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Tazza F, Boffa G, Schiavi S, Lapucci C, Piredda GF, Cipriano E, Zacà D, Roccatagliata L, Hilbert T, Kober T, Inglese M, Costagli M. Multiparametric Characterization and Spatial Distribution of Different MS Lesion Phenotypes. AJNR Am J Neuroradiol 2024:ajnr.A8271. [PMID: 38816021 DOI: 10.3174/ajnr.a8271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 03/01/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND AND PURPOSE MS lesions exhibit varying degrees of axonal and myelin damage. A comprehensive description of lesion phenotypes could contribute to an improved radiologic evaluation of smoldering inflammation and remyelination processes. This study aimed to identify in vivo distinct MS lesion types using quantitative susceptibility mapping and susceptibility mapping-weighted imaging and to characterize them through T1-relaxometry, myelin mapping, and diffusion MR imaging. The spatial distribution of lesion phenotypes in relation to ventricular CSF was investigated. MATERIALS AND METHODS MS lesions of 53 individuals were categorized into iso- or hypointense lesions, hyperintense lesions, and paramagnetic rim lesions, on the basis of their appearance on quantitative susceptibility mapping alone, according to published criteria, and with the additional support of susceptibility mapping-weighted imaging. Susceptibility values, T1-relaxation times, myelin and free water fractions, intracellular volume fraction, and the orientation dispersion index were compared among lesion phenotypes. The distance of the geometric center of each lesion from the ventricular CSF was calculated. RESULTS Eight hundred ninety-six MS lesions underwent the categorization process using quantitative susceptibility mapping and susceptibility mapping-weighted imaging. The novel use of susceptibility mapping-weighted images, which revealed additional microvasculature details, led us to re-allocate several lesions to different categories, resulting in a 35.6% decrease in the number of paramagnetic rim lesions, a 22.5% decrease in hyperintense lesions, and a 17.2% increase in iso- or hypointense lesions, with respect to the categorization based on quantitative susceptibility mapping only. The outcome of the categorization based on the joint use of quantitative susceptibility mapping and susceptibility mapping-weighted imaging was that 44.4% of lesions were iso- or hypointense lesions, 47.9% were hyperintense lesions, and 7.7% were paramagnetic rim lesions. A worsening gradient was observed from iso- or hypointense lesions to hyperintense lesions to paramagnetic rim lesions in T1-relaxation times, myelin water fraction, free water faction, and intracellular volume fraction. Paramagnetic rim lesions were located closer to ventricular CSF than iso- or hypointense lesions. The volume of hyperintense lesions was associated with a more severe disease course. CONCLUSIONS Quantitative susceptibility mapping and susceptibility mapping-weighted imaging allow in vivo classification of MS lesions into different phenotypes, characterized by different levels of axonal and myelin loss and spatial distribution. Hyperintense lesions and paramagnetic rim lesions, which have the most severe microstructural damage, were more often observed in the periventricular WM and were associated with a more severe disease course.
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Affiliation(s)
- Francesco Tazza
- From the Departments of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (F.T., G.B., S.S., E.C., M.I., M.C.), University of Genoa, Genoa, Italy
| | - Giacomo Boffa
- From the Departments of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (F.T., G.B., S.S., E.C., M.I., M.C.), University of Genoa, Genoa, Italy
| | - Simona Schiavi
- From the Departments of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (F.T., G.B., S.S., E.C., M.I., M.C.), University of Genoa, Genoa, Italy
| | - Caterina Lapucci
- Istituto di Ricovero e Cura a Carattere Scientifico (C.L., L.R., M.I., M.C.), Ospedale Policlinico San Martino, Genoa, Italy
| | - Gian Franco Piredda
- Advanced Clinical Imaging Technology (G.F.P., T.H., T.K.), Siemens Healthineers International AG, Lausanne, Switzerland
| | - Emilio Cipriano
- From the Departments of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (F.T., G.B., S.S., E.C., M.I., M.C.), University of Genoa, Genoa, Italy
| | | | - Luca Roccatagliata
- Istituto di Ricovero e Cura a Carattere Scientifico (C.L., L.R., M.I., M.C.), Ospedale Policlinico San Martino, Genoa, Italy
- Department of Health Sciences (L.R.), University of Genoa, Genoa, Italy
| | - Tom Hilbert
- Advanced Clinical Imaging Technology (G.F.P., T.H., T.K.), Siemens Healthineers International AG, Lausanne, Switzerland
- Department of Radiology (T.H., T.K.), Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- LTS5 (T.H., T.K.), École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Tobias Kober
- Advanced Clinical Imaging Technology (G.F.P., T.H., T.K.), Siemens Healthineers International AG, Lausanne, Switzerland
- Department of Radiology (T.H., T.K.), Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- LTS5 (T.H., T.K.), École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Matilde Inglese
- From the Departments of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (F.T., G.B., S.S., E.C., M.I., M.C.), University of Genoa, Genoa, Italy
- Istituto di Ricovero e Cura a Carattere Scientifico (C.L., L.R., M.I., M.C.), Ospedale Policlinico San Martino, Genoa, Italy
| | - Mauro Costagli
- From the Departments of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (F.T., G.B., S.S., E.C., M.I., M.C.), University of Genoa, Genoa, Italy
- Istituto di Ricovero e Cura a Carattere Scientifico (C.L., L.R., M.I., M.C.), Ospedale Policlinico San Martino, Genoa, Italy
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Beck ES, Mullins WA, dos Santos Silva J, Filippini S, Parvathaneni P, Maranzano J, Morrison M, Suto DJ, Donnay C, Dieckhaus H, Luciano NJ, Sharma K, Gaitán MI, Liu J, de Zwart JA, van Gelderen P, Cortese I, Narayanan S, Duyn JH, Nair G, Sati P, Reich DS. Contribution of new and chronic cortical lesions to disability accrual in multiple sclerosis. Brain Commun 2024; 6:fcae158. [PMID: 38818331 PMCID: PMC11137753 DOI: 10.1093/braincomms/fcae158] [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: 12/11/2023] [Revised: 02/22/2024] [Accepted: 04/30/2024] [Indexed: 06/01/2024] Open
Abstract
Cortical lesions are common in multiple sclerosis and are associated with disability and progressive disease. We asked whether cortical lesions continue to form in people with stable white matter lesions and whether the association of cortical lesions with worsening disability relates to pre-existing or new cortical lesions. Fifty adults with multiple sclerosis and no new white matter lesions in the year prior to enrolment (33 relapsing-remitting and 17 progressive) and a comparison group of nine adults who had formed at least one new white matter lesion in the year prior to enrolment (active relapsing-remitting) were evaluated annually with 7 tesla (T) brain MRI and 3T brain and spine MRI for 2 years, with clinical assessments for 3 years. Cortical lesions and paramagnetic rim lesions were identified on 7T images. Seven total cortical lesions formed in 3/30 individuals in the stable relapsing-remitting group (median 0, range 0-5), four total cortical lesions formed in 4/17 individuals in the progressive group (median 0, range 0-1), and 16 cortical lesions formed in 5/9 individuals in the active relapsing-remitting group (median 1, range 0-10, stable relapsing-remitting versus progressive versus active relapsing-remitting P = 0.006). New cortical lesions were not associated with greater change in any individual disability measure or in a composite measure of disability worsening (worsening Expanded Disability Status Scale or 9-hole peg test or 25-foot timed walk). Individuals with at least three paramagnetic rim lesions had a greater increase in cortical lesion volume over time (median 16 µl, range -61 to 215 versus median 1 µl, range -24 to 184, P = 0.007), but change in lesion volume was not associated with disability change. Baseline cortical lesion volume was higher in people with worsening disability (median 1010 µl, range 13-9888 versus median 267 µl, range 0-3539, P = 0.001, adjusted for age and sex) and in individuals with relapsing-remitting multiple sclerosis who subsequently transitioned to secondary progressive multiple sclerosis (median 2183 µl, range 270-9888 versus median 321 µl, range 0-6392 in those who remained relapsing-remitting, P = 0.01, adjusted for age and sex). Baseline white matter lesion volume was not associated with worsening disability or transition from relapsing-remitting to secondary progressive multiple sclerosis. Cortical lesion formation is rare in people with stable white matter lesions, even in those with worsening disability. Cortical but not white matter lesion burden predicts disability worsening, suggesting that disability progression is related to long-term effects of cortical lesions that form early in the disease, rather than to ongoing cortical lesion formation.
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Affiliation(s)
- Erin S Beck
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892, USA
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - W Andrew Mullins
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892, USA
| | | | - Stefano Filippini
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892, USA
- Department of Neurosciences, Drug, and Child Health, University of Florence, Florence 50121, Italy
| | - Prasanna Parvathaneni
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892, USA
| | - Josefina Maranzano
- McConnell Brain Imaging Centre, Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC H3A2B4, Canada
- Department of Anatomy, University of Quebec, Trois-Rivieres, QC G9A5H7, Canada
| | - Mark Morrison
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892, USA
| | - Daniel J Suto
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892, USA
| | - Corinne Donnay
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892, USA
| | - Henry Dieckhaus
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892, USA
| | - Nicholas J Luciano
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892, USA
| | - Kanika Sharma
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892, USA
| | - María Ines Gaitán
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892, USA
| | - Jiaen Liu
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892, USA
- Advanced Imaging Research Center and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Jacco A de Zwart
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892, USA
| | - Peter van Gelderen
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892, USA
| | - Irene Cortese
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892, USA
| | - Sridar Narayanan
- McConnell Brain Imaging Centre, Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC H3A2B4, Canada
| | - Jeff H Duyn
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892, USA
| | - Govind Nair
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892, USA
| | - Pascal Sati
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892, USA
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Daniel S Reich
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892, USA
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Rocca MA, Preziosa P, Filippi M. Juxtacortical Paramagnetic Rim: A New MRI Marker to Characterize Focal Cortical Pathology in Multiple Sclerosis? Neurology 2024; 102:e208085. [PMID: 38165304 DOI: 10.1212/wnl.0000000000208085] [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: 09/11/2023] [Accepted: 11/09/2023] [Indexed: 01/03/2024] Open
Abstract
The accumulation of focal white matter and cortical inflammatory demyelinating lesions represents the pathologic hallmark of multiple sclerosis (MS).1 Typically, acute white matter lesions are characterized by an increased blood-brain barrier (BBB) permeability, an inflammatory infiltrate, and ongoing demyelination and axonal transection.2 In the chronic phase, a substantial proportion of white matter lesions, known as chronic active lesions, exhibit a hypocellular core with a rim of iron-laden activated microglia/macrophages, with no abnormal BBB permeability.2 Some of these lesions can be identified on susceptibility-based MRI as exhibiting a paramagnetic rim, and they are, therefore, referred to as "paramagnetic rim lesions" (PRLs).3.
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Affiliation(s)
- Maria A Rocca
- From the Neuroimaging Research Unit (M.A.R., P.P., M.F.), Division of Neuroscience; Neurology Unit (M.A.R., P.P., M.F.), IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (M.A.R., P.P., M.F.); Neurorehabilitation Unit (M.F.); and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Preziosa
- From the Neuroimaging Research Unit (M.A.R., P.P., M.F.), Division of Neuroscience; Neurology Unit (M.A.R., P.P., M.F.), IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (M.A.R., P.P., M.F.); Neurorehabilitation Unit (M.F.); and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Filippi
- From the Neuroimaging Research Unit (M.A.R., P.P., M.F.), Division of Neuroscience; Neurology Unit (M.A.R., P.P., M.F.), IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (M.A.R., P.P., M.F.); Neurorehabilitation Unit (M.F.); and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy
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