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Prathapan V, Eipert P, Wigger N, Kipp M, Appali R, Schmitt O. Modeling and simulation for prediction of multiple sclerosis progression. Comput Biol Med 2024; 175:108416. [PMID: 38657465 DOI: 10.1016/j.compbiomed.2024.108416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 03/28/2024] [Accepted: 04/03/2024] [Indexed: 04/26/2024]
Abstract
In light of extensive work that has created a wide range of techniques for predicting the course of multiple sclerosis (MS) disease, this paper attempts to provide an overview of these approaches and put forth an alternative way to predict the disease progression. For this purpose, the existing methods for estimating and predicting the course of the disease have been categorized into clinical, radiological, biological, and computational or artificial intelligence-based markers. Weighing the weaknesses and strengths of these prognostic groups is a profound method that is yet in need and works directly at the level of diseased connectivity. Therefore, we propose using the computational models in combination with established connectomes as a predictive tool for MS disease trajectories. The fundamental conduction-based Hodgkin-Huxley model emerged as promising from examining these studies. The advantage of the Hodgkin-Huxley model is that certain properties of connectomes, such as neuronal connection weights, spatial distances, and adjustments of signal transmission rates, can be taken into account. It is precisely these properties that are particularly altered in MS and that have strong implications for processing, transmission, and interactions of neuronal signaling patterns. The Hodgkin-Huxley (HH) equations as a point-neuron model are used for signal propagation inside a small network. The objective is to change the conduction parameter of the neuron model, replicate the changes in myelin properties in MS and observe the dynamics of the signal propagation across the network. The model is initially validated for different lengths, conduction values, and connection weights through three nodal connections. Later, these individual factors are incorporated into a small network and simulated to mimic the condition of MS. The signal propagation pattern is observed after inducing changes in conduction parameters at certain nodes in the network and compared against a control model pattern obtained before the changes are applied to the network. The signal propagation pattern varies as expected by adapting to the input conditions. Similarly, when the model is applied to a connectome, the pattern changes could give an insight into disease progression. This approach has opened up a new path to explore the progression of the disease in MS. The work is in its preliminary state, but with a future vision to apply this method in a connectome, providing a better clinical tool.
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Affiliation(s)
- Vishnu Prathapan
- Medical School Hamburg University of Applied Sciences and Medical University, Am Kaiserkai 1, 20457, Hamburg, Germany.
| | - Peter Eipert
- Medical School Hamburg University of Applied Sciences and Medical University, Am Kaiserkai 1, 20457, Hamburg, Germany.
| | - Nicole Wigger
- Department of Anatomy, University of Rostock Gertrudenstr 9, 18057, Rostock, Germany.
| | - Markus Kipp
- Department of Anatomy, University of Rostock Gertrudenstr 9, 18057, Rostock, Germany.
| | - Revathi Appali
- Institute of General Electrical Engineering, University of Rostock, Albert-Einstein-Straße 2, 18059, Rostock, Germany; Department of Aging of Individuals and Society, Interdisciplinary Faculty, University of Rostock, Universitätsplatz 1, 18055, Rostock, Germany.
| | - Oliver Schmitt
- Medical School Hamburg University of Applied Sciences and Medical University, Am Kaiserkai 1, 20457, Hamburg, Germany; Department of Anatomy, University of Rostock Gertrudenstr 9, 18057, Rostock, Germany.
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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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3
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Beck ES, Maranzano J, Luciano NJ, Parvathaneni P, Filippini S, Morrison M, Suto DJ, Wu T, van Gelderen P, de Zwart JA, Antel S, Fetco D, Ohayon J, Andrada F, Mina Y, Thomas C, Jacobson S, Duyn J, Cortese I, Narayanan S, Nair G, Sati P, Reich DS. Cortical lesion hotspots and association of subpial lesions with disability in multiple sclerosis. Mult Scler 2022; 28:1351-1363. [PMID: 35142571 DOI: 10.1177/13524585211069167] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Dramatic improvements in visualization of cortical (especially subpial) multiple sclerosis (MS) lesions allow assessment of impact on clinical course. OBJECTIVE Characterize cortical lesions by 7 tesla (T) T2*-/T1-weighted magnetic resonance imaging (MRI); determine relationship with other MS pathology and contribution to disability. METHODS Sixty-four adults with MS (45 relapsing-remitting/19 progressive) underwent 3 T brain/spine MRI, 7 T brain MRI, and clinical testing. RESULTS Cortical lesions were found in 94% (progressive: median 56/range 2-203; relapsing-remitting: 15/0-168; p = 0.004). Lesion distribution across 50 cortical regions was nonuniform (p = 0.006), with highest lesion burden in supplementary motor cortex and highest prevalence in superior frontal gyrus. Leukocortical and white matter lesion volumes were strongly correlated (r = 0.58, p < 0.0001), while subpial and white matter lesion volumes were moderately correlated (r = 0.30, p = 0.002). Leukocortical (p = 0.02) but not subpial lesions (p = 0.40) were correlated with paramagnetic rim lesions; both were correlated with spinal cord lesions (p = 0.01). Cortical lesion volumes (total and subtypes) were correlated with expanded disability status scale, 25-foot timed walk, nine-hole peg test, and symbol digit modality test scores. CONCLUSION Cortical lesions are highly prevalent and are associated with disability and progressive disease. Subpial lesion burden is not strongly correlated with white matter lesions, suggesting differences in inflammation and repair mechanisms.
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Affiliation(s)
- Erin S Beck
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA; Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Josefina Maranzano
- McConnell Brain Imaging Centre, Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada; Department of Anatomy, University of Quebec in Trois-Rivières, Trois-Rivières, QC, Canada
| | - Nicholas J Luciano
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Prasanna Parvathaneni
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Stefano Filippini
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA.,Department of Neurosciences, Drug and Child Health, University of Florence, Florence, Italy
| | - Mark Morrison
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Daniel J Suto
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Tianxia Wu
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Peter van Gelderen
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Jacco A de Zwart
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Samson Antel
- McConnell Brain Imaging Centre, Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
| | - Dumitru Fetco
- McConnell Brain Imaging Centre, Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
| | - Joan Ohayon
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Frances Andrada
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Yair Mina
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Chevaz Thomas
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Steve Jacobson
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Jeff Duyn
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Irene Cortese
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Sridar Narayanan
- McConnell Brain Imaging Centre, Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
| | - Govind Nair
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Pascal Sati
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA.,Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Daniel S Reich
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
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Madsen MAJ, Wiggermann V, Bramow S, Christensen JR, Sellebjerg F, Siebner HR. Imaging cortical multiple sclerosis lesions with ultra-high field MRI. NEUROIMAGE-CLINICAL 2021; 32:102847. [PMID: 34653837 PMCID: PMC8517925 DOI: 10.1016/j.nicl.2021.102847] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 08/19/2021] [Accepted: 08/25/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cortical lesions are abundant in multiple sclerosis (MS), yet difficult to visualize in vivo. Ultra-high field (UHF) MRI at 7 T and above provides technological advances suited to optimize the detection of cortical lesions in MS. PURPOSE To provide a narrative and quantitative systematic review of the literature on UHF MRI of cortical lesions in MS. METHODS A systematic search of all literature on UHF MRI of cortical lesions in MS published before September 2020. Quantitative outcome measures included cortical lesion numbers reported using 3 T and 7 T MRI and between 7 T MRI sequences, along with sensitivity of UHF MRI towards cortical lesions verified by histopathology. RESULTS 7 T MRI detected on average 52 ± 26% (mean ± 95% confidence interval) more cortical lesions than the best performing image contrast at 3 T, with the largest increase in type II-IV intracortical lesion detection. Across all studies, the mean cortical lesion number was 17 ± 6 per patient. In progressive MS cohorts, approximately four times more cortical lesions were reported than in CIS/early RRMS, and RRMS. Yet, there was no difference in lesion type ratio between these MS subtypes. Furthermore, superiority of one MRI sequence over another could not be established from available data. Post-mortem lesion detection with UHF MRI agreed only modestly with pathological examinations. Mean pro- and retrospective sensitivity was 33 ± 6% and 71 ± 10%, respectively, with the highest sensitivity towards type I and type IV lesions. CONCLUSION UHF MRI improves cortical lesion detection in MS considerably compared to 3 T MRI, particularly for type II-IV lesions. Despite modest sensitivity, 7 T MRI is still capable of visualizing all aspects of cortical lesion pathology and could potentially aid clinicians in diagnosing and monitoring MS, and progressive MS in particular. However, standardization of acquisition and segmentation protocols is needed.
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Affiliation(s)
- Mads A J Madsen
- Danish Research Centre for Magnetic Resonance, Copenhagen University Hospital - Amager & Hvidovre, Kettegard Allé 30, 2650 Hvidovre, Denmark.
| | - Vanessa Wiggermann
- Danish Research Centre for Magnetic Resonance, Copenhagen University Hospital - Amager & Hvidovre, Kettegard Allé 30, 2650 Hvidovre, Denmark
| | - Stephan Bramow
- Danish Multiple Sclerosis Center, Department of Neurology, Copenhagen University Hospital - Rigshospitalet, Valdemar Hansens Vej 1-23, 2600 Glostrup, Denmark
| | - Jeppe Romme Christensen
- Danish Multiple Sclerosis Center, Department of Neurology, Copenhagen University Hospital - Rigshospitalet, Valdemar Hansens Vej 1-23, 2600 Glostrup, Denmark
| | - Finn Sellebjerg
- Danish Multiple Sclerosis Center, Department of Neurology, Copenhagen University Hospital - Rigshospitalet, Valdemar Hansens Vej 1-23, 2600 Glostrup, Denmark; Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3b, 2200 Copenhagen, Denmark
| | - Hartwig R Siebner
- Danish Research Centre for Magnetic Resonance, Copenhagen University Hospital - Amager & Hvidovre, Kettegard Allé 30, 2650 Hvidovre, Denmark; Department of Neurology, Copenhagen University Hospital - Bispebjerg, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3b, 2200 Copenhagen, Denmark
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5
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Stojic A, Bojcevski J, Williams SK, Diem R, Fairless R. Early Nodal and Paranodal Disruption in Autoimmune Optic Neuritis. J Neuropathol Exp Neurol 2018; 77:361-373. [DOI: 10.1093/jnen/nly011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Aleksandar Stojic
- Department of Neurology, University Clinic Heidelberg, Heidelberg, Germany
| | - Jovana Bojcevski
- Department of Neurology, University Clinic Heidelberg, Heidelberg, Germany
| | - Sarah K Williams
- Department of Neurology, University Clinic Heidelberg, Heidelberg, Germany
| | - Ricarda Diem
- Department of Neurology, University Clinic Heidelberg, Heidelberg, Germany
| | - Richard Fairless
- Department of Neurology, University Clinic Heidelberg, Heidelberg, Germany
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Lycke J, Zetterberg H. The role of blood and CSF biomarkers in the evaluation of new treatments against multiple sclerosis. Expert Rev Clin Immunol 2017; 13:1143-1153. [PMID: 29090607 DOI: 10.1080/1744666x.2017.1400380] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
INTRODUCTION Multiple sclerosis (MS) is an immune-mediated chronic neurodegenerative disease of the central nervous system (CNS). Therapeutic interventions with immunomodulatory agents reduce disease activity and disability development, which are monitored clinically and by magnetic resonance imaging (MRI). However, these measures largely lack information on the impact from these therapies on inflammation, demyelination and axonal injury, the essential pathophysiological features of MS. Several biomarkers for inflammation and neurodegeneration have been detected in cerebrospinal fluid (CSF). In MS, some of these biomarkers seem to reflect disease activity, disability progression, and therapeutic response. Areas covered: In this review, we describe the most promising CSF biomarkers of inflammation and degeneration for monitoring therapeutic interventions in MS. We also describe the evolution of highly sensitive immunoassays that enable determination of neuron-specific biomarkers in blood. Expert commentary: Together with clinical and MRI measures, CSF biomarkers may improve the assessment of therapeutic efficacy and make personalized treatment possible. One disadvantage has been the need of repetitive lumbar punctures to obtain CSF. However, the technical development of highly sensitive immunoassays allows determination of extremely low quantities of neuron-specific proteins in blood. This will potentially open a new era for monitoring disease activity and treatment response in MS.
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Affiliation(s)
- Jan Lycke
- a Department of Clinical Neuroscience, Institute of Neuroscience and Physiology , The Sahlgrenska Academy, University of Gothenburg , Gothenburg , Sweden
| | - Henrik Zetterberg
- b Department of Psychiatry and Neurochemistry; Institute of Neuroscience and Physiology at Sahlgrenska Academy , University of Gothenburg , Gothenburg , Sweden.,c Clinical Neurochemistry Laboratory , Sahlgrenska University Hospital , Mölndal , Sweden.,d Department of Molecular Neuroscience , UCL Institute of Neurology , London , UK.,e UK Dementia Research Institute , London , UK
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7
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Kipp M, Nyamoya S, Hochstrasser T, Amor S. Multiple sclerosis animal models: a clinical and histopathological perspective. Brain Pathol 2017; 27:123-137. [PMID: 27792289 DOI: 10.1111/bpa.12454] [Citation(s) in RCA: 153] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Accepted: 10/26/2016] [Indexed: 12/11/2022] Open
Abstract
There is a broad consensus that multiple sclerosis (MS) represents more than an inflammatory disease: it harbors several characteristic aspects of a classical neurodegenerative disorder, that is, damage to axons, synapses and nerve cell bodies. While we are equipped with appropriate therapeutic options to prevent immune-cell driven relapses, effective therapeutic options to prevent the progressing neurodegeneration are still missing. In this review article, we will discuss to what extent pathology of the progressive disease stage can be modeled in MS animal models. While acute and relapsing-remitting forms of experimental autoimmune encephalomyelitis (EAE), which are T cell dependent, are aptly suited to model relapsing-remitting phases of MS, other EAE models, especially the secondary progressive EAE stage in Biozzi ABH mice is better representing the secondary progressive phase of MS, which is refractory to many immune therapies. Besides EAE, the cuprizone model is rapidly gaining popularity to study the formation and progression of demyelinating CNS lesions without T cell involvement. Here, we discuss these two non-popular MS models. It is our aim to point out the pathological hallmarks of MS, and discuss which pathological aspects of the disease can be best studied in the various animal models available.
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Affiliation(s)
- Markus Kipp
- Department of Neuroanatomy, Faculty of Medicine, LMU München University, München, 80336, Germany
| | - Stella Nyamoya
- Department of Neuroanatomy, Faculty of Medicine, LMU München University, München, 80336, Germany.,Institute of Neuroanatomy, Faculty of Medicine, RWTH Aachen University, Aachen, D-52074, Germany
| | - Tanja Hochstrasser
- Department of Neuroanatomy, Faculty of Medicine, LMU München University, München, 80336, Germany
| | - Sandra Amor
- Department of Pathology, VU University Medical Centre, Amsterdam, The Netherlands.,Barts and The London School of Medicine and Dentistry, Neuroimmunology Unit, , Queen Mary University of London, Neuroscience Centre, Blizard Institute of Cell and Molecular Science, London, UK
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8
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Rudko DA, Derakhshan M, Maranzano J, Nakamura K, Arnold DL, Narayanan S. Delineation of cortical pathology in multiple sclerosis using multi-surface magnetization transfer ratio imaging. NEUROIMAGE-CLINICAL 2016; 12:858-868. [PMID: 27872808 PMCID: PMC5107650 DOI: 10.1016/j.nicl.2016.10.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 09/23/2016] [Accepted: 10/11/2016] [Indexed: 01/06/2023]
Abstract
The purpose of our study was to evaluate the utility of measurements of cortical surface magnetization transfer ratio (csMTR) on the inner, mid and outer cortical boundaries as clinically accessible biomarkers of cortical gray matter pathology in multiple sclerosis (MS). Twenty-five MS patients and 12 matched controls were recruited from the MS Clinic of the Montreal Neurological Institute. Anatomical and magnetization transfer ratio (MTR) images were acquired using 3 Tesla MRI at baseline and two-year time-points. MTR maps were smoothed along meshes representing the inner, mid and outer neocortical boundaries. To evaluate csMTR reductions suggestive of sub-pial demyelination in MS patients, a mixed model analysis was carried out at both the individual vertex level and in anatomically parcellated brain regions. Our results demonstrate that focal areas of csMTR reduction are most prevalent along the outer cortical surface in the superior temporal and posterior cingulate cortices, as well as in the cuneus and precentral gyrus. Additionally, age regression analysis identified that reductions of csMTR in MS patients increase with age but appear to hit a plateau in the outer caudal anterior cingulate, as well as in the precentral and postcentral cortex. After correction for the naturally occurring gradient in cortical MTR, the difference in csMTR between the inner and outer cortex in focal areas in the brains of MS patients correlated with clinical disability. Overall, our findings support multi-surface analysis of csMTR as a sensitive marker of cortical sub-pial abnormality indicative of demyelination in MS patients. Novel cortical MTR analysis identifies areas of sub-pial abnormality in MS patients. A greater area of sub-pial abnormality in MS exists on the outer cortical layer. Cortical regions most affected were involved in executive function and processing speed. Normalized differences between outer and inner cortex MTR correlate with EDSS in MS. This technique can be applied for clinical trials at the MRI field strength of 3 T.
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Affiliation(s)
- David A Rudko
- McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada; Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
| | - Mishkin Derakhshan
- McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - Josefina Maranzano
- McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada; Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
| | - Kunio Nakamura
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Avenue Cleveland, OH 44195, United States
| | - Douglas L Arnold
- McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada; Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
| | - Sridar Narayanan
- McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada; Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
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9
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Maranzano J, Rudko DA, Arnold DL, Narayanan S. Manual Segmentation of MS Cortical Lesions Using MRI: A Comparison of 3 MRI Reading Protocols. AJNR Am J Neuroradiol 2016; 37:1623-8. [PMID: 27197988 DOI: 10.3174/ajnr.a4799] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 03/04/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Double inversion recovery has been suggested as the MR imaging contrast of choice for segmenting cortical lesions in patients with multiple sclerosis. In this study, we sought to determine the utility of double inversion recovery for cortical lesion identification by comparing 3 MR imaging reading protocols that combine different MR imaging contrasts. MATERIALS AND METHODS Twenty-five patients with relapsing-remitting MS and 3 with secondary-progressive MS were imaged with 3T MR imaging by using double inversion recovery, dual fast spin-echo proton-density/T2-weighted, 3D FLAIR, and 3D T1-weighted imaging sequences. Lesions affecting the cortex were manually segmented by using the following 3 MR imaging reading protocols: Protocol 1 (P1) used all available MR imaging contrasts; protocol 2 (P2) used all the available contrasts except for double inversion recovery; and protocol 3(P3) used only double inversion recovery. RESULTS Six hundred forty-three cortical lesions were identified with P1 (mean = 22.96); 633, with P2 (mean = 22.6); and 280, with P3 (mean = 10). The counts obtained by using P1 and P2 were not significantly different (P = .93). The counts obtained by using P3 were significantly smaller than those obtained by using either P1 (P < .001) or P2 (P < .001). The intraclass correlation coefficients were P1 versus P2 = 0.989, P1 versus P3 = 0.615, and P2 versus P3 = 0.588. CONCLUSIONS MR imaging cortical lesion segmentation can be performed by using 3D T1-weighted and 3D FLAIR images acquired with a 1-mm isotropic voxel size, supported by conventional T2-weighted and proton-density images with 3-mm-thick sections. Inclusion of double inversion recovery in this multimodal reading protocol did not significantly improve the cortical lesion identification rate. A multimodal approach is superior to using double inversion recovery alone.
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Affiliation(s)
- J Maranzano
- From the Department of Neurology and Neurosurgery, Montreal Neurological Hospital and Institute, McGill University, Montreal, Quebec, Canada
| | - D A Rudko
- From the Department of Neurology and Neurosurgery, Montreal Neurological Hospital and Institute, McGill University, Montreal, Quebec, Canada
| | - D L Arnold
- From the Department of Neurology and Neurosurgery, Montreal Neurological Hospital and Institute, McGill University, Montreal, Quebec, Canada
| | - S Narayanan
- From the Department of Neurology and Neurosurgery, Montreal Neurological Hospital and Institute, McGill University, Montreal, Quebec, Canada.
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10
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Bodini B, Chard D, Altmann DR, Tozer D, Miller DH, Thompson AJ, Wheeler-Kingshott C, Ciccarelli O. White and gray matter damage in primary progressive MS: The chicken or the egg? Neurology 2015; 86:170-6. [PMID: 26674332 DOI: 10.1212/wnl.0000000000002237] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Accepted: 08/25/2015] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE The temporal relationship between white matter (WM) and gray matter (GM) damage in vivo in early primary progressive multiple sclerosis (PPMS) was investigated testing 2 hypotheses: (1) WM tract abnormalities predict subsequent changes in the connected cortex ("primary WM damage model"); and (2) cortical abnormalities predict later changes in connected WM tracts ("primary GM damage model"). METHODS Forty-seven patients with early PPMS and 18 healthy controls had conventional and magnetization transfer imaging at baseline; a subgroup of 35 patients repeated the protocol after 2 years. Masks of the corticospinal tracts, genu of the corpus callosum and optic radiations, and of connected cortical regions, were used for extracting the mean magnetization transfer ratio (MTR). Multiple regressions within each of 5 tract-cortex pairs were performed, adjusting for the dependent variable's baseline MTR; tract lesion load and MTR, spinal cord area, age, and sex were examined for potential confounding. RESULTS The baseline MTR of most regions was lower in patients than in healthy controls. The tract-cortex pair relationships in the primary WM damage model were significant for the bilateral motor pair and right visual pair, while those in the primary GM damage model were only significant for the right motor pair. Lower lesion MTR at baseline was associated with lower MTR in the same tract normal-appearing WM at 2 years in 3 tracts. CONCLUSION These results are consistent with the hypothesis that in early PPMS, cortical damage is for the most part a sequela of normal-appearing WM pathology, which, in turn, is predicted by abnormalities within WM lesions.
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Affiliation(s)
- Benedetta Bodini
- From the Department of Neuroinflammation (B.B., D.C., D.R.A., D.T., D.H.M., A.J.T., C.W.-K., O.C.), Queen Square MS Centre, University College of London Institute of Neurology; Department of Neuroimaging (B.B.), Institute of Psychiatry, King's College London; London School of Hygiene and Tropical Medicine (D.R.A.), University of London; NIHR UCL/UCLH Biomedical Research Centre (D.H.M., A.J.T., O.C.), London, UK.
| | - Declan Chard
- From the Department of Neuroinflammation (B.B., D.C., D.R.A., D.T., D.H.M., A.J.T., C.W.-K., O.C.), Queen Square MS Centre, University College of London Institute of Neurology; Department of Neuroimaging (B.B.), Institute of Psychiatry, King's College London; London School of Hygiene and Tropical Medicine (D.R.A.), University of London; NIHR UCL/UCLH Biomedical Research Centre (D.H.M., A.J.T., O.C.), London, UK
| | - Daniel R Altmann
- From the Department of Neuroinflammation (B.B., D.C., D.R.A., D.T., D.H.M., A.J.T., C.W.-K., O.C.), Queen Square MS Centre, University College of London Institute of Neurology; Department of Neuroimaging (B.B.), Institute of Psychiatry, King's College London; London School of Hygiene and Tropical Medicine (D.R.A.), University of London; NIHR UCL/UCLH Biomedical Research Centre (D.H.M., A.J.T., O.C.), London, UK
| | - Daniel Tozer
- From the Department of Neuroinflammation (B.B., D.C., D.R.A., D.T., D.H.M., A.J.T., C.W.-K., O.C.), Queen Square MS Centre, University College of London Institute of Neurology; Department of Neuroimaging (B.B.), Institute of Psychiatry, King's College London; London School of Hygiene and Tropical Medicine (D.R.A.), University of London; NIHR UCL/UCLH Biomedical Research Centre (D.H.M., A.J.T., O.C.), London, UK
| | - David H Miller
- From the Department of Neuroinflammation (B.B., D.C., D.R.A., D.T., D.H.M., A.J.T., C.W.-K., O.C.), Queen Square MS Centre, University College of London Institute of Neurology; Department of Neuroimaging (B.B.), Institute of Psychiatry, King's College London; London School of Hygiene and Tropical Medicine (D.R.A.), University of London; NIHR UCL/UCLH Biomedical Research Centre (D.H.M., A.J.T., O.C.), London, UK
| | - Alan J Thompson
- From the Department of Neuroinflammation (B.B., D.C., D.R.A., D.T., D.H.M., A.J.T., C.W.-K., O.C.), Queen Square MS Centre, University College of London Institute of Neurology; Department of Neuroimaging (B.B.), Institute of Psychiatry, King's College London; London School of Hygiene and Tropical Medicine (D.R.A.), University of London; NIHR UCL/UCLH Biomedical Research Centre (D.H.M., A.J.T., O.C.), London, UK
| | - Claudia Wheeler-Kingshott
- From the Department of Neuroinflammation (B.B., D.C., D.R.A., D.T., D.H.M., A.J.T., C.W.-K., O.C.), Queen Square MS Centre, University College of London Institute of Neurology; Department of Neuroimaging (B.B.), Institute of Psychiatry, King's College London; London School of Hygiene and Tropical Medicine (D.R.A.), University of London; NIHR UCL/UCLH Biomedical Research Centre (D.H.M., A.J.T., O.C.), London, UK
| | - Olga Ciccarelli
- From the Department of Neuroinflammation (B.B., D.C., D.R.A., D.T., D.H.M., A.J.T., C.W.-K., O.C.), Queen Square MS Centre, University College of London Institute of Neurology; Department of Neuroimaging (B.B.), Institute of Psychiatry, King's College London; London School of Hygiene and Tropical Medicine (D.R.A.), University of London; NIHR UCL/UCLH Biomedical Research Centre (D.H.M., A.J.T., O.C.), London, UK
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11
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Steenwijk MD, Geurts JJG, Daams M, Tijms BM, Wink AM, Balk LJ, Tewarie PK, Uitdehaag BMJ, Barkhof F, Vrenken H, Pouwels PJW. Cortical atrophy patterns in multiple sclerosis are non-random and clinically relevant. Brain 2015; 139:115-26. [DOI: 10.1093/brain/awv337] [Citation(s) in RCA: 175] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 09/29/2015] [Indexed: 01/07/2023] Open
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12
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Papathanasiou A, Messinis L, Zampakis P, Panagiotakis G, Gourzis P, Georgiou V, Papathanasopoulos P. Thalamic atrophy predicts cognitive impairment in relapsing remitting multiple sclerosis. Effect on instrumental activities of daily living and employment status. J Neurol Sci 2015; 358:236-42. [DOI: 10.1016/j.jns.2015.09.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2015] [Revised: 08/31/2015] [Accepted: 09/01/2015] [Indexed: 11/30/2022]
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13
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Louapre C, Govindarajan ST, Giannì C, Cohen-Adad J, Gregory MD, Nielsen AS, Madigan N, Sloane JA, Kinkel RP, Mainero C. Is the Relationship between Cortical and White Matter Pathologic Changes in Multiple Sclerosis Spatially Specific? A Multimodal 7-T and 3-T MR Imaging Study with Surface and Tract-based Analysis. Radiology 2015; 278:524-35. [PMID: 26334679 DOI: 10.1148/radiol.2015150486] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE To investigate in vivo the spatial specificity of the interdependence between intracortical and white matter (WM) pathologic changes as function of cortical depth and distance from the cortex in multiple sclerosis (MS), and their independent contribution to physical and cognitive disability. MATERIALS AND METHODS This study was institutional review board-approved and participants gave written informed consent. In 34 MS patients and 17 age-matched control participants, 7-T quantitative T2* maps, 3-T T1-weighted anatomic images for cortical surface reconstruction, and 3-T diffusion tensor images (DTI) were obtained. Cortical quantitative T2* maps were sampled at 25%, 50%, 75% depth from pial surface. Tracts of interest were reconstructed by using probabilistic tractography. The relationship between DTI metrics voxelwise of the tracts and cortical integrity in the projection cortex was tested by using multilinear regression models. RESULTS In MS, DTI abnormal findings along tracts correlated with quantitative T2* changes (suggestive of iron and myelin loss) at each depth of the cortical projection area (P < .01, corrected). This association, however, was not spatially specific because abnormal findings in WM tracts also related to cortical pathologic changes outside of the projection cortex of the tract (P < .001). Expanded Disability Status Scale pyramidal score was predicted by axial diffusivity along the corticospinal tract (β = 4.6 × 10(3); P < .001), Symbol Digit Modalities Test score by radial diffusivity along the cingulum (β = -4.3 × 10(4); P < .01), and T2* in the cingulum cortical projection at 25% depth (β = -1.7; P < .05). CONCLUSION Intracortical and WM injury are concomitant pathologic processes in MS, which are not uniquely distributed according to a tract-cortex-specific pattern; their association may reflect a common stage-dependent mechanism.
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Affiliation(s)
- Céline Louapre
- From the Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Building 149, Thirteenth St, Charlestown, MA 02129 (C.L., S.T.G., C.G., C.M.); Department of Radiology, Harvard Medical School, Boston, Mass (C.L., C.G., C.M.); Department of Electrical Engineering, École Polytechnique de Montréal, Montreal, QC, Canada (J.C.A.); Section on Integrative Neuroimaging, National Institute of Mental Health, National Institutes of Health, Bethesda, Md (M.D.G.); Department of Neurology and Neurosurgery, Virginia Mason Medical Center, Seattle, Wash (A.S.N.); Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Mass (N.M., J.A.S.); and Department of Neurosciences, University of California-San Diego, San Diego, Calif (R.P.K.)
| | - Sindhuja T Govindarajan
- From the Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Building 149, Thirteenth St, Charlestown, MA 02129 (C.L., S.T.G., C.G., C.M.); Department of Radiology, Harvard Medical School, Boston, Mass (C.L., C.G., C.M.); Department of Electrical Engineering, École Polytechnique de Montréal, Montreal, QC, Canada (J.C.A.); Section on Integrative Neuroimaging, National Institute of Mental Health, National Institutes of Health, Bethesda, Md (M.D.G.); Department of Neurology and Neurosurgery, Virginia Mason Medical Center, Seattle, Wash (A.S.N.); Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Mass (N.M., J.A.S.); and Department of Neurosciences, University of California-San Diego, San Diego, Calif (R.P.K.)
| | - Costanza Giannì
- From the Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Building 149, Thirteenth St, Charlestown, MA 02129 (C.L., S.T.G., C.G., C.M.); Department of Radiology, Harvard Medical School, Boston, Mass (C.L., C.G., C.M.); Department of Electrical Engineering, École Polytechnique de Montréal, Montreal, QC, Canada (J.C.A.); Section on Integrative Neuroimaging, National Institute of Mental Health, National Institutes of Health, Bethesda, Md (M.D.G.); Department of Neurology and Neurosurgery, Virginia Mason Medical Center, Seattle, Wash (A.S.N.); Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Mass (N.M., J.A.S.); and Department of Neurosciences, University of California-San Diego, San Diego, Calif (R.P.K.)
| | - Julien Cohen-Adad
- From the Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Building 149, Thirteenth St, Charlestown, MA 02129 (C.L., S.T.G., C.G., C.M.); Department of Radiology, Harvard Medical School, Boston, Mass (C.L., C.G., C.M.); Department of Electrical Engineering, École Polytechnique de Montréal, Montreal, QC, Canada (J.C.A.); Section on Integrative Neuroimaging, National Institute of Mental Health, National Institutes of Health, Bethesda, Md (M.D.G.); Department of Neurology and Neurosurgery, Virginia Mason Medical Center, Seattle, Wash (A.S.N.); Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Mass (N.M., J.A.S.); and Department of Neurosciences, University of California-San Diego, San Diego, Calif (R.P.K.)
| | - Michael D Gregory
- From the Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Building 149, Thirteenth St, Charlestown, MA 02129 (C.L., S.T.G., C.G., C.M.); Department of Radiology, Harvard Medical School, Boston, Mass (C.L., C.G., C.M.); Department of Electrical Engineering, École Polytechnique de Montréal, Montreal, QC, Canada (J.C.A.); Section on Integrative Neuroimaging, National Institute of Mental Health, National Institutes of Health, Bethesda, Md (M.D.G.); Department of Neurology and Neurosurgery, Virginia Mason Medical Center, Seattle, Wash (A.S.N.); Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Mass (N.M., J.A.S.); and Department of Neurosciences, University of California-San Diego, San Diego, Calif (R.P.K.)
| | - A Scott Nielsen
- From the Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Building 149, Thirteenth St, Charlestown, MA 02129 (C.L., S.T.G., C.G., C.M.); Department of Radiology, Harvard Medical School, Boston, Mass (C.L., C.G., C.M.); Department of Electrical Engineering, École Polytechnique de Montréal, Montreal, QC, Canada (J.C.A.); Section on Integrative Neuroimaging, National Institute of Mental Health, National Institutes of Health, Bethesda, Md (M.D.G.); Department of Neurology and Neurosurgery, Virginia Mason Medical Center, Seattle, Wash (A.S.N.); Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Mass (N.M., J.A.S.); and Department of Neurosciences, University of California-San Diego, San Diego, Calif (R.P.K.)
| | - Nancy Madigan
- From the Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Building 149, Thirteenth St, Charlestown, MA 02129 (C.L., S.T.G., C.G., C.M.); Department of Radiology, Harvard Medical School, Boston, Mass (C.L., C.G., C.M.); Department of Electrical Engineering, École Polytechnique de Montréal, Montreal, QC, Canada (J.C.A.); Section on Integrative Neuroimaging, National Institute of Mental Health, National Institutes of Health, Bethesda, Md (M.D.G.); Department of Neurology and Neurosurgery, Virginia Mason Medical Center, Seattle, Wash (A.S.N.); Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Mass (N.M., J.A.S.); and Department of Neurosciences, University of California-San Diego, San Diego, Calif (R.P.K.)
| | - Jacob A Sloane
- From the Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Building 149, Thirteenth St, Charlestown, MA 02129 (C.L., S.T.G., C.G., C.M.); Department of Radiology, Harvard Medical School, Boston, Mass (C.L., C.G., C.M.); Department of Electrical Engineering, École Polytechnique de Montréal, Montreal, QC, Canada (J.C.A.); Section on Integrative Neuroimaging, National Institute of Mental Health, National Institutes of Health, Bethesda, Md (M.D.G.); Department of Neurology and Neurosurgery, Virginia Mason Medical Center, Seattle, Wash (A.S.N.); Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Mass (N.M., J.A.S.); and Department of Neurosciences, University of California-San Diego, San Diego, Calif (R.P.K.)
| | - Revere P Kinkel
- From the Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Building 149, Thirteenth St, Charlestown, MA 02129 (C.L., S.T.G., C.G., C.M.); Department of Radiology, Harvard Medical School, Boston, Mass (C.L., C.G., C.M.); Department of Electrical Engineering, École Polytechnique de Montréal, Montreal, QC, Canada (J.C.A.); Section on Integrative Neuroimaging, National Institute of Mental Health, National Institutes of Health, Bethesda, Md (M.D.G.); Department of Neurology and Neurosurgery, Virginia Mason Medical Center, Seattle, Wash (A.S.N.); Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Mass (N.M., J.A.S.); and Department of Neurosciences, University of California-San Diego, San Diego, Calif (R.P.K.)
| | - Caterina Mainero
- From the Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Building 149, Thirteenth St, Charlestown, MA 02129 (C.L., S.T.G., C.G., C.M.); Department of Radiology, Harvard Medical School, Boston, Mass (C.L., C.G., C.M.); Department of Electrical Engineering, École Polytechnique de Montréal, Montreal, QC, Canada (J.C.A.); Section on Integrative Neuroimaging, National Institute of Mental Health, National Institutes of Health, Bethesda, Md (M.D.G.); Department of Neurology and Neurosurgery, Virginia Mason Medical Center, Seattle, Wash (A.S.N.); Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Mass (N.M., J.A.S.); and Department of Neurosciences, University of California-San Diego, San Diego, Calif (R.P.K.)
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14
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Steenwijk MD, Daams M, Pouwels PJW, J Balk L, Tewarie PK, Geurts JJG, Barkhof F, Vrenken H. Unraveling the relationship between regional gray matter atrophy and pathology in connected white matter tracts in long-standing multiple sclerosis. Hum Brain Mapp 2015; 36:1796-807. [PMID: 25627545 DOI: 10.1002/hbm.22738] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 11/23/2014] [Accepted: 01/06/2015] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Gray matter (GM) atrophy is common in multiple sclerosis (MS), but the relationship with white matter (WM) pathology is largely unknown. Some studies found a co-occurrence in specific systems, but a regional analysis across the brain in different clinical phenotypes is necessary to further understand the disease mechanism underlying GM atrophy in MS. Therefore, we investigated the association between regional GM atrophy and pathology in anatomically connected WM tracts. METHODS Conventional and diffusion tensor imaging was performed at 3T in 208 patients with long-standing MS and 60 healthy controls. Deep and cortical GM regions were segmented and quantified, and both lesion volumes and average normal appearing WM fractional anisotropy of their associated tracts were derived using an atlas obtained by probabilistic tractography in the controls. Linear regression was then performed to quantify the amount of regional GM atrophy that can be explained by WM pathology in the connected tract. RESULTS MS patients showed extensive deep and cortical GM atrophy. Cortical atrophy was particularly present in frontal and temporal regions. Pathology in connected WM tracts statistically explained both regional deep and cortical GM atrophy in relapsing-remitting (RR) patients, but only deep GM atrophy in secondary-progressive (SP) patients. CONCLUSION In RRMS patients, both deep and cortical GM atrophy were associated with pathology in connected WM tracts. In SPMS patients, only regional deep GM atrophy could be explained by pathology in connected WM tracts. This suggests that in SPMS patients cortical GM atrophy and WM damage are (at least partly) independent disease processes.
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Affiliation(s)
- Martijn D Steenwijk
- Department of Radiology and Nuclear Medicine, Neuroscience Campus Amsterdam, VU University Medical Center, The Netherlands
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15
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van Veluw SJ, Fracasso A, Visser F, Spliet WGM, Luijten PR, Biessels GJ, Zwanenburg JJM. FLAIR images at 7 Tesla MRI highlight the ependyma and the outer layers of the cerebral cortex. Neuroimage 2014; 104:100-9. [PMID: 25315783 DOI: 10.1016/j.neuroimage.2014.10.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 10/01/2014] [Accepted: 10/04/2014] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Fluid-attenuated inversion recovery (FLAIR) imaging is an important clinical 'work horse' for brain MRI and has proven to facilitate imaging of both intracortical lesions as well as cortical layers at 7T MRI. A prominent observation on 7T FLAIR images is a hyperintense rim at the cortical surface and around the ventricles. We aimed to clarify the anatomical correlates and underlying contrast mechanisms of this hyperintense rim. MATERIALS AND METHODS Two experiments with post-mortem human brain tissue were performed. FLAIR and T2-weighted images were obtained at typical in vivo (0.8mm isotropic) and high resolution (0.25mm isotropic). At one location the cortical surface was partly removed, and scanned again. Imaging was followed by histological and immunohistochemical analysis. Additionally, several simulations were performed to evaluate the potential contribution from an artifact due to water diffusion. RESULTS The hyperintense rim corresponded to the outer - glia rich - layer of the cortex and disappeared upon removal of that layer. At the ventricles, the rim corresponded to the ependymal layer, and was not present at white matter/fluid borders at an artificial cut. The simulations supported the hypothesis that the hyperintense rim reflects the tissue properties in the outer cortical layers (or ependymal layer for the ventricles), and is not merely an artifact, although not all observations were explained by the simulated model of the contrast mechanism. CONCLUSIONS 7T FLAIR seems to amplify the signal from layers I-III of the cortex and the ependyma around the ventricles. Although diffusion of water from layer I into CSF does contribute to this effect, a long T2 relaxation time constant in layer I, and probably also layer II-III, is most likely the major contributor, since the rim disappears upon removal of that layer. This knowledge can help the interpretation of imaging results in cortical development and in patients with cortical pathology.
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Affiliation(s)
- Susanne J van Veluw
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands.
| | - Alessio Fracasso
- Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, the Netherlands
| | - Fredy Visser
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands; Philips Healthcare, Best, the Netherlands
| | - Wim G M Spliet
- Department of Pathology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Peter R Luijten
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Geert Jan Biessels
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jaco J M Zwanenburg
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
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Krauspe BM, Dreher W, Beyer C, Baumgartner W, Denecke B, Janssen K, Langhans CD, Clarner T, Kipp M. Short-term cuprizone feeding verifies N-acetylaspartate quantification as a marker of neurodegeneration. J Mol Neurosci 2014; 55:733-48. [PMID: 25189319 DOI: 10.1007/s12031-014-0412-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 08/20/2014] [Indexed: 01/27/2023]
Abstract
Proton magnetic resonance spectroscopy (1H-MRS) is a quantitative MR imaging technique often used to complement conventional MR imaging with specific metabolic information. A key metabolite is the amino acid derivative N-Acetylaspartate (NAA) which is an accepted marker to measure the extent of neurodegeneration in multiple sclerosis (MS) patients. NAA is catabolized by the enzyme aspartoacylase (ASPA) which is predominantly expressed in oligodendrocytes. Since the formation of MS lesions is paralleled by oligodendrocyte loss, NAA might accumulate in the brain, and therefore, the extent of neurodegeneration might be underestimated. In the present study, we used the well-characterized cuprizone model. There, the loss of oligodendrocytes is paralleled by a reduction in ASPA expression and activity as demonstrated by genome-wide gene expression analysis and enzymatic activity assays. Notably, brain levels of NAA were not increased as determined by gas chromatography-mass spectrometry and 1H-MRS. These important findings underpin the reliability of NAA quantification as a valid marker for the paraclinical determination of the extent of neurodegeneration, even under conditions of oligodendrocyte loss in which impaired metabolization of NAA is expected. Future studies have to reveal whether other enzymes are able to metabolize NAA or whether an excess of NAA is cleared by other mechanisms rather than enzymatic metabolism.
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Affiliation(s)
- Barbara Maria Krauspe
- Institute of Neuroanatomy, Faculty of Medicine, RWTH Aachen University, Wendlingweg 2, 52074, Aachen, Germany
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Abstract
We review the current state of knowledge of remyelination in multiple sclerosis (MS), concentrating on advances in the understanding of the pathology and the regenerative response, and we summarise progress on the development of new therapies to enhance remyelination aimed at reducing progressive accumulation of disability in MS. We discuss key target pathways identified in experimental models, as although most identified targets have not yet progressed to the stage of being tested in human clinical trials, they may provide treatment strategies for demyelinating diseases in the future. Finally, we discuss some of the problems associated with testing this class of drugs, where they might fit into the therapeutic arsenal and the gaps in our knowledge.
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Affiliation(s)
- E. Jolanda Münzel
- MRC Centre for Regenerative Medicine, University of Edinburgh, Edinburgh Bioquarter, 5 Little France Drive, Edinburgh, EH16 4UU UK
| | - Anna Williams
- MRC Centre for Regenerative Medicine, University of Edinburgh, Edinburgh Bioquarter, 5 Little France Drive, Edinburgh, EH16 4UU UK
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