University of Basel, Switzerland; Translational Neuroradiology Section (C.T), National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD; Medical Image Analysis Center (MIAC) and Quantitative Biomedical Imaging Group (qbig), Department of Biomedical Engineering (E.R., P.C.C.), University Basel; Departments of Neurology (S.M., J.V.) and Radiology (J.W.), Cantonal Hospital St. Gallen; Departments of Neurology (L.A., O.F.) and Radiology (L.R.), Cantonal Hospital Aarau; Departments of Neurology (G.D., C.Z., C.G.) and Neuroradiology (E.P.), Neurocenter of Southern Switzerland, Lugano; Departments of Neurology, Inselspital (A. Chan, A.S.), and Diagnostic and Interventional Neuroradiology, Inselspital (F.W.) Bern University Hospital and University of Bern; Departments of Clinical Neurosciences, Division of Neurology (C.P., R.A.D.P.), and Radiology (R.A.D.P.) Lausanne University Hospital and University of Lausanne; Department of Clinical Neurosciences, Division of Neurology (C.B., P.H.L.), and Radiology (M.I.V.) Geneva University Hospitals and Faculty of Medicine; Faculty of Biomedical Sciences (C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Institute of Experimental Neurology, Division of Neuroscience (M.A.); Vita-Salute San Raffaele University and Hospital, Milan, Italy
| | - Bettina Fischer-Barnicol
- From Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine (A. Cagol, L.M.-G., S.L., C.T., M.B., R.G., P.-J.L., M.W., E.R., E.-W.R., Ö.Y., L.K., C. Granziera), Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (A. Cagol, L.M.-G., C.T., M.B., R.G., P.-J.L., M.W., E.R.,O.Y., J.O., J.L., M.D.S., B.F.-B., T.D., D.L., L.K., J.K., C. Granziera), Department of Clinical Research (P.B., S.A.S.), Division of Radiological Physics, Department of Radiology (M.W.), and Division of Diagnostic and Interventional Neuroradiology, Clinic for Radiology and Nuclear Medicine (J.M.L.), University Hospital Basel, University of Basel, Switzerland; Translational Neuroradiology Section (C.T), National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD; Medical Image Analysis Center (MIAC) and Quantitative Biomedical Imaging Group (qbig), Department of Biomedical Engineering (E.R., P.C.C.), University Basel; Departments of Neurology (S.M., J.V.) and Radiology (J.W.), Cantonal Hospital St. Gallen; Departments of Neurology (L.A., O.F.) and Radiology (L.R.), Cantonal Hospital Aarau; Departments of Neurology (G.D., C.Z., C.G.) and Neuroradiology (E.P.), Neurocenter of Southern Switzerland, Lugano; Departments of Neurology, Inselspital (A. Chan, A.S.), and Diagnostic and Interventional Neuroradiology, Inselspital (F.W.) Bern University Hospital and University of Bern; Departments of Clinical Neurosciences, Division of Neurology (C.P., R.A.D.P.), and Radiology (R.A.D.P.) Lausanne University Hospital and University of Lausanne; Department of Clinical Neurosciences, Division of Neurology (C.B., P.H.L.), and Radiology (M.I.V.) Geneva University Hospitals and Faculty of Medicine; Faculty of Biomedical Sciences (C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Institute of Experimental Neurology, Division of Neuroscience (M.A.); Vita-Salute San Raffaele University and Hospital, Milan, Italy
| | - Stefanie Müller
- From Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine (A. Cagol, L.M.-G., S.L., C.T., M.B., R.G., P.-J.L., M.W., E.R., E.-W.R., Ö.Y., L.K., C. Granziera), Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (A. Cagol, L.M.-G., C.T., M.B., R.G., P.-J.L., M.W., E.R.,O.Y., J.O., J.L., M.D.S., B.F.-B., T.D., D.L., L.K., J.K., C. Granziera), Department of Clinical Research (P.B., S.A.S.), Division of Radiological Physics, Department of Radiology (M.W.), and Division of Diagnostic and Interventional Neuroradiology, Clinic for Radiology and Nuclear Medicine (J.M.L.), University Hospital Basel, University of Basel, Switzerland; Translational Neuroradiology Section (C.T), National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD; Medical Image Analysis Center (MIAC) and Quantitative Biomedical Imaging Group (qbig), Department of Biomedical Engineering (E.R., P.C.C.), University Basel; Departments of Neurology (S.M., J.V.) and Radiology (J.W.), Cantonal Hospital St. Gallen; Departments of Neurology (L.A., O.F.) and Radiology (L.R.), Cantonal Hospital Aarau; Departments of Neurology (G.D., C.Z., C.G.) and Neuroradiology (E.P.), Neurocenter of Southern Switzerland, Lugano; Departments of Neurology, Inselspital (A. Chan, A.S.), and Diagnostic and Interventional Neuroradiology, Inselspital (F.W.) Bern University Hospital and University of Bern; Departments of Clinical Neurosciences, Division of Neurology (C.P., R.A.D.P.), and Radiology (R.A.D.P.) Lausanne University Hospital and University of Lausanne; Department of Clinical Neurosciences, Division of Neurology (C.B., P.H.L.), and Radiology (M.I.V.) Geneva University Hospitals and Faculty of Medicine; Faculty of Biomedical Sciences (C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Institute of Experimental Neurology, Division of Neuroscience (M.A.); Vita-Salute San Raffaele University and Hospital, Milan, Italy
| | - Lutz Achtnichts
- From Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine (A. Cagol, L.M.-G., S.L., C.T., M.B., R.G., P.-J.L., M.W., E.R., E.-W.R., Ö.Y., L.K., C. Granziera), Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (A. Cagol, L.M.-G., C.T., M.B., R.G., P.-J.L., M.W., E.R.,O.Y., J.O., J.L., M.D.S., B.F.-B., T.D., D.L., L.K., J.K., C. Granziera), Department of Clinical Research (P.B., S.A.S.), Division of Radiological Physics, Department of Radiology (M.W.), and Division of Diagnostic and Interventional Neuroradiology, Clinic for Radiology and Nuclear Medicine (J.M.L.), University Hospital Basel, University of Basel, Switzerland; Translational Neuroradiology Section (C.T), National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD; Medical Image Analysis Center (MIAC) and Quantitative Biomedical Imaging Group (qbig), Department of Biomedical Engineering (E.R., P.C.C.), University Basel; Departments of Neurology (S.M., J.V.) and Radiology (J.W.), Cantonal Hospital St. Gallen; Departments of Neurology (L.A., O.F.) and Radiology (L.R.), Cantonal Hospital Aarau; Departments of Neurology (G.D., C.Z., C.G.) and Neuroradiology (E.P.), Neurocenter of Southern Switzerland, Lugano; Departments of Neurology, Inselspital (A. Chan, A.S.), and Diagnostic and Interventional Neuroradiology, Inselspital (F.W.) Bern University Hospital and University of Bern; Departments of Clinical Neurosciences, Division of Neurology (C.P., R.A.D.P.), and Radiology (R.A.D.P.) Lausanne University Hospital and University of Lausanne; Department of Clinical Neurosciences, Division of Neurology (C.B., P.H.L.), and Radiology (M.I.V.) Geneva University Hospitals and Faculty of Medicine; Faculty of Biomedical Sciences (C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Institute of Experimental Neurology, Division of Neuroscience (M.A.); Vita-Salute San Raffaele University and Hospital, Milan, Italy
| | - Jochen Vehoff
- From Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine (A. Cagol, L.M.-G., S.L., C.T., M.B., R.G., P.-J.L., M.W., E.R., E.-W.R., Ö.Y., L.K., C. Granziera), Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (A. Cagol, L.M.-G., C.T., M.B., R.G., P.-J.L., M.W., E.R.,O.Y., J.O., J.L., M.D.S., B.F.-B., T.D., D.L., L.K., J.K., C. Granziera), Department of Clinical Research (P.B., S.A.S.), Division of Radiological Physics, Department of Radiology (M.W.), and Division of Diagnostic and Interventional Neuroradiology, Clinic for Radiology and Nuclear Medicine (J.M.L.), University Hospital Basel, University of Basel, Switzerland; Translational Neuroradiology Section (C.T), National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD; Medical Image Analysis Center (MIAC) and Quantitative Biomedical Imaging Group (qbig), Department of Biomedical Engineering (E.R., P.C.C.), University Basel; Departments of Neurology (S.M., J.V.) and Radiology (J.W.), Cantonal Hospital St. Gallen; Departments of Neurology (L.A., O.F.) and Radiology (L.R.), Cantonal Hospital Aarau; Departments of Neurology (G.D., C.Z., C.G.) and Neuroradiology (E.P.), Neurocenter of Southern Switzerland, Lugano; Departments of Neurology, Inselspital (A. Chan, A.S.), and Diagnostic and Interventional Neuroradiology, Inselspital (F.W.) Bern University Hospital and University of Bern; Departments of Clinical Neurosciences, Division of Neurology (C.P., R.A.D.P.), and Radiology (R.A.D.P.) Lausanne University Hospital and University of Lausanne; Department of Clinical Neurosciences, Division of Neurology (C.B., P.H.L.), and Radiology (M.I.V.) Geneva University Hospitals and Faculty of Medicine; Faculty of Biomedical Sciences (C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Institute of Experimental Neurology, Division of Neuroscience (M.A.); Vita-Salute San Raffaele University and Hospital, Milan, Italy
| | - Giulio Disanto
- From Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine (A. Cagol, L.M.-G., S.L., C.T., M.B., R.G., P.-J.L., M.W., E.R., E.-W.R., Ö.Y., L.K., C. Granziera), Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (A. Cagol, L.M.-G., C.T., M.B., R.G., P.-J.L., M.W., E.R.,O.Y., J.O., J.L., M.D.S., B.F.-B., T.D., D.L., L.K., J.K., C. Granziera), Department of Clinical Research (P.B., S.A.S.), Division of Radiological Physics, Department of Radiology (M.W.), and Division of Diagnostic and Interventional Neuroradiology, Clinic for Radiology and Nuclear Medicine (J.M.L.), University Hospital Basel, University of Basel, Switzerland; Translational Neuroradiology Section (C.T), National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD; Medical Image Analysis Center (MIAC) and Quantitative Biomedical Imaging Group (qbig), Department of Biomedical Engineering (E.R., P.C.C.), University Basel; Departments of Neurology (S.M., J.V.) and Radiology (J.W.), Cantonal Hospital St. Gallen; Departments of Neurology (L.A., O.F.) and Radiology (L.R.), Cantonal Hospital Aarau; Departments of Neurology (G.D., C.Z., C.G.) and Neuroradiology (E.P.), Neurocenter of Southern Switzerland, Lugano; Departments of Neurology, Inselspital (A. Chan, A.S.), and Diagnostic and Interventional Neuroradiology, Inselspital (F.W.) Bern University Hospital and University of Bern; Departments of Clinical Neurosciences, Division of Neurology (C.P., R.A.D.P.), and Radiology (R.A.D.P.) Lausanne University Hospital and University of Lausanne; Department of Clinical Neurosciences, Division of Neurology (C.B., P.H.L.), and Radiology (M.I.V.) Geneva University Hospitals and Faculty of Medicine; Faculty of Biomedical Sciences (C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Institute of Experimental Neurology, Division of Neuroscience (M.A.); Vita-Salute San Raffaele University and Hospital, Milan, Italy
| | - Oliver Findling
- From Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine (A. Cagol, L.M.-G., S.L., C.T., M.B., R.G., P.-J.L., M.W., E.R., E.-W.R., Ö.Y., L.K., C. Granziera), Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (A. Cagol, L.M.-G., C.T., M.B., R.G., P.-J.L., M.W., E.R.,O.Y., J.O., J.L., M.D.S., B.F.-B., T.D., D.L., L.K., J.K., C. Granziera), Department of Clinical Research (P.B., S.A.S.), Division of Radiological Physics, Department of Radiology (M.W.), and Division of Diagnostic and Interventional Neuroradiology, Clinic for Radiology and Nuclear Medicine (J.M.L.), University Hospital Basel, University of Basel, Switzerland; Translational Neuroradiology Section (C.T), National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD; Medical Image Analysis Center (MIAC) and Quantitative Biomedical Imaging Group (qbig), Department of Biomedical Engineering (E.R., P.C.C.), University Basel; Departments of Neurology (S.M., J.V.) and Radiology (J.W.), Cantonal Hospital St. Gallen; Departments of Neurology (L.A., O.F.) and Radiology (L.R.), Cantonal Hospital Aarau; Departments of Neurology (G.D., C.Z., C.G.) and Neuroradiology (E.P.), Neurocenter of Southern Switzerland, Lugano; Departments of Neurology, Inselspital (A. Chan, A.S.), and Diagnostic and Interventional Neuroradiology, Inselspital (F.W.) Bern University Hospital and University of Bern; Departments of Clinical Neurosciences, Division of Neurology (C.P., R.A.D.P.), and Radiology (R.A.D.P.) Lausanne University Hospital and University of Lausanne; Department of Clinical Neurosciences, Division of Neurology (C.B., P.H.L.), and Radiology (M.I.V.) Geneva University Hospitals and Faculty of Medicine; Faculty of Biomedical Sciences (C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Institute of Experimental Neurology, Division of Neuroscience (M.A.); Vita-Salute San Raffaele University and Hospital, Milan, Italy
| | - Andrew Chan
- From Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine (A. Cagol, L.M.-G., S.L., C.T., M.B., R.G., P.-J.L., M.W., E.R., E.-W.R., Ö.Y., L.K., C. Granziera), Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (A. Cagol, L.M.-G., C.T., M.B., R.G., P.-J.L., M.W., E.R.,O.Y., J.O., J.L., M.D.S., B.F.-B., T.D., D.L., L.K., J.K., C. Granziera), Department of Clinical Research (P.B., S.A.S.), Division of Radiological Physics, Department of Radiology (M.W.), and Division of Diagnostic and Interventional Neuroradiology, Clinic for Radiology and Nuclear Medicine (J.M.L.), University Hospital Basel, University of Basel, Switzerland; Translational Neuroradiology Section (C.T), National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD; Medical Image Analysis Center (MIAC) and Quantitative Biomedical Imaging Group (qbig), Department of Biomedical Engineering (E.R., P.C.C.), University Basel; Departments of Neurology (S.M., J.V.) and Radiology (J.W.), Cantonal Hospital St. Gallen; Departments of Neurology (L.A., O.F.) and Radiology (L.R.), Cantonal Hospital Aarau; Departments of Neurology (G.D., C.Z., C.G.) and Neuroradiology (E.P.), Neurocenter of Southern Switzerland, Lugano; Departments of Neurology, Inselspital (A. Chan, A.S.), and Diagnostic and Interventional Neuroradiology, Inselspital (F.W.) Bern University Hospital and University of Bern; Departments of Clinical Neurosciences, Division of Neurology (C.P., R.A.D.P.), and Radiology (R.A.D.P.) Lausanne University Hospital and University of Lausanne; Department of Clinical Neurosciences, Division of Neurology (C.B., P.H.L.), and Radiology (M.I.V.) Geneva University Hospitals and Faculty of Medicine; Faculty of Biomedical Sciences (C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Institute of Experimental Neurology, Division of Neuroscience (M.A.); Vita-Salute San Raffaele University and Hospital, Milan, Italy
| | - Anke Salmen
- From Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine (A. Cagol, L.M.-G., S.L., C.T., M.B., R.G., P.-J.L., M.W., E.R., E.-W.R., Ö.Y., L.K., C. Granziera), Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (A. Cagol, L.M.-G., C.T., M.B., R.G., P.-J.L., M.W., E.R.,O.Y., J.O., J.L., M.D.S., B.F.-B., T.D., D.L., L.K., J.K., C. Granziera), Department of Clinical Research (P.B., S.A.S.), Division of Radiological Physics, Department of Radiology (M.W.), and Division of Diagnostic and Interventional Neuroradiology, Clinic for Radiology and Nuclear Medicine (J.M.L.), University Hospital Basel, University of Basel, Switzerland; Translational Neuroradiology Section (C.T), National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD; Medical Image Analysis Center (MIAC) and Quantitative Biomedical Imaging Group (qbig), Department of Biomedical Engineering (E.R., P.C.C.), University Basel; Departments of Neurology (S.M., J.V.) and Radiology (J.W.), Cantonal Hospital St. Gallen; Departments of Neurology (L.A., O.F.) and Radiology (L.R.), Cantonal Hospital Aarau; Departments of Neurology (G.D., C.Z., C.G.) and Neuroradiology (E.P.), Neurocenter of Southern Switzerland, Lugano; Departments of Neurology, Inselspital (A. Chan, A.S.), and Diagnostic and Interventional Neuroradiology, Inselspital (F.W.) Bern University Hospital and University of Bern; Departments of Clinical Neurosciences, Division of Neurology (C.P., R.A.D.P.), and Radiology (R.A.D.P.) Lausanne University Hospital and University of Lausanne; Department of Clinical Neurosciences, Division of Neurology (C.B., P.H.L.), and Radiology (M.I.V.) Geneva University Hospitals and Faculty of Medicine; Faculty of Biomedical Sciences (C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Institute of Experimental Neurology, Division of Neuroscience (M.A.); Vita-Salute San Raffaele University and Hospital, Milan, Italy
| | - Caroline Pot
- From Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine (A. Cagol, L.M.-G., S.L., C.T., M.B., R.G., P.-J.L., M.W., E.R., E.-W.R., Ö.Y., L.K., C. Granziera), Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (A. Cagol, L.M.-G., C.T., M.B., R.G., P.-J.L., M.W., E.R.,O.Y., J.O., J.L., M.D.S., B.F.-B., T.D., D.L., L.K., J.K., C. Granziera), Department of Clinical Research (P.B., S.A.S.), Division of Radiological Physics, Department of Radiology (M.W.), and Division of Diagnostic and Interventional Neuroradiology, Clinic for Radiology and Nuclear Medicine (J.M.L.), University Hospital Basel, University of Basel, Switzerland; Translational Neuroradiology Section (C.T), National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD; Medical Image Analysis Center (MIAC) and Quantitative Biomedical Imaging Group (qbig), Department of Biomedical Engineering (E.R., P.C.C.), University Basel; Departments of Neurology (S.M., J.V.) and Radiology (J.W.), Cantonal Hospital St. Gallen; Departments of Neurology (L.A., O.F.) and Radiology (L.R.), Cantonal Hospital Aarau; Departments of Neurology (G.D., C.Z., C.G.) and Neuroradiology (E.P.), Neurocenter of Southern Switzerland, Lugano; Departments of Neurology, Inselspital (A. Chan, A.S.), and Diagnostic and Interventional Neuroradiology, Inselspital (F.W.) Bern University Hospital and University of Bern; Departments of Clinical Neurosciences, Division of Neurology (C.P., R.A.D.P.), and Radiology (R.A.D.P.) Lausanne University Hospital and University of Lausanne; Department of Clinical Neurosciences, Division of Neurology (C.B., P.H.L.), and Radiology (M.I.V.) Geneva University Hospitals and Faculty of Medicine; Faculty of Biomedical Sciences (C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Institute of Experimental Neurology, Division of Neuroscience (M.A.); Vita-Salute San Raffaele University and Hospital, Milan, Italy
| | - Claire Bridel
- From Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine (A. Cagol, L.M.-G., S.L., C.T., M.B., R.G., P.-J.L., M.W., E.R., E.-W.R., Ö.Y., L.K., C. Granziera), Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (A. Cagol, L.M.-G., C.T., M.B., R.G., P.-J.L., M.W., E.R.,O.Y., J.O., J.L., M.D.S., B.F.-B., T.D., D.L., L.K., J.K., C. Granziera), Department of Clinical Research (P.B., S.A.S.), Division of Radiological Physics, Department of Radiology (M.W.), and Division of Diagnostic and Interventional Neuroradiology, Clinic for Radiology and Nuclear Medicine (J.M.L.), University Hospital Basel, University of Basel, Switzerland; Translational Neuroradiology Section (C.T), National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD; Medical Image Analysis Center (MIAC) and Quantitative Biomedical Imaging Group (qbig), Department of Biomedical Engineering (E.R., P.C.C.), University Basel; Departments of Neurology (S.M., J.V.) and Radiology (J.W.), Cantonal Hospital St. Gallen; Departments of Neurology (L.A., O.F.) and Radiology (L.R.), Cantonal Hospital Aarau; Departments of Neurology (G.D., C.Z., C.G.) and Neuroradiology (E.P.), Neurocenter of Southern Switzerland, Lugano; Departments of Neurology, Inselspital (A. Chan, A.S.), and Diagnostic and Interventional Neuroradiology, Inselspital (F.W.) Bern University Hospital and University of Bern; Departments of Clinical Neurosciences, Division of Neurology (C.P., R.A.D.P.), and Radiology (R.A.D.P.) Lausanne University Hospital and University of Lausanne; Department of Clinical Neurosciences, Division of Neurology (C.B., P.H.L.), and Radiology (M.I.V.) Geneva University Hospitals and Faculty of Medicine; Faculty of Biomedical Sciences (C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Institute of Experimental Neurology, Division of Neuroscience (M.A.); Vita-Salute San Raffaele University and Hospital, Milan, Italy
| | - Chiara Zecca
- From Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine (A. Cagol, L.M.-G., S.L., C.T., M.B., R.G., P.-J.L., M.W., E.R., E.-W.R., Ö.Y., L.K., C. Granziera), Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (A. Cagol, L.M.-G., C.T., M.B., R.G., P.-J.L., M.W., E.R.,O.Y., J.O., J.L., M.D.S., B.F.-B., T.D., D.L., L.K., J.K., C. Granziera), Department of Clinical Research (P.B., S.A.S.), Division of Radiological Physics, Department of Radiology (M.W.), and Division of Diagnostic and Interventional Neuroradiology, Clinic for Radiology and Nuclear Medicine (J.M.L.), University Hospital Basel, University of Basel, Switzerland; Translational Neuroradiology Section (C.T), National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD; Medical Image Analysis Center (MIAC) and Quantitative Biomedical Imaging Group (qbig), Department of Biomedical Engineering (E.R., P.C.C.), University Basel; Departments of Neurology (S.M., J.V.) and Radiology (J.W.), Cantonal Hospital St. Gallen; Departments of Neurology (L.A., O.F.) and Radiology (L.R.), Cantonal Hospital Aarau; Departments of Neurology (G.D., C.Z., C.G.) and Neuroradiology (E.P.), Neurocenter of Southern Switzerland, Lugano; Departments of Neurology, Inselspital (A. Chan, A.S.), and Diagnostic and Interventional Neuroradiology, Inselspital (F.W.) Bern University Hospital and University of Bern; Departments of Clinical Neurosciences, Division of Neurology (C.P., R.A.D.P.), and Radiology (R.A.D.P.) Lausanne University Hospital and University of Lausanne; Department of Clinical Neurosciences, Division of Neurology (C.B., P.H.L.), and Radiology (M.I.V.) Geneva University Hospitals and Faculty of Medicine; Faculty of Biomedical Sciences (C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Institute of Experimental Neurology, Division of Neuroscience (M.A.); Vita-Salute San Raffaele University and Hospital, Milan, Italy
| | - Tobias Derfuss
- From Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine (A. Cagol, L.M.-G., S.L., C.T., M.B., R.G., P.-J.L., M.W., E.R., E.-W.R., Ö.Y., L.K., C. Granziera), Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (A. Cagol, L.M.-G., C.T., M.B., R.G., P.-J.L., M.W., E.R.,O.Y., J.O., J.L., M.D.S., B.F.-B., T.D., D.L., L.K., J.K., C. Granziera), Department of Clinical Research (P.B., S.A.S.), Division of Radiological Physics, Department of Radiology (M.W.), and Division of Diagnostic and Interventional Neuroradiology, Clinic for Radiology and Nuclear Medicine (J.M.L.), University Hospital Basel, University of Basel, Switzerland; Translational Neuroradiology Section (C.T), National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD; Medical Image Analysis Center (MIAC) and Quantitative Biomedical Imaging Group (qbig), Department of Biomedical Engineering (E.R., P.C.C.), University Basel; Departments of Neurology (S.M., J.V.) and Radiology (J.W.), Cantonal Hospital St. Gallen; Departments of Neurology (L.A., O.F.) and Radiology (L.R.), Cantonal Hospital Aarau; Departments of Neurology (G.D., C.Z., C.G.) and Neuroradiology (E.P.), Neurocenter of Southern Switzerland, Lugano; Departments of Neurology, Inselspital (A. Chan, A.S.), and Diagnostic and Interventional Neuroradiology, Inselspital (F.W.) Bern University Hospital and University of Bern; Departments of Clinical Neurosciences, Division of Neurology (C.P., R.A.D.P.), and Radiology (R.A.D.P.) Lausanne University Hospital and University of Lausanne; Department of Clinical Neurosciences, Division of Neurology (C.B., P.H.L.), and Radiology (M.I.V.) Geneva University Hospitals and Faculty of Medicine; Faculty of Biomedical Sciences (C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Institute of Experimental Neurology, Division of Neuroscience (M.A.); Vita-Salute San Raffaele University and Hospital, Milan, Italy
| | - Johanna M Lieb
- From Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine (A. Cagol, L.M.-G., S.L., C.T., M.B., R.G., P.-J.L., M.W., E.R., E.-W.R., Ö.Y., L.K., C. Granziera), Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (A. Cagol, L.M.-G., C.T., M.B., R.G., P.-J.L., M.W., E.R.,O.Y., J.O., J.L., M.D.S., B.F.-B., T.D., D.L., L.K., J.K., C. Granziera), Department of Clinical Research (P.B., S.A.S.), Division of Radiological Physics, Department of Radiology (M.W.), and Division of Diagnostic and Interventional Neuroradiology, Clinic for Radiology and Nuclear Medicine (J.M.L.), University Hospital Basel, University of Basel, Switzerland; Translational Neuroradiology Section (C.T), National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD; Medical Image Analysis Center (MIAC) and Quantitative Biomedical Imaging Group (qbig), Department of Biomedical Engineering (E.R., P.C.C.), University Basel; Departments of Neurology (S.M., J.V.) and Radiology (J.W.), Cantonal Hospital St. Gallen; Departments of Neurology (L.A., O.F.) and Radiology (L.R.), Cantonal Hospital Aarau; Departments of Neurology (G.D., C.Z., C.G.) and Neuroradiology (E.P.), Neurocenter of Southern Switzerland, Lugano; Departments of Neurology, Inselspital (A. Chan, A.S.), and Diagnostic and Interventional Neuroradiology, Inselspital (F.W.) Bern University Hospital and University of Bern; Departments of Clinical Neurosciences, Division of Neurology (C.P., R.A.D.P.), and Radiology (R.A.D.P.) Lausanne University Hospital and University of Lausanne; Department of Clinical Neurosciences, Division of Neurology (C.B., P.H.L.), and Radiology (M.I.V.) Geneva University Hospitals and Faculty of Medicine; Faculty of Biomedical Sciences (C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Institute of Experimental Neurology, Division of Neuroscience (M.A.); Vita-Salute San Raffaele University and Hospital, Milan, Italy
| | - Luca Remonda
- From Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine (A. Cagol, L.M.-G., S.L., C.T., M.B., R.G., P.-J.L., M.W., E.R., E.-W.R., Ö.Y., L.K., C. Granziera), Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (A. Cagol, L.M.-G., C.T., M.B., R.G., P.-J.L., M.W., E.R.,O.Y., J.O., J.L., M.D.S., B.F.-B., T.D., D.L., L.K., J.K., C. Granziera), Department of Clinical Research (P.B., S.A.S.), Division of Radiological Physics, Department of Radiology (M.W.), and Division of Diagnostic and Interventional Neuroradiology, Clinic for Radiology and Nuclear Medicine (J.M.L.), University Hospital Basel, University of Basel, Switzerland; Translational Neuroradiology Section (C.T), National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD; Medical Image Analysis Center (MIAC) and Quantitative Biomedical Imaging Group (qbig), Department of Biomedical Engineering (E.R., P.C.C.), University Basel; Departments of Neurology (S.M., J.V.) and Radiology (J.W.), Cantonal Hospital St. Gallen; Departments of Neurology (L.A., O.F.) and Radiology (L.R.), Cantonal Hospital Aarau; Departments of Neurology (G.D., C.Z., C.G.) and Neuroradiology (E.P.), Neurocenter of Southern Switzerland, Lugano; Departments of Neurology, Inselspital (A. Chan, A.S.), and Diagnostic and Interventional Neuroradiology, Inselspital (F.W.) Bern University Hospital and University of Bern; Departments of Clinical Neurosciences, Division of Neurology (C.P., R.A.D.P.), and Radiology (R.A.D.P.) Lausanne University Hospital and University of Lausanne; Department of Clinical Neurosciences, Division of Neurology (C.B., P.H.L.), and Radiology (M.I.V.) Geneva University Hospitals and Faculty of Medicine; Faculty of Biomedical Sciences (C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Institute of Experimental Neurology, Division of Neuroscience (M.A.); Vita-Salute San Raffaele University and Hospital, Milan, Italy
| | - Franca Wagner
- From Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine (A. Cagol, L.M.-G., S.L., C.T., M.B., R.G., P.-J.L., M.W., E.R., E.-W.R., Ö.Y., L.K., C. Granziera), Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (A. Cagol, L.M.-G., C.T., M.B., R.G., P.-J.L., M.W., E.R.,O.Y., J.O., J.L., M.D.S., B.F.-B., T.D., D.L., L.K., J.K., C. Granziera), Department of Clinical Research (P.B., S.A.S.), Division of Radiological Physics, Department of Radiology (M.W.), and Division of Diagnostic and Interventional Neuroradiology, Clinic for Radiology and Nuclear Medicine (J.M.L.), University Hospital Basel, University of Basel, Switzerland; Translational Neuroradiology Section (C.T), National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD; Medical Image Analysis Center (MIAC) and Quantitative Biomedical Imaging Group (qbig), Department of Biomedical Engineering (E.R., P.C.C.), University Basel; Departments of Neurology (S.M., J.V.) and Radiology (J.W.), Cantonal Hospital St. Gallen; Departments of Neurology (L.A., O.F.) and Radiology (L.R.), Cantonal Hospital Aarau; Departments of Neurology (G.D., C.Z., C.G.) and Neuroradiology (E.P.), Neurocenter of Southern Switzerland, Lugano; Departments of Neurology, Inselspital (A. Chan, A.S.), and Diagnostic and Interventional Neuroradiology, Inselspital (F.W.) Bern University Hospital and University of Bern; Departments of Clinical Neurosciences, Division of Neurology (C.P., R.A.D.P.), and Radiology (R.A.D.P.) Lausanne University Hospital and University of Lausanne; Department of Clinical Neurosciences, Division of Neurology (C.B., P.H.L.), and Radiology (M.I.V.) Geneva University Hospitals and Faculty of Medicine; Faculty of Biomedical Sciences (C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Institute of Experimental Neurology, Division of Neuroscience (M.A.); Vita-Salute San Raffaele University and Hospital, Milan, Italy
| | - Maria Isabel Vargas
- From Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine (A. Cagol, L.M.-G., S.L., C.T., M.B., R.G., P.-J.L., M.W., E.R., E.-W.R., Ö.Y., L.K., C. Granziera), Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (A. Cagol, L.M.-G., C.T., M.B., R.G., P.-J.L., M.W., E.R.,O.Y., J.O., J.L., M.D.S., B.F.-B., T.D., D.L., L.K., J.K., C. Granziera), Department of Clinical Research (P.B., S.A.S.), Division of Radiological Physics, Department of Radiology (M.W.), and Division of Diagnostic and Interventional Neuroradiology, Clinic for Radiology and Nuclear Medicine (J.M.L.), University Hospital Basel, University of Basel, Switzerland; Translational Neuroradiology Section (C.T), National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD; Medical Image Analysis Center (MIAC) and Quantitative Biomedical Imaging Group (qbig), Department of Biomedical Engineering (E.R., P.C.C.), University Basel; Departments of Neurology (S.M., J.V.) and Radiology (J.W.), Cantonal Hospital St. Gallen; Departments of Neurology (L.A., O.F.) and Radiology (L.R.), Cantonal Hospital Aarau; Departments of Neurology (G.D., C.Z., C.G.) and Neuroradiology (E.P.), Neurocenter of Southern Switzerland, Lugano; Departments of Neurology, Inselspital (A. Chan, A.S.), and Diagnostic and Interventional Neuroradiology, Inselspital (F.W.) Bern University Hospital and University of Bern; Departments of Clinical Neurosciences, Division of Neurology (C.P., R.A.D.P.), and Radiology (R.A.D.P.) Lausanne University Hospital and University of Lausanne; Department of Clinical Neurosciences, Division of Neurology (C.B., P.H.L.), and Radiology (M.I.V.) Geneva University Hospitals and Faculty of Medicine; Faculty of Biomedical Sciences (C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Institute of Experimental Neurology, Division of Neuroscience (M.A.); Vita-Salute San Raffaele University and Hospital, Milan, Italy
| | - Renaud A Du Pasquier
- From Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine (A. Cagol, L.M.-G., S.L., C.T., M.B., R.G., P.-J.L., M.W., E.R., E.-W.R., Ö.Y., L.K., C. Granziera), Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (A. Cagol, L.M.-G., C.T., M.B., R.G., P.-J.L., M.W., E.R.,O.Y., J.O., J.L., M.D.S., B.F.-B., T.D., D.L., L.K., J.K., C. Granziera), Department of Clinical Research (P.B., S.A.S.), Division of Radiological Physics, Department of Radiology (M.W.), and Division of Diagnostic and Interventional Neuroradiology, Clinic for Radiology and Nuclear Medicine (J.M.L.), University Hospital Basel, University of Basel, Switzerland; Translational Neuroradiology Section (C.T), National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD; Medical Image Analysis Center (MIAC) and Quantitative Biomedical Imaging Group (qbig), Department of Biomedical Engineering (E.R., P.C.C.), University Basel; Departments of Neurology (S.M., J.V.) and Radiology (J.W.), Cantonal Hospital St. Gallen; Departments of Neurology (L.A., O.F.) and Radiology (L.R.), Cantonal Hospital Aarau; Departments of Neurology (G.D., C.Z., C.G.) and Neuroradiology (E.P.), Neurocenter of Southern Switzerland, Lugano; Departments of Neurology, Inselspital (A. Chan, A.S.), and Diagnostic and Interventional Neuroradiology, Inselspital (F.W.) Bern University Hospital and University of Bern; Departments of Clinical Neurosciences, Division of Neurology (C.P., R.A.D.P.), and Radiology (R.A.D.P.) Lausanne University Hospital and University of Lausanne; Department of Clinical Neurosciences, Division of Neurology (C.B., P.H.L.), and Radiology (M.I.V.) Geneva University Hospitals and Faculty of Medicine; Faculty of Biomedical Sciences (C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Institute of Experimental Neurology, Division of Neuroscience (M.A.); Vita-Salute San Raffaele University and Hospital, Milan, Italy
| | - Patrice H Lalive
- From Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine (A. Cagol, L.M.-G., S.L., C.T., M.B., R.G., P.-J.L., M.W., E.R., E.-W.R., Ö.Y., L.K., C. Granziera), Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (A. Cagol, L.M.-G., C.T., M.B., R.G., P.-J.L., M.W., E.R.,O.Y., J.O., J.L., M.D.S., B.F.-B., T.D., D.L., L.K., J.K., C. Granziera), Department of Clinical Research (P.B., S.A.S.), Division of Radiological Physics, Department of Radiology (M.W.), and Division of Diagnostic and Interventional Neuroradiology, Clinic for Radiology and Nuclear Medicine (J.M.L.), University Hospital Basel, University of Basel, Switzerland; Translational Neuroradiology Section (C.T), National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD; Medical Image Analysis Center (MIAC) and Quantitative Biomedical Imaging Group (qbig), Department of Biomedical Engineering (E.R., P.C.C.), University Basel; Departments of Neurology (S.M., J.V.) and Radiology (J.W.), Cantonal Hospital St. Gallen; Departments of Neurology (L.A., O.F.) and Radiology (L.R.), Cantonal Hospital Aarau; Departments of Neurology (G.D., C.Z., C.G.) and Neuroradiology (E.P.), Neurocenter of Southern Switzerland, Lugano; Departments of Neurology, Inselspital (A. Chan, A.S.), and Diagnostic and Interventional Neuroradiology, Inselspital (F.W.) Bern University Hospital and University of Bern; Departments of Clinical Neurosciences, Division of Neurology (C.P., R.A.D.P.), and Radiology (R.A.D.P.) Lausanne University Hospital and University of Lausanne; Department of Clinical Neurosciences, Division of Neurology (C.B., P.H.L.), and Radiology (M.I.V.) Geneva University Hospitals and Faculty of Medicine; Faculty of Biomedical Sciences (C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Institute of Experimental Neurology, Division of Neuroscience (M.A.); Vita-Salute San Raffaele University and Hospital, Milan, Italy
| | - Emanuele Pravatà
- From Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine (A. Cagol, L.M.-G., S.L., C.T., M.B., R.G., P.-J.L., M.W., E.R., E.-W.R., Ö.Y., L.K., C. Granziera), Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (A. Cagol, L.M.-G., C.T., M.B., R.G., P.-J.L., M.W., E.R.,O.Y., J.O., J.L., M.D.S., B.F.-B., T.D., D.L., L.K., J.K., C. Granziera), Department of Clinical Research (P.B., S.A.S.), Division of Radiological Physics, Department of Radiology (M.W.), and Division of Diagnostic and Interventional Neuroradiology, Clinic for Radiology and Nuclear Medicine (J.M.L.), University Hospital Basel, University of Basel, Switzerland; Translational Neuroradiology Section (C.T), National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD; Medical Image Analysis Center (MIAC) and Quantitative Biomedical Imaging Group (qbig), Department of Biomedical Engineering (E.R., P.C.C.), University Basel; Departments of Neurology (S.M., J.V.) and Radiology (J.W.), Cantonal Hospital St. Gallen; Departments of Neurology (L.A., O.F.) and Radiology (L.R.), Cantonal Hospital Aarau; Departments of Neurology (G.D., C.Z., C.G.) and Neuroradiology (E.P.), Neurocenter of Southern Switzerland, Lugano; Departments of Neurology, Inselspital (A. Chan, A.S.), and Diagnostic and Interventional Neuroradiology, Inselspital (F.W.) Bern University Hospital and University of Bern; Departments of Clinical Neurosciences, Division of Neurology (C.P., R.A.D.P.), and Radiology (R.A.D.P.) Lausanne University Hospital and University of Lausanne; Department of Clinical Neurosciences, Division of Neurology (C.B., P.H.L.), and Radiology (M.I.V.) Geneva University Hospitals and Faculty of Medicine; Faculty of Biomedical Sciences (C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Institute of Experimental Neurology, Division of Neuroscience (M.A.); Vita-Salute San Raffaele University and Hospital, Milan, Italy
| | - Johannes Weber
- From Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine (A. Cagol, L.M.-G., S.L., C.T., M.B., R.G., P.-J.L., M.W., E.R., E.-W.R., Ö.Y., L.K., C. Granziera), Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (A. Cagol, L.M.-G., C.T., M.B., R.G., P.-J.L., M.W., E.R.,O.Y., J.O., J.L., M.D.S., B.F.-B., T.D., D.L., L.K., J.K., C. Granziera), Department of Clinical Research (P.B., S.A.S.), Division of Radiological Physics, Department of Radiology (M.W.), and Division of Diagnostic and Interventional Neuroradiology, Clinic for Radiology and Nuclear Medicine (J.M.L.), University Hospital Basel, University of Basel, Switzerland; Translational Neuroradiology Section (C.T), National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD; Medical Image Analysis Center (MIAC) and Quantitative Biomedical Imaging Group (qbig), Department of Biomedical Engineering (E.R., P.C.C.), University Basel; Departments of Neurology (S.M., J.V.) and Radiology (J.W.), Cantonal Hospital St. Gallen; Departments of Neurology (L.A., O.F.) and Radiology (L.R.), Cantonal Hospital Aarau; Departments of Neurology (G.D., C.Z., C.G.) and Neuroradiology (E.P.), Neurocenter of Southern Switzerland, Lugano; Departments of Neurology, Inselspital (A. Chan, A.S.), and Diagnostic and Interventional Neuroradiology, Inselspital (F.W.) Bern University Hospital and University of Bern; Departments of Clinical Neurosciences, Division of Neurology (C.P., R.A.D.P.), and Radiology (R.A.D.P.) Lausanne University Hospital and University of Lausanne; Department of Clinical Neurosciences, Division of Neurology (C.B., P.H.L.), and Radiology (M.I.V.) Geneva University Hospitals and Faculty of Medicine; Faculty of Biomedical Sciences (C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Institute of Experimental Neurology, Division of Neuroscience (M.A.); Vita-Salute San Raffaele University and Hospital, Milan, Italy
| | - Philippe C Cattin
- From Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine (A. Cagol, L.M.-G., S.L., C.T., M.B., R.G., P.-J.L., M.W., E.R., E.-W.R., Ö.Y., L.K., C. Granziera), Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (A. Cagol, L.M.-G., C.T., M.B., R.G., P.-J.L., M.W., E.R.,O.Y., J.O., J.L., M.D.S., B.F.-B., T.D., D.L., L.K., J.K., C. Granziera), Department of Clinical Research (P.B., S.A.S.), Division of Radiological Physics, Department of Radiology (M.W.), and Division of Diagnostic and Interventional Neuroradiology, Clinic for Radiology and Nuclear Medicine (J.M.L.), University Hospital Basel, University of Basel, Switzerland; Translational Neuroradiology Section (C.T), National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD; Medical Image Analysis Center (MIAC) and Quantitative Biomedical Imaging Group (qbig), Department of Biomedical Engineering (E.R., P.C.C.), University Basel; Departments of Neurology (S.M., J.V.) and Radiology (J.W.), Cantonal Hospital St. Gallen; Departments of Neurology (L.A., O.F.) and Radiology (L.R.), Cantonal Hospital Aarau; Departments of Neurology (G.D., C.Z., C.G.) and Neuroradiology (E.P.), Neurocenter of Southern Switzerland, Lugano; Departments of Neurology, Inselspital (A. Chan, A.S.), and Diagnostic and Interventional Neuroradiology, Inselspital (F.W.) Bern University Hospital and University of Bern; Departments of Clinical Neurosciences, Division of Neurology (C.P., R.A.D.P.), and Radiology (R.A.D.P.) Lausanne University Hospital and University of Lausanne; Department of Clinical Neurosciences, Division of Neurology (C.B., P.H.L.), and Radiology (M.I.V.) Geneva University Hospitals and Faculty of Medicine; Faculty of Biomedical Sciences (C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Institute of Experimental Neurology, Division of Neuroscience (M.A.); Vita-Salute San Raffaele University and Hospital, Milan, Italy
| | - Martina Absinta
- From Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine (A. Cagol, L.M.-G., S.L., C.T., M.B., R.G., P.-J.L., M.W., E.R., E.-W.R., Ö.Y., L.K., C. Granziera), Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (A. Cagol, L.M.-G., C.T., M.B., R.G., P.-J.L., M.W., E.R.,O.Y., J.O., J.L., M.D.S., B.F.-B., T.D., D.L., L.K., J.K., C. Granziera), Department of Clinical Research (P.B., S.A.S.), Division of Radiological Physics, Department of Radiology (M.W.), and Division of Diagnostic and Interventional Neuroradiology, Clinic for Radiology and Nuclear Medicine (J.M.L.), University Hospital Basel, University of Basel, Switzerland; Translational Neuroradiology Section (C.T), National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD; Medical Image Analysis Center (MIAC) and Quantitative Biomedical Imaging Group (qbig), Department of Biomedical Engineering (E.R., P.C.C.), University Basel; Departments of Neurology (S.M., J.V.) and Radiology (J.W.), Cantonal Hospital St. Gallen; Departments of Neurology (L.A., O.F.) and Radiology (L.R.), Cantonal Hospital Aarau; Departments of Neurology (G.D., C.Z., C.G.) and Neuroradiology (E.P.), Neurocenter of Southern Switzerland, Lugano; Departments of Neurology, Inselspital (A. Chan, A.S.), and Diagnostic and Interventional Neuroradiology, Inselspital (F.W.) Bern University Hospital and University of Bern; Departments of Clinical Neurosciences, Division of Neurology (C.P., R.A.D.P.), and Radiology (R.A.D.P.) Lausanne University Hospital and University of Lausanne; Department of Clinical Neurosciences, Division of Neurology (C.B., P.H.L.), and Radiology (M.I.V.) Geneva University Hospitals and Faculty of Medicine; Faculty of Biomedical Sciences (C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Institute of Experimental Neurology, Division of Neuroscience (M.A.); Vita-Salute San Raffaele University and Hospital, Milan, Italy
| | - Claudio Gobbi
- From Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine (A. Cagol, L.M.-G., S.L., C.T., M.B., R.G., P.-J.L., M.W., E.R., E.-W.R., Ö.Y., L.K., C. Granziera), Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (A. Cagol, L.M.-G., C.T., M.B., R.G., P.-J.L., M.W., E.R.,O.Y., J.O., J.L., M.D.S., B.F.-B., T.D., D.L., L.K., J.K., C. Granziera), Department of Clinical Research (P.B., S.A.S.), Division of Radiological Physics, Department of Radiology (M.W.), and Division of Diagnostic and Interventional Neuroradiology, Clinic for Radiology and Nuclear Medicine (J.M.L.), University Hospital Basel, University of Basel, Switzerland; Translational Neuroradiology Section (C.T), National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD; Medical Image Analysis Center (MIAC) and Quantitative Biomedical Imaging Group (qbig), Department of Biomedical Engineering (E.R., P.C.C.), University Basel; Departments of Neurology (S.M., J.V.) and Radiology (J.W.), Cantonal Hospital St. Gallen; Departments of Neurology (L.A., O.F.) and Radiology (L.R.), Cantonal Hospital Aarau; Departments of Neurology (G.D., C.Z., C.G.) and Neuroradiology (E.P.), Neurocenter of Southern Switzerland, Lugano; Departments of Neurology, Inselspital (A. Chan, A.S.), and Diagnostic and Interventional Neuroradiology, Inselspital (F.W.) Bern University Hospital and University of Bern; Departments of Clinical Neurosciences, Division of Neurology (C.P., R.A.D.P.), and Radiology (R.A.D.P.) Lausanne University Hospital and University of Lausanne; Department of Clinical Neurosciences, Division of Neurology (C.B., P.H.L.), and Radiology (M.I.V.) Geneva University Hospitals and Faculty of Medicine; Faculty of Biomedical Sciences (C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Institute of Experimental Neurology, Division of Neuroscience (M.A.); Vita-Salute San Raffaele University and Hospital, Milan, Italy
| | - David Leppert
- From Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine (A. Cagol, L.M.-G., S.L., C.T., M.B., R.G., P.-J.L., M.W., E.R., E.-W.R., Ö.Y., L.K., C. Granziera), Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (A. Cagol, L.M.-G., C.T., M.B., R.G., P.-J.L., M.W., E.R.,O.Y., J.O., J.L., M.D.S., B.F.-B., T.D., D.L., L.K., J.K., C. Granziera), Department of Clinical Research (P.B., S.A.S.), Division of Radiological Physics, Department of Radiology (M.W.), and Division of Diagnostic and Interventional Neuroradiology, Clinic for Radiology and Nuclear Medicine (J.M.L.), University Hospital Basel, University of Basel, Switzerland; Translational Neuroradiology Section (C.T), National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD; Medical Image Analysis Center (MIAC) and Quantitative Biomedical Imaging Group (qbig), Department of Biomedical Engineering (E.R., P.C.C.), University Basel; Departments of Neurology (S.M., J.V.) and Radiology (J.W.), Cantonal Hospital St. Gallen; Departments of Neurology (L.A., O.F.) and Radiology (L.R.), Cantonal Hospital Aarau; Departments of Neurology (G.D., C.Z., C.G.) and Neuroradiology (E.P.), Neurocenter of Southern Switzerland, Lugano; Departments of Neurology, Inselspital (A. Chan, A.S.), and Diagnostic and Interventional Neuroradiology, Inselspital (F.W.) Bern University Hospital and University of Bern; Departments of Clinical Neurosciences, Division of Neurology (C.P., R.A.D.P.), and Radiology (R.A.D.P.) Lausanne University Hospital and University of Lausanne; Department of Clinical Neurosciences, Division of Neurology (C.B., P.H.L.), and Radiology (M.I.V.) Geneva University Hospitals and Faculty of Medicine; Faculty of Biomedical Sciences (C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Institute of Experimental Neurology, Division of Neuroscience (M.A.); Vita-Salute San Raffaele University and Hospital, Milan, Italy
| | - Ludwig Kappos
- From Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine (A. Cagol, L.M.-G., S.L., C.T., M.B., R.G., P.-J.L., M.W., E.R., E.-W.R., Ö.Y., L.K., C. Granziera), Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (A. Cagol, L.M.-G., C.T., M.B., R.G., P.-J.L., M.W., E.R.,O.Y., J.O., J.L., M.D.S., B.F.-B., T.D., D.L., L.K., J.K., C. Granziera), Department of Clinical Research (P.B., S.A.S.), Division of Radiological Physics, Department of Radiology (M.W.), and Division of Diagnostic and Interventional Neuroradiology, Clinic for Radiology and Nuclear Medicine (J.M.L.), University Hospital Basel, University of Basel, Switzerland; Translational Neuroradiology Section (C.T), National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD; Medical Image Analysis Center (MIAC) and Quantitative Biomedical Imaging Group (qbig), Department of Biomedical Engineering (E.R., P.C.C.), University Basel; Departments of Neurology (S.M., J.V.) and Radiology (J.W.), Cantonal Hospital St. Gallen; Departments of Neurology (L.A., O.F.) and Radiology (L.R.), Cantonal Hospital Aarau; Departments of Neurology (G.D., C.Z., C.G.) and Neuroradiology (E.P.), Neurocenter of Southern Switzerland, Lugano; Departments of Neurology, Inselspital (A. Chan, A.S.), and Diagnostic and Interventional Neuroradiology, Inselspital (F.W.) Bern University Hospital and University of Bern; Departments of Clinical Neurosciences, Division of Neurology (C.P., R.A.D.P.), and Radiology (R.A.D.P.) Lausanne University Hospital and University of Lausanne; Department of Clinical Neurosciences, Division of Neurology (C.B., P.H.L.), and Radiology (M.I.V.) Geneva University Hospitals and Faculty of Medicine; Faculty of Biomedical Sciences (C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Institute of Experimental Neurology, Division of Neuroscience (M.A.); Vita-Salute San Raffaele University and Hospital, Milan, Italy
| | - Jens Kuhle
- From Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine (A. Cagol, L.M.-G., S.L., C.T., M.B., R.G., P.-J.L., M.W., E.R., E.-W.R., Ö.Y., L.K., C. Granziera), Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (A. Cagol, L.M.-G., C.T., M.B., R.G., P.-J.L., M.W., E.R.,O.Y., J.O., J.L., M.D.S., B.F.-B., T.D., D.L., L.K., J.K., C. Granziera), Department of Clinical Research (P.B., S.A.S.), Division of Radiological Physics, Department of Radiology (M.W.), and Division of Diagnostic and Interventional Neuroradiology, Clinic for Radiology and Nuclear Medicine (J.M.L.), University Hospital Basel, University of Basel, Switzerland; Translational Neuroradiology Section (C.T), National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD; Medical Image Analysis Center (MIAC) and Quantitative Biomedical Imaging Group (qbig), Department of Biomedical Engineering (E.R., P.C.C.), University Basel; Departments of Neurology (S.M., J.V.) and Radiology (J.W.), Cantonal Hospital St. Gallen; Departments of Neurology (L.A., O.F.) and Radiology (L.R.), Cantonal Hospital Aarau; Departments of Neurology (G.D., C.Z., C.G.) and Neuroradiology (E.P.), Neurocenter of Southern Switzerland, Lugano; Departments of Neurology, Inselspital (A. Chan, A.S.), and Diagnostic and Interventional Neuroradiology, Inselspital (F.W.) Bern University Hospital and University of Bern; Departments of Clinical Neurosciences, Division of Neurology (C.P., R.A.D.P.), and Radiology (R.A.D.P.) Lausanne University Hospital and University of Lausanne; Department of Clinical Neurosciences, Division of Neurology (C.B., P.H.L.), and Radiology (M.I.V.) Geneva University Hospitals and Faculty of Medicine; Faculty of Biomedical Sciences (C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Institute of Experimental Neurology, Division of Neuroscience (M.A.); Vita-Salute San Raffaele University and Hospital, Milan, Italy
| | - Cristina Granziera
- From Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine (A. Cagol, L.M.-G., S.L., C.T., M.B., R.G., P.-J.L., M.W., E.R., E.-W.R., Ö.Y., L.K., C. Granziera), Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (A. Cagol, L.M.-G., C.T., M.B., R.G., P.-J.L., M.W., E.R.,O.Y., J.O., J.L., M.D.S., B.F.-B., T.D., D.L., L.K., J.K., C. Granziera), Department of Clinical Research (P.B., S.A.S.), Division of Radiological Physics, Department of Radiology (M.W.), and Division of Diagnostic and Interventional Neuroradiology, Clinic for Radiology and Nuclear Medicine (J.M.L.), University Hospital Basel, University of Basel, Switzerland; Translational Neuroradiology Section (C.T), National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD; Medical Image Analysis Center (MIAC) and Quantitative Biomedical Imaging Group (qbig), Department of Biomedical Engineering (E.R., P.C.C.), University Basel; Departments of Neurology (S.M., J.V.) and Radiology (J.W.), Cantonal Hospital St. Gallen; Departments of Neurology (L.A., O.F.) and Radiology (L.R.), Cantonal Hospital Aarau; Departments of Neurology (G.D., C.Z., C.G.) and Neuroradiology (E.P.), Neurocenter of Southern Switzerland, Lugano; Departments of Neurology, Inselspital (A. Chan, A.S.), and Diagnostic and Interventional Neuroradiology, Inselspital (F.W.) Bern University Hospital and University of Bern; Departments of Clinical Neurosciences, Division of Neurology (C.P., R.A.D.P.), and Radiology (R.A.D.P.) Lausanne University Hospital and University of Lausanne; Department of Clinical Neurosciences, Division of Neurology (C.B., P.H.L.), and Radiology (M.I.V.) Geneva University Hospitals and Faculty of Medicine; Faculty of Biomedical Sciences (C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Institute of Experimental Neurology, Division of Neuroscience (M.A.); Vita-Salute San Raffaele University and Hospital, Milan, Italy
| |
Collapse
|
6
|
Al-Tameemi HN, Hassoun HK, Mohammed IQ, Allebban Z. MRI assessment of cervical spinal cord cross-sectional area in patients with multiple sclerosis. J Neurosci Rural Pract 2023; 14:660-666. [PMID: 38059247 PMCID: PMC10696324 DOI: 10.25259/jnrp_87_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 06/30/2023] [Indexed: 12/08/2023] Open
Abstract
Objectives Spinal cord abnormalities including cervical cord atrophy are common in multiple sclerosis (MS). This study aimed to assess the cervical spinal cord cross-sectional area (CSA) using magnetic resonance imaging (MRI) in MS patients. Materials and Methods Sixty participants were enrolled in this study (16 male and 44 female), 30 patients with MS, diagnosed according to the revised McDonald criteria, and 30 apparently healthy individuals as the control group. CSA of the spinal cord was measured on axial T2-weighted images of the cervical MRI studies from C2 to C7 vertebral levels. Results There was a significant difference between MS patients and the control group in mean CSA at a different level. The mean CSA at C2, in MS cases, was significantly lower than controls (67.7 ± 9.4 mm2 vs. 81.3 ± 4.6 mm2). Similarly, the mean CSA at C7 (64.4 ± 9.9 mm2) and average C2-7 (68 ± 9.1 mm2) of MS cases were significantly lower than the control. There was a strong inverse correlation between mean cervical cord CSA and duration of the disease and disability score. The reduction in cervical cord CSA was more prominent in patients with secondary progressive MS. There was no significant difference regarding age, gender, type of treatment, or the number of cervical cord lesions. Conclusion The mean CSA was significantly lower in patients with MS than in the control group and was lesser in progressive types. Patients with a longer duration of MS and a high disability score tend to have smaller CSA.
Collapse
Affiliation(s)
- Haider N. Al-Tameemi
- Middle Euphrates Neurosciences Center, Faculty of Medicine, Kufa University, Al-Najaf, Iraq
| | - Hayder K. Hassoun
- Middle Euphrates Neurosciences Center, Faculty of Medicine, Kufa University, Al-Najaf, Iraq
| | | | - Zuhair Allebban
- Middle Euphrates Unit of Cancer Research, Kufa University College of Medicine, Al-Najaf, Iraq
| |
Collapse
|
7
|
Pogoda-Wesołowska A, Dziedzic A, Maciak K, Stȩpień A, Dziaduch M, Saluk J. Neurodegeneration and its potential markers in the diagnosing of secondary progressive multiple sclerosis. A review. Front Mol Neurosci 2023; 16:1210091. [PMID: 37781097 PMCID: PMC10535108 DOI: 10.3389/fnmol.2023.1210091] [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: 04/24/2023] [Accepted: 08/25/2023] [Indexed: 10/03/2023] Open
Abstract
Approximately 70% of relapsing-remitting multiple sclerosis (RRMS) patients will develop secondary progressive multiple sclerosis (SPMS) within 10-15 years. This progression is characterized by a gradual decline in neurological functionality and increasing limitations of daily activities. Growing evidence suggests that both inflammation and neurodegeneration are associated with various pathological processes throughout the development of MS; therefore, to delay disease progression, it is critical to initiate disease-modifying therapy as soon as it is diagnosed. Currently, a diagnosis of SPMS requires a retrospective assessment of physical disability exacerbation, usually over the previous 6-12 months, which results in a delay of up to 3 years. Hence, there is a need to identify reliable and objective biomarkers for predicting and defining SPMS conversion. This review presents current knowledge of such biomarkers in the context of neurodegeneration associated with MS, and SPMS conversion.
Collapse
Affiliation(s)
| | - Angela Dziedzic
- Department of General Biochemistry, Faculty of Biology and Environmental Protection, University of Lodz, Lodz, Poland
| | - Karina Maciak
- Department of General Biochemistry, Faculty of Biology and Environmental Protection, University of Lodz, Lodz, Poland
| | - Adam Stȩpień
- Clinic of Neurology, Military Institute of Medicine–National Research Institute, Warsaw, Poland
| | - Marta Dziaduch
- Medical Radiology Department of Military Institute of Medicine – National Research Institute, Warsaw, Poland
| | - Joanna Saluk
- Department of General Biochemistry, Faculty of Biology and Environmental Protection, University of Lodz, Lodz, Poland
| |
Collapse
|
8
|
Bian B, Zhou B, Shao Z, Zhu X, Jie Y, Li D. Feasibility of diffusion kurtosis imaging in evaluating cervical spinal cord injury in multiple sclerosis. Medicine (Baltimore) 2023; 102:e34205. [PMID: 37478237 PMCID: PMC10662919 DOI: 10.1097/md.0000000000034205] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 06/14/2023] [Indexed: 07/23/2023] Open
Abstract
This research aimed to assess gray matter (GM), white matter (WM), lesions of multiple sclerosis (MS) and the therapeutic effect using diffusion kurtosis imaging (DKI). From January 2018 to October 2019, 78 subjects (48 of MS and 30 of health) perform routine MR scan and DKI of cervical spinal cord. The MS patients were divided into 2 groups according to the presence or absence of T2 hyperintensity. DKI-metrics were measured in the lesions, normal-appearing GM and WM. Significant differences were detected in DKI metrics between MS and healthy (P < .05) and between patients with cervical spinal cord T2-hyperintense and without T2-hyperintense (P < .001). Compared to healthy, GM-mean kurtosis (MK), GM-radial kurtosis, and WM-fractional anisotropy, WM-axial diffusion were statistically reduced in patients without T2-hyperintense (P < .05). Significant differences were observed in DKI metrics between patients with T2-hyperintense after therapy (P < .05), as well as GM-MK and WM-fractional anisotropy, WM-axial diffusion in patients without T2-hyperintense (P < .05); Expanded Disability Status Scale was correlated with MK values, as well as Expanded Disability Status Scale scores and MK values after therapy. Our results indicate that DKI-metrics can detect and quantitatively evaluate the changes in cervical spinal cord micropathological structure.
Collapse
Affiliation(s)
- BingYang Bian
- Department of Radiology, The First Hospital of Jilin University, Changchun, China
| | - BoXu Zhou
- Department of Radiology, The First Hospital of Jilin University, Changchun, China
| | - ZhiQing Shao
- Department of Radiology, The First Hospital of Jilin University, Changchun, China
| | - XiaoNa Zhu
- Department of Radiology, The First Hospital of Jilin University, Changchun, China
| | - YiGe Jie
- Department of Radiology, The First Hospital of Jilin University, Changchun, China
| | - Dan Li
- Department of Radiology, The First Hospital of Jilin University, Changchun, China
| |
Collapse
|
9
|
Matthews PM, Gupta D, Mittal D, Bai W, Scalfari A, Pollock KG, Sharma V, Hill N. The association between brain volume loss and disability in multiple sclerosis: A systematic review. Mult Scler Relat Disord 2023; 74:104714. [PMID: 37068369 DOI: 10.1016/j.msard.2023.104714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 03/23/2023] [Accepted: 04/08/2023] [Indexed: 04/19/2023]
Abstract
BACKGROUND Multiple sclerosis (MS) is a chronic, inflammatory, demyelinating, degenerative disease of the central nervous system that affects approximately 2.8 million people worldwide. Compelling evidence from observational studies and clinical trials indicates a strong association between brain volume loss (BVL) and the accumulation of disability in MS. However, the considerable heterogeneity in study designs and methods of assessment of BVL invites questions concerning the generalizability of the reported findings. Therefore, we conducted this systematic review to characterize the relationship between BVL and physical disability in patients with MS. METHODS A systematic literature search of MEDLINE and EMBASE databases was performed supplemented by gray literature searches. The following study designs were included: prospective/retrospective cohort, cross-sectional and case-control. Only English language articles published from 2010 onwards were eligible for final inclusion. There were no restrictions on MS subtype, age, or ethnicity. Of the 1620 citations retrieved by the structured searches, 50 publications met our screening criteria and were included in the final data set. RESULTS Across all BVL measures, there was considerable heterogeneity in studies regarding the underlying study population, the definitions of BVL and image analysis methodologies, the physical disability measure used, the measures of association reported and whether the analysis conducted was univariable or multivariable. A total of 36 primary studies providing data on the association between whole BVL and physical disability in MS collectively suggest that whole brain atrophy is associated with greater physical disability progression in MS patients. Similarly, a total of 15 primary studies providing data on the association between ventricular atrophy and physical disability in MS suggest that ventricular atrophy is associated with greater physical disability progression in MS patients. Along similar lines, the existing evidence based on a total of 13 primary studies suggests that gray matter atrophy is associated with greater physical disability progression in MS patients. Four primary studies suggest that corpus callosum atrophy is associated with greater physical disability progression in MS patients. The majority of the existing evidence (6 primary studies) suggests no association between white matter atrophy and physical disability in MS. It is difficult to assign a relationship between basal ganglia volume loss and physical disability as well as medulla oblongata width and physical disability in MS due to very limited data. CONCLUSION The evidence gathered from this systematic review, although very heterogeneous, suggests that whole brain atrophy is associated with greater physical disability progression in MS patients. Our review can help define future imaging biomarkers for physical disability progression and treatment monitoring in MS.
Collapse
Affiliation(s)
- Paul M Matthews
- Department of Brain Sciences and UK Dementia Research Institute at Imperial College London, Burlington Danes Building, Hammersmith Hospital, DuCane Road, London, UK.
| | - Digant Gupta
- Bridge Medical Consulting Limited, 2 Marsault Court, 11 Kew Foot Road, Richmond, London, TW9 2SS, UK
| | - Deepali Mittal
- Bridge Medical Consulting Limited, 2 Marsault Court, 11 Kew Foot Road, Richmond, London, TW9 2SS, UK
| | - Wenjia Bai
- Department of Brain Sciences and UK Dementia Research Institute at Imperial College London, Burlington Danes Building, Hammersmith Hospital, DuCane Road, London, UK; Department of Computing, Imperial College London, William Penny Building, South Kensington Campus, London, UK
| | - Antonio Scalfari
- Imperial College Healthcare Trust, Centre of Neuroscience, Department of Medicine, Charing Cross Hospital, Fulham Palace Rd, London W6 8RF, UK
| | - Kevin G Pollock
- Bristol-Myers Squibb, Uxbridge Business Park, Sanderson Road, Uxbridge, UB8 1DH, UK
| | - Vishal Sharma
- Bristol-Myers Squibb, Uxbridge Business Park, Sanderson Road, Uxbridge, UB8 1DH, UK
| | - Nathan Hill
- Bristol-Myers Squibb, Uxbridge Business Park, Sanderson Road, Uxbridge, UB8 1DH, UK
| |
Collapse
|
10
|
Wenzel N, Wittayer M, Weber CE, Platten M, Gass A, Eisele P. Multiple sclerosis iron rim lesions are linked to impaired cervical spinal cord integrity using the T1/T2-weighted ratio. J Neuroimaging 2023; 33:240-246. [PMID: 36504270 DOI: 10.1111/jon.13076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/27/2022] [Accepted: 11/29/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND AND PURPOSE In multiple sclerosis (MS), iron rim lesions (IRLs) are characterized by pronounced tissue matrix damage. The T1/T2-weighted (T1/T2w) ratio represents a postprocessing MRI approach to investigate tissue integrity, but studies investigating spinal cord pathology are missing until now. The aim of this study was to characterize tissue integrity using the T1/T2w ratio in lesions and the normal-appearing white and gray matter (NAWM, NAGM) in the spinal cord and brain in MS patients with and without brain IRLs. METHODS Forty MS patients (20 patients with at least one brain IRL and 20 age- and sex-matched patients without IRLs) were included. Normalized cross-sectional area (nCSA) of the upper cervical cord was calculated in addition to T1/T2w values and standard brain and spinal cord MRI parameters. RESULTS Patients with IRLs had higher disability scores, a smaller nCSA, and a higher cervical T2 lesion volume. T1/T2w values of brain IRLs were significantly lower compared to non-IRLs (p < .001). Furthermore, T1/T2w values of lesions were significantly lower compared to the NAGM and NAWM, both in the brain and the spinal cord (p < .05 for all comparisons). T1/T2w values of the NAGM and NAWM in the brain and spinal cord did not statistically differ between the IRL group and the non-IRL group. CONCLUSION IRLs constitute an imaging marker of disease severity. T1/T2w ratio maps represent an interesting technique to capture diffuse tissue properties. Calculation of T1/T2w ratio maps of the spinal cord might provide additional insights into the pathophysiological processes of MS.
Collapse
Affiliation(s)
- Nicolas Wenzel
- Department of Neurology, Medical Faculty Mannheim and Mannheim Center of Translational Neurosciences (MCTN), Heidelberg University, Mannheim, Germany
| | - Matthias Wittayer
- Department of Neurology, Medical Faculty Mannheim and Mannheim Center of Translational Neurosciences (MCTN), Heidelberg University, Mannheim, Germany
| | - Claudia E Weber
- Department of Neurology, Medical Faculty Mannheim and Mannheim Center of Translational Neurosciences (MCTN), Heidelberg University, Mannheim, Germany
| | - Michael Platten
- Department of Neurology, Medical Faculty Mannheim and Mannheim Center of Translational Neurosciences (MCTN), Heidelberg University, Mannheim, Germany.,DKTK CCU Neuroimmunology and Brain Tumor Immunology, DKFZ, Heidelberg, Germany
| | - Achim Gass
- Department of Neurology, Medical Faculty Mannheim and Mannheim Center of Translational Neurosciences (MCTN), Heidelberg University, Mannheim, Germany
| | - Philipp Eisele
- Department of Neurology, Medical Faculty Mannheim and Mannheim Center of Translational Neurosciences (MCTN), Heidelberg University, Mannheim, Germany
| |
Collapse
|
11
|
Matusche B, Litvin L, Schneider R, Bellenberg B, Mühlau M, Pongratz V, Berthele A, Groppa S, Muthuraman M, Zipp F, Paul F, Wiendl H, Meuth SG, Sämann P, Weber F, Linker RA, Kümpfel T, Gold R, Lukas C. Early spinal cord pseudoatrophy in interferon-beta-treated multiple sclerosis. Eur J Neurol 2023; 30:453-462. [PMID: 36318271 DOI: 10.1111/ene.15620] [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: 10/10/2022] [Accepted: 10/26/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Brain pseudoatrophy has been shown to play a pivotal role in the interpretation of brain atrophy measures during the first year of disease-modifying therapy in multiple sclerosis. Whether pseudoatrophy also affects the spinal cord remains unclear. The aim of this study was to analyze the extent of pseudoatrophy in the upper spinal cord during the first 2 years after therapy initiation and compare this to the brain. METHODS A total of 129 patients from a prospective longitudinal multicentric national cohort study for whom magnetic resonance imaging scans at baseline, 12 months, and 24 months were available were selected for brain and spinal cord volume quantification. Annual percentage brain volume and cord area change were calculated using SIENA (Structural Image Evaluation of Normalized Atrophy) and NeuroQLab, respectively. Linear mixed model analyses were performed to compare patients on interferon-beta therapy (n = 84) and untreated patients (n = 45). RESULTS Patients treated with interferon-beta demonstrated accelerated annual percentage brain volume and cervical cord area change in the first year after treatment initiation, whereas atrophy rates stabilized to a similar and not significantly different level compared to untreated patients during the second year. CONCLUSIONS These results suggest that pseudoatrophy occurs not only in the brain, but also in the spinal cord during the first year of interferon-beta treatment.
Collapse
Affiliation(s)
- Britta Matusche
- Institute for Neuroradiology, St Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Ludmila Litvin
- Institute for Neuroradiology, St Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Ruth Schneider
- Department of Neurology, St Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Barbara Bellenberg
- Institute for Neuroradiology, St Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Mark Mühlau
- Department of Neurology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Viola Pongratz
- Department of Neurology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Achim Berthele
- Department of Neurology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Sergiu Groppa
- Department of Neurology, Focus Program Translational Neuroscience and Immunotherapy, Rhine-Main Neuroscience Network, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Muthuraman Muthuraman
- Department of Neurology, Focus Program Translational Neuroscience and Immunotherapy, Rhine-Main Neuroscience Network, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Frauke Zipp
- Department of Neurology, Focus Program Translational Neuroscience and Immunotherapy, Rhine-Main Neuroscience Network, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Friedemann Paul
- Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Heinz Wiendl
- Department of Neurology, Institute of Translational Neurology, University of Münster, Münster, Germany
| | - Sven G Meuth
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | | | - Frank Weber
- Neurological Clinic, Sana Clinic Cham, Cham, Germany
| | - Ralf A Linker
- Department of Neurology, University of Regensburg, Regensburg, Germany
| | - Tania Kümpfel
- Institute of Clinical Neuroimmunology, Biomedical Center and University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Ralf Gold
- Department of Neurology, St Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Carsten Lukas
- Institute for Neuroradiology, St Josef Hospital, Ruhr University Bochum, Bochum, Germany
| |
Collapse
|
12
|
Rocca MA, Valsasina P, Meani A, Gobbi C, Zecca C, Barkhof F, Schoonheim MM, Strijbis EM, Vrenken H, Gallo A, Bisecco A, Ciccarelli O, Yiannakas M, Rovira A, Sastre-Garriga J, Palace J, Matthews L, Gass A, Eisele P, Lukas C, Bellenberg B, Margoni M, Preziosa P, Filippi M. Spinal cord lesions and brain grey matter atrophy independently predict clinical worsening in definite multiple sclerosis: a 5-year, multicentre study. J Neurol Neurosurg Psychiatry 2023; 94:10-18. [PMID: 36171105 DOI: 10.1136/jnnp-2022-329854] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 09/05/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To evaluate the combined contribution of brain and cervical cord damage in predicting 5-year clinical worsening in a multicentre cohort of definite multiple sclerosis (MS) patients. METHODS Baseline 3.0T brain and cervical cord T2-weighted and three-dimensional T1-weighted MRI was acquired in 367 patients with MS (326 relapse-onset and 41 progressive-onset) and 179 healthy controls. Expanded Disability Status Scale (EDSS) score was obtained at baseline and after a median follow-up of 5.1 years (IQR=4.8-5.2). At follow-up, patients were classified as clinically stable/worsened according to EDSS changes. Generalised linear mixed models identified predictors of clinical worsening, evolution to secondary progressive (SP) MS and reaching EDSS=3.0, 4.0 and 6.0 milestones at 5 years. RESULTS At follow-up, 120/367 (33%) patients with MS worsened clinically; 36/256 (14%) patients with relapsing-remitting evolved to SPMS. Baseline predictors of EDSS worsening were progressive-onset versus relapse-onset MS (standardised beta (β)=0.97), higher EDSS (β=0.41), higher cord lesion number (β=0.41), lower normalised cortical volume (β=-0.15) and lower cord area (β=-0.28) (C-index=0.81). Older age (β=0.86), higher EDSS (β=1.40) and cord lesion number (β=0.87) independently predicted SPMS conversion (C-index=0.91). Predictors of reaching EDSS=3.0 after 5 years were higher baseline EDSS (β=1.49), cord lesion number (β=1.02) and lower normalised cortical volume (β=-0.56) (C-index=0.88). Baseline age (β=0.30), higher EDSS (β=2.03), higher cord lesion number (β=0.66) and lower cord area (β=-0.41) predicted EDSS=4.0 (C-index=0.92). Finally, higher baseline EDSS (β=1.87) and cord lesion number (β=0.54) predicted EDSS=6.0 (C-index=0.91). CONCLUSIONS Spinal cord damage and, to a lesser extent, cortical volume loss helped predicting worse 5-year clinical outcomes in MS.
Collapse
Affiliation(s)
- Maria A Rocca
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milano, Italy .,Neurology Unit, IRCCS Ospedale San Raffaele, Milano, Italy.,Vita-Salute San Raffaele University, Milano, Italy
| | - Paola Valsasina
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milano, Italy
| | - Alessandro Meani
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milano, Italy
| | - Claudio Gobbi
- Neurology Clinic, MS Center/Headache Center, Neurocenter of Southern Switzerland EOC, Lugano, Switzerland.,Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Chiara Zecca
- Neurology Clinic, MS Center/Headache Center, Neurocenter of Southern Switzerland EOC, Lugano, Switzerland.,Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Frederik Barkhof
- Radiology and Nuclear Medicine, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC - Locatie VUMC, Amsterdam, Netherlands.,Department of Neurology, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC - Locatie VUMC, Amsterdam, Netherlands
| | - Menno M Schoonheim
- Department of Anatomy and Neurosciences, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC Locatie VUmc, Amsterdam, Netherlands
| | - Eva M Strijbis
- Department of Neurology, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC - Locatie VUMC, Amsterdam, Netherlands
| | - Hugo Vrenken
- Radiology and Nuclear Medicine, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC - Locatie VUMC, Amsterdam, Netherlands.,Department of Neurology, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC - Locatie VUMC, Amsterdam, Netherlands
| | - Antonio Gallo
- Department of Advanced Medical and Surgical Sciences, and 3T MRI-Center, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Alvino Bisecco
- Department of Advanced Medical and Surgical Sciences, and 3T MRI-Center, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Olga Ciccarelli
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, London, UK
| | - Marios Yiannakas
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, London, UK
| | - Alex Rovira
- Section of Neuroradiology, Department of Radiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Jaume Sastre-Garriga
- Department of Neurology/Neuroimmunology, Multiple Sclerosis Centre of Catalonia, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Jacqueline Palace
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Lucy Matthews
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Achim Gass
- Department of Neurology, and Mannheim Center of Translational Neurosciences (MCTN), Ruprecht Karls University Heidelberg Faculty of Medicine Mannheim, Mannheim, Germany
| | - Philipp Eisele
- Department of Neurology, and Mannheim Center of Translational Neurosciences (MCTN), Ruprecht Karls University Heidelberg Faculty of Medicine Mannheim, Mannheim, Germany
| | - Carsten Lukas
- Institute of Neuroradiology, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany.,Department of Radiology and Nuclear Medicine, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Barbara Bellenberg
- Institute of Neuroradiology, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Monica Margoni
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milano, Italy
| | - Paolo Preziosa
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milano, Italy.,Neurology Unit, IRCCS Ospedale San Raffaele, Milano, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milano, Italy.,Neurology Unit, IRCCS Ospedale San Raffaele, Milano, Italy.,Vita-Salute San Raffaele University, Milano, Italy.,Neurorehabilitation Unit, IRCCS Ospedale San Raffaele, Milano, Italy.,Neurophysiology Service, IRCCS Ospedale San Raffaele, Milano, Italy
| | | |
Collapse
|
13
|
Weil EL, Nakawah MO, Masdeu JC. Advances in the neuroimaging of motor disorders. Handb Clin Neurol 2023; 195:359-381. [PMID: 37562878 DOI: 10.1016/b978-0-323-98818-6.00039-x] [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] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Abstract
Neuroimaging is a valuable adjunct to the history and examination in the evaluation of motor system disorders. Conventional imaging with computed tomography or magnetic resonance imaging depicts important anatomic information and helps to identify imaging patterns which may support diagnosis of a specific motor disorder. Advanced imaging techniques can provide further detail regarding volume, functional, or metabolic changes occurring in nervous system pathology. This chapter is an overview of the advances in neuroimaging with particular emphasis on both standard and less well-known advanced imaging techniques and findings, such as diffusion tensor imaging or volumetric studies, and their application to specific motor disorders. In addition, it provides reference to emerging imaging biomarkers in motor system disorders such as Parkinson disease, amyotrophic lateral sclerosis, and Huntington disease, and briefly reviews the neuroimaging findings in different causes of myelopathy and peripheral nerve disorders.
Collapse
Affiliation(s)
- Erika L Weil
- Department of Neurology, University of Michigan, Ann Arbor, MI, United States; Stanley H. Appel Department of Neurology, Houston Methodist Hospital, Houston, TX, United States.
| | - Mohammad Obadah Nakawah
- Stanley H. Appel Department of Neurology, Houston Methodist Hospital, Houston, TX, United States; Department of Neurology, Weill Cornell Medicine, New York, NY, United States
| | - Joseph C Masdeu
- Stanley H. Appel Department of Neurology, Houston Methodist Hospital, Houston, TX, United States; Department of Neurology, Weill Cornell Medicine, New York, NY, United States
| |
Collapse
|
14
|
Tsagkas C, Huck-Horvath A, Cagol A, Haas T, Barakovic M, Amann M, Ruberte E, Melie-Garcia L, Weigel M, Pezold S, Schlaeger R, Kuhle J, Sprenger T, Kappos L, Bieri O, Cattin P, Granziera C, Parmar K. Anterior horn atrophy in the cervical spinal cord: A new biomarker in progressive multiple sclerosis. Mult Scler 2022; 29:702-718. [PMID: 36550626 DOI: 10.1177/13524585221139152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Spinal cord (SC) gray and white matter pathology plays a central role in multiple sclerosis (MS). OBJECTIVE We aimed to investigate the extent, pattern, and clinical relevance of SC gray and white matter atrophy in vivo. METHODS 39 relapsing-remitting patients (RRMS), 40 progressive MS patients (PMS), and 24 healthy controls (HC) were imaged at 3T using the averaged magnetization inversion recovery acquisitions sequence. Total and lesional cervical gray and white matter, and posterior (SCPH) and anterior horn (SCAH) areas were automatically quantified. Clinical assessment included the expanded disability status scale, timed 25-foot walk test, nine-hole peg test, and the 12-item MS walking scale. RESULTS PMS patients had significantly reduced cervical SCAH - but not SCPH - areas compared with HC and RRMS (both p < 0.001). In RRMS and PMS, the cervical SCAH areas increased significantly less in the region of cervical SC enlargement compared with HC (all p < 0.001). This reduction was more pronounced in PMS compared with RRMS (both p < 0.001). In PMS, a lower cervical SCAH area was the most important magnetic resonance imaging (MRI)-variable for higher disability scores. CONCLUSION MS patients show clinically relevant cervical SCAH atrophy, which is more pronounced in PMS and at the level of cervical SC enlargement.
Collapse
Affiliation(s)
- Charidimos Tsagkas
- Neurologic Clinic and Policlinic, Departments of Head, Spine and Neuromedicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland/Translational Imaging in Neurology (ThINk) Basel, Departments of Head, Spine and Neuromedicine and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Antal Huck-Horvath
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Alessandro Cagol
- Translational Imaging in Neurology (ThINk) Basel, Departments of Head, Spine and Neuromedicine and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland/Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Tanja Haas
- Division of Radiological Physics, Department of Radiology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Muhamed Barakovic
- Translational Imaging in Neurology (ThINk) Basel, Departments of Head, Spine and Neuromedicine and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland/Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Michael Amann
- Neurologic Clinic and Policlinic, Departments of Head, Spine and Neuromedicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland/Department of Biomedical Engineering, University of Basel, Basel, Switzerland; Medical Image Analysis Center AG, Basel, Switzerland
| | - Esther Ruberte
- Translational Imaging in Neurology (ThINk) Basel, Departments of Head, Spine and Neuromedicine and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland/Medical Image Analysis Center AG, Basel, Switzerland
| | - Lester Melie-Garcia
- Neurologic Clinic and Policlinic, Departments of Head, Spine and Neuromedicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland/Translational Imaging in Neurology (ThINk) Basel, Departments of Head, Spine and Neuromedicine and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Matthias Weigel
- Neurologic Clinic and Policlinic, Departments of Head, Spine and Neuromedicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland/Translational Imaging in Neurology (ThINk) Basel, Departments of Head, Spine and Neuromedicine and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland/Department of Biomedical Engineering, University of Basel, Basel, Switzerland/Division of Radiological Physics, Department of Radiology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Simon Pezold
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Regina Schlaeger
- Neurologic Clinic and Policlinic, Departments of Head, Spine and Neuromedicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland/Translational Imaging in Neurology (ThINk) Basel, Departments of Head, Spine and Neuromedicine and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Jens Kuhle
- Neurologic Clinic and Policlinic, Departments of Head, Spine and Neuromedicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Till Sprenger
- Neurologic Clinic and Policlinic, Departments of Head, Spine and Neuromedicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland/Department of Neurology, DKD HELIOS Klinik Wiesbaden, Wiesbaden, Germany
| | - Ludwig Kappos
- Neurologic Clinic and Policlinic, Departments of Head, Spine and Neuromedicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland/Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), Departments of Head, Spine and Neuromedicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Oliver Bieri
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland/Division of Radiological Physics, Department of Radiology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Philippe Cattin
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Cristina Granziera
- Neurologic Clinic and Policlinic, Departments of Head, Spine and Neuromedicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland/Translational Imaging in Neurology (ThINk) Basel, Departments of Head, Spine and Neuromedicine and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland; Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Katrin Parmar
- Neurologic Clinic and Policlinic, Departments of Head, Spine and Neuromedicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland/Translational Imaging in Neurology (ThINk) Basel, Departments of Head, Spine and Neuromedicine and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland; Reha Rheinfelden, Rheinfelden, Switzerland
| |
Collapse
|
15
|
Ladopoulos T, Matusche B, Bellenberg B, Heuser F, Gold R, Lukas C, Schneider R. Relaxometry and brain myelin quantification with synthetic MRI in MS subtypes and their associations with spinal cord atrophy. Neuroimage Clin 2022; 36:103166. [PMID: 36081258 PMCID: PMC9463599 DOI: 10.1016/j.nicl.2022.103166] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 07/31/2022] [Accepted: 08/22/2022] [Indexed: 01/18/2023]
Abstract
Immune-mediated demyelination and neurodegeneration are pathophysiological hallmarks of Multiple Sclerosis (MS) and main drivers of disease related disability. The principal method for evaluating qualitatively demyelinating events in the clinical context is contrast-weighted magnetic resonance imaging (MRI). Moreover, advanced MRI sequences provide reliable quantification of brain myelin offering new opportunities to study tissue pathology in vivo. Towards neurodegenerative aspects of the disease, spinal cord atrophy - besides brain atrophy - is a powerful and validated predictor of disease progression. The etiology of spinal cord volume loss is still a matter of research, as it remains unclear whether the impact of local lesion pathology or the interaction with supra- and infratentorial axonal degeneration and demyelination of the long descending and ascending fiber tracts are the determining factors. Quantitative synthetic MR using a multiecho acquisition of saturation recovery pulse sequence provides fast automatic brain tissue and myelin volumetry based on R1 and R2 relaxation rates and proton density quantification, making it a promising modality for application in the clinical routine. In this cross sectional study a total of 91 MS patients and 31 control subjects were included to investigate group differences of global and regional measures of brain myelin and relaxation rates, in different MS subtypes, using QRAPMASTER sequence and SyMRI postprocessing software. Furthermore, we examined associations between these quantitative brain parameters and spinal cord atrophy to draw conclusions about possible pathophysiological relationships. Intracranial myelin volume fraction of the global brain exhibited statistically significant differences between control subjects (10.4%) and MS patients (RRMS 9.4%, PMS 8.1%). In a LASSO regression analysis with total brain lesion load, intracranial myelin volume fraction and brain parenchymal fraction, the intracranial myelin volume fraction was the variable with the highest impact on spinal cord atrophy (standardized coefficient 4.52). Regional supratentorial MRI metrics showed altered average myelin volume fraction, R1, R2 and proton density in MS patients compared to controls most pronounced in PMS. Interestingly, quantitative MRI parameters in supratentorial regions showed strong associations with upper cord atrophy, suggesting an important role of brain diffuse demyelination on spinal cord pathology possibly in the context of global disease activity. R1, R2 or proton density of the thalamus, cerebellum and brainstem correlated with upper cervical cord atrophy, probably reflecting the direct functional connection between these brain structures and the spinal cord as well as the effects of retrograde and anterograde axonal degeneration. By using Synthetic MR-derived myelin volume fraction, we were able to effectively detect significant differences of myelination in relapsing and progressive MS subtypes. Total intracranial brain myelin volume fraction seemed to predict spinal cord volume loss better than brain atrophy or total lesion load. Furthermore, demyelination in highly myelinated supratentorial regions, as an indicator of diffuse disease activity, as well as alterations of relaxation parameters in adjacent infratentorial and midbrain areas were strongly associated with upper cervical cord atrophy.
Collapse
Affiliation(s)
- Theodoros Ladopoulos
- Department of Neurology, St. Josef Hospital, Ruhr-University Bochum, Gudrunstr. 56, 44791 Bochum, Germany,Institute of Neuroradiology, St. Josef Hospital, Ruhr-University Bochum, Gudrunstr. 56, 44791 Bochum, Germany,Corresponding authors at: St. Josef Hospital, Department of Neurology, Gudrunstr. 56, 44791 Bochum, Germany.
| | - Britta Matusche
- Institute of Neuroradiology, St. Josef Hospital, Ruhr-University Bochum, Gudrunstr. 56, 44791 Bochum, Germany
| | - Barbara Bellenberg
- Institute of Neuroradiology, St. Josef Hospital, Ruhr-University Bochum, Gudrunstr. 56, 44791 Bochum, Germany
| | - Florian Heuser
- Institute of Neuroradiology, St. Josef Hospital, Ruhr-University Bochum, Gudrunstr. 56, 44791 Bochum, Germany
| | - Ralf Gold
- Department of Neurology, St. Josef Hospital, Ruhr-University Bochum, Gudrunstr. 56, 44791 Bochum, Germany
| | - Carsten Lukas
- Institute of Neuroradiology, St. Josef Hospital, Ruhr-University Bochum, Gudrunstr. 56, 44791 Bochum, Germany,Department of Diagnostic and Interventional Radiology and Nuclear Medicine, St. Josef Hospital, Ruhr-University Bochum, Gudrunstr. 56, 44791 Bochum, Germany
| | - Ruth Schneider
- Department of Neurology, St. Josef Hospital, Ruhr-University Bochum, Gudrunstr. 56, 44791 Bochum, Germany,Institute of Neuroradiology, St. Josef Hospital, Ruhr-University Bochum, Gudrunstr. 56, 44791 Bochum, Germany
| |
Collapse
|
16
|
Suleman S, Harwood M, Kang P, Narayan R, Hughes JN. Assessment of cervical spinal cord volume in pediatric-onset multiple sclerosis. Clin Imaging 2022. [DOI: 10.1016/j.clinimag.2022.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 06/15/2022] [Accepted: 06/27/2022] [Indexed: 11/23/2022]
|
17
|
Freund P, Papinutto N, Bischof A, Azzarito M, Kirkish G, Ashburner J, Thompson A, Hauser SL, Henry RG. Simultaneous assessment of regional distributions of atrophy across the neuraxis in MS patients. Neuroimage Clin 2022; 34:102985. [PMID: 35316667 DOI: 10.1016/j.nicl.2022.102985] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 03/05/2022] [Accepted: 03/07/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND The ability to assess brain and cord atrophy simultaneously would improve the efficiency of MRI to track disease evolution. OBJECTIVE To test a promising tool to simultaneously map the regional distribution of atrophy in multiple sclerosis (MS) patients across the brain and cord. METHODS Voxel-based morphometry combined with a statistical parametric mapping probabilistic brain-spinal cord (SPM-BSC) template was applied to standard T1-weighted magnetic resonance imaging (MRI) scans covering the brain and cervical cord from 37 MS patients and 20 healthy controls (HC). We also measured the cord area at C2-C3 with a semi-automatic segmentation method using (i) the same T1-weighted acquisitions used for the new voxel-based analysis and (ii) dedicated spinal cord phase sensitive inversion recovery (PSIR) acquisitions. Cervical cord findings derived from the three approaches were compared to each other and the goodness to fit to clinical scores was assessed by regression analyses. RESULTS The SPM-BSC approach revealed a severity-dependent pattern of atrophy across the cervical cord and thalamus in MS patients when compared to HCs. The magnitude of cord atrophy was confirmed by the semi-automatic extraction approach at C2-C3 using both standard brain T1-weighted and advanced cord dedicated acquisitions. Associations between atrophy of cord and thalamus with disability and cognition were demonstrated. CONCLUSION Atrophy in the brain and cervical cord of MS patients can be identified simultaneously and rapidly at the voxel-level. The SPM-BSC approach yields similar results as available standard processing tools with the added advantage of performing the analysis simultaneously and faster.
Collapse
|
18
|
Theodorsdottir A, Larsen PV, Nielsen HH, Illes Z, Ravnborg MH. Multiple sclerosis impairment scale and brain MRI in secondary progressive multiple sclerosis. Acta Neurol Scand 2022; 145:332-347. [PMID: 34799851 DOI: 10.1111/ane.13554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 11/01/2021] [Accepted: 11/02/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To examine the Multiple Sclerosis Impairment Scale (MSIS) in secondary progressive MS (SPMS) in relation to the Expanded Disability Status Scale (EDSS), magnetic resonance imaging (MRI) outcomes, and mobility. METHODS In this observational single-center study, 68 secondary progressive multiple sclerosis (SPMS) patients were examined by MSIS, EDSS, functional mobility tests of upper/lower extremities, and multimodal MRI. Participants had EDSS ≥3.5, a decline in daily activities over the last year unrelated to relapses, and/or 6-month confirmed disability progression. RESULTS Mean disease duration was 23.1 ± 8.3 years and mean age 54.4 ± 8.1 years. MSIS, EDSS, and their corresponding motor, cerebellar, and sensory subscores correlated (p < .0001). Motor subscores of MSIS correlated stronger with Timed-25-Foot-Walk (T25FW) than pyramidal functional system score (FSS) (p = .03), but EDSS had a stronger correlation to T25FW than the total MSIS score (p = .01). MSIS cerebellar subscore correlated stronger with 9-Hole Peg Test (9-HPT) than cerebellar FSS (p = .04). The sensory MSIS subscore also showed correlation with 9-HPT in contrast to sensory FSS (p = .006). MSIS subscores had stronger correlations with MRI volumetry measures than FSS scores (lesion volume and putamen, thalamus, corpus callosum volumetry, p = .0001-0.0017). CONCLUSION In patients with SPMS, MSIS correlated with functional motor tests. MSIS showed stronger correlations with atrophy of central nervous system areas, and may be more sensitive to scale cerebellar and sensory function than EDSS.
Collapse
Affiliation(s)
- Asta Theodorsdottir
- Department of Neurology Odense University Hospital Odense Denmark
- OPEN Odense Patient Data Explorative Network Odense University Hospital Odense Denmark
| | - Pia Veldt Larsen
- Mental Health Services at the Region of Southern Denmark Odense Denmark
| | - Helle Hvilsted Nielsen
- Department of Neurology Odense University Hospital Odense Denmark
- Department of Neurobiology Research Institute of Molecular Medicine University of Southern Denmark Odense Denmark
- Department of Clinical Research BRIDGE ‐ Brain Research – Inter Disciplinary Guided Excellence University of Southern Denmark Odense Denmark
| | - Zsolt Illes
- Department of Neurology Odense University Hospital Odense Denmark
- Department of Neurobiology Research Institute of Molecular Medicine University of Southern Denmark Odense Denmark
- Department of Clinical Research BRIDGE ‐ Brain Research – Inter Disciplinary Guided Excellence University of Southern Denmark Odense Denmark
| | | |
Collapse
|
19
|
Bischof A, Papinutto N, Keshavan A, Rajesh A, Kirkish G, Zhang X, Mallott JM, Asteggiano C, Sacco S, Gundel TJ, Zhao C, Stern WA, Caverzasi E, Zhou Y, Gomez R, Ragan NR, Santaniello A, Zhu AH, Juwono J, Bevan CJ, Bove RM, Crabtree E, Gelfand JM, Goodin DS, Graves JS, Green AJ, Oksenberg JR, Waubant E, Wilson MR, Zamvil SS, Cree BA, Hauser SL, Henry RG. Reply to "Spinal cord atrophy is a preclinical marker of progressive MS". Ann Neurol 2022; 91:735-736. [PMID: 35233827 PMCID: PMC9511767 DOI: 10.1002/ana.26340] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 02/26/2022] [Accepted: 02/28/2022] [Indexed: 12/03/2022]
Affiliation(s)
- Antje Bischof
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA.,Department of Neurology with Institute for Translational Neurology, University Hospital Münster, Germany
| | - Nico Papinutto
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Anisha Keshavan
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Anand Rajesh
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Gina Kirkish
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Xinheng Zhang
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Jacob M Mallott
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Carlo Asteggiano
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Simone Sacco
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Tristan J Gundel
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Chao Zhao
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - William A Stern
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Eduardo Caverzasi
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Yifan Zhou
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Refujia Gomez
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Nicholas R Ragan
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Adam Santaniello
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Alyssa H Zhu
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Jeremy Juwono
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Carolyn J Bevan
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Riley M Bove
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Elizabeth Crabtree
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Jeffrey M Gelfand
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Douglas S Goodin
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Jennifer S Graves
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Ari J Green
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Jorge R Oksenberg
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Emmanuelle Waubant
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Michael R Wilson
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Scott S Zamvil
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | -
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Bruce A Cree
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Stephen L Hauser
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Roland G Henry
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| |
Collapse
|
20
|
Weeda MM, Zywicki S, Brouwer I, Moraal B, Killestein J, Gallo P, Barkhof F, Pouwels PJW, Vrenken H. Upper cervical cord atrophy is independent of cervical cord lesion volume in early multiple sclerosis: A two-year longitudinal study. Mult Scler Relat Disord 2022; 60:103713. [PMID: 35272146 DOI: 10.1016/j.msard.2022.103713] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/10/2022] [Accepted: 02/24/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Upper cervical cord atrophy and lesions have been shown to be associated with disease and disability progression already in early relapsing-remitting multiple sclerosis (RRMS). However, their longitudinal relationship remains unclear. OBJECTIVE To investigate the cross-sectional and longitudinal relation between focal T2 cervical cord lesion volume (CCLV) and regional and global mean upper cervical cord area (UCCA), and their relations with disability. METHODS Over a two-year interval, subjects with RRMS (n = 36) and healthy controls (HC, n = 16) underwent annual clinical and MRI examinations. UCCA and CCLV were obtained from C1 through C4 level. Linear mixed model analysis was performed to investigate the relation between UCCA, CCLV, and disability over time. RESULTS UCCA at baseline was significantly lower in RRMS subjects compared to HCs (p = 0.003), but did not decrease faster over time (p ≥ 0.144). UCCA and CCLV were independent of each other at any of the time points or cervical levels, and over time. Lower baseline UCCA, but not CCLV, was related to worsening of both upper and lower extremities function over time. CONCLUSION UCCA and CCLV are independent from each other, both cross-sectionally and longitudinally, in early MS. Lower UCCA, but not CCLV, was related to increasing disability over time.
Collapse
|
21
|
Taheri K, Vavasour IM, Abel S, Lee LE, Johnson P, Ristow S, Tam R, Laule C, Ackermans NC, Schabas A, Cross H, Chan JK, Sayao AL, Bhan V, Devonshire V, Carruthers R, Li DK, Traboulsee AL, Kolind SH, Dvorak AV. Cervical Spinal Cord Atrophy can be Accurately Quantified Using Head Images. Mult Scler J Exp Transl Clin 2022; 8:20552173211070760. [PMID: 35024164 PMCID: PMC8743948 DOI: 10.1177/20552173211070760] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 12/16/2021] [Indexed: 11/16/2022] Open
Abstract
Background Spinal cord atrophy provides a clinically relevant metric for monitoring MS. However, the spinal cord is imaged far less frequently than brain due to artefacts and acquisition time, whereas MRI of the brain is routinely performed. Objective To validate spinal cord cross-sectional area measurements from routine 3DT1 whole-brain MRI versus those from dedicated cord MRI in healthy controls and people with MS. Methods We calculated cross-sectional area at C1 and C2/3 using T2*-weighted spinal cord images and 3DT1 brain images, for 28 healthy controls and 73 people with MS. Correlations for both groups were assessed between: (1) C1 and C2/3 using cord images; (2) C1 from brain and C1 from cord; and (3) C1 from brain and C2/3 from cord. Results and Conclusion C1 and C2/3 from cord were strongly correlated in controls (r = 0.94, p<0.0001) and MS (r = 0.85, p<0.0001). There was strong agreement between C1 from brain and C2/3 from cord in controls (r = 0.84, p<0.0001) and MS (r = 0.81, p<0.0001). This supports the use of C1 cross-sectional area calculated from brain imaging as a surrogate for the traditional C2/3 cross-sectional area measure for spinal cord atrophy.
Collapse
Affiliation(s)
- Kamyar Taheri
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Irene M Vavasour
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | | | | | | | - Stephen Ristow
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Roger Tam
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Cornelia Laule
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | | | | | | | | | | | | | | | - Robert Carruthers
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - David Kb Li
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | | | - Shannon H Kolind
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Adam Vladimir Dvorak
- Department of Physics & Astronomy, University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
22
|
Bischof A, Papinutto N, Keshavan A, Rajesh A, Kirkish G, Zhang X, Mallott JM, Asteggiano C, Sacco S, Gundel TJ, Zhao C, Stern WA, Caverzasi E, Zhou Y, Gomez R, Ragan NR, Santaniello A, Zhu AH, Juwono J, Bevan CJ, Bove RM, Crabtree E, Gelfand JM, Goodin DS, Graves JS, Green AJ, Oksenberg JR, Waubant E, Wilson MR, Zamvil SS, Cree BA, Hauser SL, Henry RG. Spinal cord atrophy predicts progressive disease in relapsing multiple sclerosis. Ann Neurol 2021; 91:268-281. [PMID: 34878197 PMCID: PMC8916838 DOI: 10.1002/ana.26281] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [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: 06/24/2021] [Revised: 12/04/2021] [Accepted: 12/06/2021] [Indexed: 11/06/2022]
Abstract
Objective A major challenge in multiple sclerosis (MS) research is the understanding of silent progression and Progressive MS. Using a novel method to accurately capture upper cervical cord area from legacy brain MRI scans we aimed to study the role of spinal cord and brain atrophy for silent progression and conversion to secondary progressive disease (SPMS). Methods From a single‐center observational study, all RRMS (n = 360) and SPMS (n = 47) patients and 80 matched controls were evaluated. RRMS patient subsets who converted to SPMS (n = 54) or silently progressed (n = 159), respectively, during the 12‐year observation period were compared to clinically matched RRMS patients remaining RRMS (n = 54) or stable (n = 147), respectively. From brain MRI, we assessed the value of brain and spinal cord measures to predict silent progression and SPMS conversion. Results Patients who developed SPMS showed faster cord atrophy rates (−2.19%/yr) at least 4 years before conversion compared to their RRMS matches (−0.88%/yr, p < 0.001). Spinal cord atrophy rates decelerated after conversion (−1.63%/yr, p = 0.010) towards those of SPMS patients from study entry (−1.04%). Each 1% faster spinal cord atrophy rate was associated with 69% (p < 0.0001) and 53% (p < 0.0001) shorter time to silent progression and SPMS conversion, respectively. Interpretation Silent progression and conversion to secondary progressive disease are predominantly related to cervical cord atrophy. This atrophy is often present from the earliest disease stages and predicts the speed of silent progression and conversion to Progressive MS. Diagnosis of SPMS is rather a late recognition of this neurodegenerative process than a distinct disease phase. ANN NEUROL 2022;91:268–281
Collapse
Affiliation(s)
- Antje Bischof
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Nico Papinutto
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Anisha Keshavan
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Anand Rajesh
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Gina Kirkish
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Xinheng Zhang
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Jacob M Mallott
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Carlo Asteggiano
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Simone Sacco
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Tristan J Gundel
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Chao Zhao
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - William A Stern
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Eduardo Caverzasi
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Yifan Zhou
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Refujia Gomez
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Nicholas R Ragan
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Adam Santaniello
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Alyssa H Zhu
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Jeremy Juwono
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Carolyn J Bevan
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Riley M Bove
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Elizabeth Crabtree
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Jeffrey M Gelfand
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Douglas S Goodin
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Jennifer S Graves
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Ari J Green
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Jorge R Oksenberg
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Emmanuelle Waubant
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Michael R Wilson
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Scott S Zamvil
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | -
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Bruce A Cree
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Stephen L Hauser
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Roland G Henry
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| |
Collapse
|
23
|
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.
Collapse
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
| |
Collapse
|
24
|
Kreiter DJ, van den Hurk J, Wiggins CJ, Hupperts RMM, Gerlach OHH. Ultra-high field spinal cord MRI in multiple sclerosis: Where are we standing? A literature review. Mult Scler Relat Disord 2021; 57:103436. [PMID: 34871855 DOI: 10.1016/j.msard.2021.103436] [Citation(s) in RCA: 4] [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: 10/17/2021] [Revised: 11/18/2021] [Accepted: 11/27/2021] [Indexed: 12/24/2022]
Abstract
Magnetic resonance imaging (MRI) is a cornerstone in multiple sclerosis (MS) diagnostics and monitoring. Ultra-high field (UHF) MRI is being increasingly used and becoming more accessible. Due to the small diameter and mobility of the spinal cord, imaging this structure at ultra-high fields poses additional challenges compared to brain imaging. Here we review the potential benefits for the MS field by providing a literature overview of the use UHF spinal cord MRI in MS research and we elaborate on the challenges that are faced. Benefits include increased signal- and contrast-to-noise, enabling for higher spatial resolutions, which can improve MS lesion sensitivity in both the spinal white matter as well as grey matter. Additionally, these benefits can aid imaging of microstructural abnormalities in the spinal cord in MS using advanced MRI techniques like functional imaging, MR spectroscopy and diffusion-based techniques. Technical challenges include increased magnetic field inhomogeneities, distortions from physiological motion and optimalisation of sequences. Approaches including parallel imaging techniques, real time shimming and retrospective compensation of physiological motion are making it increasingly possible to unravel the potential of spinal cord UHF MRI in the context of MS research.
Collapse
Affiliation(s)
- Daniël J Kreiter
- Academic MS center Zuyderland, Department of Neurology, Zuyderland Medical Center, Sittard-Geleen, The Netherlands; School for Mental Health and Neuroscience, Department of Neurology, Maastricht University Medical Center, Maastricht, The Netherlands.
| | - Job van den Hurk
- Scannexus, Maastricht, The Netherlands; Maastricht University, Faculty of Health, Medicine & Life Sciences, Maastricht, The Netherlands
| | | | - Raymond M M Hupperts
- Academic MS center Zuyderland, Department of Neurology, Zuyderland Medical Center, Sittard-Geleen, The Netherlands; School for Mental Health and Neuroscience, Department of Neurology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Oliver H H Gerlach
- Academic MS center Zuyderland, Department of Neurology, Zuyderland Medical Center, Sittard-Geleen, The Netherlands; School for Mental Health and Neuroscience, Department of Neurology, Maastricht University Medical Center, Maastricht, The Netherlands.
| |
Collapse
|
25
|
Barreiro-González A, Sanz MT, Carratalà-Boscà S, Pérez-Miralles F, Alcalá C, Carreres-Polo J, España-Gregori E, Casanova B. Design and Validation of an Expanded Disability Status Scale Model in Multiple Sclerosis. Eur Neurol 2021; 85:112-121. [PMID: 34788755 DOI: 10.1159/000519772] [Citation(s) in RCA: 4] [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: 09/30/2020] [Accepted: 09/19/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION We aimed to develop and validate an Expanded Disability Status Scale (EDSS) model through clinical, optical coherence tomography (OCT), and magnetic resonance imaging (MRI) measures. METHODS Sixty-four multiple sclerosis (MS) patients underwent peripapillary retinal nerve fiber layer and segmented macular layers evaluation through OCT (Spectralis, Heidelberg Engineering). Brain parenchymal fraction was quantified through Freesurfer, while cervical spinal cord (SC) volume was assessed manually guided by Spinal Cord Toolbox software analysis. EDSS, neuroradiological, and OCT assessment were carried out within 3 months. OCT parameters were calculated as the average of both nonoptic neuritis (ON) eyes, and in case the patient had previous ON, the value of the fellow non-ON eye was taken. Brain lesion volume, sex, age, disease duration, and history of disease-modifying treatment (1st or 2nd line disease-modifying treatments) were tested as covariables of the EDSS score. RESULTS EDSS values correlated with patient's age (r = 0.543, p = 0.001), SC volume (r = -0.301, p = 0.034), and ganglion cell layer (GCL, r = -0.354, p = 0.012). Using these correlations, an ordinal regression model to express probability of diverse EDSS scores were designed, the highest of which was the most probable (Nagelkerke R2 = 43.3%). Using EDSS cutoff point of 4.0 in a dichotomous model, compared to a cutoff of 2.0, permits the inclusion of GCL as a disability predictor, in addition to age and SC. CONCLUSIONS MS disability measured through EDSS is an age-dependent magnitude that is partly conditioned by SC and GCL. Further studies assessing paraclinical disability predictors are needed.
Collapse
Affiliation(s)
| | - Maria T Sanz
- Department of Mathematics Teaching, University of Valencia, Valencia, Spain
| | - Sara Carratalà-Boscà
- Neurology Department, University and Polytechnic Hospital La Fe, Valencia, Spain
| | | | - Carmen Alcalá
- Neurology Department, University and Polytechnic Hospital La Fe, Valencia, Spain
| | - Joan Carreres-Polo
- Radiology Department, University and Polytechnic Hospital La Fe, Valencia, Spain
| | - Enrique España-Gregori
- Opthalmology Department, University and Polytechnic Hospital La Fe, Valencia, Spain.,Surgery Department, University of Valencia, Valencia, Spain
| | - Bonaventura Casanova
- Neurology Department, University and Polytechnic Hospital La Fe, Valencia, Spain.,Medicine Department, University of Valencia, Valencia, Spain
| |
Collapse
|
26
|
Bellenberg B, Lukas C. Editorial for "Improved Assessment of Longitudinal Spinal Cord Atrophy in Multiple Sclerosis Using a Registration-Based Approach: Relevance for Clinical Studies". J Magn Reson Imaging 2021; 55:1569-1570. [PMID: 34655127 DOI: 10.1002/jmri.27958] [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] [Received: 10/05/2021] [Accepted: 10/06/2021] [Indexed: 11/05/2022] Open
Affiliation(s)
- Barbara Bellenberg
- Institute of Neuroradiology, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Carsten Lukas
- Institute of Neuroradiology, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
| |
Collapse
|
27
|
Valsasina P, Gobbi C, Zecca C, Rovira A, Sastre-Garriga J, Kearney H, Yiannakas M, Matthews L, Palace J, Gallo A, Bisecco A, Gass A, Eisele P, Filippi M, Rocca MA. Characterizing 1-year development of cervical cord atrophy across different MS phenotypes: A voxel-wise, multicentre analysis. Mult Scler 2021; 28:885-899. [PMID: 34605323 DOI: 10.1177/13524585211045545] [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] [Indexed: 11/15/2022]
Abstract
BACKGROUND Spatio-temporal evolution of cord atrophy in multiple sclerosis (MS) has not been investigated yet. OBJECTIVE To evaluate voxel-wise distribution and 1-year changes of cervical cord atrophy in a multicentre MS cohort. METHODS Baseline and 1-year 3D T1-weighted cervical cord scans and clinical evaluations of 54 healthy controls (HC) and 113 MS patients (14 clinically isolated syndromes (CIS), 77 relapsing-remitting (RR), 22 progressive (P)) were used to investigate voxel-wise cord volume loss in patients versus HC, 1-year volume changes and clinical correlations (SPM12). RESULTS MS patients exhibited baseline cord atrophy versus HC at anterior and posterior/lateral C1/C2 and C4-C6 (p < 0.05, corrected). While CIS patients showed baseline volume increase at C4 versus HC (p < 0.001, uncorrected), RRMS exhibited posterior/lateral C1/C2 atrophy versus CIS, and PMS showed widespread cord atrophy versus RRMS (p < 0.05, corrected). At 1 year, 13 patients had clinically worsened. Cord atrophy progressed in MS, driven by RRMS, at posterior/lateral C2 and C3-C6 (p < 0.05, corrected). CIS patients showed no volume changes, while PMS showed circumscribed atrophy progression. Baseline cord atrophy at posterior/lateral C1/C2 and C3-C6 correlated with concomitant and 1-year disability (r = -0.40/-0.62, p < 0.05, corrected). CONCLUSIONS Voxel-wise analysis characterized spinal cord neurodegeneration over 1 year across MS phenotypes and helped to explain baseline and 1-year disability.
Collapse
Affiliation(s)
- Paola Valsasina
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Claudio Gobbi
- Multiple Sclerosis Center, Department of Neurology, Neurocenter of Southern Switzerland, Civic Hospital, Lugano, Switzerland Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano. Switzerland
| | - Chiara Zecca
- Multiple Sclerosis Center, Department of Neurology, Neurocenter of Southern Switzerland, Civic Hospital, Lugano, Switzerland Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano. Switzerland
| | - Alex Rovira
- Section of Neuroradiology, Department of Radiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Jaume Sastre-Garriga
- Department of Neurology/Neuroimmunology, Multiple Sclerosis Center of Catalonia, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Hugh Kearney
- Department of Neurology, St. Vincent's University Hospital, Dublin, Ireland/NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, London, UK
| | - Marios Yiannakas
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, London, UK
| | - Lucy Matthews
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Jacqueline Palace
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Antonio Gallo
- Department of Advanced Medical and Surgical Sciences, 3T-MRI Research Centre, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Alvino Bisecco
- Department of Advanced Medical and Surgical Sciences, 3T-MRI Research Centre, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Achim Gass
- Department of Neurology/Neuroimaging, Medical Faculty Mannheim and Mannheim Center for Translational Neurosciences (MCTN), University of Heidelberg, Mannheim, Germany
| | - Philipp Eisele
- Department of Neurology/Neuroimaging, Medical Faculty Mannheim and Mannheim Center for Translational Neurosciences (MCTN), University of Heidelberg, Mannheim, Germany
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, Neurology Unit, Neurorehabilitation Unit, Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy/Vita-Salute San Raffaele University, Milan, Italy
| | - Maria A Rocca
- Neuroimaging Research Unit, Division of Neuroscience, Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | | |
Collapse
|
28
|
Rose DR, Amin M, Ontaneda D. Prediction in treatment outcomes in multiple sclerosis: challenges and recent advances. Expert Rev Clin Immunol 2021; 17:1187-1198. [PMID: 34570656 DOI: 10.1080/1744666x.2021.1986005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Multiple Sclerosis (MS) is a chronic autoimmune and neurodegenerative disease of the central nervous system with a course dependent on early treatment response. Increasing evidence also suggests that despite eliminating disease activity (relapses and lesions), many patients continue to accrue disability, highlighting the need for a more comprehensive definition of treatment success. Optimizing disability outcome measures, as well as continuously improving our understanding of neuroinflammatory and neurodegenerative biomarkers is required. AREAS COVERED This review describes the challenges inherent in classifying and monitoring disease phenotype in MS. The review also provides an assessment of clinical, radiological, and blood biomarker tools for current and future practice. EXPERT OPINION Emerging MRI techniques and standardized patient outcome assessments will increase the accuracy of initial diagnosis and understanding of disease progression.
Collapse
Affiliation(s)
- Deja R Rose
- Cleveland Clinic, Mellen Center for Multiple Sclerosis, Cleveland Ohio, United States
| | - Moein Amin
- Cleveland Clinic, Mellen Center for Multiple Sclerosis, Cleveland Ohio, United States.,Department of Neurology, Cleveland Clinic, Cleveland Ohio, United States
| | - Daniel Ontaneda
- Cleveland Clinic, Mellen Center for Multiple Sclerosis, Cleveland Ohio, United States.,Department of Neurology, Cleveland Clinic, Cleveland Ohio, United States
| |
Collapse
|
29
|
Valsasina P, Horsfield MA, Meani A, Gobbi C, Gallo A, Rocca MA, Filippi M. Improved Assessment of Longitudinal Spinal Cord Atrophy in Multiple Sclerosis Using a Registration-Based Approach: Relevance for Clinical Studies. J Magn Reson Imaging 2021; 55:1559-1568. [PMID: 34582062 DOI: 10.1002/jmri.27937] [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: 07/15/2021] [Revised: 09/15/2021] [Accepted: 09/17/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Reliable measurements of cervical cord atrophy progression may be useful for monitoring neurodegeneration in multiple sclerosis (MS). PURPOSE To compare a new, registration-based (Reg) method with two existing methods (active surface [AS] and propagation segmentation [PropSeg]) to measure cord atrophy changes over time in MS. STUDY TYPE Retrospective. SUBJECTS Cohort I: Eight healthy controls (HC) and 28 MS patients enrolled at a single institution, and cohort II: 25 HC and 63 MS patients enrolled at three European sites. FIELD STRENGTH/SEQUENCE 3D T1-weighted gradient echo sequence, acquired at 1.5 T (cohort I) and 3.0 T (cohort II). ASSESSMENT Percentage cord area changes (PCACs) between baseline and follow-up (cohort I: 2.34 years [interquartile range = 2.00-2.55 years], cohort II: 1.05 years [interquartile range = 1.01-1.18 years]) were evaluated for all subjects using Reg, AS, and PropSeg. Reg included an accurate registration of baseline and follow-up straightened cord images, followed by AS-based optimized cord segmentation. A subset of studies was analyzed twice by two observers. STATISTICAL TESTS Linear regression models were used to estimate annualized PCAC, and effect sizes expressed as the ratio between the estimated differences and HC error term (P < 0.05). Reproducibility was assessed by linear mixed-effect models. Annualized PCACs were used for sample size calculations (significance: α = 0.05, power: 1 - β = 0.80). RESULTS Annualized PCACs and related standard errors (SEs) were lower with Reg than with other methods: PCAC in MS patients at 1.5 T was -1.12% (SE = 0.22) with Reg, -1.32% (SE = 0.30) with AS, and -1.40% (SE = 0.33) with PropSeg, while at 3.0 T PCAC was -0.83% (SE = 0.25) with Reg, -0.92% (SE = 0.32) with AS, and -1.18 (SE = 0.53) with PropSeg. This was reflected in larger effect sizes and lower sample sizes. Intra- and inter-observer agreement range was 0.72-0.91 with AS, and it was >0.96 with Reg. DATA CONCLUSION The results support the use of the registration method to measure cervical cord atrophy progression in future MS clinical studies. LEVEL OF EVIDENCE 3 TECHNICAL EFFICACY STAGE: 2.
Collapse
Affiliation(s)
- Paola Valsasina
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Alessandro Meani
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Claudio Gobbi
- Multiple Sclerosis Center, Department of Neurology, Neurocenter of Southern Switzerland (NSI), Lugano, Switzerland.,Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland
| | - Antonio Gallo
- Department of Advanced Medical and Surgical Sciences and 3T-MRI Research Centre, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Maria A Rocca
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy.,Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy
| |
Collapse
|
30
|
Weber CE, Krämer J, Wittayer M, Gregori J, Randoll S, Weiler F, Heldmann S, Roßmanith C, Platten M, Gass A, Eisele P. Association of iron rim lesions with brain and cervical cord volume in relapsing multiple sclerosis. Eur Radiol 2021; 32:2012-2022. [PMID: 34549326 PMCID: PMC8831268 DOI: 10.1007/s00330-021-08233-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 06/22/2021] [Accepted: 07/22/2021] [Indexed: 10/28/2022]
Abstract
OBJECTIVES In multiple sclerosis (MS), iron rim lesions (IRLs) are indicators of chronic low-grade inflammation and ongoing tissue destruction. The aim of this study was to assess the relationship of IRLs with clinical measures and magnetic resonance imaging (MRI) markers, in particular brain and cervical cord volume. METHODS Clinical and MRI parameters from 102 relapsing MS patients (no relapses for at least 6 months, no contrast-enhancing lesions) were included; follow-up data obtained after 12 months was available in 49 patients. IRLs were identified on susceptibility-weighted images (SWIs). In addition to standard brain and spinal cord MRI parameters, normalised cross-sectional area (nCSA) of the upper cervical cord was calculated. RESULTS Thirty-eight patients had at least one IRL on SWI MRI. At baseline, patients with IRLs had higher EDSS scores, higher lesion loads (brain and spinal cord), and lower cortical grey matter volumes and a lower nCSA. At follow-up, brain atrophy rates were higher in patients with IRLs. IRLs correlated spatially with T1-hypointense lesions. CONCLUSIONS Relapsing MS patients with IRLs showed more aggressive MRI disease characteristics in both the cross-sectional and longitudinal analyses. KEY POINTS • Multiple sclerosis patients with iron rim lesions had higher EDSS scores, higher brain and spinal cord lesion loads, lower cortical grey matter volumes, and a lower normalised cross-sectional area of the upper cervical spinal cord. • Iron rim lesions are a new lesion descriptor obtained from susceptibility-weighted MRI. Our data suggests that further exploration of this lesion characteristic in regard to a poorer prognosis in multiple sclerosis patients is warranted.
Collapse
Affiliation(s)
- Claudia E Weber
- Department of Neurology, Medical Faculty Mannheim and Mannheim Center for Translational Neurosciences (MCTN), University of Heidelberg, Theodor-Kutzer-Ufer 1 - 3, 68167, Mannheim, Germany
| | - Julia Krämer
- Department of Neurology With Institute of Translational Neurology, University Hospital Münster, Albert-Schweitzer-Campus 1; Gebäude A1, Westturm, Ebene 5, 48149, Münster, Germany
| | - Matthias Wittayer
- Department of Neurology, Medical Faculty Mannheim and Mannheim Center for Translational Neurosciences (MCTN), University of Heidelberg, Theodor-Kutzer-Ufer 1 - 3, 68167, Mannheim, Germany
| | | | - Sigurd Randoll
- Mediri GmbH, Eppelheimer Straße 113, 69115, Heidelberg, Germany
| | | | | | - Christina Roßmanith
- Department of Neurology, Medical Faculty Mannheim and Mannheim Center for Translational Neurosciences (MCTN), University of Heidelberg, Theodor-Kutzer-Ufer 1 - 3, 68167, Mannheim, Germany
| | - Michael Platten
- Department of Neurology, Medical Faculty Mannheim and Mannheim Center for Translational Neurosciences (MCTN), University of Heidelberg, Theodor-Kutzer-Ufer 1 - 3, 68167, Mannheim, Germany
| | - Achim Gass
- Department of Neurology, Medical Faculty Mannheim and Mannheim Center for Translational Neurosciences (MCTN), University of Heidelberg, Theodor-Kutzer-Ufer 1 - 3, 68167, Mannheim, Germany.
| | - Philipp Eisele
- Department of Neurology, Medical Faculty Mannheim and Mannheim Center for Translational Neurosciences (MCTN), University of Heidelberg, Theodor-Kutzer-Ufer 1 - 3, 68167, Mannheim, Germany
| |
Collapse
|
31
|
Krajnc N, Bsteh G, Berger T. Clinical and Paraclinical Biomarkers and the Hitches to Assess Conversion to Secondary Progressive Multiple Sclerosis: A Systematic Review. Front Neurol 2021; 12:666868. [PMID: 34512500 PMCID: PMC8427301 DOI: 10.3389/fneur.2021.666868] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 07/06/2021] [Indexed: 12/11/2022] Open
Abstract
Conversion to secondary progressive (SP) course is the decisive factor for long-term prognosis in relapsing multiple sclerosis (MS), generally considered the clinical equivalent of progressive MS-associated neuroaxonal degeneration. Evidence is accumulating that both inflammation and neurodegeneration are present along a continuum of pathologic processes in all phases of MS. While inflammation is the prominent feature in early stages, its quality changes and relative importance to disease course decreases while neurodegenerative processes prevail with ongoing disease. Consequently, anti-inflammatory disease-modifying therapies successfully used in relapsing MS are ineffective in SPMS, whereas specific treatment for the latter is increasingly a focus of MS research. Therefore, the prevention, but also the (anticipatory) diagnosis of SPMS, is of crucial importance. The problem is that currently SPMS diagnosis is exclusively based on retrospectively assessing the increase of overt physical disability usually over the past 6–12 months. This inevitably results in a delay of diagnosis of up to 3 years resulting in periods of uncertainty and, thus, making early therapy adaptation to prevent SPMS conversion impossible. Hence, there is an urgent need for reliable and objective biomarkers to prospectively predict and define SPMS conversion. Here, we review current evidence on clinical parameters, magnetic resonance imaging and optical coherence tomography measures, and serum and cerebrospinal fluid biomarkers in the context of MS-associated neurodegeneration and SPMS conversion. Ultimately, we discuss the necessity of multimodal approaches in order to approach objective definition and prediction of conversion to SPMS.
Collapse
Affiliation(s)
- Nik Krajnc
- Department of Neurology, Medical University of Vienna, Vienna, Austria.,Department of Neurology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Gabriel Bsteh
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Thomas Berger
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
32
|
Zheng F, Li Y, Zhuo Z, Duan Y, Cao G, Tian D, Zhang X, Li K, Zhou F, Huang M, Li H, Li Y, Zeng C, Zhang N, Sun J, Yu C, Han X, Hallar S, Barkhof F, Liu Y. Structural and functional hippocampal alterations in Multiple sclerosis and neuromyelitis optica spectrum disorder. Mult Scler 2021; 28:707-717. [PMID: 34379008 DOI: 10.1177/13524585211032800] [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] [Indexed: 02/01/2023]
Abstract
BACKGROUND Hippocampal involvement may differ between multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD). OBJECTIVE To investigate the morphometric, diffusion and functional alterations in hippocampus in MS and NMOSD and the clinical significance. METHODS A total of 752 participants including 236 MS, 236 NMOSD and 280 healthy controls (HC) were included in this retrospective multi-center study. The hippocampus and subfield volumes, fractional anisotropy (FA) and mean diffusivity (MD), amplitude of low frequency fluctuation (ALFF) and degree centrality (DC) were analyzed, and their associations with clinical variables were investigated. RESULTS The hippocampus showed significantly lower volume, FA and greater MD in MS compared to NMOSD and HC (p < 0.05), while no abnormal ALFF or DC was identified in any group. Hippocampal subfields were affected in both diseases, though subiculum, presubiculum and fimbria showed significantly lower volume only in MS (p < 0.05). Significant correlations between diffusion alterations, several subfield volumes and clinical variables were observed in both diseases, especially in MS (R = -0.444 to 0.498, p < 0.05). FA and MD showed fair discriminative power between MS and HC, NMOSD and HC (AUC > 0.7). CONCLUSIONS Hippocampal atrophy and diffusion abnormalities were identified in MS and NMOSD, partly explaining how clinical disability and cognitive impairment are differentially affected.
Collapse
Affiliation(s)
- Fenglian Zheng
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yuxin Li
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Zhizheng Zhuo
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yunyun Duan
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Guanmei Cao
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Decai Tian
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xinghu Zhang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Kuncheng Li
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Fuqing Zhou
- Department of Radiology, The First Affiliated Hospital, Nanchang University, Nanchang, China/Neuroimaging Lab, Jiangxi Province Medical Imaging Research Institute, Nanchang, China
| | - Muhua Huang
- Department of Radiology, The First Affiliated Hospital, Nanchang University, Nanchang, China/Neuroimaging Lab, Jiangxi Province Medical Imaging Research Institute, Nanchang, China
| | - Haiqing Li
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Yongmei Li
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Chun Zeng
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ningnannan Zhang
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, China
| | - Jie Sun
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, China
| | - Chunshui Yu
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, China
| | - Xuemei Han
- Department of Neurology, China-Japan Union hospital of Jilin University, Changchun, China
| | - Sven Hallar
- Centre d'Imagerie Médicale de Cornavin, Geneva, Switzerland/Department of Surgical Sciences, Radiology, Uppsala University, Sweden/Faculty of Medicine of the University of Geneva, Switzerland/Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Amsterdam, The Netherlands/Queen Square Institute of Neurology and Center for Medical Image Computing, University College London, London, UK
| | - Yaou Liu
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
33
|
Lukas C, Bellenberg B, Prados F, Valsasina P, Parmar K, Brouwer I, Pareto D, Rovira À, Sastre-Garriga J, Gandini Wheeler-Kingshott CAM, Kappos L, Rocca MA, Filippi M, Yiannakas M, Barkhof F, Vrenken H. Quantification of Cervical Cord Cross-Sectional Area: Which Acquisition, Vertebra Level, and Analysis Software? A Multicenter Repeatability Study on a Traveling Healthy Volunteer. Front Neurol 2021; 12:693333. [PMID: 34421797 PMCID: PMC8371197 DOI: 10.3389/fneur.2021.693333] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 06/14/2021] [Indexed: 11/15/2022] Open
Abstract
Background: Considerable spinal cord (SC) atrophy occurs in multiple sclerosis (MS). While MRI-based techniques for SC cross-sectional area (CSA) quantification have improved over time, there is no common agreement on whether to measure at single vertebral levels or across larger regions and whether upper SC CSA can be reliably measured from brain images. Aim: To compare in a multicenter setting three CSA measurement methods in terms of repeatability at different anatomical levels. To analyze the agreement between measurements performed on the cervical cord and on brain MRI. Method: One healthy volunteer was scanned three times on the same day in six sites (three scanner vendors) using a 3T MRI protocol including sagittal 3D T1-weighted imaging of the brain (covering the upper cervical cord) and of the SC. Images were analyzed using two semiautomated methods [NeuroQLab (NQL) and the Active Surface Model (ASM)] and the fully automated Spinal Cord Toolbox (SCT) on different vertebral levels (C1-C2; C2/3) on SC and brain images and the entire cervical cord (C1-C7) on SC images only. Results: CSA estimates were significantly smaller using SCT compared to NQL and ASM (p < 0.001), regardless of the cord level. Inter-scanner repeatability was best in C1-C7: coefficients of variation for NQL, ASM, and SCT: 0.4, 0.6, and 1.0%, respectively. CSAs estimated in brain MRI were slightly lower than in SC MRI (all p ≤ 0.006 at the C1-C2 level). Despite protocol harmonization between the centers with regard to image resolution and use of high-contrast 3D T1-weighted sequences, the variability of CSA was partly scanner dependent probably due to differences in scanner geometry, coil design, and details of the MRI parameter settings. Conclusion: For CSA quantification, dedicated isotropic SC MRI should be acquired, which yielded best repeatability in the entire cervical cord. In the upper part of the cervical cord, use of brain MRI scans entailed only a minor loss of CSA repeatability compared to SC MRI. Due to systematic differences between scanners and the CSA quantification software, both should be kept constant within a study. The MRI dataset of this study is available publicly to test new analysis approaches.
Collapse
Affiliation(s)
- Carsten Lukas
- Institute of Neuroradiology, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Barbara Bellenberg
- Institute of Neuroradiology, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Ferran Prados
- Department of Medical Physics and Biomedical Engineering, Centre for Medical Image Computing (CMIC), University College London, London, United Kingdom
- Queen Square Multiple Sclerosis Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
- e-Health Centre, Universitat Oberta de Catalunya, Barcelona, Spain
| | - Paola Valsasina
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Katrin Parmar
- Neurological Clinic and Policlinic, Department of Medicine, University Hospital Basel, Basel, Switzerland
| | - Iman Brouwer
- Department of Radiology and Nuclear Medicine, Multiple Sclerosis Center Amsterdam, Amsterdam Neuroscience Amsterdam University Medical Centers (UMC), Vrije Universiteit Medical Center (VUmc), Amsterdam, Netherlands
| | - Deborah Pareto
- Section of Neuroradiology, Department of Radiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Àlex Rovira
- Section of Neuroradiology, Department of Radiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Jaume Sastre-Garriga
- Department of Neurology–Neuroimmunology, Multiple Sclerosis Center of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Claudia A. M. Gandini Wheeler-Kingshott
- Queen Square Multiple Sclerosis Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
- Department of Brain & Behavioral Sciences, University of Pavia, Pavia, Italy
- Brain Connectivity Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Ludwig Kappos
- Neurological Clinic and Policlinic, Department of Medicine, University Hospital Basel, Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, Allschwig, Switzerland
| | - Maria A. Rocca
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marios Yiannakas
- Queen Square Multiple Sclerosis Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Frederik Barkhof
- Department of Medical Physics and Biomedical Engineering, Centre for Medical Image Computing (CMIC), University College London, London, United Kingdom
- Queen Square Multiple Sclerosis Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
- Department of Radiology and Nuclear Medicine, Multiple Sclerosis Center Amsterdam, Amsterdam Neuroscience Amsterdam University Medical Centers (UMC), Vrije Universiteit Medical Center (VUmc), Amsterdam, Netherlands
| | - Hugo Vrenken
- Department of Radiology and Nuclear Medicine, Multiple Sclerosis Center Amsterdam, Amsterdam Neuroscience Amsterdam University Medical Centers (UMC), Vrije Universiteit Medical Center (VUmc), Amsterdam, Netherlands
| |
Collapse
|
34
|
Adibi I, Najafi A, Merajifar F, Ramezani N, Nouri H, Jalilvand N, Ashtari F, Vard A, Shaygannejad V. Quantitative Magnetic Resonance Imaging Analysis of Early Markers of Upper Cervical Cord Atrophy in Multiple Sclerosis and Neuromyelitis Optica Spectrum Disorder. Mult Scler Int 2021; 2021:9917582. [PMID: 34306756 DOI: 10.1155/2021/9917582] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 06/18/2021] [Accepted: 06/26/2021] [Indexed: 11/25/2022] Open
Abstract
Purpose To quantitatively analyze the C2/C3 segments of the spinal cord on magnetic resonance imaging (MRI) scans of neuromyelitis optica spectrum disorder (NMOSD) and relapsing-remitting multiple sclerosis (RRMS) patients in their first five years of the disease and to investigate the intergroup differences regarding markers of spinal cord atrophy and their correlations with expanded disability status scale (EDSS). Materials and Methods Twenty NMOSD patients and twenty RRMS patients, within their first five years of the disease, were enrolled in this cross-sectional study. All patients underwent spinal cord MR imaging using 1.5 Tesla systems, and C2/C3 portions of the spinal cord were segmented in the obtained scans. C2/C3 anteroposterior diameter (C2/C3 SC-APD), transversal diameter (C2/C3 SC-TD), and cross-sectional area (C2/C3 SC-CSA) were quantitatively measured using Spinal Cord Toolbox v.4.3. Results Three NMOSD patients were seropositive for anti-AQP4 IgG. The mean C2/C3 SC-CSA in NMOSD patients was significantly lower than in RRMS patients. NMOSD patients had significantly lower C2/C3 SC-TDs than RRMS patients. With the three anti-AQP4+ patients excluded from the analysis, C2/C3 SC-TD was negatively correlated with EDSS. Conclusion In the early stages of the disease, quantitative evaluation of C2/C3 spinal cord parameters, including cross-sectional area and transversal diameter in NMOSD patients, appears to be of potential diagnostic and prognostic value.
Collapse
|
35
|
Ruggieri S, Petracca M, De Giglio L, De Luca F, Giannì C, Gurreri F, Petsas N, Tommasin S, Pozzilli C, Pantano P. A matter of atrophy: differential impact of brain and spine damage on disability worsening in multiple sclerosis. J Neurol 2021. [PMID: 33942160 DOI: 10.1007/s00415-021-10576-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 04/20/2021] [Accepted: 04/21/2021] [Indexed: 11/29/2022]
Abstract
As atrophy represents the most relevant driver of progression in multiple sclerosis (MS), we investigated the impact of different patterns of brain and spinal cord atrophy on disability worsening in MS. We acquired clinical and MRI data from 90 patients with relapsing–remitting MS and 24 healthy controls (HC). Clinical progression at follow-up (mean 3.7 years) was defined according to the Expanded Disability Status Scale-Plus. Brain and spinal cord volumes were computed on MRI brain scans. After normalizing each participants’ brain and spine volume to the mean of the HC, z-score cut-offs were applied to separate pathologically atrophic from normal brain and spine volumes (accepting a 2.5% error probability). Accordingly, MS patients were classified into four groups (Group I: no brain or spinal cord atrophy N = 40, Group II: brain atrophy/no spinal cord atrophy N = 11, Group III: no brain atrophy/ spinal cord atrophy N = 32, Group IV: both brain and spinal cord atrophy N = 7). All patients’ groups showed significantly lower brain volume than HC (p < 0.0001). Group III and IV showed lower spine volume than HC (p < 0.0001 for both). Higher brain lesion load was identified in Group II (p = 0.049) and Group IV (p = 0.023) vs Group I, and in Group IV (p = 0.048) vs Group III. Spinal cord atrophy (OR = 3.75, p = 0.018) and brain + spinal cord atrophy (OR = 5.71, p = 0.046) were significant predictors of disability progression. The presence of concomitant brain and spinal cord atrophy is the strongest correlate of progression over time. Isolated spinal cord atrophy exerts a similar effect, confirming the leading role of spinal cord atrophy in the determination of motor disability.
Collapse
|
36
|
Mina Y, Azodi S, Dubuche T, Andrada F, Osuorah I, Ohayon J, Cortese I, Wu T, Johnson KR, Reich DS, Nair G, Jacobson S. Cervical and thoracic cord atrophy in multiple sclerosis phenotypes: Quantification and correlation with clinical disability. Neuroimage Clin 2021; 30:102680. [PMID: 34215150 PMCID: PMC8131917 DOI: 10.1016/j.nicl.2021.102680] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 04/15/2021] [Accepted: 04/16/2021] [Indexed: 12/01/2022]
Abstract
Spinal cord atrophy is prevalent across multiple sclerosis phenotypes. It correlates with disability, especially in relapsing-remitting patients. This correlation can be demonstrated both cross-sectionally and longitudinally. Cervical atrophy is highly associated with disability and disease progression. Thoracic atrophy contributes to improved correlation and radiological subgrouping.
Objective We sought to characterize spinal cord atrophy along the entire spinal cord in the major multiple sclerosis (MS) phenotypes, and evaluate its correlation with clinical disability. Methods Axial T1-weighted images were automatically reformatted at each point along the cord. Spinal cord cross‐sectional area (SCCSA) were calculated from C1-T10 vertebral body levels and profile plots were compared across phenotypes. Average values from C2-3, C4-5, and T4-9 regions were compared across phenotypes and correlated with clinical scores, and then categorized as atrophic/normal based on z-scores derived from controls, to compare clinical scores between subgroups. In a subset of relapsing-remitting cases with longitudinal scans these regions were compared to change in clinical scores. Results The cross-sectional study consisted of 149 adults diagnosed with relapsing-remitting MS (RRMS), 49 with secondary-progressive MS (SPMS), 58 with primary-progressive MS (PPMS) and 48 controls. The longitudinal study included 78 RRMS cases. Compared to controls, all MS groups had smaller average regions except RRMS in T4-9 region. In all MS groups, SCCSA from all regions, particularly the cervical cord, correlated with most clinical measures. In the RRMS cohort, 22% of cases had at least one atrophic region, whereas in progressive MS the rate was almost 70%. Longitudinal analysis showed correlation between clinical disability and cervical cord thinning. Conclusions Spinal cord atrophy was prevalent across MS phenotypes, with regional measures from the RRMS cohort and the progressive cohort, including SPMS and PPMS, being correlated with disability. Longitudinal changes in the spinal cord were documented in RRMS cases, making it a potential marker for disease progression. While cervical SCCSA correlated with most disability and progression measures, inclusion of thoracic measurements improved this correlation and allowed for better subgrouping of spinal cord phenotypes. Cord atrophy is an important and easily obtainable imaging marker of clinical and sub-clinical progression in all MS phenotypes, and such measures can play a key role in patient selection for clinical trials.
Collapse
Affiliation(s)
- Yair Mina
- Viral Immunology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Shila Azodi
- Viral Immunology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States; Neuroimmunology Clinic, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
| | - Tsemacha Dubuche
- Viral Immunology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
| | - Frances Andrada
- Neuroimmunology Clinic, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
| | - Ikesinachi Osuorah
- Neuroimmunology Clinic, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
| | - Joan Ohayon
- Neuroimmunology Clinic, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
| | - Irene Cortese
- Neuroimmunology Clinic, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
| | - Tianxia Wu
- Clinical Trials Unit, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
| | - Kory R Johnson
- Bioinformatics Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
| | - Daniel S Reich
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
| | - Govind Nair
- Neuroimmunology Clinic, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States; Quantitative MRI Core Facility, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
| | - Steven Jacobson
- Viral Immunology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States.
| |
Collapse
|
37
|
Sestito C, Leurs CE, Steenwijk MD, Brevé JJP, Twisk JWR, Wilhelmus MMM, Drukarch B, Teunissen CE, van Dam AM, Killestein J. Tissue Transglutaminase Expression Associates With Progression of Multiple Sclerosis. Neurol Neuroimmunol Neuroinflamm 2021; 8:8/4/e998. [PMID: 33906937 PMCID: PMC8105890 DOI: 10.1212/nxi.0000000000000998] [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] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 02/22/2021] [Indexed: 11/25/2022]
Abstract
Objective The clinical course of multiple sclerosis (MS) is variable and largely unpredictable pointing to an urgent need for markers to monitor disease activity and progression. Recent evidence revealed that tissue transglutaminase (TG2) is altered in patient-derived monocytes. We hypothesize that blood cell–derived TG2 messenger RNA (mRNA) can potentially be used as biomarker in patients with MS. Methods In peripheral blood mononuclear cells (PBMCs) from 151 healthy controls and 161 patients with MS, TG2 mRNA was measured and correlated with clinical and MRI parameters of disease activity (annualized relapse rate, gadolinium-enhanced lesions, and T2 lesion volume) and disease progression (Expanded Disability Status Scale [EDSS], normalized brain volume, and hypointense T1 lesion volume). Results PBMC-derived TG2 mRNA levels were significantly associated with disease progression, i.e., worsening of the EDSS over 2 years of follow-up, normalized brain volume, and normalized gray and white matter volume in the total MS patient group at baseline. Of these, in patients with relapsing-remitting MS, TG2 expression was significantly associated with worsening of the EDSS scores over 2 years of follow-up. In the patients with primary progressive (PP) MS, TG2 mRNA levels were significantly associated with EDSS, normalized brain volume, and normalized gray and white matter volume at baseline. In addition, TG2 mRNA associated with T1 hypointense lesion volume in the patients with PP MS at baseline. Conclusion PBMC-derived TG2 mRNA levels hold promise as biomarker for disease progression in patients with MS. Classification of Evidence This study provides Class II evidence that in patients with MS, PBMC-derived TG2 mRNA levels are associated with disease progression.
Collapse
Affiliation(s)
- Claudia Sestito
- From Amsterdam UMC, Vrije Universiteit, Amsterdam Neuroscience, MS Center Amsterdam, Department of Anatomy and Neurosciences (C.S., M.D.S., J.J.P.B., M.M.M.W., B.D., A.-M.v.D.), Department of Neurology (C.E.L., J.K.), Department of Epidemiology and Biostatistics (J.W.R.T.), and Department of Clinical Chemistry (C.E.T.), Amsterdam, the Netherlands
| | - Cyra E Leurs
- From Amsterdam UMC, Vrije Universiteit, Amsterdam Neuroscience, MS Center Amsterdam, Department of Anatomy and Neurosciences (C.S., M.D.S., J.J.P.B., M.M.M.W., B.D., A.-M.v.D.), Department of Neurology (C.E.L., J.K.), Department of Epidemiology and Biostatistics (J.W.R.T.), and Department of Clinical Chemistry (C.E.T.), Amsterdam, the Netherlands
| | - Martijn D Steenwijk
- From Amsterdam UMC, Vrije Universiteit, Amsterdam Neuroscience, MS Center Amsterdam, Department of Anatomy and Neurosciences (C.S., M.D.S., J.J.P.B., M.M.M.W., B.D., A.-M.v.D.), Department of Neurology (C.E.L., J.K.), Department of Epidemiology and Biostatistics (J.W.R.T.), and Department of Clinical Chemistry (C.E.T.), Amsterdam, the Netherlands
| | - John J P Brevé
- From Amsterdam UMC, Vrije Universiteit, Amsterdam Neuroscience, MS Center Amsterdam, Department of Anatomy and Neurosciences (C.S., M.D.S., J.J.P.B., M.M.M.W., B.D., A.-M.v.D.), Department of Neurology (C.E.L., J.K.), Department of Epidemiology and Biostatistics (J.W.R.T.), and Department of Clinical Chemistry (C.E.T.), Amsterdam, the Netherlands
| | - Jos W R Twisk
- From Amsterdam UMC, Vrije Universiteit, Amsterdam Neuroscience, MS Center Amsterdam, Department of Anatomy and Neurosciences (C.S., M.D.S., J.J.P.B., M.M.M.W., B.D., A.-M.v.D.), Department of Neurology (C.E.L., J.K.), Department of Epidemiology and Biostatistics (J.W.R.T.), and Department of Clinical Chemistry (C.E.T.), Amsterdam, the Netherlands
| | - Micha M M Wilhelmus
- From Amsterdam UMC, Vrije Universiteit, Amsterdam Neuroscience, MS Center Amsterdam, Department of Anatomy and Neurosciences (C.S., M.D.S., J.J.P.B., M.M.M.W., B.D., A.-M.v.D.), Department of Neurology (C.E.L., J.K.), Department of Epidemiology and Biostatistics (J.W.R.T.), and Department of Clinical Chemistry (C.E.T.), Amsterdam, the Netherlands
| | - Benjamin Drukarch
- From Amsterdam UMC, Vrije Universiteit, Amsterdam Neuroscience, MS Center Amsterdam, Department of Anatomy and Neurosciences (C.S., M.D.S., J.J.P.B., M.M.M.W., B.D., A.-M.v.D.), Department of Neurology (C.E.L., J.K.), Department of Epidemiology and Biostatistics (J.W.R.T.), and Department of Clinical Chemistry (C.E.T.), Amsterdam, the Netherlands
| | - Charlotte E Teunissen
- From Amsterdam UMC, Vrije Universiteit, Amsterdam Neuroscience, MS Center Amsterdam, Department of Anatomy and Neurosciences (C.S., M.D.S., J.J.P.B., M.M.M.W., B.D., A.-M.v.D.), Department of Neurology (C.E.L., J.K.), Department of Epidemiology and Biostatistics (J.W.R.T.), and Department of Clinical Chemistry (C.E.T.), Amsterdam, the Netherlands
| | - Anne-Marie van Dam
- From Amsterdam UMC, Vrije Universiteit, Amsterdam Neuroscience, MS Center Amsterdam, Department of Anatomy and Neurosciences (C.S., M.D.S., J.J.P.B., M.M.M.W., B.D., A.-M.v.D.), Department of Neurology (C.E.L., J.K.), Department of Epidemiology and Biostatistics (J.W.R.T.), and Department of Clinical Chemistry (C.E.T.), Amsterdam, the Netherlands.
| | - Joep Killestein
- From Amsterdam UMC, Vrije Universiteit, Amsterdam Neuroscience, MS Center Amsterdam, Department of Anatomy and Neurosciences (C.S., M.D.S., J.J.P.B., M.M.M.W., B.D., A.-M.v.D.), Department of Neurology (C.E.L., J.K.), Department of Epidemiology and Biostatistics (J.W.R.T.), and Department of Clinical Chemistry (C.E.T.), Amsterdam, the Netherlands
| |
Collapse
|
38
|
Meca-Lallana V, Berenguer-Ruiz L, Carreres-Polo J, Eichau-Madueño S, Ferrer-Lozano J, Forero L, Higueras Y, Téllez Lara N, Vidal-Jordana A, Pérez-Miralles FC. Deciphering Multiple Sclerosis Progression. Front Neurol 2021; 12:608491. [PMID: 33897583 PMCID: PMC8058428 DOI: 10.3389/fneur.2021.608491] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 03/11/2021] [Indexed: 12/12/2022] Open
Abstract
Multiple sclerosis (MS) is primarily an inflammatory and degenerative disease of the central nervous system, triggered by unknown environmental factors in patients with predisposing genetic risk profiles. The prevention of neurological disability is one of the essential goals to be achieved in a patient with MS. However, the pathogenic mechanisms driving the progressive phase of the disease remain unknown. It was described that the pathophysiological mechanisms associated with disease progression are present from disease onset. In daily practice, there is a lack of clinical, radiological, or biological markers that favor an early detection of the disease's progression. Different definitions of disability progression were used in clinical trials. According to the most descriptive, progression was defined as a minimum increase in the Expanded Disability Status Scale (EDSS) of 1.5, 1.0, or 0.5 from a baseline level of 0, 1.0–5.0, and 5.5, respectively. Nevertheless, the EDSS is not the most sensitive scale to assess progression, and there is no consensus regarding any specific diagnostic criteria for disability progression. This review document discusses the current pathophysiological concepts associated with MS progression, the different measurement strategies, the biomarkers associated with disability progression, and the available pharmacologic therapeutic approaches.
Collapse
Affiliation(s)
- Virginia Meca-Lallana
- Multiple Sclerosis Unit, Neurology Department, Fundación de Investigación Biomédica, Hospital Universitario de la Princesa, Madrid, Spain
| | | | - Joan Carreres-Polo
- Neuroradiology Section, Radiology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Sara Eichau-Madueño
- Multiple Sclerosis CSUR Unit, Neurology Department, Hospital Universitario Virgen Macarena, Seville, Spain
| | - Jaime Ferrer-Lozano
- Department of Pathology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Lucía Forero
- Neurology Department, Hospital Puerta del Mar, Cádiz, Spain
| | - Yolanda Higueras
- Neurology Department, Instituto de Investigación Sanitaria Gregorio Marañón (IISGM), Hospital Universitario Gregorio Marañón, Madrid, Spain.,Department of Experimental Psychology, Cognitive Processes and Speech Therapy, Universidad Complutense, Madrid, Spain
| | - Nieves Téllez Lara
- Neurology Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Angela Vidal-Jordana
- Neurology/Neuroimmunology Department, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Francisco Carlos Pérez-Miralles
- Neuroimmunology Unit, Neurology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain.,Department of Medicine, University of València, Valencia, Spain
| |
Collapse
|
39
|
Sechi E, Messina S, Keegan BM, Buciuc M, Pittock SJ, Kantarci OH, Weinshenker BG, Flanagan EP. Critical spinal cord lesions associate with secondary progressive motor impairment in long-standing MS: A population-based case-control study. Mult Scler 2021; 27:667-673. [PMID: 32552535 PMCID: PMC10477711 DOI: 10.1177/1352458520929192] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Progressive motor impairment anatomically attributable to prominent, focally atrophic lateral column spinal cord lesions ("critical lesions") can be seen in multiple sclerosis (MS), for example, progressive hemiparetic MS. OBJECTIVE The aim of this study was to investigate whether similar spinal cord lesions are more frequent in long-standing MS patients with secondary progressive motor impairment (secondary progressive MS (SPMS)) versus those maintaining a relapsing-remitting course (relapsing-remitting MS (RRMS)). METHODS We retrospectively identified Olmsted County (MN, USA) residents on 31 December 2011 with (1) RRMS or SPMS for ⩾25 years, and (2) available brain and spine magnetic resonance imaging (MRI). A blinded neuroradiologist determined demyelinating lesion burden and presence of potential critical lesions (prominent focally atrophic spinal cord lateral column lesions). RESULTS In total, 32 patients were included: RRMS, 18; SPMS, 14. Median (range) disease duration (34 (27-53) vs. 39 (29-47) years) and relapse number (4 (1-10) vs. 3 (1-15)) were similar. In comparison to RRMS, SPMS patients more commonly showed potential critical spinal cord lesions (8/18 (44%) vs. 14/14 (100%)), higher spinal cord (median (range) 4 (1-7) vs. 7.5 (3-12)), and brain infratentorial (median (range) 1 (0-12) vs. 2.5 (1-13)) lesion number; p < 0.05. By multivariate analysis, only the presence of potential critical lesions independently associated with motor progression (p = 0.02). CONCLUSION Critical spinal cord lesions may be important contributors to motor progression in MS.
Collapse
Affiliation(s)
- Elia Sechi
- Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Steven Messina
- Department of Radiology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - B Mark Keegan
- Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Marina Buciuc
- Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Sean J Pittock
- Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA/Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Orhun H Kantarci
- Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Brian G Weinshenker
- Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Eoin P Flanagan
- Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA/Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, MN, USA
| |
Collapse
|
40
|
Simmons SB, Schippling S, Giovannoni G, Ontaneda D. Predicting disability worsening in relapsing and progressive multiple sclerosis. Curr Opin Neurol 2021; 34:312-21. [PMID: 33709974 DOI: 10.1097/WCO.0000000000000928] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Multiple sclerosis (MS) is a clinically heterogeneous disease, which complicates expectant management as well as treatment decisions. This review provides an overview of both well established and emerging predictors of disability worsening, including clinical factors, imaging factors, biomarkers and treatment strategies. RECENT FINDINGS In addition to well known clinical predictors (age, male sex, clinical presentation, relapse behaviour), smoking, obesity, vascular and psychiatric comorbidities are associated with subsequent disability worsening in persons with MS. A number of imaging features are predictive of disability worsening and are present to varying degrees in relapsing and progressive forms of MS. These include brain volumes, spinal cord atrophy, lesion volumes and optical coherence tomography features. Cerebrospinal and more recently blood biomarkers including neurofilament light show promise as more easily attainable biomarkers of future disability accumulation. Importantly, recent observational studies suggest that initiation of early-intensive therapy, as opposed to escalation based on breakthrough disease, is associated with decreased accumulation of disability overall, although randomized controlled trials investigating this question are underway. SUMMARY Understanding risk factors associated with disability progression can help to both counsel patients and enhance the clinician's availability to provide evidence-based treatment recommendations.
Collapse
|
41
|
Dekker I, Schoonheim MM, Venkatraghavan V, Eijlers AJC, Brouwer I, Bron EE, Klein S, Wattjes MP, Wink AM, Geurts JJG, Uitdehaag BMJ, Oxtoby NP, Alexander DC, Vrenken H, Killestein J, Barkhof F, Wottschel V. The sequence of structural, functional and cognitive changes in multiple sclerosis. Neuroimage Clin 2020; 29:102550. [PMID: 33418173 PMCID: PMC7804841 DOI: 10.1016/j.nicl.2020.102550] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 12/09/2020] [Accepted: 12/20/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND As disease progression remains poorly understood in multiple sclerosis (MS), we aim to investigate the sequence in which different disease milestones occur using a novel data-driven approach. METHODS We analysed a cohort of 295 relapse-onset MS patients and 96 healthy controls, and considered 28 features, capturing information on T2-lesion load, regional brain and spinal cord volumes, resting-state functional centrality ("hubness"), microstructural tissue integrity of major white matter (WM) tracts and performance on multiple cognitive tests. We used a discriminative event-based model to estimate the sequence of biomarker abnormality in MS progression in general, as well as specific models for worsening physical disability and cognitive impairment. RESULTS We demonstrated that grey matter (GM) atrophy of the cerebellum, thalamus, and changes in corticospinal tracts are early events in MS pathology, whereas other WM tracts as well as the cognitive domains of working memory, attention, and executive function are consistently late events. The models for disability and cognition show early functional changes of the default-mode network and earlier changes in spinal cord volume compared to the general MS population. Overall, GM atrophy seems crucial due to its early involvement in the disease course, whereas WM tract integrity appears to be affected relatively late despite the early onset of WM lesions. CONCLUSION Data-driven modelling revealed the relative occurrence of both imaging and non-imaging events as MS progresses, providing insights into disease propagation mechanisms, and allowing fine-grained staging of patients for monitoring purposes.
Collapse
Affiliation(s)
- Iris Dekker
- Amsterdam UMC, Location VUmc, Departments of Radiology and Nuclear Medicine, MS Center Amsterdam, Amsterdam Neuroscience, De Boelelaan 1117, Amsterdam, The Netherlands; Neurology, MS Center Amsterdam, Amsterdam Neuroscience, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Menno M Schoonheim
- Anatomy and Neurosciences, MS Center Amsterdam, Amsterdam Neuroscience, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Vikram Venkatraghavan
- Biomedical Imaging Group Rotterdam, Departments of Medical Informatics and Radiology & Nuclear Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Anand J C Eijlers
- Anatomy and Neurosciences, MS Center Amsterdam, Amsterdam Neuroscience, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Iman Brouwer
- Amsterdam UMC, Location VUmc, Departments of Radiology and Nuclear Medicine, MS Center Amsterdam, Amsterdam Neuroscience, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Esther E Bron
- Biomedical Imaging Group Rotterdam, Departments of Medical Informatics and Radiology & Nuclear Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Stefan Klein
- Biomedical Imaging Group Rotterdam, Departments of Medical Informatics and Radiology & Nuclear Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Mike P Wattjes
- Dept. of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany
| | - Alle Meije Wink
- Amsterdam UMC, Location VUmc, Departments of Radiology and Nuclear Medicine, MS Center Amsterdam, Amsterdam Neuroscience, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Jeroen J G Geurts
- Anatomy and Neurosciences, MS Center Amsterdam, Amsterdam Neuroscience, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Bernard M J Uitdehaag
- Neurology, MS Center Amsterdam, Amsterdam Neuroscience, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Neil P Oxtoby
- Centre for Medical Image Computing, Department of Computer Science, UCL, London, UK
| | - Daniel C Alexander
- Centre for Medical Image Computing, Department of Computer Science, UCL, London, UK
| | - Hugo Vrenken
- Amsterdam UMC, Location VUmc, Departments of Radiology and Nuclear Medicine, MS Center Amsterdam, Amsterdam Neuroscience, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Joep Killestein
- Neurology, MS Center Amsterdam, Amsterdam Neuroscience, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Frederik Barkhof
- Amsterdam UMC, Location VUmc, Departments of Radiology and Nuclear Medicine, MS Center Amsterdam, Amsterdam Neuroscience, De Boelelaan 1117, Amsterdam, The Netherlands; Centre for Medical Image Computing, Department of Computer Science, UCL, London, UK; Institute of Neurology, UCL, London, UK
| | - Viktor Wottschel
- Amsterdam UMC, Location VUmc, Departments of Radiology and Nuclear Medicine, MS Center Amsterdam, Amsterdam Neuroscience, De Boelelaan 1117, Amsterdam, The Netherlands.
| |
Collapse
|
42
|
Leguy S, Combès B, Bannier E, Kerbrat A. Prognostic value of spinal cord MRI in multiple sclerosis patients. Rev Neurol (Paris) 2020; 177:571-581. [PMID: 33069379 DOI: 10.1016/j.neurol.2020.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 06/10/2020] [Revised: 08/04/2020] [Accepted: 08/05/2020] [Indexed: 11/19/2022]
Abstract
Multiple sclerosis [MS] is a common inflammatory, demyelinating and neurodegenerative disease of the central nervous system that affects both the brain and the spinal cord. In clinical practice, spinal cord MRI is performed far less frequently than brain MRI, mainly owing to technical limitations and time constraints. However, improvements of acquisition techniques, combined with a strong diagnosis and prognostic value, suggest an increasing use of spinal cord MRI in the near future. This review summarizes the current data from the literature on the prognostic value of spinal cord MRI in MS patients in the early and later stages of their disease. Both conventional and quantitative MRI techniques are discussed. The prognostic value of spinal cord lesions is clearly established at the onset of disease, underlining the interest of spinal cord conventional MRI at this stage. However, studies are currently lacking to affirm the prognostic role of spinal cord lesions later in the disease, and therefore the added value of regular follow-up with spinal cord MRI in addition to brain MRI. Besides, spinal cord atrophy, as measured by the loss of cervical spinal cord area, is also associated with disability progression, independently of other clinical and MRI factors including spinal cord lesions. Although potentially interesting, this measurement is not currently performed as a routine clinical procedure. Finally, other measures extracted from quantitative MRI have been established as valuable for a better understanding of the physiopathology of MS, but still remain a field of research.
Collapse
Affiliation(s)
- S Leguy
- CHU de Rennes, Neurology department, 2, Rue Henri-le-Guilloux, 35000 Rennes, France; University Rennes, Inria, CNRS, Inserm, IRISA UMR 6074, Empenn U1228, Rennes, France
| | - B Combès
- University Rennes, Inria, CNRS, Inserm, IRISA UMR 6074, Empenn U1228, Rennes, France
| | - E Bannier
- University Rennes, Inria, CNRS, Inserm, IRISA UMR 6074, Empenn U1228, Rennes, France; CHU de Rennes, Radiology department, Rennes, France
| | - A Kerbrat
- CHU de Rennes, Neurology department, 2, Rue Henri-le-Guilloux, 35000 Rennes, France; University Rennes, Inria, CNRS, Inserm, IRISA UMR 6074, Empenn U1228, Rennes, France.
| |
Collapse
|
43
|
Timmermans ST, de Groot V, Beckerman H. Ten-year disease progression in multiple sclerosis: walking declines more rapidly than arm and hand function. Mult Scler Relat Disord 2020; 45:102343. [PMID: 32674028 DOI: 10.1016/j.msard.2020.102343] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 06/13/2020] [Accepted: 06/21/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND AIMS From a clinical perspective there is a difference in the decline of arm and hand function and leg function in patients with multiple sclerosis (PwMS). Therefore, this study investigated the course of walking and arm and hand functions in PwMS over the first 10 years after diagnosis, including whether any function declined earlier or faster. METHODS A long-term prospective follow-up study of an incidence cohort of 156 patients with a definite diagnosis of MS, either non-relapse onset (n=28) or relapse onset (n=128) type. Participants were systematically examined immediately after definite diagnosis, at 6 months, and at 1, 2, 3, 6 and 10 years. Walking was determined with the fast 10-meter timed walk test (10mTWT), arm and hand function with the Action Research Arm test (ARAT) and the nine-hole peg test (9HPT). The 10-year trajectories of walking and arm and hand functions were compared using standardized z-scores. RESULTS From 3 years onwards the z-scores of the arm and leg function were visually diverging, with a trend towards significance at 6 years, and at 10 years the 10mTWT z-score is significantly higher than the 9HPT. This difference is more pronounced in non-relapse onset patients than in patients with relapse onset type MS, but present in both groups over the first 10 years. In the non-relapse onset group a difference in z-scores at 10 years post-diagnosis between the 10m TWT and 9HPT was found of -12.94 (95% confidence interval (CI) -20.2 to -5.73) for the right and -10.14 (95% CI -17.3 to -2.93) for the left hand. In the relapse onset group there was a difference at 10 years post-diagnosis of -2.17 (95% CI -3.75 to -0.59) for the right and a difference of -2.29 (95% CI -3.87 to -0.71) for the left hand. CONCLUSION This is the first longitudinal study that shows that walking declines earlier and more rapidly than arm and hand function in patients with MS. These results give important insights that can be linked to the pathophysiological disease process regarding the ascending order of deterioration in patients with MS.
Collapse
|
44
|
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.
Collapse
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
| |
Collapse
|
45
|
Marrodan M, Gaitán MI, Correale J. Spinal Cord Involvement in MS and Other Demyelinating Diseases. Biomedicines 2020; 8:E130. [PMID: 32455910 PMCID: PMC7277673 DOI: 10.3390/biomedicines8050130] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 05/18/2020] [Accepted: 05/20/2020] [Indexed: 12/13/2022] Open
Abstract
Diagnostic accuracy is poor in demyelinating myelopathies, and therefore a challenge for neurologists in daily practice, mainly because of the multiple underlying pathophysiologic mechanisms involved in each subtype. A systematic diagnostic approach combining data from the clinical setting and presentation with magnetic resonance imaging (MRI) lesion patterns, cerebrospinal fluid (CSF) findings, and autoantibody markers can help to better distinguish between subtypes. In this review, we describe spinal cord involvement, and summarize clinical findings, MRI and diagnostic characteristics, as well as treatment options and prognostic implications in different demyelinating disorders including: multiple sclerosis (MS), neuromyelitis optica spectrum disorder, acute disseminated encephalomyelitis, anti-myelin oligodendrocyte glycoprotein antibody-associated disease, and glial fibrillary acidic protein IgG-associated disease. Thorough understanding of individual case etiology is crucial, not only to provide valuable prognostic information on whether the disorder is likely to relapse, but also to make therapeutic decision-making easier and reduce treatment failures which may lead to new relapses and long-term disability. Identifying patients with monophasic disease who may only require acute management, symptomatic treatment, and subsequent rehabilitation, rather than immunosuppression, is also important.
Collapse
Affiliation(s)
| | | | - Jorge Correale
- Neurology Department, Fleni, C1428AQK Buenos Aires, Argentina; (M.M.); (M.I.G.)
| |
Collapse
|
46
|
Abstract
INTRODUCTION In multiple sclerosis (MS), inflammatory, demyelinating, and neurodegenerative phenomena affect the spinal cord, with detrimental effects on patients' clinical disability. Although spinal cord imaging may be challenging, improvements in MRI technologies have contributed to better evaluate spinal cord involvement in MS. AREAS COVERED This review summarizes the current state-of-art of the application of conventional and advanced MRI techniques to evaluate spinal cord damage in MS. Typical features of spinal cord lesions, their role in the diagnostic work-up of suspected MS, their predictive role for subsequent disease course and clinical worsening, and their utility to define treatment response are discussed. The role of spinal cord atrophy and of other advanced MRI techniques to better evaluate the associations between spinal cord abnormalities and the accumulation of clinical disability are also evaluated. Finally, how spinal cord assessment could evolve in the future to improve monitoring of disease progression and treatment effects is examined. EXPERT OPINION Spinal cord MRI provides relevant additional information to brain MRI in understanding MS pathophysiology, in allowing an earlier and more accurate diagnosis of MS, and in identifying MS patients at higher risk to develop more severe disability. A future role in monitoring the effects of treatments is also foreseen.
Collapse
Affiliation(s)
- Maria A Rocca
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute , Milan, Italy.,Neurology Unit, IRCCS San Raffaele Scientific Institute , Milan, Italy
| | - Paolo Preziosa
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute , Milan, Italy.,Neurology Unit, IRCCS San Raffaele Scientific Institute , Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute , Milan, Italy.,Neurology Unit, IRCCS San Raffaele Scientific Institute , Milan, Italy.,Neurophysiology Unit, IRCCS San Raffaele Scientific Institute , Milan, Italy.,Vita-Salute San Raffaele University , Milan, Italy
| |
Collapse
|
47
|
Sastre-Garriga J, Pareto D, Battaglini M, Rocca MA, Ciccarelli O, Enzinger C, Wuerfel J, Sormani MP, Barkhof F, Yousry TA, De Stefano N, Tintoré M, Filippi M, Gasperini C, Kappos L, Río J, Frederiksen J, Palace J, Vrenken H, Montalban X, Rovira À. MAGNIMS consensus recommendations on the use of brain and spinal cord atrophy measures in clinical practice. Nat Rev Neurol 2020; 16:171-182. [PMID: 32094485 PMCID: PMC7054210 DOI: 10.1038/s41582-020-0314-x] [Citation(s) in RCA: 130] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2020] [Indexed: 11/08/2022]
Abstract
Early evaluation of treatment response and prediction of disease evolution are key issues in the management of people with multiple sclerosis (MS). In the past 20 years, MRI has become the most useful paraclinical tool in both situations and is used clinically to assess the inflammatory component of the disease, particularly the presence and evolution of focal lesions - the pathological hallmark of MS. However, diffuse neurodegenerative processes that are at least partly independent of inflammatory mechanisms can develop early in people with MS and are closely related to disability. The effects of these neurodegenerative processes at a macroscopic level can be quantified by estimation of brain and spinal cord atrophy with MRI. MRI measurements of atrophy in MS have also been proposed as a complementary approach to lesion assessment to facilitate the prediction of clinical outcomes and to assess treatment responses. In this Consensus statement, the Magnetic Resonance Imaging in MS (MAGNIMS) study group critically review the application of brain and spinal cord atrophy in clinical practice in the management of MS, considering the role of atrophy measures in prognosis and treatment monitoring and the barriers to clinical use of these measures. On the basis of this review, the group makes consensus statements and recommendations for future research.
Collapse
Affiliation(s)
- Jaume Sastre-Garriga
- Multiple Sclerosis Centre of Catalonia (Cemcat), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Deborah Pareto
- Section of Neuroradiology and Magnetic Resonance Unit, Department of Radiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marco Battaglini
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Maria A Rocca
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Olga Ciccarelli
- NMR Research Unit, University College London Queen Square Institute of Neurology, London, UK
- National Institute for Health Research Biomedical Research Centre, University College London Hospitals, London, UK
| | - Christian Enzinger
- Department of Neurology and Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Jens Wuerfel
- Medical Image Analysis Center (MIAC AG) and Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Maria P Sormani
- Biostatistics Unit, Department of Health Sciences, University of Genoa, Genoa, Italy
- IRCCS, Ospedale Policlinico San Martino, Genoa, Italy
| | - Frederik Barkhof
- National Institute for Health Research Biomedical Research Centre, University College London Hospitals, London, UK
- Amsterdam Neuroscience, MS Center Amsterdam, Department of Radiology and Nuclear Medicine, Amsterdam UMC, Amsterdam, Netherlands
- Institutes of Neurology and Healthcare Engineering, University College London, London, UK
| | - Tarek A Yousry
- NMR Research Unit, University College London Queen Square Institute of Neurology, London, UK
- Lysholm Department of Neuroradiology, University College London Hospitals National Hospital for Neurology and Neurosurgery, University College London Institute of Neurology, London, UK
| | - Nicola De Stefano
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Mar Tintoré
- Multiple Sclerosis Centre of Catalonia (Cemcat), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Massimo Filippi
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Claudio Gasperini
- Multiple Sclerosis Center, Department of Neurosciences, San Camillo-Forlanini Hospital, Rome, Italy
| | - Ludwig Kappos
- Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedical Engineering, University Hospital, University of Basel, Basel, Switzerland
| | - Jordi Río
- Multiple Sclerosis Centre of Catalonia (Cemcat), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jette Frederiksen
- Department of Neurology, Rigshospitalet-Glostrup and University of Copenhagen, Glostrup, Denmark
| | - Jackie Palace
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Hugo Vrenken
- Amsterdam Neuroscience, MS Center Amsterdam, Department of Radiology and Nuclear Medicine, Amsterdam UMC, Amsterdam, Netherlands
| | - Xavier Montalban
- Multiple Sclerosis Centre of Catalonia (Cemcat), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
- Division of Neurology, St Michael's Hospital, University of Toronto, Toronto, Canada
| | - Àlex Rovira
- Section of Neuroradiology and Magnetic Resonance Unit, Department of Radiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
| |
Collapse
|
48
|
Rocca MA, Valsasina P, Meani A, Gobbi C, Zecca C, Rovira À, Montalban X, Kearney H, Ciccarelli O, Matthews L, Palace J, Gallo A, Bisecco A, Gass A, Eisele P, Lukas C, Bellenberg B, Barkhof F, Vrenken H, Preziosa P, Comi G, Filippi M. Clinically relevant cranio-caudal patterns of cervical cord atrophy evolution in MS. Neurology 2019; 93:e1852-e1866. [PMID: 31611336 DOI: 10.1212/wnl.0000000000008466] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 06/04/2019] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To characterize the distribution and regional evolution of cervical cord atrophy in patients with multiple sclerosis (MS) in a multicenter dataset. METHODS MRI and clinical evaluations were acquired from 179 controls and 435 patients (35 clinically isolated syndromes [CIS], 259 relapsing-remitting multiple sclerosis [RRMS], 99 secondary progressive multiple sclerosis [SPMS], and 42 primary progressive multiple sclerosis [PPMS]). Sixty-nine controls and 178 patients underwent a 1-year MRI and clinical follow-up. Patients were classified as clinically stable/worsened according to their disability change. Longitudinal changes of cord atrophy were investigated with linear mixed-effect models. Sample size calculations were performed using age-, sex- and site-adjusted annualized percentage normalized cord cross-sectional area (CSAn) changes. RESULTS Baseline CSAn was lower in patients with MS vs controls (p < 0.001), but not different between controls and patients with CIS or between patients with early RRMS (disease duration ≤5 years) and patients with CIS. Patients with late RRMS (disease duration >5 years) showed significant cord atrophy vs patients with early RRMS (p = 0.02). Patients with progressive MS had decreased CSAn (p < 0.001) vs patients with RRMS. Atrophy was located between C1/C2 and C5 in patients with RRMS vs patients with CIS, and widespread along the cord in patients with progressive MS vs patients with RRMS, with an additional C5/C6 involvement in patients with SPMS vs patients with PPMS. At follow-up, CSAn decreased in all phenotypes (p < 0.001), except CIS. Cord atrophy rates were highest in patients with early RRMS and clinically worsened patients, who had a more widespread cord involvement than stable patients. The sample size per arm required to detect a 50% treatment effect was 118 for patients with early RRMS. CONCLUSIONS Cord atrophy increased in MS during 1 year, except for CIS. Faster atrophy contributed to explain clinical worsening.
Collapse
Affiliation(s)
- Maria A Rocca
- From the Neuroimaging Research Unit (M.A.R., P.V., A.M., P.P., M.F.) and Neurology Unit (M.A.R., P.P., G.C., M.F.), Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Neurology (C.G., C.Z.), Neurocenter of Southern Switzerland, Regional Hospital Lugano (EOC), Lugano; Faculty of Biomedical Sciences (C.G., C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Section of Neuroradiology and MRI Unit, Department of Radiology (A.R.), and Department of Neurology/Neuroimmunology (X.M.), Multiple Sclerosis Centre of Catalonia, Hospital Universitari Vall d'Hebron, Barcelona, Spain; NMR Research Unit (H.K., O.C.), Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, London; Nuffield Department of Clinical Neurosciences (L.M., J.P.), University of Oxford, UK; Department of Advanced Medical and Surgical Sciences, and 3T MRI Center, (A.G., A.B.), University of Campania "Luigi Vanvitelli," Naples, Italy; Department of Neurology (A.G., P.E.), Universitätsmedizin Mannheim, University of Heidelberg, Germany; Department of Radiology and Nuclear Medicine (C.L., B.B.) and Institute of Neuroradiology (C.L., B.B.), St. Josef Hospital, Ruhr-University Bochum, Germany; Department of Radiology and Nuclear Medicine (F.B., H.V.), MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, location VUmc, the Netherlands; Institutes of Neurology and Healthcare Engineering (F.B.), University College London, UK; and Vita-Salute San Raffaele University (P.P., G.C., M.F.), Milan, Italy.
| | - Paola Valsasina
- From the Neuroimaging Research Unit (M.A.R., P.V., A.M., P.P., M.F.) and Neurology Unit (M.A.R., P.P., G.C., M.F.), Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Neurology (C.G., C.Z.), Neurocenter of Southern Switzerland, Regional Hospital Lugano (EOC), Lugano; Faculty of Biomedical Sciences (C.G., C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Section of Neuroradiology and MRI Unit, Department of Radiology (A.R.), and Department of Neurology/Neuroimmunology (X.M.), Multiple Sclerosis Centre of Catalonia, Hospital Universitari Vall d'Hebron, Barcelona, Spain; NMR Research Unit (H.K., O.C.), Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, London; Nuffield Department of Clinical Neurosciences (L.M., J.P.), University of Oxford, UK; Department of Advanced Medical and Surgical Sciences, and 3T MRI Center, (A.G., A.B.), University of Campania "Luigi Vanvitelli," Naples, Italy; Department of Neurology (A.G., P.E.), Universitätsmedizin Mannheim, University of Heidelberg, Germany; Department of Radiology and Nuclear Medicine (C.L., B.B.) and Institute of Neuroradiology (C.L., B.B.), St. Josef Hospital, Ruhr-University Bochum, Germany; Department of Radiology and Nuclear Medicine (F.B., H.V.), MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, location VUmc, the Netherlands; Institutes of Neurology and Healthcare Engineering (F.B.), University College London, UK; and Vita-Salute San Raffaele University (P.P., G.C., M.F.), Milan, Italy
| | - Alessandro Meani
- From the Neuroimaging Research Unit (M.A.R., P.V., A.M., P.P., M.F.) and Neurology Unit (M.A.R., P.P., G.C., M.F.), Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Neurology (C.G., C.Z.), Neurocenter of Southern Switzerland, Regional Hospital Lugano (EOC), Lugano; Faculty of Biomedical Sciences (C.G., C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Section of Neuroradiology and MRI Unit, Department of Radiology (A.R.), and Department of Neurology/Neuroimmunology (X.M.), Multiple Sclerosis Centre of Catalonia, Hospital Universitari Vall d'Hebron, Barcelona, Spain; NMR Research Unit (H.K., O.C.), Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, London; Nuffield Department of Clinical Neurosciences (L.M., J.P.), University of Oxford, UK; Department of Advanced Medical and Surgical Sciences, and 3T MRI Center, (A.G., A.B.), University of Campania "Luigi Vanvitelli," Naples, Italy; Department of Neurology (A.G., P.E.), Universitätsmedizin Mannheim, University of Heidelberg, Germany; Department of Radiology and Nuclear Medicine (C.L., B.B.) and Institute of Neuroradiology (C.L., B.B.), St. Josef Hospital, Ruhr-University Bochum, Germany; Department of Radiology and Nuclear Medicine (F.B., H.V.), MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, location VUmc, the Netherlands; Institutes of Neurology and Healthcare Engineering (F.B.), University College London, UK; and Vita-Salute San Raffaele University (P.P., G.C., M.F.), Milan, Italy
| | - Claudio Gobbi
- From the Neuroimaging Research Unit (M.A.R., P.V., A.M., P.P., M.F.) and Neurology Unit (M.A.R., P.P., G.C., M.F.), Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Neurology (C.G., C.Z.), Neurocenter of Southern Switzerland, Regional Hospital Lugano (EOC), Lugano; Faculty of Biomedical Sciences (C.G., C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Section of Neuroradiology and MRI Unit, Department of Radiology (A.R.), and Department of Neurology/Neuroimmunology (X.M.), Multiple Sclerosis Centre of Catalonia, Hospital Universitari Vall d'Hebron, Barcelona, Spain; NMR Research Unit (H.K., O.C.), Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, London; Nuffield Department of Clinical Neurosciences (L.M., J.P.), University of Oxford, UK; Department of Advanced Medical and Surgical Sciences, and 3T MRI Center, (A.G., A.B.), University of Campania "Luigi Vanvitelli," Naples, Italy; Department of Neurology (A.G., P.E.), Universitätsmedizin Mannheim, University of Heidelberg, Germany; Department of Radiology and Nuclear Medicine (C.L., B.B.) and Institute of Neuroradiology (C.L., B.B.), St. Josef Hospital, Ruhr-University Bochum, Germany; Department of Radiology and Nuclear Medicine (F.B., H.V.), MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, location VUmc, the Netherlands; Institutes of Neurology and Healthcare Engineering (F.B.), University College London, UK; and Vita-Salute San Raffaele University (P.P., G.C., M.F.), Milan, Italy
| | - Chiara Zecca
- From the Neuroimaging Research Unit (M.A.R., P.V., A.M., P.P., M.F.) and Neurology Unit (M.A.R., P.P., G.C., M.F.), Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Neurology (C.G., C.Z.), Neurocenter of Southern Switzerland, Regional Hospital Lugano (EOC), Lugano; Faculty of Biomedical Sciences (C.G., C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Section of Neuroradiology and MRI Unit, Department of Radiology (A.R.), and Department of Neurology/Neuroimmunology (X.M.), Multiple Sclerosis Centre of Catalonia, Hospital Universitari Vall d'Hebron, Barcelona, Spain; NMR Research Unit (H.K., O.C.), Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, London; Nuffield Department of Clinical Neurosciences (L.M., J.P.), University of Oxford, UK; Department of Advanced Medical and Surgical Sciences, and 3T MRI Center, (A.G., A.B.), University of Campania "Luigi Vanvitelli," Naples, Italy; Department of Neurology (A.G., P.E.), Universitätsmedizin Mannheim, University of Heidelberg, Germany; Department of Radiology and Nuclear Medicine (C.L., B.B.) and Institute of Neuroradiology (C.L., B.B.), St. Josef Hospital, Ruhr-University Bochum, Germany; Department of Radiology and Nuclear Medicine (F.B., H.V.), MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, location VUmc, the Netherlands; Institutes of Neurology and Healthcare Engineering (F.B.), University College London, UK; and Vita-Salute San Raffaele University (P.P., G.C., M.F.), Milan, Italy
| | - Àlex Rovira
- From the Neuroimaging Research Unit (M.A.R., P.V., A.M., P.P., M.F.) and Neurology Unit (M.A.R., P.P., G.C., M.F.), Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Neurology (C.G., C.Z.), Neurocenter of Southern Switzerland, Regional Hospital Lugano (EOC), Lugano; Faculty of Biomedical Sciences (C.G., C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Section of Neuroradiology and MRI Unit, Department of Radiology (A.R.), and Department of Neurology/Neuroimmunology (X.M.), Multiple Sclerosis Centre of Catalonia, Hospital Universitari Vall d'Hebron, Barcelona, Spain; NMR Research Unit (H.K., O.C.), Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, London; Nuffield Department of Clinical Neurosciences (L.M., J.P.), University of Oxford, UK; Department of Advanced Medical and Surgical Sciences, and 3T MRI Center, (A.G., A.B.), University of Campania "Luigi Vanvitelli," Naples, Italy; Department of Neurology (A.G., P.E.), Universitätsmedizin Mannheim, University of Heidelberg, Germany; Department of Radiology and Nuclear Medicine (C.L., B.B.) and Institute of Neuroradiology (C.L., B.B.), St. Josef Hospital, Ruhr-University Bochum, Germany; Department of Radiology and Nuclear Medicine (F.B., H.V.), MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, location VUmc, the Netherlands; Institutes of Neurology and Healthcare Engineering (F.B.), University College London, UK; and Vita-Salute San Raffaele University (P.P., G.C., M.F.), Milan, Italy
| | - Xavier Montalban
- From the Neuroimaging Research Unit (M.A.R., P.V., A.M., P.P., M.F.) and Neurology Unit (M.A.R., P.P., G.C., M.F.), Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Neurology (C.G., C.Z.), Neurocenter of Southern Switzerland, Regional Hospital Lugano (EOC), Lugano; Faculty of Biomedical Sciences (C.G., C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Section of Neuroradiology and MRI Unit, Department of Radiology (A.R.), and Department of Neurology/Neuroimmunology (X.M.), Multiple Sclerosis Centre of Catalonia, Hospital Universitari Vall d'Hebron, Barcelona, Spain; NMR Research Unit (H.K., O.C.), Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, London; Nuffield Department of Clinical Neurosciences (L.M., J.P.), University of Oxford, UK; Department of Advanced Medical and Surgical Sciences, and 3T MRI Center, (A.G., A.B.), University of Campania "Luigi Vanvitelli," Naples, Italy; Department of Neurology (A.G., P.E.), Universitätsmedizin Mannheim, University of Heidelberg, Germany; Department of Radiology and Nuclear Medicine (C.L., B.B.) and Institute of Neuroradiology (C.L., B.B.), St. Josef Hospital, Ruhr-University Bochum, Germany; Department of Radiology and Nuclear Medicine (F.B., H.V.), MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, location VUmc, the Netherlands; Institutes of Neurology and Healthcare Engineering (F.B.), University College London, UK; and Vita-Salute San Raffaele University (P.P., G.C., M.F.), Milan, Italy
| | - Hugh Kearney
- From the Neuroimaging Research Unit (M.A.R., P.V., A.M., P.P., M.F.) and Neurology Unit (M.A.R., P.P., G.C., M.F.), Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Neurology (C.G., C.Z.), Neurocenter of Southern Switzerland, Regional Hospital Lugano (EOC), Lugano; Faculty of Biomedical Sciences (C.G., C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Section of Neuroradiology and MRI Unit, Department of Radiology (A.R.), and Department of Neurology/Neuroimmunology (X.M.), Multiple Sclerosis Centre of Catalonia, Hospital Universitari Vall d'Hebron, Barcelona, Spain; NMR Research Unit (H.K., O.C.), Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, London; Nuffield Department of Clinical Neurosciences (L.M., J.P.), University of Oxford, UK; Department of Advanced Medical and Surgical Sciences, and 3T MRI Center, (A.G., A.B.), University of Campania "Luigi Vanvitelli," Naples, Italy; Department of Neurology (A.G., P.E.), Universitätsmedizin Mannheim, University of Heidelberg, Germany; Department of Radiology and Nuclear Medicine (C.L., B.B.) and Institute of Neuroradiology (C.L., B.B.), St. Josef Hospital, Ruhr-University Bochum, Germany; Department of Radiology and Nuclear Medicine (F.B., H.V.), MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, location VUmc, the Netherlands; Institutes of Neurology and Healthcare Engineering (F.B.), University College London, UK; and Vita-Salute San Raffaele University (P.P., G.C., M.F.), Milan, Italy
| | - Olga Ciccarelli
- From the Neuroimaging Research Unit (M.A.R., P.V., A.M., P.P., M.F.) and Neurology Unit (M.A.R., P.P., G.C., M.F.), Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Neurology (C.G., C.Z.), Neurocenter of Southern Switzerland, Regional Hospital Lugano (EOC), Lugano; Faculty of Biomedical Sciences (C.G., C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Section of Neuroradiology and MRI Unit, Department of Radiology (A.R.), and Department of Neurology/Neuroimmunology (X.M.), Multiple Sclerosis Centre of Catalonia, Hospital Universitari Vall d'Hebron, Barcelona, Spain; NMR Research Unit (H.K., O.C.), Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, London; Nuffield Department of Clinical Neurosciences (L.M., J.P.), University of Oxford, UK; Department of Advanced Medical and Surgical Sciences, and 3T MRI Center, (A.G., A.B.), University of Campania "Luigi Vanvitelli," Naples, Italy; Department of Neurology (A.G., P.E.), Universitätsmedizin Mannheim, University of Heidelberg, Germany; Department of Radiology and Nuclear Medicine (C.L., B.B.) and Institute of Neuroradiology (C.L., B.B.), St. Josef Hospital, Ruhr-University Bochum, Germany; Department of Radiology and Nuclear Medicine (F.B., H.V.), MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, location VUmc, the Netherlands; Institutes of Neurology and Healthcare Engineering (F.B.), University College London, UK; and Vita-Salute San Raffaele University (P.P., G.C., M.F.), Milan, Italy
| | - Lucy Matthews
- From the Neuroimaging Research Unit (M.A.R., P.V., A.M., P.P., M.F.) and Neurology Unit (M.A.R., P.P., G.C., M.F.), Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Neurology (C.G., C.Z.), Neurocenter of Southern Switzerland, Regional Hospital Lugano (EOC), Lugano; Faculty of Biomedical Sciences (C.G., C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Section of Neuroradiology and MRI Unit, Department of Radiology (A.R.), and Department of Neurology/Neuroimmunology (X.M.), Multiple Sclerosis Centre of Catalonia, Hospital Universitari Vall d'Hebron, Barcelona, Spain; NMR Research Unit (H.K., O.C.), Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, London; Nuffield Department of Clinical Neurosciences (L.M., J.P.), University of Oxford, UK; Department of Advanced Medical and Surgical Sciences, and 3T MRI Center, (A.G., A.B.), University of Campania "Luigi Vanvitelli," Naples, Italy; Department of Neurology (A.G., P.E.), Universitätsmedizin Mannheim, University of Heidelberg, Germany; Department of Radiology and Nuclear Medicine (C.L., B.B.) and Institute of Neuroradiology (C.L., B.B.), St. Josef Hospital, Ruhr-University Bochum, Germany; Department of Radiology and Nuclear Medicine (F.B., H.V.), MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, location VUmc, the Netherlands; Institutes of Neurology and Healthcare Engineering (F.B.), University College London, UK; and Vita-Salute San Raffaele University (P.P., G.C., M.F.), Milan, Italy
| | - Jacqueline Palace
- From the Neuroimaging Research Unit (M.A.R., P.V., A.M., P.P., M.F.) and Neurology Unit (M.A.R., P.P., G.C., M.F.), Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Neurology (C.G., C.Z.), Neurocenter of Southern Switzerland, Regional Hospital Lugano (EOC), Lugano; Faculty of Biomedical Sciences (C.G., C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Section of Neuroradiology and MRI Unit, Department of Radiology (A.R.), and Department of Neurology/Neuroimmunology (X.M.), Multiple Sclerosis Centre of Catalonia, Hospital Universitari Vall d'Hebron, Barcelona, Spain; NMR Research Unit (H.K., O.C.), Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, London; Nuffield Department of Clinical Neurosciences (L.M., J.P.), University of Oxford, UK; Department of Advanced Medical and Surgical Sciences, and 3T MRI Center, (A.G., A.B.), University of Campania "Luigi Vanvitelli," Naples, Italy; Department of Neurology (A.G., P.E.), Universitätsmedizin Mannheim, University of Heidelberg, Germany; Department of Radiology and Nuclear Medicine (C.L., B.B.) and Institute of Neuroradiology (C.L., B.B.), St. Josef Hospital, Ruhr-University Bochum, Germany; Department of Radiology and Nuclear Medicine (F.B., H.V.), MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, location VUmc, the Netherlands; Institutes of Neurology and Healthcare Engineering (F.B.), University College London, UK; and Vita-Salute San Raffaele University (P.P., G.C., M.F.), Milan, Italy
| | - Antonio Gallo
- From the Neuroimaging Research Unit (M.A.R., P.V., A.M., P.P., M.F.) and Neurology Unit (M.A.R., P.P., G.C., M.F.), Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Neurology (C.G., C.Z.), Neurocenter of Southern Switzerland, Regional Hospital Lugano (EOC), Lugano; Faculty of Biomedical Sciences (C.G., C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Section of Neuroradiology and MRI Unit, Department of Radiology (A.R.), and Department of Neurology/Neuroimmunology (X.M.), Multiple Sclerosis Centre of Catalonia, Hospital Universitari Vall d'Hebron, Barcelona, Spain; NMR Research Unit (H.K., O.C.), Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, London; Nuffield Department of Clinical Neurosciences (L.M., J.P.), University of Oxford, UK; Department of Advanced Medical and Surgical Sciences, and 3T MRI Center, (A.G., A.B.), University of Campania "Luigi Vanvitelli," Naples, Italy; Department of Neurology (A.G., P.E.), Universitätsmedizin Mannheim, University of Heidelberg, Germany; Department of Radiology and Nuclear Medicine (C.L., B.B.) and Institute of Neuroradiology (C.L., B.B.), St. Josef Hospital, Ruhr-University Bochum, Germany; Department of Radiology and Nuclear Medicine (F.B., H.V.), MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, location VUmc, the Netherlands; Institutes of Neurology and Healthcare Engineering (F.B.), University College London, UK; and Vita-Salute San Raffaele University (P.P., G.C., M.F.), Milan, Italy
| | - Alvino Bisecco
- From the Neuroimaging Research Unit (M.A.R., P.V., A.M., P.P., M.F.) and Neurology Unit (M.A.R., P.P., G.C., M.F.), Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Neurology (C.G., C.Z.), Neurocenter of Southern Switzerland, Regional Hospital Lugano (EOC), Lugano; Faculty of Biomedical Sciences (C.G., C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Section of Neuroradiology and MRI Unit, Department of Radiology (A.R.), and Department of Neurology/Neuroimmunology (X.M.), Multiple Sclerosis Centre of Catalonia, Hospital Universitari Vall d'Hebron, Barcelona, Spain; NMR Research Unit (H.K., O.C.), Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, London; Nuffield Department of Clinical Neurosciences (L.M., J.P.), University of Oxford, UK; Department of Advanced Medical and Surgical Sciences, and 3T MRI Center, (A.G., A.B.), University of Campania "Luigi Vanvitelli," Naples, Italy; Department of Neurology (A.G., P.E.), Universitätsmedizin Mannheim, University of Heidelberg, Germany; Department of Radiology and Nuclear Medicine (C.L., B.B.) and Institute of Neuroradiology (C.L., B.B.), St. Josef Hospital, Ruhr-University Bochum, Germany; Department of Radiology and Nuclear Medicine (F.B., H.V.), MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, location VUmc, the Netherlands; Institutes of Neurology and Healthcare Engineering (F.B.), University College London, UK; and Vita-Salute San Raffaele University (P.P., G.C., M.F.), Milan, Italy
| | - Achim Gass
- From the Neuroimaging Research Unit (M.A.R., P.V., A.M., P.P., M.F.) and Neurology Unit (M.A.R., P.P., G.C., M.F.), Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Neurology (C.G., C.Z.), Neurocenter of Southern Switzerland, Regional Hospital Lugano (EOC), Lugano; Faculty of Biomedical Sciences (C.G., C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Section of Neuroradiology and MRI Unit, Department of Radiology (A.R.), and Department of Neurology/Neuroimmunology (X.M.), Multiple Sclerosis Centre of Catalonia, Hospital Universitari Vall d'Hebron, Barcelona, Spain; NMR Research Unit (H.K., O.C.), Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, London; Nuffield Department of Clinical Neurosciences (L.M., J.P.), University of Oxford, UK; Department of Advanced Medical and Surgical Sciences, and 3T MRI Center, (A.G., A.B.), University of Campania "Luigi Vanvitelli," Naples, Italy; Department of Neurology (A.G., P.E.), Universitätsmedizin Mannheim, University of Heidelberg, Germany; Department of Radiology and Nuclear Medicine (C.L., B.B.) and Institute of Neuroradiology (C.L., B.B.), St. Josef Hospital, Ruhr-University Bochum, Germany; Department of Radiology and Nuclear Medicine (F.B., H.V.), MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, location VUmc, the Netherlands; Institutes of Neurology and Healthcare Engineering (F.B.), University College London, UK; and Vita-Salute San Raffaele University (P.P., G.C., M.F.), Milan, Italy
| | - Philipp Eisele
- From the Neuroimaging Research Unit (M.A.R., P.V., A.M., P.P., M.F.) and Neurology Unit (M.A.R., P.P., G.C., M.F.), Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Neurology (C.G., C.Z.), Neurocenter of Southern Switzerland, Regional Hospital Lugano (EOC), Lugano; Faculty of Biomedical Sciences (C.G., C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Section of Neuroradiology and MRI Unit, Department of Radiology (A.R.), and Department of Neurology/Neuroimmunology (X.M.), Multiple Sclerosis Centre of Catalonia, Hospital Universitari Vall d'Hebron, Barcelona, Spain; NMR Research Unit (H.K., O.C.), Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, London; Nuffield Department of Clinical Neurosciences (L.M., J.P.), University of Oxford, UK; Department of Advanced Medical and Surgical Sciences, and 3T MRI Center, (A.G., A.B.), University of Campania "Luigi Vanvitelli," Naples, Italy; Department of Neurology (A.G., P.E.), Universitätsmedizin Mannheim, University of Heidelberg, Germany; Department of Radiology and Nuclear Medicine (C.L., B.B.) and Institute of Neuroradiology (C.L., B.B.), St. Josef Hospital, Ruhr-University Bochum, Germany; Department of Radiology and Nuclear Medicine (F.B., H.V.), MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, location VUmc, the Netherlands; Institutes of Neurology and Healthcare Engineering (F.B.), University College London, UK; and Vita-Salute San Raffaele University (P.P., G.C., M.F.), Milan, Italy
| | - Carsten Lukas
- From the Neuroimaging Research Unit (M.A.R., P.V., A.M., P.P., M.F.) and Neurology Unit (M.A.R., P.P., G.C., M.F.), Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Neurology (C.G., C.Z.), Neurocenter of Southern Switzerland, Regional Hospital Lugano (EOC), Lugano; Faculty of Biomedical Sciences (C.G., C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Section of Neuroradiology and MRI Unit, Department of Radiology (A.R.), and Department of Neurology/Neuroimmunology (X.M.), Multiple Sclerosis Centre of Catalonia, Hospital Universitari Vall d'Hebron, Barcelona, Spain; NMR Research Unit (H.K., O.C.), Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, London; Nuffield Department of Clinical Neurosciences (L.M., J.P.), University of Oxford, UK; Department of Advanced Medical and Surgical Sciences, and 3T MRI Center, (A.G., A.B.), University of Campania "Luigi Vanvitelli," Naples, Italy; Department of Neurology (A.G., P.E.), Universitätsmedizin Mannheim, University of Heidelberg, Germany; Department of Radiology and Nuclear Medicine (C.L., B.B.) and Institute of Neuroradiology (C.L., B.B.), St. Josef Hospital, Ruhr-University Bochum, Germany; Department of Radiology and Nuclear Medicine (F.B., H.V.), MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, location VUmc, the Netherlands; Institutes of Neurology and Healthcare Engineering (F.B.), University College London, UK; and Vita-Salute San Raffaele University (P.P., G.C., M.F.), Milan, Italy
| | - Barbara Bellenberg
- From the Neuroimaging Research Unit (M.A.R., P.V., A.M., P.P., M.F.) and Neurology Unit (M.A.R., P.P., G.C., M.F.), Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Neurology (C.G., C.Z.), Neurocenter of Southern Switzerland, Regional Hospital Lugano (EOC), Lugano; Faculty of Biomedical Sciences (C.G., C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Section of Neuroradiology and MRI Unit, Department of Radiology (A.R.), and Department of Neurology/Neuroimmunology (X.M.), Multiple Sclerosis Centre of Catalonia, Hospital Universitari Vall d'Hebron, Barcelona, Spain; NMR Research Unit (H.K., O.C.), Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, London; Nuffield Department of Clinical Neurosciences (L.M., J.P.), University of Oxford, UK; Department of Advanced Medical and Surgical Sciences, and 3T MRI Center, (A.G., A.B.), University of Campania "Luigi Vanvitelli," Naples, Italy; Department of Neurology (A.G., P.E.), Universitätsmedizin Mannheim, University of Heidelberg, Germany; Department of Radiology and Nuclear Medicine (C.L., B.B.) and Institute of Neuroradiology (C.L., B.B.), St. Josef Hospital, Ruhr-University Bochum, Germany; Department of Radiology and Nuclear Medicine (F.B., H.V.), MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, location VUmc, the Netherlands; Institutes of Neurology and Healthcare Engineering (F.B.), University College London, UK; and Vita-Salute San Raffaele University (P.P., G.C., M.F.), Milan, Italy
| | - Frederik Barkhof
- From the Neuroimaging Research Unit (M.A.R., P.V., A.M., P.P., M.F.) and Neurology Unit (M.A.R., P.P., G.C., M.F.), Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Neurology (C.G., C.Z.), Neurocenter of Southern Switzerland, Regional Hospital Lugano (EOC), Lugano; Faculty of Biomedical Sciences (C.G., C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Section of Neuroradiology and MRI Unit, Department of Radiology (A.R.), and Department of Neurology/Neuroimmunology (X.M.), Multiple Sclerosis Centre of Catalonia, Hospital Universitari Vall d'Hebron, Barcelona, Spain; NMR Research Unit (H.K., O.C.), Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, London; Nuffield Department of Clinical Neurosciences (L.M., J.P.), University of Oxford, UK; Department of Advanced Medical and Surgical Sciences, and 3T MRI Center, (A.G., A.B.), University of Campania "Luigi Vanvitelli," Naples, Italy; Department of Neurology (A.G., P.E.), Universitätsmedizin Mannheim, University of Heidelberg, Germany; Department of Radiology and Nuclear Medicine (C.L., B.B.) and Institute of Neuroradiology (C.L., B.B.), St. Josef Hospital, Ruhr-University Bochum, Germany; Department of Radiology and Nuclear Medicine (F.B., H.V.), MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, location VUmc, the Netherlands; Institutes of Neurology and Healthcare Engineering (F.B.), University College London, UK; and Vita-Salute San Raffaele University (P.P., G.C., M.F.), Milan, Italy
| | - Hugo Vrenken
- From the Neuroimaging Research Unit (M.A.R., P.V., A.M., P.P., M.F.) and Neurology Unit (M.A.R., P.P., G.C., M.F.), Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Neurology (C.G., C.Z.), Neurocenter of Southern Switzerland, Regional Hospital Lugano (EOC), Lugano; Faculty of Biomedical Sciences (C.G., C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Section of Neuroradiology and MRI Unit, Department of Radiology (A.R.), and Department of Neurology/Neuroimmunology (X.M.), Multiple Sclerosis Centre of Catalonia, Hospital Universitari Vall d'Hebron, Barcelona, Spain; NMR Research Unit (H.K., O.C.), Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, London; Nuffield Department of Clinical Neurosciences (L.M., J.P.), University of Oxford, UK; Department of Advanced Medical and Surgical Sciences, and 3T MRI Center, (A.G., A.B.), University of Campania "Luigi Vanvitelli," Naples, Italy; Department of Neurology (A.G., P.E.), Universitätsmedizin Mannheim, University of Heidelberg, Germany; Department of Radiology and Nuclear Medicine (C.L., B.B.) and Institute of Neuroradiology (C.L., B.B.), St. Josef Hospital, Ruhr-University Bochum, Germany; Department of Radiology and Nuclear Medicine (F.B., H.V.), MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, location VUmc, the Netherlands; Institutes of Neurology and Healthcare Engineering (F.B.), University College London, UK; and Vita-Salute San Raffaele University (P.P., G.C., M.F.), Milan, Italy
| | - Paolo Preziosa
- From the Neuroimaging Research Unit (M.A.R., P.V., A.M., P.P., M.F.) and Neurology Unit (M.A.R., P.P., G.C., M.F.), Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Neurology (C.G., C.Z.), Neurocenter of Southern Switzerland, Regional Hospital Lugano (EOC), Lugano; Faculty of Biomedical Sciences (C.G., C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Section of Neuroradiology and MRI Unit, Department of Radiology (A.R.), and Department of Neurology/Neuroimmunology (X.M.), Multiple Sclerosis Centre of Catalonia, Hospital Universitari Vall d'Hebron, Barcelona, Spain; NMR Research Unit (H.K., O.C.), Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, London; Nuffield Department of Clinical Neurosciences (L.M., J.P.), University of Oxford, UK; Department of Advanced Medical and Surgical Sciences, and 3T MRI Center, (A.G., A.B.), University of Campania "Luigi Vanvitelli," Naples, Italy; Department of Neurology (A.G., P.E.), Universitätsmedizin Mannheim, University of Heidelberg, Germany; Department of Radiology and Nuclear Medicine (C.L., B.B.) and Institute of Neuroradiology (C.L., B.B.), St. Josef Hospital, Ruhr-University Bochum, Germany; Department of Radiology and Nuclear Medicine (F.B., H.V.), MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, location VUmc, the Netherlands; Institutes of Neurology and Healthcare Engineering (F.B.), University College London, UK; and Vita-Salute San Raffaele University (P.P., G.C., M.F.), Milan, Italy
| | - Giancarlo Comi
- From the Neuroimaging Research Unit (M.A.R., P.V., A.M., P.P., M.F.) and Neurology Unit (M.A.R., P.P., G.C., M.F.), Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Neurology (C.G., C.Z.), Neurocenter of Southern Switzerland, Regional Hospital Lugano (EOC), Lugano; Faculty of Biomedical Sciences (C.G., C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Section of Neuroradiology and MRI Unit, Department of Radiology (A.R.), and Department of Neurology/Neuroimmunology (X.M.), Multiple Sclerosis Centre of Catalonia, Hospital Universitari Vall d'Hebron, Barcelona, Spain; NMR Research Unit (H.K., O.C.), Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, London; Nuffield Department of Clinical Neurosciences (L.M., J.P.), University of Oxford, UK; Department of Advanced Medical and Surgical Sciences, and 3T MRI Center, (A.G., A.B.), University of Campania "Luigi Vanvitelli," Naples, Italy; Department of Neurology (A.G., P.E.), Universitätsmedizin Mannheim, University of Heidelberg, Germany; Department of Radiology and Nuclear Medicine (C.L., B.B.) and Institute of Neuroradiology (C.L., B.B.), St. Josef Hospital, Ruhr-University Bochum, Germany; Department of Radiology and Nuclear Medicine (F.B., H.V.), MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, location VUmc, the Netherlands; Institutes of Neurology and Healthcare Engineering (F.B.), University College London, UK; and Vita-Salute San Raffaele University (P.P., G.C., M.F.), Milan, Italy
| | - Massimo Filippi
- From the Neuroimaging Research Unit (M.A.R., P.V., A.M., P.P., M.F.) and Neurology Unit (M.A.R., P.P., G.C., M.F.), Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Neurology (C.G., C.Z.), Neurocenter of Southern Switzerland, Regional Hospital Lugano (EOC), Lugano; Faculty of Biomedical Sciences (C.G., C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Section of Neuroradiology and MRI Unit, Department of Radiology (A.R.), and Department of Neurology/Neuroimmunology (X.M.), Multiple Sclerosis Centre of Catalonia, Hospital Universitari Vall d'Hebron, Barcelona, Spain; NMR Research Unit (H.K., O.C.), Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, London; Nuffield Department of Clinical Neurosciences (L.M., J.P.), University of Oxford, UK; Department of Advanced Medical and Surgical Sciences, and 3T MRI Center, (A.G., A.B.), University of Campania "Luigi Vanvitelli," Naples, Italy; Department of Neurology (A.G., P.E.), Universitätsmedizin Mannheim, University of Heidelberg, Germany; Department of Radiology and Nuclear Medicine (C.L., B.B.) and Institute of Neuroradiology (C.L., B.B.), St. Josef Hospital, Ruhr-University Bochum, Germany; Department of Radiology and Nuclear Medicine (F.B., H.V.), MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, location VUmc, the Netherlands; Institutes of Neurology and Healthcare Engineering (F.B.), University College London, UK; and Vita-Salute San Raffaele University (P.P., G.C., M.F.), Milan, Italy
| | | |
Collapse
|
49
|
Moccia M, Prados F, Filippi M, Rocca MA, Valsasina P, Brownlee WJ, Zecca C, Gallo A, Rovira A, Gass A, Palace J, Lukas C, Vrenken H, Ourselin S, Gandini Wheeler‐Kingshott CAM, Ciccarelli O, Barkhof F. Longitudinal spinal cord atrophy in multiple sclerosis using the generalized boundary shift integral. Ann Neurol 2019; 86:704-713. [DOI: 10.1002/ana.25571] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 07/29/2019] [Accepted: 08/01/2019] [Indexed: 11/10/2022]
Affiliation(s)
- Marcello Moccia
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain SciencesUniversity College London London United Kingdom
- Multiple Sclerosis Clinical Care and Research Center, Department of NeurosciencesFederico II University Naples Italy
| | - Ferran Prados
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain SciencesUniversity College London London United Kingdom
- Centre for Medical Image Computing, Department of Medical Physics and BioengineeringUniversity College London London United Kingdom
- National Institute for Health ResearchUniversity College London Hospitals Biomedical Research Centre London United Kingdom
- Open University of Catalonia Barcelona Spain
| | - Massimo Filippi
- Division of Neuroscience, San Raffaele Scientific Institute, Vita‐Salute San Raffaele UniversityNeuroimaging Research Unit, Institute of Experimental Neurology Milan Italy
- Department of NeurologySan Raffaele Scientific Institute Milan Italy
| | - Maria A. Rocca
- Division of Neuroscience, San Raffaele Scientific Institute, Vita‐Salute San Raffaele UniversityNeuroimaging Research Unit, Institute of Experimental Neurology Milan Italy
- Department of NeurologySan Raffaele Scientific Institute Milan Italy
| | - Paola Valsasina
- Division of Neuroscience, San Raffaele Scientific Institute, Vita‐Salute San Raffaele UniversityNeuroimaging Research Unit, Institute of Experimental Neurology Milan Italy
| | - Wallace J. Brownlee
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain SciencesUniversity College London London United Kingdom
| | - Chiara Zecca
- Neurocenter of Southern SwitzerlandLugano Regional Hospital Lugano Switzerland
| | - Antonio Gallo
- 3T‐MRI Research Center, Department of Advanced Medical and Surgical SciencesUniversity of Campania Luigi Vanvitelli Naples Italy
| | - Alex Rovira
- Section of Neuroradiology, Department of RadiologyVall d'Hebron University Hospital, Autonomous University of Barcelona Barcelona Spain
| | - Achim Gass
- Department of NeurologyUniversitätsmedizin Mannheim, University of Heidelberg Mannheim Germany
| | - Jacqueline Palace
- Nuffield Department of Clinical NeurosciencesJohn Radcliffe Hospital Oxford United Kingdom
| | | | - Hugo Vrenken
- Department of Radiology and Nuclear MedicineVU University Medical Center Amsterdam the Netherlands
| | - Sebastien Ourselin
- Department of Imaging and Biomedical EngineeringKing's College London London United Kingdom
| | - Claudia A. M. Gandini Wheeler‐Kingshott
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain SciencesUniversity College London London United Kingdom
- Department of Brain and Behavioral SciencesUniversity of Pavia Pavia Italy
- Brain MRI 3T Research Center, Mondino FoundationScientific Institute for Research and Health Care Pavia Italy
| | - Olga Ciccarelli
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain SciencesUniversity College London London United Kingdom
- National Institute for Health ResearchUniversity College London Hospitals Biomedical Research Centre London United Kingdom
| | - Frederik Barkhof
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain SciencesUniversity College London London United Kingdom
- Centre for Medical Image Computing, Department of Medical Physics and BioengineeringUniversity College London London United Kingdom
- National Institute for Health ResearchUniversity College London Hospitals Biomedical Research Centre London United Kingdom
- Department of Radiology and Nuclear MedicineVU University Medical Center Amsterdam the Netherlands
| | | |
Collapse
|
50
|
Andelova M, Uher T, Krasensky J, Sobisek L, Kusova E, Srpova B, Vodehnalova K, Friedova L, Motyl J, Preiningerova JL, Kubala Havrdova E, Horakova D, Vaneckova M. Additive Effect of Spinal Cord Volume, Diffuse and Focal Cord Pathology on Disability in Multiple Sclerosis. Front Neurol 2019; 10:820. [PMID: 31447759 PMCID: PMC6691803 DOI: 10.3389/fneur.2019.00820] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 07/16/2019] [Indexed: 11/30/2022] Open
Abstract
Introduction: Spinal cord (SC) pathology is strongly associated with disability in multiple sclerosis (MS). We aimed to evaluate the association between focal and diffuse SC abnormalities and spinal cord volume and to assess their contribution to physical disability in MS patients. Methods: This large sample-size cross-sectional study investigated 1,249 patients with heterogeneous MS phenotypes. Upper cervical-cord cross-sectional area (MUCCA) was calculated on an axial 3D-T2w-FatSat sequence acquired at 3T using a novel semiautomatic edge-finding tool. SC images were scored for the presence of sharply demarcated hyperintense areas (focal lesions) and homogenously increased signal intensity (diffuse changes). Patients were dichotomized according EDSS in groups with mild (EDSS up to 3.0) and moderate (EDSS ≥ 3.5) physical disability. Analysis of covariance was used to identify factors associated with dichotomized MUCCA. In binary logistic regression, the SC imaging parameters were entered in blocks to assess their individual contribution to risk of moderate disability. In order to assess the risk of combined SC damage in terms of atrophy and lesional pathology on disability, secondary analysis was carried out where patients were divided into four categories (SC phenotypes) according to median dichotomized MUCCA and presence/absence of focal and/or diffuse changes. Results: MUCCA was strongly associated with total intracranial volume, followed by presence of diffuse SC pathology, and disease duration. Compared to the reference group (normally appearing SC, MUCCA>median), patients with the most severe SC changes (SC affected with focal and/or diffuse lesions, MUCCA<median) had an almost 5-times higher risk of having moderate disability (OR 4.75, 95% CI 3.07–7.49, p < 0.001). Patients with normally appearing SC and MUCCA below the median had a 2-fold increased risk of being in the moderate disability group when compared to the reference patients (OR 2.15, 95% CI 1.26–3.67, p < 0.001). In contrast, patients with MUCCA above the median with SC lesions/diffuse changes did not differ significantly from the reference group. Conclusion: Low cervical SC volume is a strong independent predictor of physical disability in MS patients. The contribution of focal SC lesions and diffuse changes to the worse disability outcomes is limited and present especially in patients with low SC volume.
Collapse
Affiliation(s)
- Michaela Andelova
- Department of Neurology, First Faculty of Medicine, Center of Clinical Neuroscience, Charles University and General University Hospital in Prague, Prague, Czechia
| | - Tomas Uher
- Department of Neurology, First Faculty of Medicine, Center of Clinical Neuroscience, Charles University and General University Hospital in Prague, Prague, Czechia
| | - Jan Krasensky
- Department of Radiology, Charles University in Prague, 1st Faculty of Medicine and General University Hospital, Prague, Czechia
| | | | - Eliska Kusova
- Department of Radiology, Charles University in Prague, 1st Faculty of Medicine and General University Hospital, Prague, Czechia
| | - Barbora Srpova
- Department of Neurology, First Faculty of Medicine, Center of Clinical Neuroscience, Charles University and General University Hospital in Prague, Prague, Czechia
| | - Karolina Vodehnalova
- Department of Neurology, First Faculty of Medicine, Center of Clinical Neuroscience, Charles University and General University Hospital in Prague, Prague, Czechia
| | - Lucie Friedova
- Department of Neurology, First Faculty of Medicine, Center of Clinical Neuroscience, Charles University and General University Hospital in Prague, Prague, Czechia
| | - Jiri Motyl
- Department of Neurology, First Faculty of Medicine, Center of Clinical Neuroscience, Charles University and General University Hospital in Prague, Prague, Czechia
| | - Jana Lizrova Preiningerova
- Department of Neurology, First Faculty of Medicine, Center of Clinical Neuroscience, Charles University and General University Hospital in Prague, Prague, Czechia
| | - Eva Kubala Havrdova
- Department of Neurology, First Faculty of Medicine, Center of Clinical Neuroscience, Charles University and General University Hospital in Prague, Prague, Czechia
| | - Dana Horakova
- Department of Neurology, First Faculty of Medicine, Center of Clinical Neuroscience, Charles University and General University Hospital in Prague, Prague, Czechia
| | - Manuela Vaneckova
- Department of Radiology, Charles University in Prague, 1st Faculty of Medicine and General University Hospital, Prague, Czechia
| |
Collapse
|