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Siger M, Wydra J, Wildner P, Podyma M, Puzio T, Matera K, Stasiołek M, Świderek-Matysiak M. Differences in Brain Atrophy Pattern between People with Multiple Sclerosis and Systemic Diseases with Central Nervous System Involvement Based on Two-Dimensional Linear Measures. J Clin Med 2024; 13:333. [PMID: 38256467 PMCID: PMC10816254 DOI: 10.3390/jcm13020333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 01/02/2024] [Accepted: 01/04/2024] [Indexed: 01/24/2024] Open
Abstract
Conventional brain magnetic resonance imaging (MRI) in systemic diseases with central nervous system involvement (SDCNS) may imitate MRI findings of multiple sclerosis (MS). In order to better describe the MRI characteristics of these conditions, in our study we assessed brain volume parameters in MS (n = 58) and SDCNS (n = 41) patients using two-dimensional linear measurements (2DLMs): bicaudate ratio (BCR), corpus callosum index (CCI) and width of third ventricle (W3V). In SDCNS patients, all 2DLMs were affected by age (CCI p = 0.005, BCR p < 0.001, W3V p < 0.001, respectively), whereas in MS patients only BCR and W3V were (p = 0.001 and p = 0.015, respectively). Contrary to SDCNS, in the MS cohort BCR and W3V were associated with T1 lesion volume (T1LV) (p = 0.020, p = 0.009, respectively) and T2 lesion volume (T2LV) (p = 0.015, p = 0.009, respectively). CCI was associated with T1LV in the MS cohort only (p = 0.015). Moreover, BCR was significantly higher in the SDCNS group (p = 0.01) and CCI was significantly lower in MS patients (p = 0.01). The best predictive model to distinguish MS and SDCNS encompassed gender, BCR and T2LV as the explanatory variables (sensitivity 0.91; specificity 0.68; AUC 0.86). Implementation of 2DLMs in the brain MRI analysis of MS and SDCNS patients allowed for the identification of diverse patterns of local brain atrophy in these clinical conditions.
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Affiliation(s)
- Małgorzata Siger
- Department of Neurology, Medical University of Lodz, Kopcinskiego Street 22, 90-414 Lodz, Poland; (M.S.); (P.W.); (M.Ś.-M.)
| | - Jacek Wydra
- Pixel Technology LLC, Piekna 1, 93-558 Lodz, Poland; (J.W.); (M.P.); (T.P.); (K.M.)
| | - Paula Wildner
- Department of Neurology, Medical University of Lodz, Kopcinskiego Street 22, 90-414 Lodz, Poland; (M.S.); (P.W.); (M.Ś.-M.)
| | - Marek Podyma
- Pixel Technology LLC, Piekna 1, 93-558 Lodz, Poland; (J.W.); (M.P.); (T.P.); (K.M.)
| | - Tomasz Puzio
- Pixel Technology LLC, Piekna 1, 93-558 Lodz, Poland; (J.W.); (M.P.); (T.P.); (K.M.)
| | - Katarzyna Matera
- Pixel Technology LLC, Piekna 1, 93-558 Lodz, Poland; (J.W.); (M.P.); (T.P.); (K.M.)
| | - Mariusz Stasiołek
- Department of Neurology, Medical University of Lodz, Kopcinskiego Street 22, 90-414 Lodz, Poland; (M.S.); (P.W.); (M.Ś.-M.)
| | - Mariola Świderek-Matysiak
- Department of Neurology, Medical University of Lodz, Kopcinskiego Street 22, 90-414 Lodz, Poland; (M.S.); (P.W.); (M.Ś.-M.)
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Pontillo G, Cocozza S, Di Stasi M, Carotenuto A, Paolella C, Cipullo MB, Perillo T, Vola EA, Russo C, Masullo M, Moccia M, Lanzillo R, Tedeschi E, Elefante A, Brescia Morra V, Brunetti A, Quarantelli M, Petracca M. 2D linear measures of ventricular enlargement may be relevant markers of brain atrophy and long-term disability progression in multiple sclerosis. Eur Radiol 2020; 30:3813-3822. [PMID: 32100089 DOI: 10.1007/s00330-020-06738-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 02/04/2020] [Accepted: 02/10/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Aim of this study was to investigate the reliability and validity of 2D linear measures of ventricular enlargement as indirect markers of brain atrophy and possible predictors of clinical disability. METHODS In this retrospective longitudinal analysis of relapsing-remitting MS patients, brain volumes were computed at baseline and after 2 years. Frontal horn width (FHW), intercaudate distance (ICD), third ventricle width (TVW), and 4th ventricle width were obtained. Two-dimensional measures associated with brain volume at correlation analyses were entered in linear and logistic regression models testing the relationship with baseline clinical disability and 10-year confirmed disability progression (CDP), respectively. Possible cutoff values for clinically relevant atrophy were estimated via receiver operating characteristic (ROC) analyses and probed as 10-year CDP predictors using hierarchical logistic regression. RESULTS Eighty-seven patients were available (61/26 = F/M; 34.1 ± 8.5 years). Moderate negative correlations emerged between ICD and TVW and normalized brain volume (NBV; p < 0.001) and percentage brain volume change per year (PBVC/y) and FHW, ICD, and TVW annual changes (p ≤ 0.005). Baseline disability was moderately associated with NBV, ICD, and TVW (p < 0.001), while PBVC/y predicted 10-year CDP (p = 0.01). A cutoff percentage ICD change per year (PICDC/y) value of 4.38%, corresponding to - 0.91% PBVC/y, correlated with 10-year CDP (p = 0.04). These estimated cutoff values provided extra value for predicting 10-year CDP (PBVC/y: p = 0.001; PICDC/y: p = 0.03). CONCLUSIONS Two-dimensional measures of ventricular enlargement are reproducible and clinically relevant markers of brain atrophy, with ICD and its increase over time showing the best association with clinical disability. Specifically, a cutoff PICDC/y value of 4.38% could serve as a potential surrogate marker of long-term disability progression. KEY POINTS • Assessment of ventricular enlargement as a rapidly accessible indirect marker of brain atrophy may prove useful in cases in which brain volume quantification is not practicable. • Two-dimensional linear measures of ventricular enlargement represent reliable, valid, and clinically relevant markers of brain atrophy. • A cutoff annualized percentage brain volume change of - 0.91% and the corresponding annualized percentage increase of 4.38% for intercaudate distance are able to discriminate patients who will develop long-term disability progression.
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Affiliation(s)
- Giuseppe Pontillo
- Department of Advanced Biomedical Sciences, University "Federico II", Via Pansini, 5, 80131, Naples, Italy
| | - Sirio Cocozza
- Department of Advanced Biomedical Sciences, University "Federico II", Via Pansini, 5, 80131, Naples, Italy.
| | - Martina Di Stasi
- Department of Advanced Biomedical Sciences, University "Federico II", Via Pansini, 5, 80131, Naples, Italy
| | - Antonio Carotenuto
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, University "Federico II", Naples, Italy
| | - Chiara Paolella
- Department of Advanced Biomedical Sciences, University "Federico II", Via Pansini, 5, 80131, Naples, Italy
| | - Maria Brunella Cipullo
- Department of Advanced Biomedical Sciences, University "Federico II", Via Pansini, 5, 80131, Naples, Italy
| | - Teresa Perillo
- Department of Advanced Biomedical Sciences, University "Federico II", Via Pansini, 5, 80131, Naples, Italy
| | - Elena Augusta Vola
- Department of Advanced Biomedical Sciences, University "Federico II", Via Pansini, 5, 80131, Naples, Italy
| | - Camilla Russo
- Department of Advanced Biomedical Sciences, University "Federico II", Via Pansini, 5, 80131, Naples, Italy
| | - Marco Masullo
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, University "Federico II", Naples, Italy
| | - Marcello Moccia
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, University "Federico II", Naples, Italy
| | - Roberta Lanzillo
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, University "Federico II", Naples, Italy
| | - Enrico Tedeschi
- Department of Advanced Biomedical Sciences, University "Federico II", Via Pansini, 5, 80131, Naples, Italy
| | - Andrea Elefante
- Department of Advanced Biomedical Sciences, University "Federico II", Via Pansini, 5, 80131, Naples, Italy
| | - Vincenzo Brescia Morra
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, University "Federico II", Naples, Italy
| | - Arturo Brunetti
- Department of Advanced Biomedical Sciences, University "Federico II", Via Pansini, 5, 80131, Naples, Italy
| | - Mario Quarantelli
- Institute of Biostructure and Bioimaging, National Research Council, Naples, Italy
| | - Maria Petracca
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, University "Federico II", Naples, Italy
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Yoo SW, Oh YS, Yoo JY, Ryu DW, Lee KS, Shin NY, Kim JS. Intervening Effects of Orthostatic Blood Pressure Change on Subcortical Atrophy and Cognition in De Novo and Drug-Naïve Parkinson’s Disease. JOURNAL OF PARKINSONS DISEASE 2020; 10:153-160. [DOI: 10.3233/jpd-191748] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Sang-Won Yoo
- Department of Neurology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yoon-Sang Oh
- Department of Neurology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ji-Yeon Yoo
- Department of Neurology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Dong-Woo Ryu
- Department of Neurology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kwang-Soo Lee
- Department of Neurology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Na-Young Shin
- Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Joong-Seok Kim
- Department of Neurology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Büyükşerbetçi G, Saka E, Oğuz KK, Göçmen R, Arsava EM, Topçuoğlu MA. Cognitive Dysfunction in Relation to Topography and Burden of Cerebral Microbleeds. NORO PSIKIYATRI ARSIVI 2018; 55:84-90. [PMID: 30042647 DOI: 10.29399/npa.23018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 12/03/2017] [Indexed: 12/31/2022]
Abstract
Introduction Contribution of cerebral microbleeds (CMBs) on cognitive dysfunctions in elderly patients with otherwise asymptomatic white matter lesions (WMLs) is not well-documented. Methods MRI parameters of cerebral atrophy, CMBs and WMLs were herein analyzed in relation to global and main domains (attention, executive, memory, visuospatial, language) of cognitive function. Eighty-five patients older than 50, without neurodegenerative/cerebrovascular disease, but had CMBs were recruited from 2562 with T2*-gradient-echo MR imaging during one-year period. Results Global cognition, evaluated by mini-mental status examination (MMSE), was impaired (score ≤24) in 42%. In contrast to CMBs load, WML burden and temporal atrophy were significantly higher in cases with MMSE≤24. Cholinergic Pathways HyperIntensities Scale (CHIPS) was positively correlated with global cognitive dysfunction but its CMB counterpart, Cholinergic Pathways Bleeding Scale described herein, was not. However, burden of CMBs in thalamic/cortical regions predicted language dysfunction. Conclusion Cognitive dysfunction associated with CMBs may be dependent on their distribution rather than their absolute number.
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Affiliation(s)
- Gülseren Büyükşerbetçi
- Department of Neurology, Balıkesir University Hospital, Balıkesir, Turkey.,Department of Neurology, Hacettepe University Medical School Hospital, Ankara, Turkey
| | - Esen Saka
- Department of Neurology, Hacettepe University Medical School Hospital, Ankara, Turkey
| | - Kader Karli Oğuz
- Department of Radiology, Hacettepe University Medical School Hospital, Ankara, Turkey
| | - Rahşan Göçmen
- Department of Radiology, Hacettepe University Medical School Hospital, Ankara, Turkey
| | - Ethem Murat Arsava
- Department of Neurology, Hacettepe University Medical School Hospital, Ankara, Turkey
| | - Mehmet Akif Topçuoğlu
- Department of Neurology, Hacettepe University Medical School Hospital, Ankara, Turkey
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Lutz T, Bellenberg B, Schneider R, Weiler F, Köster O, Lukas C. Central Atrophy Early in Multiple Sclerosis: Third Ventricle Volumetry versus Planimetry. J Neuroimaging 2016; 27:348-354. [PMID: 27897360 DOI: 10.1111/jon.12410] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 10/13/2016] [Accepted: 10/29/2016] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND AND PURPOSE Cerebral atrophy has been suggested to be a reliable magnetic resonance imaging (MRI) predictor of subsequent disability in all stages of multiple sclerosis (MS). However, no accepted methodology for routine clinical use exists to date. We sought an easy to apply and fast technique to evaluate cerebral ventricular volume in patients with MS with similar accuracy as a semiautomatic volumetric method. METHODS The study included 104 patients, 61 diagnosed with MS and 43 with clinically isolated syndrome. In addition, 30 healthy controls were enrolled. Physical disability was assessed with the expanded disability status scale and cognitive disability with the Multiple Sclerosis Inventory Cognition (MUSIC) test. All subjects received standardized 3-dimensional (3D) MR-imaging on a 3 T scanner. Third ventricle volume (3VV) was obtained from 3D T1-weighted images using a semiautomated technique, and compared against planimetric assessment of the width of the third ventricle aligned (a3VW) and unaligned (u3VW) to anatomical landmarks. RESULTS a3VW was obtained within seconds with excellent intra- and interrater agreement, and outperformed volumetric measurements regarding the differentiation of MS patients from healthy controls. a3VW had the strongest correlations with 3VV (r = .78, P < .001) and showed moderate inverse correlation with MUSIC cognition score (r = -.310, P < .005). CONCLUSIONS a3VW is a time-effective and robust biomarker that has strong correlations with volumetric measurements and can be established as standard in the MRI quantification of central brain atrophy in patients with early MS.
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Affiliation(s)
- Theodor Lutz
- Institute for Radiology and Nuclear Medicine, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Barbara Bellenberg
- Institute for Radiology and Nuclear Medicine, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Ruth Schneider
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | | | - Odo Köster
- Institute for Radiology and Nuclear Medicine, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Carsten Lukas
- Institute for Radiology and Nuclear Medicine, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
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Radomski AD, Power C, Purdon SE, Emery DJ, Blevins G, Warren KG, Fujiwara E. Decision-making under explicit risk is impaired in multiple sclerosis: relationships with ventricular width and disease disability. BMC Neurol 2015; 15:61. [PMID: 25899600 PMCID: PMC4428249 DOI: 10.1186/s12883-015-0318-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 04/10/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Decision-making is an essential function of everyday life. Decision-making under explicit risk requires developing advantageous decision strategies based on fixed outcomes (e.g., probabilities of winning or losing a bet). Decision-making and its neural substrates have been rarely studied in MS. We expected performance in decision-making under risk to be lowered in MS patients, and negatively correlated with disease-related disability, cognition, and ventricular width. METHODS Three groups were included: 32 MS patients and 20 healthy controls were examined with conventional neuropsychological tests and the Game-of-Dice Task (GDT) assessing decision-making under explicit risk. Linear 2-D ventricular width was assessed on MS patients' clinical MRIs and compared to a third group, 20 non-MS neurological control patients. RESULTS Compared to healthy controls, MS patients showed impaired GDT and neuropsychological performance, depending on the MS-subtype (relapsing-remitting (RR), n = 22; secondary progressive, n = 10) and disability severity among RR-MS patients. In MS patients, GDT performance correlated with processing speed, intercaudate ratio, and third ventricle ratio (p's < 0.05). Mediation analysis showed that the link between GDT performance and processing speed was fully explained by ventricular size. CONCLUSION Decision-making under explicit risk was reduced in MS patients, but only those with more pronounced disability. Independent of processing speed, decision-making under explicit risk correlates inversely with central atrophy in MS.
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Affiliation(s)
- Ashley D Radomski
- Department of Psychiatry, University of Alberta, 1E1.01 WCM Health Sciences Centre, Edmonton, Alberta, T6G 2R7, Canada.
| | - Christopher Power
- Department of Psychiatry, University of Alberta, 1E1.01 WCM Health Sciences Centre, Edmonton, Alberta, T6G 2R7, Canada.
- Department of Medicine (Neurology), University of Alberta, Edmonton, Canada.
| | - Scot E Purdon
- Department of Psychiatry, University of Alberta, 1E1.01 WCM Health Sciences Centre, Edmonton, Alberta, T6G 2R7, Canada.
- Neuropsychology Service, Alberta Hospital Edmonton, Edmonton, Canada.
| | - Derek J Emery
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Canada.
| | - Gregg Blevins
- Department of Medicine (Neurology), University of Alberta, Edmonton, Canada.
| | - Kenneth G Warren
- Department of Medicine (Neurology), University of Alberta, Edmonton, Canada.
| | - Esther Fujiwara
- Department of Psychiatry, University of Alberta, 1E1.01 WCM Health Sciences Centre, Edmonton, Alberta, T6G 2R7, Canada.
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Amann M, Andělová M, Pfister A, Mueller-Lenke N, Traud S, Reinhardt J, Magon S, Bendfeldt K, Kappos L, Radue EW, Stippich C, Sprenger T. Subcortical brain segmentation of two dimensional T1-weighted data sets with FMRIB's Integrated Registration and Segmentation Tool (FIRST). NEUROIMAGE-CLINICAL 2014; 7:43-52. [PMID: 25610766 PMCID: PMC4299953 DOI: 10.1016/j.nicl.2014.11.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Revised: 11/05/2014] [Accepted: 11/12/2014] [Indexed: 12/16/2022]
Abstract
Brain atrophy has been identified as an important contributing factor to the development of disability in multiple sclerosis (MS). In this respect, more and more interest is focussing on the role of deep grey matter (DGM) areas. Novel data analysis pipelines are available for the automatic segmentation of DGM using three-dimensional (3D) MRI data. However, in clinical trials, often no such high-resolution data are acquired and hence no conclusions regarding the impact of new treatments on DGM atrophy were possible so far. In this work, we used FMRIB's Integrated Registration and Segmentation Tool (FIRST) to evaluate the possibility of segmenting DGM structures using standard two-dimensional (2D) T1-weighted MRI. In a cohort of 70 MS patients, both 2D and 3D T1-weighted data were acquired. The thalamus, putamen, pallidum, nucleus accumbens, and caudate nucleus were bilaterally segmented using FIRST. Volumes were calculated for each structure and for the sum of basal ganglia (BG) as well as for the total DGM. The accuracy and reliability of the 2D data segmentation were compared with the respective results of 3D segmentations using volume difference, volume overlap and intra-class correlation coefficients (ICCs). The mean differences for the individual substructures were between 1.3% (putamen) and −25.2% (nucleus accumbens). The respective values for the BG were −2.7% and for DGM 1.3%. Mean volume overlap was between 89.1% (thalamus) and 61.5% (nucleus accumbens); BG: 84.1%; DGM: 86.3%. Regarding ICC, all structures showed good agreement with the exception of the nucleus accumbens. The results of the segmentation were additionally validated through expert manual delineation of the caudate nucleus and putamen in a subset of the 3D data. In conclusion, we demonstrate that subcortical segmentation of 2D data are feasible using FIRST. The larger subcortical GM structures can be segmented with high consistency. This forms the basis for the application of FIRST in large 2D MRI data sets of clinical trials in order to determine the impact of therapeutic interventions on DGM atrophy in MS. Segmentation of deep grey matter (DGM) using 2-dimensional MRI data is challenging. We performed a systematic comparison between 2 and 3D data segmentation using FIRST. The DGM volumes of 70 multiple sclerosis patients were statistically compared. We found a good agreement of the segmentation results for the large DGM structures. Our results indicate that FIRST is suitable for the segmentation of 2D data sets acquired in multicentre studies.
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Affiliation(s)
- Michael Amann
- Department of Neurology, University Hospital Basel, Petersgraben 4, Basel 4031, Switzerland ; Division of Diagnostic and Interventional Neuroradiology, Department of Radiology, Petersgraben 4, Basel 4031, Switzerland
| | - Michaela Andělová
- Department of Neurology, University Hospital Basel, Petersgraben 4, Basel 4031, Switzerland
| | - Armanda Pfister
- Department of Neurology, University Hospital Basel, Petersgraben 4, Basel 4031, Switzerland
| | - Nicole Mueller-Lenke
- Division of Diagnostic and Interventional Neuroradiology, Department of Radiology, Petersgraben 4, Basel 4031, Switzerland ; Medical Image Analysis Center (MIAC), Schanzenstrasse 55, Basel 4031, Switzerland
| | - Stefan Traud
- Medical Image Analysis Center (MIAC), Schanzenstrasse 55, Basel 4031, Switzerland
| | - Julia Reinhardt
- Division of Diagnostic and Interventional Neuroradiology, Department of Radiology, Petersgraben 4, Basel 4031, Switzerland
| | - Stefano Magon
- Department of Neurology, University Hospital Basel, Petersgraben 4, Basel 4031, Switzerland
| | - Kerstin Bendfeldt
- Medical Image Analysis Center (MIAC), Schanzenstrasse 55, Basel 4031, Switzerland
| | - Ludwig Kappos
- Department of Neurology, University Hospital Basel, Petersgraben 4, Basel 4031, Switzerland
| | - Ernst-Wilhelm Radue
- Division of Diagnostic and Interventional Neuroradiology, Department of Radiology, Petersgraben 4, Basel 4031, Switzerland ; Medical Image Analysis Center (MIAC), Schanzenstrasse 55, Basel 4031, Switzerland
| | - Christoph Stippich
- Division of Diagnostic and Interventional Neuroradiology, Department of Radiology, Petersgraben 4, Basel 4031, Switzerland
| | - Till Sprenger
- Department of Neurology, University Hospital Basel, Petersgraben 4, Basel 4031, Switzerland ; Division of Diagnostic and Interventional Neuroradiology, Department of Radiology, Petersgraben 4, Basel 4031, Switzerland
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Neuroradiologic correlates of clinical disability and progression in the X-linked leukodystrophy Pelizaeus-Merzbacher disease. J Neurol Sci 2013; 335:75-81. [PMID: 24139698 DOI: 10.1016/j.jns.2013.08.030] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Revised: 07/15/2013] [Accepted: 08/21/2013] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To determine whether quantitative measure of magnetic resonance imaging data from patients with the inherited leukodystrophy, Pelizaeus-Merzbacher disease (PMD) correlates with clinical severity or progression. METHODS In our current work we have analyzed the clinical phenotypes and MRI scans of 51 male patients with PMD and 10 female carriers for whom the PLP1 genotype had been determined. In addition, we developed a 32-point functional disability scoring (FDS) system for PMD, and validated it for inter-rater reliability. Using conventional T1- and T2-weighted MRI images of the whole brain, we measured white matter and total brain volume (WMV and TBV), inter-caudate ratio (ICR), and corpus callosum area. RESULTS There was a significant positive correlation of FDS with white matter fraction (WMV/TBV) and corpus callosum area. Also, when applying a median split based on FDS, patients with lower FDS showed reduced white matter fraction and corpus callosum area, and increased ICR compared to patients with relatively higher FDS, regardless of age. CONCLUSION Although this patient population is heterogeneous, with multiple genetic and molecular mechanisms causing PMD, these data imply that white matter atrophy is a major pathological determinant of the clinical disability in most patients. Development of reliable non-invasive quantitative biomarkers of disease activity would be useful not only for following the natural history of the disease, but also raising the potential for evaluating future therapies.
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Ceccarelli A, Rocca MA, Neema M, Martinelli V, Arora A, Tauhid S, Ghezzi A, Comi G, Bakshi R, Filippi M. Deep gray matter T2 hypointensity is present in patients with clinically isolated syndromes suggestive of multiple sclerosis. Mult Scler 2009; 16:39-44. [PMID: 19965516 DOI: 10.1177/1352458509350310] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Gray matter (GM) magnetic resonance imaging (MRI) T2 hypointensity, a putative marker of iron deposition, is a frequent finding in patients with clinically definite (CD) multiple sclerosis (MS). The objective of this study was to assess: (a) how early deep GM T2 hypointensity occurs in MS, by studying patients with clinically isolated syndromes (CIS) suggestive of MS, and (b) whether they contribute to predict subsequent evolution to CDMS. Dual-echo scans using two different acquisition protocols were acquired from 47 CIS patients and 13 healthy controls (HC). Normalized T2-intensity of the basal ganglia and thalamus was quantified. Patients were assessed clinically at the time of MRI acquisition and after three years. During the observation period, 18 patients (38%) evolved to CDMS. At the baseline, only the GM T2-intensity of the left caudate nucleus was significantly reduced in CIS patients in comparison with the HC (p = 0.04). At the baseline, the T2 intensity of the left caudate nucleus was significantly lower (p = 0.01) in CIS patients with disease dissemination in space (DIS), but not in those without DIS, compared to the HC. The baseline T2 lesion volume, but not GM T2 hypointensity, was associated with evolution to CDMS (hazard ratio = 1.60, 95% confidence interval (CI) = 1.05-2.42; p = 0.02). In CIS patients, deep GM is not spared, suggesting that iron-related changes and neurodegeneration occurs early. The magnitude of such damage is only minor and not associated with an increased risk of evolution to CDMS.
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Affiliation(s)
- Antonia Ceccarelli
- Institute of Experimental Neurology, Division of Neuroscience, Scientific Institute and University Ospedale San Raffaele, Milan, Italy
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Hasan KM, Halphen C, Kamali A, Nelson FM, Wolinsky JS, Narayana PA. Caudate nuclei volume, diffusion tensor metrics, and T(2) relaxation in healthy adults and relapsing-remitting multiple sclerosis patients: implications for understanding gray matter degeneration. J Magn Reson Imaging 2009; 29:70-7. [PMID: 19097116 DOI: 10.1002/jmri.21648] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
PURPOSE To investigate the utility of caudate nuclei (CN) macro- and microstructural metrics as markers of gray matter degeneration in healthy adults and relapsing-remitting multiple sclerosis (RRMS) patients. MATERIALS AND METHODS The normal age- and pathology-related changes in caudate nuclei volume (CNV), the corresponding diffusion tensor metrics, and the T(2) relaxation times were measured in a cohort of 32 healthy adults (12 men/20 women; age range 21-59 years) and 32 age-matched RRMS patients (8 men/34 women; age range 21-57 years). RESULTS Smaller values in both the absolute CNV and the caudate volume ratio relative to the total intracranial volume (CNVp) were observed in the RRMS group relative to healthy controls. The fractional anisotropy (FA), based on the diffusion tensor imaging (DTI) of the CN increased with age in healthy adults (r = 0.52; P = 0.003) but not in patients (r = 0.28; P = 0.12). The caudate FA value was approximately 9% larger in RRMS patients relative to controls (P = 0.001). The mean diffusivity of the CN was greater in the RRMS group compared to controls (P = 0.02). The caudate T(2) relaxation times were smaller in the RRMS group relative to the control group (3% reduction, P = 0.05). T(2) relaxation times did not exhibit age-related changes (P > 0.35) in either cohort. Strong and significant correlations between CNVp and whole-brain lesion load (r = -0.48; P = 0.005) and whole-brain CSF fraction (r = -0.46; P = 0.01) were also noted. CONCLUSION These preliminary findings indicate that caudate DTI-derived metrics can serve as potential quantitative radiological markers of MS pathology.
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Affiliation(s)
- Khader M Hasan
- Department of Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston, Houston, Texas, USA.
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Validation of linear cerebral atrophy markers in multiple sclerosis. J Clin Neurosci 2008; 15:130-7. [DOI: 10.1016/j.jocn.2007.02.089] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2006] [Revised: 02/07/2007] [Accepted: 02/21/2007] [Indexed: 11/22/2022]
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Abstract
Primary headache disorders, such as migraine, chronic daily headache (CDH), and chronic tension-type headache (CTTH), are some of the most frequent disorders encountered by physicians in the outpatient setting. Chronic headache disorders cause significant morbidity and functional impairment. Despite important advances in both pharmacological and behavioral management of headache disorders, a number of patients remain treatment resistant. Botulinum toxin (BT) is emerging as a new therapeutic alternative in the preventative treatment of headaches. BT has several advantages over current prophylactic strategies, such as reduced side-effect profile and improved patient compliance. Furthermore, there have been several studies supporting the safety and tolerability of BT in the treatment of headache disorders. Although additional large-scale studies are needed to clarify clinical predictors of response as well as optimal dosing, injection sites and mechanism of action, BT has demonstrated efficacy in the treatment of migraines and CDH. The evidence for the treatment for CTTH is less compelling.
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Affiliation(s)
- Julia Samton
- New York Headache Center, New York, NY 10021, USA.
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Abstract
Brain atrophy has emerged as a clinically relevant component of disease progression in multiple sclerosis. Progressive loss of brain tissue bulk can be detected in vivo in a sensitive and reproducible manner by MRI. Clinical studies have shown that brain atrophy begins early in the disease course. The increasing amount of data linking brain atrophy to clinical impairments suggest that irreversible tissue destruction is an important determinant of disease progression to a greater extent than can be explained by conventional lesion assessments. In this review, we will summarise the proposed mechanisms contributing to brain atrophy in patients with multiple sclerosis. We will critically discuss the wide range of MRI-based methods used to quantify regional and whole-brain-volume loss. Based on a review of current information, we will summarise the rate of atrophy among phenotypes for multiple sclerosis, the clinical relevance of brain atrophy, and the effect of disease-modifying treatments on its progression.
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Affiliation(s)
- Robert A Bermel
- Department of Neurology, Cleveland Clinic Foundation, Cleveland, OH, USA
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Abstract
Atrophy is one of the hallmarks in multiple sclerosis (MS), especially in the advanced stage. Modern magnetic resonance (MR) techniques can reliably measure brain volume and changes therein. Depending on the technique used, changes of about 1% may be detected. Clinicoradiological studies show good correlation between atrophy measures, both in brain and spinal cord, and clinical measures. The exact relationship between focal MS lesions and global atrophy has yet to be established. Number of lesions early in the disease seems to predict later atrophy. The exact pathomechanism of atrophy in MS probably may be explained by both demyelination and axonal loss--which may occur independently from each other.
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