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Margoni M, Preziosa P, Pagani E, Storelli L, Gueye M, Moiola L, Filippi M, Rocca MA. Assessment of central vein sign and paramagnetic rim lesions in pediatric multiple sclerosis. Ann Clin Transl Neurol 2024. [PMID: 39291789 DOI: 10.1002/acn3.52208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2024] [Revised: 08/19/2024] [Accepted: 08/27/2024] [Indexed: 09/19/2024] Open
Abstract
The evaluation of white matter lesions (WMLs) showing the central vein sign (CVS) and paramagnetic rim lesions (PRLs) has been suggested to enhance the diagnostic work-up of adult multiple sclerosis (MS). We aimed to evaluate the fulfillment of different CVS criteria and the added value of PRLs in 22 pediatric MS patients. Eleven patients (50%) fulfilled the 40%-rule threshold. Nineteen (86%) patients had ≥3 CVS+ WMLs or ≥1 PRL, whereas 17 (77%) had ≥6 CVS+ WMLs or ≥1 PRL. A simplified CVS-based approach, with the combined evaluation of ≥1 PRL in patients with ≥6 CVS+ WMLs, may improve MS diagnosis in pediatric patients.
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Affiliation(s)
- Margoni Margoni
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Preziosa
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Elisabetta Pagani
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Loredana Storelli
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Mor Gueye
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Lucia Moiola
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria A Rocca
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
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Rjeily NB, Solomon AJ. Misdiagnosis of Multiple Sclerosis: Past, Present, and Future. Curr Neurol Neurosci Rep 2024:10.1007/s11910-024-01371-w. [PMID: 39243340 DOI: 10.1007/s11910-024-01371-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2024] [Indexed: 09/09/2024]
Abstract
PURPOSE OF REVIEW Misdiagnosis of multiple sclerosis (MS) is a prevalent worldwide problem. This review discusses how MS misdiagnosis has evolved over time and focuses on contemporary challenges and potential strategies for its prevention. RECENT FINDINGS Recent studies report cohorts with a range of misdiagnosis between 5 and 18%. Common disorders are frequently misdiagnosed as MS. Overreliance on MRI findings and misapplication of MS diagnostic criteria are often associated with misdiagnosis. Emerging imaging biomarkers, including the central vein sign and paramagnetic rim lesions, may aid diagnostic accuracy when evaluating patients for suspected MS. MS misdiagnosis can have harmful consequences for patients and healthcare systems. Further research is needed to better understand its causes. Concerted and novel educational efforts to ensure accurate and widespread implementation of MS diagnostic criteria remain an unmet need. The incorporation of diagnostic biomarkers highly specific for MS in the future may prevent misdiagnosis.
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Affiliation(s)
- Nicole Bou Rjeily
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Andrew J Solomon
- Department of Neurological Sciences, Larner College of Medicine, The University of Vermont, 1 South Prospect St., Burlington, VT, 05477, USA.
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Filippi M, Preziosa P, Margoni M, Rocca MA. Diagnostic Criteria for Multiple Sclerosis, Neuromyelitis Optica Spectrum Disorders, and Myelin Oligodendrocyte Glycoprotein-immunoglobulin G-associated Disease. Neuroimaging Clin N Am 2024; 34:293-316. [PMID: 38942518 DOI: 10.1016/j.nic.2024.03.001] [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] [Indexed: 06/30/2024]
Abstract
The diagnostic workup of multiple sclerosis (MS) has evolved considerably. The 2017 revision of the McDonald criteria shows high sensitivity and accuracy in predicting clinically definite MS in patients with a typical clinically isolated syndrome and allows an earlier MS diagnosis. Neuromyelitis optica spectrum disorders (NMOSD) and myelin oligodendrocyte glycoprotein-immunoglobulin G-associated disease (MOGAD) are recognized as separate conditions from MS, with specific diagnostic criteria. New MR imaging markers may improve diagnostic specificity for these conditions, thus reducing the risk of misdiagnosis. This study summarizes the most recent updates regarding the application of MR imaging for the diagnosis of MS, NMOSD, and MOGAD.
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Affiliation(s)
- Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy.
| | - Paolo Preziosa
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Monica Margoni
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria A Rocca
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
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Hemond CC, Gaitán MI, Absinta M, Reich DS. New Imaging Markers in Multiple Sclerosis and Related Disorders: Smoldering Inflammation and the Central Vein Sign. Neuroimaging Clin N Am 2024; 34:359-373. [PMID: 38942521 PMCID: PMC11213979 DOI: 10.1016/j.nic.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2024]
Abstract
Concepts of multiple sclerosis (MS) biology continue to evolve, with observations such as "progression independent of disease activity" challenging traditional phenotypic categorization. Iron-sensitive, susceptibility-based imaging techniques are emerging as highly translatable MR imaging sequences that allow for visualization of at least 2 clinically useful biomarkers: the central vein sign and the paramagnetic rim lesion (PRL). Both biomarkers demonstrate high specificity in the discrimination of MS from other mimics and can be seen at 1.5 T and 3 T field strengths. Additionally, PRLs represent a subset of chronic active lesions engaged in "smoldering" compartmentalized inflammation behind an intact blood-brain barrier.
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Affiliation(s)
- Christopher C Hemond
- Department of Neurology, University of Massachusetts Memorial Medical Center and University of Massachusetts Chan Medical School, Worcester, MA, USA; National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA.
| | - María I Gaitán
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Martina Absinta
- Translational Neuropathology Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Daniel S Reich
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
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Borrelli S, Martire MS, Stölting A, Vanden Bulcke C, Pedrini E, Guisset F, Bugli C, Yildiz H, Pothen L, Elands S, Martinelli V, Smith B, Jacobson S, Du Pasquier RA, Van Pesch V, Filippi M, Reich DS, Absinta M, Maggi P. Central Vein Sign, Cortical Lesions, and Paramagnetic Rim Lesions for the Diagnostic and Prognostic Workup of Multiple Sclerosis. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2024; 11:e200253. [PMID: 38788180 PMCID: PMC11129678 DOI: 10.1212/nxi.0000000000200253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 03/13/2024] [Indexed: 05/26/2024]
Abstract
BACKGROUND AND OBJECTIVES The diagnosis of multiple sclerosis (MS) can be challenging in clinical practice because MS presentation can be atypical and mimicked by other diseases. We evaluated the diagnostic performance, alone or in combination, of the central vein sign (CVS), paramagnetic rim lesion (PRL), and cortical lesion (CL), as well as their association with clinical outcomes. METHODS In this multicenter observational study, we first conducted a cross-sectional analysis of the CVS (proportion of CVS-positive lesions or simplified determination of CVS in 3/6 lesions-Select3*/Select6*), PRL, and CL in MS and non-MS cases on 3T-MRI brain images, including 3D T2-FLAIR, T2*-echo-planar imaging magnitude and phase, double inversion recovery, and magnetization prepared rapid gradient echo image sequences. Then, we longitudinally analyzed the progression independent of relapse and MRI activity (PIRA) in MS cases over the 2 years after study entry. Receiver operating characteristic curves were used to test diagnostic performance and regression models to predict diagnosis and clinical outcomes. RESULTS The presence of ≥41% CVS-positive lesions/≥1 CL/≥1 PRL (optimal cutoffs) had 96%/90%/93% specificity, 97%/84%/60% sensitivity, and 0.99/0.90/0.77 area under the curve (AUC), respectively, to distinguish MS (n = 185) from non-MS (n = 100) cases. The Select3*/Select6* algorithms showed 93%/95% specificity, 97%/89% sensitivity, and 0.95/0.92 AUC. The combination of CVS, CL, and PRL improved the diagnostic performance, especially when Select3*/Select6* were used (93%/94% specificity, 98%/96% sensitivity, 0.99/0.98 AUC; p = 0.002/p < 0.001). In MS cases (n = 185), both CL and PRL were associated with higher MS disability and severity. Longitudinal analysis (n = 61) showed that MS cases with >4 PRL at baseline were more likely to experience PIRA at 2-year follow-up (odds ratio 17.0, 95% confidence interval: 2.1-138.5; p = 0.008), whereas no association was observed between other baseline MRI measures and PIRA, including the number of CL. DISCUSSION The combination of CVS, CL, and PRL can improve MS differential diagnosis. CL and PRL also correlated with clinical measures of poor prognosis, with PRL being a predictor of disability accrual independent of clinical/MRI activity.
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Affiliation(s)
- Serena Borrelli
- From the Neuroinflammation Imaging Lab (NIL) (S.B., A.S., C.V.B., F.G., P.M.), Institute of NeuroScience, Université catholique de Louvain; Department of Neurology (S.B., S.E.), Hôpital Erasme, Hôpital Universitaire de Bruxelles; Department of Neurology (S.B.), Centre Hospitalier Universitaire Brugmann, Université Libre de Brussels, Belgium; Neurology Unit (M.S.M., V.M., M.F.), IRCCS San Raffaele Hospital, Milan, Italy; ICTEAM Institute (C.V.B.), Université catholique de Louvain, Louvain-la-Neuve, Belgium; Vita-Salute San Raffaele University (E.P., M.F., M.A.); Translational Neuropathology Unit (E.P., M.A.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Plateforme technologique de Support en Méthodologie et Calcul Statistique (C.B.); Department of Internal Medicine and Infectious Diseases (H.Y., L.P.), Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Section of Infections of the Nervous System (B.S.); Viral Immunology Section (S.J.), National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD; Neurology Service (R.A.D.P., P.M.), Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Switzerland; Department of Neurology (V.V.P., P.M.), Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Neuroimaging Research Unit (M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Translational Neuroradiology Section (D.S.R.), National Institute of Neurological Disorders and Stroke (NINDS), National In-stitutes of Health (NIH); and Department of Neurology (M.A.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Maria Sofia Martire
- From the Neuroinflammation Imaging Lab (NIL) (S.B., A.S., C.V.B., F.G., P.M.), Institute of NeuroScience, Université catholique de Louvain; Department of Neurology (S.B., S.E.), Hôpital Erasme, Hôpital Universitaire de Bruxelles; Department of Neurology (S.B.), Centre Hospitalier Universitaire Brugmann, Université Libre de Brussels, Belgium; Neurology Unit (M.S.M., V.M., M.F.), IRCCS San Raffaele Hospital, Milan, Italy; ICTEAM Institute (C.V.B.), Université catholique de Louvain, Louvain-la-Neuve, Belgium; Vita-Salute San Raffaele University (E.P., M.F., M.A.); Translational Neuropathology Unit (E.P., M.A.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Plateforme technologique de Support en Méthodologie et Calcul Statistique (C.B.); Department of Internal Medicine and Infectious Diseases (H.Y., L.P.), Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Section of Infections of the Nervous System (B.S.); Viral Immunology Section (S.J.), National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD; Neurology Service (R.A.D.P., P.M.), Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Switzerland; Department of Neurology (V.V.P., P.M.), Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Neuroimaging Research Unit (M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Translational Neuroradiology Section (D.S.R.), National Institute of Neurological Disorders and Stroke (NINDS), National In-stitutes of Health (NIH); and Department of Neurology (M.A.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Anna Stölting
- From the Neuroinflammation Imaging Lab (NIL) (S.B., A.S., C.V.B., F.G., P.M.), Institute of NeuroScience, Université catholique de Louvain; Department of Neurology (S.B., S.E.), Hôpital Erasme, Hôpital Universitaire de Bruxelles; Department of Neurology (S.B.), Centre Hospitalier Universitaire Brugmann, Université Libre de Brussels, Belgium; Neurology Unit (M.S.M., V.M., M.F.), IRCCS San Raffaele Hospital, Milan, Italy; ICTEAM Institute (C.V.B.), Université catholique de Louvain, Louvain-la-Neuve, Belgium; Vita-Salute San Raffaele University (E.P., M.F., M.A.); Translational Neuropathology Unit (E.P., M.A.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Plateforme technologique de Support en Méthodologie et Calcul Statistique (C.B.); Department of Internal Medicine and Infectious Diseases (H.Y., L.P.), Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Section of Infections of the Nervous System (B.S.); Viral Immunology Section (S.J.), National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD; Neurology Service (R.A.D.P., P.M.), Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Switzerland; Department of Neurology (V.V.P., P.M.), Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Neuroimaging Research Unit (M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Translational Neuroradiology Section (D.S.R.), National Institute of Neurological Disorders and Stroke (NINDS), National In-stitutes of Health (NIH); and Department of Neurology (M.A.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Colin Vanden Bulcke
- From the Neuroinflammation Imaging Lab (NIL) (S.B., A.S., C.V.B., F.G., P.M.), Institute of NeuroScience, Université catholique de Louvain; Department of Neurology (S.B., S.E.), Hôpital Erasme, Hôpital Universitaire de Bruxelles; Department of Neurology (S.B.), Centre Hospitalier Universitaire Brugmann, Université Libre de Brussels, Belgium; Neurology Unit (M.S.M., V.M., M.F.), IRCCS San Raffaele Hospital, Milan, Italy; ICTEAM Institute (C.V.B.), Université catholique de Louvain, Louvain-la-Neuve, Belgium; Vita-Salute San Raffaele University (E.P., M.F., M.A.); Translational Neuropathology Unit (E.P., M.A.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Plateforme technologique de Support en Méthodologie et Calcul Statistique (C.B.); Department of Internal Medicine and Infectious Diseases (H.Y., L.P.), Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Section of Infections of the Nervous System (B.S.); Viral Immunology Section (S.J.), National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD; Neurology Service (R.A.D.P., P.M.), Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Switzerland; Department of Neurology (V.V.P., P.M.), Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Neuroimaging Research Unit (M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Translational Neuroradiology Section (D.S.R.), National Institute of Neurological Disorders and Stroke (NINDS), National In-stitutes of Health (NIH); and Department of Neurology (M.A.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Edoardo Pedrini
- From the Neuroinflammation Imaging Lab (NIL) (S.B., A.S., C.V.B., F.G., P.M.), Institute of NeuroScience, Université catholique de Louvain; Department of Neurology (S.B., S.E.), Hôpital Erasme, Hôpital Universitaire de Bruxelles; Department of Neurology (S.B.), Centre Hospitalier Universitaire Brugmann, Université Libre de Brussels, Belgium; Neurology Unit (M.S.M., V.M., M.F.), IRCCS San Raffaele Hospital, Milan, Italy; ICTEAM Institute (C.V.B.), Université catholique de Louvain, Louvain-la-Neuve, Belgium; Vita-Salute San Raffaele University (E.P., M.F., M.A.); Translational Neuropathology Unit (E.P., M.A.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Plateforme technologique de Support en Méthodologie et Calcul Statistique (C.B.); Department of Internal Medicine and Infectious Diseases (H.Y., L.P.), Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Section of Infections of the Nervous System (B.S.); Viral Immunology Section (S.J.), National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD; Neurology Service (R.A.D.P., P.M.), Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Switzerland; Department of Neurology (V.V.P., P.M.), Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Neuroimaging Research Unit (M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Translational Neuroradiology Section (D.S.R.), National Institute of Neurological Disorders and Stroke (NINDS), National In-stitutes of Health (NIH); and Department of Neurology (M.A.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - François Guisset
- From the Neuroinflammation Imaging Lab (NIL) (S.B., A.S., C.V.B., F.G., P.M.), Institute of NeuroScience, Université catholique de Louvain; Department of Neurology (S.B., S.E.), Hôpital Erasme, Hôpital Universitaire de Bruxelles; Department of Neurology (S.B.), Centre Hospitalier Universitaire Brugmann, Université Libre de Brussels, Belgium; Neurology Unit (M.S.M., V.M., M.F.), IRCCS San Raffaele Hospital, Milan, Italy; ICTEAM Institute (C.V.B.), Université catholique de Louvain, Louvain-la-Neuve, Belgium; Vita-Salute San Raffaele University (E.P., M.F., M.A.); Translational Neuropathology Unit (E.P., M.A.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Plateforme technologique de Support en Méthodologie et Calcul Statistique (C.B.); Department of Internal Medicine and Infectious Diseases (H.Y., L.P.), Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Section of Infections of the Nervous System (B.S.); Viral Immunology Section (S.J.), National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD; Neurology Service (R.A.D.P., P.M.), Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Switzerland; Department of Neurology (V.V.P., P.M.), Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Neuroimaging Research Unit (M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Translational Neuroradiology Section (D.S.R.), National Institute of Neurological Disorders and Stroke (NINDS), National In-stitutes of Health (NIH); and Department of Neurology (M.A.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Céline Bugli
- From the Neuroinflammation Imaging Lab (NIL) (S.B., A.S., C.V.B., F.G., P.M.), Institute of NeuroScience, Université catholique de Louvain; Department of Neurology (S.B., S.E.), Hôpital Erasme, Hôpital Universitaire de Bruxelles; Department of Neurology (S.B.), Centre Hospitalier Universitaire Brugmann, Université Libre de Brussels, Belgium; Neurology Unit (M.S.M., V.M., M.F.), IRCCS San Raffaele Hospital, Milan, Italy; ICTEAM Institute (C.V.B.), Université catholique de Louvain, Louvain-la-Neuve, Belgium; Vita-Salute San Raffaele University (E.P., M.F., M.A.); Translational Neuropathology Unit (E.P., M.A.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Plateforme technologique de Support en Méthodologie et Calcul Statistique (C.B.); Department of Internal Medicine and Infectious Diseases (H.Y., L.P.), Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Section of Infections of the Nervous System (B.S.); Viral Immunology Section (S.J.), National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD; Neurology Service (R.A.D.P., P.M.), Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Switzerland; Department of Neurology (V.V.P., P.M.), Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Neuroimaging Research Unit (M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Translational Neuroradiology Section (D.S.R.), National Institute of Neurological Disorders and Stroke (NINDS), National In-stitutes of Health (NIH); and Department of Neurology (M.A.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Halil Yildiz
- From the Neuroinflammation Imaging Lab (NIL) (S.B., A.S., C.V.B., F.G., P.M.), Institute of NeuroScience, Université catholique de Louvain; Department of Neurology (S.B., S.E.), Hôpital Erasme, Hôpital Universitaire de Bruxelles; Department of Neurology (S.B.), Centre Hospitalier Universitaire Brugmann, Université Libre de Brussels, Belgium; Neurology Unit (M.S.M., V.M., M.F.), IRCCS San Raffaele Hospital, Milan, Italy; ICTEAM Institute (C.V.B.), Université catholique de Louvain, Louvain-la-Neuve, Belgium; Vita-Salute San Raffaele University (E.P., M.F., M.A.); Translational Neuropathology Unit (E.P., M.A.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Plateforme technologique de Support en Méthodologie et Calcul Statistique (C.B.); Department of Internal Medicine and Infectious Diseases (H.Y., L.P.), Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Section of Infections of the Nervous System (B.S.); Viral Immunology Section (S.J.), National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD; Neurology Service (R.A.D.P., P.M.), Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Switzerland; Department of Neurology (V.V.P., P.M.), Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Neuroimaging Research Unit (M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Translational Neuroradiology Section (D.S.R.), National Institute of Neurological Disorders and Stroke (NINDS), National In-stitutes of Health (NIH); and Department of Neurology (M.A.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Lucie Pothen
- From the Neuroinflammation Imaging Lab (NIL) (S.B., A.S., C.V.B., F.G., P.M.), Institute of NeuroScience, Université catholique de Louvain; Department of Neurology (S.B., S.E.), Hôpital Erasme, Hôpital Universitaire de Bruxelles; Department of Neurology (S.B.), Centre Hospitalier Universitaire Brugmann, Université Libre de Brussels, Belgium; Neurology Unit (M.S.M., V.M., M.F.), IRCCS San Raffaele Hospital, Milan, Italy; ICTEAM Institute (C.V.B.), Université catholique de Louvain, Louvain-la-Neuve, Belgium; Vita-Salute San Raffaele University (E.P., M.F., M.A.); Translational Neuropathology Unit (E.P., M.A.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Plateforme technologique de Support en Méthodologie et Calcul Statistique (C.B.); Department of Internal Medicine and Infectious Diseases (H.Y., L.P.), Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Section of Infections of the Nervous System (B.S.); Viral Immunology Section (S.J.), National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD; Neurology Service (R.A.D.P., P.M.), Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Switzerland; Department of Neurology (V.V.P., P.M.), Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Neuroimaging Research Unit (M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Translational Neuroradiology Section (D.S.R.), National Institute of Neurological Disorders and Stroke (NINDS), National In-stitutes of Health (NIH); and Department of Neurology (M.A.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Sophie Elands
- From the Neuroinflammation Imaging Lab (NIL) (S.B., A.S., C.V.B., F.G., P.M.), Institute of NeuroScience, Université catholique de Louvain; Department of Neurology (S.B., S.E.), Hôpital Erasme, Hôpital Universitaire de Bruxelles; Department of Neurology (S.B.), Centre Hospitalier Universitaire Brugmann, Université Libre de Brussels, Belgium; Neurology Unit (M.S.M., V.M., M.F.), IRCCS San Raffaele Hospital, Milan, Italy; ICTEAM Institute (C.V.B.), Université catholique de Louvain, Louvain-la-Neuve, Belgium; Vita-Salute San Raffaele University (E.P., M.F., M.A.); Translational Neuropathology Unit (E.P., M.A.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Plateforme technologique de Support en Méthodologie et Calcul Statistique (C.B.); Department of Internal Medicine and Infectious Diseases (H.Y., L.P.), Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Section of Infections of the Nervous System (B.S.); Viral Immunology Section (S.J.), National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD; Neurology Service (R.A.D.P., P.M.), Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Switzerland; Department of Neurology (V.V.P., P.M.), Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Neuroimaging Research Unit (M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Translational Neuroradiology Section (D.S.R.), National Institute of Neurological Disorders and Stroke (NINDS), National In-stitutes of Health (NIH); and Department of Neurology (M.A.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Vittorio Martinelli
- From the Neuroinflammation Imaging Lab (NIL) (S.B., A.S., C.V.B., F.G., P.M.), Institute of NeuroScience, Université catholique de Louvain; Department of Neurology (S.B., S.E.), Hôpital Erasme, Hôpital Universitaire de Bruxelles; Department of Neurology (S.B.), Centre Hospitalier Universitaire Brugmann, Université Libre de Brussels, Belgium; Neurology Unit (M.S.M., V.M., M.F.), IRCCS San Raffaele Hospital, Milan, Italy; ICTEAM Institute (C.V.B.), Université catholique de Louvain, Louvain-la-Neuve, Belgium; Vita-Salute San Raffaele University (E.P., M.F., M.A.); Translational Neuropathology Unit (E.P., M.A.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Plateforme technologique de Support en Méthodologie et Calcul Statistique (C.B.); Department of Internal Medicine and Infectious Diseases (H.Y., L.P.), Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Section of Infections of the Nervous System (B.S.); Viral Immunology Section (S.J.), National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD; Neurology Service (R.A.D.P., P.M.), Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Switzerland; Department of Neurology (V.V.P., P.M.), Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Neuroimaging Research Unit (M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Translational Neuroradiology Section (D.S.R.), National Institute of Neurological Disorders and Stroke (NINDS), National In-stitutes of Health (NIH); and Department of Neurology (M.A.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Bryan Smith
- From the Neuroinflammation Imaging Lab (NIL) (S.B., A.S., C.V.B., F.G., P.M.), Institute of NeuroScience, Université catholique de Louvain; Department of Neurology (S.B., S.E.), Hôpital Erasme, Hôpital Universitaire de Bruxelles; Department of Neurology (S.B.), Centre Hospitalier Universitaire Brugmann, Université Libre de Brussels, Belgium; Neurology Unit (M.S.M., V.M., M.F.), IRCCS San Raffaele Hospital, Milan, Italy; ICTEAM Institute (C.V.B.), Université catholique de Louvain, Louvain-la-Neuve, Belgium; Vita-Salute San Raffaele University (E.P., M.F., M.A.); Translational Neuropathology Unit (E.P., M.A.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Plateforme technologique de Support en Méthodologie et Calcul Statistique (C.B.); Department of Internal Medicine and Infectious Diseases (H.Y., L.P.), Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Section of Infections of the Nervous System (B.S.); Viral Immunology Section (S.J.), National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD; Neurology Service (R.A.D.P., P.M.), Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Switzerland; Department of Neurology (V.V.P., P.M.), Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Neuroimaging Research Unit (M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Translational Neuroradiology Section (D.S.R.), National Institute of Neurological Disorders and Stroke (NINDS), National In-stitutes of Health (NIH); and Department of Neurology (M.A.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Steven Jacobson
- From the Neuroinflammation Imaging Lab (NIL) (S.B., A.S., C.V.B., F.G., P.M.), Institute of NeuroScience, Université catholique de Louvain; Department of Neurology (S.B., S.E.), Hôpital Erasme, Hôpital Universitaire de Bruxelles; Department of Neurology (S.B.), Centre Hospitalier Universitaire Brugmann, Université Libre de Brussels, Belgium; Neurology Unit (M.S.M., V.M., M.F.), IRCCS San Raffaele Hospital, Milan, Italy; ICTEAM Institute (C.V.B.), Université catholique de Louvain, Louvain-la-Neuve, Belgium; Vita-Salute San Raffaele University (E.P., M.F., M.A.); Translational Neuropathology Unit (E.P., M.A.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Plateforme technologique de Support en Méthodologie et Calcul Statistique (C.B.); Department of Internal Medicine and Infectious Diseases (H.Y., L.P.), Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Section of Infections of the Nervous System (B.S.); Viral Immunology Section (S.J.), National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD; Neurology Service (R.A.D.P., P.M.), Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Switzerland; Department of Neurology (V.V.P., P.M.), Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Neuroimaging Research Unit (M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Translational Neuroradiology Section (D.S.R.), National Institute of Neurological Disorders and Stroke (NINDS), National In-stitutes of Health (NIH); and Department of Neurology (M.A.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Renaud A Du Pasquier
- From the Neuroinflammation Imaging Lab (NIL) (S.B., A.S., C.V.B., F.G., P.M.), Institute of NeuroScience, Université catholique de Louvain; Department of Neurology (S.B., S.E.), Hôpital Erasme, Hôpital Universitaire de Bruxelles; Department of Neurology (S.B.), Centre Hospitalier Universitaire Brugmann, Université Libre de Brussels, Belgium; Neurology Unit (M.S.M., V.M., M.F.), IRCCS San Raffaele Hospital, Milan, Italy; ICTEAM Institute (C.V.B.), Université catholique de Louvain, Louvain-la-Neuve, Belgium; Vita-Salute San Raffaele University (E.P., M.F., M.A.); Translational Neuropathology Unit (E.P., M.A.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Plateforme technologique de Support en Méthodologie et Calcul Statistique (C.B.); Department of Internal Medicine and Infectious Diseases (H.Y., L.P.), Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Section of Infections of the Nervous System (B.S.); Viral Immunology Section (S.J.), National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD; Neurology Service (R.A.D.P., P.M.), Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Switzerland; Department of Neurology (V.V.P., P.M.), Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Neuroimaging Research Unit (M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Translational Neuroradiology Section (D.S.R.), National Institute of Neurological Disorders and Stroke (NINDS), National In-stitutes of Health (NIH); and Department of Neurology (M.A.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Vincent Van Pesch
- From the Neuroinflammation Imaging Lab (NIL) (S.B., A.S., C.V.B., F.G., P.M.), Institute of NeuroScience, Université catholique de Louvain; Department of Neurology (S.B., S.E.), Hôpital Erasme, Hôpital Universitaire de Bruxelles; Department of Neurology (S.B.), Centre Hospitalier Universitaire Brugmann, Université Libre de Brussels, Belgium; Neurology Unit (M.S.M., V.M., M.F.), IRCCS San Raffaele Hospital, Milan, Italy; ICTEAM Institute (C.V.B.), Université catholique de Louvain, Louvain-la-Neuve, Belgium; Vita-Salute San Raffaele University (E.P., M.F., M.A.); Translational Neuropathology Unit (E.P., M.A.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Plateforme technologique de Support en Méthodologie et Calcul Statistique (C.B.); Department of Internal Medicine and Infectious Diseases (H.Y., L.P.), Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Section of Infections of the Nervous System (B.S.); Viral Immunology Section (S.J.), National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD; Neurology Service (R.A.D.P., P.M.), Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Switzerland; Department of Neurology (V.V.P., P.M.), Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Neuroimaging Research Unit (M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Translational Neuroradiology Section (D.S.R.), National Institute of Neurological Disorders and Stroke (NINDS), National In-stitutes of Health (NIH); and Department of Neurology (M.A.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Massimo Filippi
- From the Neuroinflammation Imaging Lab (NIL) (S.B., A.S., C.V.B., F.G., P.M.), Institute of NeuroScience, Université catholique de Louvain; Department of Neurology (S.B., S.E.), Hôpital Erasme, Hôpital Universitaire de Bruxelles; Department of Neurology (S.B.), Centre Hospitalier Universitaire Brugmann, Université Libre de Brussels, Belgium; Neurology Unit (M.S.M., V.M., M.F.), IRCCS San Raffaele Hospital, Milan, Italy; ICTEAM Institute (C.V.B.), Université catholique de Louvain, Louvain-la-Neuve, Belgium; Vita-Salute San Raffaele University (E.P., M.F., M.A.); Translational Neuropathology Unit (E.P., M.A.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Plateforme technologique de Support en Méthodologie et Calcul Statistique (C.B.); Department of Internal Medicine and Infectious Diseases (H.Y., L.P.), Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Section of Infections of the Nervous System (B.S.); Viral Immunology Section (S.J.), National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD; Neurology Service (R.A.D.P., P.M.), Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Switzerland; Department of Neurology (V.V.P., P.M.), Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Neuroimaging Research Unit (M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Translational Neuroradiology Section (D.S.R.), National Institute of Neurological Disorders and Stroke (NINDS), National In-stitutes of Health (NIH); and Department of Neurology (M.A.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Daniel S Reich
- From the Neuroinflammation Imaging Lab (NIL) (S.B., A.S., C.V.B., F.G., P.M.), Institute of NeuroScience, Université catholique de Louvain; Department of Neurology (S.B., S.E.), Hôpital Erasme, Hôpital Universitaire de Bruxelles; Department of Neurology (S.B.), Centre Hospitalier Universitaire Brugmann, Université Libre de Brussels, Belgium; Neurology Unit (M.S.M., V.M., M.F.), IRCCS San Raffaele Hospital, Milan, Italy; ICTEAM Institute (C.V.B.), Université catholique de Louvain, Louvain-la-Neuve, Belgium; Vita-Salute San Raffaele University (E.P., M.F., M.A.); Translational Neuropathology Unit (E.P., M.A.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Plateforme technologique de Support en Méthodologie et Calcul Statistique (C.B.); Department of Internal Medicine and Infectious Diseases (H.Y., L.P.), Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Section of Infections of the Nervous System (B.S.); Viral Immunology Section (S.J.), National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD; Neurology Service (R.A.D.P., P.M.), Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Switzerland; Department of Neurology (V.V.P., P.M.), Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Neuroimaging Research Unit (M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Translational Neuroradiology Section (D.S.R.), National Institute of Neurological Disorders and Stroke (NINDS), National In-stitutes of Health (NIH); and Department of Neurology (M.A.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Martina Absinta
- From the Neuroinflammation Imaging Lab (NIL) (S.B., A.S., C.V.B., F.G., P.M.), Institute of NeuroScience, Université catholique de Louvain; Department of Neurology (S.B., S.E.), Hôpital Erasme, Hôpital Universitaire de Bruxelles; Department of Neurology (S.B.), Centre Hospitalier Universitaire Brugmann, Université Libre de Brussels, Belgium; Neurology Unit (M.S.M., V.M., M.F.), IRCCS San Raffaele Hospital, Milan, Italy; ICTEAM Institute (C.V.B.), Université catholique de Louvain, Louvain-la-Neuve, Belgium; Vita-Salute San Raffaele University (E.P., M.F., M.A.); Translational Neuropathology Unit (E.P., M.A.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Plateforme technologique de Support en Méthodologie et Calcul Statistique (C.B.); Department of Internal Medicine and Infectious Diseases (H.Y., L.P.), Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Section of Infections of the Nervous System (B.S.); Viral Immunology Section (S.J.), National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD; Neurology Service (R.A.D.P., P.M.), Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Switzerland; Department of Neurology (V.V.P., P.M.), Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Neuroimaging Research Unit (M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Translational Neuroradiology Section (D.S.R.), National Institute of Neurological Disorders and Stroke (NINDS), National In-stitutes of Health (NIH); and Department of Neurology (M.A.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Pietro Maggi
- From the Neuroinflammation Imaging Lab (NIL) (S.B., A.S., C.V.B., F.G., P.M.), Institute of NeuroScience, Université catholique de Louvain; Department of Neurology (S.B., S.E.), Hôpital Erasme, Hôpital Universitaire de Bruxelles; Department of Neurology (S.B.), Centre Hospitalier Universitaire Brugmann, Université Libre de Brussels, Belgium; Neurology Unit (M.S.M., V.M., M.F.), IRCCS San Raffaele Hospital, Milan, Italy; ICTEAM Institute (C.V.B.), Université catholique de Louvain, Louvain-la-Neuve, Belgium; Vita-Salute San Raffaele University (E.P., M.F., M.A.); Translational Neuropathology Unit (E.P., M.A.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Plateforme technologique de Support en Méthodologie et Calcul Statistique (C.B.); Department of Internal Medicine and Infectious Diseases (H.Y., L.P.), Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Section of Infections of the Nervous System (B.S.); Viral Immunology Section (S.J.), National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD; Neurology Service (R.A.D.P., P.M.), Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Switzerland; Department of Neurology (V.V.P., P.M.), Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Neuroimaging Research Unit (M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Translational Neuroradiology Section (D.S.R.), National Institute of Neurological Disorders and Stroke (NINDS), National In-stitutes of Health (NIH); and Department of Neurology (M.A.), Johns Hopkins University School of Medicine, Baltimore, MD
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Levit E, Ren Z, Gonzenbach V, Azevedo CJ, Calabresi PA, Cree BA, Freeman L, Longbrake EE, Oh J, Schindler MK, Sicotte NL, Reich DS, Ontaneda D, Sati P, Cao Q, Shinohara RT, Solomon AJ. Choroid plexus volume differentiates MS from its mimics. Mult Scler 2024; 30:1072-1076. [PMID: 38481081 PMCID: PMC11288781 DOI: 10.1177/13524585241238094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/31/2024]
Abstract
This study aimed to determine whether choroid plexus volume (CPV) could differentiate multiple sclerosis (MS) from its mimics. A secondary analysis of two previously enrolled studies, 50 participants with MS and 64 with alternative diagnoses were included. CPV was automatically segmented from 3T magnetic resonance imaging (MRI), followed by manual review to remove misclassified tissue. Mean normalized choroid plexus volume (nCPV) to intracranial volume demonstrated relatively high specificity for MS participants in each cohort (0.80 and 0.76) with an area under the receiver-operator characteristic curve of 0.71 (95% confidence interval (CI) = 0.55-0.87) and 0.65 (95% CI = 0.52-0.77). In this preliminary study, nCPV differentiated MS from its mimics.
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Affiliation(s)
- Elle Levit
- Department of Neurological Sciences, Larner College of Medicine, The University of Vermont, Burlington, VT, USA
- The University of Vermont Medical Center, Burlington, VT, USA
| | - Zheng Ren
- Penn Statistics in Imaging and Visualization Center (PennSIVE), Department of Biostatistics, Epidemiology and Informatics and Center for Biomedical Image Computing and Analytics, Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Virgilio Gonzenbach
- Penn Statistics in Imaging and Visualization Center (PennSIVE), Department of Biostatistics, Epidemiology and Informatics and Center for Biomedical Image Computing and Analytics, Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Christina J Azevedo
- Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Peter A Calabresi
- Departments of Neurology and Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Bruce Ac Cree
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Leorah Freeman
- Dell Medical School, The University of Texas at Austin, Austin, TX, USA
| | | | - Jiwon Oh
- Division of Neurology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Matthew K Schindler
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Nancy L Sicotte
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Daniel S Reich
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Daniel Ontaneda
- Mellen Center for Multiple Sclerosis, Cleveland Clinic, Cleveland, OH, USA
| | - Pascal Sati
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Quy Cao
- Penn Statistics in Imaging and Visualization Center (PennSIVE), Department of Biostatistics, Epidemiology and Informatics and Center for Biomedical Image Computing and Analytics, Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Russell T Shinohara
- Penn Statistics in Imaging and Visualization Center (PennSIVE), Department of Biostatistics, Epidemiology and Informatics and Center for Biomedical Image Computing and Analytics, Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Andrew J Solomon
- Department of Neurological Sciences, Larner College of Medicine, The University of Vermont, Burlington, VT, USA
- The University of Vermont Medical Center, Burlington, VT, USA
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Rimkus CDM, Otsuka FS, Nunes DM, Chaim KT, Otaduy MCG. Central Vein Sign and Paramagnetic Rim Lesions: Susceptibility Changes in Brain Tissues and Their Implications for the Study of Multiple Sclerosis Pathology. Diagnostics (Basel) 2024; 14:1362. [PMID: 39001252 PMCID: PMC11240827 DOI: 10.3390/diagnostics14131362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Revised: 05/29/2024] [Accepted: 06/03/2024] [Indexed: 07/16/2024] Open
Abstract
Multiple sclerosis (MS) is the most common acquired inflammatory and demyelinating disease in adults. The conventional diagnostic of MS and the follow-up of inflammatory activity is based on the detection of hyperintense foci in T2 and fluid-attenuated inversion recovery (FLAIR) magnetic resonance imaging (MRI) and lesions with brain-blood barrier (BBB) disruption in the central nervous system (CNS) parenchyma. However, T2/FLAIR hyperintense lesions are not specific to MS and the MS pathology and inflammatory processes go far beyond focal lesions and can be independent of BBB disruption. MRI techniques based on the magnetic susceptibility properties of the tissue, such as T2*, susceptibility-weighted images (SWI), and quantitative susceptibility mapping (QSM) offer tools for advanced MS diagnostic, follow-up, and the assessment of more detailed features of MS dynamic pathology. Susceptibility-weighted techniques are sensitive to the paramagnetic components of biological tissues, such as deoxyhemoglobin. This capability enables the visualization of brain parenchymal veins. Consequently, it presents an opportunity to identify veins within the core of multiple sclerosis (MS) lesions, thereby affirming their venocentric characteristics. This advancement significantly enhances the accuracy of the differential diagnostic process. Another important paramagnetic component in biological tissues is iron. In MS, the dynamic trafficking of iron between different cells, such as oligodendrocytes, astrocytes, and microglia, enables the study of different stages of demyelination and remyelination. Furthermore, the accumulation of iron in activated microglia serves as an indicator of latent inflammatory activity in chronic MS lesions, termed paramagnetic rim lesions (PRLs). PRLs have been correlated with disease progression and degenerative processes, underscoring their significance in MS pathology. This review will elucidate the underlying physical principles of magnetic susceptibility and their implications for the formation and interpretation of T2*, SWI, and QSM sequences. Additionally, it will explore their applications in multiple sclerosis (MS), particularly in detecting the central vein sign (CVS) and PRLs, and assessing iron metabolism. Furthermore, the review will discuss their role in advancing early and precise MS diagnosis and prognostic evaluation, as well as their utility in studying chronic active inflammation and degenerative processes.
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Affiliation(s)
- Carolina de Medeiros Rimkus
- Department of Radiology and Oncology, Hospital das Clínicas da Faculdade de Medicina da Universidade de Sao Paulo (HCFMUSP), Sao Paulo 05403-010, SP, Brazil
- Laboratory of Medical Investigation in Magnetic Resonance-44 (LIM 44), University of Sao Paulo, Sao Paulo 05403-000, SP, Brazil
- MS Center Amsterdam, Anatomy and Neurosciences, Vrije Universiteit Amsterdam, Amsterdam UMC, Location VUmc, 1081 HV Amsterdam, The Netherlands
- Instituto D'Or de Ensino e Pesquisa (IDOR), Sao Paulo 01401-002, SP, Brazil
| | - Fábio Seiji Otsuka
- Laboratory of Medical Investigation in Magnetic Resonance-44 (LIM 44), University of Sao Paulo, Sao Paulo 05403-000, SP, Brazil
| | - Douglas Mendes Nunes
- Department of Radiology and Oncology, Hospital das Clínicas da Faculdade de Medicina da Universidade de Sao Paulo (HCFMUSP), Sao Paulo 05403-010, SP, Brazil
- Grupo Fleury, Sao Paulo 04701-200, SP, Brazil
| | - Khallil Taverna Chaim
- Laboratory of Medical Investigation in Magnetic Resonance-44 (LIM 44), University of Sao Paulo, Sao Paulo 05403-000, SP, Brazil
| | - Maria Concepción Garcia Otaduy
- Department of Radiology and Oncology, Hospital das Clínicas da Faculdade de Medicina da Universidade de Sao Paulo (HCFMUSP), Sao Paulo 05403-010, SP, Brazil
- Laboratory of Medical Investigation in Magnetic Resonance-44 (LIM 44), University of Sao Paulo, Sao Paulo 05403-000, SP, Brazil
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Landes-Chateau C, Levraut M, Okuda DT, Themelin A, Cohen M, Kantarci OH, Siva A, Pelletier D, Mondot L, Lebrun-Frenay C. The diagnostic value of the central vein sign in radiologically isolated syndrome. Ann Clin Transl Neurol 2024; 11:662-672. [PMID: 38186317 DOI: 10.1002/acn3.51986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 12/15/2023] [Accepted: 12/16/2023] [Indexed: 01/09/2024] Open
Abstract
OBJECTIVE The radiologically isolated syndrome (RIS) represents the earliest detectable preclinical phase of multiple sclerosis (MS). Increasing evidence suggests that the central vein sign (CVS) enhances lesion specificity, allowing for greater MS diagnostic accuracy. This study evaluated the diagnostic performance of the CVS in RIS. METHODS Patients were prospectively recruited in a single tertiary center for MS care. Participants with RIS were included and compared to a control group of sex and age-matched subjects. All participants underwent 3 Tesla magnetic resonance imaging, including postcontrast susceptibility-based sequences, and the presence of CVS was analyzed. Sensitivity and specificity were assessed for different CVS lesion criteria, defined by proportions of lesions positive for CVS (CVS+) or by the absolute number of CVS+ lesions. RESULTS 180 participants (45 RIS, 45 MS, 90 non-MS) were included, representing 5285 white matter lesions. Among them, 4608 were eligible for the CVS assessment (970 in RIS, 1378 in MS, and 2260 in non-MS). According to independent ROC comparisons, the proportion of CVS+ lesions performed similarly in diagnosing RIS from non-MS than MS from non-MS (p = 0.837). When a 6-lesion CVS+ threshold was applied, RIS lesions could be diagnosed with an accuracy of 87%. MS could be diagnosed with a sensitivity of 98% and a specificity of 83%. Adding OCBs or Kappa index to CVS biomarker increased the specificity to 100% for RIS diagnosis. INTERPRETATION This study shows evidence that CVS is an effective imaging biomarker in differentiating RIS from non-MS, with similar performances to those in MS.
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Affiliation(s)
| | - Michael Levraut
- Université Cote d'Azur, UMR2CA (URRIS), Nice, France
- Service de Médecine Interne, Centre Hospitalier Universitaire de Nice, Hôpital l'Archet 1, Nice, France
| | - Darin T Okuda
- The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Albert Themelin
- Service de Radiologie, Centre Hospitalier Universitaire de Nice, Hôpital Pasteur 2, Nice, France
| | - Mikael Cohen
- Université Cote d'Azur, UMR2CA (URRIS), Nice, France
- Service de Neurologie, Centre de Ressource et de Compétence Sclérose en Plaques (CRC-SEP), Centre Hospitalier Universitaire de Nice, Hôpital Pasteur 2, Nice, France
| | | | - Aksel Siva
- Istanbul University, Cerrahpasa School of Medicine, Istanbul, Turkey
| | | | - Lydiane Mondot
- Université Cote d'Azur, UMR2CA (URRIS), Nice, France
- Service de Radiologie, Centre Hospitalier Universitaire de Nice, Hôpital Pasteur 2, Nice, France
| | - Christine Lebrun-Frenay
- Université Cote d'Azur, UMR2CA (URRIS), Nice, France
- Service de Neurologie, Centre de Ressource et de Compétence Sclérose en Plaques (CRC-SEP), Centre Hospitalier Universitaire de Nice, Hôpital Pasteur 2, Nice, France
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9
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Amin M, Nakamura K, Ontaneda D. Differentiating multiple sclerosis from non-specific white matter changes using a convolutional neural network image classification model. Mult Scler Relat Disord 2024; 82:105420. [PMID: 38183693 DOI: 10.1016/j.msard.2023.105420] [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: 08/14/2023] [Revised: 11/07/2023] [Accepted: 12/30/2023] [Indexed: 01/08/2024]
Abstract
BACKGROUND The diagnosis of multiple sclerosis (MS) relies heavily on neuroimaging with magnetic resonance imaging (MRI) and exclusion of mimics. This can be a challenging task due to radiological overlap in several disorders and may require ancillary testing or longitudinal follow up. One of the most common radiological MS mimickers is non-specific white matter disease (NSWMD). We aimed to develop and evaluate models leveraging machine learning algorithms to help distinguish MS and NSWMD. METHODS All adult patients who underwent MRI brain using a demyelinating protocol with available electronic medical records between 2015 and 2019 at Cleveland Clinic affiliated facilities were included. Diagnosis of MS and NSWMD were assessed from clinical documentation. Those with a diagnosis of MS and NSWMD were matched using total T2 lesion volume (T2LV) and used to train models with logistic regression and convolutional neural networks (CNN). Performance metrices were reported for each model. RESULTS A total of 250 NSWMD MRI scans were identified, and 250 unique MS MRI scans were matched on T2LV. Cross validated logistic regression model was able to use 20 variables (including spinal cord area, regional volumes, and fractions) to predict MS compared to NSWMD with 68.0% accuracy while the CNN model was able to classify MS compared to NSWMD in two independent validation and testing cohorts with 77% and 78% accuracy on average. CONCLUSION Automated methods can be used to differentiate MS compared to NSWMD. These methods can be used to supplement currently available diagnostic tools for patients being evaluated for MS.
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Affiliation(s)
- Moein Amin
- Mellen Center for Multiple Sclerosis Treatment and Research, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Kunio Nakamura
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, Ohio, USA
| | - Daniel Ontaneda
- Mellen Center for Multiple Sclerosis Treatment and Research, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA.
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10
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Kaisey M, Solomon AJ. Multiple Sclerosis Diagnostic Delay and Misdiagnosis. Neurol Clin 2024; 42:1-13. [PMID: 37980109 DOI: 10.1016/j.ncl.2023.07.001] [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] [Indexed: 11/20/2023]
Abstract
Multiple sclerosis (MS) misdiagnosis in the form of an incorrect diagnosis of MS, as well as delayed diagnosis in patients who do have MS, both influence patient clinical outcomes. Contemporary studies have reported data on factors associated with these diagnostic challenges and their frequency. Expediting diagnosis in patients with MS and reducing MS misdiagnosis in patients who do not have MS may be aided by educational efforts surrounding early MS symptoms and proper application of MS diagnostic criteria. Emerging novel MS diagnostic biomarkers may aid early and accurate diagnosis of MS in the future.
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Affiliation(s)
- Marwa Kaisey
- Department of Neurology, Cedars-Sinai Medical Center, 127 South San Vicente Boulevard, A6600, Los Angeles, CA 90048, USA.
| | - Andrew J Solomon
- Department of Neurological Sciences, University of Vermont, Larner College of Medicine, University Health Center, Arnold 2, 1 South Prospect Street, Burlington, VT 05401, USA
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11
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Chertcoff A, Schneider R, Azevedo CJ, Sicotte N, Oh J. Recent Advances in Diagnostic, Prognostic, and Disease-Monitoring Biomarkers in Multiple Sclerosis. Neurol Clin 2024; 42:15-38. [PMID: 37980112 DOI: 10.1016/j.ncl.2023.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2023]
Abstract
Multiple sclerosis (MS) is a highly heterogeneous disease. Currently, a combination of clinical features, MRI, and cerebrospinal fluid markers are used in clinical practice for diagnosis and treatment decisions. In recent years, there has been considerable effort to develop novel biomarkers that better reflect the pathologic substrates of the disease to aid in diagnosis and early prognosis, evaluation of ongoing inflammatory activity, detection and monitoring of disease progression, prediction of treatment response, and monitoring of disease-modifying treatment safety. In this review, the authors provide an overview of promising recent developments in diagnostic, prognostic, and disease-monitoring/treatment-response biomarkers in MS.
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Affiliation(s)
- Anibal Chertcoff
- Division of Neurology, Department of Medicine, St. Michael's Hospital, University of Toronto, 30 Bond Street, PGT 17-742, Toronto, Ontario M5B 1W8, Canada
| | - Raphael Schneider
- Division of Neurology, Department of Medicine, St. Michael's Hospital, University of Toronto, 30 Bond Street, PGT 17-742, Toronto, Ontario M5B 1W8, Canada
| | - Christina J Azevedo
- Department of Neurology, Keck School of Medicine, University of Southern California, HCT 1520 San Pablo Street, Health Sciences Campus, Los Angeles, CA 90033, USA
| | - Nancy Sicotte
- Department of Neurology, Cedars-Sinai Medical Center, 127 S San Vicente Boulevard, 6th floor, Suite A6600, Los Angeles, CA 90048, USA
| | - Jiwon Oh
- Division of Neurology, Department of Medicine, St. Michael's Hospital, University of Toronto, 30 Bond Street, PGT 17-742, Toronto, Ontario M5B 1W8, Canada; Department of Neurology, Johns Hopkins University, Baltimore, MD, USA.
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12
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Daboul L, O’Donnell CM, Amin M, Rodrigues P, Derbyshire J, Azevedo C, Bar-Or A, Caverzasi E, Calabresi PA, Cree BA, Freeman L, Henry RG, Longbrake EE, Oh J, Papinutto N, Pelletier D, Prchkovska V, Raza P, Ramos M, Samudralwar RD, Schindler MK, Sotirchos ES, Sicotte NL, Solomon AJ, Shinohara RT, Reich DS, Sati P, Ontaneda D. A multicenter pilot study evaluating simplified central vein assessment for the diagnosis of multiple sclerosis. Mult Scler 2024; 30:25-34. [PMID: 38088067 PMCID: PMC11037932 DOI: 10.1177/13524585231214360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
BACKGROUND The central vein sign (CVS) is a proposed magnetic resonance imaging (MRI) biomarker for multiple sclerosis (MS); the optimal method for abbreviated CVS scoring is not yet established. OBJECTIVE The aim of this study was to evaluate the performance of a simplified approach to CVS assessment in a multicenter study of patients being evaluated for suspected MS. METHODS Adults referred for possible MS to 10 sites were recruited. A post-Gd 3D T2*-weighted MRI sequence (FLAIR*) was obtained in each subject. Trained raters at each site identified up to six CVS-positive lesions per FLAIR* scan. Diagnostic performance of CVS was evaluated for a diagnosis of MS which had been confirmed using the 2017 McDonald criteria at thresholds including three positive lesions (Select-3*) and six positive lesions (Select-6*). Inter-rater reliability assessments were performed. RESULTS Overall, 78 participants were analyzed; 37 (47%) were diagnosed with MS, and 41 (53%) were not. The mean age of participants was 45 (range: 19-64) years, and most were female (n = 55, 71%). The area under the receiver operating characteristic curve (AUROC) for the simplified counting method was 0.83 (95% CI: 0.73-0.93). Select-3* and Select-6* had sensitivity of 81% and 65% and specificity of 68% and 98%, respectively. Inter-rater agreement was 78% for Select-3* and 83% for Select-6*. CONCLUSION A simplified method for CVS assessment in patients referred for suspected MS demonstrated good diagnostic performance and inter-rater agreement.
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Affiliation(s)
- Lynn Daboul
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD
- Cleveland Clinic Lerner College of Medicine, Cleveland, OH
| | - Carly M. O’Donnell
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Moein Amin
- Neurological Institute, Cleveland Clinic, Cleveland, OH
| | | | - John Derbyshire
- Functional MRI Facility, NIMH, National Institutes of Health, Bethesda, MD
| | - Christina Azevedo
- Department of Neurology, University of Southern California, Los Angeles, CA
| | - Amit Bar-Or
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Eduardo Caverzasi
- Department of Neurology, University of California at San Francisco, San Francisco, CA
| | | | - Bruce A.C. Cree
- Department of Neurology, University of California at San Francisco, San Francisco, CA
| | - Leorah Freeman
- Department of Neurology, Dell Medical School, The University of Texas, Austin, TX
| | - Roland G. Henry
- Department of Neurology, University of California at San Francisco, San Francisco, CA
| | | | - Jiwon Oh
- Division of Neurology, St. Michael’s Hospital, University of Toronto, Toronto, ON, CANADA
| | - Nico Papinutto
- Department of Neurology, University of California at San Francisco, San Francisco, CA
| | - Daniel Pelletier
- Department of Neurology, University of Southern California, Los Angeles, CA
| | | | - Praneeta Raza
- Cleveland Clinic Lerner College of Medicine, Cleveland, OH
| | - Marc Ramos
- QMENTA Cloud Platform, QMENTA Inc., Boston, MA, USA
| | | | - Matthew K. Schindler
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | | | - Nancy L. Sicotte
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Andrew J. Solomon
- Department of Neurological Sciences, Larner College of Medicine, The University of Vermont, Burlington, VT
| | - Russell T. Shinohara
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Daniel S. Reich
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD
| | - Pascal Sati
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Daniel Ontaneda
- Mellen Center for Multiple Sclerosis, Cleveland Clinic, Cleveland, OH
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13
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Cacciaguerra L, Rocca MA, Filippi M. Understanding the Pathophysiology and Magnetic Resonance Imaging of Multiple Sclerosis and Neuromyelitis Optica Spectrum Disorders. Korean J Radiol 2023; 24:1260-1283. [PMID: 38016685 DOI: 10.3348/kjr.2023.0360] [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: 04/26/2023] [Revised: 08/09/2023] [Accepted: 08/21/2023] [Indexed: 11/30/2023] Open
Abstract
Magnetic resonance imaging (MRI) has been extensively applied in the study of multiple sclerosis (MS), substantially contributing to diagnosis, differential diagnosis, and disease monitoring. MRI studies have significantly contributed to the understanding of MS through the characterization of typical radiological features and their clinical or prognostic implications using conventional MRI pulse sequences and further with the application of advanced imaging techniques sensitive to microstructural damage. Interpretation of results has often been validated by MRI-pathology studies. However, the application of MRI techniques in the study of neuromyelitis optica spectrum disorders (NMOSD) remains an emerging field, and MRI studies have focused on radiological correlates of NMOSD and its pathophysiology to aid in diagnosis, improve monitoring, and identify relevant prognostic factors. In this review, we discuss the main contributions of MRI to the understanding of MS and NMOSD, focusing on the most novel discoveries to clarify differences in the pathophysiology of focal inflammation initiation and perpetuation, involvement of normal-appearing tissue, potential entry routes of pathogenic elements into the CNS, and existence of primary or secondary mechanisms of neurodegeneration.
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Affiliation(s)
- Laura Cacciaguerra
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Maria A Rocca
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milano, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy
- Vita-Salute San Raffaele University, Milano, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milano, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy
- Vita-Salute San Raffaele University, Milano, Italy
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milano, Italy.
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14
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Carnero Contentti E, Okuda DT, Rojas JI, Chien C, Paul F, Alonso R. MRI to differentiate multiple sclerosis, neuromyelitis optica, and myelin oligodendrocyte glycoprotein antibody disease. J Neuroimaging 2023; 33:688-702. [PMID: 37322542 DOI: 10.1111/jon.13137] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 05/31/2023] [Accepted: 06/05/2023] [Indexed: 06/17/2023] Open
Abstract
Differentiating multiple sclerosis (MS) from other relapsing inflammatory autoimmune diseases of the central nervous system such as neuromyelitis optica spectrum disorder (NMOSD) and myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is crucial in clinical practice. The differential diagnosis may be challenging but making the correct ultimate diagnosis is critical, since prognosis and treatments differ, and inappropriate therapy may promote disability. In the last two decades, significant advances have been made in MS, NMOSD, and MOGAD including new diagnostic criteria with better characterization of typical clinical symptoms and suggestive imaging (magnetic resonance imaging [MRI]) lesions. MRI is invaluable in making the ultimate diagnosis. An increasing amount of new evidence with respect to the specificity of observed lesions as well as the associated dynamic changes in the acute and follow-up phase in each condition has been reported in distinct studies recently published. Additionally, differences in brain (including the optic nerve) and spinal cord lesion patterns between MS, aquaporin4-antibody-positive NMOSD, and MOGAD have been described. We therefore present a narrative review on the most relevant findings in brain, spinal cord, and optic nerve lesions on conventional MRI for distinguishing adult patients with MS from NMOSD and MOGAD in clinical practice. In this context, cortical and central vein sign lesions, brain and spinal cord lesions characteristic of MS, NMOSD, and MOGAD, optic nerve involvement, role of MRI at follow-up, and new proposed diagnostic criteria to differentiate MS from NMOSD and MOGAD were discussed.
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Affiliation(s)
| | - Darin T Okuda
- Department of Neurology, Neuroinnovation Program, Multiple Sclerosis & Neuroimmunology Imaging Program, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Juan I Rojas
- Centro de esclerosis múltiple de Buenos Aires, Buenos Aires, Argentina
| | - Claudia Chien
- NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Friedemman Paul
- NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Ricardo Alonso
- Centro Universitario de Esclerosis Múltiple (CUEM), Hospital Ramos Mejía, Buenos Aires, Argentina
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15
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Harrison KL, Gaudioso C, Levasseur VA, Dunham SR, Schanzer N, Keuchel C, Salter A, Goyal MS, Mar S. Central Vein Sign in Pediatric Multiple Sclerosis and Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease. Pediatr Neurol 2023; 146:21-25. [PMID: 37406422 DOI: 10.1016/j.pediatrneurol.2023.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 05/17/2023] [Accepted: 05/18/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND The central vein sign (CVS) on brain magnetic resonance imaging (MRI) is a promising diagnostic marker for distinguishing adult multiple sclerosis (MS) from other demyelinating conditions, but its prevalence is not well-established in pediatric-onset multiple sclerosis (POMS) versus myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD). MOGAD can mimic MS radiologically. This study seeks to determine the utility of CVS, together with other radiological findings, in distinguishing POMS from MOGAD in children. METHODS Children with POMS or MOGAD were identified in a pediatric demyelinating database. Two reviewers, blinded to diagnosis, fused fluid-attenuated inversion recovery sequences and susceptibility-weighted imaging from clinical imaging to identify CVS. Agreement in CVS number was reported using intraclass correlation coefficients (ICC). We performed topographic analyses as well as characterization of the clinical information and lesions on brain, spinal cord, and orbital MRI when available. RESULTS Twenty children, 10 with POMS and 10 with MOGAD, were assessed. The median lesion percentage of CVS was higher in POMS versus MOGAD for both raters (rater 1: 80% vs 9.8%; rater 2: 22.7% vs 7.5%). Inter-rater reliability for identifying total white matter lesions was strong (ICC 0.94 [95% confidence interval [CI] 0.84, 0.97]); however, it was poor for detecting CVS lesions (ICC -0.17 [95% CI: -0.37, 0.58]). CONCLUSION The CVS can be a useful diagnostic tool for differentiating POMS from MOGAD. However, advanced clinical imaging tools that can better detect CVS are needed to increase inter-rater reliability before clinical application.
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Affiliation(s)
- Kimystian L Harrison
- Department of Neurology, Washington University in St. Louis School of Medicine, St. Louis, Missouri.
| | - Cristina Gaudioso
- Department of Neurology, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Victoria A Levasseur
- Department of Neurology, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - S Richard Dunham
- Department of Neurology, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Natalie Schanzer
- Department of Neurology, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Connor Keuchel
- Department of Neurology, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Amber Salter
- Department of Biostatistics, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Manu S Goyal
- Department of Neurology, Washington University in St. Louis School of Medicine, St. Louis, Missouri; Department of Radiology, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Soe Mar
- Department of Neurology, Washington University in St. Louis School of Medicine, St. Louis, Missouri
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16
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Lapucci C, Tazza F, Rebella S, Boffa G, Sbragia E, Bruschi N, Mancuso E, Mavilio N, Signori A, Roccatagliata L, Cellerino M, Schiavi S, Inglese M. Central vein sign and diffusion MRI differentiate microstructural features within white matter lesions of multiple sclerosis patients with comorbidities. Front Neurol 2023; 14:1084661. [PMID: 36970546 PMCID: PMC10030505 DOI: 10.3389/fneur.2023.1084661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 01/30/2023] [Indexed: 03/29/2023] Open
Abstract
Introduction The Central Vein Sign (CVS) has been suggested as a potential biomarker to improve diagnostic specificity in multiple sclerosis (MS). Nevertheless, the impact of comorbidities on CVS performance has been poorly investigated so far. Despite the similar features shared by MS, migraine and Small Vessel Disease (SVD) at T2-weighted conventional MRI sequences, ex-vivo studies demonstrated their heterogeneous histopathological substrates. If in MS, inflammation, primitive demyelination and axonal loss coexist, in SVD demyelination is secondary to ischemic microangiopathy, while the contemporary presence of inflammatory and ischemic processes has been suggested in migraine. The aims of this study were to investigate the impact of comorbidities (risk factors for SVD and migraine) on the global and subregional assessment of the CVS in a large cohort of MS patients and to apply the Spherical Mean Technique (SMT) diffusion model to evaluate whether perivenular and non-perivenular lesions show distinctive microstructural features. Methods 120 MS patients stratified into 4 Age Groups performed 3T brain MRI. WM lesions were classified in "perivenular" and "non-perivenular" by visual inspection of FLAIR* images; mean values of SMT metrics, indirect estimators of inflammation, demyelination and fiber disruption (EXTRAMD: extraneurite mean diffusivity, EXTRATRANS: extraneurite transverse diffusivity and INTRA: intraneurite signal fraction, respectively) were extracted. Results Of the 5303 lesions selected for the CVS assessment, 68.7% were perivenular. Significant differences were found between perivenular and non-perivenular lesion volume in the whole brain (p < 0.001) and between perivenular and non-perivenular lesion volume and number in all the four subregions (p < 0.001 for all). The percentage of perivenular lesions decreased from youngest to oldest patients (79.7%-57.7%), with the deep/subcortical WM of oldest patients as the only subregion where the number of non-perivenular was higher than the number of perivenular lesions. Older age and migraine were independent predictors of a higher percentage of non-perivenular lesions (p < 0.001 and p = 0.013 respectively). Whole brain perivenular lesions showed higher inflammation, demyelination and fiber disruption than non perivenular lesions (p = 0.001, p = 0.001 and p = 0.02 for EXTRAMD, EXTRATRANS and INTRA respectively). Similar findings were found in the deep/subcortical WM (p = 0.001 for all). Compared to non-perivenular lesions, (i) perivenular lesions located in periventricular areas showed a more severe fiber disruption (p = 0.001), (ii) perivenular lesions located in juxtacortical and infratentorial regions exhibited a higher degree of inflammation (p = 0.01 and p = 0.05 respectively) and (iii) perivenular lesions located in infratentorial areas showed a higher degree of demyelination (p = 0.04). Discussion Age and migraine have a relevant impact in reducing the percentage of perivenular lesions, particularly in the deep/subcortical WM. SMT may differentiate perivenular lesions, characterized by higher inflammation, demyelination and fiber disruption, from non perivenular lesions, where these pathological processes seemed to be less pronounced. The development of new non-perivenular lesions, especially in the deep/subcortical WM of older patients, should be considered a "red flag" for a different -other than MS- pathophysiology.
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Affiliation(s)
- Caterina Lapucci
- HNSR, IRRCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Francesco Tazza
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | | | - Giacomo Boffa
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Elvira Sbragia
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Nicolò Bruschi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Elisabetta Mancuso
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Nicola Mavilio
- Department of Neuroradiology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Alessio Signori
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Luca Roccatagliata
- Department of Neuroradiology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Maria Cellerino
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Simona Schiavi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Matilde Inglese
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino IRCCS, Genoa, Italy
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17
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Bachhuber A. [Diagnostic work-up, findings, and documentation of multiple sclerosis]. RADIOLOGIE (HEIDELBERG, GERMANY) 2023; 63:115-119. [PMID: 36658297 DOI: 10.1007/s00117-022-01104-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/01/2022] [Indexed: 01/21/2023]
Abstract
BACKGROUND Although multiple sclerosis is the most common chronic inflammatory demyelinating disease of the central nervous system, the rate of misdiagnosis in clinical practice is high. This is usually due to the inadequate application of the McDonald criteria and misinterpretation of images. OBJECTIVE This review focuses on typical clinical symptoms, choice of magnetic resonance imaging (MRI) sequences, correct application of the McDonald criteria, and finally interpretation of the images.
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Affiliation(s)
- Armin Bachhuber
- Klinik für Diagnostische und Interventionelle, Neuroradiologie, Universitätsklinikum des Saarlandes, Kirrberger Straße, 66424, Homburg-Saar, Deutschland.
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18
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Daboul L, O'Donnell CM, Cao Q, Amin M, Rodrigues P, Derbyshire J, Azevedo C, Bar-Or A, Caverzasi E, Calabresi P, Cree BAC, Freeman L, Henry RG, Longbrake EE, Nakamura K, Oh J, Papinutto N, Pelletier D, Samudralwar RD, Suthiphosuwan S, Schindler MK, Sotirchos ES, Sicotte NL, Solomon AJ, Shinohara RT, Reich DS, Ontaneda D, Sati P. Effect of GBCA Use on Detection and Diagnostic Performance of the Central Vein Sign: Evaluation Using a 3-T FLAIR* Sequence in Patients With Suspected Multiple Sclerosis. AJR Am J Roentgenol 2023; 220:115-125. [PMID: 35975888 PMCID: PMC10016223 DOI: 10.2214/ajr.22.27731] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND. The central vein sign (CVS) is a proposed MRI biomarker of multiple sclerosis (MS). The impact of gadolinium-based contrast agent (GBCA) administration on CVS evaluation remains poorly investigated. OBJECTIVE. The purpose of this study was to assess the effect of GBCA use on CVS detection and on the diagnostic performance of the CVS for MS using a 3-T FLAIR* sequence. METHODS. This study was a secondary analysis of data from the pilot study for the prospective multicenter Central Vein Sign: A Diagnostic Biomarker in Multiple Sclerosis (CAVS-MS), which recruited adults with suspected MS from April 2018 to February 2020. Participants underwent 3-T brain MRI including FLAIR and precontrast and post-contrast echo-planar imaging T2*-weighted acquisitions. Postprocessing was used to generate combined FLAIR and T2*-weighted images (hereafter, FLAIR*). MS diagnoses were established using the 2017 McDonald criteria. Thirty participants (23 women, seven men; mean age, 45 years) were randomly selected from the CAVS-MS pilot study cohort. White matter lesions (WMLs) were marked using FLAIR* images. A single observer, blinded to clinical data and GBCA use, reviewed marked WMLs on FLAIR* images for the presence of the CVS. RESULTS. Thirteen of 30 participants had MS. Across participants, on precontrast FLAIR* imaging, 218 CVS-positive and 517 CVS-negative WMLs were identified; on post-contrast FLAIR* imaging, 269 CVS-positive and 459 CVS-negative WMLs were identified. The fraction of WMLs that were CVS-positive on precontrast and postcontrast images was 48% and 58% in participants with MS and 7% and 10% in participants without MS, respectively. The median patient-level CVS-positivity rate on precontrast and postcontrast images was 43% and 67% for participants with MS and 4% and 8% for participants without MS, respectively. In a binomial model adjusting for MS diagnoses, GBCA use was associated with an increased likelihood of at least one CVS-positive WML (odds ratio, 1.6; p < .001). At a 40% CVS-positivity threshold, the sensitivity of the CVS for MS increased from 62% on precontrast images to 92% on postcontrast images (p = .046). Specificity was not significantly different between precontrast (88%) and postcontrast (82%) images (p = .32). CONCLUSION. GBCA use increased CVS detection on FLAIR* images, thereby increasing the sensitivity of the CVS for MS diagnoses. CLINICAL IMPACT. The postcontrast FLAIR* sequence should be considered for CVS evaluation in future investigational trials and clinical practice.
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Affiliation(s)
- Lynn Daboul
- Department of Neurology, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD
- Cleveland Clinic Lerner College of Medicine, Cleveland, OH
| | - Carly M O'Donnell
- Department of Biostatistics, Epidemiology, and Informatics, Penn Statistics in Imaging and Visualization Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Quy Cao
- Department of Biostatistics, Epidemiology, and Informatics, Penn Statistics in Imaging and Visualization Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Moein Amin
- Neurological Institute, Cleveland Clinic, Cleveland, OH
| | | | | | - Christina Azevedo
- Department of Neurology, University of Southern California, Los Angeles, CA
| | - Amit Bar-Or
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Eduardo Caverzasi
- Department of Neurology, University of California at San Francisco, San Francisco, CA
| | - Peter Calabresi
- Department of Neurology, Johns Hopkins University, Baltimore, MD
| | - Bruce A C Cree
- Department of Neurology, University of California at San Francisco, San Francisco, CA
| | - Leorah Freeman
- Department of Neurology, Dell Medical School, The University of Texas at Austin, Austin, TX
| | - Roland G Henry
- Department of Neurology, University of California at San Francisco, San Francisco, CA
| | | | - Kunio Nakamura
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH
| | - Jiwon Oh
- Division of Neurology, St. Michael's Hospital, University of Toronto, ON, Canada
| | - Nico Papinutto
- Department of Neurology, University of California at San Francisco, San Francisco, CA
| | - Daniel Pelletier
- Department of Neurology, University of Southern California, Los Angeles, CA
| | - Rohini D Samudralwar
- Department of Neurology, The University of Texas Health Science Center at Houston, Houston, TX
| | - Suradech Suthiphosuwan
- Department of Medical Imaging, St. Michael's Hospital, University of Toronto, ON, Canada
| | - Matthew K Schindler
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | | | - Nancy L Sicotte
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Andrew J Solomon
- Department of Neurological Sciences, Larner College of Medicine, The University of Vermont, Burlington, VT
| | - Russell T Shinohara
- Department of Biostatistics, Epidemiology, and Informatics, Penn Statistics in Imaging and Visualization Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Daniel S Reich
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD
| | - Daniel Ontaneda
- Mellen Center for Multiple Sclerosis, Cleveland Clinic, Cleveland, OH
| | - Pascal Sati
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA
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19
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Present and future of the diagnostic work-up of multiple sclerosis: the imaging perspective. J Neurol 2023; 270:1286-1299. [PMID: 36427168 PMCID: PMC9971159 DOI: 10.1007/s00415-022-11488-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/09/2022] [Accepted: 11/10/2022] [Indexed: 11/26/2022]
Abstract
In recent years, the use of magnetic resonance imaging (MRI) for the diagnostic work-up of multiple sclerosis (MS) has evolved considerably. The 2017 McDonald criteria show high sensitivity and accuracy in predicting a second clinical attack in patients with a typical clinically isolated syndrome and allow an earlier diagnosis of MS. They have been validated, are evidence-based, simplify the clinical use of MRI criteria and improve MS patients' management. However, to limit the risk of misdiagnosis, they should be applied by expert clinicians only after the careful exclusion of alternative diagnoses. Recently, new MRI markers have been proposed to improve diagnostic specificity for MS and reduce the risk of misdiagnosis. The central vein sign and chronic active lesions (i.e., paramagnetic rim lesions) may increase the specificity of MS diagnostic criteria, but further effort is necessary to validate and standardize their assessment before implementing them in the clinical setting. The feasibility of subpial demyelination assessment and the clinical relevance of leptomeningeal enhancement evaluation in the diagnostic work-up of MS appear more limited. Artificial intelligence tools may capture MRI attributes that are beyond the human perception, and, in the future, artificial intelligence may complement human assessment to further ameliorate the diagnostic work-up and patients' classification. However, guidelines that ensure reliability, interpretability, and validity of findings obtained from artificial intelligence approaches are still needed to implement them in the clinical scenario. This review provides a summary of the most recent updates regarding the application of MRI for the diagnosis of MS.
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20
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Martire MS, Moiola L, Rocca MA, Filippi M, Absinta M. What is the potential of paramagnetic rim lesions as diagnostic indicators in multiple sclerosis? Expert Rev Neurother 2022; 22:829-837. [PMID: 36342396 DOI: 10.1080/14737175.2022.2143265] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
INTRODUCTION In multiple sclerosis (MS), paramagnetic rim lesions (PRLs) on MRI identify a subset of chronic active lesions (CALs), which have been linked through clinical and pathological studies to more severe disease course and greater disability accumulation. Beside their prognostic relevance, increasing evidence supports the use of PRL as a diagnostic biomarker. AREAS COVERED This review summarizes the most recent updates regarding the MRI pathophysiology of PRL, their prevalence in MS (by clinical phenotypes) vs mimicking conditions, and their potential role as diagnostic MS biomarkers. We searched PubMed with terms including 'multiple sclerosis' AND 'paramagnetic rim lesions' OR 'iron rim lesions' OR 'rim lesions' for manuscripts published between January 2008 and July 2022. EXPERT OPINION Current research suggests that PRL can improve the diagnostic specificity and the overall accuracy of MS diagnosis when used together with the dissemination in space MRI criteria and the central vein sign. Nevertheless, future prospective multicenter studies should further define the real-world prevalence and specificity of PRL. International guidelines are needed to establish methodological criteria for PRL identification before its implementation into clinical practice.
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Affiliation(s)
| | - Lucia Moiola
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria Assunta Rocca
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Division of Neuroscience, Vita-Salute San Raffaele University, Milan, Italy
| | - Massimo Filippi
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Division of Neuroscience, Vita-Salute San Raffaele University, Milan, Italy.,Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Martina Absinta
- Division of Neuroscience, Vita-Salute San Raffaele University, Milan, Italy.,Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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21
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La Rosa F, Wynen M, Al-Louzi O, Beck ES, Huelnhagen T, Maggi P, Thiran JP, Kober T, Shinohara RT, Sati P, Reich DS, Granziera C, Absinta M, Bach Cuadra M. Cortical lesions, central vein sign, and paramagnetic rim lesions in multiple sclerosis: Emerging machine learning techniques and future avenues. Neuroimage Clin 2022; 36:103205. [PMID: 36201950 PMCID: PMC9668629 DOI: 10.1016/j.nicl.2022.103205] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 09/09/2022] [Accepted: 09/16/2022] [Indexed: 12/14/2022]
Abstract
The current diagnostic criteria for multiple sclerosis (MS) lack specificity, and this may lead to misdiagnosis, which remains an issue in present-day clinical practice. In addition, conventional biomarkers only moderately correlate with MS disease progression. Recently, some MS lesional imaging biomarkers such as cortical lesions (CL), the central vein sign (CVS), and paramagnetic rim lesions (PRL), visible in specialized magnetic resonance imaging (MRI) sequences, have shown higher specificity in differential diagnosis. Moreover, studies have shown that CL and PRL are potential prognostic biomarkers, the former correlating with cognitive impairments and the latter with early disability progression. As machine learning-based methods have achieved extraordinary performance in the assessment of conventional imaging biomarkers, such as white matter lesion segmentation, several automated or semi-automated methods have been proposed as well for CL, PRL, and CVS. In the present review, we first introduce these MS biomarkers and their imaging methods. Subsequently, we describe the corresponding machine learning-based methods that were proposed to tackle these clinical questions, putting them into context with respect to the challenges they are facing, including non-standardized MRI protocols, limited datasets, and moderate inter-rater variability. We conclude by presenting the current limitations that prevent their broader deployment and suggesting future research directions.
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Key Words
- ms, multiple sclerosis
- mri, magnetic resonance imaging
- dl, deep learning
- ml, machine learning
- cl, cortical lesions
- prl, paramagnetic rim lesions
- cvs, central vein sign
- wml, white matter lesions
- flair, fluid-attenuated inversion recovery
- mprage, magnetization prepared rapid gradient-echo
- gm, gray matter
- wm, white matter
- psir, phase-sensitive inversion recovery
- dir, double inversion recovery
- mp2rage, magnetization-prepared 2 rapid gradient echoes
- sels, slowly evolving/expanding lesions
- cnn, convolutional neural network
- xai, explainable ai
- pv, partial volume
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Affiliation(s)
- Francesco La Rosa
- Signal Processing Laboratory (LTS5), Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland; CIBM Center for Biomedical Imaging, Switzerland; Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Maxence Wynen
- CIBM Center for Biomedical Imaging, Switzerland; ICTeam, UCLouvain, Louvain-la-Neuve, Belgium; Louvain Inflammation Imaging Lab (NIL), Institute of Neuroscience (IoNS), UCLouvain, Brussels, Belgium; Radiology Department, Lausanne University and University Hospital, Switzerland
| | - Omar Al-Louzi
- Translational Neuroradiology Section, 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
| | - Erin S Beck
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Till Huelnhagen
- Signal Processing Laboratory (LTS5), Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland; Radiology Department, Lausanne University and University Hospital, Switzerland; Advanced Clinical Imaging Technology, Siemens Healthcare AG, Lausanne, Switzerland
| | - Pietro Maggi
- Louvain Inflammation Imaging Lab (NIL), Institute of Neuroscience (IoNS), UCLouvain, Brussels, Belgium; Department of Neurology, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Department of Neurology, CHUV, Lausanne, Switzerland
| | - Jean-Philippe Thiran
- Signal Processing Laboratory (LTS5), Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland; CIBM Center for Biomedical Imaging, Switzerland; Radiology Department, Lausanne University and University Hospital, Switzerland
| | - Tobias Kober
- Signal Processing Laboratory (LTS5), Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland; Radiology Department, Lausanne University and University Hospital, Switzerland; Advanced Clinical Imaging Technology, Siemens Healthcare AG, Lausanne, Switzerland
| | - Russell T Shinohara
- Center for Biomedical Image Computing and Analysis (CBICA), Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA; Penn Statistics in Imaging and Visualization Endeavor (PennSIVE), Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, USA; Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Pascal Sati
- Translational Neuroradiology Section, 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
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Cristina Granziera
- Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel, Switzerland; Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
| | - Martina Absinta
- IRCCS San Raffaele Hospital and Vita-Salute San Raffaele University, Milan, Italy; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Meritxell Bach Cuadra
- CIBM Center for Biomedical Imaging, Switzerland; Radiology Department, Lausanne University and University Hospital, Switzerland
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22
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Kolb H, Al-Louzi O, Beck ES, Sati P, Absinta M, Reich DS. From pathology to MRI and back: Clinically relevant biomarkers of multiple sclerosis lesions. Neuroimage Clin 2022; 36:103194. [PMID: 36170753 PMCID: PMC9668624 DOI: 10.1016/j.nicl.2022.103194] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 09/07/2022] [Accepted: 09/09/2022] [Indexed: 12/14/2022]
Abstract
Focal lesions in both white and gray matter are characteristic of multiple sclerosis (MS). Histopathological studies have helped define the main underlying pathological processes involved in lesion formation and evolution, serving as a gold standard for many years. However, histopathology suffers from an intrinsic bias resulting from over-reliance on tissue samples from late stages of the disease or atypical cases and is inadequate for routine patient assessment. Pathological-radiological correlative studies have established advanced MRI's sensitivity to several relevant MS-pathological substrates and its practicality for assessing dynamic changes and following lesions over time. This review focuses on novel imaging techniques that serve as biomarkers of critical pathological substrates of MS lesions: the central vein, chronic inflammation, remyelination and repair, and cortical lesions. For each pathological process, we address the correlative value of MRI to MS pathology, its contribution in elucidating MS pathology in vivo, and the clinical utility of the imaging biomarker.
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Affiliation(s)
- Hadar Kolb
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD, USA,Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv-Yaffo, Israel,Corresponding author at: Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv-Yaffo, Israel.
| | - Omar Al-Louzi
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD, USA,Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Erin S. Beck
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD, USA,Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Pascal Sati
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD, USA,Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Martina Absinta
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD, USA,Institute of Experimental Neurology (INSPE), IRCSS San Raffaele Hospital and Vita-Salute San Raffaele University, Milan, Italy,Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Daniel S. Reich
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD, USA
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23
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Abstract
PURPOSE OF REVIEW The diagnosis of multiple sclerosis (MS) can be made based on clinical symptoms and signs alone or a combination of clinical and paraclinical features. Diagnostic criteria for MS have evolved over time, and the latest version facilitates earlier diagnosis of MS in those presenting with typical clinical syndromes. This article summarizes the current diagnostic criteria for MS, typical and atypical presentations of MS, and when diagnostic criteria should be applied with caution. RECENT FINDINGS The most recent version of the MS diagnostic criteria has the benefits of simplicity and greater sensitivity in comparison to previous iterations. However, misdiagnosis remains a significant issue in MS clinical care, even at MS specialty centers. It is, therefore, evident that careful clinical application of the current version of the diagnostic criteria is necessary and that tools improving the diagnostic accuracy of MS would be of substantial clinical utility. Emerging diagnostic biomarkers that may be useful in this regard, including the central vein sign, paramagnetic rim lesions, and fluid biomarkers, are discussed. SUMMARY Current MS diagnostic criteria facilitate the early diagnosis of MS in people presenting with typical clinical syndromes but should be used cautiously in those presenting with atypical syndromes and in special populations. Clinical judgment and existing paraclinical tools, including sequential MRIs of the neuraxis and laboratory tests, are useful in minimizing misdiagnosis and facilitating the accurate diagnosis of MS. Diagnostic biomarkers that may facilitate or refute a diagnosis of MS in these settings, and emerging imaging and fluid biomarkers may eventually become available for use in clinical settings.
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24
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Al-Louzi O, Manukyan S, Donadieu M, Absinta M, Letchuman V, Calabresi B, Desai P, Beck ES, Roy S, Ohayon J, Pham DL, Thomas A, Jacobson S, Cortese I, Auluck PK, Nair G, Sati P, Reich DS. Lesion size and shape in central vein sign assessment for multiple sclerosis diagnosis: An in vivo and postmortem MRI study. Mult Scler 2022; 28:1891-1902. [PMID: 35674284 DOI: 10.1177/13524585221097560] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The "central vein sign" (CVS), a linear hypointensity on T2*-weighted imaging corresponding to a central vein/venule, is associated with multiple sclerosis (MS) lesions. The effect of lesion-size exclusion criteria on MS diagnostic accuracy has not been extensively studied. OBJECTIVE Investigate the optimal lesion-size exclusion criteria for CVS use in MS diagnosis. METHODS Cross-sectional study of 163 MS and 51 non-MS, and radiological/histopathological correlation of 5 MS and 1 control autopsy cases. The effects of lesion-size exclusion on MS diagnosis using the CVS, and intralesional vein detection on histopathology were evaluated. RESULTS CVS+ lesions were larger compared to CVS- lesions, with effect modification by MS diagnosis (mean difference +7.7 mm3, p = 0.004). CVS percentage-based criteria with no lesion-size exclusion showed the highest diagnostic accuracy in differentiating MS cases. However, a simple count of three or more CVS+ lesions greater than 3.5 mm is highly accurate and can be rapidly implemented (sensitivity 93%; specificity 88%). On magnetic resonance imaging (MRI)-histopathological correlation, the CVS had high specificity for identifying intralesional veins (0/7 false positives). CONCLUSION Lesion-size measures add important information when using CVS+ lesion counts for MS diagnosis. The CVS is a specific biomarker corresponding to intralesional veins on histopathology.
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Affiliation(s)
- Omar Al-Louzi
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA; Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Sargis Manukyan
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA; Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Maxime Donadieu
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
| | - Martina Absinta
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA; Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD; USA/IRCCS San Raffaele Hospital and Vita-Salute San Raffaele University, Milan, Italy
| | - Vijay Letchuman
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
| | - Brent Calabresi
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
| | - Parth Desai
- Developmental Therapeutics Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Erin S Beck
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA; Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Snehashis Roy
- Section on Neural Function, National Institute of Mental Health, Bethesda, MD, USA
| | - Joan Ohayon
- Neuroimmunology Clinic, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
| | - Dzung L Pham
- Center for Neuroscience and Regenerative Medicine, The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Anish Thomas
- Developmental Therapeutics Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Steven Jacobson
- Viral Immunology Section, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
| | - Irene Cortese
- Neuroimmunology Clinic, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
| | - Pavan K Auluck
- Human Brain Collection Core, National Institute of Mental Health, Bethesda, MD, USA
| | - Govind Nair
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
| | - Pascal Sati
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA; Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Daniel S Reich
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
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25
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Chaaban L, Safwan N, Moussa H, El‐Sammak S, Khoury S, Hannoun S. Central vein sign: A putative diagnostic marker for multiple sclerosis. Acta Neurol Scand 2022; 145:279-287. [PMID: 34796472 DOI: 10.1111/ane.13553] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 10/04/2021] [Accepted: 11/03/2021] [Indexed: 11/29/2022]
Abstract
The presence of a "central vein sign" (CVS) has been introduced as a biomarker for the diagnosis of multiple sclerosis (MS) and shown to have the ability to accurately differentiate MS from other white matter diseases (MS mimics). Following the development of susceptibility-based magnetic resonance venography that allowed the in vivo detection of CVS, a standard CVS definition was established by introducing the "40% rule" that assesses the number of MS lesions with CVS as a fraction of the total number of lesions to differentiate MS lesions from other types of lesions. The "50% rule," the "three-lesion criteria," and the "six-lesion criteria" were later introduced and defined. Each of these rules had high levels of sensitivity, specificity, and accuracy in differentiating MS from other diseases, which has been recognized by the Magnetic Resonance Imaging in MS (MAGNIMS) group and the Consortium of MS Centers task force. The North American Imaging in Multiple Sclerosis Cooperative even provided statements and recommendations aiming to refine, standardize and evaluate the CVS in MS. Herein, we review the existing literature on CVS and evaluate its added value in the diagnosis of MS and usefulness in differentiating it from other vasculopathies. We also review the histopathology of CVS and identify available automated CVS assessment methods as well as define the role of vascular comorbidities in the diagnosis of MS.
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Affiliation(s)
- Lara Chaaban
- Department of Agriculture and Food Sciences American University of Beirut Beirut Lebanon
| | - Nancy Safwan
- Department of Agriculture and Food Sciences American University of Beirut Beirut Lebanon
| | - Hussein Moussa
- Nehme and Therese Tohme Multiple Sclerosis Center American University of Beirut Medical Center Beirut Lebanon
| | - Sally El‐Sammak
- Nehme and Therese Tohme Multiple Sclerosis Center American University of Beirut Medical Center Beirut Lebanon
| | - Samia J. Khoury
- Nehme and Therese Tohme Multiple Sclerosis Center American University of Beirut Medical Center Beirut Lebanon
- Faculty of Medicine Abu‐Haidar Neuroscience Institute American University of Beirut Medical Center Beirut Lebanon
| | - Salem Hannoun
- Nehme and Therese Tohme Multiple Sclerosis Center American University of Beirut Medical Center Beirut Lebanon
- Medical Imaging Sciences Program Division of Health Professions Faculty of Health Sciences American University of Beirut Beirut Lebanon
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Abdel Ghany H, Karam-Allah A, Edward R, Abdel Naseer M, Hegazy MI. Sensitivity and Specificity of Central Vein Sign as a Diagnostic Biomarker in Egyptian Patients with Multiple Sclerosis. Neuropsychiatr Dis Treat 2022; 18:1985-1992. [PMID: 36072679 PMCID: PMC9444024 DOI: 10.2147/ndt.s377877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 08/03/2022] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Magnetic resonance imaging (MRI) findings in multiple sclerosis (MS) overlap with numerous MS mimics. The central vein sign (CVS) can help to differentiate MS from other mimics. This study aimed to determine the value of CVS as a diagnostic biomarker for distinguishing MS from its mimics. PATIENTS AND METHODS Patients were prospectively recruited into two groups: a typical clinical (TC) MS presentation with an atypical MRI for MS and an atypical clinical (ATC) MS presentation with a typical MRI for MS. Patients underwent a 1.5T MRI brain scan with a T2*-weighted gradient-echo sequence. The presence of the central vein was assessed by a radiologist blinded to patients' clinical presentation. The MS consultant made the final diagnosis without reviewing the T2*-weighted gradient-echo sequence or the CVS analysis results. RESULTS Forty-two patients were included. Ten (40%) out of 25 TC patients were diagnosed with clinically definite MS (CDMS), with a mean percentage of CV-positive lesions of 65.5% among CDMS patients. Four (23.5%) out of 17 ATC patients were diagnosed with CDMS with a mean CV-positive lesions percentage of 68.25% among CDMS patients. TC patients who were not diagnosed as CDMS had a mean CV-positive lesions percentage of 10.13%, while ATC patients who were not diagnosed as CDMS had a mean CV-positive lesions percentage of 16.38%. The CVS showed 85.7% sensitivity and 100% specificity (95% confidence interval: 0.919-1.018) for diagnosis of MS at a cut off value of 45% (p < 0.001). The percentage of CV-positive lesions was significantly higher in oligoclonal bands (OCBs) positive patients compared to OCBs negative patients (p < 0.001) and those with spinal cord lesions compared to patients with no spinal cord lesions (p = 0.017). CONCLUSION The CVS has 85.7% sensitivity and 100% specificity for the diagnosis of MS at a cutoff value of 45%.
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Affiliation(s)
- Hend Abdel Ghany
- Neurology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed Karam-Allah
- Neurology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ramy Edward
- Radiology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Maged Abdel Naseer
- Neurology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mohamed I Hegazy
- Neurology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
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Ineichen BV, Beck ES, Piccirelli M, Reich DS. New Prospects for Ultra-High-Field Magnetic Resonance Imaging in Multiple Sclerosis. Invest Radiol 2021; 56:773-784. [PMID: 34120128 PMCID: PMC8505164 DOI: 10.1097/rli.0000000000000804] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 05/09/2021] [Accepted: 05/09/2021] [Indexed: 11/26/2022]
Abstract
ABSTRACT There is growing interest in imaging multiple sclerosis (MS) through the ultra-high-field (UHF) lens, which currently means a static magnetic field strength of 7 T or higher. Because of higher signal-to-noise ratio and enhanced susceptibility effects, UHF magnetic resonance imaging improves conspicuity of MS pathological hallmarks, among them cortical demyelination and the central vein sign. This could, in turn, improve confidence in MS diagnosis and might also facilitate therapeutic monitoring of MS patients. Furthermore, UHF imaging offers unique insight into iron-related pathology, leptomeningeal inflammation, and spinal cord pathologies in neuroinflammation. Yet, limitations such as the longer scanning times to achieve improved resolution and incipient safety data on implanted medical devices need to be considered. In this review, we discuss applications of UHF imaging in MS, its advantages and limitations, and practical aspects of UHF in the clinical setting.
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Affiliation(s)
- Benjamin V. Ineichen
- From the Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Erin S. Beck
- From the Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD
| | - Marco Piccirelli
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Daniel S. Reich
- From the Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD
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28
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Ontaneda D, Sati P, Raza P, Kilbane M, Gombos E, Alvarez E, Azevedo C, Calabresi P, Cohen JA, Freeman L, Henry RG, Longbrake EE, Mitra N, Illenberger N, Schindler M, Moreno-Dominguez D, Ramos M, Mowry E, Oh J, Rodrigues P, Chahin S, Kaisey M, Waubant E, Cutter G, Shinohara R, Reich DS, Solomon A, Sicotte NL. Central vein sign: A diagnostic biomarker in multiple sclerosis (CAVS-MS) study protocol for a prospective multicenter trial. Neuroimage Clin 2021; 32:102834. [PMID: 34592690 PMCID: PMC8482479 DOI: 10.1016/j.nicl.2021.102834] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 09/16/2021] [Accepted: 09/19/2021] [Indexed: 01/06/2023]
Abstract
The specificity and implementation of current MRI-based diagnostic criteria for multiple sclerosis (MS) are imperfect. Approximately 1 in 5 of individuals diagnosed with MS are eventually determined not to have the disease, with overreliance on MRI findings a major cause of MS misdiagnosis. The central vein sign (CVS), a proposed MRI biomarker for MS lesions, has been extensively studied in numerous cross sectional studies and may increase diagnostic specificity for MS. CVS has desirable analytical, measurement, and scalability properties. "Central Vein Sign: A Diagnostic Biomarker in Multiple Sclerosis (CAVS-MS)" is an NIH-supported, 2-year, prospective, international, multicenter study conducted by the North American Imaging in MS Cooperative (NAIMS) to evaluate CVS as a diagnostic biomarker for immediate translation into clinical care. Study objectives include determining the concordance of CVS and McDonald Criteria to diagnose MS, the sensitivity of CVS to detect MS in those with typical presentations, and the specificity of CVS among those with atypical presentations. The study will recruit a total of 400 participants (200 with typical and 200 with atypical presentations) across 11 sites. T2*-weighted, high-isotropic-resolution, segmented echo-planar MRI will be acquired at baseline and 24 months on 3-tesla scanners, and FLAIR* images (combination of FLAIR and T2*) will be generated for evaluating CVS. Data will be processed on a cloud-based platform that contains clinical and CVS rating modules. Imaging quality control will be conducted by automated methods and neuroradiologist review. CVS will be determined by Select6* and Select3* lesion methods following published criteria at each site and by central readers, including neurologists and neuroradiologists. Automated CVS detection and algorithms for incorporation of CVS into McDonald Criteria will be tested. Diagnosis will be adjudicated by three neurologists who served on the 2017 International Panel on the Diagnosis of MS. The CAVS-MS study aims to definitively establish CVS as a diagnostic biomarker that can be applied broadly to individuals presenting for evaluation of the diagnosis of MS.
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Affiliation(s)
- D Ontaneda
- Cleveland Clinic Foundation, Cleveland, OH, United States.
| | - P Sati
- Cedars Sinai, Los Angeles, CA, United States; NINDS, NIH, Bethesda, MD, United States
| | - P Raza
- Cleveland Clinic Foundation, Cleveland, OH, United States
| | - M Kilbane
- Cleveland Clinic Foundation, Cleveland, OH, United States
| | - E Gombos
- Cedars Sinai, Los Angeles, CA, United States
| | - E Alvarez
- Neurology, U of Colorado, Denver, CO, United States
| | | | - P Calabresi
- Neurology, Johns Hopkins, Baltimore, MD, United States
| | - J A Cohen
- Cleveland Clinic Foundation, Cleveland, OH, United States
| | - L Freeman
- Dell Medical School, The University of Texas at Austin, Austin, TX, United States
| | - R G Henry
- University of California San Francisco, San Francisco, CA, United States
| | | | - N Mitra
- University of Pennsylvania, Philadelphia, PA, United States
| | - N Illenberger
- University of Pennsylvania, Philadelphia, PA, United States
| | - M Schindler
- University of Pennsylvania, Philadelphia, PA, United States
| | | | - M Ramos
- QMENTA Inc, Boston, MA, United States
| | - E Mowry
- Neurology, Johns Hopkins, Baltimore, MD, United States
| | - J Oh
- University of Toronto, Toronto, ON, Canada
| | | | - S Chahin
- Washington University, St. Louis, MO, United States
| | - M Kaisey
- Cedars Sinai, Los Angeles, CA, United States
| | - E Waubant
- University of California San Francisco, San Francisco, CA, United States
| | - G Cutter
- UAB School of Public Health, Birmingham, AL, United States
| | - R Shinohara
- University of Pennsylvania, Philadelphia, PA, United States
| | - D S Reich
- NINDS, NIH, Bethesda, MD, United States
| | - A Solomon
- The University of Vermont, Burlington, VT, United States
| | - N L Sicotte
- Cedars Sinai, Los Angeles, CA, United States
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Abstract
PURPOSE OF REVIEW To summarize recent evidence from the application of susceptibility-based MRI sequences to investigate the 'central vein sign' (CVS) and 'iron rim' as biomarkers to improve the diagnostic work-up of multiple sclerosis (MS) and predict disease severity. RECENT FINDINGS The CVS is a specific biomarker for MS being detectable from the earliest phase of the disease. A threshold of 40% of lesions with the CVS can be optimal to distinguish MS from non-MS patients. Iron rim lesions, reflecting chronic active lesions, develop in relapsing-remitting MS patients and persist in progressive MS. They increase in size in the first few years after their formation and then stabilize. Iron rim lesions can distinguish MS from non-MS patients but not the different MS phenotypes. The presence of at least four iron rim lesions is associated with an earlier clinical disability, higher prevalence of clinically progressive MS and more severe brain atrophy. Automated methods for CVS and iron rim lesion detection are under development to facilitate their quantification. SUMMARY The assessment of the CVS and iron rim lesions is feasible in the clinical scenario and provides MRI measures specific to MS pathological substrates, improving diagnosis and prognosis of these patients.
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Yang CC, Ro LS, Tsai NW, Lin CC, Huang WN, Tsai CP, Lin TS, Su JJ, Huang CC, Lyu RK, Chen HH, Lee WJ, Chen PL, Yang A. Real-world evidence on the safety and effectiveness of fingolimod in patients with multiple sclerosis from Taiwan. J Formos Med Assoc 2021; 120:542-550. [DOI: 10.1016/j.jfma.2020.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 06/10/2020] [Accepted: 07/01/2020] [Indexed: 02/06/2023] Open
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Kaisey M, Solomon AJ, Guerrero BL, Renner B, Fan Z, Ayala N, Luu M, Diniz MA, Sati P, Sicotte NL. Preventing multiple sclerosis misdiagnosis using the "central vein sign": A real-world study. Mult Scler Relat Disord 2020; 48:102671. [PMID: 33444958 DOI: 10.1016/j.msard.2020.102671] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 11/15/2020] [Accepted: 11/30/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Misdiagnosis of multiple sclerosis (MS) is common and often occurs due to misattribution of non-MS magnetic resonance imaging (MRI) lesions to MS demyelination. A recently developed MRI biomarker, the central vein sign (CVS), has demonstrated high specificity for MS lesions and may thus help prevent misdiagnosis. OBJECTIVE This study explores the potential "real world" diagnostic value of CVS by comparing CVS in patients with MS and patients previously misdiagnosed with MS. METHODS Fifteen patients with MS and 15 misdiagnosed with MS were prospectively recruited to undergo 3T brain MRI. T2-weighted fluid-attenuated inversion recovery (FLAIR) and T2*-weighted segmented echo-planar-imaging (T2*-EPI) were acquired. The generated FLAIR* images were analyzed by two independent raters. The percentage of lesions with CVS was calculated for each patient. RESULTS A CVS lesion threshold of 29% or higher resulted in high sensitivity (0.79) and specificity (0.88) for MS and correctly identified 87% of patients previously misdiagnosed with MS. Interrater reliability for CVS was high with a Cohen's kappa coefficient of 0.86. CONCLUSION This study demonstrates the ability of CVS to differentiate between patients with MS and patients with an MS misdiagnosis resulting from standard MRI and clinical evaluation. Clinical application of CVS may reduce MS misdiagnosis.
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Affiliation(s)
- Marwa Kaisey
- Cedars-Sinai Medical Center Department of Neurology, 127 S. San Vicente Blvd, Suite A6600, Los Angeles, CA 90048, USA.
| | - Andrew J Solomon
- Larner College of Medicine at the University of Vermont, Department of Neurological Sciences, 1 South Prospect Street, Arnold, Level 2, Burlington, Vermont 05401, USA.
| | - Brooke L Guerrero
- Cedars-Sinai Medical Center Department of Neurology, 127 S. San Vicente Blvd, Suite A6600, Los Angeles, CA 90048, USA.
| | - Brian Renner
- Cedars-Sinai Medical Center Department of Neurology, 127 S. San Vicente Blvd, Suite A6600, Los Angeles, CA 90048, USA.
| | - Zhaoyang Fan
- Cedars-Sinai Biomedical Imaging Research Institute, 116 N Robertson Blvd, Los Angeles, CA 90048, USA.
| | - Natalie Ayala
- Cedars-Sinai Medical Center Department of Neurology, 127 S. San Vicente Blvd, Suite A6600, Los Angeles, CA 90048, USA.
| | - Michael Luu
- Cedars-Sinai Biostatistics and Bioinformatics Research Center, 8700 Beverly Blvd North Tower, Los Angeles, CA 90048, USA.
| | - Marcio A Diniz
- Cedars-Sinai Biostatistics and Bioinformatics Research Center, 8700 Beverly Blvd North Tower, Los Angeles, CA 90048, USA.
| | - Pascal Sati
- Cedars-Sinai Medical Center Department of Neurology, 127 S. San Vicente Blvd, Suite A6600, Los Angeles, CA 90048, USA.
| | - Nancy L Sicotte
- Cedars-Sinai Medical Center Department of Neurology, 127 S. San Vicente Blvd, Suite A6600, Los Angeles, CA 90048, USA.
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32
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Castellaro M, Tamanti A, Pisani AI, Pizzini FB, Crescenzo F, Calabrese M. The Use of the Central Vein Sign in the Diagnosis of Multiple Sclerosis: A Systematic Review and Meta-analysis. Diagnostics (Basel) 2020; 10:diagnostics10121025. [PMID: 33260401 PMCID: PMC7760678 DOI: 10.3390/diagnostics10121025] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 11/26/2020] [Accepted: 11/26/2020] [Indexed: 02/01/2023] Open
Abstract
Background: The central vein sign (CVS) is a radiological feature proposed as a multiple sclerosis (MS) imaging biomarker able to accurately differentiate MS from other white matter diseases of the central nervous system. In this work, we evaluated the pooled proportion of the CVS in brain MS lesions and to estimate the diagnostic performance of CVS to perform a diagnosis of MS and propose an optimal cut-off value. Methods: A systematic search was performed on publicly available databases (PUBMED/MEDLINE and Web of Science) up to 24 August 2020. Analysis of the proportion of white matter MS lesions with a central vein was performed using bivariate random-effect models. A meta-regression analysis was performed and the impact of using particular sequences (such as 3D echo-planar imaging) and post-processing techniques (such as FLAIR*) was investigated. Pooled sensibility and specificity were estimated using bivariate models and meta-regression was performed to address heterogeneity. Inclusion and publication bias were assessed using asymmetry tests and a funnel plot. A hierarchical summary receiver operating curve (HSROC) was used to estimate the summary accuracy in diagnostic performance. The Youden index was employed to estimate the optimal cut-off value using individual patient data. Results: The pooled proportion of lesions showing a CVS in the MS population was 73%. The use of the CVS showed a remarkable diagnostic performance in MS cases, providing a pooled specificity of 92% and a sensitivity of 95%. The optimal cut-off value obtained from the individual patient data pooled together was 40% with excellent accuracy calculated by the area under the ROC (0.946). The 3D-EPI sequences showed both a higher pooled proportion compared to other sequences and explained heterogeneity in the meta-regression analysis of diagnostic performances. The 1.5 Tesla (T) scanners showed a lower (58%) proportion of MS lesions with a CVS compared to both 3T (74%) and 7T (82%). Conclusions: The meta-analysis we have performed shows that the use of the CVS in differentiating MS from other mimicking diseases is encouraged; moreover, the use of dedicated sequences such as 3D-EPI and the high MRI field is beneficial.
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Affiliation(s)
- Marco Castellaro
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37134 Verona, Italy; (A.T.); (A.I.P.); (F.C.); (M.C.)
- Correspondence:
| | - Agnese Tamanti
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37134 Verona, Italy; (A.T.); (A.I.P.); (F.C.); (M.C.)
| | - Anna Isabella Pisani
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37134 Verona, Italy; (A.T.); (A.I.P.); (F.C.); (M.C.)
| | | | - Francesco Crescenzo
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37134 Verona, Italy; (A.T.); (A.I.P.); (F.C.); (M.C.)
| | - Massimiliano Calabrese
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37134 Verona, Italy; (A.T.); (A.I.P.); (F.C.); (M.C.)
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Sinnecker T, Clarke MA, Meier D, Enzinger C, Calabrese M, De Stefano N, Pitiot A, Giorgio A, Schoonheim MM, Paul F, Pawlak MA, Schmidt R, Kappos L, Montalban X, Rovira À, Evangelou N, Wuerfel J. Evaluation of the Central Vein Sign as a Diagnostic Imaging Biomarker in Multiple Sclerosis. JAMA Neurol 2020; 76:1446-1456. [PMID: 31424490 DOI: 10.1001/jamaneurol.2019.2478] [Citation(s) in RCA: 107] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Importance The central vein sign has been proposed as a specific imaging biomarker for distinguishing between multiple sclerosis (MS) and not MS, mainly based on findings from ultrahigh-field magnetic resonance imaging (MRI) studies. The diagnostic value of the central vein sign in a multicenter setting with a variety of clinical 3 tesla (T) MRI protocols, however, remains unknown. Objective To evaluate the sensitivity and specificity of various central vein sign lesion criteria for differentiating MS from non-MS conditions using 3T brain MRI with various commonly used pulse sequences. Design, Setting, and Participants This large multicenter, cross-sectional study enrolled participants (n = 648) of ongoing observational studies and patients included in neuroimaging research databases of 8 neuroimaging centers in Europe. Patient enrollment and MRI data collection were performed between January 1, 2010, and November 30, 2016. Data analysis was conducted between January 1, 2016, and April 30, 2018. Investigators were blinded to participant diagnosis by a novel blinding procedure. Main Outcomes and Measures Occurrence of central vein sign was detected on 3T T2*-weighted or susceptibility-weighted imaging. Sensitivity and specificity were assessed for these MRI sequences and for different central vein sign lesion criteria, which were defined by the proportion of lesions with central vein sign or by absolute numbers of lesions with central vein sign. Results A total of 606 participants were included in the study after exclusion of 42 participants. Among the 606 participants, 413 (68.2%) were women. Patients with clinically isolated syndrome and relapsing-remitting MS (RRMS) included 235 women (66.6%) and had a median (range) age of 37 (14.7-61.4) years, a median (range) disease duration of 2 (0-33) years, and a median (range) Expanded Disability Status Scale score of 1.5 (0-6.5). Patients without MS included 178 women (70.4%) and had a median (range) age of 54 (18-83) years. A total of 4447 lesions were analyzed in a total of 487 patients: 690 lesions in 98 participants with clinically isolated syndrome, 2815 lesions in 225 participants with RRMS, 54 lesions in 13 participants with neuromyelitis optica spectrum disorder, 54 lesions in 14 participants with systemic lupus erythematosus, 121 lesions in 29 participants with migraine or cluster headache, 240 lesions in 20 participants with diabetes, and 473 lesions in 88 participants with other types of small-vessel disease. The sensitivity was 68.1% and specificity was 82.9% for distinguishing MS from not MS using a 35% central vein sign proportion threshold. The 3 central vein sign lesion criteria had a sensitivity of 61.9% and specificity of 89.0%. Sensitivity was higher when an optimized T2*-weighted sequence was used. Conclusions and Relevance In this study, use of the central vein sign at 3T MRI yielded a high specificity and a moderate sensitivity in differentiating MS from not MS; international, multicenter studies may be needed to ascertain whether the central vein sign-based criteria can accurately detect MS.
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Affiliation(s)
- Tim Sinnecker
- Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedical Engineering, University Hospital, University of Basel, Basel, Switzerland.,Medical Image Analysis Center, Basel, Switzerland.,Neurocure Clinical Research Center, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,qbig, Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Margareta A Clarke
- School of Psychology, University of Nottingham, Nottingham, United Kingdom.,Clinical Neurology, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Dominik Meier
- Medical Image Analysis Center, Basel, Switzerland.,qbig, Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Christian Enzinger
- Division of Neuroradiology, Vascular and Interventional Radiology, Departments of Neurology and Radiology, Medical University of Graz, Graz, Austria
| | - Massimiliano Calabrese
- Neurology Unit, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Nicola De Stefano
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Alain Pitiot
- Laboratory of Image and Data Analysis, Ilixa Ltd, London, United Kingdom
| | - Antonio Giorgio
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Menno M Schoonheim
- Department of Anatomy and Neurosciences, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Friedemann Paul
- Neurocure Clinical Research Center, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Experimental and Clinical Research Center, Charité-Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health and Max Delbrück Center for Molecular Medicine, Berlin, Germany
| | - Mikolaj A Pawlak
- Department of Neurology and Cerebrovascular Disorders, Poznan University of Medical Sciences, Poznan, Poland
| | - Reinhold Schmidt
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Ludwig Kappos
- Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedical Engineering, University Hospital, University of Basel, Basel, Switzerland
| | - Xavier Montalban
- Section of Neuroradiology, Department of Radiology (IDI), VHIR, Barcelona, Spain.,Division of Neurology, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Àlex Rovira
- Section of Neuroradiology, Department of Radiology (IDI), VHIR, Barcelona, Spain
| | - Nikos Evangelou
- Division of Clinical Neuroscience, University of Nottingham, Nottingham, United Kingdom
| | - Jens Wuerfel
- Medical Image Analysis Center, Basel, Switzerland.,Neurocure Clinical Research Center, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,qbig, Department of Biomedical Engineering, University of Basel, Basel, Switzerland.,Experimental and Clinical Research Center, Charité-Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health and Max Delbrück Center for Molecular Medicine, Berlin, Germany
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Guisset F, Lolli V, Bugli C, Perrotta G, Absil J, Dachy B, Pot C, Théaudin M, Pasi M, van Pesch V, Maggi P. The central vein sign in multiple sclerosis patients with vascular comorbidities. Mult Scler 2020; 27:1057-1065. [DOI: 10.1177/1352458520943785] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: The central vein sign (CVS) is an imaging biomarker able to differentiate multiple sclerosis (MS) from other conditions causing similar appearance lesions on magnetic resonance imaging (MRI), including cerebral small vessel disease (CSVD). However, the impact of vascular risk factors (VRFs) for CSVD on the percentage of CVS positive (CVS+) lesions in MS has never been evaluated. Objective: To investigate the association between different VRFs and the percentage of CVS+ lesions in MS. Methods: In 50 MS patients, 3T brain MRIs (including high-resolution 3-dimensional T2*-weighted images) were analyzed for the presence of the CVS and MRI markers of CSVD. A backward stepwise regression model was used to predict the combined predictive effect of VRF (i.e. age, hypertension, diabetes, obesity, ever-smoking, and hypercholesterolemia) and MRI markers of CSVD on the CVS. Results: The median frequency of CVS+ lesions was 71% (range: 35%–100%). In univariate analysis, age ( p < 0.0001), hypertension ( p < 0.001), diabetes ( p < 0.01), obesity ( p < 0.01), smoking ( p < 0.05), and the presence of enlarged-perivascular-spaces on MRI ( p < 0.005) were all associated with a lower percentage of CVS+ lesions. The stepwise regression model showed that age and arterial hypertension were both associated with the percentage of CVS+ lesions in MS (adjusted R2 = 0.46; p < 0.0001 and p = 0.01, respectively). Conclusion: The proportion of CVS+ lesions significantly decreases in older and hypertensive MS patients. Although this study was conducted in patients with an already established MS diagnosis, the diagnostic yield of the previously proposed 35% CVS proportion-based diagnostic threshold appears to be not affected. Overall these results suggest that the presence of VRF for CSVD should be taken into account during the CVS assessment.
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Affiliation(s)
- François Guisset
- Department of Neurology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium/Department of Neurology, Hôpital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Valentina Lolli
- Department of Radiology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Céline Bugli
- Plateforme technologique de Support en Méthodologie et Calcul Statistique, Université Catholique de Louvain, Brussels, Belgium
| | - Gaetano Perrotta
- Department of Neurology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Julie Absil
- Department of Radiology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Bernard Dachy
- Department of Neurology, Hôpital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Caroline Pot
- Department of Neurology, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Marie Théaudin
- Department of Neurology, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Marco Pasi
- University of Lille, Inserm, CHU Lille, U1172—LilNCog—Lille Neuroscience & Cognition, Lille, France
| | - Vincent van Pesch
- Department of Neurology, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Pietro Maggi
- Department of Neurology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium/Department of Neurology, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland/Department of Neurology, Cliniques universitaires Saint Luc, Université Catholique de Louvain, Brussels, Belgium
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Clarke MA, Pareto D, Pessini-Ferreira L, Arrambide G, Alberich M, Crescenzo F, Cappelle S, Tintoré M, Sastre-Garriga J, Auger C, Montalban X, Evangelou N, Rovira À. Value of 3T Susceptibility-Weighted Imaging in the Diagnosis of Multiple Sclerosis. AJNR Am J Neuroradiol 2020; 41:1001-1008. [PMID: 32439639 DOI: 10.3174/ajnr.a6547] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 03/19/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Previous studies have suggested that the central vein sign and iron rims are specific features of MS lesions. Using 3T SWI, we aimed to compare the frequency of lesions with central veins and iron rims in patients with clinically isolated syndrome and MS-mimicking disorders and test their diagnostic value in predicting conversion from clinically isolated syndrome to MS. MATERIALS AND METHODS For each patient, we calculated the number of brain lesions with central veins and iron rims. We then identified a simple rule involving an absolute number of lesions with central veins and iron rims to predict conversion from clinically isolated syndrome to MS. Additionally, we tested the diagnostic performance of central veins and iron rims when combined with evidence of dissemination in space. RESULTS We included 112 patients with clinically isolated syndrome and 35 patients with MS-mimicking conditions. At follow-up, 94 patients with clinically isolated syndrome developed MS according to the 2017 McDonald criteria. Patients with clinically isolated syndrome had a median of 2 central veins (range, 0-19), while the non-MS group had a median of 1 central vein (range, 0-6). Fifty-six percent of patients who developed MS had ≥1 iron rim, and none of the patients without MS had iron rims. The sensitivity and specificity of finding ≥3 central veins and/or ≥1 iron rim were 70% and 86%, respectively. In combination with evidence of dissemination in space, the 2 imaging markers had higher specificity than dissemination in space and positive findings of oligoclonal bands currently used to support the diagnosis of MS. CONCLUSIONS A single 3T SWI scan offers valuable diagnostic information, which has the potential to prevent MS misdiagnosis.
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Affiliation(s)
- M A Clarke
- From the Vall d'Hebron Research Institute (M.A.C., D.P., M.A., M.T., J.S.-G., C.A., X.M., A.R.), Barcelona, Spain
| | - D Pareto
- From the Vall d'Hebron Research Institute (M.A.C., D.P., M.A., M.T., J.S.-G., C.A., X.M., A.R.), Barcelona, Spain.,Section of Neuroradiology, Department of Radiology (D.P., L.P.-F., C.A., A.R.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - L Pessini-Ferreira
- Section of Neuroradiology, Department of Radiology (D.P., L.P.-F., C.A., A.R.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - G Arrambide
- Department of Neurology-Neuroimmunology (G.A., M.T., J.S.-G., X.M.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - M Alberich
- From the Vall d'Hebron Research Institute (M.A.C., D.P., M.A., M.T., J.S.-G., C.A., X.M., A.R.), Barcelona, Spain
| | - F Crescenzo
- Department of Neurosciences, Biomedicine and Movement Sciences (F.C.), University of Verona, Verona, Italy
| | - S Cappelle
- Division of Radiology (S.C.), University Hospital Leuven, Leuven, Belgium
| | - M Tintoré
- From the Vall d'Hebron Research Institute (M.A.C., D.P., M.A., M.T., J.S.-G., C.A., X.M., A.R.), Barcelona, Spain.,Department of Neurology-Neuroimmunology (G.A., M.T., J.S.-G., X.M.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - J Sastre-Garriga
- From the Vall d'Hebron Research Institute (M.A.C., D.P., M.A., M.T., J.S.-G., C.A., X.M., A.R.), Barcelona, Spain.,Department of Neurology-Neuroimmunology (G.A., M.T., J.S.-G., X.M.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - C Auger
- From the Vall d'Hebron Research Institute (M.A.C., D.P., M.A., M.T., J.S.-G., C.A., X.M., A.R.), Barcelona, Spain.,Section of Neuroradiology, Department of Radiology (D.P., L.P.-F., C.A., A.R.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - X Montalban
- From the Vall d'Hebron Research Institute (M.A.C., D.P., M.A., M.T., J.S.-G., C.A., X.M., A.R.), Barcelona, Spain.,Department of Neurology-Neuroimmunology (G.A., M.T., J.S.-G., X.M.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.,Division of Neurology (X.M.), St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - N Evangelou
- Division of Clinical Neuroscience (N.E.), University of Nottingham, Nottingham, UK
| | - À Rovira
- From the Vall d'Hebron Research Institute (M.A.C., D.P., M.A., M.T., J.S.-G., C.A., X.M., A.R.), Barcelona, Spain .,Section of Neuroradiology, Department of Radiology (D.P., L.P.-F., C.A., A.R.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
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Filippi M, Preziosa P, Banwell BL, Barkhof F, Ciccarelli O, De Stefano N, Geurts JJG, Paul F, Reich DS, Toosy AT, Traboulsee A, Wattjes MP, Yousry TA, Gass A, Lubetzki C, Weinshenker BG, Rocca MA. Assessment of lesions on magnetic resonance imaging in multiple sclerosis: practical guidelines. Brain 2020; 142:1858-1875. [PMID: 31209474 PMCID: PMC6598631 DOI: 10.1093/brain/awz144] [Citation(s) in RCA: 288] [Impact Index Per Article: 72.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 04/29/2019] [Accepted: 05/01/2019] [Indexed: 12/19/2022] Open
Abstract
MRI has improved the diagnostic work-up of multiple sclerosis, but inappropriate image interpretation and application of MRI diagnostic criteria contribute to misdiagnosis. Some diseases, now recognized as conditions distinct from multiple sclerosis, may satisfy the MRI criteria for multiple sclerosis (e.g. neuromyelitis optica spectrum disorders, Susac syndrome), thus making the diagnosis of multiple sclerosis more challenging, especially if biomarker testing (such as serum anti-AQP4 antibodies) is not informative. Improvements in MRI technology contribute and promise to better define the typical features of multiple sclerosis lesions (e.g. juxtacortical and periventricular location, cortical involvement). Greater understanding of some key aspects of multiple sclerosis pathobiology has allowed the identification of characteristics more specific to multiple sclerosis (e.g. central vein sign, subpial demyelination and lesional rims), which are not included in the current multiple sclerosis diagnostic criteria. In this review, we provide the clinicians and researchers with a practical guide to enhance the proper recognition of multiple sclerosis lesions, including a thorough definition and illustration of typical MRI features, as well as a discussion of red flags suggestive of alternative diagnoses. We also discuss the possible place of emerging qualitative features of lesions which may become important in the near future.
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Affiliation(s)
- Massimo Filippi
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurology Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Paolo Preziosa
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Brenda L Banwell
- Division of Neurology, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands.,Institutes of Neurology and Healthcare Engineering, University College London, London, UK
| | - Olga Ciccarelli
- Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London, UK.,National Institute for Health Research University College London Hospitals Biomedical Research Center, National Institute for Health Research, London, UK
| | - Nicola De Stefano
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Jeroen J G Geurts
- Department of Anatomy and Neurosciences, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Friedemann Paul
- NeuroCure Clinical Research Center and Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine and Charité -Universitätsmedizin Berlin, Berlin, Germany
| | - Daniel S Reich
- Translational Neuroradiology Section, Division of Neuroimmunology and Neurovirology, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Ahmed T Toosy
- Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London, UK
| | - Anthony Traboulsee
- MS/MRI Research Group, Djavad Mowafaghian Centre for Brain Health, Division of Neurology, University of British Columbia, Vancouver, British Columbia, Canada.,Faculty of Medicine, Division of Neurology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mike P Wattjes
- Department of Neuroradiology, Hannover Medical School, Hannover, Germany
| | - Tarek A Yousry
- Division of Neuroradiology and Neurophysics, UCL Institute of Neurology, London, UK.,Lysholm Department of Neuroradiology, London, UK
| | - Achim Gass
- Department of Neurology, Universitätsmedizin Mannheim, University of Heidelberg, Mannheim, Germany
| | - Catherine Lubetzki
- Sorbonne University, AP-HP Pitié-Salpétriére Hospital, Department of Neurology, 75013 Paris, France
| | | | - Maria A Rocca
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurology Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Maggi P, Fartaria MJ, Jorge J, La Rosa F, Absinta M, Sati P, Meuli R, Du Pasquier R, Reich DS, Cuadra MB, Granziera C, Richiardi J, Kober T. CVSnet: A machine learning approach for automated central vein sign assessment in multiple sclerosis. NMR IN BIOMEDICINE 2020; 33:e4283. [PMID: 32125737 PMCID: PMC7754184 DOI: 10.1002/nbm.4283] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 01/22/2020] [Accepted: 02/05/2020] [Indexed: 05/28/2023]
Abstract
The central vein sign (CVS) is an efficient imaging biomarker for multiple sclerosis (MS) diagnosis, but its application in clinical routine is limited by inter-rater variability and the expenditure of time associated with manual assessment. We describe a deep learning-based prototype for automated assessment of the CVS in white matter MS lesions using data from three different imaging centers. We retrospectively analyzed data from 3 T magnetic resonance images acquired on four scanners from two different vendors, including adults with MS (n = 42), MS mimics (n = 33, encompassing 12 distinct neurological diseases mimicking MS) and uncertain diagnosis (n = 5). Brain white matter lesions were manually segmented on FLAIR* images. Perivenular assessment was performed according to consensus guidelines and used as ground truth, yielding 539 CVS-positive (CVS+ ) and 448 CVS-negative (CVS- ) lesions. A 3D convolutional neural network ("CVSnet") was designed and trained on 47 datasets, keeping 33 for testing. FLAIR* lesion patches of CVS+ /CVS- lesions were used for training and validation (n = 375/298) and for testing (n = 164/150). Performance was evaluated lesion-wise and subject-wise and compared with a state-of-the-art vesselness filtering approach through McNemar's test. The proposed CVSnet approached human performance, with lesion-wise median balanced accuracy of 81%, and subject-wise balanced accuracy of 89% on the validation set, and 91% on the test set. The process of CVS assessment, in previously manually segmented lesions, was ~ 600-fold faster using the proposed CVSnet compared with human visual assessment (test set: 4 seconds vs. 40 minutes). On the validation and test sets, the lesion-wise performance outperformed the vesselness filter method (P < 0.001). The proposed deep learning prototype shows promising performance in differentiating MS from its mimics. Our approach was evaluated using data from different hospitals, enabling larger multicenter trials to evaluate the benefit of introducing the CVS marker into MS diagnostic criteria.
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Affiliation(s)
- Pietro Maggi
- Department of Neurology, Lausanne University Hospital, Lausanne, Switzerland
- Department of Neurology, Saint-Luc University Hospital, Brussels, Belgium
| | - Mário João Fartaria
- Advanced Clinical Imaging Technology, Siemens Healthcare AG, Lausanne, Switzerland
- Signal Processing Laboratory (LTS5), École Polytechnique Fédéral de Lausanne, Switzerland
| | - João Jorge
- Laboratory for Functional and Metabolic Imaging, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Francesco La Rosa
- Signal Processing Laboratory (LTS5), École Polytechnique Fédéral de Lausanne, Switzerland
- Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Martina Absinta
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD
| | - Pascal Sati
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD
| | - Reto Meuli
- Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Renaud Du Pasquier
- Department of Neurology, Lausanne University Hospital, Lausanne, Switzerland
| | - Daniel S. Reich
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD
| | - Meritxell Bach Cuadra
- Signal Processing Laboratory (LTS5), École Polytechnique Fédéral de Lausanne, Switzerland
- Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Medical Image Analysis Laboratory (MIAL), Centre d’Imagerie BioMédicale (CIBM), Lausanne, Switzerland
| | - Cristina Granziera
- Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland
- Translational Imaging in Neurology (ThINK) Basel, Department of Medicine and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Jonas Richiardi
- Advanced Clinical Imaging Technology, Siemens Healthcare AG, Lausanne, Switzerland
- Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Tobias Kober
- Advanced Clinical Imaging Technology, Siemens Healthcare AG, Lausanne, Switzerland
- Signal Processing Laboratory (LTS5), École Polytechnique Fédéral de Lausanne, Switzerland
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38
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Affiliation(s)
- Andrew J Solomon
- Department of Neurological Sciences, Larner College of Medicine, The University of Vermont, Burlington, VT, USA
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39
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Oh J, Sati P. Detection of central vein should be part of MS diagnostic criteria – Commentary. Mult Scler 2020; 26:409-410. [DOI: 10.1177/1352458520905759] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Jiwon Oh
- Division of Neurology, Department of Medicine, St. Michael’s Hospital, University of Toronto, Toronto, ON, Canada/Department of Neurology, Johns Hopkins University, Baltimore, MD, USA
| | - Pascal Sati
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
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41
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Bhandari A, Xiang H, Lechner-Scott J, Agzarian M. Central vein sign for multiple sclerosis: A systematic review and meta-analysis. Clin Radiol 2020; 75:479.e9-479.e15. [PMID: 32143784 DOI: 10.1016/j.crad.2020.01.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Accepted: 01/24/2020] [Indexed: 10/24/2022]
Abstract
AIMS To systematically review the diagnostic value of the central vein sign (CVS) in multiple sclerosis (MS) and to meta-analyse the proportion of positive lesions for CVS needed to distinguish MS from non-MS mimics. MATERIALS AND METHODS A literature review was performed and a proportion meta-analysis was performed to examine the proportion of the CVS in MS lesions. Studies reporting a threshold of the CVS containing lesions with 100% diagnostic accuracy were included in the meta-analysis. This was compared to MS mimics in order to establish the discriminative value of the CVS. RESULTS The CVS was found to be viable at lower field strengths (3 T and 1.5 T) and automated analysis is currently less accurate than manual counting. Five studies were included for the proportional meta-analysis. From the analysis, a proportion of 45% of lesions having the CVS was suggested given that the findings that the weighted proportion was 46.4% (95% confidence interval [CI]: of 40.3%-52.6%) with low heterogeneity (I2 = 0.0%; p=0.5). CONCLUSION Although the CVS is a clinically relevant and viable sign, further work is needed to integrate this into the existing diagnostic criteria. As manual determination is a time-consuming process, the development of automated methods will be beneficial. With improvements in computational imaging techniques, the CVS will have an important role in the diagnosis and differentiation of MS.
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Affiliation(s)
- A Bhandari
- Department of Anatomy, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia; Townsville University Hospital, Townsville, Queensland, Australia.
| | - H Xiang
- Department of Anatomy, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - J Lechner-Scott
- Hunter Medical Research Institute, Newcastle, Australia; Faculty of Medicine and Public Health, The University of Newcastle, Newcastle, Australia; Department of Neurology, John Hunter Hospital, Newcastle, Australia
| | - M Agzarian
- South Australia Medical Imaging, Flinders Medical Centre, Adelaide, Australia; College of Medicine & Public Health, Flinders University, Adelaide, Australia
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Dworkin JD, Linn KA, Solomon AJ, Satterthwaite TD, Raznahan A, Bakshi R, Shinohara RT. A local group differences test for subject-level multivariate density neuroimaging outcomes. Biostatistics 2019; 22:646-661. [PMID: 31875881 DOI: 10.1093/biostatistics/kxz058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 11/24/2019] [Accepted: 11/29/2019] [Indexed: 11/14/2022] Open
Abstract
A great deal of neuroimaging research focuses on voxel-wise analysis or segmentation of damaged tissue, yet many diseases are characterized by diffuse or non-regional neuropathology. In simple cases, these processes can be quantified using summary statistics of voxel intensities. However, the manifestation of a disease process in imaging data is often unknown, or appears as a complex and nonlinear relationship between the voxel intensities on various modalities. When the relevant pattern is unknown, summary statistics are often unable to capture differences between disease groups, and their use may encourage post hoc searches for the optimal summary measure. In this study, we introduce the multi-modal density testing (MMDT) framework for the naive discovery of group differences in voxel intensity profiles. MMDT operationalizes multi-modal magnetic resonance imaging (MRI) data as multivariate subject-level densities of voxel intensities and utilizes kernel density estimation to develop a local two-sample test for individual points within the density space. Through simulations, we show that this method controls type I error and recovers relevant differences when applied to a specified point. Additionally, we demonstrate the ability to maintain power while controlling the family-wise error rate and false discovery rate when applying the test over a grid of points within the density space. Finally, we apply this method to a study of subjects with either multiple sclerosis (MS) or conditions that tend to mimic MS on MRI, and find significant differences between the two groups in their voxel intensity profiles within the thalamus.
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Affiliation(s)
- Jordan D Dworkin
- Penn Statistics in Imaging and Visualization Center, Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, 423 Guardian Drive, Philadelphia, PA 19104, USA
| | - Kristin A Linn
- Penn Statistics in Imaging and Visualization Center, Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, 423 Guardian Drive, Philadelphia, PA 19104, USA
| | - Andrew J Solomon
- Department of Neurological Sciences, Larner College of Medicine at The University of Vermont, 149 Beaumont Avenue, Burlington, VT 05405, USA
| | - Theodore D Satterthwaite
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Armin Raznahan
- Developmental Neurogenomics Unit, National Institute of Mental Health, National Institutes of Health, 10 Center Drive, Bethesda, MD 20892, USA
| | - Rohit Bakshi
- Departments of Neurology and Radiology, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Road, Boston, MA 02115, USA
| | - Russell T Shinohara
- Penn Statistics in Imaging and Visualization Center, Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, 423 Guardian Drive, Philadelphia, PA 19104, USA
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Suh CH, Kim SJ, Jung SC, Choi CG, Kim HS. The "Central Vein Sign" on T2*-weighted Images as a Diagnostic Tool in Multiple Sclerosis: A Systematic Review and Meta-analysis using Individual Patient Data. Sci Rep 2019; 9:18188. [PMID: 31796822 PMCID: PMC6890741 DOI: 10.1038/s41598-019-54583-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 11/14/2019] [Indexed: 12/15/2022] Open
Abstract
We aimed to evaluate the pooled incidence of central vein sign on T2*-weighted images from patients with multiple sclerosis (MS), and to determine the diagnostic performance of this central vein sign for differentiating MS from other white matter lesions and provide an optimal cut-off value. A computerized systematic search of the literature in PUBMED and EMBASE was conducted up to December 14, 2018. Original articles investigating central vein sign on T2*-weighted images of patients with MS were selected. The pooled incidence was obtained using random-effects model. The pooled sensitivity and specificity were obtained using a bivariate random-effects model. An optimal cut-off value for the proportion of lesions with a central vein sign was calculated from those studies providing individual patient data. Twenty-one eligible articles covering 501 patients with MS were included. The pooled incidence of central vein sign at the level of individual lesion in patients with MS was 74% (95% CI, 65-82%). The pooled sensitivity and pooled specificity for the diagnostic performance of the central vein sign were 98% (95% CI, 92-100%) and 97% (95% CI, 91-99%), respectively. The area under the HSROC curve was 1.00 (95% CI, 0.99-1.00). The optimal cut-off value for the proportion of lesions with a central vein sign was found to be 45%. Although various T2*-weighted images have been used across studies, the current evidence supports the use of the central vein sign on T2*-weighted images to differentiate MS from other white matter lesions.
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Affiliation(s)
- Chong Hyun Suh
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea
| | - Sang Joon Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea.
| | - Seung Chai Jung
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea
| | - Choong Gon Choi
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea
| | - Ho Sung Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea
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44
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Maggi P, Absinta M, Sati P, Perrotta G, Massacesi L, Dachy B, Pot C, Meuli R, Reich DS, Filippi M, Pasquier RD, Théaudin M. The "central vein sign" in patients with diagnostic "red flags" for multiple sclerosis: A prospective multicenter 3T study. Mult Scler 2019; 26:421-432. [PMID: 31536435 DOI: 10.1177/1352458519876031] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The central vein sign (CVS) has been shown to help in the differential diagnosis of multiple sclerosis (MS), but most prior studies are retrospective. OBJECTIVES To prospectively assess the diagnostic predictive value of the CVS in diagnostically difficult cases. METHODS In this prospective multicenter study, 51 patients with suspected MS who had clinical, imaging, or laboratory "red flags" (i.e. features atypical for MS) underwent 3T fluid-attenuated inversion recovery (FLAIR*) magnetic resonance imaging (MRI) for CVS assessment. After the diagnostic work-up, expert clinicians blinded to the results of the CVS assessment came to a clinical diagnosis. The value of the CVS to prospectively predict an MS diagnosis was assessed. RESULTS Of the 39 patients who received a clinical diagnosis by the end of the study, 27 had MS and 12 received a non-MS diagnosis that included systemic lupus erythematosus, sarcoidosis, migraine, Sjögren disease, SPG4-spastic-paraparesis, neuromyelitis optica, and Susac syndrome. The percentage of perivenular lesions was higher in MS (median = 86%) compared to non-MS (median = 21%; p < 0.0001) patients. A 40% perivenular lesion cutoff was associated with 97% accuracy and a 96% positive/100% negative predictive value. CONCLUSION The CVS detected on 3T FLAIR* images can accurately predict an MS diagnosis in patients suspected to have MS, but with atypical clinical, laboratory, and imaging features.
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Affiliation(s)
- Pietro Maggi
- Department of Neurology, Center of Clinical Neurosciences, Lausanne University Hospital, Lausanne, Switzerland/ Department of Neurology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Martina Absinta
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA/ Department of Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy/ Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Pascal Sati
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Gaetano Perrotta
- Department of Neurology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Luca Massacesi
- Department of Neuroscience, Psychology, Drug and Child Health (NEUROFARBA), University of Florence, Florence, Italy/ Multiple Sclerosis Center, Department of Neurology 2, Careggi University Hospital, University of Florence, Florence, Italy
| | - Bernard Dachy
- Department of Neurology, Hopital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Caroline Pot
- Department of Neurology, Center of Clinical Neurosciences, Lausanne University Hospital, Lausanne, Switzerland
| | - Reto Meuli
- Department of Radiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Daniel S Reich
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Massimo Filippi
- Department of Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy/ Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Renaud Du Pasquier
- Department of Neurology, Center of Clinical Neurosciences, Lausanne University Hospital, Lausanne, Switzerland
| | - Marie Théaudin
- Department of Neurology, Center of Clinical Neurosciences, Lausanne University Hospital, Lausanne, Switzerland
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45
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Cortese R, Collorone S, Ciccarelli O, Toosy AT. Advances in brain imaging in multiple sclerosis. Ther Adv Neurol Disord 2019; 12:1756286419859722. [PMID: 31275430 PMCID: PMC6598314 DOI: 10.1177/1756286419859722] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 05/21/2019] [Indexed: 12/31/2022] Open
Abstract
Brain imaging is increasingly used to support clinicians in diagnosing multiple sclerosis (MS) and monitoring its progression. However, the role of magnetic resonance imaging (MRI) in MS goes far beyond its clinical application. Indeed, advanced imaging techniques have helped to detect different components of MS pathogenesis in vivo, which is now considered a heterogeneous process characterized by widespread damage of the central nervous system, rather than multifocal demyelination of white matter. Recently, MRI biomarkers more sensitive to disease activity than clinical disability outcome measures, have been used to monitor response to anti-inflammatory agents in patients with relapsing-remitting MS. Similarly, MRI markers of neurodegeneration exhibit the potential as primary and secondary outcomes in clinical trials for progressive phenotypes. This review will summarize recent advances in brain neuroimaging in MS from the research setting to clinical applications.
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Affiliation(s)
- Rosa Cortese
- Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, Faculty of Brain Sciences, University College London (UCL), London, UK
| | - Sara Collorone
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Institute of Neurology, Russell Square, London WC1B 5EH, UK
| | - Olga Ciccarelli
- Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, Faculty of Brain Sciences, University College London (UCL), London, UK
- National Institute for Health Research, UCL Hospitals, Biomedical Research Centre, London, UK
| | - Ahmed T. Toosy
- Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, Faculty of Brain Sciences, University College London (UCL), London, UK
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46
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Hu XY, Rajendran L, Lapointe E, Tam R, Li D, Traboulsee A, Rauscher A. Three-dimensional MRI sequences in MS diagnosis and research. Mult Scler 2019; 25:1700-1709. [DOI: 10.1177/1352458519848100] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The most recent guidelines for magnetic resonance imaging (MRI) in multiple sclerosis (MS) recommend three-dimensional (3D) MRI sequences over their two-dimensional (2D) counterparts. This development has been made possible by advances in MRI scanner hardware and software. In this article, we review the 3D versions of conventional sequences, including T1-weighted, T2-weighted and fluid-attenuated inversion recovery (FLAIR), as well as more advanced scans, including double inversion recovery (DIR), FLAIR2, FLAIR*, phase-sensitive inversion recovery, and susceptibility weighted imaging (SWI).
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Affiliation(s)
- Xun Yang Hu
- Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Luckshi Rajendran
- Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Emmanuelle Lapointe
- Department of Medicine, Division of Neurology, University of Sherbrooke, Sherbrooke, QC, Canada
| | - Roger Tam
- Department of Radiology, School of Biomedical Engineering, The University of British Columbia, Vancouver, BC, Canada
| | - David Li
- Department of Radiology, UBC Hospital, Vancouver, BC, Canada
| | - Anthony Traboulsee
- Division of Neurology, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Alexander Rauscher
- Department of Radiology, The University of British Columbia, Vancouver, BC, Canada
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47
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Suthiphosuwan S, Sati P, Guenette M, Montalban X, Reich DS, Bharatha A, Oh J. The Central Vein Sign in Radiologically Isolated Syndrome. AJNR Am J Neuroradiol 2019; 40:776-783. [PMID: 31000526 DOI: 10.3174/ajnr.a6045] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 03/25/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Radiologically isolated syndrome describes asymptomatic individuals with incidental radiologic abnormalities suggestive of multiple sclerosis. Recent studies have demonstrated that >40% of white matter lesions in MS (and often substantially more) have visible central veins on MR imaging. This "central vein sign" reflects perivenous inflammatory demyelination and can assist in differentiating MS from other white matter disorders. We therefore hypothesized that >40% of white matter lesions in cases of radiologically isolated syndrome would show the central vein sign. MATERIALS AND METHODS We recruited 20 participants diagnosed with radiologically isolated syndrome after evaluation by a neurologist. We performed 3T MR imaging of the brain and cervical spinal cord. White matter lesions were analyzed for the central vein sign. RESULTS Of 391 total white matter lesions, 292 (75%) demonstrated the central vein sign (central vein sign+). The median proportion of central vein sign+ lesions per case was 87% (range, 29%-100%). When the "40% rule" that has been proposed to distinguish MS from other disorders was applied, of 20 participants, 18 cases of radiologically isolated syndrome (90%) had ≥40% central vein sign+ lesions (range, 55%-100%). Two participants (10%) had <40% central vein sign+ lesions (29% and 31%). When the simpler "rule of 6" was applied, 19 participants (95%) met these criteria. In multivariable models, the number of spinal cord and infratentorial lesions was associated with a higher proportion of central vein sign+ lesions (P = .002; P = .06, respectively). CONCLUSIONS Most cases of radiologically isolated syndrome had a high proportion of central vein sign+ lesions, suggesting that lesions in these individuals reflect perivenous inflammatory demyelination. Moreover, we found correlations between the proportion of central vein sign+ lesions and spinal cord lesions, a known risk factor for radiologically isolated syndrome progressing to MS. These findings raise the possibility, testable prospectively, that the central vein sign may have prognostic value in distinguishing patients with radiologically isolated syndrome at risk of developing clinical MS from those with white matter lesions of other etiologies.
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Affiliation(s)
- S Suthiphosuwan
- From the Division of Neuroradiology (S.S., A.B.)
- Division of Neurology (S.S., M.G., X.M., J.O.), Department of Medicine
| | - P Sati
- Translational Neuroradiology Section (P.S., D.S.R.), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
| | - M Guenette
- Division of Neurology (S.S., M.G., X.M., J.O.), Department of Medicine
| | - X Montalban
- Division of Neurology (S.S., M.G., X.M., J.O.), Department of Medicine
| | - D S Reich
- Translational Neuroradiology Section (P.S., D.S.R.), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
- Department of Neurology (D.S.R., J.O.), Johns Hopkins University, Baltimore, Maryland
| | - A Bharatha
- From the Division of Neuroradiology (S.S., A.B.)
- Division of Neurosurgery (A.B.), Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - J Oh
- Division of Neurology (S.S., M.G., X.M., J.O.), Department of Medicine
- Department of Neurology (D.S.R., J.O.), Johns Hopkins University, Baltimore, Maryland
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48
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Colombo B, Messina R, Rocca MA, Filippi M. Imaging the migrainous brain: the present and the future. Neurol Sci 2019; 40:49-54. [DOI: 10.1007/s10072-019-03851-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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49
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Abstract
Multiple sclerosis (MS) is the most common chronic inflammatory, demyelinating and neurodegenerative disease of the central nervous system in young adults. This disorder is a heterogeneous, multifactorial, immune-mediated disease that is influenced by both genetic and environmental factors. In most patients, reversible episodes of neurological dysfunction lasting several days or weeks characterize the initial stages of the disease (that is, clinically isolated syndrome and relapsing-remitting MS). Over time, irreversible clinical and cognitive deficits develop. A minority of patients have a progressive disease course from the onset. The pathological hallmark of MS is the formation of demyelinating lesions in the brain and spinal cord, which can be associated with neuro-axonal damage. Focal lesions are thought to be caused by the infiltration of immune cells, including T cells, B cells and myeloid cells, into the central nervous system parenchyma, with associated injury. MS is associated with a substantial burden on society owing to the high cost of the available treatments and poorer employment prospects and job retention for patients and their caregivers.
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Affiliation(s)
- Massimo Filippi
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy. .,Department of Neurology, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.
| | - Amit Bar-Or
- Department of Neurology and Center for Neuroinflammation and Experimental Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Fredrik Piehl
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.,Department of Neurology, Karolinska University Hospital, Stockholm, Sweden.,Neuroimmunology Unit, Center for Molecular Medicine, Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden
| | - Paolo Preziosa
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.,Department of Neurology, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Alessandra Solari
- Unit of Neuroepidemiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Sandra Vukusic
- Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Fondation Eugène Devic EDMUS Contre la Sclérose en Plaques, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
| | - Maria A Rocca
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.,Department of Neurology, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
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50
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Dworkin JD, Sati P, Solomon A, Pham DL, Watts R, Martin ML, Ontaneda D, Schindler MK, Reich DS, Shinohara RT. Automated Integration of Multimodal MRI for the Probabilistic Detection of the Central Vein Sign in White Matter Lesions. AJNR Am J Neuroradiol 2018; 39:1806-1813. [PMID: 30213803 DOI: 10.3174/ajnr.a5765] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 06/25/2018] [Indexed: 01/16/2023]
Abstract
BACKGROUND AND PURPOSE The central vein sign is a promising MR imaging diagnostic biomarker for multiple sclerosis. Recent studies have demonstrated that patients with MS have higher proportions of white matter lesions with the central vein sign compared with those with diseases that mimic MS on MR imaging. However, the clinical application of the central vein sign as a biomarker is limited by interrater differences in the adjudication of the central vein sign as well as the time burden required for the determination of the central vein sign for each lesion in a patient's full MR imaging scan. In this study, we present an automated technique for the detection of the central vein sign in white matter lesions. MATERIALS AND METHODS Using multimodal MR imaging, the proposed method derives a central vein sign probability, πij, for each lesion, as well as a patient-level central vein sign biomarker, ψi. The method is probabilistic in nature, allows site-specific lesion segmentation methods, and is potentially robust to intersite variability. The proposed algorithm was tested on imaging acquired at the University of Vermont in 16 participants who have MS and 15 participants who do not. RESULTS By means of the proposed automated technique, participants with MS were found to have significantly higher values of ψ than those without MS (ψMS = 0.55 ± 0.18; ψnon-MS = 0.31 ± 0.12; P < .001). The algorithm was also found to show strong discriminative ability between patients with and without MS, with an area under the curve of 0.88. CONCLUSIONS The current study presents the first fully automated method for detecting the central vein sign in white matter lesions and demonstrates promising performance in a sample of patients with and without MS.
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Affiliation(s)
- J D Dworkin
- From the Department of Biostatistics, Epidemiology, and Informatics (J.D.D., M.L.M., R.T.S.), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - P Sati
- Translational Neuroradiology Section (P.S., M.K.S., D.S.R.), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
| | - A Solomon
- Departments of Neurological Sciences (A.S.)
| | - D L Pham
- Center for Neuroscience and Regenerative Medicine (D.L.P.), Henry M. Jackson Foundation, Bethesda, Maryland
| | - R Watts
- Radiology (R.W.), Larner College of Medicine at the University of Vermont, Burlington, Vermont
| | - M L Martin
- From the Department of Biostatistics, Epidemiology, and Informatics (J.D.D., M.L.M., R.T.S.), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - D Ontaneda
- Mellen Center for Multiple Sclerosis Treatment and Research (D.O.), Cleveland Clinic, Cleveland, Ohio
| | - M K Schindler
- Translational Neuroradiology Section (P.S., M.K.S., D.S.R.), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
| | - D S Reich
- Translational Neuroradiology Section (P.S., M.K.S., D.S.R.), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
- Department of Neurology (D.S.R.), Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - R T Shinohara
- From the Department of Biostatistics, Epidemiology, and Informatics (J.D.D., M.L.M., R.T.S.), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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