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Weerasinghe-Mudiyanselage PDE, Kim JS, Shin T, Moon C. Understanding the spectrum of non-motor symptoms in multiple sclerosis: insights from animal models. Neural Regen Res 2024; 19:84-91. [PMID: 37488849 PMCID: PMC10479859 DOI: 10.4103/1673-5374.375307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 04/12/2023] [Accepted: 04/17/2023] [Indexed: 07/26/2023] Open
Abstract
Multiple sclerosis is a chronic autoimmune disease of the central nervous system and is generally considered to be a non-traumatic, physically debilitating neurological disorder. In addition to experiencing motor disability, patients with multiple sclerosis also experience a variety of non-motor symptoms, including cognitive deficits, anxiety, depression, sensory impairments, and pain. However, the pathogenesis and treatment of such non-motor symptoms in multiple sclerosis are still under research. Preclinical studies for multiple sclerosis benefit from the use of disease-appropriate animal models, including experimental autoimmune encephalomyelitis. Prior to understanding the pathophysiology and developing treatments for non-motor symptoms, it is critical to characterize the animal model in terms of its ability to replicate certain non-motor features of multiple sclerosis. As such, no single animal model can mimic the entire spectrum of symptoms. This review focuses on the non-motor symptoms that have been investigated in animal models of multiple sclerosis as well as possible underlying mechanisms. Further, we highlighted gaps in the literature to explain the non-motor aspects of multiple sclerosis in experimental animal models, which will serve as the basis for future studies.
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Affiliation(s)
- Poornima D. E. Weerasinghe-Mudiyanselage
- Department of Veterinary Anatomy and Animal Behavior, College of Veterinary Medicine and BK21 FOUR program, Chonnam National University, Gwangju, Republic of Korea
| | - Joong-Sun Kim
- Department of Veterinary Anatomy and Animal Behavior, College of Veterinary Medicine and BK21 FOUR program, Chonnam National University, Gwangju, Republic of Korea
| | - Taekyun Shin
- Department of Veterinary Anatomy, College of Veterinary Medicine and Veterinary Medical Research Institute, Jeju National University, Jeju, Republic of Korea
| | - Changjong Moon
- Department of Veterinary Anatomy and Animal Behavior, College of Veterinary Medicine and BK21 FOUR program, Chonnam National University, Gwangju, Republic of Korea
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2
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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] [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.
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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
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3
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Owiti W, Peev N, Arif S, Brady Z, AbdelHafiz T. Is surgery beneficial for patients with concurrent multiple sclerosis and degenerative cervical myelopathy? A review of literature. BRAIN AND SPINE 2022; 2:100870. [PMID: 36248132 PMCID: PMC9560582 DOI: 10.1016/j.bas.2022.100870] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/22/2022] [Accepted: 01/25/2022] [Indexed: 12/25/2022]
Abstract
Introduction Due to an overlap in symptoms, there is significant delay in surgical treatment of patients that have concomitant multiple sclerosis (MS) and degenerative cervical Myelopathy (DCM). The purpose of this review is to evaluate if surgical intervention is beneficial to patients that have concurrent presentations. Research question Is surgery beneficial in concurrent MS and DCM? Materials and methods A literature search with no date restrictions was conducted on Pubmed and Medline databases. Keywords searched: Degenerative Cervical Myelopathy, Multiple sclerosis, Treatment, Surgery, Quality of Life. Randomised controlled trials, prospective, retrospective, and case series reporting timing of surgery, post-operative outcomes such as improvement in myelopathic symptoms, quality of life, and any serious complications were included. Results The literature search yielded a total of 8 studies across all databases. Seven articles were selected for full text review, and all of them were sectioned for inclusion in this review. Seven studies evaluated 160 participants with concurrent multiple sclerosis and degenerative cervical myelopathy. Earlier studies had discouraged performing surgery in this subset of patients, the majority of studies found it worthwhile to perform early surgery for patients with concomitant multiple sclerosis and degenerative cord compression, if the patients had radiculopathy. Quality of life for MS patients did not improve as much as it did for patients that did not have MS. Discussion and conclusion Patients with radiculopathy, neck pain and cord compression are most likely to benefit from early surgery. There is no need for delaying to offer surgery unless other medical/anaesthetic contraindications exist.
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Affiliation(s)
- William Owiti
- Department of Neurosurgery, Royal Infirmary of Edinburgh, Edinburgh, UK
- Corresponding author. Department of Neurosurgery, Royal infirmary of Edinburgh, 51 little France crescent, Edinburgh, EH16 4SA, UK.
| | - Nikolay Peev
- Department of Neurosurgery, Royal Victoria Hospital, Belfast Health and Social Care Trust, Belfast, Northern Ireland, UK
| | - Shahswar Arif
- Department of Neurosurgery, Royal Victoria Hospital, Belfast Health and Social Care Trust, Belfast, Northern Ireland, UK
- Medical University ‘Prof. Dr. Paraskev Stoyanov’ Varna, Varna, Bulgaria
| | - Zarina Brady
- Department of Neurosurgery, Royal Victoria Hospital, Belfast Health and Social Care Trust, Belfast, Northern Ireland, UK
- Medical University ‘Prof. Dr. Paraskev Stoyanov’ Varna, Varna, Bulgaria
| | - Tarek AbdelHafiz
- Department of Neurosurgery, Royal Victoria Hospital, Belfast Health and Social Care Trust, Belfast, Northern Ireland, UK
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4
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Orian JM, D'Souza CS, Kocovski P, Krippner G, Hale MW, Wang X, Peter K. Platelets in Multiple Sclerosis: Early and Central Mediators of Inflammation and Neurodegeneration and Attractive Targets for Molecular Imaging and Site-Directed Therapy. Front Immunol 2021; 12:620963. [PMID: 33679764 PMCID: PMC7933211 DOI: 10.3389/fimmu.2021.620963] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 01/27/2021] [Indexed: 12/20/2022] Open
Abstract
Platelets are clearly central to thrombosis and hemostasis. In addition, more recently, evidence has emerged for non-hemostatic roles of platelets including inflammatory and immune reactions/responses. Platelets express immunologically relevant ligands and receptors, demonstrate adhesive interactions with endothelial cells, monocytes and neutrophils, and toll-like receptor (TLR) mediated responses. These properties make platelets central to innate and adaptive immunity and potential candidate key mediators of autoimmune disorders. Multiple sclerosis (MS) is the most common chronic autoimmune central nervous system (CNS) disease. An association between platelets and MS was first indicated by the increased adhesion of platelets to endothelial cells. This was followed by reports identifying structural and functional changes of platelets, their chronic activation in the peripheral blood of MS patients, platelet presence in MS lesions and the more recent revelation that these structural and functional abnormalities are associated with all MS forms and stages. Investigations based on the murine experimental autoimmune encephalomyelitis (EAE) MS model first revealed a contribution to EAE pathogenesis by exacerbation of CNS inflammation and an early role for platelets in EAE development via platelet-neuron and platelet-astrocyte associations, through sialated gangliosides in lipid rafts. Our own studies refined and extended these findings by identifying the critical timing of platelet accumulation in pre-clinical EAE and establishing an initiating and central rather than merely exacerbating role for platelets in disease development. Furthermore, we demonstrated platelet-neuron associations in EAE, coincident with behavioral changes, but preceding the earliest detectable autoreactive T cell accumulation. In combination, these findings establish a new paradigm by asserting that platelets play a neurodegenerative as well as a neuroinflammatory role in MS and therefore, that these two pathological processes are causally linked. This review will discuss the implications of these findings for our understanding of MS, for future applications for imaging toward early detection of MS, and for novel strategies for platelet-targeted treatment of MS.
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Affiliation(s)
- Jacqueline M Orian
- Department of Biochemistry and Genetics, La Trobe Institute for Molecular Science, La Trobe University, Melbourne, VIC, Australia
| | - Claretta S D'Souza
- Department of Biochemistry and Genetics, La Trobe Institute for Molecular Science, La Trobe University, Melbourne, VIC, Australia
| | - Pece Kocovski
- Department of Psychology and Counselling, School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University, Melbourne, VIC, Australia
| | - Guy Krippner
- Medicinal Chemistry, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Matthew W Hale
- Department of Psychology and Counselling, School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University, Melbourne, VIC, Australia
| | - Xiaowei Wang
- Atherothrombosis and Vascular Biology Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia.,Department of Cardiometabolic Health, University of Melbourne, Melbourne, VIC, Australia.,Molecular Imaging and Theranostics Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia.,Department of Physiology, Anatomy and Microbiology, School of Life Science, La Trobe University, Melbourne, VIC, Australia
| | - Karlheinz Peter
- Atherothrombosis and Vascular Biology Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia.,Department of Cardiometabolic Health, University of Melbourne, Melbourne, VIC, Australia.,Department of Physiology, Anatomy and Microbiology, School of Life Science, La Trobe University, Melbourne, VIC, Australia
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5
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Kerbrat A, Gros C, Badji A, Bannier E, Galassi F, Combès B, Chouteau R, Labauge P, Ayrignac X, Carra-Dalliere C, Maranzano J, Granberg T, Ouellette R, Stawiarz L, Hillert J, Talbott J, Tachibana Y, Hori M, Kamiya K, Chougar L, Lefeuvre J, Reich DS, Nair G, Valsasina P, Rocca MA, Filippi M, Chu R, Bakshi R, Callot V, Pelletier J, Audoin B, Maarouf A, Collongues N, De Seze J, Edan G, Cohen-Adad J. Multiple sclerosis lesions in motor tracts from brain to cervical cord: spatial distribution and correlation with disability. Brain 2020; 143:2089-2105. [PMID: 32572488 DOI: 10.1093/brain/awaa162] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 02/27/2020] [Accepted: 04/02/2020] [Indexed: 11/12/2022] Open
Abstract
Despite important efforts to solve the clinico-radiological paradox, correlation between lesion load and physical disability in patients with multiple sclerosis remains modest. One hypothesis could be that lesion location in corticospinal tracts plays a key role in explaining motor impairment. In this study, we describe the distribution of lesions along the corticospinal tracts from the cortex to the cervical spinal cord in patients with various disease phenotypes and disability status. We also assess the link between lesion load and location within corticospinal tracts, and disability at baseline and 2-year follow-up. We retrospectively included 290 patients (22 clinically isolated syndrome, 198 relapsing remitting, 39 secondary progressive, 31 primary progressive multiple sclerosis) from eight sites. Lesions were segmented on both brain (T2-FLAIR or T2-weighted) and cervical (axial T2- or T2*-weighted) MRI scans. Data were processed using an automated and publicly available pipeline. Brain, brainstem and spinal cord portions of the corticospinal tracts were identified using probabilistic atlases to measure the lesion volume fraction. Lesion frequency maps were produced for each phenotype and disability scores assessed with Expanded Disability Status Scale score and pyramidal functional system score. Results show that lesions were not homogeneously distributed along the corticospinal tracts, with the highest lesion frequency in the corona radiata and between C2 and C4 vertebral levels. The lesion volume fraction in the corticospinal tracts was higher in secondary and primary progressive patients (mean = 3.6 ± 2.7% and 2.9 ± 2.4%), compared to relapsing-remitting patients (1.6 ± 2.1%, both P < 0.0001). Voxel-wise analyses confirmed that lesion frequency was higher in progressive compared to relapsing-remitting patients, with significant bilateral clusters in the spinal cord corticospinal tracts (P < 0.01). The baseline Expanded Disability Status Scale score was associated with lesion volume fraction within the brain (r = 0.31, P < 0.0001), brainstem (r = 0.45, P < 0.0001) and spinal cord (r = 0.57, P < 0.0001) corticospinal tracts. The spinal cord corticospinal tracts lesion volume fraction remained the strongest factor in the multiple linear regression model, independently from cord atrophy. Baseline spinal cord corticospinal tracts lesion volume fraction was also associated with disability progression at 2-year follow-up (P = 0.003). Our results suggest a cumulative effect of lesions within the corticospinal tracts along the brain, brainstem and spinal cord portions to explain physical disability in multiple sclerosis patients, with a predominant impact of intramedullary lesions.
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Affiliation(s)
- Anne Kerbrat
- NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montreal, Montreal, Canada.,CHU Rennes, Neurology department, Empenn U 1128 Inserm, CIC1414 Inserm, Rennes, France
| | - Charley Gros
- NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montreal, Montreal, Canada
| | - Atef Badji
- NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montreal, Montreal, Canada.,Department of Neurosciences, Faculty of Medicine, Université de Montréal, QC, Canada
| | - Elise Bannier
- CHU Rennes, Radiology department, Rennes, France.,Univ Rennes, Inria, CNRS, Inserm, IRISA UMR 6074, Empenn U1128, Rennes, France
| | - Francesca Galassi
- Univ Rennes, Inria, CNRS, Inserm, IRISA UMR 6074, Empenn U1128, Rennes, France
| | - Benoit Combès
- Univ Rennes, Inria, CNRS, Inserm, IRISA UMR 6074, Empenn U1128, Rennes, France
| | - Raphaël Chouteau
- CHU Rennes, Neurology department, Empenn U 1128 Inserm, CIC1414 Inserm, Rennes, France
| | - Pierre Labauge
- MS Unit, Department of Neurology, CHU Montpellier, Montpellier, France
| | - Xavier Ayrignac
- MS Unit, Department of Neurology, CHU Montpellier, Montpellier, France
| | | | - Josefina Maranzano
- McConnell Brain Imaging Centre, Montreal Neurological Institute, Montreal, Canada.,University of Quebec in Trois-Rivieres, Quebec, Canada
| | - Tobias Granberg
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Russell Ouellette
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Leszek Stawiarz
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Jan Hillert
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Jason Talbott
- Department of Radiology and Biomedical Imaging, Zuckerberg San Francisco General Hospital, University of California, San Francisco, CA, USA
| | | | - Masaaki Hori
- Toho University Omori Medical Center, Tokyo, Japan
| | | | - Lydia Chougar
- Department of Neuroradiology, La Pitié Salpêtrière Hospital, Paris, France
| | - Jennifer Lefeuvre
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Maryland, USA
| | - Daniel S Reich
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Maryland, USA
| | - Govind Nair
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Maryland, USA
| | - Paola Valsasina
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, and Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Maria A Rocca
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, and Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, and Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Renxin Chu
- Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - Rohit Bakshi
- Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - Virginie Callot
- AP-HM, Pôle d'imagerie médicale, Hôpital de la Timone, CEMEREM, Marseille, France.,Aix-Marseille Univ, CNRS, CRMBM, Marseille, France
| | - Jean Pelletier
- Aix-Marseille Univ, CNRS, CRMBM, Marseille, France.,AP-HM, CHU Timone, Pôle de Neurosciences Cliniques, Department of Neurology, Marseille, France
| | - Bertrand Audoin
- Aix-Marseille Univ, CNRS, CRMBM, Marseille, France.,AP-HM, CHU Timone, Pôle de Neurosciences Cliniques, Department of Neurology, Marseille, France
| | - Adil Maarouf
- Aix-Marseille Univ, CNRS, CRMBM, Marseille, France.,AP-HM, CHU Timone, Pôle de Neurosciences Cliniques, Department of Neurology, Marseille, France
| | - Nicolas Collongues
- Biopathologie de la Myéline, Neuroprotection et Stratégies Thérapeutiques, INSERM U1119, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Bâtiment 3 de la Faculté de Médecine, 67 000 Strasbourg, France.,Département de Neurologie, Centre Hospitalier Universitaire de Strasbourg, 67200 Strasbourg, France.,Centre d'investigation Clinique, INSERM U1434, Centre Hospitalier Universitaire de Strasbourg, 67000 Strasbourg, France
| | - Jérôme De Seze
- Biopathologie de la Myéline, Neuroprotection et Stratégies Thérapeutiques, INSERM U1119, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Bâtiment 3 de la Faculté de Médecine, 67 000 Strasbourg, France.,Département de Neurologie, Centre Hospitalier Universitaire de Strasbourg, 67200 Strasbourg, France.,Centre d'investigation Clinique, INSERM U1434, Centre Hospitalier Universitaire de Strasbourg, 67000 Strasbourg, France
| | - Gilles Edan
- CHU Rennes, Neurology department, Empenn U 1128 Inserm, CIC1414 Inserm, Rennes, France
| | - Julien Cohen-Adad
- NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montreal, Montreal, Canada.,Functional Neuroimaging Unit, CRIUGM, University of Montreal, Montreal, Canada
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6
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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] [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.
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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.
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7
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Moccia M, van de Pavert S, Eshaghi A, Haider L, Pichat J, Yiannakas M, Ourselin S, Wang Y, Wheeler-Kingshott C, Thompson A, Barkhof F, Ciccarelli O. Pathologic correlates of the magnetization transfer ratio in multiple sclerosis. Neurology 2020; 95:e2965-e2976. [PMID: 32938787 DOI: 10.1212/wnl.0000000000010909] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 07/22/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To identify pathologic correlates of magnetization transfer ratio (MTR) in multiple sclerosis (MS) in an MRI-pathology study. METHODS We acquired MTR maps at 3T from 16 fixed MS brains and 4 controls, and immunostained 100 tissue blocks for neuronal neurofilaments, myelin (SMI94), tissue macrophages (CD68), microglia (IBA1), B-lymphocytes, T-lymphocytes, cytotoxic T-lymphocytes, astrocytes (glial fibrillary acidic protein), and mitochondrial damage (COX4, VDAC). We defined regions of interest in lesions, normal-appearing white matter (NAWM), and cortical normal-appearing gray matter (NAGM). Associations between MTR and immunostaining intensities were explored using linear mixed-effects models (with cassettes nested within patients) and interaction terms (for differences between regions of interest and between cases and controls); a multivariate linear mixed-effects model identified the best pathologic correlates of MTR. RESULTS MTR was the lowest in white matter (WM) lesions (23.4 ± 9.4%) and the highest in NAWM (38.1 ± 8.7%). In MS brains, lower MTR was associated with lower immunostaining intensity for myelin (coefficient 0.31; 95% confidence interval [CI] 0.07-0.55), macrophages (coefficient 0.03; 95% CI 0.01-0.07), and astrocytes (coefficient 0.51; 95% CI 0.02-1.00), and with greater mitochondrial damage (coefficient 0.31; 95% CI 0.07-0.55). Based on interaction terms, MTR was more strongly associated with myelin in WM (coefficient 1.58; 95% CI 1.09-2.08) and gray matter (GM) lesions (coefficient 0.66; 95% CI 0.13-1.20), and with macrophages (coefficient 1.40; 95% CI 0.56-2.25), astrocytes (coefficient 2.66; 95% CI 1.31-4.01), and mitochondrial damage (coefficient -12.59; 95% CI -23.16 to -2.02) in MS brains than controls. In the multivariate model, myelin immunostaining intensity was the best correlate of MTR (coefficient 0.31; 95% CI 0.09-0.52; p = 0.004). CONCLUSIONS Myelin was the strongest correlate of MTR, especially in WM and cortical GM lesions, but additional correlates should be kept in mind when designing and interpreting MTR observational and experimental studies in MS.
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Affiliation(s)
- Marcello Moccia
- From the Department of Neuroinflammation, Queen Square MS Centre, NMR Research Unit, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences (M.M., S.v.d.P., A.E., L.H., M.Y., Y.W., C.W.-K., A.T., F.B., O.C.), Centre for Medical Image Computing, Department of Medical Physics and Bioengineering (J.P., S.O.), and Translational Imaging Group, UCL Institute of Healthcare Engineering (F.B.), University College London, UK; Multiple Sclerosis Clinical Care and Research Centre, Department of Neurosciences (M.M.), Federico II University, Naples, Italy; Department of Radiology and Nuclear Medicine (F.B.), VU University Medical Center, Amsterdam, the Netherlands; and National Institute for Health Research University College London Hospitals Biomedical Research Centre (A.T., F.B., O.C.), UK
| | - Steven van de Pavert
- From the Department of Neuroinflammation, Queen Square MS Centre, NMR Research Unit, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences (M.M., S.v.d.P., A.E., L.H., M.Y., Y.W., C.W.-K., A.T., F.B., O.C.), Centre for Medical Image Computing, Department of Medical Physics and Bioengineering (J.P., S.O.), and Translational Imaging Group, UCL Institute of Healthcare Engineering (F.B.), University College London, UK; Multiple Sclerosis Clinical Care and Research Centre, Department of Neurosciences (M.M.), Federico II University, Naples, Italy; Department of Radiology and Nuclear Medicine (F.B.), VU University Medical Center, Amsterdam, the Netherlands; and National Institute for Health Research University College London Hospitals Biomedical Research Centre (A.T., F.B., O.C.), UK
| | - Arman Eshaghi
- From the Department of Neuroinflammation, Queen Square MS Centre, NMR Research Unit, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences (M.M., S.v.d.P., A.E., L.H., M.Y., Y.W., C.W.-K., A.T., F.B., O.C.), Centre for Medical Image Computing, Department of Medical Physics and Bioengineering (J.P., S.O.), and Translational Imaging Group, UCL Institute of Healthcare Engineering (F.B.), University College London, UK; Multiple Sclerosis Clinical Care and Research Centre, Department of Neurosciences (M.M.), Federico II University, Naples, Italy; Department of Radiology and Nuclear Medicine (F.B.), VU University Medical Center, Amsterdam, the Netherlands; and National Institute for Health Research University College London Hospitals Biomedical Research Centre (A.T., F.B., O.C.), UK
| | - Lukas Haider
- From the Department of Neuroinflammation, Queen Square MS Centre, NMR Research Unit, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences (M.M., S.v.d.P., A.E., L.H., M.Y., Y.W., C.W.-K., A.T., F.B., O.C.), Centre for Medical Image Computing, Department of Medical Physics and Bioengineering (J.P., S.O.), and Translational Imaging Group, UCL Institute of Healthcare Engineering (F.B.), University College London, UK; Multiple Sclerosis Clinical Care and Research Centre, Department of Neurosciences (M.M.), Federico II University, Naples, Italy; Department of Radiology and Nuclear Medicine (F.B.), VU University Medical Center, Amsterdam, the Netherlands; and National Institute for Health Research University College London Hospitals Biomedical Research Centre (A.T., F.B., O.C.), UK
| | - Jonas Pichat
- From the Department of Neuroinflammation, Queen Square MS Centre, NMR Research Unit, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences (M.M., S.v.d.P., A.E., L.H., M.Y., Y.W., C.W.-K., A.T., F.B., O.C.), Centre for Medical Image Computing, Department of Medical Physics and Bioengineering (J.P., S.O.), and Translational Imaging Group, UCL Institute of Healthcare Engineering (F.B.), University College London, UK; Multiple Sclerosis Clinical Care and Research Centre, Department of Neurosciences (M.M.), Federico II University, Naples, Italy; Department of Radiology and Nuclear Medicine (F.B.), VU University Medical Center, Amsterdam, the Netherlands; and National Institute for Health Research University College London Hospitals Biomedical Research Centre (A.T., F.B., O.C.), UK
| | - Marios Yiannakas
- From the Department of Neuroinflammation, Queen Square MS Centre, NMR Research Unit, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences (M.M., S.v.d.P., A.E., L.H., M.Y., Y.W., C.W.-K., A.T., F.B., O.C.), Centre for Medical Image Computing, Department of Medical Physics and Bioengineering (J.P., S.O.), and Translational Imaging Group, UCL Institute of Healthcare Engineering (F.B.), University College London, UK; Multiple Sclerosis Clinical Care and Research Centre, Department of Neurosciences (M.M.), Federico II University, Naples, Italy; Department of Radiology and Nuclear Medicine (F.B.), VU University Medical Center, Amsterdam, the Netherlands; and National Institute for Health Research University College London Hospitals Biomedical Research Centre (A.T., F.B., O.C.), UK
| | - Sebastien Ourselin
- From the Department of Neuroinflammation, Queen Square MS Centre, NMR Research Unit, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences (M.M., S.v.d.P., A.E., L.H., M.Y., Y.W., C.W.-K., A.T., F.B., O.C.), Centre for Medical Image Computing, Department of Medical Physics and Bioengineering (J.P., S.O.), and Translational Imaging Group, UCL Institute of Healthcare Engineering (F.B.), University College London, UK; Multiple Sclerosis Clinical Care and Research Centre, Department of Neurosciences (M.M.), Federico II University, Naples, Italy; Department of Radiology and Nuclear Medicine (F.B.), VU University Medical Center, Amsterdam, the Netherlands; and National Institute for Health Research University College London Hospitals Biomedical Research Centre (A.T., F.B., O.C.), UK
| | - Yi Wang
- From the Department of Neuroinflammation, Queen Square MS Centre, NMR Research Unit, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences (M.M., S.v.d.P., A.E., L.H., M.Y., Y.W., C.W.-K., A.T., F.B., O.C.), Centre for Medical Image Computing, Department of Medical Physics and Bioengineering (J.P., S.O.), and Translational Imaging Group, UCL Institute of Healthcare Engineering (F.B.), University College London, UK; Multiple Sclerosis Clinical Care and Research Centre, Department of Neurosciences (M.M.), Federico II University, Naples, Italy; Department of Radiology and Nuclear Medicine (F.B.), VU University Medical Center, Amsterdam, the Netherlands; and National Institute for Health Research University College London Hospitals Biomedical Research Centre (A.T., F.B., O.C.), UK
| | - Claudia Wheeler-Kingshott
- From the Department of Neuroinflammation, Queen Square MS Centre, NMR Research Unit, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences (M.M., S.v.d.P., A.E., L.H., M.Y., Y.W., C.W.-K., A.T., F.B., O.C.), Centre for Medical Image Computing, Department of Medical Physics and Bioengineering (J.P., S.O.), and Translational Imaging Group, UCL Institute of Healthcare Engineering (F.B.), University College London, UK; Multiple Sclerosis Clinical Care and Research Centre, Department of Neurosciences (M.M.), Federico II University, Naples, Italy; Department of Radiology and Nuclear Medicine (F.B.), VU University Medical Center, Amsterdam, the Netherlands; and National Institute for Health Research University College London Hospitals Biomedical Research Centre (A.T., F.B., O.C.), UK
| | - Alan Thompson
- From the Department of Neuroinflammation, Queen Square MS Centre, NMR Research Unit, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences (M.M., S.v.d.P., A.E., L.H., M.Y., Y.W., C.W.-K., A.T., F.B., O.C.), Centre for Medical Image Computing, Department of Medical Physics and Bioengineering (J.P., S.O.), and Translational Imaging Group, UCL Institute of Healthcare Engineering (F.B.), University College London, UK; Multiple Sclerosis Clinical Care and Research Centre, Department of Neurosciences (M.M.), Federico II University, Naples, Italy; Department of Radiology and Nuclear Medicine (F.B.), VU University Medical Center, Amsterdam, the Netherlands; and National Institute for Health Research University College London Hospitals Biomedical Research Centre (A.T., F.B., O.C.), UK
| | - Frederik Barkhof
- From the Department of Neuroinflammation, Queen Square MS Centre, NMR Research Unit, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences (M.M., S.v.d.P., A.E., L.H., M.Y., Y.W., C.W.-K., A.T., F.B., O.C.), Centre for Medical Image Computing, Department of Medical Physics and Bioengineering (J.P., S.O.), and Translational Imaging Group, UCL Institute of Healthcare Engineering (F.B.), University College London, UK; Multiple Sclerosis Clinical Care and Research Centre, Department of Neurosciences (M.M.), Federico II University, Naples, Italy; Department of Radiology and Nuclear Medicine (F.B.), VU University Medical Center, Amsterdam, the Netherlands; and National Institute for Health Research University College London Hospitals Biomedical Research Centre (A.T., F.B., O.C.), UK
| | - Olga Ciccarelli
- From the Department of Neuroinflammation, Queen Square MS Centre, NMR Research Unit, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences (M.M., S.v.d.P., A.E., L.H., M.Y., Y.W., C.W.-K., A.T., F.B., O.C.), Centre for Medical Image Computing, Department of Medical Physics and Bioengineering (J.P., S.O.), and Translational Imaging Group, UCL Institute of Healthcare Engineering (F.B.), University College London, UK; Multiple Sclerosis Clinical Care and Research Centre, Department of Neurosciences (M.M.), Federico II University, Naples, Italy; Department of Radiology and Nuclear Medicine (F.B.), VU University Medical Center, Amsterdam, the Netherlands; and National Institute for Health Research University College London Hospitals Biomedical Research Centre (A.T., F.B., O.C.), UK.
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8
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Geldschläger O, Bosch D, Avdievich NI, Henning A. Ultrahigh-resolution quantitative spinal cord MRI at 9.4T. Magn Reson Med 2020; 85:1013-1027. [PMID: 32789980 DOI: 10.1002/mrm.28455] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 07/06/2020] [Accepted: 07/10/2020] [Indexed: 11/08/2022]
Abstract
PURPOSE To present the results of the first human spinal cord in vivo MRI scans at 9.4T. METHODS A human brain coil was used to image the human spinal cord at 9.4T. All anatomical images were acquired with a T2 *-weighted gradient-echo sequence. A comparison of the influence of four different B0 shimming routines on the image quality was performed. Intrinsic signal-to-noise-ratio maps were determined using a pseudo-multiple replica approach. Measurements with different echo times were compared and processed to one multiecho data image combination image. Based on the multiecho acquisitions, T2 *-relaxation time maps were calculated. Algorithmic spinal cord detection and gray matter/white matter segmentation were tested. RESULTS An echo time between 9 and 13.8 ms compromised best between gray matter/white matter contrast and image quality. A maximum in-plane resolution of 0.15 × 0.15 mm2 was achieved for anatomical images. These images offered excellent image quality and made small structures of the spinal cord visible. The scanner vendor implemented B0 shimming routine performed best during this work. Intrinsic signal-to-noise-ratio values of between 6600 and 8060 at the upper cervical spinal cord were achieved. Detection and segmentation worked reliably. An average T2 *-time of 24.88 ms ± 6.68 ms for gray matter and 19.37 ms ± 8.66 ms for white matter was calculated. CONCLUSION The proposed human brain coil can be used to image the spinal cord. The maximum in-plane resolution in this work was higher compared with the 7T results from the literature. The 9.4T acquisitions made the small structures of the spinal cord clearly visible.
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Affiliation(s)
- Ole Geldschläger
- High-Field Magnetic Resonance Center, Max Planck Institute for Biological Cybernetics, Tübingen, Germany
| | - Dario Bosch
- High-Field Magnetic Resonance Center, Max Planck Institute for Biological Cybernetics, Tübingen, Germany.,Biomedical Magnetic Resonance, University Hospital Tübingen, Tübingen, Germany
| | - Nikolai I Avdievich
- High-Field Magnetic Resonance Center, Max Planck Institute for Biological Cybernetics, Tübingen, Germany
| | - Anke Henning
- High-Field Magnetic Resonance Center, Max Planck Institute for Biological Cybernetics, Tübingen, Germany.,Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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9
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Weller D, Filli L, Meyer C, Lörincz L, Linnebank M, Weller M, Curt A, Zörner B. Impaired speed-dependent modulation of the gait pattern in multiple sclerosis. J Neurol 2020; 267:2998-3007. [PMID: 32500374 DOI: 10.1007/s00415-020-09965-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 05/28/2020] [Accepted: 05/30/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Walking dysfunction is common in people with multiple sclerosis (MS). Besides walking speed or endurance, one crucial feature of ambulatory function is the ability to adjust the gait pattern according to walking speed which relies on the integrity of spinal motor centres, their reciprocal connections to supraspinal networks and peripheral sensory input. OBJECTIVE To investigate the capacity of people with MS to modify their gait pattern in response to changes in walking speed. METHODS 3D gait analysis during free treadmill walking was performed in 35 people with MS and 20 healthy controls. Twelve kinematic parameters ranging from basic spatiotemporal measures to complex indicators of intralimb coordination were assessed at different absolute and relative walking speeds. RESULTS Cadence, double-limb support time, trunk movements and especially measures of intralimb coordination demonstrated significantly less speed-dependent modifications in MS than in controls. These limitations were more prominent in subjects with stronger MS-related impairment (worse outcome in clinical walking tests, higher Expanded Disability Status Scale). CONCLUSION The incapacity to modify specific elements of the walking pattern according to walking speed contributes to gait dysfunction in people with MS limiting activities of daily living. Gait modulation may serve as sensitive marker of walking function in MS. TRIAL REGISTRATION Clinicaltrials.gov, NCT01576354; first posted April 12, 2012.
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Affiliation(s)
- David Weller
- Department of Neurology, University Hospital and University of Zurich, Frauenklinikstrasse 26, 8091, Zurich, Switzerland
| | - Linard Filli
- Spinal Cord Injury Center, Balgrist University Hospital, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Christian Meyer
- Spinal Cord Injury Center, Balgrist University Hospital, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Lilla Lörincz
- Department of Neurology, University Hospital and University of Zurich, Frauenklinikstrasse 26, 8091, Zurich, Switzerland
| | - Michael Linnebank
- Department of Neurology, University Witten/Herdecke and Evangelische Kliniken Gelsenkirchen, Munckelstraße 32, 45879, Gelsenkirchen, Germany
| | - Michael Weller
- Department of Neurology, University Hospital and University of Zurich, Frauenklinikstrasse 26, 8091, Zurich, Switzerland
| | - Armin Curt
- Spinal Cord Injury Center, Balgrist University Hospital, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Björn Zörner
- Spinal Cord Injury Center, Balgrist University Hospital, Forchstrasse 340, 8008, Zurich, Switzerland.
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10
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Durand-Dubief F. Should spinal cord MRI be systematically performed for diagnosis and follow-up of multiple sclerosis? Synthesis. Rev Neurol (Paris) 2020; 176:490-493. [DOI: 10.1016/j.neurol.2020.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 03/23/2020] [Indexed: 11/25/2022]
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11
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Rocca MA, Preziosa P, Filippi M. What role should spinal cord MRI take in the future of multiple sclerosis surveillance? Expert Rev Neurother 2020; 20:783-797. [PMID: 32133874 DOI: 10.1080/14737175.2020.1739524] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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.
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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
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12
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Eden D, Gros C, Badji A, Dupont SM, De Leener B, Maranzano J, Zhuoquiong R, Liu Y, Granberg T, Ouellette R, Stawiarz L, Hillert J, Talbott J, Bannier E, Kerbrat A, Edan G, Labauge P, Callot V, Pelletier J, Audoin B, Rasoanandrianina H, Brisset JC, Valsasina P, Rocca MA, Filippi M, Bakshi R, Tauhid S, Prados F, Yiannakas M, Kearney H, Ciccarelli O, Smith SA, Andrada Treaba C, Mainero C, Lefeuvre J, Reich DS, Nair G, Shepherd TM, Charlson E, Tachibana Y, Hori M, Kamiya K, Chougar L, Narayanan S, Cohen-Adad J. Spatial distribution of multiple sclerosis lesions in the cervical spinal cord. Brain 2020; 142:633-646. [PMID: 30715195 DOI: 10.1093/brain/awy352] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Revised: 10/25/2018] [Accepted: 11/20/2018] [Indexed: 12/12/2022] Open
Abstract
Spinal cord lesions detected on MRI hold important diagnostic and prognostic value for multiple sclerosis. Previous attempts to correlate lesion burden with clinical status have had limited success, however, suggesting that lesion location may be a contributor. Our aim was to explore the spatial distribution of multiple sclerosis lesions in the cervical spinal cord, with respect to clinical status. We included 642 suspected or confirmed multiple sclerosis patients (31 clinically isolated syndrome, and 416 relapsing-remitting, 84 secondary progressive, and 73 primary progressive multiple sclerosis) from 13 clinical sites. Cervical spine lesions were manually delineated on T2- and T2*-weighted axial and sagittal MRI scans acquired at 3 or 7 T. With an automatic publicly-available analysis pipeline we produced voxelwise lesion frequency maps to identify predilection sites in various patient groups characterized by clinical subtype, Expanded Disability Status Scale score and disease duration. We also measured absolute and normalized lesion volumes in several regions of interest using an atlas-based approach, and evaluated differences within and between groups. The lateral funiculi were more frequently affected by lesions in progressive subtypes than in relapsing in voxelwise analysis (P < 0.001), which was further confirmed by absolute and normalized lesion volumes (P < 0.01). The central cord area was more often affected by lesions in primary progressive than relapse-remitting patients (P < 0.001). Between white and grey matter, the absolute lesion volume in the white matter was greater than in the grey matter in all phenotypes (P < 0.001); however when normalizing by each region, normalized lesion volumes were comparable between white and grey matter in primary progressive patients. Lesions appearing in the lateral funiculi and central cord area were significantly correlated with Expanded Disability Status Scale score (P < 0.001). High lesion frequencies were observed in patients with a more aggressive disease course, rather than long disease duration. Lesions located in the lateral funiculi and central cord area of the cervical spine may influence clinical status in multiple sclerosis. This work shows the added value of cervical spine lesions, and provides an avenue for evaluating the distribution of spinal cord lesions in various patient groups.
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Affiliation(s)
- Dominique Eden
- NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montreal, Montreal, QC, Canada
| | - Charley Gros
- NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montreal, Montreal, QC, Canada
| | - Atef Badji
- NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montreal, Montreal, QC, Canada.,Department of Neuroscience, Faculty of Medicine, University of Montreal, Montreal, QC, Canada
| | - Sara M Dupont
- NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montreal, Montreal, QC, Canada.,Department of Radiology and Biomedical Imaging, Zuckerberg San Francisco General Hospital, University of California, San Francisco, CA, USA
| | - Benjamin De Leener
- NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montreal, Montreal, QC, Canada
| | - Josefina Maranzano
- McConnell Brain Imaging Centre, Montreal Neurological Institute, Montreal, Canada.,Department of Anatomy, Université de Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Ren Zhuoquiong
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, P. R. China
| | - Yaou Liu
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, P. R. China.,Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, P. R. China
| | - Tobias Granberg
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Massachusetts General Hospital, Boston, USA
| | - Russell Ouellette
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Massachusetts General Hospital, Boston, USA
| | - Leszek Stawiarz
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Jan Hillert
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Jason Talbott
- Department of Radiology and Biomedical Imaging, Zuckerberg San Francisco General Hospital, University of California, San Francisco, CA, USA
| | - Elise Bannier
- CHU Rennes, Radiology Department, Rennes, France.,Univ Rennes, CNRS, Inria, Inserm, IRISA UMR 6074, EMPENN - ERL U 1228, Rennes, France
| | - Anne Kerbrat
- Univ Rennes, CNRS, Inria, Inserm, IRISA UMR 6074, EMPENN - ERL U 1228, Rennes, France.,CHU Rennes, Neurology Department, Rennes, France
| | - Gilles Edan
- Univ Rennes, CNRS, Inria, Inserm, IRISA UMR 6074, EMPENN - ERL U 1228, Rennes, France.,CHU Rennes, Neurology Department, Rennes, France
| | - Pierre Labauge
- MS Unit, Department of Neurology, University Hospital of Montpellier, Montpellier, France
| | - Virginie Callot
- Aix Marseille University, CNRS, CRMBM, Marseille, France.,APHM, CHU Timone, CEMEREM, Marseille, France
| | - Jean Pelletier
- APHM, CHU Timone, CEMEREM, Marseille, France.,APHM, Department of Neurology, CHU Timone, APHM, Marseille
| | - Bertrand Audoin
- APHM, CHU Timone, CEMEREM, Marseille, France.,APHM, Department of Neurology, CHU Timone, APHM, Marseille
| | - Henitsoa Rasoanandrianina
- Aix Marseille University, CNRS, CRMBM, Marseille, France.,APHM, CHU Timone, CEMEREM, Marseille, France
| | - Jean-Christophe Brisset
- Observatoire Français de la Sclérose en Plaques (OFSEP) ; Université de Lyon, Université Claude Bernard Lyon 1; Hospices Civils de Lyon; CREATIS-LRMN, UMR 5220 CNRS and U 1044 INSERM; Lyon, France
| | - Paola Valsasina
- Neuroimaging Research Unit, INSPE, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Maria A Rocca
- Neuroimaging Research Unit, INSPE, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, INSPE, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Rohit Bakshi
- Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - Shahamat Tauhid
- Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - Ferran Prados
- Queen Square MS Centre, UCL Institute of Neurology, Faculty of Brain Sciences, University College London, London,UK.,Center for Medical Image Computing (CMIC), Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Marios Yiannakas
- Queen Square MS Centre, UCL Institute of Neurology, Faculty of Brain Sciences, University College London, London,UK
| | - Hugh Kearney
- Queen Square MS Centre, UCL Institute of Neurology, Faculty of Brain Sciences, University College London, London,UK
| | - Olga Ciccarelli
- Queen Square MS Centre, UCL Institute of Neurology, Faculty of Brain Sciences, University College London, London,UK
| | - Seth A Smith
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | | | - Jennifer Lefeuvre
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Maryland, USA
| | - Daniel S Reich
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Maryland, USA
| | - Govind Nair
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Maryland, USA
| | | | - Erik Charlson
- Department of Radiology, NYU Langone Medical Center, New York, USA
| | | | - Masaaki Hori
- Department of Radiology, Juntendo University School of Medicine, Tokyo, Japan
| | - Kouhei Kamiya
- Department of Radiology, Juntendo University School of Medicine, Tokyo, Japan
| | - Lydia Chougar
- Department of Radiology, Juntendo University School of Medicine, Tokyo, Japan.,Hospital Cochin, Paris, France
| | - Sridar Narayanan
- McConnell Brain Imaging Centre, Montreal Neurological Institute, Montreal, Canada
| | - Julien Cohen-Adad
- NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montreal, Montreal, QC, Canada.,Department of Neuroscience, Faculty of Medicine, University of Montreal, Montreal, QC, Canada.,Functional Neuroimaging Unit, CRIUGM, Université de Montréal, Montreal, QC, Canada
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13
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Schmierer K, Miquel ME. Magnetic resonance imaging correlates of neuro-axonal pathology in the MS spinal cord. Brain Pathol 2019; 28:765-772. [PMID: 30375114 DOI: 10.1111/bpa.12648] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 07/18/2018] [Indexed: 12/21/2022] Open
Abstract
In people with multiple sclerosis (MS), the spinal cord is the structure most commonly affected by clinically detectable pathology at presentation, and a key part of the central nervous system involved in chronic disease deterioration. Indices, such as the spinal cord cross-sectional area at the level C2 have been developed as tools to predict future disability, and-by inference-axonal loss. However, this and other histo-pathological correlates of spinal cord magnetic resonance imaging (MRI) changes in MS remain incompletely understood. In recent years, there has been a surge of interest in developing quantitative MRI tools to measure specific tissue features, including axonal density, myelin content, neurite density, and orientation, among others, with an emphasis on the spinal cord. Quantitative MRI techniques including T1 and T2 , magnetization transfer and a number of diffusion-derived indices have all been applied to MS spinal cord. Particularly diffusion-based MRI techniques combined with microscopic resolution achievable using high magnetic field scanners enable a new level of anatomical detail and quantification of indices that are clinically meaningful.
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Affiliation(s)
- Klaus Schmierer
- Queen Mary University of London, Barts and The London School of Medicine & Dentistry, Blizard Institute (Neuroscience), London, UK.,Barts Health NHS Trust, Clinical Board Medicine (Neuroscience), The Royal London Hospital, London, UK
| | - Marc E Miquel
- Barts Health NHS Trust, Clinical Physics, London, UK
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14
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Filippi M, Brück W, Chard D, Fazekas F, Geurts JJG, Enzinger C, Hametner S, Kuhlmann T, Preziosa P, Rovira À, Schmierer K, Stadelmann C, Rocca MA. Association between pathological and MRI findings in multiple sclerosis. Lancet Neurol 2019; 18:198-210. [DOI: 10.1016/s1474-4422(18)30451-4] [Citation(s) in RCA: 87] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 10/22/2018] [Accepted: 11/12/2018] [Indexed: 12/12/2022]
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15
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Abstract
Spinal cord (SC) MRI in multiple sclerosis (MS) has significant usefulness in clinical and investigational settings. Conventional MRI of the SC is used in clinical practice, because it has both diagnostic and prognostic value. A number of advanced, quantitative SC MRI measures that assess the structural and functional integrity of the SC have been evaluated in investigational settings. These techniques have collectively demonstrated usefulness in providing insight into microstructural and functional changes relevant to disability in MS. With further development, these techniques may be useful in clinical trial settings as biomarkers of neurodegeneration and protection, and in day-to-day clinical practice.
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Affiliation(s)
- Alexandra Muccilli
- Division of Neurology, St. Michael's Hospital, University of Toronto, 30 Bond Street, Toronto, Ontario, M5B 1W8, Canada; Division of Neurology, Centre Hospitalier de L'Université de Montréal, Université de Montréal, 1058 Saint-Denis Street, Montreal, Quebec H2X 3J4, Canada
| | - Estelle Seyman
- Division of Neurology, St. Michael's Hospital, University of Toronto, 30 Bond Street, Toronto, Ontario, M5B 1W8, Canada
| | - Jiwon Oh
- Division of Neurology, St. Michael's Hospital, University of Toronto, 30 Bond Street, Toronto, Ontario, M5B 1W8, Canada; Department of Neurology, Johns Hopkins University, Baltimore, MD, USA.
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16
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Hypothermia in Multiple Sclerosis: Beyond the Hypothalamus? A Case Report and Review of the Literature. Case Rep Neurol Med 2018; 2018:2768493. [PMID: 29755800 PMCID: PMC5884398 DOI: 10.1155/2018/2768493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 01/06/2018] [Accepted: 02/06/2018] [Indexed: 11/18/2022] Open
Abstract
Hypothermia is a rare and poorly understood complication of Multiple Sclerosis (MS). We report on a 66-year-old patient currently with Secondary Progressive MS (SP-MS) who developed unexplained hypothermia associated with multiple hospitalisations and we review the literature on this topic. In our case, magnetic resonance imaging (MRI) of the brain failed to highlight hypothalamic disease, but spinal MRI identified a number of spinal cord lesions. Given the incidence and clinical significance of spinal involvement in MS and the hypothermic disturbances observed in high Spinal Cord Injury (SCI), we hypothesise that upper spinal cord pathology, along with hypothalamic and brainstem dysfunctions, can contribute to hypothermia.
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17
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Calabrese E, Adil SM, Cofer G, Perone CS, Cohen-Adad J, Lad SP, Johnson GA. Postmortem diffusion MRI of the entire human spinal cord at microscopic resolution. Neuroimage Clin 2018; 18:963-971. [PMID: 29876281 PMCID: PMC5988447 DOI: 10.1016/j.nicl.2018.03.029] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 01/15/2018] [Accepted: 03/21/2018] [Indexed: 11/20/2022]
Abstract
The human spinal cord is a central nervous system structure that plays an important role in normal motor and sensory function, and can be affected by many debilitating neurologic diseases. Due to its clinical importance, the spinal cord is frequently the subject of imaging research. Common methods for visualizing spinal cord anatomy and pathology include histology and magnetic resonance imaging (MRI), both of which have unique benefits and drawbacks. Postmortem microscopic resolution MRI of fixed specimens, sometimes referred to as magnetic resonance microscopy (MRM), combines many of the benefits inherent to both techniques. However, the elongated shape of the human spinal cord, along with hardware and scan time limitations, have restricted previous microscopic resolution MRI studies (both in vivo and ex vivo) to small sections of the cord. Here we present the first MRM dataset of the entire postmortem human spinal cord. These data include 50 μm isotropic resolution anatomic image data and 100 μm isotropic resolution diffusion data, made possible by a 280 h long multi-segment acquisition and automated image segment composition. We demonstrate the use of these data for spinal cord lesion detection, automated volumetric gray matter segmentation, and quantitative spinal cord morphometry including estimates of cross sectional dimensions and gray matter fraction throughout the length of the cord.
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Affiliation(s)
- Evan Calabrese
- Department of Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA; Center for In Vivo Microscopy, Duke University Medical Center, Durham, NC, USA.
| | - Syed M Adil
- Center for In Vivo Microscopy, Duke University Medical Center, Durham, NC, USA; Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA
| | - Gary Cofer
- Center for In Vivo Microscopy, Duke University Medical Center, Durham, NC, USA
| | - Christian S Perone
- NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montreal, Montreal, QC, Canada
| | - Julien Cohen-Adad
- NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montreal, Montreal, QC, Canada
| | - Shivanand P Lad
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA
| | - G Allan Johnson
- Center for In Vivo Microscopy, Duke University Medical Center, Durham, NC, USA
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18
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Schmierer K, McDowell A, Petrova N, Carassiti D, Thomas DL, Miquel ME. Quantifying multiple sclerosis pathology in post mortem spinal cord using MRI. Neuroimage 2018; 182:251-258. [PMID: 29373838 DOI: 10.1016/j.neuroimage.2018.01.052] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 01/04/2018] [Accepted: 01/21/2018] [Indexed: 11/26/2022] Open
Abstract
Multiple sclerosis (MS) is a common inflammatory, demyelinating and degenerative disease of the central nervous system. The majority of people with MS present with symptoms due to spinal cord damage, and in more advanced MS a clinical syndrome resembling that of progressive myelopathy is not uncommon. Significant efforts have been undertaken to predict MS-related disability based on short-term observations, for example, the spinal cord cross-sectional area measured using MRI. The histo-pathological correlates of spinal cord MRI changes in MS are incompletely understood, however a surge of interest in tissue microstructure has recently led to new approaches to improve the precision with which MRI indices relate to underlying tissue features, such as myelin content, neurite density and orientation, among others. Quantitative MRI techniques including T1 and T2, magnetisation transfer (MT) and a number of diffusion-derived indices have all been successfully applied to post mortem MS spinal cord. Combining advanced quantification of histological features with quantitative - particularly diffusion-based - MRI techniques provide a new platform for high-quality MR/pathology data generation. To more accurately quantify grey matter pathology in the MS spinal cord, a key driver of physical disability in advanced MS, remains an important challenge of microstructural imaging.
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Affiliation(s)
- K Schmierer
- Queen Mary University of London, Barts and The London School of Medicine & Dentistry, Blizard Institute (Neuroscience), London, UK; Barts Health NHS Trust, Clinical Board Medicine (Neuroscience), The Royal London Hospital, London, UK.
| | - A McDowell
- UCL Great Ormond Street Institute of Child Health, Developmental Imaging and Biophysics Section, London, UK
| | - N Petrova
- Queen Mary University of London, Barts and The London School of Medicine & Dentistry, Blizard Institute (Neuroscience), London, UK
| | - D Carassiti
- Queen Mary University of London, Barts and The London School of Medicine & Dentistry, Blizard Institute (Neuroscience), London, UK
| | - D L Thomas
- UCL Institute of Neurology, Leonard Wolfson Experimental Neurology Centre, Department of Brain Repair and Rehabilitation, Queen Square, London, UK
| | - M E Miquel
- Barts Health NHS Trust, Clinical Physics, London, UK
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19
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Affiliation(s)
- Daniel S Reich
- From the Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda (D.S.R.), and the Departments of Neurology and Neuroscience, Johns Hopkins School of Medicine, Baltimore (P.A.C.) - both in Maryland; and the Department of Neurology, Mayo Clinic, Rochester, MN (C.F.L.)
| | - Claudia F Lucchinetti
- From the Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda (D.S.R.), and the Departments of Neurology and Neuroscience, Johns Hopkins School of Medicine, Baltimore (P.A.C.) - both in Maryland; and the Department of Neurology, Mayo Clinic, Rochester, MN (C.F.L.)
| | - Peter A Calabresi
- From the Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda (D.S.R.), and the Departments of Neurology and Neuroscience, Johns Hopkins School of Medicine, Baltimore (P.A.C.) - both in Maryland; and the Department of Neurology, Mayo Clinic, Rochester, MN (C.F.L.)
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20
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Abstract
The neuropsychological aspects of multiple sclerosis (MS) have evolved over the past three decades. What was once thought to be a rare occurrence, cognitive dysfunction is now viewed as one of the most disabling symptoms of the disease, with devastating effects on patients' quality of life. This selective review will highlight major innovations and scientific discoveries in the areas of neuropathology, neuroimaging, diagnosis, and treatment that pertain to our understanding of the neuropsychological aspects of MS. Specifically, we focus on the recent discovery that MS produces pathogical lesions of gray matter (GM) that have consequences for cognitive functions. Methods for imaging these GM lesions in MS are discussed along with multimodal imaging studies that integrate structural and functional imaging methods to provide a better understanding of the relationship between cognitive test performance and functional reserve. Innovations in the screening and comprehensive assessment of cognitive disorders are presented along with recent research that examines cognitive dysfunction in pediatric MS. Results of innovative outcome studies in cognitive rehabilitation are discussed. Finally, we highlight trends for potential future innovations over the next decade. (JINS, 2017, 23, 832-842).
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21
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Mahajan KR, Ontaneda D. The Role of Advanced Magnetic Resonance Imaging Techniques in Multiple Sclerosis Clinical Trials. Neurotherapeutics 2017; 14:905-923. [PMID: 28770481 PMCID: PMC5722766 DOI: 10.1007/s13311-017-0561-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Magnetic resonance imaging has been crucial in the development of anti-inflammatory disease-modifying treatments. The current landscape of multiple sclerosis clinical trials is currently expanding to include testing not only of anti-inflammatory agents, but also neuroprotective, remyelinating, neuromodulating, and restorative therapies. This is especially true of therapies targeting progressive forms of the disease where neurodegeneration is a prominent feature. Imaging techniques of the brain and spinal cord have rapidly evolved in the last decade to permit in vivo characterization of tissue microstructural changes, connectivity, metabolic changes, neuronal loss, glial activity, and demyelination. Advanced magnetic resonance imaging techniques hold significant promise for accelerating the development of different treatment modalities targeting a variety of pathways in MS.
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Affiliation(s)
- Kedar R Mahajan
- Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic, 9500 Euclid Avenue, U-10, Cleveland, OH, 44195, USA
| | - Daniel Ontaneda
- Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic, 9500 Euclid Avenue, U-10, Cleveland, OH, 44195, USA.
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22
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Battiston M, Grussu F, Ianus A, Schneider T, Prados F, Fairney J, Ourselin S, Alexander DC, Cercignani M, Gandini Wheeler-Kingshott CAM, Samson RS. An optimized framework for quantitative magnetization transfer imaging of the cervical spinal cord in vivo. Magn Reson Med 2017; 79:2576-2588. [PMID: 28921614 PMCID: PMC5836910 DOI: 10.1002/mrm.26909] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 08/15/2017] [Accepted: 08/16/2017] [Indexed: 11/06/2022]
Abstract
PURPOSE To develop a framework to fully characterize quantitative magnetization transfer indices in the human cervical cord in vivo within a clinically feasible time. METHODS A dedicated spinal cord imaging protocol for quantitative magnetization transfer was developed using a reduced field-of-view approach with echo planar imaging (EPI) readout. Sequence parameters were optimized based in the Cramer-Rao-lower bound. Quantitative model parameters (i.e., bound pool fraction, free and bound pool transverse relaxation times [ T2F, T2B], and forward exchange rate [kFB ]) were estimated implementing a numerical model capable of dealing with the novelties of the sequence adopted. The framework was tested on five healthy subjects. RESULTS Cramer-Rao-lower bound minimization produces optimal sampling schemes without requiring the establishment of a steady-state MT effect. The proposed framework allows quantitative voxel-wise estimation of model parameters at the resolution typically used for spinal cord imaging (i.e. 0.75 × 0.75 × 5 mm3 ), with a protocol duration of ∼35 min. Quantitative magnetization transfer parametric maps agree with literature values. Whole-cord mean values are: bound pool fraction = 0.11(±0.01), T2F = 46.5(±1.6) ms, T2B = 11.0(±0.2) µs, and kFB = 1.95(±0.06) Hz. Protocol optimization has a beneficial effect on reproducibility, especially for T2B and kFB . CONCLUSION The framework developed enables robust characterization of spinal cord microstructure in vivo using qMT. Magn Reson Med 79:2576-2588, 2018. © 2017 The Authors Magnetic Resonance in Medicine published by Wiley Periodicals, Inc. on behalf of International Society for Magnetic Resonance in Medicine. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
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Affiliation(s)
- Marco Battiston
- Queen Square MS Centre, UCL Institute of Neurology, University College London, London, United Kingdom
| | - Francesco Grussu
- Queen Square MS Centre, UCL Institute of Neurology, University College London, London, United Kingdom
| | - Andrada Ianus
- Centre for Medical Image Computing, Department of Computer Science, University College London, London, United Kingdom.,Champalimaud Neuroscience Programme, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | | | - Ferran Prados
- Queen Square MS Centre, UCL Institute of Neurology, University College London, London, United Kingdom.,Translational Imaging Group, Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - James Fairney
- Queen Square MS Centre, UCL Institute of Neurology, University College London, London, United Kingdom.,UCL Department of Medical Physics and Bioengineering, University College London, London, United Kingdom
| | - Sebastien Ourselin
- Translational Imaging Group, Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - Daniel C Alexander
- Centre for Medical Image Computing, Department of Computer Science, University College London, London, United Kingdom
| | - Mara Cercignani
- CISC, Department of Neuroscience, Brighton & Sussex Medical School, Brighton, Sussex, United Kingdom
| | - Claudia A M Gandini Wheeler-Kingshott
- Queen Square MS Centre, UCL Institute of Neurology, University College London, London, United Kingdom.,Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy.,Brain MRI 3T Mondino Research Center, C. Mondino National Neurological Institute, Pavia, Italy
| | - Rebecca S Samson
- Queen Square MS Centre, UCL Institute of Neurology, University College London, London, United Kingdom
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23
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Bond KM, Brinjikji W, Eckel LJ, Kallmes DF, McDonald RJ, Carr CM. Dentate Update: Imaging Features of Entities That Affect the Dentate Nucleus. AJNR Am J Neuroradiol 2017; 38:1467-1474. [PMID: 28408628 PMCID: PMC7960439 DOI: 10.3174/ajnr.a5138] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The dentate nucleus is a cerebellar structure involved in voluntary motor function and cognition. There are relatively few entities that affect the dentate, and the clinical features of these conditions are often complex and nonspecific. Because these entities are rarely encountered, the formulation of a differential diagnosis can be difficult. Many of the conditions are reversible or treatable with early intervention. Therefore, it is important to recognize classic clinical presentations and their associated characteristic imaging findings. We provide a summary of entities that affect the dentate nucleus and a diagnostic workflow for approaching dentate nucleus imaging abnormalities.
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Affiliation(s)
- K M Bond
- From Mayo Clinic School of Medicine (K.M.B.)
| | - W Brinjikji
- the Department of Radiology (W.B., L.J.E., D.F.K., R.J.M., C.M.C.), Mayo Clinic, Rochester, Minnesota
| | - L J Eckel
- the Department of Radiology (W.B., L.J.E., D.F.K., R.J.M., C.M.C.), Mayo Clinic, Rochester, Minnesota
| | - D F Kallmes
- the Department of Radiology (W.B., L.J.E., D.F.K., R.J.M., C.M.C.), Mayo Clinic, Rochester, Minnesota
| | - R J McDonald
- the Department of Radiology (W.B., L.J.E., D.F.K., R.J.M., C.M.C.), Mayo Clinic, Rochester, Minnesota
| | - C M Carr
- the Department of Radiology (W.B., L.J.E., D.F.K., R.J.M., C.M.C.), Mayo Clinic, Rochester, Minnesota.
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24
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Battiston M, Schneider T, Prados F, Grussu F, Yiannakas MC, Ourselin S, Gandini Wheeler-Kingshott CAM, Samson RS. Fast and reproducible in vivo T 1 mapping of the human cervical spinal cord. Magn Reson Med 2017; 79:2142-2148. [PMID: 28736946 DOI: 10.1002/mrm.26852] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 07/04/2017] [Accepted: 07/05/2017] [Indexed: 12/16/2022]
Abstract
PURPOSE To develop a fast and robust method for measuring T1 in the whole cervical spinal cord in vivo, and to assess its reproducibility. METHODS A spatially nonselective adiabatic inversion pulse is combined with zonally oblique-magnified multislice echo-planar imaging to produce a reduced field-of-view inversion-recovery echo-planar imaging protocol. Multi- inversion time data are obtained by cycling slice order throughout sequence repetitions. Measurement of T1 is performed using 12 inversion times for a total protocol duration of 7 min. Reproducibility of regional T1 estimates is assessed in a scan-rescan experiment on five heathy subjects. RESULTS Regional mean (standard deviation) T1 was: 1108.5 (±77.2) ms for left lateral column, 1110.1 (±83.2) ms for right lateral column, 1150.4 (±102.6) ms for dorsal column, and 1136.4 (±90.8) ms for gray matter. Regional T1 estimates showed good correlation between sessions (Pearson correlation coefficient = 0.89 (P value < 0.01); mean difference = 2 ms, 95% confidence interval ± 20 ms); and high reproducibility (intersession coefficient of variation approximately 1% in all the regions considered, intraclass correlation coefficient = 0.88 (P value < 0.01, confidence interval 0.71-0.95)). CONCLUSIONS T1 estimates in the cervical spinal cord are reproducible using inversion-recovery zonally oblique-magnified multislice echo-planar imaging. The short acquisition time and large coverage of this method paves the way for accurate T1 mapping for various spinal cord pathologies. Magn Reson Med 79:2142-2148, 2018. © 2017 The Authors Magnetic Resonance in Medicine published by Wiley Periodicals, Inc. on behalf of International Society for Magnetic Resonance in Medicine. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
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Affiliation(s)
- Marco Battiston
- NMR Research Unit, Queen Square MS Center, Department of Neuroinflammation, UCL Institute of Neurology, University College London, London, United Kingdom
| | | | - Ferran Prados
- NMR Research Unit, Queen Square MS Center, Department of Neuroinflammation, UCL Institute of Neurology, University College London, London, United Kingdom.,Translational Imaging Group, Center for Medical Image Computing, Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - Francesco Grussu
- NMR Research Unit, Queen Square MS Center, Department of Neuroinflammation, UCL Institute of Neurology, University College London, London, United Kingdom
| | - Marios C Yiannakas
- NMR Research Unit, Queen Square MS Center, Department of Neuroinflammation, UCL Institute of Neurology, University College London, London, United Kingdom
| | - Sebastien Ourselin
- Translational Imaging Group, Center for Medical Image Computing, Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - Claudia A M Gandini Wheeler-Kingshott
- NMR Research Unit, Queen Square MS Center, Department of Neuroinflammation, UCL Institute of Neurology, University College London, London, United Kingdom.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.,Brain MRI 3T Mondino Research Center, C. Mondino National Neurological Institute, Pavia, Italy
| | - Rebecca S Samson
- NMR Research Unit, Queen Square MS Center, Department of Neuroinflammation, UCL Institute of Neurology, University College London, London, United Kingdom
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25
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Dekker I, Wattjes MP. Brain and Spinal Cord MR Imaging Features in Multiple Sclerosis and Variants. Neuroimaging Clin N Am 2017; 27:205-227. [DOI: 10.1016/j.nic.2016.12.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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26
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Rocca MA, De Meo E, Filippi M. Functional MRI in investigating cognitive impairment in multiple sclerosis. Acta Neurol Scand 2016; 134 Suppl 200:39-46. [PMID: 27580905 DOI: 10.1111/ane.12654] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2016] [Indexed: 12/01/2022]
Abstract
There is increasing evidence that the severity of the clinical manifestations of multiple sclerosis (MS) does not simply result from the extent of tissue destruction, but it rather represents a complex balance between tissue damage, tissue repair, and cortical reorganization. Functional magnetic resonance imaging (fMRI) provides information about the plasticity of the human brain. Therefore, it has the potential to provide important pieces of information about brain reorganization following MS-related structural damage. When investigating cognitive systems, fMRI changes have been described in virtually all patients with MS and different clinical phenotypes. These functional changes have been related to the extent of brain damage within and outside T2-visible lesions as well as to the involvement of specific central nervous system structures. It has also been suggested that a maladaptive recruitment of specific brain regions might be associated with the appearance of clinical symptoms in MS, such as fatigue and cognitive impairment. fMRI studies from clinically (and cognitively) impaired MS patients may be influenced by different task performances between patients and controls. As a consequence, new strategies have been introduced to assess the role, if any, of brain reorganization in severely impaired patients, including the analysis of resting-state networks. The enhancement of any beneficial effects of this brain adaptive plasticity should be considered as a potential target of therapy for MS.
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Affiliation(s)
- M. A. Rocca
- Neuroimaging Research Unit; Institute of Experimental Neurology; Division of Neuroscience; Milan Italy
- Department of Neurology; San Raffaele Scientific Institute; Vita-Salute San Raffaele University; Milan Italy
| | - E. De Meo
- Neuroimaging Research Unit; Institute of Experimental Neurology; Division of Neuroscience; Milan Italy
| | - M. Filippi
- Neuroimaging Research Unit; Institute of Experimental Neurology; Division of Neuroscience; Milan Italy
- Department of Neurology; San Raffaele Scientific Institute; Vita-Salute San Raffaele University; Milan Italy
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27
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Samson RS, Lévy S, Schneider T, Smith AK, Smith SA, Cohen-Adad J, Gandini Wheeler-Kingshott CAM. ZOOM or Non-ZOOM? Assessing Spinal Cord Diffusion Tensor Imaging Protocols for Multi-Centre Studies. PLoS One 2016; 11:e0155557. [PMID: 27171194 PMCID: PMC4865165 DOI: 10.1371/journal.pone.0155557] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 04/29/2016] [Indexed: 12/02/2022] Open
Abstract
The purpose of this study was to develop and evaluate two spinal cord (SC) diffusion tensor imaging (DTI) protocols, implemented at multiple sites (using scanners from two different manufacturers), one available on any clinical scanner, and one using more advanced options currently available in the research setting, and to use an automated processing method for unbiased quantification. DTI parameters are sensitive to changes in the diseased SC. However, imaging the cord can be technically challenging due to various factors including its small size, patient-related and physiological motion, and field inhomogeneities. Rapid acquisition sequences such as Echo Planar Imaging (EPI) are desirable but may suffer from image distortions. We present a multi-centre comparison of two acquisition protocols implemented on scanners from two different vendors (Siemens and Philips), one using a reduced field-of-view (rFOV) EPI sequence, and one only using options available on standard clinical scanners such as outer volume suppression (OVS). Automatic analysis was performed with the Spinal Cord Toolbox for unbiased and reproducible quantification of DTI metrics in the white matter. Images acquired using the rFOV sequence appear less distorted than those acquired using OVS alone. SC DTI parameter values obtained using both sequences at all sites were consistent with previous measurements made at 3T. For the same scanner manufacturer, DTI parameter inter-site SDs were smaller for the rFOV sequence compared to the OVS sequence. The higher inter-site reproducibility (for the same manufacturer and acquisition details, i.e. ZOOM data acquired at the two Philips sites) of rFOV compared to the OVS sequence supports the idea that making research options such as rFOV more widely available would improve accuracy of measurements obtained in multi-centre clinical trials. Future multi-centre studies should also aim to match the rFOV technique and signal-to-noise ratios in all sequences from different manufacturers/sites in order to avoid any bias in measured DTI parameters and ensure similar sensitivity to pathological changes.
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Affiliation(s)
- Rebecca S. Samson
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, London, United Kingdom
- * E-mail:
| | - Simon Lévy
- Institute of Biomedical Engineering, Ecole Polytechnique de Montreal, Montreal, QC, Canada
- Functional Neuroimaging Unit, University of Montreal, Montreal, QC, Canada
| | - Torben Schneider
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, London, United Kingdom
- Philips Healthcare, Guilford, Surrey, United Kingdom
| | - Alex K. Smith
- Vanderbilt University Institute of Imaging Science (VUIIS), Vanderbilt University, Nashville, Tennessee, United States of America
- Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee, United States of America
| | - Seth A. Smith
- Vanderbilt University Institute of Imaging Science (VUIIS), Vanderbilt University, Nashville, Tennessee, United States of America
- Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee, United States of America
- Department of Radiology and Radiological Sciences, Vanderbilt University, Nashville, Tennessee, United States of America
| | - Julien Cohen-Adad
- Institute of Biomedical Engineering, Ecole Polytechnique de Montreal, Montreal, QC, Canada
- Functional Neuroimaging Unit, University of Montreal, Montreal, QC, Canada
| | - Claudia A. M. Gandini Wheeler-Kingshott
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, London, United Kingdom
- Brain MRI 3T Center, C. Mondino National Neurological Institute, Pavia, Italy
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
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28
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Brown JWL, Chard DT. The role of MRI in the evaluation of secondary progressive multiple sclerosis. Expert Rev Neurother 2016; 16:157-71. [PMID: 26692498 DOI: 10.1586/14737175.2016.1134323] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Magnetic resonance imaging already has an established role in the diagnosis of multiple sclerosis, but it also has the potential to provide prognostic information, and to monitor [corrected] disease progression in clinical trials and practice. Magnetic resonance imaging measures are increasingly being used as the primary outcome in early phase clinical trials of immunomodulatory therapies (for example brain white matter lesion counts or volumes, and gadolinium contrast enhancing lesions) and putatively neuroprotective agents (for example measures of whole brain atrophy), and trials of agents that promote remyelination are also likely to follow suit. In this review we consider the use of magnetic resonance imaging measures as predictors and markers of disease progression in multiple sclerosis, and explore possible future directions in this rapidly developing field.
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Affiliation(s)
- J William L Brown
- a Department of Clinical Neurosciences , University of Cambridge , Cambridge , UK.,b NMR Research Unit, Queen Square Multiple Sclerosis Centre, Institute of Neurology , University College London (UCL) , London , UK
| | - Declan T Chard
- b NMR Research Unit, Queen Square Multiple Sclerosis Centre, Institute of Neurology , University College London (UCL) , London , UK.,c Biomedical Research Centre, National Institute for Health Research (NIHR) , University College London Hospitals (UCLH) , London , UK
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29
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Galler S, Stellmann JP, Young KL, Kutzner D, Heesen C, Fiehler J, Siemonsen S. Improved Lesion Detection by Using Axial T2-Weighted MRI with Full Spinal Cord Coverage in Multiple Sclerosis. AJNR Am J Neuroradiol 2016; 37:963-9. [PMID: 26744444 DOI: 10.3174/ajnr.a4638] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 11/03/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Identification of lesions in specific locations gains importance in multiple sclerosis imaging diagnostic criteria. In clinical routine, axial scans are usually exclusively obtained to depict the cervical spinal cord or used to confirm suspected lesions on sagittal scans. We sought to evaluate the detection rate for MS lesions on axial T2WI scans with full spinal cord coverage in comparison with sagittal scans. MATERIALS AND METHODS One hundred fifteen patients with definite or suspected MS underwent an MR imaging examination including 3-mm sagittal and 3.5-mm axial T2-weighted images with full spinal cord coverage. T2WI lesions were identified on axial and sagittal scans independently by 2 raters. Axial diameter, craniocaudal extension, lesion intensity, and location were analyzed. RESULTS Four hundred forty-nine of 509 (88.2%) lesions were detected on axial and 337/509 (66.2%) on sagittal scans. Only 277/449 (61.7%) axial lesions were also detected on sagittal images. The number of lesions visible on sagittal and axial images was dependent on the axial lesion diameter (P < .001). CONCLUSIONS Axial T2WI scans with full spinal cord coverage showed 22% more lesions in patients with MS in comparison with sagittal scans, especially for lesions with small axial diameters. We suggest including biplanar spinal MR imaging with full spinal cord coverage for lesion detection in MS in clinical routine and for clinical studies.
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Affiliation(s)
- S Galler
- From the Departments of Diagnostic and Interventional Neuroradiology (S.G., D.K., J.F., S.S.)
| | - J-P Stellmann
- Neurology (J.-P.S., K.L.Y., C.H.) the Institute of Neuroimmunology and Multiple Sclerosis (J.-P.S., K.L.Y., C.H., S.S.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - K L Young
- Neurology (J.-P.S., K.L.Y., C.H.) the Institute of Neuroimmunology and Multiple Sclerosis (J.-P.S., K.L.Y., C.H., S.S.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - D Kutzner
- From the Departments of Diagnostic and Interventional Neuroradiology (S.G., D.K., J.F., S.S.)
| | - C Heesen
- Neurology (J.-P.S., K.L.Y., C.H.) the Institute of Neuroimmunology and Multiple Sclerosis (J.-P.S., K.L.Y., C.H., S.S.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - J Fiehler
- From the Departments of Diagnostic and Interventional Neuroradiology (S.G., D.K., J.F., S.S.)
| | - S Siemonsen
- From the Departments of Diagnostic and Interventional Neuroradiology (S.G., D.K., J.F., S.S.) the Institute of Neuroimmunology and Multiple Sclerosis (J.-P.S., K.L.Y., C.H., S.S.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Kearney H, Miszkiel KA, Yiannakas MC, Altmann DR, Ciccarelli O, Miller DH. Grey matter involvement by focal cervical spinal cord lesions is associated with progressive multiple sclerosis. Mult Scler 2015; 22:910-20. [DOI: 10.1177/1352458515604905] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 08/17/2015] [Indexed: 11/17/2022]
Abstract
Background: The in vivo relationship of spinal cord lesion features with clinical course and function in multiple sclerosis (MS) is poorly defined. Objective: The objective of this paper is to investigate the associations of spinal cord lesion features on MRI with MS subgroup and disability. Methods: We recruited 120 people: 25 clinically isolated syndrome, 35 relapsing–remitting (RR), 30 secondary progressive (SP), and 30 primary progressive (PP) MS. Disability was measured using the Expanded Disability Status Scale. We performed 3T axial cervical cord MRI, using 3D-fast-field-echo and phase-sensitive-inversion-recovery sequences. Both focal lesions and diffuse abnormalities were recorded. Focal lesions were classified according to the number of white matter (WM) columns involved and whether they extended to grey matter (GM). Results: The proportion of patients with focal lesions involving at least two WM columns and extending to GM was higher in SPMS than in RRMS ( p = 0.03) and PPMS ( p = 0.015). Diffuse abnormalities were more common in both PPMS and SPMS, compared with RRMS (OR 6.1 ( p = 0.002) and 5.7 ( p = 0.003), respectively). The number of lesions per patient involving both the lateral column and extending to GM was independently associated with disability ( p < 0.001). Conclusions: More extensive focal cord lesions, extension of lesions to GM, and diffuse abnormalities are associated with progressive MS and disability.
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Affiliation(s)
- Hugh Kearney
- NMR Research Unit, Queen Square MS Centre, UCL Institute of Neurology, UK
| | - Katherine A Miszkiel
- Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, UK
| | - Marios C Yiannakas
- NMR Research Unit, Queen Square MS Centre, UCL Institute of Neurology, UK
| | - Daniel R Altmann
- NMR Research Unit, Queen Square MS Centre, UCL Institute of Neurology, UK/Medical Statistics Department, London School of Hygiene & Tropical Medicine, UK
| | - Olga Ciccarelli
- NMR Research Unit, Queen Square MS Centre, UCL Institute of Neurology, UK/NIHR University College London Hospitals Biomedical Research Centre, UK
| | - David H Miller
- NMR Research Unit, Queen Square MS Centre, UCL Institute of Neurology, UK/NIHR University College London Hospitals Biomedical Research Centre, UK
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Trifunović D, Djedović N, Lavrnja I, Wendrich KS, Paquet-Durand F, Miljković D. Cell death of spinal cord ED1(+) cells in a rat model of multiple sclerosis. PeerJ 2015; 3:e1189. [PMID: 26413432 PMCID: PMC4581773 DOI: 10.7717/peerj.1189] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 07/24/2015] [Indexed: 11/24/2022] Open
Abstract
Infiltration of macrophages into the central nervous system and activation of microglia are hallmarks of multiple sclerosis and its animal model—experimental autoimmune encephalomyelitis (EAE). Cell death in EAE has been demonstrated as an essential mechanism in the local regulation of the inflammatory reaction, but also as one of the major factors contributing to the destruction of the nervous tissue. The focus of this study was on detection of cell death among ED1+ cells (macrophages/activated microglia) in the spinal cord of Dark Agouti rats at the peak of EAE. Cell death was assessed using the TUNEL assay and immunostaining for cleaved caspase 3, as markers for cell death in general and “classical” apoptosis, respectively. Major infiltrates of immune cells were detected both in white matter and gray matter of spinal cords in rats at the disease peak. ED1, TUNEL, and caspase 3 positive cells were detected within, but also outside the infiltrates. There were more dying ED1+ cells in white matter than in gray matter, both in the general population and in infiltrated regions. The observed discrepancy in the proportion of dying ED1+ cells in spinal cord gray and white matter indicated that in EAE rat macrophages/microglia within gray matter are less prone to cell death induction. This is of special interest in the context of the increasingly appreciated contribution of spinal cord gray matter inflammation to multiple sclerosis pathogenesis. Our findings suggest that activated macrophages/microglia of gray matter are less susceptible to cell death induction. Alternatively, it can be assumed that intrinsic cell death-inductive mechanisms of nervous tissue differ in white and gray matter. Thus, further research on the gray matter macrophages/microglia cell death during EAE is warranted. They should be aimed at identification of the reasons for the observed differences and finding suitable ways to stimulate gray matter activated macrophages/microglia death.
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Affiliation(s)
- Dragana Trifunović
- Institute for Ophthalmic Research, University of Tuebingen , Tuebingen , Germany
| | - Neda Djedović
- Department of Immunology, Institute for Biological Research "Siniša Stanković", University of Belgrade , Belgrade , Serbia
| | - Irena Lavrnja
- Department of Neurobiology, Institute for Biological Research "Siniša Stanković", University of Belgrade , Belgrade , Serbia
| | | | | | - Djordje Miljković
- Department of Immunology, Institute for Biological Research "Siniša Stanković", University of Belgrade , Belgrade , Serbia
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Favaretto A, Lazzarotto A, Poggiali D, Rolma G, Causin F, Rinaldi F, Perini P, Gallo P. MRI-detectable cortical lesions in the cerebellum and their clinical relevance in multiple sclerosis. Mult Scler 2015; 22:494-501. [PMID: 26163070 DOI: 10.1177/1352458515594043] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 06/07/2015] [Indexed: 01/11/2023]
Abstract
BACKGROUND The demonstration of cortical lesions (CL) in the cerebellum by magnetic resonance imaging (MRI) is hampered by technical and anatomical constraints. OBJECTIVE To investigate the occurrence of cerebellar CL and their correlation with cerebellar-related disability by combining Double Inversion Recovery (DIR) and Phase Sensitive Inversion Recovery (PSIR) MRI images in multiple sclerosis (MS) patients. MATERIAL AND METHODS 40 MS patients (10 CIS/eRRMS, 24 RRMS, 6 SPMS), having a wide range of disability and disease duration, were enrolled. DIR and PSIR images were obtained with a 3T-MRI. RESULTS Cerebellar white matter lesions (WML) and/or CL were observed in 33/40 patients (82.5%) among which 14/40 had only CL. CL were demonstrated in 26/40 patients by DIR and in 31/40 by PSIR, and their number increased from CIS/eRRMS to SPMS. PSIR disclosed a significantly higher number of CL compared to DIR (RRMS: p=0.0008; SPMS: p=0.002). CL number correlates with the cerebellar Expanded Disability Status Score (EDSS) score (r=0.72, p<0.0001). No correlation was observed between supra-tentorial and cerebellar CL. CONCLUSIONS CL are detected by PSIR in the cerebellum of the majority of MS patients, are more than WML, increase with disease progression and strongly correlate with the cerebellar EDSS. Thus, the observation of CL in the cerebellum of MS at clinical onset might be useful for prognostic and therapeutic aims.
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Affiliation(s)
- Alice Favaretto
- Department of Neurosciences DNS, The Multiple Sclerosis Centre - Veneto Region (CeSMuV), University Hospital of Padova, Italy
| | - Andrea Lazzarotto
- Department of Neurosciences DNS, The Multiple Sclerosis Centre - Veneto Region (CeSMuV), University Hospital of Padova, Italy
| | - Davide Poggiali
- Department of Neurosciences DNS, The Multiple Sclerosis Centre - Veneto Region (CeSMuV), University Hospital of Padova, Italy
| | - Giuseppe Rolma
- Neuroradiology Unit, University Hospital of Padova, Italy
| | | | - Francesca Rinaldi
- Department of Neurosciences DNS, The Multiple Sclerosis Centre - Veneto Region (CeSMuV), University Hospital of Padova, Italy
| | - Paola Perini
- Department of Neurosciences DNS, The Multiple Sclerosis Centre - Veneto Region (CeSMuV), University Hospital of Padova, Italy
| | - Paolo Gallo
- Department of Neurosciences DNS, The Multiple Sclerosis Centre - Veneto Region (CeSMuV), University Hospital of Padova, Italy
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Kearney H, Schneider T, Yiannakas MC, Altmann DR, Wheeler-Kingshott CAM, Ciccarelli O, Miller DH. Spinal cord grey matter abnormalities are associated with secondary progression and physical disability in multiple sclerosis. J Neurol Neurosurg Psychiatry 2015; 86:608-14. [PMID: 25097217 DOI: 10.1136/jnnp-2014-308241] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Accepted: 07/16/2014] [Indexed: 11/04/2022]
Abstract
BACKGROUND In multiple sclerosis (MS), pathological studies have identified substantial demyelination and neuronal loss in the spinal cord grey matter (GM). However, there has been limited in vivo investigation of cord GM abnormalities and their possible functional effects using MRI combined with clinical evaluation. METHODS We recruited healthy controls (HC) and people with a clinically isolated syndrome (CIS), relapsing remitting (RR) and secondary progressive (SP) MS. All subjects had 3 T spinal cord MRI with measurement of cord cross-sectional area and diffusion tensor imaging metrics in the GM and posterior and lateral column white matter tracts using region of interest analysis. Physical disability was assessed using the expanded disability status scale (EDSS) and motor components of the MS functional composite scale. We calculated differences between MS and HC using a ANOVA and associations with disability using linear regression. RESULTS 113 people were included in this study: 30 controls, 21 CIS, 33 RR and 29 SPMS. Spinal cord radial diffusivity (RD), fractional anisotropy and mean diffusivity in the GM and posterior columns were significantly more abnormal in SPMS than in RRMS. Spinal cord GM RD (β=0.33, p<0.01) and cord area (β=-0.45, p<0.01) were independently associated with EDSS (R(2)=0.77); spinal cord GM RD was also independently associated with a 9-hole peg test (β=-0.33, p<0.01) and timed walk (β=-0.20, p=0.04). CONCLUSIONS The study findings suggest that pathological involvement of the spinal cord GM contributes significantly to physical disability in relapse-onset MS and SPMS in particular.
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Affiliation(s)
- H Kearney
- NMR Research Unit, Department of Neuroinflammation, Queen Square MS Centre, UCL Institute of Neurology, London, UK
| | - T Schneider
- NMR Research Unit, Department of Neuroinflammation, Queen Square MS Centre, UCL Institute of Neurology, London, UK
| | - M C Yiannakas
- NMR Research Unit, Department of Neuroinflammation, Queen Square MS Centre, UCL Institute of Neurology, London, UK
| | - D R Altmann
- NMR Research Unit, Department of Neuroinflammation, Queen Square MS Centre, UCL Institute of Neurology, London, UK Medical Statistics Department, London School of Hygiene & Tropical Medicine, London, UK
| | - C A M Wheeler-Kingshott
- NMR Research Unit, Department of Neuroinflammation, Queen Square MS Centre, UCL Institute of Neurology, London, UK NIHR, University College London Hospitals, Biomedical Research Centre, London, UK
| | - O Ciccarelli
- NMR Research Unit, Department of Neuroinflammation, Queen Square MS Centre, UCL Institute of Neurology, London, UK NIHR, University College London Hospitals, Biomedical Research Centre, London, UK
| | - D H Miller
- NMR Research Unit, Department of Neuroinflammation, Queen Square MS Centre, UCL Institute of Neurology, London, UK NIHR, University College London Hospitals, Biomedical Research Centre, London, UK
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Abstract
Multiple sclerosis (MS) is an inflammatory disorder of the CNS that affects both the brain and the spinal cord. MRI studies in MS focus more often on the brain than on the spinal cord, owing to the technical challenges in imaging this smaller, mobile structure. However, spinal cord abnormalities at disease onset have important implications for diagnosis and prognosis. Furthermore, later in the disease course, in progressive MS, myelopathy becomes the primary characteristic of the clinical presentation, and extensive spinal cord pathology--including atrophy, diffuse abnormalities and numerous focal lesions--is common. Recent spinal cord imaging studies have employed increasingly sophisticated techniques to improve detection and quantification of spinal cord lesions, and to elucidate their relationship with physical disability. Quantitative MRI measures of cord size and tissue integrity could be more sensitive to the axonal loss and other pathological processes in the spinal cord than is conventional MRI, putting quantitative MRI in a key role to elucidate the association between disability and spinal cord abnormalities seen in people with MS. In this Review, we summarize the most recent MS spinal cord imaging studies and discuss the new insights they have provided into the mechanisms of neurological impairment. Finally, we suggest directions for further and future research.
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Gass A, Rocca MA, Agosta F, Ciccarelli O, Chard D, Valsasina P, Brooks JCW, Bischof A, Eisele P, Kappos L, Barkhof F, Filippi M. MRI monitoring of pathological changes in the spinal cord in patients with multiple sclerosis. Lancet Neurol 2015; 14:443-54. [PMID: 25748099 DOI: 10.1016/s1474-4422(14)70294-7] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The spinal cord is a clinically important site that is affected by pathological changes in most patients with multiple sclerosis; however, imaging of the spinal cord with conventional MRI can be difficult. Improvements in MRI provide a major advantage for spinal cord imaging, with better signal-to-noise ratio and improved spatial resolution. Through the use of multiplanar MRI, identification of diffuse and focal changes in the whole spinal cord is now routinely possible. Corroborated by related histopathological analyses, several new techniques, such as magnetisation transfer, diffusion tension imaging, functional MRI, and proton magnetic resonance spectroscopy, can detect non-focal, spinal cord pathological changes in patients with multiple sclerosis. Additionally, functional MRI can reveal changes in the response pattern to sensory stimulation in patients with multiple sclerosis. Through use of these techniques, findings of cord atrophy, intrinsic cord damage, and adaptation are shown to occur largely independently of focal spinal cord lesion load, which emphasises their relevance in depiction of the true burden of disease. Combinations of magnetisation transfer ratio or diffusion tension imaging indices with cord atrophy markers seem to be the most robust and meaningful biomarkers to monitor disease evolution in early multiple sclerosis.
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Affiliation(s)
- Achim Gass
- Department of Neurology, Universitätsmedizin Mannheim UMM, University of Heidelberg, Germany.
| | - Maria A Rocca
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience and Department of Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Federica Agosta
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience and Department of Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Olga Ciccarelli
- Department of Brain Repair and Rehabilitation, University College London, Institute of Neurology National Institute for Health Research, University College London Hospitals, Biomedical Research Centre, London, UK
| | - Declan Chard
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, University College London, Institute of Neurology National Institute for Health Research, University College London Hospitals, Biomedical Research Centre, London, UK
| | - Paola Valsasina
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience and Department of Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | | | - Antje Bischof
- Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Philipp Eisele
- Department of Neurology, Universitätsmedizin Mannheim UMM, University of Heidelberg, Germany
| | - Ludwig Kappos
- Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, Netherlands
| | - Massimo Filippi
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience and Department of Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
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Harrison DM, Oh J, Roy S, Wood ET, Whetstone A, Seigo MA, Jones CK, Pham D, van Zijl P, Reich DS, Calabresi PA. Thalamic lesions in multiple sclerosis by 7T MRI: Clinical implications and relationship to cortical pathology. Mult Scler 2015; 21:1139-50. [PMID: 25583851 DOI: 10.1177/1352458514558134] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Accepted: 10/10/2014] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Pathology in both cortex and deep gray matter contribute to disability in multiple sclerosis (MS). We used the increased signal-to-noise ratio of 7-tesla (7T) MRI to visualize small lesions within the thalamus and to relate this to clinical information and cortical lesions. METHODS We obtained 7T MRI scans on 34 MS cases and 15 healthy volunteers. Thalamic lesion number and volume were related to demographic data, clinical disability measures, and lesions in cortical gray matter. RESULTS Thalamic lesions were found in 24/34 of MS cases. Two lesion subtypes were noted: discrete, ovoid lesions, and more diffuse lesional areas lining the periventricular surface. The number of thalamic lesions was greater in progressive MS compared to relapsing-remitting (mean ±SD, 10.7 ±0.7 vs. 3.0 ±0.7, respectively, p < 0.001). Thalamic lesion burden (count and volume) correlated with EDSS score and measures of cortical lesion burden, but not with white matter lesion burden or white matter volume. CONCLUSIONS Using 7T MRI allows identification of thalamic lesions in MS, which are associated with disability, progressive disease, and cortical lesions. Thalamic lesion analysis may be a simpler, more rapid estimate of overall gray matter lesion burden in MS.
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Affiliation(s)
- Daniel M Harrison
- Department of Neurology, Johns Hopkins University School of Medicine, Johns Hopkins School of Medicine, USA
| | - Jiwon Oh
- Department of Neurology, Johns Hopkins University School of Medicine, Johns Hopkins School of Medicine, USA
| | - Snehashis Roy
- Center for Neuroscience and Regenerative Medicine, Henry Jackson Foundation, Uniformed Services University of the Health Sciences, USA
| | - Emily T Wood
- Translational Neuroradiology Unit, National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), USA/Department of Neuroscience, Johns Hopkins School of Medicine, USA
| | - Anna Whetstone
- Department of Neurology, Johns Hopkins University School of Medicine, Johns Hopkins School of Medicine, USA
| | - Michaela A Seigo
- Department of Neurology, Johns Hopkins University School of Medicine, Johns Hopkins School of Medicine, USA
| | - Craig K Jones
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, USA/Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, USA
| | - Dzung Pham
- Center for Neuroscience and Regenerative Medicine, Henry Jackson Foundation, Uniformed Services University of the Health Sciences, USA
| | - Peter van Zijl
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, USA/Department of Neuroscience, Johns Hopkins School of Medicine, USA/Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, USA
| | - Daniel S Reich
- Department of Neurology, Johns Hopkins University School of Medicine, Johns Hopkins School of Medicine, USA/Translational Neuroradiology Unit, National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), USA/Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, USA
| | - Peter A Calabresi
- Department of Neurology, Johns Hopkins University School of Medicine, Johns Hopkins School of Medicine, USA
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Pathology of multiple sclerosis and related inflammatory demyelinating diseases. HANDBOOK OF CLINICAL NEUROLOGY 2014; 122:15-58. [PMID: 24507512 DOI: 10.1016/b978-0-444-52001-2.00002-9] [Citation(s) in RCA: 196] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
This article provides a comprehensive overview of the pathology of multiple sclerosis (MS), including recent insights into its molecular neuropathology and immunology. It shows that all clinical manifestations of relapsing and progressive MS display the same basic features of pathology, such as chronic inflammation, demyelination in the white and gray matter, and diffuse neurodegeneration within the entire central nervous system. However, the individual components of the pathological spectrum vary quantitatively between early relapsing and late progressive MS. Widespread confluent and plaque-like demyelination with oligodendrocyte destruction is the unique pathological hallmark of the disease, but axonal injury and neurodegeneration are additionally present and in part extensive. Remyelination of existing lesions may occur in MS brains; it is extensive in a subset of patients, while it fails in others. Active tissue injury in MS is always associated with inflammation, consistent with T-cell and macrophage infiltration and microglia activation. Recent data suggest that oxidative injury and subsequent mitochondrial damage play a major pathogenetic role in neurodegeneration. Finally we discuss similarities and differences of the pathology between classical MS and other inflammatory demyelinating diseases, such as neuromyelitis optica, concentric sclerosis, or acute disseminated encephalomyelitis.
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Tona F, Petsas N, Sbardella E, Prosperini L, Carmellini M, Pozzilli C, Pantano P. Multiple sclerosis: altered thalamic resting-state functional connectivity and its effect on cognitive function. Radiology 2014; 271:814-21. [PMID: 24484065 DOI: 10.1148/radiol.14131688] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To investigate, by using resting-state (RS) functional magnetic resonance (MR) imaging, thalamocortical functional connectivity (FC) and its correlations with cognitive impairment in multiple sclerosis (MS). MATERIALS AND METHODS All subjects provided written informed consent; the study protocol was approved by the university institutional review board for this HIPAA-compliant study. Forty-eight patients with relapsing-remitting MS and 24 control subjects underwent multimodal MR imaging, including diffusion-tensor imaging, three-dimensional (3D) T1-weighted imaging, and functional MR imaging at rest and a neuropsychological examination with the Paced Auditory Serial Addition Test (PASAT). Functional MR imaging data were analyzed with tools from FMRIB Software Library, by using the seed-based method to identify the thalamic RS network (RSN). RESULTS When compared with control subjects, patients showed gray matter and white matter atrophy, as well as diffusion-tensor imaging abnormalities (P < .01). Patients displayed significantly greater synchronization than control subjects in the cerebellum; basal ganglia; hippocampus; cingulum; and temporo-occipital, insular, frontal, and parietal cortices. They also exhibited significantly lower synchronization in the thalamus; cerebellum; cingulum; and insular, prefrontal, and parieto-occipital cortices (cluster level, P < .05, corrected for familywise error [FWE]). In patients, the PASAT score at 3 seconds significantly inversely correlated with the thalamus, cerebellum, and some cortical areas in all cerebral lobes; the PASAT score at 2 seconds significantly correlated, even more strongly, with all the aforementioned regions and, in addition, with the cingulum and the left hippocampus (cluster level, P < .05, corrected for FWE). CONCLUSION Thalamic RSN is disrupted in MS, and decreased performance in cognitive testing is associated with increased thalamocortical FC, thus suggesting that neuroplasticity changes are unable to compensate for tissue damage and to prevent cognitive dysfunction.
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Affiliation(s)
- Francesca Tona
- From the Department of Neurology and Psychiatry, Sapienza University of Rome, Viale dell'Università 30, 00185 Rome, Italy; and IRCCS Neuromed, Pozzilli, Italy (P.P.)
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Samson RS, Ciccarelli O, Kachramanoglou C, Brightman L, Lutti A, Thomas DL, Weiskopf N, Wheeler-Kingshott CAM. Tissue- and column-specific measurements from multi-parameter mapping of the human cervical spinal cord at 3 T. NMR IN BIOMEDICINE 2013; 26:1823-30. [PMID: 24105923 PMCID: PMC4034603 DOI: 10.1002/nbm.3022] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Revised: 06/25/2013] [Accepted: 08/09/2013] [Indexed: 05/05/2023]
Abstract
The aim of this study was to quantify a range of MR parameters [apparent proton density, longitudinal relaxation time T1, magnetisation transfer (MT) ratio, MT saturation (which represents the additional percentage MT saturation of the longitudinal magnetisation caused by a single MT pulse) and apparent transverse relaxation rate R2*] in the white matter columns and grey matter of the healthy cervical spinal cord. The cervical cords of 13 healthy volunteers were scanned at 3 T using a protocol optimised for multi-parameter mapping. Intra-subject co-registration was performed using linear registration, and tissue- and column-specific parameter values were calculated. Cervical cord parameter values measured from levels C1-C5 in 13 subjects are: apparent proton density, 4822 ± 718 a.u.; MT ratio, 40.4 ± 1.53 p.u.; MT saturation, 1.40 ± 0.12 p.u.; T1 = 1848 ± 143 ms; R2* = 22.6 ± 1.53 s(-1). Inter-subject coefficients of variation were low in both the cervical cord and tissue- and column-specific measurements, illustrating the potential of this method for the investigation of changes in these parameters caused by pathology. In summary, an optimised cervical cord multi-parameter mapping protocol was developed, enabling tissue- and column-specific measurements to be made. This technique has the potential to provide insight into the pathological processes occurring in the cervical cord affected by neurological disorders.
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Affiliation(s)
- RS Samson
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of NeurologyQueen Square, London, UK
- *Correspondence to: R. Samson, UCL Institute of Neurology, Queen Square House, Queen Square, London WC1N 3BG, UK., E-mail:
| | - O Ciccarelli
- NMR Research Unit, Queen Square MS Centre, Department of Brain Repair and Rehabilitation, UCL Institute of NeurologyQueen Square, London, UK
| | - C Kachramanoglou
- NMR Research Unit, Queen Square MS Centre, Department of Brain Repair and Rehabilitation, UCL Institute of NeurologyQueen Square, London, UK
| | | | - A Lutti
- Wellcome Trust Centre for Neuroimaging, UCL Institute of NeurologyQueen Square, London, UK
| | - DL Thomas
- Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, UCL Institute of NeurologyQueen Square, London, UK
| | - N Weiskopf
- Wellcome Trust Centre for Neuroimaging, UCL Institute of NeurologyQueen Square, London, UK
| | - CAM Wheeler-Kingshott
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of NeurologyQueen Square, London, UK
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40
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Lassmann H. Pathology and disease mechanisms in different stages of multiple sclerosis. J Neurol Sci 2013; 333:1-4. [DOI: 10.1016/j.jns.2013.05.010] [Citation(s) in RCA: 121] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2012] [Revised: 05/03/2013] [Accepted: 05/10/2013] [Indexed: 10/26/2022]
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Raz E, Bester M, Sigmund EE, Tabesh A, Babb JS, Jaggi H, Helpern J, Mitnick RJ, Inglese M. A better characterization of spinal cord damage in multiple sclerosis: a diffusional kurtosis imaging study. AJNR Am J Neuroradiol 2013; 34:1846-52. [PMID: 23578677 DOI: 10.3174/ajnr.a3512] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND PURPOSE The spinal cord is a site of predilection for MS lesions. While diffusion tensor imaging is useful for the study of anisotropic systems such as WM tracts, it is of more limited utility in tissues with more isotropic microstructures (on the length scales studied with diffusion MR imaging) such as gray matter. In contrast, diffusional kurtosis imaging, which measures both Gaussian and non-Gaussian properties of water diffusion, provides more biomarkers of both anisotropic and isotropic structural changes. The aim of this study was to investigate the cervical spinal cord of patients with MS and to characterize lesional and normal-appearing gray matter and WM damage by using diffusional kurtosis imaging. MATERIALS AND METHODS Nineteen patients (13 women, mean age = 41.1 ± 10.7 years) and 16 controls (7 women, mean age = 35.6 ± 11.2-years) underwent MR imaging of the cervical spinal cord on a 3T scanner (T2 TSE, T1 magnetization-prepared rapid acquisition of gradient echo, diffusional kurtosis imaging, T2 fast low-angle shot). Fractional anisotropy, mean diffusivity, and mean kurtosis were measured on the whole cord and in normal-appearing gray matter and WM. RESULTS Spinal cord T2-hyperintense lesions were identified in 18 patients. Whole spinal cord fractional anisotropy and mean kurtosis (P = .0009, P = .003), WM fractional anisotropy (P = .01), and gray matter mean kurtosis (P = .006) were significantly decreased, and whole spinal cord mean diffusivity (P = .009) was increased in patients compared with controls. Mean spinal cord area was significantly lower in patients (P = .04). CONCLUSIONS Diffusional kurtosis imaging of the spinal cord can provide a more comprehensive characterization of lesions and normal-appearing WM and gray matter damage in patients with MS. Diffusional kurtosis imaging can provide additional and complementary information to DTI on spinal cord pathology.
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Affiliation(s)
- E Raz
- Department of Radiology, New York University School of Medicine, New York, New York
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Zhao W, Cohen-Adad J, Polimeni JR, Keil B, Guerin B, Setsompop K, Serano P, Mareyam A, Hoecht P, Wald LL. Nineteen-channel receive array and four-channel transmit array coil for cervical spinal cord imaging at 7T. Magn Reson Med 2013; 72:291-300. [PMID: 23963998 DOI: 10.1002/mrm.24911] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Revised: 06/12/2013] [Accepted: 07/15/2013] [Indexed: 11/10/2022]
Abstract
PURPOSE To design and validate a radiofrequency (RF) array coil for cervical spinal cord imaging at 7T. METHODS A 19-channel receive array with a four-channel transmit array was developed on a close-fitting coil former at 7T. Transmit efficiency and specific absorption rate were evaluated in a B1 (+) mapping study and an electromagnetic model. Receive signal-to-noise ratio (SNR) and noise amplification for parallel imaging were evaluated and compared with a commercial 3T 19-channel head-neck array and a 7T four-channel spine array. The performance of the array was qualitatively demonstrated in human volunteers using high-resolution imaging (down to 300 μm in-plane). RESULTS The transmit and receive arrays showed good bench performance. The SNR was approximately 4.2-fold higher in the 7T receive array at the location of the cord with respect to the 3T coil. The g-factor results showed an additional acceleration was possible with the 7T array. In vivo imaging was feasible and showed high SNR and tissue contrast. CONCLUSION The highly parallel transmit and receive arrays were demonstrated to be fit for spinal cord imaging at 7T. The high sensitivity of the receive coil combined with ultra-high field will likely improve investigations of microstructure and tissue segmentation in the healthy and pathological spinal cord.
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Affiliation(s)
- Wei Zhao
- A. A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA
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43
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Kearney H, Miszkiel K, Yiannakas M, Ciccarelli O, Miller D. A pilot MRI study of white and grey matter involvement by multiple sclerosis spinal cord lesions. Mult Scler Relat Disord 2013; 2:103-8. [DOI: 10.1016/j.msard.2012.09.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Revised: 08/30/2012] [Accepted: 09/12/2012] [Indexed: 01/04/2023]
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44
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Neuropathologic Correlates of Magnetic Resonance Imaging in Multiple Sclerosis. J Neuropathol Exp Neurol 2012; 71:762-78. [DOI: 10.1097/nen.0b013e3182676388] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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45
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Weier K, Mazraeh J, Naegelin Y, Thoeni A, Hirsch JG, Fabbro T, Bruni N, Duyar H, Bendfeldt K, Radue EW, Kappos L, Gass A. Biplanar MRI for the assessment of the spinal cord in multiple sclerosis. Mult Scler 2012; 18:1560-9. [DOI: 10.1177/1352458512442754] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: To investigate the entire spinal cord (SC) of multiple sclerosis (MS) patients with biplanar MRI and to relate these MRI findings to clinical functional scores. Methods: Two hundred and two patients (140 women, 62 men 24–74 years, Expanded Disability Status Scale (EDSS) scores 0–7.5) were investigated clinically and with biplanar MRI. Sagittal and axial proton density weighted (PDw) and T2 weighted (T2w) images of the whole SC were obtained employing parallel imaging. Data were analyzed by consensus reading using a standardized reporting scheme. Different combinations of findings were compared to EDSS scores with Spearman’s rank correlation coefficient (ρ). Results: The combined analysis of sagittal and axial planes demonstrated slightly differing results in 97/202 (48%) patients. There were 9% additional lesions identified, leading to a higher lesion count in 28% of these patients, but also rejection of equivocal abnormality leading to a lower lesion count in 11% of patients. Considering both sagittal and axial images, SC abnormalities were found in 167/202 (83%) patients. When compared with EDSS scores, the combination of focal lesions, signs of atrophy and diffuse abnormalities showed a moderate correlation (ρ=0.52), that precludes its use for individual patient assessment. Conclusion: Biplanar MRI facilitates a comprehensive identification, localization, and grading of pathological SC findings in MS patients. This improves the confidence and utility of SC imaging.
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Affiliation(s)
- Katrin Weier
- Department of Neurology, University Hospital Basel, Switzerland
| | - Jilla Mazraeh
- Division of Neuroradiology, University Hospital Basel, Switzerland
| | - Yvonne Naegelin
- Department of Neurology, University Hospital Basel, Switzerland
| | - Alain Thoeni
- Division of Neuroradiology, University Hospital Basel, Switzerland
- Medical Image Analysis Center, University Hospital Basel, Switzerland
| | - Jochen G Hirsch
- Department of Neurology, University Hospital Basel, Switzerland
- Division of Neuroradiology, University Hospital Basel, Switzerland
| | - Thomas Fabbro
- Study Coordination Center, University Hospital Basel, Switzerland
| | - Nicole Bruni
- Study Coordination Center, University Hospital Basel, Switzerland
| | - Hüseyin Duyar
- Department of Neurology, University Hospital Basel, Switzerland
| | - Kerstin Bendfeldt
- Medical Image Analysis Center, University Hospital Basel, Switzerland
| | - Ernst-Wilhelm Radue
- Division of Neuroradiology, University Hospital Basel, Switzerland
- Medical Image Analysis Center, University Hospital Basel, Switzerland
| | - Ludwig Kappos
- Department of Neurology, University Hospital Basel, Switzerland
| | - Achim Gass
- Department of Neurology, University Hospital Basel, Switzerland
- Division of Neuroradiology, University Hospital Basel, Switzerland
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46
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Kilsdonk ID, de Graaf WL, Barkhof F, Wattjes MP. Inflammation high-field magnetic resonance imaging. Neuroimaging Clin N Am 2012; 22:135-57, ix. [PMID: 22548925 DOI: 10.1016/j.nic.2012.02.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Multiple sclerosis (MS) is the most common inflammatory demyelinating disorder of the central nervous system (CNS). MS has been subject to high-field magnetic resonance (MR) imaging research to a great extent during the past years, and much data has been collected that might be helpful in the investigation of other inflammatory CNS disorders. This article reviews the value of high-field MR imaging in examining inflammatory MS abnormalities. Furthermore, possibilities and challenges for the future of high-field MR imaging in MS are discussed.
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Affiliation(s)
- Iris D Kilsdonk
- Department of Radiology, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands
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47
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Filippi M, Rocca MA, Barkhof F, Brück W, Chen JT, Comi G, DeLuca G, De Stefano N, Erickson BJ, Evangelou N, Fazekas F, Geurts JJG, Lucchinetti C, Miller DH, Pelletier D, Popescu BFG, Lassmann H. Association between pathological and MRI findings in multiple sclerosis. Lancet Neurol 2012; 11:349-60. [PMID: 22441196 DOI: 10.1016/s1474-4422(12)70003-0] [Citation(s) in RCA: 262] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The identification of pathological processes that could be targeted by therapeutic interventions is a major goal of research into multiple sclerosis (MS). Pathological assessment is the gold standard for such identification, but has intrinsic limitations owing to the limited availability of autopsy and biopsy tissue. MRI has gained a leading role in the assessment of MS because it allows doctors to obtain an ante mortem picture of the degree of CNS involvement. A number of correlative pathological and MRI studies have helped to define in vivo the pathological substrates of MS in focal lesions and normal-appearing white matter, not only in the brain, but also in the spinal cord. These studies have resulted in the identification of aspects of pathophysiology that were previously neglected, including grey matter involvement and vascular pathology. Despite these important achievements, numerous open questions still need to be addressed to resolve controversies about how the pathology of MS results in fixed neurological disability.
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Affiliation(s)
- Massimo Filippi
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, Vita-Salute San Raffaele University, Milan, Italy.
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Zollinger LV, Kim TH, Hill K, Jeong EK, Rose JW. Using diffusion tensor imaging and immunofluorescent assay to evaluate the pathology of multiple sclerosis. J Magn Reson Imaging 2011; 33:557-64. [PMID: 21516179 DOI: 10.1002/jmri.22502] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE To determine the ability of the principal diffusion tensor imaging (DTI) indices to predict the underlying histopathology evaluated with immunofluorescent assay (IFA). MATERIALS AND METHODS Conventional T2 and 3D multishot-diffusion weighted echoplanar imaging (3D ms-DWEPI) was performed on a fixed, ex vivo human cervical spinal cord (CSC) from a patient with a history of multiple sclerosis (MS). In all, 170 regions of interest (ROIs) were selected within the white matter and categorized as a high intensity lesion (HIL), low intensity lesion (LIL), and normal-appearing white matter (NAWM). The longitudinal diffusivity (λl), radial diffusivity (λr), and fractional anisotropy (FA) were obtained from each ROI. The underlying histopathology was then evaluated using immunofluorescent assay with antibodies directed to myelin and neurofilament staining. RESULTS The mean values for λl and λr were significantly elevated within HIL relative to NAWM and LIL. IFA analysis of HIL demonstrated significant demyelination, without significant if any axon loss. The FA values were significantly reduced in HIL and LILs. FA values were also reduced in lesions with increased λl and λr values relative to normal. CONCLUSION Aberrant λl, λr, and FA relative to normal values are strong indicators of demyelination. DTI indices are not specific for axon loss. IFA analysis is a reliable method to demonstrate myelin and axon pathology within the ex vivo setting.
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Affiliation(s)
- Lauren V Zollinger
- University of Utah Department of Radiology, Salt Lake City, Utah 84123-2140, USA.
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Anderson VM, Wheeler-Kingshott CAM, Abdel-Aziz K, Miller DH, Toosy A, Thompson AJ, Ciccarelli O. A comprehensive assessment of cerebellar damage in multiple sclerosis using diffusion tractography and volumetric analysis. Mult Scler 2011; 17:1079-87. [PMID: 21511688 PMCID: PMC3281565 DOI: 10.1177/1352458511403528] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background: White matter (WM) and grey matter (GM) brain damage in multiple sclerosis (MS) is widespread, but the extent of cerebellar involvement and impact on disability needs to be clarified. Objective: This study aimed to assess cerebellar WM and GM atrophy and the degree of fibre coherence in the main cerebellar connections, and their contribution to disability in relapsing–remitting MS (RRMS) and primary progressive MS (PPMS). Methods: Fourteen patients with RRMS, 12 patients with PPMS and 16 healthy controls were recruited. Cerebellar WM and GM volumes and tractography-derived measures from the middle and superior cerebellar peduncles, including fractional anisotropy (FA), mean diffusivity (MD), and directional diffusivities, were quantified from magnetic resonance imaging (MRI). Patients were assessed on clinical scores, including the MS Functional Composite score subtests. Linear regression models were used to compare imaging measures between 12 RRMS, 11 PPMS and 16 controls, and investigate their association with clinical scores. Results: Patients with PPMS showed reduced FA and increased radial diffusivity in the middle cerebellar peduncle compared with controls and patients with RRMS. In PPMS, lower cerebellar WM volume was associated with worse performance on the upper limb test. In the same patient group, we found significant relationships between superior cerebellar peduncle FA and upper limb function, and between superior cerebellar peduncle FA, MD and radial diffusivity and speed of walking. Conclusion: These findings indicate reduced fibre coherence in the main cerebellar connections, and link damage in the whole cerebellar WM, and, in particular, in the superior cerebellar peduncle, to motor deficit in PPMS.
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Affiliation(s)
- VM Anderson
- Department of Neuroinflammation, UCL Institute of Neurology, London, UK
| | | | - K Abdel-Aziz
- Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, London, UK
| | - DH Miller
- Department of Neuroinflammation, UCL Institute of Neurology, London, UK
| | - A Toosy
- Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, London, UK
| | - AJ Thompson
- Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, London, UK
| | - O Ciccarelli
- Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, London, UK
- Dr Olga Ciccarelli, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK
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Pott F, Gingele S, Clarner T, Dang J, Baumgartner W, Beyer C, Kipp M. Cuprizone effect on myelination, astrogliosis and microglia attraction in the mouse basal ganglia. Brain Res 2009; 1305:137-49. [DOI: 10.1016/j.brainres.2009.09.084] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2009] [Revised: 09/18/2009] [Accepted: 09/19/2009] [Indexed: 10/20/2022]
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