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Nguyen PT, Zarghami A, Makowiecki K, Stevens N, Ezegbe C, Kyle K, Wang C, Ly L, De La Rue K, Hinder MR, Johnson L, Rodger J, Cooper S, Cullen CL, Barnett M, Young KM, Taylor BV. Low-intensity repetitive transcranial magnetic stimulation is safe and well tolerated by people living with MS - outcomes of the phase I randomised controlled trial (TAURUS). Mult Scler J Exp Transl Clin 2024; 10:20552173241252571. [PMID: 38756414 PMCID: PMC11097717 DOI: 10.1177/20552173241252571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 04/17/2024] [Indexed: 05/18/2024] Open
Abstract
Background Low-intensity repetitive transcranial magnetic stimulation (rTMS), delivered as a daily intermittent theta burst stimulation (iTBS) for four consecutive weeks, increased the number of new oligodendrocytes in the adult mouse brain. Therefore, rTMS holds potential as a remyelinating intervention for people with multiple sclerosis (MS). Objective Primarily to determine the safety and tolerability of our rTMS protocol in people with MS. Secondary objectives include feasibility, blinding and an exploration of changes in magnetic resonance imaging (MRI) metrics, patient-reported outcome measures (PROMs) and cognitive or motor performance. Methods A randomised (2:1), placebo controlled, single blind, parallel group, phase 1 trial of 20 rTMS sessions (600 iTBS pulses per hemisphere; 25% maximum stimulator output), delivered over 4-5 weeks. Twenty participants were randomly assigned to 'sham' (n = 7) or active rTMS (n = 13), with the coil positioned at 90° or 0°, respectively. Results Five adverse events (AEs) including one serious AE reported. None were related to treatment. Protocol compliance was high (85%) and blinding successful. Within participant MRI metrics, PROMs and cognitive or motor performance were unchanged over time. Conclusion Twenty sessions of rTMS is safe and well tolerated in a small group of people with MS. The study protocol and procedures are feasible. Improvement of sham is warranted before further investigating safety and efficacy.
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Affiliation(s)
| | | | | | | | - Chigozie Ezegbe
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Kain Kyle
- Sydney Neuroimaging Analysis Centre (SNAC), Sydney, New South Wales, Australia
| | - Chenyu Wang
- Sydney Neuroimaging Analysis Centre (SNAC), Sydney, New South Wales, Australia
- Brain & Mind Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Linda Ly
- Sydney Neuroimaging Analysis Centre (SNAC), Sydney, New South Wales, Australia
| | - Katie De La Rue
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Mark R Hinder
- School of Psychological Sciences, University of Tasmania, Hobart, Tasmania, Australia
| | - Lewis Johnson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Jennifer Rodger
- School of Biological Sciences, The University of Western Australia, Crawley, Western Australia, Australia
- Perron Institute for Neurological and Translational Science, Nedlands, Western Australia, Australia
| | | | - Carlie L Cullen
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
- Mater Research Institute, University of Queensland, Woolloongabba, Queensland, Australia
| | - Michael Barnett
- Sydney Neuroimaging Analysis Centre (SNAC), Sydney, New South Wales, Australia
- Brain & Mind Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Kaylene M Young
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Bruce V Taylor
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
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York EN, Thrippleton MJ, Meijboom R, Hunt DPJ, Waldman AD. Quantitative magnetization transfer imaging in relapsing-remitting multiple sclerosis: a systematic review and meta-analysis. Brain Commun 2022; 4:fcac088. [PMID: 35652121 PMCID: PMC9149789 DOI: 10.1093/braincomms/fcac088] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 12/17/2021] [Accepted: 03/31/2022] [Indexed: 11/28/2022] Open
Abstract
Myelin-sensitive MRI such as magnetization transfer imaging has been widely used in multiple sclerosis. The influence of methodology and differences in disease subtype on imaging findings is, however, not well established. Here, we systematically review magnetization transfer brain imaging findings in relapsing-remitting multiple sclerosis. We examine how methodological differences, disease effects and their interaction influence magnetization transfer imaging measures. Articles published before 06/01/2021 were retrieved from online databases (PubMed, EMBASE and Web of Science) with search terms including 'magnetization transfer' and 'brain' for systematic review, according to a pre-defined protocol. Only studies that used human in vivo quantitative magnetization transfer imaging in adults with relapsing-remitting multiple sclerosis (with or without healthy controls) were included. Additional data from relapsing-remitting multiple sclerosis subjects acquired in other studies comprising mixed disease subtypes were included in meta-analyses. Data including sample size, MRI acquisition protocol parameters, treatments and clinical findings were extracted and qualitatively synthesized. Where possible, effect sizes were calculated for meta-analyses to determine magnetization transfer (i) differences between patients and healthy controls; (ii) longitudinal change and (iii) relationships with clinical disability in relapsing-remitting multiple sclerosis. Eighty-six studies met inclusion criteria. MRI acquisition parameters varied widely, and were also underreported. The majority of studies examined the magnetization transfer ratio in white matter, but magnetization transfer metrics, brain regions examined and results were heterogeneous. The analysis demonstrated a risk of bias due to selective reporting and small sample sizes. The pooled random-effects meta-analysis across all brain compartments revealed magnetization transfer ratio was 1.17 per cent units (95% CI -1.42 to -0.91) lower in relapsing-remitting multiple sclerosis than healthy controls (z-value: -8.99, P < 0.001, 46 studies). Linear mixed-model analysis did not show a significant longitudinal change in magnetization transfer ratio across all brain regions [β = 0.12 (-0.56 to 0.80), t-value = 0.35, P = 0.724, 14 studies] or normal-appearing white matter alone [β = 0.037 (-0.14 to 0.22), t-value = 0.41, P = 0.68, eight studies]. There was a significant negative association between the magnetization transfer ratio and clinical disability, as assessed by the Expanded Disability Status Scale [r = -0.32 (95% CI -0.46 to -0.17); z-value = -4.33, P < 0.001, 13 studies]. Evidence suggests that magnetization transfer imaging metrics are sensitive to pathological brain changes in relapsing-remitting multiple sclerosis, although effect sizes were small in comparison to inter-study variability. Recommendations include: better harmonized magnetization transfer acquisition protocols with detailed methodological reporting standards; larger, well-phenotyped cohorts, including healthy controls; and, further exploration of techniques such as magnetization transfer saturation or inhomogeneous magnetization transfer ratio.
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Affiliation(s)
- Elizabeth N. York
- Centre for Clinical Brain Sciences, University of
Edinburgh, Edinburgh, UK
| | | | - Rozanna Meijboom
- Centre for Clinical Brain Sciences, University of
Edinburgh, Edinburgh, UK
| | - David P. J. Hunt
- Centre for Clinical Brain Sciences, University of
Edinburgh, Edinburgh, UK
- UK Dementia Research Institute, University of
Edinburgh, Edinburgh, UK
- Anne Rowling Regenerative Neurology Clinic,
University of Edinburgh, Edinburgh, UK
| | - Adam D. Waldman
- Centre for Clinical Brain Sciences, University of
Edinburgh, Edinburgh, UK
- UK Dementia Research Institute, University of
Edinburgh, Edinburgh, UK
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Smets I, Goris A, Vandebergh M, Demeestere J, Sunaert S, Dupont P, Dubois B. Quantitative MRI phenotypes capture biological heterogeneity in multiple sclerosis patients. Sci Rep 2021; 11:1573. [PMID: 33452402 PMCID: PMC7811013 DOI: 10.1038/s41598-021-81035-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 12/23/2020] [Indexed: 01/29/2023] Open
Abstract
Magnetization transfer ratio (MTR) and brain volumetric imaging are (semi-)quantitative MRI markers capturing demyelination, axonal degeneration and/or inflammation. However, factors shaping variation in these traits are largely unknown. In this study, we collected a longitudinal cohort of 33 multiple sclerosis (MS) patients and extended it cross-sectionally to 213. We measured MTR in lesions, normal-appearing white matter (NAWM), normal-appearing grey matter (NAGM) and total brain, grey matter, white matter and lesion volume. We also calculated the polygenic MS risk score. Longitudinally, inter-patient differences at inclusion and intra-patient changes during follow-up together explained > 70% of variance in MRI, with inter-patient differences at inclusion being the predominant source of variance. Cross-sectionally, we observed a moderate correlation of MTR between NAGM and NAWM and, less pronounced, with lesions. Age and gender explained about 30% of variance in total brain and grey matter volume. However, they contributed less than 10% to variance in MTR measures. There were no significant associations between MRI traits and the genetic risk score. In conclusion, (semi-)quantitative MRI traits change with ongoing disease activity but this change is modest in comparison to pre-existing inter-patient differences. These traits reflect individual variation in biological processes, which appear different from those involved in genetic MS susceptibility.
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Affiliation(s)
- Ide Smets
- Laboratory for Neuroimmunology, Department of Neurosciences, KU Leuven, Herestraat 49, Box 1022, 3000, Leuven, Belgium
- Leuven Brain Institute KU Leuven, Leuven, Belgium
- Department of Neurology, University Hospitals Leuven, 3000, Leuven, Belgium
| | - An Goris
- Laboratory for Neuroimmunology, Department of Neurosciences, KU Leuven, Herestraat 49, Box 1022, 3000, Leuven, Belgium.
- Leuven Brain Institute KU Leuven, Leuven, Belgium.
| | - Marijne Vandebergh
- Laboratory for Neuroimmunology, Department of Neurosciences, KU Leuven, Herestraat 49, Box 1022, 3000, Leuven, Belgium
- Leuven Brain Institute KU Leuven, Leuven, Belgium
| | - Jelle Demeestere
- Department of Neurology, University Hospitals Leuven, 3000, Leuven, Belgium
| | - Stefan Sunaert
- Leuven Brain Institute KU Leuven, Leuven, Belgium
- Department of Imaging and Pathology, Translational MRI, KU Leuven, 3000, Leuven, Belgium
| | - Patrick Dupont
- Leuven Brain Institute KU Leuven, Leuven, Belgium
- Department of Neurosciences, Laboratory for Cognitive Neurology, KU Leuven, 3000, Leuven, Belgium
| | - Bénédicte Dubois
- Laboratory for Neuroimmunology, Department of Neurosciences, KU Leuven, Herestraat 49, Box 1022, 3000, Leuven, Belgium
- Leuven Brain Institute KU Leuven, Leuven, Belgium
- Department of Neurology, University Hospitals Leuven, 3000, Leuven, Belgium
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4
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deSouza NM, Achten E, Alberich-Bayarri A, Bamberg F, Boellaard R, Clément O, Fournier L, Gallagher F, Golay X, Heussel CP, Jackson EF, Manniesing R, Mayerhofer ME, Neri E, O'Connor J, Oguz KK, Persson A, Smits M, van Beek EJR, Zech CJ. Validated imaging biomarkers as decision-making tools in clinical trials and routine practice: current status and recommendations from the EIBALL* subcommittee of the European Society of Radiology (ESR). Insights Imaging 2019; 10:87. [PMID: 31468205 PMCID: PMC6715762 DOI: 10.1186/s13244-019-0764-0] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 06/28/2019] [Indexed: 12/12/2022] Open
Abstract
Observer-driven pattern recognition is the standard for interpretation of medical images. To achieve global parity in interpretation, semi-quantitative scoring systems have been developed based on observer assessments; these are widely used in scoring coronary artery disease, the arthritides and neurological conditions and for indicating the likelihood of malignancy. However, in an era of machine learning and artificial intelligence, it is increasingly desirable that we extract quantitative biomarkers from medical images that inform on disease detection, characterisation, monitoring and assessment of response to treatment. Quantitation has the potential to provide objective decision-support tools in the management pathway of patients. Despite this, the quantitative potential of imaging remains under-exploited because of variability of the measurement, lack of harmonised systems for data acquisition and analysis, and crucially, a paucity of evidence on how such quantitation potentially affects clinical decision-making and patient outcome. This article reviews the current evidence for the use of semi-quantitative and quantitative biomarkers in clinical settings at various stages of the disease pathway including diagnosis, staging and prognosis, as well as predicting and detecting treatment response. It critically appraises current practice and sets out recommendations for using imaging objectively to drive patient management decisions.
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Affiliation(s)
- Nandita M deSouza
- Cancer Research UK Imaging Centre, The Institute of Cancer Research and The Royal Marsden Hospital, Downs Road, Sutton, Surrey, SM2 5PT, UK.
| | | | | | - Fabian Bamberg
- Department of Radiology, University of Freiburg, Freiburg im Breisgau, Germany
| | | | | | | | | | | | - Claus Peter Heussel
- Universitätsklinik Heidelberg, Translational Lung Research Center (TLRC), German Center for Lung Research (DZL), University of Heidelberg, Im Neuenheimer Feld 156, 69120, Heidelberg, Germany
| | - Edward F Jackson
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Rashindra Manniesing
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Geert Grooteplein 10, 6525, GA, Nijmegen, The Netherlands
| | | | - Emanuele Neri
- Department of Translational Research, University of Pisa, Pisa, Italy
| | - James O'Connor
- Division of Cancer Sciences, University of Manchester, Manchester, UK
| | | | | | - Marion Smits
- Department of Radiology and Nuclear Medicine (Ne-515), Erasmus MC, PO Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - Edwin J R van Beek
- Edinburgh Imaging, Queen's Medical Research Institute, Edinburgh Bioquarter, 47 Little France Crescent, Edinburgh, UK
| | - Christoph J Zech
- University Hospital Basel, Radiology and Nuclear Medicine, University of Basel, Petersgraben 4, CH-4031, Basel, Switzerland
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5
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Sormani MP, Pardini M. Assessing Repair in Multiple Sclerosis: Outcomes for Phase II Clinical Trials. Neurotherapeutics 2017; 14:924-933. [PMID: 28695472 PMCID: PMC5722763 DOI: 10.1007/s13311-017-0558-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Multiple Sclerosis (MS) pathology is complex and includes inflammatory processes, neurodegeneration, and demyelination. While multiple drugs have been developed to tackle MS-related inflammation, to date there is scant evidence regarding which therapeutic approach, if any, could be used to reverse demyelination, foster tissue repair, and thus positively impact on chronic disability. Here, we reviewed the current structural and functional markers (magnetic resonance imaging, positron emission tomography, optical coherence tomography, and visual evoked potentials) which could be used in phase II clinical trials of new compounds aimed to foster tissue repair in MS. Magnetic transfer ratio recovery in newly formed lesions currently represents the most widely used biomarker of tissue repair in MS, even if other markers, such as optical coherence tomography and positron emission tomography hold great promise to complement magnetic transfer ratio in tissue repair clinical trials. Future studies are needed to better characterize the different possible biomarkers to study tissue repair in MS, especially regarding their pathological specificity, sensitivity to change, and their relationship with disease activity.
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Affiliation(s)
- Maria Pia Sormani
- Biostatistics Unit, Department of Health Sciences, University of Genoa, Genoa, Italy.
| | - Matteo Pardini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health, University of Genoa, Genoa, Italy
- Policlinic San Martino-IST, Genoa, Italy
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6
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Gracien RM, Reitz SC, Hof SM, Fleischer V, Droby A, Wahl M, Steinmetz H, Groppa S, Deichmann R, Klein JC. Longitudinal quantitative MRI assessment of cortical damage in multiple sclerosis: A pilot study. J Magn Reson Imaging 2017; 46:1485-1490. [PMID: 28240801 DOI: 10.1002/jmri.25685] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 02/06/2017] [Indexed: 12/15/2022] Open
Abstract
PURPOSE Quantitative MRI (qMRI) allows assessing cortical pathology in multiple sclerosis (MS) on a microstructural level, where cortical damage has been shown to prolong T1 -relaxation time and increase proton density (PD) compared to controls. However, the evolution of these changes in MS over time has not been investigated so far. In this pilot study we used an advanced method for the longitudinal assessment of cortical tissue change in MS patients with qMRI in comparison to cortical atrophy, as derived from conventional MRI. MATERIALS AND METHODS Twelve patients with relapsing-remitting MS underwent 3T T1 /PD-mapping at two timepoints with a mean interval of 12 months. The respective cortical T1 /PD-values were extracted from the middle of the cortical layer and the cortical thickness was measured for surface-based identification of clusters with increasing/decreasing values. RESULTS Statistical analysis showed clusters with increasing PD- and T1 -values over time (annualized rate for T1 /PD increase in these clusters: 3.4 ± 2.56% for T1 , P = 0.0007; 2.3 ± 2.59% for PD, P = 0.01). Changes are heterogeneous across the cortex and different patterns of longitudinal PD and T1 increase emerged. Analysis of the cortical thickness yielded only one small cluster indicating a decrease of cortical thickness. CONCLUSION Changes of cortical tissue composition in MS seem to be reflected by a spatially inhomogeneous, multifocal increase of the PD values, indicating replacement of neural tissue by water, and of the T1 -relaxation time, a surrogate of demyelination, axonal loss, and gliosis. qMRI changes were more prominent than cortical atrophy, showing the potential of qMRI techniques to quantify microstructural alterations that remain undetected by conventional MRI. LEVEL OF EVIDENCE 1 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2017;46:1485-1490.
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Affiliation(s)
- René-Maxime Gracien
- Department of Neurology, Goethe University, Frankfurt/Main, Germany.,Brain Imaging Center, Goethe University, Frankfurt/Main, Germany
| | - Sarah C Reitz
- Department of Neurology, Goethe University, Frankfurt/Main, Germany.,Brain Imaging Center, Goethe University, Frankfurt/Main, Germany
| | - Stephanie-Michelle Hof
- Department of Neurology, Goethe University, Frankfurt/Main, Germany.,Brain Imaging Center, Goethe University, Frankfurt/Main, Germany
| | - Vinzenz Fleischer
- Department of Neurology, Johannes Gutenberg University, Mainz, Germany.,Neuroimaging Center (NIC) of the Focus Program Translational Neuroscience (FTN), Johannes Gutenberg-University, Mainz, Germany
| | - Amgad Droby
- Department of Neurology, Johannes Gutenberg University, Mainz, Germany.,Neuroimaging Center (NIC) of the Focus Program Translational Neuroscience (FTN), Johannes Gutenberg-University, Mainz, Germany
| | - Mathias Wahl
- Department of Neurology, Goethe University, Frankfurt/Main, Germany.,Brain Imaging Center, Goethe University, Frankfurt/Main, Germany
| | | | - Sergiu Groppa
- Department of Neurology, Johannes Gutenberg University, Mainz, Germany.,Neuroimaging Center (NIC) of the Focus Program Translational Neuroscience (FTN), Johannes Gutenberg-University, Mainz, Germany
| | - Ralf Deichmann
- Brain Imaging Center, Goethe University, Frankfurt/Main, Germany
| | - Johannes C Klein
- Department of Neurology, Goethe University, Frankfurt/Main, Germany.,Brain Imaging Center, Goethe University, Frankfurt/Main, Germany.,Nuffield Department of Clinical Neurosciences, University of Oxford, UK
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Altmann DR, Button T, Schmierer K, Hunter K, Tozer DJ, Wheeler-Kingshott CA, Coles A, Miller DH. Sample sizes for lesion magnetisation transfer ratio outcomes in remyelination trials for multiple sclerosis. Mult Scler Relat Disord 2013; 3:237-43. [PMID: 25878011 DOI: 10.1016/j.msard.2013.09.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Revised: 09/06/2013] [Accepted: 09/16/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND Enhancing remyelination in MS might improve function and protect axons from future damage. Lesion magnetisation transfer ratio (MTR) is sensitive to myelin content, and may be a useful measure for trials evaluating potential remyelinating agents. OBJECTIVE Estimating sample sizes required for a parallel group, placebo-controlled trial in MS using change in mean MTR of all T2lesions as a primary outcome measure. METHODS The primary sample size calculation was derived from data from a natural history study of relapsing remitting MS (n=18). The MTR values observed in demyelinated and remyelinated lesions in an ex vivo study were used to estimate the effect of remyelination on lesion MTR. The ex vivo data were also used to independently calculate sample sizes in order to inform the robustness of the in vivo estimates. RESULTS Calculations suggest that 30% remyelination of T2 lesions could be detected with 80% power in 38 (95% confidence interval 12-96) patients per arm based on the in vivo data, and in 66 per arm based on the ex vivo data. CONCLUSION The sample sizes derived are in a range that makes MTR a feasible outcome measure for proof-of-concept trials of putative therapies achieving remyelination in MS lesions.
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Affiliation(s)
- D R Altmann
- Nuclear Magnetic Resonance (NMR) Research Unit, Queen Square Multiple Sclerosis Centre, UCL Institute of Neurology, London, UK; Medical Statistics Department, London School of Hygiene & Tropical Medicine (LSHTM), Keppel Street, London WC1E 7HT, UK.
| | - T Button
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.
| | - K Schmierer
- Nuclear Magnetic Resonance (NMR) Research Unit, Queen Square Multiple Sclerosis Centre, UCL Institute of Neurology, London, UK; Blizard Institute, Centre for Neuroscience & Trauma, Barts and The London School of Medicine & Dentistry, London, UK.
| | - K Hunter
- Nuclear Magnetic Resonance (NMR) Research Unit, Queen Square Multiple Sclerosis Centre, UCL Institute of Neurology, London, UK.
| | - D J Tozer
- Nuclear Magnetic Resonance (NMR) Research Unit, Queen Square Multiple Sclerosis Centre, UCL Institute of Neurology, London, UK.
| | - C A Wheeler-Kingshott
- Nuclear Magnetic Resonance (NMR) Research Unit, Queen Square Multiple Sclerosis Centre, UCL Institute of Neurology, London, UK.
| | - A Coles
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.
| | - D H Miller
- Nuclear Magnetic Resonance (NMR) Research Unit, Queen Square Multiple Sclerosis Centre, UCL Institute of Neurology, London, UK.
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van den Bogaard SJA, Dumas EM, Hart EP, Milles J, Reilmann R, Stout JC, Craufurd D, Gibbard CR, Tabrizi SJ, van Buchem MA, van der Grond J, Roos RAC. Magnetization transfer imaging in premanifest and manifest huntington disease: a 2-year follow-up. AJNR Am J Neuroradiol 2012; 34:317-22. [PMID: 22918430 DOI: 10.3174/ajnr.a3303] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE MTI is a quantitative MR imaging technique that has recently demonstrated structural integrity differences between controls and patients with HD. Potentially, MTI can be used as a biomarker for monitoring disease progression. To establish the value of MTI as a biomarker, we aimed to examine the change in these measures during the course of HD. MATERIALS AND METHODS From the Leiden TRACK-HD study, 25 controls, 21 premanifest gene carriers, and 21 patients with manifest HD participated at baseline and during a 2-year follow-up visit. Brain segmentation of the cortical gray matter, white matter, caudate nucleus, putamen, pallidum, thalamus, amygdala, and hippocampus was performed by using the automated tools FAST and FIRST in FSL. Individual MTR values were calculated from these regions, and MTR histograms were constructed. RESULTS In the premanifest HD group stage "far from disease onset," a significant increase in MTR peak height of the putamen was observed with time. During the manifest HD stage, neither the mean MTR nor the MTR peak height showed a significant change during a 2-year follow-up. CONCLUSIONS MTI-derived measures are not suitable for monitoring in Huntington disease during a 2-year period because there was no decrease in structural integrity detected in any of the manifest HD groups longitudinally. The finding of increased putaminal MTR peak height in the premanifest far from disease onset group could relate to a predegenerative process, compensatory mechanisms, or aberrant development but should be interpreted with caution until future studies confirm this finding.
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9
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Giulietti G, Bozzali M, Figura V, Spanò B, Perri R, Marra C, Lacidogna G, Giubilei F, Caltagirone C, Cercignani M. Quantitative magnetization transfer provides information complementary to grey matter atrophy in Alzheimer's disease brains. Neuroimage 2011; 59:1114-22. [PMID: 21983184 DOI: 10.1016/j.neuroimage.2011.09.043] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2011] [Revised: 09/15/2011] [Accepted: 09/19/2011] [Indexed: 10/17/2022] Open
Abstract
Preliminary studies, based on a region-of-interest approach, suggest that quantitative magnetization transfer (qMT), an extension of magnetization transfer imaging, provides complementary information to conventional magnetic resonance imaging (MRI) in the characterisation of Alzheimer's disease (AD). The aim of this study was to extend these findings to the whole brain, using a voxel-wise approach. We recruited 19AD patients and 11 healthy subjects (HS). All subjects had an MRI acquisition at 3.0T including a T(1)-weighted volume, 12 MT-weighted volumes for qMT, and data for computing T(1) and B(1) maps. The T(1)-weighted volumes were processed to yield grey matter (GM) volumetric maps, while the other sequences were used to compute qMT parametric maps of the whole brain. qMT maps were warped to standard space and smoothed, and subsequently compared between groups. Of all the qMT parameters considered, only the forward exchange rate, RM(0)(B), showed significant group differences. These images were therefore retained for the multimodal statistical analysis, designed to locate brain regions of RM(0)(B) differences between AD and HS groups, adjusting for local GM atrophy. Widespread areas of reduced RM(0)(B) were found in AD patients, mainly located in the hippocampus, in the temporal lobe, in the posterior cingulate and in the parietal cortex. These results indicate that, among qMT parameters, RM(0)(B) is the most sensitive to AD pathology. This quantity is altered in the hippocampus of patients with AD (as found by previous works) but also in other brain areas, that PET studies have highlighted as involved with both, reduced glucose metabolism and amyloid β deposition. RM(0)(B) might reflect, through the measurement of the efficiency of MT exchange, some information with a specific pathological counterpart. Given previous evidence of a strict relationship between RM(0)(B) and intracellular pH, an intriguing speculation is that our findings might reflect metabolic changes related to mitochondrial dysfunction, which has been proposed as a contributor to neurodegeneration in AD.
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Affiliation(s)
- Giovanni Giulietti
- Neuroimaging Laboratory, Santa Lucia Foundation IRCCS, via Ardeatina 306, 00179 Rome, Italy.
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