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Vanheule E, Cambron M, Dobai A, Casselman JW. Rim lesions in MS at 3T: clinical correlation and possible radiological alternatives for daily practice at lower field strength. J Neuroradiol 2024; 51:101165. [PMID: 37907156 DOI: 10.1016/j.neurad.2023.10.010] [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: 08/09/2023] [Accepted: 10/28/2023] [Indexed: 11/02/2023]
Abstract
BACKGROUND AND PURPOSE Paramagnetic rim lesions (PRLs) have been described as an imaging feature specific to multiple sclerosis (MS) using high-field strength phase-sensitive MR imaging. These lesions are suggested to reflect chronic active inflammation associated with greater disease severity and a more rapid disability progression. The aim of our study is to investigate the relationship between PRLs, clinical parameters, other radiological findings and disease progression. MATERIAL AND METHODS This cross-sectional study included MS patients treated with teriflunomide, fingolimod, natalizumab or ocrelizumab for at least 2 years. PRLs seen at 3T MRI were analysed and correlated with clinical data and radiological progression, defined as an increase of the T2/FLAIR-lesion load during therapy. In the search for alternatives for these PRLs, we defined two additional radiological markers: 'FLAIR-bullet lesions', and on post-contrast black-blood (BB) images, 'BB-bullet lesions'. RESULTS We included 84 MS patients of whom 27 (32 %) had at least 1 PRL. PRLs were associated with radiological progression under therapy (p=0.039) and higher clinical disability scores, although only significant for 9-Hole Peg Test (p=0.023). Patients with FLAIR-bullet or BB-bullet lesions at 3T MRI had a higher chance of PRL (p<0.001) with a likelihood ratio of 13.2 for FLAIR-bullets and 12.6 for BB-bullet lesions, thanks to the high negative predictive value of respectively 83 % and 90 %. CONCLUSION PRLs are associated with an increase of T2/FLAIR-lesion load under therapy and unfavourable clinical outcome. Our newly defined 'bullet lesions' are associated with PRLs and might be an interesting MRI marker for centres without access to high-field SWI images.
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Affiliation(s)
- Eva Vanheule
- Department of Radiology, AZ Sint-Jan Brugge-Oostende, Campus Brugge, Ruddershove 10, Bruges 8000, Belgium.
| | - Melissa Cambron
- Department of Neurology, AZ Sint-Jan Brugge-Oostende, Campus Brugge, Ruddershove 10, Bruges 8000, Belgium
| | - Adrienn Dobai
- Department of Oral Diagnostics, Faculty of Dentistry, Semmelweis University, Szentkirályi u. 47, Budapest, 1088, Hungary; Department of Neuroradiology, Medical Imaging Centre, Semmelweis University, Balassa street 6, Budapest, 1083, Hungary
| | - Jan W Casselman
- Department of Radiology, AZ Sint-Jan Brugge-Oostende, Campus Brugge, Ruddershove 10, Bruges 8000, Belgium; Department of Diagnostic Radiology, Dalhousie University, Halifax, Nova Scotia, Canada
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Huerta MM, Conway DS, Planchon SM, Thoomukuntla B, Se-Hong O, Sakaie KE, Ontaneda D, Nakamura K. Longitudinal myelin content measures of slowly expanding lesions using 7T MRI in multiple sclerosis. J Neuroimaging 2024. [PMID: 38778455 DOI: 10.1111/jon.13209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 05/08/2024] [Accepted: 05/08/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND AND PURPOSE Slowly expanding lesions (SELs) are thought to represent a subset of chronic active lesions and have been associated with clinical disability, severity, and disease progression. The purpose of this study was to characterize SELs using advanced magnetic resonance imaging (MRI) measures related to myelin and neurite density on 7 Tesla (T) MRI. METHODS The study design was retrospective, longitudinal, observational cohort with multiple sclerosis (n = 15). Magnetom 7T scanner was used to acquire magnetization-prepared 2 rapid acquisition gradient echo and advanced MRI including visualization of short transverse relaxation time component (ViSTa) for myelin, quantitative magnetization transfer (qMT) for myelin, and neurite orientation dispersion density imaging (NODDI). SELs were defined as lesions showing ≥12% of growth over 12 months on serial MRI. Comparisons of quantitative measures in SELs and non-SELs were performed at baseline and over time. Statistical analyses included two-sample t-test, analysis of variance, and mixed-effects linear model for MRI metrics between lesion types. RESULTS A total of 1075 lesions were evaluated. Two hundred twenty-four lesions (21%) were SELs, and 216 (96%) of the SELs were black holes. At baseline, compared to non-SELs, SELs showed significantly lower ViSTa (1.38 vs. 1.53, p < .001) and qMT (2.47 vs. 2.97, p < .001) but not in NODDI measures (p > .27). Longitudinally, only ViSTa showed a greater loss when comparing SEL and non-SEL (p = .03). CONCLUSIONS SELs have a lower myelin content relative to non-SELs without a difference in neurite measures. SELs showed a longitudinal decrease in apparent myelin water fraction reflecting greater tissue injury.
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Affiliation(s)
- Mina M Huerta
- School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Devon S Conway
- Mellen Center for Multiple Sclerosis Treatment and Research, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Sarah M Planchon
- Mellen Center for Multiple Sclerosis Treatment and Research, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Oh Se-Hong
- Department of Biomedical Engineering, Hankuk University of Foreign Studies, Yongin, Republic of Korea
| | - Ken E Sakaie
- Imaging Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Daniel Ontaneda
- 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
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Rathmann E, Hemkemeier P, Raths S, Grothe M, Mankertz F, Hosten N, Flessa S. Changes in MRI Workflow of Multiple Sclerosis after Introduction of an AI-Software: A Qualitative Study. Healthcare (Basel) 2024; 12:978. [PMID: 38786390 PMCID: PMC11121325 DOI: 10.3390/healthcare12100978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 04/30/2024] [Accepted: 05/08/2024] [Indexed: 05/25/2024] Open
Abstract
The purpose of this study was to explore the effects of the integration of machine learning into daily radiological diagnostics, using the example of the machine learning software mdbrain® (Mediaire GmbH, Germany) in the diagnostic MRI workflow of patients with multiple sclerosis at the University Medicine Greifswald. The data were assessed through expert interviews, a comparison of analysis times with and without the machine learning software, as well as a process analysis of MRI workflows. Our results indicate a reduction in the screen-reading workload, improved decision-making regarding contrast administration, an optimized workflow, reduced examination times, and facilitated report communication with colleagues and patients. Our results call for a broader and quantitative analysis.
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Affiliation(s)
- Eiko Rathmann
- Institute of Radiology and Neuroradiology, University Medicine Greifswald, 17475 Greifswald, Germany or (N.H.)
| | - Pia Hemkemeier
- Department of Business Administration and Health Care Management, Faculty of Law and Economics, University of Greifswald, 17489 Greifswald, Germany (S.F.)
| | - Susan Raths
- Department of Business Administration and Health Care Management, Faculty of Law and Economics, University of Greifswald, 17489 Greifswald, Germany (S.F.)
| | - Matthias Grothe
- Department of Neurology, University Medicine Greifswald, 17475 Greifswald, Germany;
| | - Fiona Mankertz
- Institute of Radiology and Neuroradiology, University Medicine Greifswald, 17475 Greifswald, Germany or (N.H.)
| | - Norbert Hosten
- Institute of Radiology and Neuroradiology, University Medicine Greifswald, 17475 Greifswald, Germany or (N.H.)
| | - Steffen Flessa
- Department of Business Administration and Health Care Management, Faculty of Law and Economics, University of Greifswald, 17489 Greifswald, Germany (S.F.)
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Ontaneda D, Chitnis T, Rammohan K, Obeidat AZ. Identification and management of subclinical disease activity in early multiple sclerosis: a review. J Neurol 2024; 271:1497-1514. [PMID: 37864717 PMCID: PMC10972995 DOI: 10.1007/s00415-023-12021-5] [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] [Received: 06/30/2023] [Revised: 09/22/2023] [Accepted: 09/24/2023] [Indexed: 10/23/2023]
Abstract
IMPORTANCE Early treatment initiation in multiple sclerosis (MS) is crucial in preventing irreversible neurological damage and disability progression. The current assessment of disease activity relies on relapse rates and magnetic resonance imaging (MRI) lesion activity, but inclusion of other early, often "hidden," indicators of disease activity may describe a more comprehensive picture of MS. OBSERVATIONS Early indicators of MS disease activity other than relapses and MRI activity, such as cognitive impairment, brain atrophy, and fatigue, are not typically captured by routine disease monitoring. Furthermore, silent progression (neurological decline not clearly captured by standard methods) may occur undetected by relapse and MRI lesion activity monitoring. Consequently, patients considered to have no disease activity actually may have worsening disease, suggesting a need to revise MS management strategies with respect to timely initiation and escalation of disease-modifying therapy (DMT). Traditionally, first-line MS treatment starts with low- or moderate-efficacy therapies, before escalating to high-efficacy therapies (HETs) after evidence of breakthrough disease activity. However, multiple observational studies have shown that early initiation of HETs can prevent or reduce disability progression. Ongoing randomized clinical trials are comparing escalation and early HET approaches. CONCLUSIONS AND RELEVANCE There is an urgent need to reassess how MS disease activity and worsening are measured. A greater awareness of "hidden" indicators, potentially combined with biomarkers to reveal silent disease activity and neurodegeneration underlying MS, would provide a more complete picture of MS and allow for timely therapeutic intervention with HET or switching DMTs to address suboptimal treatment responses.
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Affiliation(s)
- Daniel Ontaneda
- Mellen Center for Multiple Sclerosis, Department of Neurology, Cleveland Clinic, Cleveland, OH, USA.
| | - Tanuja Chitnis
- Brigham Multiple Sclerosis Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Kottil Rammohan
- Division of Multiple Sclerosis, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ahmed Z Obeidat
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA
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Naval-Baudin P, Pons-Escoda A, Castillo-Pinar A, Martínez-Zalacaín I, Arroyo-Pereiro P, Flores-Casaperalta S, Garay-Buitron F, Calvo N, Martinez-Yélamos A, Cos M, Martínez-Yélamos S, Majós C. The T1-dark-rim: A novel imaging sign for detecting smoldering inflammation in multiple sclerosis. Eur J Radiol 2024; 173:111358. [PMID: 38340569 DOI: 10.1016/j.ejrad.2024.111358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 01/24/2024] [Accepted: 02/03/2024] [Indexed: 02/12/2024]
Abstract
PURPOSE Paramagnetic rim lesions (PRLs), usually identified in susceptibility-weighted imaging (SWI), are a promising prognostic biomarker of disability progression in multiple sclerosis (MS). However, SWI is not routinely performed in clinical practice. The objective of this study is to define a novel imaging sign, the T1-dark rim, identifiable in a standard 3DT1 gradient-echo inversion-recovery sequence, such as 3D T1 turbo field echo (3DT1FE) and explore its performance as a SWI surrogate to define PRLs. METHODS This observational cross-sectional study analyzed MS patients who underwent 3T magnetic resonance imaging (MRI) including 3DT1TFE and SWI. Rim lesions were evaluated in 3DT1TFE, processed SWI, and SWI phase and categorized as true positive, false positive, or false negative based on the value of the T1-dark rim in predicting SWI phase PRLs. Sensitivity and positive predictive values of the T1-dark rim for detecting PRLs were calculated. RESULTS Overall, 80 rim lesions were identified in 63 patients (60 in the SWI phase and 78 in 3DT1TFE; 58 true positives, 20 false positives, and two false negatives). The T1-dark rim demonstrated 97% sensitivity and 74% positive predictive value for detecting PRLs. More PRLs were detected in the SWI phase than in processed SWI (60 and 57, respectively). CONCLUSION The T1-dark rim sign is a promising and accessible novel imaging marker to detect PRLs whose high sensitivity may enable earlier detection of chronic active lesions to guide MS treatment escalation. The relevance of T1-dark rim lesions that are negative on SWI opens up a new field for analysis.
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Affiliation(s)
- Pablo Naval-Baudin
- Radiology Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Carrer de Feixa Llarga SN, 08907 Barcelona, Spain; Institut de Diagnòstic Per La Imatge (IDI), L'Hospitalet de Llobregat, Centre Bellvige, Carrer de Feixa Llarga SN, 08907 Barcelona, Spain; Diagnostic Imaging and Nuclear Medicine Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, 08907 Barcelona, Spain; Departament de Ciències Clíniques, Facultat de Medicina I Ciències de La Salut, Universitat de Barcelona (UB), Carrer de Casanova 143, 08036 Barcelona, Spain.
| | - Albert Pons-Escoda
- Radiology Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Carrer de Feixa Llarga SN, 08907 Barcelona, Spain; Institut de Diagnòstic Per La Imatge (IDI), L'Hospitalet de Llobregat, Centre Bellvige, Carrer de Feixa Llarga SN, 08907 Barcelona, Spain; Diagnostic Imaging and Nuclear Medicine Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, 08907 Barcelona, Spain; Departament de Ciències Clíniques, Facultat de Medicina I Ciències de La Salut, Universitat de Barcelona (UB), Carrer de Casanova 143, 08036 Barcelona, Spain
| | - Albert Castillo-Pinar
- Radiology Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Carrer de Feixa Llarga SN, 08907 Barcelona, Spain
| | - Ignacio Martínez-Zalacaín
- Radiology Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Carrer de Feixa Llarga SN, 08907 Barcelona, Spain
| | - Pablo Arroyo-Pereiro
- Departament de Ciències Clíniques, Facultat de Medicina I Ciències de La Salut, Universitat de Barcelona (UB), Carrer de Casanova 143, 08036 Barcelona, Spain; Multiple Sclerosis Unit, Department of Neurology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Carrer de Feixa Llarga SN, 08907 Barcelona, Spain; Neurological Diseases and Neurogenetic Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Susanie Flores-Casaperalta
- Radiology Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Carrer de Feixa Llarga SN, 08907 Barcelona, Spain; Institut de Diagnòstic Per La Imatge (IDI), L'Hospitalet de Llobregat, Centre Bellvige, Carrer de Feixa Llarga SN, 08907 Barcelona, Spain; Diagnostic Imaging and Nuclear Medicine Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Francis Garay-Buitron
- Radiology Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Carrer de Feixa Llarga SN, 08907 Barcelona, Spain; Institut de Diagnòstic Per La Imatge (IDI), L'Hospitalet de Llobregat, Centre Bellvige, Carrer de Feixa Llarga SN, 08907 Barcelona, Spain; Diagnostic Imaging and Nuclear Medicine Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Nahum Calvo
- Radiology Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Carrer de Feixa Llarga SN, 08907 Barcelona, Spain; Institut de Diagnòstic Per La Imatge (IDI), L'Hospitalet de Llobregat, Centre Bellvige, Carrer de Feixa Llarga SN, 08907 Barcelona, Spain; Diagnostic Imaging and Nuclear Medicine Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Antonio Martinez-Yélamos
- Departament de Ciències Clíniques, Facultat de Medicina I Ciències de La Salut, Universitat de Barcelona (UB), Carrer de Casanova 143, 08036 Barcelona, Spain; Multiple Sclerosis Unit, Department of Neurology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Carrer de Feixa Llarga SN, 08907 Barcelona, Spain; Neurological Diseases and Neurogenetic Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Mónica Cos
- Radiology Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Carrer de Feixa Llarga SN, 08907 Barcelona, Spain; Institut de Diagnòstic Per La Imatge (IDI), L'Hospitalet de Llobregat, Centre Bellvige, Carrer de Feixa Llarga SN, 08907 Barcelona, Spain; Diagnostic Imaging and Nuclear Medicine Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Sergio Martínez-Yélamos
- Departament de Ciències Clíniques, Facultat de Medicina I Ciències de La Salut, Universitat de Barcelona (UB), Carrer de Casanova 143, 08036 Barcelona, Spain; Multiple Sclerosis Unit, Department of Neurology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Carrer de Feixa Llarga SN, 08907 Barcelona, Spain; Neurological Diseases and Neurogenetic Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Carles Majós
- Radiology Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Carrer de Feixa Llarga SN, 08907 Barcelona, Spain; Institut de Diagnòstic Per La Imatge (IDI), L'Hospitalet de Llobregat, Centre Bellvige, Carrer de Feixa Llarga SN, 08907 Barcelona, Spain; Diagnostic Imaging and Nuclear Medicine Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, 08907 Barcelona, Spain
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Nakamura K, Thoomukuntla B, Bena J, Cohen JA, Fox RJ, Ontaneda D. Ibudilast reduces slowly enlarging lesions in progressive multiple sclerosis. Mult Scler 2024; 30:369-380. [PMID: 38286755 DOI: 10.1177/13524585231224702] [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: 01/31/2024]
Abstract
BACKGROUND Ibudilast has shown beneficial effects on several imaging outcomes in progressive multiple sclerosis (MS). Slowly enlarging lesions are a proposed imaging biomarker of compartmentalized inflammation within chronic active lesions. OBJECTIVE To assess the treatment effect of ibudilast on slowly enlarging lesion volumes over 96 weeks from a phase II clinical trial of ibudilast (Secondary and Primary Progressive Ibudilast NeuroNEXT Trial in Multiple Sclerosis [SPRINT-MS]). METHODS In total, 255 participants with progressive MS from 28 sites were randomized to oral ibudilast or placebo. Participants with at least four analyzable magnetic resonance imaging (MRI) were included. Slowly enlarging lesions were quantified using Jacobian determinant maps. A linear model was used to assess the effect of ibudilast. Magnetization transfer ratio within slowly enlarging lesions was assessed to determine the effect of ibudilast on tissue integrity. RESULTS In total, 195 participants were included in this analysis. Ibudilast significantly decreased slowly enlarging lesion volume (23%, p = 0.003). Ibudilast also reduced magnetization transfer ratio change in slowly enlarging lesions: 0.22%/year, p = 0.04. CONCLUSION Ibudilast showed a significant effect on baseline volume of lesions that were slowly enlarging and magnetization transfer ratio in slowly enlarging lesions. The results support the use of slowly enlarging lesions for assessment of compartmentalized inflammation represented by chronic active lesions and provide further support for the neuroprotective effects of ibudilast in progressive MS.
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Affiliation(s)
- Kunio Nakamura
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Bhaskar Thoomukuntla
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - James Bena
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jeffrey A Cohen
- Mellen Center for Multiple Sclerosis, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Robert J Fox
- Mellen Center for Multiple Sclerosis, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Daniel Ontaneda
- Mellen Center for Multiple Sclerosis, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
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De Keersmaecker AV, Van Doninck E, Popescu V, Willem L, Cambron M, Laureys G, D’ Haeseleer M, Bjerke M, Roelant E, Lemmerling M, D’hooghe MB, Derdelinckx J, Reynders T, Willekens B. A metformin add-on clinical study in multiple sclerosis to evaluate brain remyelination and neurodegeneration (MACSiMiSE-BRAIN): study protocol for a multi-center randomized placebo controlled clinical trial. Front Immunol 2024; 15:1362629. [PMID: 38680485 PMCID: PMC11046490 DOI: 10.3389/fimmu.2024.1362629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 02/05/2024] [Indexed: 05/01/2024] Open
Abstract
Introduction Despite advances in immunomodulatory treatments of multiple sclerosis (MS), patients with non-active progressive multiple sclerosis (PMS) continue to face a significant unmet need. Demyelination, smoldering inflammation and neurodegeneration are important drivers of disability progression that are insufficiently targeted by current treatment approaches. Promising preclinical data support repurposing of metformin for treatment of PMS. The objective of this clinical trial is to evaluate whether metformin, as add-on treatment, is superior to placebo in delaying disease progression in patients with non-active PMS. Methods and analysis MACSiMiSE-BRAIN is a multi-center two-arm, 1:1 randomized, triple-blind, placebo-controlled clinical trial, conducted at five sites in Belgium. Enrollment of 120 patients with non-active PMS is planned. Each participant will undergo a screening visit with assessment of baseline magnetic resonance imaging (MRI), clinical tests, questionnaires, and a safety laboratory assessment. Following randomization, participants will be assigned to either the treatment (metformin) or placebo group. Subsequently, they will undergo a 96-week follow-up period. The primary outcome is change in walking speed, as measured by the Timed 25-Foot Walk Test, from baseline to 96 weeks. Secondary outcome measures include change in neurological disability (Expanded Disability Status Score), information processing speed (Symbol Digit Modalities Test) and hand function (9-Hole Peg test). Annual brain MRI will be performed to assess evolution in brain volumetry and diffusion metrics. As patients may not progress in all domains, a composite outcome, the Overall Disability Response Score will be additionally evaluated as an exploratory outcome. Other exploratory outcomes will consist of paramagnetic rim lesions, the 2-minute walking test and health economic analyses as well as both patient- and caregiver-reported outcomes like the EQ-5D-5L, the Multiple Sclerosis Impact Scale and the Caregiver Strain Index. Ethics and dissemination Clinical trial authorization from regulatory agencies [Ethical Committee and Federal Agency for Medicines and Health Products (FAMHP)] was obtained after submission to the centralized European Clinical Trial Information System. The results of this clinical trial will be disseminated at scientific conferences, in peer-reviewed publications, to patient associations and the general public. Trial registration ClinicalTrials.gov Identifier: NCT05893225, EUCT number: 2023-503190-38-00.
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Affiliation(s)
- Anna-Victoria De Keersmaecker
- Department of Neurology, Antwerp University Hospital, Edegem, Belgium
- Translational Neurosciences Research Group, Faculty of Medicine and Health Sciences, University of Antwerp, Edegem, Belgium
| | - Eline Van Doninck
- Department of Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
- Center of Health Economic Research and Modelling Infectious Diseases, University of Antwerp, Wilrijk, Belgium
| | - Veronica Popescu
- Immunology and Infection, University of Hasselt, Diepenbeek, Belgium
- Biomedical Research Institute, University of Hasselt, Diepenbeek, Belgium
- Department of Neurology, Noorderhart Maria Hospital, Pelt, Belgium
- University Multiple Sclerosis Centre, University of Hasselt, Hasselt, Belgium
| | - Lander Willem
- Department of Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
- Center of Health Economic Research and Modelling Infectious Diseases, University of Antwerp, Wilrijk, Belgium
| | - Melissa Cambron
- Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgium
- Department of Neurology, Algemeen Ziekenhuis Sint Jan, Bruges, Belgium
| | - Guy Laureys
- Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgium
- Department of Neurology, University Hospital Ghent, Ghent, Belgium
| | - Miguel D’ Haeseleer
- Department of Neurology, University Hospital Brussels, Brussels, Belgium
- Department of Neurology, National Multiple Sclerosis Center, Melsbroek, Belgium
- Department Neuroprotection and Neuromodulation, Center for Neurosciences, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Maria Bjerke
- Department Neuroprotection and Neuromodulation, Center for Neurosciences, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
- Neurochemistry Laboratory, Department of Clinical Biology, Brussels, University Hospital Brussels, Brussels, Belgium
- Department of Biomedical Sciences, University of Antwerp, Wilrijk, Belgium
| | - Ella Roelant
- Clinical Trial Center, Antwerp University Hospital, Edegem, Belgium
| | - Marc Lemmerling
- Department of Radiology, Antwerp University Hospital, Edegem, Wilrijk, Belgium
| | - Marie Beatrice D’hooghe
- Department of Neurology, University Hospital Brussels, Brussels, Belgium
- Department of Neurology, National Multiple Sclerosis Center, Melsbroek, Belgium
- Department Neuroprotection and Neuromodulation, Center for Neurosciences, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Judith Derdelinckx
- Department of Neurology, Antwerp University Hospital, Edegem, Belgium
- Laboratory of Experimental Hematology, Vaccine and Infectious Disease Institute, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Tatjana Reynders
- Department of Neurology, Antwerp University Hospital, Edegem, Belgium
- Translational Neurosciences Research Group, Faculty of Medicine and Health Sciences, University of Antwerp, Edegem, Belgium
| | - Barbara Willekens
- Department of Neurology, Antwerp University Hospital, Edegem, Belgium
- Translational Neurosciences Research Group, Faculty of Medicine and Health Sciences, University of Antwerp, Edegem, Belgium
- Laboratory of Experimental Hematology, Vaccine and Infectious Disease Institute, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
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Moura J, Granziera C, Marta M, Silva AM. Emerging imaging markers in radiologically isolated syndrome: implications for earlier treatment initiation. Neurol Sci 2024:10.1007/s10072-024-07402-1. [PMID: 38374458 DOI: 10.1007/s10072-024-07402-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 02/13/2024] [Indexed: 02/21/2024]
Abstract
The presence of central nervous system lesions fulfilling the criteria of dissemination in space and time on MRI leads to the diagnosis of a radiologically isolated syndrome (RIS), which may be an early sign of multiple sclerosis (MS). However, some patients who do not fulfill the necessary criteria for RIS still evolve to MS, and some T2 hyperintensities that resemble demyelinating lesions may originate from mimics. In light of the recent recognition of the efficacy of disease-modifying therapy (DMT) in RIS, it is relevant to consider additional imaging features that are more specific of MS. We performed a narrative review on cortical lesions (CL), the central vein sign (CVS), and paramagnetic rim lesions (PRL) in patients with RIS. In previous RIS studies, the reported prevalence of CLs ranges between 20.0 and 40.0%, CVS + white matter lesions (WMLs) between 87.0 and 93.0% and PRLs between 26.7 and 63.0%. Overall, these imaging findings appear to be frequent in RIS cohorts, although not consistently taken into account in previous studies. The search for CLs, CVS + WML and PRLs in RIS patients could lead to earlier identification of patients who will evolve to MS and benefit from DMTs.
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Affiliation(s)
- João Moura
- Department of Neurology, Centro Hospitalar Universitário de Santo António, Largo Professor Abel Salazar, 4099-001, Porto, Portugal.
- ICBAS School of Medicine and Biomedical Sciences, University of Porto, Porto, Portugal.
| | - Cristina Granziera
- Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel, 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
| | - Monica Marta
- Department of Neurology, Royal London Hospital, Barts Health NHS Trust, London, UK
- Neuroscience and Trauma, Blizard Institute of Cell and Molecular Science, London, UK
| | - Ana Martins Silva
- Department of Neurology, Centro Hospitalar Universitário de Santo António, Largo Professor Abel Salazar, 4099-001, Porto, Portugal
- ICBAS School of Medicine and Biomedical Sciences, University of Porto, Porto, Portugal
- Unit of Multidisciplinary Research in Biomedicine, Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal
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9
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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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10
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Tur C, Rocca MA. Progression Independent of Relapse Activity in Multiple Sclerosis: Closer to Solving the Pathologic Puzzle. Neurology 2024; 102:e207936. [PMID: 38165383 DOI: 10.1212/wnl.0000000000207936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 08/24/2023] [Indexed: 01/03/2024] Open
Abstract
Progression independent of relapse activity (PIRA) is one of the main mechanisms of disability accrual in multiple sclerosis (MS) even in people with relapsing-remitting MS (RRMS).1 PIRA can occur at any stage of the disease and is associated with unfavorable long-term outcomes, especially if PIRA occurs early in the disease course.2 The pathologic substrates of PIRA are not yet well understood, although there is growing evidence suggesting that PIRA may occur mainly in a predominant neurodegenerative context,3-6 sometimes in combination with an acute inflammatory activity.2,5 A deeper understanding of the pathologic processes underlying PIRA represents a vital initial stride toward averting the accumulation of irreversible disability in MS.
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Affiliation(s)
- Carmen Tur
- From the Multiple Sclerosis Centre of Catalonia (Cemcat) (C.T.), Department of Neurology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; NMR Unit, Queen Square MS Centre (C.T.), Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London, United Kingdom; Neuroimaging Research Unit (M.A.R.), Institute of Experimental Neurology, Division of Neuroscience, and Neurology Unit, IRCCS San Raffaele Scientific Institute; and Vita-Salute San Raffaele University (M.A.R.), Milan, Italy
| | - Maria A Rocca
- From the Multiple Sclerosis Centre of Catalonia (Cemcat) (C.T.), Department of Neurology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; NMR Unit, Queen Square MS Centre (C.T.), Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London, United Kingdom; Neuroimaging Research Unit (M.A.R.), Institute of Experimental Neurology, Division of Neuroscience, and Neurology Unit, IRCCS San Raffaele Scientific Institute; and Vita-Salute San Raffaele University (M.A.R.), Milan, Italy
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11
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Clarke MA, Cheek R, Kazimuddin HF, Hernandez B, Clarke R, McKnight CD, Derwenskus J, Eaton J, Irlmeier R, Ye F, O’Grady KP, Rogers B, Smith SA, Bagnato F. Paramagnetic rim lesions and the central vein sign: Characterizing multiple sclerosis imaging markers. J Neuroimaging 2024; 34:86-94. [PMID: 38018353 PMCID: PMC10842224 DOI: 10.1111/jon.13173] [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] [Received: 10/22/2023] [Revised: 11/09/2023] [Accepted: 11/14/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND AND PURPOSE Paramagnetic rims and the central vein sign (CVS) are proposed imaging markers of multiple sclerosis (MS) lesions. Using 7 tesla magnetic resonance imaging, we aimed to: (1) characterize the appearance of paramagnetic rim lesions (PRLs); (2) assess whether PRLs and the CVS are associated with higher levels of MS pathology; and (3) compare the characteristics between subjects with and without PRLs in early MS. METHODS Prospective study of 32 treatment-naïve subjects around the time of diagnosis who were assessed for the presence of PRLs and the CVS. Comparisons of lesion volume and macromolecular pool size ratio (PSR) index, a proxy of myelin integrity, between PRLs and non-PRLs, and CVS-positive and CVS-negative lesions were carried out. Differences in clinical/demographic characteristics between patients with PRLs and those without were tested. RESULTS Fifteen subjects had ≥1 PRL for a total of 36 PRLs, of which two-thirds had a full rim. PRLs predicted a larger lesion size and decreased PSR signal. Lesion volume and presence of cervical spine lesions were significantly different between subjects with PRLs and those without, although neither remained significant after adjusting for multiple comparisons. One hundred and eighty-one lesions with CVS were identified with no differences between CVS-positive and CVS-negative lesions in volume (p = .27) and PSR values (p = .62). CONCLUSIONS PRLs, but not CVS-positive lesions, are larger and have lower myelin integrity. Our findings indicate that PRLs are associated with higher levels of lesion-specific pathology prior to the start of disease-modifying therapy.
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Affiliation(s)
- Margareta A. Clarke
- Neuroimaging Unit, Neuro-immunology Division, Department of Neurology, Vanderbilt University Medical Center
| | - Rachael Cheek
- Neuroimaging Unit, Neuro-immunology Division, Department of Neurology, Vanderbilt University Medical Center
- Meharry Medical College
| | - Habeeb F. Kazimuddin
- Neuroimaging Unit, Neuro-immunology Division, Department of Neurology, Vanderbilt University Medical Center
| | - Bryan Hernandez
- Neuroimaging Unit, Neuro-immunology Division, Department of Neurology, Vanderbilt University Medical Center
- Vanderbilt Medical Scientist Training Program, Vanderbilt University
| | - Reece Clarke
- Neuroimaging Unit, Neuro-immunology Division, Department of Neurology, Vanderbilt University Medical Center
| | - Colin D. McKnight
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center
| | - Joy Derwenskus
- Neuro-immunology Division, Department of Neurology, Vanderbilt University Medical Center
| | - James Eaton
- Neuro-immunology Division, Department of Neurology, Vanderbilt University Medical Center
| | - Rebecca Irlmeier
- Department of Biostatistics, Vanderbilt University Medica Center
| | - Fei Ye
- Department of Biostatistics, Vanderbilt University Medica Center
| | - Kristin P. O’Grady
- Vanderbilt Medical Scientist Training Program, Vanderbilt University
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medica Center
| | - Baxter Rogers
- Vanderbilt Medical Scientist Training Program, Vanderbilt University
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medica Center
| | - Seth A. Smith
- Vanderbilt Medical Scientist Training Program, Vanderbilt University
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medica Center
| | - Francesca Bagnato
- Neuroimaging Unit, Neuro-immunology Division, Department of Neurology, Vanderbilt University Medical Center
- Department of Neurology, VA Hospital, TN Valley Healthcare Center, Nashville, TN
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12
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Calvi A, Mendelsohn Z, Hamed W, Chard D, Tur C, Stutters J, MacManus D, Kanber B, Wheeler-Kingshott CAMG, Barkhof F, Prados F. Treatment reduces the incidence of newly appearing multiple sclerosis lesions evolving into chronic active, slowly expanding lesions: A retrospective analysis. Eur J Neurol 2024; 31:e16092. [PMID: 37823722 DOI: 10.1111/ene.16092] [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] [Received: 05/31/2023] [Revised: 09/05/2023] [Accepted: 09/21/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND AND PURPOSE Newly appearing lesions in multiple sclerosis (MS) may evolve into chronically active, slowly expanding lesions (SELs), leading to sustained disability progression. The aim of this study was to evaluate the incidence of newly appearing lesions developing into SELs, and their correlation to clinical evolution and treatment. METHODS A retrospective analysis of a fingolimod trial in primary progressive MS (PPMS; INFORMS, NCT00731692) was undertaken. Data were available from 324 patients with magnetic resonance imaging scans up to 3 years after screening. New lesions at year 1 were identified with convolutional neural networks, and SELs obtained through a deformation-based method. Clinical disability was assessed annually by Expanded Disability Status Scale (EDSS), Nine-Hole Peg Test, Timed 25-Foot Walk, and Paced Auditory Serial Addition Test. Linear, logistic, and mixed-effect models were used to assess the relationship between the Jacobian expansion in new lesions and SELs, disability scores, and treatment status. RESULTS One hundred seventy patients had ≥1 new lesions at year 1 and had a higher lesion count at screening compared to patients with no new lesions (median = 27 vs. 22, p = 0.007). Among the new lesions (median = 2 per patient), 37% evolved into definite or possible SELs. Higher SEL volume and count were associated with EDSS worsening and confirmed disability progression. Treated patients had lower volume and count of definite SELs (β = -0.04, 95% confidence interval [CI] = -0.07 to -0.01, p = 0.015; β = -0.36, 95% CI = -0.67 to -0.06, p = 0.019, respectively). CONCLUSIONS Incident chronic active lesions are common in PPMS, and fingolimod treatment can reduce their number.
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Affiliation(s)
- Alberto Calvi
- NMR Research Unit, Institute of Neurology, University College London, London, UK
- Laboratory of Advanced Imaging in Neuroimmunological Diseases, Hospital Clinic Barcelona, Fundació Clinic per a la Recerca Biomèdica, Barcelona, Spain
| | - Zoe Mendelsohn
- NMR Research Unit, Institute of Neurology, University College London, London, UK
- Department of Radiology, Charité School of Medicine and University Hospital Berlin, Berlin, Germany
| | - Weaam Hamed
- NMR Research Unit, Institute of Neurology, University College London, London, UK
- Department of Radiology, Mansoura University Hospital, Mansoura, Egypt
| | - Declan Chard
- NMR Research Unit, Institute of Neurology, University College London, London, UK
- National Institute for Health Research, Biomedical Research Centre, University College London Hospitals, London, UK
| | - Carmen Tur
- NMR Research Unit, Institute of Neurology, University College London, London, UK
- Neurology-Neuroimmunology Department, Multiple Sclerosis Centre of Catalonia, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Jon Stutters
- NMR Research Unit, Institute of Neurology, University College London, London, UK
| | - David MacManus
- NMR Research Unit, Institute of Neurology, University College London, London, UK
| | - Baris Kanber
- National Institute for Health Research, Biomedical Research Centre, University College London Hospitals, London, UK
- Department of Medical Physics and Biomedical Engineering, Centre for Medical Image Computing, University College London, London, UK
| | - Claudia A M Gandini Wheeler-Kingshott
- NMR Research Unit, Institute of Neurology, University College London, London, UK
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Frederik Barkhof
- NMR Research Unit, Institute of Neurology, University College London, London, UK
- Department of Medical Physics and Biomedical Engineering, Centre for Medical Image Computing, University College London, London, UK
- Radiology and Nuclear Medicine, Amsterdam University Medical Centers (UMC), Vrije Universiteit, Amsterdam, the Netherlands
| | - Ferran Prados
- NMR Research Unit, Institute of Neurology, University College London, London, UK
- Department of Medical Physics and Biomedical Engineering, Centre for Medical Image Computing, University College London, London, UK
- e-Health Centre, Universitat Oberta de Catalunya, Barcelona, Spain
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13
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Krajnc N, Schmidbauer V, Leinkauf J, Haider L, Bsteh G, Kasprian G, Leutmezer F, Kornek B, Rommer PS, Berger T, Lassmann H, Dal-Bianco A, Hametner S. Paramagnetic rim lesions lead to pronounced diffuse periplaque white matter damage in multiple sclerosis. Mult Scler 2023; 29:1406-1417. [PMID: 37712486 PMCID: PMC10580674 DOI: 10.1177/13524585231197954] [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: 02/26/2023] [Revised: 07/27/2023] [Accepted: 07/31/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND Paramagnetic rim lesions (PRLs) are an imaging biomarker in multiple sclerosis (MS), associated with a more severe disease. OBJECTIVES To determine quantitative magnetic resonance imaging (MRI) metrics of PRLs, lesions with diffuse susceptibility-weighted imaging (SWI)-hypointense signal (DSHLs) and SWI-isointense lesions (SILs), their surrounding periplaque area (PPA) and the normal-appearing white matter (NAWM). METHODS In a cross-sectional study, quantitative MRI metrics were measured in people with multiple sclerosis (pwMS) using the multi-dynamic multi-echo (MDME) sequence post-processing software "SyMRI." RESULTS In 30 pwMS, 59 PRLs, 74 DSHLs, and 107 SILs were identified. Beside longer T1 relaxation times of PRLs compared to DSHLs and SILs (2030.5 (1519-2540) vs 1615.8 (1403.3-1953.5) vs 1199.5 (1089.6-1334.6), both p < 0.001), longer T1 relaxation times were observed in the PRL PPA compared to the SIL PPA and the NAWM but not the DSHL PPA. Patients with secondary progressive multiple sclerosis (SPMS) had longer T1 relaxation times in PRLs compared to patients with late relapsing multiple sclerosis (lRMS) (2394.5 (2030.5-3040) vs 1869.3 (1491.4-2451.3), p = 0.015) and also in the PRL PPA compared to patients with early relapsing multiple sclerosis (eRMS) (982 (927-1093.5) vs 904.3 (793.3-958.5), p = 0.013). CONCLUSION PRLs are more destructive than SILs, leading to diffuse periplaque white matter (WM) damage. The quantitative MRI-based evaluation of the PRL PPA could be a marker for silent progression in pwMS.
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Affiliation(s)
- Nik Krajnc
- Department of Neurology, Medical University of Vienna, Vienna, Austria/Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria/Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Victor Schmidbauer
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria/Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Joel Leinkauf
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria/Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Lukas Haider
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria/Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Gabriel Bsteh
- Department of Neurology, Medical University of Vienna, Vienna, Austria/Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Gregor Kasprian
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria/Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Fritz Leutmezer
- Department of Neurology, Medical University of Vienna, Vienna, Austria/Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Barbara Kornek
- Department of Neurology, Medical University of Vienna, Vienna, Austria/Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Paulus Stefan Rommer
- Department of Neurology, Medical University of Vienna, Vienna, Austria/Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Thomas Berger
- Department of Neurology, Medical University of Vienna, Vienna, Austria/Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Hans Lassmann
- Center for Brain Research, Medical University of Vienna, Vienna, Austria
| | - Assunta Dal-Bianco
- Department of Neurology, Medical University of Vienna, Vienna, Austria/Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Simon Hametner
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria/Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
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14
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Abou Mrad T, Naja K, Khoury SJ, Hannoun S. Central vein sign and paramagnetic rim sign: From radiologically isolated syndrome to multiple sclerosis. Eur J Neurol 2023; 30:2912-2918. [PMID: 37350369 DOI: 10.1111/ene.15922] [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: 03/26/2023] [Revised: 06/02/2023] [Accepted: 06/07/2023] [Indexed: 06/24/2023]
Abstract
The widespread use of magnetic resonance imaging (MRI) has led to an increase in incidental findings in the central nervous system. Radiologically isolated syndrome (RIS) is a condition where imaging reveals lesions suggestive of demyelinating disease without any clinical episodes consistent with multiple sclerosis (MS). The prognosis for RIS patients is uncertain, with some remaining asymptomatic while others progress to MS. Several risk factors for disease progression have been identified, including male sex, younger age at diagnosis, and spinal cord lesions. This article reviews two promising biomarkers, the central vein sign (CVS) and the paramagnetic rim sign (PRS), and their potential role in the diagnosis and prognosis of MS and RIS. Both CVS and PRS have been shown to be accurate diagnostic markers in MS, with high sensitivity and specificity, and have been useful in distinguishing MS from other disorders. Further research is needed to validate these findings and determine the clinical utility of these biomarkers in routine practice.
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Affiliation(s)
- Tatiana Abou Mrad
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Kim Naja
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Samia J Khoury
- Nehme and Therese Tohme Multiple Sclerosis Center, Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Salem Hannoun
- Medical Imaging Sciences Program, Division of Health Professions, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
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Maggi P, Bulcke CV, Pedrini E, Bugli C, Sellimi A, Wynen M, Stölting A, Mullins WA, Kalaitzidis G, Lolli V, Perrotta G, El Sankari S, Duprez T, Li X, Calabresi PA, van Pesch V, Reich DS, Absinta M. B cell depletion therapy does not resolve chronic active multiple sclerosis lesions. EBioMedicine 2023; 94:104701. [PMID: 37437310 PMCID: PMC10436266 DOI: 10.1016/j.ebiom.2023.104701] [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: 01/23/2023] [Revised: 06/23/2023] [Accepted: 06/23/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND Chronic active lesions (CAL) in multiple sclerosis (MS) have been observed even in patients taking high-efficacy disease-modifying therapy, including B-cell depletion. Given that CAL are a major determinant of clinical progression, including progression independent of relapse activity (PIRA), understanding the predicted activity and real-world effects of targeting specific lymphocyte populations is critical for designing next-generation treatments to mitigate chronic inflammation in MS. METHODS We analyzed published lymphocyte single-cell transcriptomes from MS lesions and bioinformatically predicted the effects of depleting lymphocyte subpopulations (including CD20 B-cells) from CAL via gene-regulatory-network machine-learning analysis. Motivated by the results, we performed in vivo MRI assessment of PRL changes in 72 adults with MS, 46 treated with anti-CD20 antibodies and 26 untreated, over ∼2 years. FINDINGS Although only 4.3% of lymphocytes in CAL were CD20 B-cells, their depletion is predicted to affect microglial genes involved in iron/heme metabolism, hypoxia, and antigen presentation. In vivo, tracking 202 PRL (150 treated) and 175 non-PRL (124 treated), none of the treated paramagnetic rims disappeared at follow-up, nor was there a treatment effect on PRL for lesion volume, magnetic susceptibility, or T1 time. PIRA occurred in 20% of treated patients, more frequently in those with ≥4 PRL (p = 0.027). INTERPRETATION Despite predicted effects on microglia-mediated inflammatory networks in CAL and iron metabolism, anti-CD20 therapies do not fully resolve PRL after 2-year MRI follow up. Limited tissue turnover of B-cells, inefficient passage of anti-CD20 antibodies across the blood-brain-barrier, and a paucity of B-cells in CAL could explain our findings. FUNDING Intramural Research Program of NINDS, NIH; NINDS grants R01NS082347 and R01NS082347; Dr. Miriam and Sheldon G. Adelson Medical Research Foundation; Cariplo Foundation (grant #1677), FRRB Early Career Award (grant #1750327); Fund for Scientific Research (FNRS).
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Affiliation(s)
- Pietro Maggi
- Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium; Neuroinflammation Imaging Lab (NIL), Université Catholique de Louvain, Brussels, Belgium; Centre Hospitalier Universitaire Vaudois, Université de Lausanne, Lausanne, Switzerland.
| | - Colin Vanden Bulcke
- Neuroinflammation Imaging Lab (NIL), Université Catholique de Louvain, Brussels, Belgium
| | - Edoardo Pedrini
- Institute of Experimental Neurology, Division of Neuroscience, Vita-Salute San Raffaele University and IRCCS San Raffaele Hospital, Milan, Italy
| | - Céline Bugli
- Plateforme Technologique de Support en Méthodologie et Calcul Statistique, Université Catholique de Louvain, Brussels, Belgium
| | - Amina Sellimi
- Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Maxence Wynen
- Neuroinflammation Imaging Lab (NIL), Université Catholique de Louvain, Brussels, Belgium
| | - Anna Stölting
- Neuroinflammation Imaging Lab (NIL), Université Catholique de Louvain, Brussels, Belgium
| | - William A Mullins
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Grigorios Kalaitzidis
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Valentina Lolli
- Hôpital Erasme, Université Libre de Bruxelles, Bruxelles, Belgium
| | - Gaetano Perrotta
- Hôpital Erasme, Université Libre de Bruxelles, Bruxelles, Belgium
| | - Souraya El Sankari
- Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Thierry Duprez
- Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Xu Li
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Peter A Calabresi
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Vincent van Pesch
- Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Daniel S Reich
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Martina Absinta
- Institute of Experimental Neurology, Division of Neuroscience, Vita-Salute San Raffaele University and IRCCS San Raffaele Hospital, Milan, Italy; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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