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Ananthavarathan P, Sahi N, Chard DT. An update on the role of magnetic resonance imaging in predicting and monitoring multiple sclerosis progression. Expert Rev Neurother 2024; 24:201-216. [PMID: 38235594 DOI: 10.1080/14737175.2024.2304116] [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: 11/01/2023] [Accepted: 01/08/2024] [Indexed: 01/19/2024]
Abstract
INTRODUCTION While magnetic resonance imaging (MRI) is established in diagnosing and monitoring disease activity in multiple sclerosis (MS), its utility in predicting and monitoring disease progression is less clear. AREAS COVERED The authors consider changing concepts in the phenotypic classification of MS, including progression independent of relapses; pathological processes underpinning progression; advances in MRI measures to assess them; how well MRI features explain and predict clinical outcomes, including models that assess disease effects on neural networks, and the potential role for machine learning. EXPERT OPINION Relapsing-remitting and progressive MS have evolved from being viewed as mutually exclusive to having considerable overlap. Progression is likely the consequence of several pathological elements, each important in building more holistic prognostic models beyond conventional phenotypes. MRI is well placed to assess pathogenic processes underpinning progression, but we need to bridge the gap between MRI measures and clinical outcomes. Mapping pathological effects on specific neural networks may help and machine learning methods may be able to optimize predictive markers while identifying new, or previously overlooked, clinically relevant features. The ever-increasing ability to measure features on MRI raises the dilemma of what to measure and when, and the challenge of translating research methods into clinically useable tools.
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Affiliation(s)
- Piriyankan Ananthavarathan
- Department of Neuroinflammation, University College London Queen Square Multiple Sclerosis Centre, London, UK
| | - Nitin Sahi
- Department of Neuroinflammation, University College London Queen Square Multiple Sclerosis Centre, London, UK
| | - Declan T Chard
- Clinical Research Associate & Consultant Neurologist, Institute of Neurology - Queen Square Multiple Sclerosis Centre, London, UK
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Ortí JEDLR, Cuerda-Ballester M, Sanchis-Sanchis CE, Lajara Romance JM, Navarro-Illana E, García Pardo MP. Exploring the impact of ketogenic diet on multiple sclerosis: obesity, anxiety, depression, and the glutamate system. Front Nutr 2023; 10:1227431. [PMID: 37693246 PMCID: PMC10485376 DOI: 10.3389/fnut.2023.1227431] [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: 05/23/2023] [Accepted: 08/10/2023] [Indexed: 09/12/2023] Open
Abstract
Background Multiple sclerosis (MS) is a neurodegenerative disorder. Individuals with MS frequently present symptoms such as functional disability, obesity, and anxiety and depression. Axonal demyelination can be observed and implies alterations in mitochondrial activity and increased inflammation associated with disruptions in glutamate neurotransmitter activity. In this context, the ketogenic diet (KD), which promotes the production of ketone bodies in the blood [mainly β-hydroxybutyrate (βHB)], is a non-pharmacological therapeutic alternative that has shown promising results in peripheral obesity reduction and central inflammation reduction. However, the association of this type of diet with emotional symptoms through the modulation of glutamate activity in MS individuals remains unknown. Aim To provide an update on the topic and discuss the potential impact of KD on anxiety and depression through the modulation of glutamate activity in subjects with MS. Discussion The main findings suggest that the KD, as a source of ketone bodies in the blood, improves glutamate activity by reducing obesity, which is associated with insulin resistance and dyslipidemia, promoting central inflammation (particularly through an increase in interleukins IL-1β, IL-6, and IL-17). This improvement would imply a decrease in extrasynaptic glutamate activity, which has been linked to functional disability and the presence of emotional disorders such as anxiety and depression.
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Affiliation(s)
| | | | | | - Jose María Lajara Romance
- Faculty of Legal, Economic and Social Sciences, Catholic University of Valencia San Vicente Mártir, Valencia, Spain
| | - Esther Navarro-Illana
- Department of Nursing, Catholic University of Valencia San Vicente Mártir, Valencia, Spain
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Mainero C, Treaba CA, Barbuti E. Imaging cortical lesions in multiple sclerosis. Curr Opin Neurol 2023; 36:222-228. [PMID: 37078649 DOI: 10.1097/wco.0000000000001152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
PURPOSE OF REVIEW Cortical lesions are an established pathological feature of multiple sclerosis, develop from the earliest disease stages and contribute to disease progression. Here, we discuss current imaging approaches for detecting cortical lesions in vivo and their contribution for improving our understanding of cortical lesion pathogenesis as well as their clinical significance. RECENT FINDINGS Although a variable portion of cortical lesions goes undetected at clinical field strength and even at ultra-high field MRI, their evaluation is still clinically relevant. Cortical lesions are important for differential multiple sclerosis (MS) diagnosis, have relevant prognostic value and independently predict disease progression. Some studies also show that cortical lesion assessment could be used as a therapeutic outcome target in clinical trials. Advances in ultra-high field MRI not only allow increased cortical lesion detection in vivo but also the disclosing of some interesting features of cortical lesions related to their pattern of development and evolution as well to the nature of associated pathological changes, which might prove relevant for better understanding the pathogenesis of these lesions. SUMMARY Despite some limitations, imaging of cortical lesions is of paramount importance in MS for elucidating disease mechanisms as well as for improving patient management in clinic.
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Affiliation(s)
- Caterina Mainero
- A. A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital
- Harvard Medical School, Boston, Massachusetts, USA
| | - Constantina A Treaba
- A. A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital
- Harvard Medical School, Boston, Massachusetts, USA
| | - Elena Barbuti
- A. A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital
- Ospedale Sant'Andrea, University "La Sapienza", Rome, Italy
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Pareto D, Corral JF, Garcia-Vidal A, Alberich M, Auger C, Rio J, Mongay N, Sastre-Garriga J, Rovira À. Assessing the Equivalence of Brain-Derived Measures from Two 3D T1-Weighted Acquisitions: One Covering the Brain and One Covering the Brain and Spinal Cord. AJNR Am J Neuroradiol 2023; 44:569-573. [PMID: 37080719 PMCID: PMC10171373 DOI: 10.3174/ajnr.a7843] [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: 06/14/2022] [Accepted: 02/01/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND AND PURPOSE In MS, it is common to acquire brain and spinal cord MR imaging sequences separately to assess the extent of the disease. The goal of this study was to see how replacing the traditional brain T1-weighted images (brain-T1) with an acquisition that included both the brain and the cervical spinal cord (cns-T1) affected brain- and spinal cord-derived measures. MATERIALS AND METHODS Thirty-six healthy controls (HC) and 42 patients with MS were included. Of those, 18 HC and 35 patients with MS had baseline and follow-up at 1 year acquired on a 3T magnet. Two 3D T1-weighted images (brain-T1 and cns-T1) were acquired at each time point. Regional cortical thickness and volumes were determined with FastSurfer, and the percentage brain volume change per year was obtained with SIENA. The spinal cord area was estimated with the Spinal Cord Toolbox. Intraclass correlation coefficients (ICC) were calculated to check for consistency of measures obtained from brain-T1 and cns-T1. RESULTS Cortical thickness measures showed an ICC >0.75 in 94% of regions in healthy controls and 80% in patients with MS. Estimated regional volumes had an ICC >0.88, and the percentage brain volume change had an ICC >0.79 for both groups. The spinal cord area measures had an ICC of 0.68 in healthy controls and 0.92 in patients with MS. CONCLUSIONS Brain measurements obtained from 3D cns-T1 are highly equivalent to those obtained from a brain-T1, suggesting that it could be feasible to replace the brain-T1 with cns-T1.
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Affiliation(s)
- D Pareto
- From the Neuroradiology Group (D.P., J.F.C., A.G.-V., C.A., À.R.), Vall d'Hebron Research Institute, Barcelona, Spain
- Section of Neuroradiology (D.P., J.F.C., M.A., À.R.), Radiology Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - J F Corral
- From the Neuroradiology Group (D.P., J.F.C., A.G.-V., C.A., À.R.), Vall d'Hebron Research Institute, Barcelona, Spain
- Section of Neuroradiology (D.P., J.F.C., M.A., À.R.), Radiology Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - A Garcia-Vidal
- From the Neuroradiology Group (D.P., J.F.C., A.G.-V., C.A., À.R.), Vall d'Hebron Research Institute, Barcelona, Spain
| | - M Alberich
- Section of Neuroradiology (D.P., J.F.C., M.A., À.R.), Radiology Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - C Auger
- From the Neuroradiology Group (D.P., J.F.C., A.G.-V., C.A., À.R.), Vall d'Hebron Research Institute, Barcelona, Spain
| | - J Rio
- Department of Neurology and Neuroimmunology (J.R., N.M., J.S.-G.), Multiple Sclerosis Centre of Catalonia, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - N Mongay
- Department of Neurology and Neuroimmunology (J.R., N.M., J.S.-G.), Multiple Sclerosis Centre of Catalonia, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - J Sastre-Garriga
- Department of Neurology and Neuroimmunology (J.R., N.M., J.S.-G.), Multiple Sclerosis Centre of Catalonia, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - À Rovira
- From the Neuroradiology Group (D.P., J.F.C., A.G.-V., C.A., À.R.), Vall d'Hebron Research Institute, Barcelona, Spain
- Section of Neuroradiology (D.P., J.F.C., M.A., À.R.), Radiology Department, Vall d'Hebron University Hospital, Barcelona, Spain
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Park CC, Brummer ME, Sadigh G, Saindane AM, Mullins ME, Allen JW, Hu R. Automated Registration and Color Labeling of Serial 3D Double Inversion Recovery MR Imaging for Detection of Lesion Progression in Multiple Sclerosis. J Digit Imaging 2023; 36:450-457. [PMID: 36352165 PMCID: PMC10039147 DOI: 10.1007/s10278-022-00737-1] [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: 03/10/2022] [Revised: 11/01/2022] [Accepted: 11/02/2022] [Indexed: 11/11/2022] Open
Abstract
Automated co-registration and subtraction techniques have been shown to be useful in the assessment of longitudinal changes in multiple sclerosis (MS) lesion burden, but the majority depend on T2-fluid-attenuated inversion recovery sequences. We aimed to investigate the use of a novel automated temporal color complement imaging (CCI) map overlapped on 3D double inversion recovery (DIR), and to assess its diagnostic performance for detecting disease progression in patients with multiple sclerosis (MS) as compared to standard review of serial 3D DIR images. We developed a fully automated system that co-registers and compares baseline to follow-up 3D DIR images and outputs a pseudo-color RGB map in which red pixels indicate increased intensity values in the follow-up image (i.e., progression; new/enlarging lesion), blue-green pixels represent decreased intensity values (i.e., disappearing/shrinking lesion), and gray-scale pixels reflect unchanged intensity values. Three neuroradiologists blinded to clinical information independently reviewed each patient using standard DIR images alone and using CCI maps based on DIR images at two separate exams. Seventy-six follow-up examinations from 60 consecutive MS patients who underwent standard 3 T MR brain MS protocol that included 3D DIR were included. Median cohort age was 38.5 years, with 46 women, 59 relapsing-remitting type MS, and median follow-up interval of 250 days (interquartile range: 196-394 days). Lesion progression was detected in 67.1% of cases using CCI review versus 22.4% using standard review, with a total of 182 new or enlarged lesions using CCI review versus 28 using standard review. There was a statistically significant difference between the two methods in the rate of all progressive lesions (P < 0.001, McNemar's test) as well as cortical progressive lesions (P < 0.001). Automated CCI maps using co-registered serial 3D DIR, compared to standard review of 3D DIR alone, increased detection rate of MS lesion progression in patients undergoing clinical brain MRI exam.
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Affiliation(s)
- Charlie C Park
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Road NE, Suite BG20, Atlanta, GA, 30322, USA
| | - Marijn E Brummer
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Road NE, Suite BG20, Atlanta, GA, 30322, USA
| | - Gelareh Sadigh
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Road NE, Suite BG20, Atlanta, GA, 30322, USA
| | - Amit M Saindane
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Road NE, Suite BG20, Atlanta, GA, 30322, USA
| | - Mark E Mullins
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Road NE, Suite BG20, Atlanta, GA, 30322, USA
| | - Jason W Allen
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Road NE, Suite BG20, Atlanta, GA, 30322, USA
| | - Ranliang Hu
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Road NE, Suite BG20, Atlanta, GA, 30322, USA.
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Cuerda-Ballester M, Proaño B, Alarcón-Jimenez J, de Bernardo N, Villaron-Casales C, Lajara Romance JM, de la Rubia Ortí JE. Improvements in gait and balance in patients with multiple sclerosis after treatment with coconut oil and epigallocatechin gallate. A pilot study. Food Funct 2023; 14:1062-1071. [PMID: 36594273 DOI: 10.1039/d2fo02207a] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Multiple sclerosis (MS) is a neurodegenerative disease that progressively decreases the muscular and functional capacity. Thus, there is an alteration in the ability to walk that affects balance, speed and resistance. Since MS pathology involves neuroinflammation, cellular oxidation and mitochondrial alterations, the objective of the study was to assess the impact of a nutritional intervention with coconut oil and epigallocatechin gallate (EGCG) on gait and balance. In order to do this, 51 patients with MS were enrolled and randomly distributed into an intervention group and a control group, which received either a daily dose of 800 mg of EGCG and 60 ml of coconut oil, or a placebo, all during a period of 4 months and which followed a Mediterranean isocaloric diet. Initial and final assessments consisted of the evaluation of quantitative balance (Berg scale), perceived balance (ABC scale), gait speed (10MWT) and resistance (2MWT). Besides, muscle strength was measured using a dynamometer and levels of β-hydroxybutyrate (BHB) were measured in serum samples. In the intervention group, there was a significant improvement in the gait speed, quantitative balance and muscle strength of the right quadriceps; an improvement in gait resistance was observed in both groups. There were also significant and positive correlations between balance and gait scales. In conclusion, the administration of EGCG and coconut oil seems to improve gait speed and balance in MS patients, although the latter was not perceived by them. Furthermore, these variables appear to be related and contribute to functionality.
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Affiliation(s)
- María Cuerda-Ballester
- Doctoral Degree School, Catholic University of Valencia San Vicente Mártir, C/Quevedo, 2, 46001 Valencia, Spain.
| | - Belén Proaño
- Department of Nursing, Catholic University of Valencia San Vicente Mártir, C/Espartero, 7, 46007 Valencia, Spain.
| | - Jorge Alarcón-Jimenez
- Department of Physiotherapy, Catholic University of Valencia San Vicente Mártir, C/Quevedo, 2, 46001 Valencia, Spain.
| | - Nieves de Bernardo
- Department of Physiotherapy, Catholic University of Valencia San Vicente Mártir, C/Quevedo, 2, 46001 Valencia, Spain.
| | - Carlos Villaron-Casales
- Department of Physiotherapy, European University of Valencia, Avda/Alameda, 7, 46010, Valencia, Spain.
| | - José María Lajara Romance
- Department of Law, Economical and Social Sciences, Multimedia Area, Catholic University of Valencia San Vicente Mártir, C/Guillem de Castro, 94, 46001 Valencia, Spain.
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Chitnis T, Vandercappellen J, King M, Brichetto G. Symptom Interconnectivity in Multiple Sclerosis: A Narrative Review of Potential Underlying Biological Disease Processes. Neurol Ther 2022; 11:1043-1070. [PMID: 35680693 PMCID: PMC9338216 DOI: 10.1007/s40120-022-00368-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 05/16/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction Fatigue, cognitive impairment, depression, and pain are highly prevalent symptoms in multiple sclerosis (MS). These often co-occur and may be explained by a common etiology. By reviewing existing literature, we aimed to identify potential underlying biological processes implicated in the interconnectivity between these symptoms. Methods A literature search was conducted to identify articles reporting research into the biological mechanisms responsible for the manifestation of fatigue, cognitive impairment, depression, and pain in MS. PubMed was used to search for articles published from July 2011 to July 2021. We reviewed and assessed findings from the literature to identify biological processes common to the symptoms of interest. Results Of 693 articles identified from the search, 252 were selected following screening of titles and abstracts and assessing reference lists of review articles. Four biological processes linked with two or more of the symptoms of interest were frequently identified from the literature: (1) direct neuroanatomical changes to brain regions linked with symptoms of interest (e.g., thalamic injury associated with cognitive impairment, fatigue, and depression), (2) pro-inflammatory cytokines associated with so-called ‘sickness behavior,’ including manifestation of fatigue, transient cognitive impairment, depression, and pain, (3) dysregulation of monoaminergic pathways leading to depressive symptoms and fatigue, and (4) hyperactivity of the hypothalamic–pituitary-adrenal (HPA) axis as a result of pro-inflammatory cytokines promoting the release of brain noradrenaline, serotonin, and tryptophan, which is associated with symptoms of depression and cognitive impairment. Conclusion The co-occurrence of fatigue, cognitive impairment, depression, and pain in MS appears to be associated with a common set of etiological factors, namely neuroanatomical changes, pro-inflammatory cytokines, dysregulation of monoaminergic pathways, and a hyperactive HPA axis. This association of symptoms and biological processes has important implications for disease management strategies and, eventually, could help find a common therapeutic pathway that will impact both inflammation and neuroprotection. Supplementary Information The online version contains supplementary material available at 10.1007/s40120-022-00368-2.
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Affiliation(s)
- Tanuja Chitnis
- Department of Neurology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.
| | | | - Miriam King
- Novartis Pharma AG, Fabrikstrasse 12-2, 4056, Basel, Switzerland
| | - Giampaolo Brichetto
- Associazione Italiana Sclerosi Multipla Rehabilitation Center, Via Operai, 30, 16149, Genoa, GE, Italy
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Madsen MAJ, Wiggermann V, Marques MFM, Lundell H, Cerri S, Puonti O, Blinkenberg M, Christensen JR, Sellebjerg F, Siebner HR. Linking lesions in sensorimotor cortex to contralateral hand function in multiple sclerosis: a 7 T MRI study. Brain 2022; 145:3522-3535. [PMID: 35653498 PMCID: PMC9586550 DOI: 10.1093/brain/awac203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 05/17/2022] [Accepted: 05/20/2022] [Indexed: 11/14/2022] Open
Abstract
Abstract
Cortical lesions constitute a key manifestation of multiple sclerosis and contribute to clinical disability and cognitive impairment. Yet it is unknown whether local cortical lesions and cortical lesion subtypes contribute to domain-specific impairments attributable to the function of the lesioned cortex.
In this cross-sectional study, we assessed how cortical lesions in the primary sensorimotor hand area (SM1-HAND) relate to corticomotor physiology and sensorimotor function of the contralateral hand. 50 relapse-free patients with relapsing-remitting or secondary-progressive multiple sclerosis and 28 healthy age- and sex-matched participants underwent whole-brain 7 T MRI to map cortical lesions. Brain scans were also used to estimate normalized brain volume, pericentral cortical thickness, white matter lesion fraction of the corticospinal tract, infratentorial lesion volume and the cross-sectional area of the upper cervical spinal cord. We tested sensorimotor hand function and calculated a motor and sensory composite score for each hand. In 37 patients and 20 healthy controls, we measured maximal motor evoked potential (MEP) amplitude, resting motor threshold and corticomotor conduction time with transcranial magnetic stimulation (TMS) and the N20 latency from somatosensory evoked potentials (SSEPs).
Patients showed at least one cortical lesion in the SM1-HAND in 47 of 100 hemispheres. The presence of a lesion was associated with worse contralateral sensory (P = 0.014) and motor (P = 0.009) composite scores. TMS of a lesion-positive SM1-HAND revealed a decreased maximal MEP amplitude (P < 0.001) and delayed corticomotor conduction (P = 0.002) relative to a lesion-negative SM1-HAND. Stepwise mixed linear regressions showed that the presence of an SM1-HAND lesion, higher white-matter lesion fraction of the corticospinal tract, reduced spinal cord cross-sectional area and higher infratentorial lesion volume were associated with reduced contralateral motor hand function. Cortical lesions in SM1-HAND, spinal cord cross-sectional area and normalized brain volume were also associated with smaller maximal MEP amplitude and longer corticomotor conduction times. The effect of cortical lesions on sensory function was no longer significant when controlling for MRI-based covariates. Lastly, we found that intracortical and subpial lesions had the largest effect on reduced motor hand function, intracortical lesions on reduced MEP amplitude and leukocortical lesions on delayed corticomotor conduction.
Together, this comprehensive multi-level assessment of sensorimotor brain damage shows that the presence of a cortical lesion in SM1-HAND is associated with impaired corticomotor function of the hand, after accounting for damage at the subcortical level. The results also provide preliminary evidence that cortical lesion types may affect the various facets of corticomotor function differentially.
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Affiliation(s)
- Mads A. J. Madsen
- Copenhagen University Hospital - Amager & Hvidovre Danish Research Centre for Magnetic Resonance, , 2650 Hvidovre, Denmark
| | - Vanessa Wiggermann
- Copenhagen University Hospital - Amager & Hvidovre Danish Research Centre for Magnetic Resonance, , 2650 Hvidovre, Denmark
| | - Marta F. M. Marques
- Copenhagen University Hospital - Amager & Hvidovre Danish Research Centre for Magnetic Resonance, , 2650 Hvidovre, Denmark
| | - Henrik Lundell
- Copenhagen University Hospital - Amager & Hvidovre Danish Research Centre for Magnetic Resonance, , 2650 Hvidovre, Denmark
| | - Stefano Cerri
- Copenhagen University Hospital - Amager & Hvidovre Danish Research Centre for Magnetic Resonance, , 2650 Hvidovre, Denmark
- Technical University of Denmark Department of Health Technology, , 2800 Kgs. Lyngby, Denmark
| | - Oula Puonti
- Copenhagen University Hospital - Amager & Hvidovre Danish Research Centre for Magnetic Resonance, , 2650 Hvidovre, Denmark
| | - Morten Blinkenberg
- Copenhagen University Hospital – Rigshospitalet Danish Multiple Sclerosis Center, Department of Neurology, , 2600 Glostrup, Denmark
| | - Jeppe Romme Christensen
- Copenhagen University Hospital – Rigshospitalet Danish Multiple Sclerosis Center, Department of Neurology, , 2600 Glostrup, Denmark
| | - Finn Sellebjerg
- Copenhagen University Hospital – Rigshospitalet Danish Multiple Sclerosis Center, Department of Neurology, , 2600 Glostrup, Denmark
- University of Copenhagen Department of Clinical Medicine, , 2200 Copenhagen, Denmark
| | - Hartwig R. Siebner
- Copenhagen University Hospital - Amager & Hvidovre Danish Research Centre for Magnetic Resonance, , 2650 Hvidovre, Denmark
- Copenhagen University Hospital - Bispebjerg & Frederiksberg Department of Neurology, , 2400 Copenhagen, Denmark
- University of Copenhagen Department of Clinical Medicine, , 2200 Copenhagen, Denmark
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Lokhande H, Rosso M, Tauhid S, Chu R, Healy BC, Saxena S, Barro C, Paul A, Polgar-Turcsanyi M, Anderson M, Glanz BI, Kropshofer H, Granziera C, Leppert D, Kappos L, Kuhle J, Weiner HL, Bakshi R, Chitnis T. Serum NfL levels in the first five years predict 10-year thalamic fraction in patients with MS. Mult Scler J Exp Transl Clin 2022; 8:20552173211069348. [PMID: 35035990 PMCID: PMC8753083 DOI: 10.1177/20552173211069348] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 11/22/2021] [Accepted: 11/23/2021] [Indexed: 11/16/2022] Open
Abstract
Background Serum neurofilament light chain (sNfL) levels are associated with relapses, MRI lesions, and brain volume in multiple sclerosis (MS). Objective To explore the value of early serum neurofilament light (sNfL) measures in prognosticating 10-year regional brain volumes in MS. Methods Patients with MS enrolled in the Comprehensive Longitudinal Investigations in MS at Brigham and Women's Hospital (CLIMB) study within five years of disease onset who had annual blood samples from years 1–10 (n = 91) were studied. sNfL was measured with a single molecule array (SIMOA) assay. We quantified global cortical thickness and normalized deep gray matter (DGM) volumes (fractions of the thalamus, caudate, putamen, and globus pallidus) from high-resolution 3 T MRI at 10 years. Correlations between yearly sNfL levels and 10-year MRI outcomes were assessed using linear regression models. Results sNfL levels from years 1 and 2 were associated with 10-year thalamus fraction. Early sNfL levels were not associated with 10-year putamen, globus pallidus or caudate fractions. At 10 years, cortical thickness was not associated with early sNfL levels, but was weakly correlated with total DGM fraction. Conclusions Early sNfL levels correlate with 10-year thalamic volume, supporting its role as a prognostic biomarker in MS.
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Affiliation(s)
| | - Mattia Rosso
- Department of Neurology, Harvard Medical School, Boston, MA, USA
| | | | - Renxin Chu
- Brigham Multiple Sclerosis Center, Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA
| | - Brian C Healy
- Department of Neurology, Harvard Medical School, Boston, MA, USA
| | - Shrishti Saxena
- Department of Neurology, Harvard Medical School, Boston, MA, USA
| | - Christian Barro
- Department of Neurology, Harvard Medical School, Boston, MA, USA
| | | | | | - Mark Anderson
- Department of Neurology, Harvard Medical School, Boston, MA, USA
| | - Bonnie I Glanz
- Brigham Multiple Sclerosis Center, Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Cristina Granziera
- Neurologic Clinic and Policlinic, Departments of Medicine, Biomedicine and Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | | | | | - Jens Kuhle
- Neurologic Clinic and Policlinic, Departments of Medicine, Biomedicine and Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | | | | | - Tanuja Chitnis
- Brigham Multiple Sclerosis Center, Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA
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Eve M, Gandawijaya J, Yang L, Oguro-Ando A. Neuronal Cell Adhesion Molecules May Mediate Neuroinflammation in Autism Spectrum Disorder. Front Psychiatry 2022; 13:842755. [PMID: 35492721 PMCID: PMC9051034 DOI: 10.3389/fpsyt.2022.842755] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 02/15/2022] [Indexed: 12/15/2022] Open
Abstract
Autism spectrum disorder (ASD) is a complex neurodevelopmental condition characterized by restrictive and repetitive behaviors, alongside deficits in social interaction and communication. The etiology of ASD is largely unknown but is strongly linked to genetic variants in neuronal cell adhesion molecules (CAMs), cell-surface proteins that have important roles in neurodevelopment. A combination of environmental and genetic factors are believed to contribute to ASD pathogenesis. Inflammation in ASD has been identified as one of these factors, demonstrated through the presence of proinflammatory cytokines, maternal immune activation, and activation of glial cells in ASD brains. Glial cells are the main source of cytokines within the brain and, therefore, their activity is vital in mediating inflammation in the central nervous system. However, it is unclear whether the aforementioned neuronal CAMs are involved in modulating neuroimmune signaling or glial behavior. This review aims to address the largely unexplored role that neuronal CAMs may play in mediating inflammatory cascades that underpin neuroinflammation in ASD, primarily focusing on the Notch, nuclear factor-κB (NF-κB), and mitogen-activated protein kinase (MAPK) cascades. We will also evaluate the available evidence on how neuronal CAMs may influence glial activity associated with inflammation. This is important when considering the impact of environmental factors and inflammatory responses on ASD development. In particular, neural CAM1 (NCAM1) can regulate NF-κB transcription in neurons, directly altering proinflammatory signaling. Additionally, NCAM1 and contactin-1 appear to mediate astrocyte and oligodendrocyte precursor proliferation which can alter the neuroimmune response. Importantly, although this review highlights the limited information available, there is evidence of a neuronal CAM regulatory role in inflammatory signaling. This warrants further investigation into the role other neuronal CAM family members may have in mediating inflammatory cascades and would advance our understanding of how neuroinflammation can contribute to ASD pathology.
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Affiliation(s)
- Madeline Eve
- University of Exeter Medical School, University of Exeter, Exeter, United Kingdom
| | - Josan Gandawijaya
- University of Exeter Medical School, University of Exeter, Exeter, United Kingdom
| | - Liming Yang
- University of Exeter Medical School, University of Exeter, Exeter, United Kingdom
| | - Asami Oguro-Ando
- University of Exeter Medical School, University of Exeter, Exeter, United Kingdom
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11
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Madsen MAJ, Wiggermann V, Bramow S, Christensen JR, Sellebjerg F, Siebner HR. Imaging cortical multiple sclerosis lesions with ultra-high field MRI. NEUROIMAGE-CLINICAL 2021; 32:102847. [PMID: 34653837 PMCID: PMC8517925 DOI: 10.1016/j.nicl.2021.102847] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 08/19/2021] [Accepted: 08/25/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cortical lesions are abundant in multiple sclerosis (MS), yet difficult to visualize in vivo. Ultra-high field (UHF) MRI at 7 T and above provides technological advances suited to optimize the detection of cortical lesions in MS. PURPOSE To provide a narrative and quantitative systematic review of the literature on UHF MRI of cortical lesions in MS. METHODS A systematic search of all literature on UHF MRI of cortical lesions in MS published before September 2020. Quantitative outcome measures included cortical lesion numbers reported using 3 T and 7 T MRI and between 7 T MRI sequences, along with sensitivity of UHF MRI towards cortical lesions verified by histopathology. RESULTS 7 T MRI detected on average 52 ± 26% (mean ± 95% confidence interval) more cortical lesions than the best performing image contrast at 3 T, with the largest increase in type II-IV intracortical lesion detection. Across all studies, the mean cortical lesion number was 17 ± 6 per patient. In progressive MS cohorts, approximately four times more cortical lesions were reported than in CIS/early RRMS, and RRMS. Yet, there was no difference in lesion type ratio between these MS subtypes. Furthermore, superiority of one MRI sequence over another could not be established from available data. Post-mortem lesion detection with UHF MRI agreed only modestly with pathological examinations. Mean pro- and retrospective sensitivity was 33 ± 6% and 71 ± 10%, respectively, with the highest sensitivity towards type I and type IV lesions. CONCLUSION UHF MRI improves cortical lesion detection in MS considerably compared to 3 T MRI, particularly for type II-IV lesions. Despite modest sensitivity, 7 T MRI is still capable of visualizing all aspects of cortical lesion pathology and could potentially aid clinicians in diagnosing and monitoring MS, and progressive MS in particular. However, standardization of acquisition and segmentation protocols is needed.
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Affiliation(s)
- Mads A J Madsen
- Danish Research Centre for Magnetic Resonance, Copenhagen University Hospital - Amager & Hvidovre, Kettegard Allé 30, 2650 Hvidovre, Denmark.
| | - Vanessa Wiggermann
- Danish Research Centre for Magnetic Resonance, Copenhagen University Hospital - Amager & Hvidovre, Kettegard Allé 30, 2650 Hvidovre, Denmark
| | - Stephan Bramow
- Danish Multiple Sclerosis Center, Department of Neurology, Copenhagen University Hospital - Rigshospitalet, Valdemar Hansens Vej 1-23, 2600 Glostrup, Denmark
| | - Jeppe Romme Christensen
- Danish Multiple Sclerosis Center, Department of Neurology, Copenhagen University Hospital - Rigshospitalet, Valdemar Hansens Vej 1-23, 2600 Glostrup, Denmark
| | - Finn Sellebjerg
- Danish Multiple Sclerosis Center, Department of Neurology, Copenhagen University Hospital - Rigshospitalet, Valdemar Hansens Vej 1-23, 2600 Glostrup, Denmark; Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3b, 2200 Copenhagen, Denmark
| | - Hartwig R Siebner
- Danish Research Centre for Magnetic Resonance, Copenhagen University Hospital - Amager & Hvidovre, Kettegard Allé 30, 2650 Hvidovre, Denmark; Department of Neurology, Copenhagen University Hospital - Bispebjerg, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3b, 2200 Copenhagen, Denmark
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12
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Tzanetakos D, Tzartos JS, Vakrakou AG, Breza M, Velonakis G, Stathopoulos P, Pantou E, Markakis I, Papadimitriou D, Karavasilis E, Toulas P, Evangelopoulos ΜE, Koutsis G, Anagnostouli M, Stefanis L, Kilidireas C. Cortical involvement and leptomeningeal inflammation in myelin oligodendrocyte glycoprotein antibody disease: A three-dimensional fluid-attenuated inversion recovery MRI study. Mult Scler 2021; 28:718-729. [PMID: 34410179 DOI: 10.1177/13524585211034362] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Cortical demyelination and meningeal inflammation have been detected neuropathologically in multiple sclerosis (MS) and recently in myelin oligodendrocyte glycoprotein antibody disease (MOGAD). OBJECTIVES To assess in vivo cortical and leptomeningeal involvement in MOGAD. METHODS We prospectively evaluated 11 MOGAD and 12 relapsing-remitting MS (RRMS) patients combining three-dimensional fluid-attenuated inversion recovery (3D-FLAIR) and 3D-T1-weighted (3D-T1w) sequences at 3-Tesla magnetic resonance imaging (MRI). Leptomeningeal contrast enhancement (LMCE) was assessed on 3D-FLAIR post-gadolinium (3D-FLAIRGd). Cerebral cortical lesions (CCLs) were classified as either intracortical-subpial (IC-SP) or leukocortical (LC). RESULTS CCLs were present in 8/11 MOGAD and 12/12 RRMS patients, with the number of CCLs being significantly lower in MOGAD (median (interquartile range (IQR)) 3 (0.5-4) vs 12 (4.75-19), p = 0.0032). In MOGAD, IC-SP lesions were slightly more prevalent than LC lesions (2 (0-2.5) vs 1 (0-2), p = 0.6579); whereas in RRMS, IC-SP lesions were less prevalent than LC lesions (3.5 (2.75-5.5) vs 9 (2-12.75), p = 0.27). LMCE was observed in 3/11 MOGAD and 1/12 RRMS patients; MOGAD with LMCE showed an increased median number of CCLs compared with MOGAD without LMCE (8 (4-9) vs 2.5 (0.75-3.25), p = 0.34). No correlation was observed between MOGAD MRI findings and (a) MOGAD duration, (b) serum MOG-immunoglobulin G1 titers, and (c) oligoclonal band presence. CONCLUSION We described cortical lesion topography and detected for the first time LMCE using 3D-FLAIRGd sequences in MOGAD patients.
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Affiliation(s)
- Dimitrios Tzanetakos
- Multiple Sclerosis & Demyelinating Diseases Unit, 1st Department of Neurology, Eginition Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - John S Tzartos
- Multiple Sclerosis & Demyelinating Diseases Unit, 1st Department of Neurology, Eginition Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece/2nd Department of Neurology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece/Tzartos NeuroDiagnostics, Athens, Greece
| | - Aigli G Vakrakou
- Multiple Sclerosis & Demyelinating Diseases Unit, 1st Department of Neurology, Eginition Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Marianthi Breza
- 1st Department of Neurology, Eginition Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Velonakis
- Research Unit of Radiology, 2nd Department of Radiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Panos Stathopoulos
- Multiple Sclerosis & Demyelinating Diseases Unit, 1st Department of Neurology, Eginition Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Eirini Pantou
- Research Unit of Radiology, 2nd Department of Radiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Markakis
- Department of Neurology, General Hospital of Nikaia, Piraeus, Greece
| | | | - Efstratios Karavasilis
- Research Unit of Radiology, 2nd Department of Radiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Panagiotis Toulas
- Research Unit of Radiology, 2nd Department of Radiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Μaria-Eleptheria Evangelopoulos
- Multiple Sclerosis & Demyelinating Diseases Unit, 1st Department of Neurology, Eginition Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Koutsis
- Multiple Sclerosis & Demyelinating Diseases Unit, 1st Department of Neurology, Eginition Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Anagnostouli
- Multiple Sclerosis & Demyelinating Diseases Unit, 1st Department of Neurology, Eginition Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Leonidas Stefanis
- 1st Department of Neurology, Eginition Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Costantinos Kilidireas
- Multiple Sclerosis & Demyelinating Diseases Unit, 1st Department of Neurology, Eginition Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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13
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Tripathi A, Pandit I, Perles A, Zhou Y, Cheng F, Dutta R. Identifying miRNAs in multiple sclerosis gray matter lesions that correlate with atrophy measures. Ann Clin Transl Neurol 2021; 8:1279-1291. [PMID: 33978322 PMCID: PMC8164853 DOI: 10.1002/acn3.51365] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 02/10/2021] [Accepted: 03/27/2021] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE Multiple sclerosis (MS) is an inflammatory, demyelinating and neurodegenerative disease of the central nervous system (CNS). Though MS was initially considered to be a white matter demyelinating disease, myelin loss in cortical gray matter has been reported in all disease stages. We previously identified microRNAs (miRNAs) in white matter lesions (WMLs) that are detected in serum from MS patients. However, miRNA expression profiles in gray matter lesions (GMLs) from progressive MS brains are understudied. METHODS We used a combination of global miRNAs and gene expression profiling of GMLs and independent validation using real-time quantitative polymerase chain reaction (RT-qPCR), immuno-in situ hybridization, and immunohistochemistry. RESULTS Compared to matched myelinated gray matter (GM) regions, we identified 82 miRNAs in GMLs, of which 10 were significantly upregulated and 17 were significantly downregulated. Among these 82 miRNAs, 13 were also detected in serum and importantly were associated with brain atrophy in MS patients. The predicted target mRNAs of these miRNAs belonged to pathways associated with axonal guidance, TGF-β signaling, and FOXO signaling. Further, using state-of-the-art human protein-protein interactome network analysis, we mapped the four key GM atrophy-associated miRNAs (hsa-miR-149*, hsa-miR-20a, hsa-miR-29c, and hsa-miR-25) to their target mRNAs that were also changed in GMLs. INTERPRETATION Our study identifies miRNAs altered in GMLs in progressive MS brains that correlate with atrophy measures. As these miRNAs were also detected in sera of MS patients, these could act as markers of GML demyelination in MS.
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Affiliation(s)
- Ajai Tripathi
- Department of Neurosciences, Cleveland Clinic, Cleveland, Ohio, USA.,Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio, USA
| | - Ishani Pandit
- Department of Neurosciences, Cleveland Clinic, Cleveland, Ohio, USA
| | - Aaron Perles
- Department of Neurosciences, Cleveland Clinic, Cleveland, Ohio, USA
| | - Yadi Zhou
- Genomic Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Feixiong Cheng
- Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio, USA.,Genomic Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ranjan Dutta
- Department of Neurosciences, Cleveland Clinic, Cleveland, Ohio, USA.,Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio, USA
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14
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Abstract
PURPOSE OF REVIEW Ultra-high field 7 T MRI has multiple applications for the in vivo characterization of the heterogeneous aspects underlying multiple sclerosis including the identification of cortical lesions, characterization of the different types of white matter plaques, evaluation of structures difficult to assess with conventional MRI (thalamus, cerebellum, spinal cord, meninges). RECENT FINDINGS The sensitivity of cortical lesion detection at 7 T is twice than at lower field MRI, especially for subpial lesions, the most common cortical lesion type in multiple sclerosis. Cortical lesion load accrual is independent of that in the white matter and predicts disability progression.Seven Tesla MRI provides details on tissue microstructure that can be used to improve white matter lesion characterization. These include the presence of a central vein, whose identification can be used to improve multiple sclerosis diagnosis, or the appearance of an iron-rich paramagnetic rim on susceptibility-weighted images, which corresponds to iron-rich microglia at the periphery of slow expanding lesions. Improvements in cerebellar and spinal cord tissue delineation and lesion characterization have also been demonstrated. SUMMARY Imaging at 7 T allows assessing more comprehensively the complementary pathophysiological aspects of multiple sclerosis, opening up novel perspectives for clinical and therapeutics evaluation.
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15
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Treaba CA, Herranz E, Barletta VT, Mehndiratta A, Ouellette R, Sloane JA, Klawiter EC, Kinkel RP, Mainero C. The relevance of multiple sclerosis cortical lesions on cortical thinning and their clinical impact as assessed by 7.0-T MRI. J Neurol 2021; 268:2473-2481. [PMID: 33523256 DOI: 10.1007/s00415-021-10400-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 01/04/2021] [Accepted: 01/05/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE This study aimed to investigate at 7.0-T MRI a) the role of multiple sclerosis (MS) cortical lesions in cortical tissue loss b) their relation to neurological disability. METHODS In 76 relapsing remitting and 26 secondary progressive MS patients (N = 102) and 56 healthy subjects 7.0-T T2*-weighted images were acquired for lesion segmentation; 3.0-T T1-weighted structural scans for cortical surface reconstruction/cortical thickness estimation. Patients were dichotomized based on the median cortical lesion volume in low and high cortical lesion load groups that differed by age, MS phenotype and degree of neurological disability. Group differences in cortical thickness were tested on reconstructed cortical surface. Patients were evaluated clinically by means of the Expanded Disability Status Scale (EDSS). RESULTS Cortical lesions were detected in 96% of patients. White matter lesion load was greater in the high than in the low cortical lesion load MS group (p = 0.01). Both MS groups disclosed clusters (prevalently parietal) of cortical thinning relative to healthy subjects, though these regions did not show the highest cortical lesion density, which predominantly involved frontal regions. Cortical thickness decreased on average by 0.37 mm, (p = 0.002) in MS patients for each unit standard deviation change in white matter lesion volume. The odds of having a higher EDSS were associated with cortical lesion volume (1.78, p = 0.01) and disease duration (1.15, p < 0.001). CONCLUSION Cortical thinning in MS is not directly related to cortical lesion load but rather with white matter lesion volume. Neurological disability in MS is better explained by cortical lesion volume assessment.
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Affiliation(s)
- Constantina A Treaba
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Elena Herranz
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Valeria T Barletta
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Ambica Mehndiratta
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Russell Ouellette
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Jacob A Sloane
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Eric C Klawiter
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | | | - Caterina Mainero
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA. .,Harvard Medical School, Boston, MA, USA.
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16
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Park CC, Thongkham DW, Sadigh G, Saindane AM, Chu R, Bakshi R, Allen JW, Hu R. Detection of Cortical and Deep Gray Matter Lesions in Multiple Sclerosis Using DIR and FLAIR at 3T. J Neuroimaging 2020; 31:408-414. [PMID: 33351983 DOI: 10.1111/jon.12822] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 11/27/2020] [Accepted: 11/27/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND AND PURPOSE The comparative detection rates of deep gray matter (GM) multiple sclerosis (MS) lesions using double inversion recovery (DIR) and fluid-attenuated inversion-recovery (FLAIR) on 3T MR imaging remain unknown. We aimed to assess the detectability of cortical and deep GM MS lesions using DIR and FLAIR on 3T clinical exams and evaluate the relationship between deep GM lesions and brain atrophy. METHODS One hundred fifty consecutive MS patients underwent routine brain MRI that included 3D DIR and 2D T2 FLAIR on the same 3T scanner. Three neuroradiologists independently reviewed all exams for cortical and deep GM lesions. Statistical parametric mapping (SPM) and FMRIB software library (FSL)-FIRST pipelines were used to determine normalized whole brain and deep GM volumes. RESULTS A total of 65 cortical and 98 deep lesions were detected on DIR versus 24 and 20, respectively, on FLAIR. Among all 150 patients, the number and percentage of patients with GM lesions on DIR and FLAIR were as follows: cortical 43 (28.7%) versus 24 (16.0%) (P < .001), thalamus 47 (31.3%) versus 20 (13.3%) (P < .001), putamen 10 (6.7%) versus 3 (2.0%) (P = .02), globus pallidus 9 (6.0%) versus 3 (1.3%) (P = .02), and caudate 5 (3.3%) versus 1 (0.7%) (P = .125). Presence of deep GM lesions weakly correlated with deep GM volume fractions. CONCLUSION Deep GM MS lesions can be detected using routine clinical brain MRI including DIR and FLAIR at 3T. Future studies to optimize these sequences may improve the detection rates of cortical and deep GM lesions. The presence of GM lesions showed weak correlation with GM atrophy.
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Affiliation(s)
- Charlie C Park
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia
| | - Dean W Thongkham
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia
| | - Gelareh Sadigh
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia
| | - Amit M Saindane
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia.,Department of Neurosurgery, Emory University, Atlanta, Georgia
| | - Renxin Chu
- Department of Neurology and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Rohit Bakshi
- Department of Neurology and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jason W Allen
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia
| | - Ranliang Hu
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia
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17
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Carass A, Roy S, Gherman A, Reinhold JC, Jesson A, Arbel T, Maier O, Handels H, Ghafoorian M, Platel B, Birenbaum A, Greenspan H, Pham DL, Crainiceanu CM, Calabresi PA, Prince JL, Roncal WRG, Shinohara RT, Oguz I. Evaluating White Matter Lesion Segmentations with Refined Sørensen-Dice Analysis. Sci Rep 2020; 10:8242. [PMID: 32427874 PMCID: PMC7237671 DOI: 10.1038/s41598-020-64803-w] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 04/20/2020] [Indexed: 11/09/2022] Open
Abstract
The Sørensen-Dice index (SDI) is a widely used measure for evaluating medical image segmentation algorithms. It offers a standardized measure of segmentation accuracy which has proven useful. However, it offers diminishing insight when the number of objects is unknown, such as in white matter lesion segmentation of multiple sclerosis (MS) patients. We present a refinement for finer grained parsing of SDI results in situations where the number of objects is unknown. We explore these ideas with two case studies showing what can be learned from our two presented studies. Our first study explores an inter-rater comparison, showing that smaller lesions cannot be reliably identified. In our second case study, we demonstrate fusing multiple MS lesion segmentation algorithms based on the insights into the algorithms provided by our analysis to generate a segmentation that exhibits improved performance. This work demonstrates the wealth of information that can be learned from refined analysis of medical image segmentations.
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Affiliation(s)
- Aaron Carass
- Department of Electrical and Computer Engineering, The Johns Hopkins University, Baltimore, MD, 21218, USA.
- Department of Computer Science, The Johns Hopkins University, Baltimore, MD, 21218, USA.
| | - Snehashis Roy
- CNRM, The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, 20817, USA
| | - Adrian Gherman
- Department of Biostatistics, The Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Jacob C Reinhold
- Department of Electrical and Computer Engineering, The Johns Hopkins University, Baltimore, MD, 21218, USA
| | - Andrew Jesson
- Centre For Intelligent Machines, McGill University, Montréal, QC, H3A 0E9, Canada
| | - Tal Arbel
- Centre For Intelligent Machines, McGill University, Montréal, QC, H3A 0E9, Canada
| | - Oskar Maier
- Institute of Medical Informatics, University of Lübeck, 23538, Lübeck, Germany
| | - Heinz Handels
- Institute of Medical Informatics, University of Lübeck, 23538, Lübeck, Germany
| | - Mohsen Ghafoorian
- Institute for Computing and Information Sciences, Radboud University, 6525, HP, Nijmegen, Netherlands
| | - Bram Platel
- Diagnostic Image Analysis Group, Radboud University Medical Center, 6525, GA, Nijmegen, Netherlands
| | - Ariel Birenbaum
- Department of Electrical Engineering, Tel-Aviv University, Tel-Aviv, 69978, Israel
| | - Hayit Greenspan
- Department of Biomedical Engineering, Tel-Aviv University, Tel-Aviv, 69978, Israel
| | - Dzung L Pham
- CNRM, The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, 20817, USA
| | - Ciprian M Crainiceanu
- Department of Biostatistics, The Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Peter A Calabresi
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Jerry L Prince
- Department of Electrical and Computer Engineering, The Johns Hopkins University, Baltimore, MD, 21218, USA
- Department of Computer Science, The Johns Hopkins University, Baltimore, MD, 21218, USA
| | - William R Gray Roncal
- Department of Computer Science, The Johns Hopkins University, Baltimore, MD, 21218, USA
| | - Russell T Shinohara
- Penn Statistics in Imaging and Visualization Center, Department of Biostatistics & Epidemiology, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Center for Biomedical Image Computing and Analytics, Department of Radiology, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Ipek Oguz
- Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, TN, 37203, USA
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18
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Cerebral hemodynamics associated with fluid-attenuated inversion recovery hyperintense vessels in patients with extracranial carotid artery stenosis. Neuroradiology 2020; 62:677-684. [PMID: 32152648 DOI: 10.1007/s00234-020-02385-0] [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: 11/08/2019] [Accepted: 02/21/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Fluid-attenuated inversion recovery hyperintense vessels (FHVs) are linked to sluggish or disordered blood flow. The purpose of this study is to compare FHVs with digital subtraction angiography (DSA) findings and cerebral hemodynamic changes on acetazolamide challenge SPECT and to determine the clinical and imaging metrics associated with FHVs in patients with extracranial carotid artery stenosis (ECAS). METHODS The subjects were patients with chronic ECAS who underwent carotid artery stenting in our department between March 2011 and October 2018. Relationships of FHVs with age, sex, medical history, cerebral angiographic findings using DSA, and quantitative values of cerebral blood flow (CBF) were examined. The resting CBF (rCBF) and cerebrovascular reactivity (CVR) in the middle cerebral artery territory were measured quantitatively using SPECT with acetazolamide challenge. We used multivariate logistic regression analysis to identify independent predictors of FHVs. RESULTS Of 173 patients included, 92 (53.2%) had FHVs. Patients with FHVs had more severe stenosis (P < 0.01) and more leptomeningeal collateral vessels (P < 0.01). FHV-positive cases had significantly reduced CVR compared with FHV-negative cases (P < 0.01), although there was no significant difference in rCBF between FHV-positive and FHV-negative cases. Logistic regression analysis showed that ipsilateral rCBF and ipsilateral CVR were significant predictors for FHVs (P < 0.01). CONCLUSION In patients with ECAS, cerebral hemodynamic metrics, especially ipsilateral rCBF and ipsilateral CVR, are associated with the presence of FHVs.
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19
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Zurawski J, Tauhid S, Chu R, Khalid F, Healy BC, Weiner HL, Bakshi R. 7T MRI cerebral leptomeningeal enhancement is common in relapsing-remitting multiple sclerosis and is associated with cortical and thalamic lesions. Mult Scler 2019; 26:177-187. [DOI: 10.1177/1352458519885106] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Background:Meningeal inflammation may contribute to gray matter (GM) involvement in multiple sclerosis (MS) and is proposed to manifest as magnetic resonance imaging (MRI) leptomeningeal enhancement (LME).Objective:To investigate how LME relates to GM lesions in relapsing-remitting multiple sclerosis (RRMS) at 7T.Methods:A total of 30 RRMS subjects (age (mean ± standard deviation (SD)): 44.0 ± 11.3 years, 93% on disease-modifying treatment) and 15 controls underwent gadolinium-enhanced three-dimensional (3D) MP2RAGE (magnetization-prepared 2 rapid gradient-echo) and fluid-attenuated inversion recovery (FLAIR) MRI. LME, cortical lesions (CLs), thalamic lesions (TLs), and white matter (WM) lesions were expert-quantified. Wilcoxon rank-sum, two-sample t-tests, Spearman correlations, and regression models were employed.Results:Two-thirds (20/30) of MS subjects and 1/15 controls (6.7%) had LME. LME+ MS subjects had 2.7 ± 1.5 foci, longer disease duration (14.9 ± 10.4 vs. 8.1 ± 5.7 years, p = 0.028), increased CL number (21.5 ± 12.6 vs. 5.5 ± 5.0, p < 0.001) and volume (0.80 ± 1.13 vs. 0.13 ± 0.13 mL, p = 0.002), and increased TL number (3.95 ± 2.11 vs. 0.70 ± 1.34, p < 0.001) and volume (0.106 ± 0.09 vs. 0.007 ± 0.01 mL, p < 0.001) versus LME– subjects. LME focus number correlated more highly with CL ( rs = 0.50, p = 0.01) and TL ( rs = 0.81, p < 0.001) than WM lesion ( rs = 0.34, p > 0.05) volume. Similar LME–CL number associations were observed in unadjusted and WM lesion–adjusted comparisons (both p < 0.001).Conclusion:Cerebral LME is common in RRMS at 7T and is independently associated with GM injury. We hypothesize that cerebrospinal fluid (CSF)-related inflammation links cortical and thalamic injury.
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Affiliation(s)
- Jonathan Zurawski
- Department of Neurology, Laboratory for Neuroimaging Research, Partners Multiple Sclerosis Center, Hale Building for Transformative Research, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Shahamat Tauhid
- Department of Neurology, Laboratory for Neuroimaging Research, Partners Multiple Sclerosis Center, Hale Building for Transformative Research, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Renxin Chu
- Department of Neurology, Laboratory for Neuroimaging Research, Partners Multiple Sclerosis Center, Hale Building for Transformative Research, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Fariha Khalid
- Department of Neurology, Laboratory for Neuroimaging Research, Partners Multiple Sclerosis Center, Hale Building for Transformative Research, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Brian C Healy
- Department of Neurology, Laboratory for Neuroimaging Research, Partners Multiple Sclerosis Center, Hale Building for Transformative Research, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA; Biostatistics Center, Massachusetts General Hospital, Boston MA, USA
| | - Howard L Weiner
- Department of Neurology, Laboratory for Neuroimaging Research, Partners Multiple Sclerosis Center, Hale Building for Transformative Research, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Rohit Bakshi
- Department of Neurology, Laboratory for Neuroimaging Research, Partners Multiple Sclerosis Center, Hale Building for Transformative Research, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA/Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
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20
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Optimizing 3D FLAIR to detect MS lesions: pushing past factory settings for precise results. J Neurol 2019; 266:2786-2795. [PMID: 31372735 DOI: 10.1007/s00415-019-09490-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 07/15/2019] [Accepted: 07/28/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND To assess the diagnostic value of three 3D FLAIR sequences with differing repetition-times (TR) at 3-Tesla when detecting multiple sclerosis (MS) lesions. METHODS In this prospective study, approved by the institutional review board, 27 patients with confirmed MS were prospectively included. One radiologist performed manual segmentations of all high-signal intensity lesions using three 3D FLAIR data sets with different TR of 4800 ms ("FLAIR4800"), 8000 ms ("FLAIR8000") and 10,000 ms ("FLAIR10,000") and two radiologists double-checked it. The main judgment criterion was the overall number of lesions; secondary objectives were the assessment of lesion location, as well as measuring contrast-to-noise ratio (CNR) and signal-to-noise ratio (SNR). A non-parametric Wilcoxon's test was used to compare the differing FLAIR. RESULTS The FLAIR8000 and FLAIR10,000 detected significantly more overall lesions per patient as compared with the FLAIR4800 [116.1 (± 61.7) (p = 0.02) and 115.8 (± 56.3) (p = 0.03) versus 99.2 (± 66.9), respectively]. The FLAIR8000 and FLAIR10,000 detected four and eight times more cortical or juxta-cortical lesions per patient as compared with FLAIR4800 [1.6 (± 2.2) (p = 0.001) and 4.1 (± 5.9) (p = 6 × 10-5) versus 0.4 (± 1.1), respectively]. CNR was significantly correlated to the TR value. It was significantly higher with FLAIR10,000 than it was with FLAIR8000 and FLAIR4800 [16.3 (± 3.5) versus 15 (± 2.4) (p = 0.01) and 12 (± 2.2) (p = 2 × 10-6), respectively] CONCLUSION: An optimized 3D FLAIR with a long TR significantly improved both overall lesion detection and CNR in MS patients as compared to a 3D FLAIR with factory settings.
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21
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Zurawski J, Glanz BI, Healy BC, Tauhid S, Khalid F, Chitnis T, Weiner HL, Bakshi R. The impact of cervical spinal cord atrophy on quality of life in multiple sclerosis. J Neurol Sci 2019; 403:38-43. [PMID: 31207364 DOI: 10.1016/j.jns.2019.04.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 03/04/2019] [Accepted: 04/15/2019] [Indexed: 01/27/2023]
Abstract
BACKGROUND Spinal cord demyelination is common in multiple sclerosis (MS) and has been linked to increased disability and progressive clinical course. Spinal cord atrophy shows an especially close relationship to MS-related physical disability, though the relationship between spinal cord lesions/atrophy and health-related quality of life (QOL) has not been explored. METHODS 62 patients (53 relapsing MS, 7 secondary progressive, 2 clinically isolated syndrome) from our center underwent 3 T MRI within 30 days of clinical examination and QOL assessment. Upper cervical (C1-C3) spinal cord area (UCCA) was obtained from 3D high-resolution MPRAGE sequences (1 mm isotropic voxels). Cervical spinal cord (C1-C7) lesion count, and cervical and brain T2 hyperintense lesion volumes were calculated. Brain parenchymal fraction (BPF) was obtained from an automated segmentation pipeline. Spearman correlations were assessed between MRI and clinical data. Partial Spearman correlations adjusting for age, disease duration, and BPF assessed the independent association between MRI variables and QOL domains. RESULTS UCCA showed an inverse relationship with age (r = -0.330, p = .009), disease duration, (r = -0.444, p < .001), and nine-hole peg test (r = -0.353, p = .005). The Upper Extremity Function QOL domain showed the strongest relationship to UCCA (r = 0.333, p = .008), with Lower Extremity Function QOL (r = 0.234, p = .067) and Satisfaction with Social Roles and Activities (r = 0.245, p = .055) correlations bordering significance. The association between UCCA and Upper Extremity QOL remained significant after adjustment for BPF, age, and disease duration. QOL domains reflective of psychological health (Depression, Anxiety, Emotional and Behavioral Dyscontrol, Positive Affect and Wellbeing) showed no relationship to UCCA. Cervical and brain lesion volume related to impairment in Stigma while cervical lesion count was unrelated to NeuroQOL impairment. Brain atrophy correlated with conventional markers of disability and cognition but did not have a significant relationship to QOL. CONCLUSION Cervical spinal cord volume is independently associated with impaired upper extremity-related QOL in patients with MS. These findings suggest specific clinical relevance of MS-related spinal cord atrophy as compared to brain or cervical spinal cord lesions, or whole brain atrophy.
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Affiliation(s)
- Jonathan Zurawski
- Department of Neurology, Laboratory for Neuroimaging Research, Partners MS Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Bonnie I Glanz
- Department of Neurology, Laboratory for Neuroimaging Research, Partners MS Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Brian C Healy
- Department of Neurology, Laboratory for Neuroimaging Research, Partners MS Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Biostatistics Center, Massachusetts General Hospital, Boston, MA, USA
| | - Shahamat Tauhid
- Department of Neurology, Laboratory for Neuroimaging Research, Partners MS Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Fariha Khalid
- Department of Neurology, Laboratory for Neuroimaging Research, Partners MS Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Tanuja Chitnis
- Department of Neurology, Laboratory for Neuroimaging Research, Partners MS Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Howard L Weiner
- Department of Neurology, Laboratory for Neuroimaging Research, Partners MS Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Rohit Bakshi
- Department of Neurology, Laboratory for Neuroimaging Research, Partners MS Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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22
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Faizy TD, Broocks G, Thaler C, Rauch G, Gebert P, Stürner KH, Flottmann F, Leischner H, Kniep HC, Stellmann JP, Heesen C, Fiehler J, Gellißen S, Hanning U. Development of Cortical Lesion Volumes on Double Inversion Recovery MRI in Patients With Relapse-Onset Multiple Sclerosis. Front Neurol 2019; 10:133. [PMID: 30873106 PMCID: PMC6401630 DOI: 10.3389/fneur.2019.00133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 02/01/2019] [Indexed: 11/30/2022] Open
Abstract
Background and Objective: In multiple sclerosis (MS) patients, Double Inversion Recovery (DIR) magnetic resonance imaging (MRI) can be used to detect cortical lesions (CL). While the quantity and distribution of CLs seems to be associated with patients' disease course, literature lacks frequent assessments of CL volumes (CL-V) in this context. We investigated the reliability of DIR for the longitudinal assessment of CL-V development with frequent follow-up MRIs and examined the course of CL-V progressions in relation to white-matter lesions (WML), contrast enhancing lesions (CEL) and clinical parameters in patients with Relapsing-Remitting Multiple Sclerosis (RRMS). Methods: In this post-hoc analysis, image- and clinical data of a subset of 24 subjects that were part of a phase IIa clinical trial on the “Safety, Tolerability and Mechanisms of Action of Boswellic Acids in Multiple Sclerosis (SABA)” (ClinicalTrials.gov, NCT01450124) were included. The study was divided in three phases (screening, treatment, study-end). All patients received 12 MRI follow-up-examinations (including DIR) during a 16-months period. CL-Vs were assessed for each patient on each follow-up MRI separately by two experienced neuroradiologists. Results of neurological screening tests, as well as other MRI parameters (WML number and volume and CELs) were included from the SABA investigation data. Results: Inter-rater agreement regarding CL-V assessment over time was good-to-excellent (κ = 0.89). Mean intraobserver variability was 1.1%. In all patients, a total number of 218 CLs was found. Total CL-Vs of all patients increased during the 4 months of baseline screening followed by a continuous and significant decrease from month 5 until study-end (p < 0.001, Kendall'W = 0.413). A positive association between WML volumes and CL-Vs was observed during baseline screening. Decreased CL-V were associated with lower EDSS and also with improvements of SDMT- and SCRIPPS scores. Conclusion: DIR MRI seems to be a reliable tool for the frequent assessment of CL-Vs. Overall CL-Vs decreased during the follow-up period and were associated with improvements of cognitive and disability status scores. Our results suggest the presence of short-term CL-V dynamics in RRMS patients and we presume that the laborious evaluation of lesion volumes may be worthwhile for future investigations. Clinical Trial Numbers:www.ClinicalTrials.gov, “The SABA trial”; number: NCT01450124
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Affiliation(s)
- Tobias D Faizy
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gabriel Broocks
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Thaler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Geraldine Rauch
- Institute of Medical Biometry and Epidemiology, Charité Berlin-University Medical Center, Berlin, Germany
| | - Pimrapat Gebert
- Institute of Medical Biometry and Epidemiology, Charité Berlin-University Medical Center, Berlin, Germany
| | - Klarissa H Stürner
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Neurology, Christian-Albrechts University of Kiel, Kiel, Germany
| | - Fabian Flottmann
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hannes Leischner
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Helge C Kniep
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jan-Patrick Stellmann
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christoph Heesen
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Susanne Gellißen
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Uta Hanning
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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23
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Tatekawa H, Sakamoto S, Hori M, Kaichi Y, Kunimatsu A, Akazawa K, Miyasaka T, Oba H, Okubo T, Hasuo K, Yamada K, Taoka T, Doishita S, Shimono T, Miki Y. Imaging Differences between Neuromyelitis Optica Spectrum Disorders and Multiple Sclerosis: A Multi-Institutional Study in Japan. AJNR Am J Neuroradiol 2018; 39:1239-1247. [PMID: 29724765 DOI: 10.3174/ajnr.a5663] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 03/18/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Both clinical and imaging criteria must be met to diagnose neuromyelitis optica spectrum disorders and multiple sclerosis. However, neuromyelitis optica spectrum disorders are often misdiagnosed as MS because of an overlap in MR imaging features. The purpose of this study was to confirm imaging differences between neuromyelitis optica spectrum disorders and MS with visually detailed quantitative analyses of large-sample data. MATERIALS AND METHODS We retrospectively examined 89 consecutive patients with neuromyelitis optica spectrum disorders (median age, 51 years; range, 16-85 years; females, 77; aquaporin 4 immunoglobulin G-positive, 93%) and 89 with MS (median age, 36 years; range, 18-67 years; females, 68; relapsing-remitting MS, 89%; primary-progressive MS, 7%; secondary-progressive MS, 2%) from 9 institutions across Japan (April 2008 to December 2012). Two neuroradiologists visually evaluated the number, location, and size of all lesions using the Mann-Whitney U test or the Fisher exact test. RESULTS We enrolled 79 patients with neuromyelitis optica spectrum disorders and 87 with MS for brain analysis, 57 with neuromyelitis optica spectrum disorders and 55 with MS for spinal cord analysis, and 42 with neuromyelitis optica spectrum disorders and 14 with MS for optic nerve analysis. We identified 911 brain lesions in neuromyelitis optica spectrum disorders, 1659 brain lesions in MS, 86 spinal cord lesions in neuromyelitis optica spectrum disorders, and 102 spinal cord lesions in MS. The frequencies of periventricular white matter and deep white matter lesions were 17% and 68% in neuromyelitis optica spectrum disorders versus 41% and 42% in MS, respectively (location of brain lesions, P < .001). We found a significant difference in the distribution of spinal cord lesions between these 2 diseases (P = .024): More thoracic lesions than cervical lesions were present in neuromyelitis optica spectrum disorders (cervical versus thoracic, 29% versus 71%), whereas they were equally distributed in MS (46% versus 54%). Furthermore, thoracic lesions were significantly longer than cervical lesions in neuromyelitis optica spectrum disorders (P = .001), but not in MS (P = .80). CONCLUSIONS Visually detailed quantitative analyses confirmed imaging differences, especially in brain and spinal cord lesions, between neuromyelitis optica spectrum disorders and MS. These observations may have clinical implications.
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Affiliation(s)
- H Tatekawa
- From the Department of Diagnostic and Interventional Radiology (H.T., S.S., S.D., T.S., Y.M.), Osaka City University Graduate School of Medicine, Osaka, Japan
| | - S Sakamoto
- From the Department of Diagnostic and Interventional Radiology (H.T., S.S., S.D., T.S., Y.M.), Osaka City University Graduate School of Medicine, Osaka, Japan
| | - M Hori
- Department of Radiology (M.H.), Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Y Kaichi
- Department of Diagnostic Radiology (Y.K.), Graduate School and Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - A Kunimatsu
- Department of Radiology (A.K.), Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - K Akazawa
- Department of Radiology (K.A., K.Y.), Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - T Miyasaka
- Department of Radiology (T.M.), Nara Medical University, Nara, Japan
| | - H Oba
- Department of Radiology (H.O.), Teikyo University School of Medicine, Tokyo, Japan
| | - T Okubo
- Department of Radiology (T.O.), Teikyo University Chiba Medical Center, Chiba, Japan
| | - K Hasuo
- Department of Diagnostic Radiology (K.H.), National Center for Global Health and Medicine, Tokyo, Japan
| | - K Yamada
- Department of Radiology (K.A., K.Y.), Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - T Taoka
- Department of Radiology (T.T.), Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - S Doishita
- From the Department of Diagnostic and Interventional Radiology (H.T., S.S., S.D., T.S., Y.M.), Osaka City University Graduate School of Medicine, Osaka, Japan
| | - T Shimono
- From the Department of Diagnostic and Interventional Radiology (H.T., S.S., S.D., T.S., Y.M.), Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Y Miki
- From the Department of Diagnostic and Interventional Radiology (H.T., S.S., S.D., T.S., Y.M.), Osaka City University Graduate School of Medicine, Osaka, Japan
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24
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Curti E, Graziuso S, Tsantes E, Crisi G, Granella F. Correlation between cortical lesions and cognitive impairment in multiple sclerosis. Brain Behav 2018; 8:e00955. [PMID: 29974667 PMCID: PMC5991593 DOI: 10.1002/brb3.955] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 01/18/2018] [Accepted: 02/21/2018] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES Gray matter (GM) damage is well known as a fundamental aspect of multiple sclerosis (MS). Above all, cortical lesions (CLs) burden, detectable at MRI with double inversion recovery (DIR) sequences, has been demonstrated to correlate with cognitive impairment (CI). The aim of this study was to investigate the role of CLs number in predicting CI in a cohort of patients with MS in a clinical practice setting. MATERIALS AND METHODS Thirty consecutive patients with MS presenting CLs (CL+) at high-field (3.0 T) MRI 3D-DIR sequences and an even group of MS patients without CLs (CL-) as a control, were investigated with the Rao Brief Repeatable Battery of Neuropsychological Tests (BRB), Version A. Total and lobar CLs number were computed in CL+ patients. RESULTS Among the sixty patients with MS enrolled, forty-seven (78.3%) had a relapsing-remitting course, while thirteen (21.7%) a progressive one, eleven secondary progressive, and two primary progressive. Compared to CL-, CL+ patients had a greater proportion of progressive forms (p = .03). The most affected region was the frontal lobe (73.3% of patients), followed by temporal and parietal ones (both 60.0%). Multivariate (logistic regression) analysis revealed a significant correlation between total CLs number and the presence of mild cognitive impairment defined as pathologic score in at least one BRB test (p = .04); it was also correlated with deficit at PASAT 3 (p = .05) and Stroop Test (p = .02). CONCLUSIONS We confirmed CLs number, evaluated with a technique quite commonly available in clinical practice, as a predictive factor of CI in patients with MS, in order to improve the diagnosis and management of CI and monitor potential neuroprotective effects of therapies.
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Affiliation(s)
- Erica Curti
- Neurosciences UnitDepartment of Medicine and Surgery (DMEC)University of ParmaParmaItaly
| | - Stefania Graziuso
- Neuroradiology UnitDepartment of DiagnosticParma University HospitalParmaItaly
| | - Elena Tsantes
- Neurosciences UnitDepartment of Medicine and Surgery (DMEC)University of ParmaParmaItaly
| | - Girolamo Crisi
- Neuroradiology UnitDepartment of DiagnosticParma University HospitalParmaItaly
| | - Franco Granella
- Neurosciences UnitDepartment of Medicine and Surgery (DMEC)University of ParmaParmaItaly
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25
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Abstract
Since its technical development in the early 1980s, magnetic resonance imaging (MRI) has quickly been adopted as an essential tool in supporting the diagnosis, longitudinal monitoring, evaluation of therapeutic response, and scientific investigations in multiple sclerosis (MS). The clinical usage of MRI has increased in parallel with technical innovations in the technique itself; the widespread adoption of clinically routine MRI at 1.5T has allowed sensitive qualitative and quantitative assessments of macroscopic central nervous system (CNS) inflammatory demyelinating lesions and tissue atrophy. However, conventional MRI lesion measures lack specificity for the underlying MS pathology and only weakly correlate with clinical status. Higher field strength units and newer, advanced MRI techniques offer increased sensitivity and specificity in the detection of disease activity and disease severity. This review summarizes the current status and future prospects regarding the role of MRI in the characterization of MS-related brain and spinal cord involvement.
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Affiliation(s)
- Christopher C Hemond
- Laboratory for Neuroimaging Research, Partners Multiple Sclerosis Center, Ann Romney Center for Neurologic Diseases, Departments of Neurology and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115
| | - Rohit Bakshi
- Laboratory for Neuroimaging Research, Partners Multiple Sclerosis Center, Ann Romney Center for Neurologic Diseases, Departments of Neurology and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115
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26
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Matsushita F, Kida H, Tabei KI, Nakano C, Matsuura K, Ii Y, Sasaki R, Taniguchi A, Narita Y, Maeda M, Satoh M, Tomimoto H. Clinical significance of cortical lesions in patients with multiple sclerosis: A neuropsychological and neuroimaging study. Brain Behav 2018; 8:e00934. [PMID: 29541544 PMCID: PMC5840446 DOI: 10.1002/brb3.934] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION This study aims to investigate the association between the presence and frequency of cortical lesions (CLs), and the clinical and psychological features of multiple sclerosis (MS). METHODS A total of 19 patients with MS were examined using double inversion recovery (DIR) sequences with 3T magnetic resonance imaging (MRI) and classified into two groups: CL and non-CL. In-house software was used to quantitatively determine the atrophy of each brain region. Activities of daily living (ADL) were estimated using the Kurtzke Expanded Disability Status Scale (EDSS). Cognitive function was assessed using the following tests: Mini-Mental State Examination (MMSE), Trail Making Test (TMT), and Paced Auditory Serial Addition Task (PASAT). Z-scores were used to assess significant differences in the neuropsychological test outcomes between the groups. RESULTS Six of 19 patients had subcortical and deep WM lesions (non-CL group; diagnosed with relapsing-remitting MS). Thirteen of 19 patients had both subcortical and cortical lesions (CL group; 9-relapsing-remitting MS; 4-primary/secondary progressive MS). There were no significant differences in age, education, and disease duration, but EDSS scores were significantly higher in the CL group compared to the non-CL group. There were no significant differences in gray and white matter volume between the CL and the non-CL groups, but the white matter lesion volume was significantly higher in the CL group compared to the non-CL group. Neuropsychological tests showed significant performance worsening in the CL group as compared to the standard values for healthy individuals in their age group, especially in the TMT data. CONCLUSIONS Progressive MS, which was associated with decreased physical functioning, ADL, and cognitive impairment, was found in patients in the CL group.
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Affiliation(s)
- Futoshi Matsushita
- Department of Dementia Prevention and Therapeutics Mie University Mie Japan.,Department of Occupational Therapy Morinomiya University Osaka Japan
| | - Hirotaka Kida
- Department of Dementia Prevention and Therapeutics Mie University Mie Japan
| | - Ken-Ichi Tabei
- Department of Dementia Prevention and Therapeutics Mie University Mie Japan
| | - Chizuru Nakano
- Department of Dementia Prevention and Therapeutics Mie University Mie Japan
| | | | - Yuichiro Ii
- Department of Neurology Mie University Mie Japan
| | | | | | - Yugo Narita
- Department of Neurology Mie University Mie Japan
| | | | - Masayuki Satoh
- Department of Dementia Prevention and Therapeutics Mie University Mie Japan
| | - Hidekazu Tomimoto
- Department of Dementia Prevention and Therapeutics Mie University Mie Japan.,Department of Neurology Mie University Mie Japan
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27
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Abstract
This chapter provides a brief overview of studies that combine postmortem magnetic resonance imaging (MRI) and histopathology. We touch upon the logistics of setting up a protocol that limits unwanted postmortem delays and explain how combining postmortem MRI and histopathology can elucidate the histologic substrate of signal changes that appear on MRI. This is demonstrated by exemplary studies in multiple sclerosis, and includes various histopathologic techniques and a wide range of conventional and advanced MRI sequences at various field strengths. We cover topics such as how to visualize white-matter pathology and repair with conventional and advanced MRI sequences, describe the history of visualizing pathology of the gray matter (with newly developed MRI and immunohistopathology techniques), and how advanced methods have aided research in other neurologic diseases. We conclude with several suggestions for future development, such as bridging the gap between postmortem and in vivo research and the importance of collecting non-neurological control tissue.
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Affiliation(s)
- Laura E Jonkman
- Department of Anatomy and Neurosciences, VU Medical Center, Amsterdam, The Netherlands
| | - Jeroen J G Geurts
- Department of Anatomy and Neurosciences, VU Medical Center, Amsterdam, The Netherlands.
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28
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Abstract
The neuropsychological aspects of multiple sclerosis (MS) have evolved over the past three decades. What was once thought to be a rare occurrence, cognitive dysfunction is now viewed as one of the most disabling symptoms of the disease, with devastating effects on patients' quality of life. This selective review will highlight major innovations and scientific discoveries in the areas of neuropathology, neuroimaging, diagnosis, and treatment that pertain to our understanding of the neuropsychological aspects of MS. Specifically, we focus on the recent discovery that MS produces pathogical lesions of gray matter (GM) that have consequences for cognitive functions. Methods for imaging these GM lesions in MS are discussed along with multimodal imaging studies that integrate structural and functional imaging methods to provide a better understanding of the relationship between cognitive test performance and functional reserve. Innovations in the screening and comprehensive assessment of cognitive disorders are presented along with recent research that examines cognitive dysfunction in pediatric MS. Results of innovative outcome studies in cognitive rehabilitation are discussed. Finally, we highlight trends for potential future innovations over the next decade. (JINS, 2017, 23, 832-842).
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Mollison D, Sellar R, Bastin M, Mollison D, Chandran S, Wardlaw J, Connick P. The clinico-radiological paradox of cognitive function and MRI burden of white matter lesions in people with multiple sclerosis: A systematic review and meta-analysis. PLoS One 2017; 12:e0177727. [PMID: 28505177 PMCID: PMC5432109 DOI: 10.1371/journal.pone.0177727] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 05/02/2017] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Moderate correlation exists between the imaging quantification of brain white matter lesions and cognitive performance in people with multiple sclerosis (MS). This may reflect the greater importance of other features, including subvisible pathology, or methodological limitations of the primary literature. OBJECTIVES To summarise the cognitive clinico-radiological paradox and explore the potential methodological factors that could influence the assessment of this relationship. METHODS Systematic review and meta-analysis of primary research relating cognitive function to white matter lesion burden. RESULTS Fifty papers met eligibility criteria for review, and meta-analysis of overall results was possible in thirty-two (2050 participants). Aggregate correlation between cognition and T2 lesion burden was r = -0.30 (95% confidence interval: -0.34, -0.26). Wide methodological variability was seen, particularly related to key factors in the cognitive data capture and image analysis techniques. CONCLUSIONS Resolving the persistent clinico-radiological paradox will likely require simultaneous evaluation of multiple components of the complex pathology using optimum measurement techniques for both cognitive and MRI feature quantification. We recommend a consensus initiative to support common standards for image analysis in MS, enabling benchmarking while also supporting ongoing innovation.
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Affiliation(s)
- Daisy Mollison
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Robin Sellar
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Mark Bastin
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Denis Mollison
- Department of Actuarial Mathematics and Statistics, Heriot-Watt University, Edinburgh, United Kingdom
| | - Siddharthan Chandran
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Joanna Wardlaw
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Peter Connick
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
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Abstract
Several neuropathologic and imaging studies have consistently confirmed that multiple sclerosis affects both white (WM) and gray matter (GM) and that GM damage plays a key role in disability progression. However, differently from WM damage, the less inflammatory cell infiltration, the absence of significant blood-brain barrier damage, the low myelin density in upper cortical layers, as well as technical constraints, make the GM damage almost undetectable by means of conventional MR imaging.
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Affiliation(s)
- Massimiliano Calabrese
- Neurology B, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Policlinico GB Rossi, Piazzale LA Scuro 10, Verona 37134, Italy.
| | - Marco Castellaro
- Department of Information Engineering, University of Padova, Via G. Gradenigo 6/a, Padova 35135, Italy
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31
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Petiet A, Aigrot MS, Stankoff B. Gray and White Matter Demyelination and Remyelination Detected with Multimodal Quantitative MRI Analysis at 11.7T in a Chronic Mouse Model of Multiple Sclerosis. Front Neurosci 2016; 10:491. [PMID: 27833528 PMCID: PMC5081351 DOI: 10.3389/fnins.2016.00491] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 10/13/2016] [Indexed: 11/13/2022] Open
Abstract
Myelin is a component of the nervous system that is disrupted in multiple sclerosis, resulting in neuro-axonal degeneration. The longitudinal effect of chronic cuprizone-induced demyelination was investigated in the cerebral gray and white matter of treated mice and the spontaneous remyelination upon treatment interruption. Multimodal Magnetic Resonance Imaging and a Cryoprobe were used at 11.7T to measure signal intensity ratios, T2 values and diffusion metrics. The results showed significant and reversible modifications in white matter and gray matter regions such as in the rostral and caudal corpus callosum, the external capsule, the cerebellar peduncles, the caudate putamen, the thalamus, and the somatosensory cortex of treated mice. T2 and radial diffusivity metrics appeared to be more sensitive than fractional anisotropy, axial diffusivity or mean diffusivity to detect those cuprizone-induced changes. In the gray matter, only signal and T2 metrics and not diffusion metrics were sensitive to detect any changes. Immunohistochemical qualitative assessments in the same regions confirmed demyelination and remyelination processes. These multimodal data will provide better understanding of the dynamics of cuprizone-induced de- and remyelination in white and gray matter structures, and will be the basis to test therapies in experimental models.
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Affiliation(s)
- Alexandra Petiet
- Center for Neuroimaging Research, Brain and Spine Institute Paris, France
| | - Marie-Stéphane Aigrot
- Pierre and Marie Curie University/INSERM UMR975, Brain and Spine Institute Paris, France
| | - Bruno Stankoff
- Pierre and Marie Curie University/INSERM UMR975, Brain and Spine InstituteParis, France; Department of Neurology, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP)Paris, France
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32
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Geisseler O, Pflugshaupt T, Bezzola L, Reuter K, Weller D, Schuknecht B, Brugger P, Linnebank M. The relevance of cortical lesions in patients with multiple sclerosis. BMC Neurol 2016; 16:204. [PMID: 27769199 PMCID: PMC5073896 DOI: 10.1186/s12883-016-0718-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 10/12/2016] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Recent studies suggest that cortical lesions in multiple sclerosis (MS) substantially contribute to clinical disease severity. The present study aimed at investigating clinical, neuroanatomical, and cognitive correlates of these cortical lesions with a novel approach, i.e. by comparing two samples of relapsing-remitting multiple sclerosis (RRMS) patients, one group with and the other without cortical lesions. METHODS High-resolution structural MRI was acquired from 42 RRMS patients and 43 controls (HC). The patient group was dichotomized based on the presence versus absence of DIR-hyperintense cortex-involving lesions, resulting in a cortical lesion group (CL, n = 32) and a non-cortical lesion group (nCL, n =10). Cognitive functioning was assessed in all participants with a comprehensive neuropsychological battery, covering mnestic, executive, and attentional functions. RESULTS Highest densities of cortical lesions in the CL group were observed in the bilateral parahippocampal gyrus. Relative to HC, patients with cortical lesions - but not those without - showed significant global cortical thinning and mnestic deficits. The two patient groups did not differ from each other regarding demographic and basic disease characteristics such as EDSS scores. CONCLUSION The appearance of cortical lesions in MS patients is associated with cortical thinning as well as mnestic deficits, which might be key characteristics of a 'cortically dominant' MS subtype.
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Affiliation(s)
- Olivia Geisseler
- Department of Neurology, University Hospital Zurich, Frauenklinikstrasse 26, 8091, Zurich, Switzerland. .,Department of Psychology, University of Zurich, Binzmühlestrasse 14/1, 8050, Zürich, Switzerland.
| | - Tobias Pflugshaupt
- Neurology and Neurorehabilitation Center, Luzerner Kantonsspital/State Hospital, 6000, Lucerne 16, Switzerland
| | - Ladina Bezzola
- URPP Dynamics of Healthy Aging, University of Zurich, Andreasstrasse 15/Box 2, 8050, Zurich, Switzerland
| | - Katja Reuter
- Department of Neurology, University Hospital Zurich, Frauenklinikstrasse 26, 8091, Zurich, Switzerland
| | - David Weller
- Department of Neurology, University Hospital Zurich, Frauenklinikstrasse 26, 8091, Zurich, Switzerland
| | - Bernhard Schuknecht
- Medizinisch Radiologisches Institut, Bahnhofplatz 3, 8001, Zurich, Switzerland
| | - Peter Brugger
- Department of Neurology, University Hospital Zurich, Frauenklinikstrasse 26, 8091, Zurich, Switzerland
| | - Michael Linnebank
- Department of Neurology, University Hospital Zurich, Frauenklinikstrasse 26, 8091, Zurich, Switzerland.,Department of Neurology, Helios-Klinik Hagen-Ambrock, Ambrocker Weg 60, 58091, Hagen, Germany
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33
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Jaywant A, Barredo J, Ahern DC, Resnik L. Neuropsychological assessment without upper limb involvement: a systematic review of oral versions of the Trail Making Test and Symbol-Digit Modalities Test. Neuropsychol Rehabil 2016; 28:1055-1077. [PMID: 27756192 DOI: 10.1080/09602011.2016.1240699] [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] [Indexed: 10/20/2022]
Abstract
The Trail Making Test (TMT) and written version of the Symbol Digit Modalities Test (SDMT) assess attention, processing speed, and executive functions but their utility is limited in populations with upper limb dysfunction. Oral versions of the TMT and SDMT exist, but a systematic review of their psychometric properties and clinical utility has not been conducted, which was the goal of this study. Searches were conducted in PubMed and PsycINFO, test manuals, and the reference lists of included articles. Four measures were identified: the SDMT-oral, oral TMT-A, oral TMT-B, and the Mental Alternation Test (MAT). Two investigators independently reviewed abstracts to identify peer-reviewed articles that reported on these measures in adult populations. From each article, one investigator extracted information on reliability, validity, responsiveness, minimum detectable change, normative data, and demographic influences. A second investigator verified the accuracy of the data in a random selection of 10% of papers. The quality of the evidence for each psychometric property was rated on a 4-point scale (unknown, poor, adequate, excellent). Results showed excellent evidence for the SDMT-oral, adequate evidence for the oral TMT-B and MAT, and adequate to poor evidence for the oral TMT-A. These findings inform the clinical assessment of attention, processing speed, and executive functions in individuals with upper limb disability.
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Affiliation(s)
- Abhishek Jaywant
- a Center of Excellence for Neurorestoration and Neurotechnology , Providence VA Medical Center , Providence , RI , USA.,b Department of Psychiatry and Human Behavior , Warren Alpert Medical School of Brown University , Providence , RI , USA
| | - Jennifer Barredo
- a Center of Excellence for Neurorestoration and Neurotechnology , Providence VA Medical Center , Providence , RI , USA.,c Brown Institute for Brain Science , Brown University , Providence , RI , USA
| | - David C Ahern
- b Department of Psychiatry and Human Behavior , Warren Alpert Medical School of Brown University , Providence , RI , USA.,d The Miriam Hospital , Providence , RI , USA
| | - Linda Resnik
- a Center of Excellence for Neurorestoration and Neurotechnology , Providence VA Medical Center , Providence , RI , USA
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Roar M, Illes Z, Sejbaek T. Practice effect in Symbol Digit Modalities Test in multiple sclerosis patients treated with natalizumab. Mult Scler Relat Disord 2016; 10:116-122. [PMID: 27919477 DOI: 10.1016/j.msard.2016.09.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 09/19/2016] [Accepted: 09/26/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVES How practice effect influences cognitive testing measured by monthly Symbol Digit Modalities Test (SDMT) during natalizumab treatment, and what factors confound such effect. METHODS Eighty patients were examined monthly with SDMT for 26.2±8.4 months. After 26.0±8.1 months, SDMT was also performed with a rearranged key in 59 cases. Results of SDMTs with the rearranged and previous regular key were compared. We examined if gender, age, Extended Disability Status Scale (EDSS), relapses, and disability progression/improvement influence SDMT performed with the regular and the rearranged key, respectively. We also explored if natalizumab applied before regular monthly SDMT may influence practice effect and cognition. RESULTS SDMT performance improved by 1.2 points/test during the first six months and by 0.4 points/test thereafter. Rearranging the symbols of the key after 26.0±8.1 months returned SDMT scores to baseline indicating a practice effect. Such practice effect was more significant after longer testing period, but was not influenced by gender, age, relapses, disability progression and prior natalizumab treatment. Although the change from baseline to 2.5 years was significant in subgroups with EDSS 0-3, 3.5-5.5 and 6-7.5, this was higher in patients with EDSS 0-3 compared to 6-7.5. CONCLUSIONS Practice effect significantly contributes to continuous improvement in SDMT performance during natalizumab treatment: to test cognition, a change in key is required. Practice effect is less pronounced in patients with advanced disease. Cognition remains stable even in patients with progressive disease during more than 2 years of natalizumab treatment indicated by scores corresponding to baseline after changing the key.
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Affiliation(s)
- Malte Roar
- Department of Neurology, Odense University Hospital, Sdr. Boulevard 29, Odense 5000, Denmark
| | - Zsolt Illes
- Department of Neurology, Odense University Hospital, Sdr. Boulevard 29, Odense 5000, Denmark; Institute of Clinical Research, University of Southern Denmark, Denmark.
| | - Tobias Sejbaek
- Department of Neurology, Odense University Hospital, Sdr. Boulevard 29, Odense 5000, Denmark
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35
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Affiliation(s)
- Dawn Langdon
- Royal Holloway, University of London, Egham, Surrey, TW20 0EX, UK
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36
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Yousuf F, Kim G, Tauhid S, Glanz BI, Chu R, Tummala S, Healy BC, Bakshi R. The Contribution of Cortical Lesions to a Composite MRI Scale of Disease Severity in Multiple Sclerosis. Front Neurol 2016; 7:99. [PMID: 27445966 PMCID: PMC4925661 DOI: 10.3389/fneur.2016.00099] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 06/13/2016] [Indexed: 12/28/2022] Open
Abstract
Objective To test a new version of the Magnetic Resonance Disease Severity Scale (v.3 = MRDSS3) for multiple sclerosis (MS), incorporating cortical gray matter lesions (CLs) from 3T magnetic resonance imaging (MRI). Background MRDSS1 was a cerebral MRI-defined composite scale of MS disease severity combining T2 lesion volume (T2LV), the ratio of T1 to T2LV (T1/T2), and whole brain atrophy [brain parenchymal fraction (BPF)]. MRDSS2 expanded the scale to include cerebral gray matter fraction (GMF) and upper cervical spinal cord area (UCCA). We tested the contribution of CLs to the scale (MRDSS3) in modeling the MRI relationship to clinical status. Methods We studied 51 patients [3 clinically isolated syndrome, 43 relapsing-remitting, 5 progressive forms, age (mean ± SD) 40.7 ± 9.1 years, Expanded Disability Status Scale (EDSS) score 1.6 ± 1.7] and 20 normal controls by high-resolution cerebrospinal MRI. CLs required visibility on both fluid-attenuated inversion-recovery (FLAIR) and modified driven equilibrium Fourier transform sequences. The MACFIMS battery defined cognitively impaired (n = 18) vs. preserved (n = 33) MS subgroups. Results EDSS significantly correlated with only BPF, UCCA, MRDSS2, and MRDSS3 (all p < 0.05). After adjusting for depressive symptoms, the cognitively impaired group had higher severity of MRI metrics than the cognitively preserved group in regard to only BPF, GMF, T1/T2, MRDSS1, and MRDSS2 (all p < 0.05). CL number was not significantly related to EDSS score or cognition status. Conclusion CLs from 3T MRI did not appear to improve the validity of the MRDSS. Further studies employing advanced sequences or higher field strengths may show more utility for the incorporation of CLs into composite scales.
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Affiliation(s)
- Fawad Yousuf
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Laboratory for Neuroimaging Research, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Gloria Kim
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Laboratory for Neuroimaging Research, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Shahamat Tauhid
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Laboratory for Neuroimaging Research, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Bonnie I Glanz
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Partners Multiple Sclerosis Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Renxin Chu
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Laboratory for Neuroimaging Research, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Subhash Tummala
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Laboratory for Neuroimaging Research, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Brian C Healy
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Partners Multiple Sclerosis Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Rohit Bakshi
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Laboratory for Neuroimaging Research, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Partners Multiple Sclerosis Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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37
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Migliore S, Ghazaryan A, Simonelli I, Pasqualetti P, Landi D, Palmieri MG, Moffa F, Rinaldi P, Vernieri F, Filippi MM. Validity of the minimal assessment of cognitive function in multiple sclerosis (MACFIMS) in the Italian population. Neurol Sci 2016; 37:1261-70. [PMID: 27095052 DOI: 10.1007/s10072-016-2578-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 04/07/2016] [Indexed: 01/21/2023]
Abstract
Cognitive dysfunction involves 40-65 % of multiple sclerosis (MS) patients. It can be detected in all MS phenotypes from the early stages of the disease, and it tends to progress over time. Minimal Assessment of Cognitive Function in MS (MACFIMS) has been proved to be the most sensitive and comprehensive battery available for MS cognitive assessment in the English population. In Italy, MACFIMS applicability is limited in everyday clinical practice since the overall validity of this battery in the Italian MS population has never been demonstrated. The aim of this study was to translate/cross-culturally adapt and validate an Italian version of the MACFIMS. A total of 130 MS patients and 60 healthy controls (HCs) were enrolled and evaluated with an Italian version of the MACFIMS. All tests discriminated MS patients from HCs; according to the literature, approximately more than half of MS patients (70.8 %) exhibit cognitive impairment. Principal component analysis showed four distinct components: visual-spatial memory/processing speed, working memory, executive functions and verbal memory. Our study is the first to validate an Italian version of the MACFIMS. Several aspects of validity have been demonstrated: criterion and, partially, construct. Future work will investigate the longitudinal course of neuropsychological dysfunction in Italian MS patients using these measures.
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Affiliation(s)
- Simone Migliore
- Clinical Psychology Service, University Campus Bio-Medico, Via Alvaro de Portillo 200, Rome, RM, Italy.
- LIRH Foundation, Via dei Mille 41, Rome, Italy.
| | - Anna Ghazaryan
- Department of Neuroscience, Fatebenefratelli Hospital-Isola Tiberina, Rome, Italy
| | - Ilaria Simonelli
- Department of Neuroscience, Fatebenefratelli Hospital-Isola Tiberina, Rome, Italy
- Neurodegeneration Lab and Department of Imaging, IRCCS San Raffaele Pisana, Rome, Italy
| | - Patrizio Pasqualetti
- Department of Neuroscience, Fatebenefratelli Hospital-Isola Tiberina, Rome, Italy
- Neurodegeneration Lab and Department of Imaging, IRCCS San Raffaele Pisana, Rome, Italy
| | - Doriana Landi
- Department of Neuroscience, Policlinico "Tor Vergata", Rome, Italy
| | | | - Filomena Moffa
- Department of Neuroscience, Fatebenefratelli Hospital-Isola Tiberina, Rome, Italy
| | - Pasquale Rinaldi
- Institute of Cognitive Sciences and Technologies, National Research Council of Italy, Rome, Italy
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Brown JWL, Chard DT. The role of MRI in the evaluation of secondary progressive multiple sclerosis. Expert Rev Neurother 2016; 16:157-71. [PMID: 26692498 DOI: 10.1586/14737175.2016.1134323] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Magnetic resonance imaging already has an established role in the diagnosis of multiple sclerosis, but it also has the potential to provide prognostic information, and to monitor [corrected] disease progression in clinical trials and practice. Magnetic resonance imaging measures are increasingly being used as the primary outcome in early phase clinical trials of immunomodulatory therapies (for example brain white matter lesion counts or volumes, and gadolinium contrast enhancing lesions) and putatively neuroprotective agents (for example measures of whole brain atrophy), and trials of agents that promote remyelination are also likely to follow suit. In this review we consider the use of magnetic resonance imaging measures as predictors and markers of disease progression in multiple sclerosis, and explore possible future directions in this rapidly developing field.
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Affiliation(s)
- J William L Brown
- a Department of Clinical Neurosciences , University of Cambridge , Cambridge , UK.,b NMR Research Unit, Queen Square Multiple Sclerosis Centre, Institute of Neurology , University College London (UCL) , London , UK
| | - Declan T Chard
- b NMR Research Unit, Queen Square Multiple Sclerosis Centre, Institute of Neurology , University College London (UCL) , London , UK.,c Biomedical Research Centre, National Institute for Health Research (NIHR) , University College London Hospitals (UCLH) , London , UK
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39
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van Munster CE, Jonkman LE, Weinstein HC, Uitdehaag BM, Geurts JJ. Gray matter damage in multiple sclerosis: Impact on clinical symptoms. Neuroscience 2015; 303:446-61. [DOI: 10.1016/j.neuroscience.2015.07.006] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Revised: 06/29/2015] [Accepted: 07/01/2015] [Indexed: 01/12/2023]
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40
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Dupuy SL, Tauhid S, Kim G, Chu R, Tummala S, Hurwitz S, Bakshi R. MRI detection of hypointense brain lesions in patients with multiple sclerosis: T1 spin-echo vs. gradient-echo. Eur J Radiol 2015; 84:1564-1568. [DOI: 10.1016/j.ejrad.2015.05.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 04/20/2015] [Accepted: 05/05/2015] [Indexed: 01/08/2023]
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41
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Daams M, Steenwijk MD, Schoonheim MM, Wattjes MP, Balk LJ, Tewarie PK, Killestein J, Uitdehaag BMJ, Geurts JJG, Barkhof F. Multi-parametric structural magnetic resonance imaging in relation to cognitive dysfunction in long-standing multiple sclerosis. Mult Scler 2015. [PMID: 26209593 DOI: 10.1177/1352458515596598] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Cognitive deficits are common in multiple sclerosis. Most previous studies investigating the imaging substrate of cognitive deficits in multiple sclerosis included patients with relatively short disease durations and were limited to one modality/brain region. OBJECTIVE To identify the strongest neuroimaging predictors for cognitive dysfunction in a large cohort of patients with long-standing multiple sclerosis. METHODS Extensive neuropsychological testing and multimodal 3.0T MRI was performed in 202 patients with multiple sclerosis and 52 controls. Cognitive scores were compared between groups using Z-scores. Whole-brain, white matter, grey matter, deep grey matter and lesion volumes; cortical thickness, (juxta)cortical and cerebellar lesions; and extent and severity of diffuse white matter damage were measured. Stepwise linear regression was used to identify the strongest predictors for cognitive dysfunction. RESULTS All cognitive domains were affected in patients. Patients showed extensive atrophy, focal pathology and damage in up to 75% of the investigated white matter. Associations between imaging markers and average cognition were two times stronger in cognitively impaired patients than in cognitively preserved patients. The final model for average cognition consisted of deep grey matter DGMV volume and fractional anisotropy severity (adjusted R²=0.490; p<0.001). CONCLUSION From all imaging markers, deep grey matter atrophy and diffuse white matter damage emerged as the strongest predictors for cognitive dysfunction in long-standing multiple sclerosis.
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Affiliation(s)
- Marita Daams
- Department of Radiology and Nuclear Medicine, Neuroscience Campus Amsterdam, VU University Medical Centre, The Netherlands/Department of Anatomy and Neurosciences, Neuroscience Campus Amsterdam, VU University Medical Centre, The Netherlands
| | - Martijn D Steenwijk
- Department of Radiology and Nuclear Medicine, Neuroscience Campus Amsterdam, VU University Medical Centre, The Netherlands
| | - Menno M Schoonheim
- Department of Anatomy and Neurosciences, Neuroscience Campus Amsterdam, VU University Medical Centre, The Netherlands
| | - Mike P Wattjes
- Department of Radiology and Nuclear Medicine, Neuroscience Campus Amsterdam, VU University Medical Centre, The Netherlands
| | - Lisanne J Balk
- Department of Neurology, Neuroscience Campus Amsterdam, VU University Medical Centre, The Netherlands
| | - Prejaas K Tewarie
- Department of Neurology, Neuroscience Campus Amsterdam, VU University Medical Centre, The Netherlands
| | - Joep Killestein
- Department of Neurology, Neuroscience Campus Amsterdam, VU University Medical Centre, The Netherlands
| | - Bernard M J Uitdehaag
- Department of Neurology, Neuroscience Campus Amsterdam, VU University Medical Centre, The Netherlands
| | - Jeroen J G Geurts
- Department of Anatomy and Neurosciences, Neuroscience Campus Amsterdam, VU University Medical Centre, The Netherlands
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, Neuroscience Campus Amsterdam, VU University Medical Centre, The Netherlands
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Kawachi I, Nishizawa M. Significance of gray matter brain lesions in multiple sclerosis and neuromyelitis optica. Neuropathology 2015; 35:481-6. [DOI: 10.1111/neup.12216] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Revised: 04/05/2015] [Accepted: 04/05/2015] [Indexed: 12/31/2022]
Affiliation(s)
- Izumi Kawachi
- Department of Neurology, Brain Research Institute; Niigata University; Niigata Japan
| | - Masatoyo Nishizawa
- Department of Neurology, Brain Research Institute; Niigata University; Niigata Japan
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Naganawa S. The Technical and Clinical Features of 3D-FLAIR in Neuroimaging. Magn Reson Med Sci 2015; 14:93-106. [PMID: 25833275 DOI: 10.2463/mrms.2014-0132] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
In clinical MR neuroimaging, 3D fluid-attenuated inversion recovery (3D-FLAIR) with a variable-flip-angle turbo spin echo sequence is becoming popular. There are more than 100 reports regarding 3D-FLAIR in the PubMed database. In this article, the technical and clinical features of 3D-FLAIR for neuroimaging are reviewed and summarized. 3D-FLAIR allows thinner slices with multi-planar reformation capability, a higher flow sensitivity, high sensitivity to subtle T1 changes in fluid, images without cerebrospinal fluid (CSF) inflow artifacts, and a 3D dataset compatible with computer-aided analysis. In addition, 3D-FLAIR can be obtained within a clinically reasonable scan time. It is important for radiologists to be familiar with the features of 3D-FLAIR and to provide useful information for patients.
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Affiliation(s)
- Shinji Naganawa
- Department of Radiology, Nagoya University Graduate School of Medicine
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44
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Yao B, Hametner S, van Gelderen P, Merkle H, Chen C, Lassmann H, Duyn JH, Bagnato F. 7 Tesla magnetic resonance imaging to detect cortical pathology in multiple sclerosis. PLoS One 2014; 9:e108863. [PMID: 25303286 PMCID: PMC4193749 DOI: 10.1371/journal.pone.0108863] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2014] [Accepted: 08/27/2014] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Neocortical lesions (NLs) are an important pathological component of multiple sclerosis (MS), but their visualization by magnetic resonance imaging (MRI) remains challenging. OBJECTIVES We aimed at assessing the sensitivity of multi echo gradient echo (ME-GRE) T2*-weighted MRI at 7.0 Tesla in depicting NLs compared to myelin and iron staining. METHODS Samples from two MS patients were imaged post mortem using a whole body 7 T MRI scanner with a 24-channel receive-only array. Isotropic 200 micron resolution images with varying T2* weighting were reconstructed from the ME-GRE data and converted into R2* maps. Immunohistochemical staining for myelin (proteolipid protein, PLP) and diaminobenzidine-enhanced Turnbull blue staining for iron were performed. RESULTS Prospective and retrospective sensitivities of MRI for the detection of NLs were 48% and 67% respectively. We observed MRI maps detecting only a small portion of 20 subpial NLs extending over large cortical areas on PLP stainings. No MRI signal changes suggestive of iron accumulation in NLs were observed. Conversely, R2* maps indicated iron loss in NLs, which was confirmed by histological quantification. CONCLUSIONS High-resolution post mortem imaging using R2* and magnitude maps permits detection of focal NLs. However, disclosing extensive subpial demyelination with MRI remains challenging.
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Affiliation(s)
- Bing Yao
- Advanced Magnetic Resonance Imaging Section, Laboratory of Functional and Molecular Imaging, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, Maryland, United States of America
- Center for Neuroimaging Research, Kessler Foundation, West Orange, New Jersey, United States of America
| | - Simon Hametner
- Center for Brain Research, Medical University, Vienna, Austria
| | - Peter van Gelderen
- Advanced Magnetic Resonance Imaging Section, Laboratory of Functional and Molecular Imaging, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, Maryland, United States of America
| | - Hellmuth Merkle
- Advanced Magnetic Resonance Imaging Section, Laboratory of Functional and Molecular Imaging, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, Maryland, United States of America
| | - Christina Chen
- Neuroimmunology Branch, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, Maryland, United States of America
| | - Hans Lassmann
- Center for Brain Research, Medical University, Vienna, Austria
| | - Jeff H. Duyn
- Advanced Magnetic Resonance Imaging Section, Laboratory of Functional and Molecular Imaging, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, Maryland, United States of America
| | - Francesca Bagnato
- Neuroimmunology Branch, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, Maryland, United States of America
- Department of Radiology and Radiological Science, Institute of Imaging Science, Vanderbilt University, Nashville, Tennessee, United States of America
- * E-mail:
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Cavallari M, Ceccarelli A, Wang GY, Moscufo N, Hannoun S, Matulis CR, Jackson JS, Glanz BI, Bakshi R, Neema M, Guttmann CRG. Microstructural changes in the striatum and their impact on motor and neuropsychological performance in patients with multiple sclerosis. PLoS One 2014; 9:e101199. [PMID: 25047083 PMCID: PMC4105540 DOI: 10.1371/journal.pone.0101199] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Accepted: 06/04/2014] [Indexed: 12/30/2022] Open
Abstract
Grey matter (GM) damage is a clinically relevant feature of multiple sclerosis (MS) that has been previously assessed with diffusion tensor imaging (DTI). Fractional anisotropy (FA) of the basal ganglia and thalamus might be increased in MS patients, and correlates with disability scores. Despite the established role of the striatum and thalamus in motor control, mood and cognition, the impact of DTI changes within these structures on motor and neuropsychological performance has not yet been specifically addressed in MS. We investigated DTI metrics of deep GM nuclei and their potential association with mobility and neuropsychological function. DTI metrics from 3T MRI were assessed in the caudate, putamen, and thalamus of 30 MS patients and 10 controls. Sixteen of the patients underwent neuropsychological testing. FA of the caudate and putamen was higher in MS patients compared to controls. Caudate FA correlated with Expanded Disability Status Scale score, Ambulation Index, and severity of depressive symptomatology. Putamen and thalamus FA correlated with deficits in memory tests. In contrast, cerebral white matter (WM) lesion burden showed no significant correlation with any of the disability, mobility and psychometric parameters. Our findings support evidence of FA changes in the basal ganglia in MS patients, as well as deep GM involvement in disabling features of MS, including mobility and cognitive impairment. Deep GM FA appears to be a more sensitive correlate of disability than WM lesion burden.
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Affiliation(s)
- Michele Cavallari
- Center for Neurological Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso (NESMOS), Università La Sapienza, Rome, Italy
| | - Antonia Ceccarelli
- Laboratory for Neuroimaging Research, Department of Neurology, Harvard Medical School, Partners Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, Massachusetts, United States of America
| | - Guang-Yi Wang
- Center for Neurological Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Radiology, Guangdong General Hospital, Guangzhou, Guangdong Province, People's Republic of China
| | - Nicola Moscufo
- Center for Neurological Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Salem Hannoun
- Centre de Recherche en Acquisition en Traitement de l'Image pour la Santé (CREATIS), Centre National de la Recherche Scientifique (CNRS) Unités Mixtes de Recherche (UMR) 5220 & Institut National de la Santé et de la Recherche Médicale (INSERM) U1044, Université Claude Bernard - Lyon 1, University of Lyon, Lyon, France
- Observatoire Français de la Sclérose en Plaques (OFSEP), University of Lyon, Lyon, France
| | - Christina R. Matulis
- Laboratory for Neuroimaging Research, Department of Neurology, Harvard Medical School, Partners Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, Massachusetts, United States of America
| | - Jonathan S. Jackson
- Laboratory for Neuroimaging Research, Department of Neurology, Harvard Medical School, Partners Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, Massachusetts, United States of America
| | - Bonnie I. Glanz
- Laboratory for Neuroimaging Research, Department of Neurology, Harvard Medical School, Partners Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, Massachusetts, United States of America
| | - Rohit Bakshi
- Laboratory for Neuroimaging Research, Department of Neurology, Harvard Medical School, Partners Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, Massachusetts, United States of America
| | - Mohit Neema
- Laboratory for Neuroimaging Research, Department of Neurology, Harvard Medical School, Partners Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, Massachusetts, United States of America
| | - Charles R. G. Guttmann
- Center for Neurological Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- * E-mail:
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Charvet LE, Beekman R, Amadiume N, Belman AL, Krupp LB. The Symbol Digit Modalities Test is an effective cognitive screen in pediatric onset multiple sclerosis (MS). J Neurol Sci 2014; 341:79-84. [DOI: 10.1016/j.jns.2014.04.006] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2014] [Revised: 03/08/2014] [Accepted: 04/05/2014] [Indexed: 11/29/2022]
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Depressive symptoms in multiple sclerosis from an in vivo study with TBSS. BIOMED RESEARCH INTERNATIONAL 2014; 2014:148465. [PMID: 24877057 PMCID: PMC4024416 DOI: 10.1155/2014/148465] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Revised: 04/05/2014] [Accepted: 04/08/2014] [Indexed: 01/20/2023]
Abstract
Clinically significant depression can impact up to 50% of patients with multiple sclerosis (MS) over a course of their life time, which is associated with an increased morbidity and mortality. In our study, fifteen relapsing-remitting MS (RRMS) patients and 15 age- and gender-matched normal controls were included. Diffusion tensor imaging (DTI) was acquired by employing a single-shot echo planar imaging sequence on a 3.0 T MR scanner and fractional anisotropy (FA) was performed with tract-based spatial statistics (TBSS) approach. Finally, widespread WM and GM abnormalities were observed in RRMS patients. Moreover, the relationships between the depressive symptoms which can be measured by Hamilton depression rating scale (HAMD) as well as clinical disabilities measured by the expanded disability status scale (EDSS) and FA changes were listed. There was a positive relation between EDSS and the FA changes in the right inferior parietal lobule, while negative relation was located in the left anterior cingulate cortex and hippocampus. Also a positive relation between HAMD and FA changes was found in the right posterior middle cingulate gyrus, the right hippocampus, the left hypothalamus, the right precentral gyrus, and the posterior cingulate which demonstrated a link between the depressive symptoms and clinically relevant brain areas in RRMS patients.
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Li T, Xiao H, Li S, Du X, Zhou J. Multiple sclerosis: clinical features and MRI findings in Northern China. Eur J Med Res 2014; 19:20. [PMID: 24731721 PMCID: PMC4003518 DOI: 10.1186/2047-783x-19-20] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2013] [Accepted: 03/28/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Reports in Asian populations suggest that ethnic and geographical differences may influence susceptibility to multiple sclerosis (MS) and its clinical behaviors. Here, we sought to retrospectively survey clinical characteristics and MRI data in Chinese subjects with MS. METHODS We conducted a retrospective analysis in 117 patients with MS. The patients were divided into subgroups with optic-spinal form of multiple sclerosis (OSMS; n = 42) and classical multiple sclerosis (CMS; n = 75). Clinical characteristics, MRI finding and expanded disability status scale (EDSS) score were compared between the two groups. RESULTS In 117 MS patients, 64.1% patients were classified as having CMS and 35.9% OSMS forms. White blood cell counts of OSMS patients were significantly higher than those of CMS patients (P <0.05). The longitudinal fusion lesions of spinal cord on MRI were statistically significant between groups (P <0.05). Spinal cord MRI showed that MS lesions were longer, and revealed spinal cord swelling in patients with CMS, but atrophy in patients with OSMS. The EDSS score at five years was significantly higher in patients with OSMS than in those with CMS (P <0.05). Relapse rates of patients with OSMS were also higher than those of patients with CMS (P <0.01) within one to three years. CONCLUSIONS OSMS accounts for a higher proportion of MS populations in Northern China than in Western countries. MRI showed a longitudinally extensive spinal cord lesion in patients with OSMS and spinal cord swelling at onset.
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Affiliation(s)
- Tianran Li
- Radiology Department, No, 1 Affiliated Hospital of Fuzhou General Hospital, 29 Xinquan Road, Putian, Fujian Province 351100, P,R, China.
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Kawachi I, Nishizawa M. Gray matter involvement in multiple sclerosis and neuromyelitis optica. ACTA ACUST UNITED AC 2014. [DOI: 10.1111/cen3.12077] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Izumi Kawachi
- Department of Neurology; Brain Research Institute; Niigata University; Niigata Japan
| | - Masatoyo Nishizawa
- Department of Neurology; Brain Research Institute; Niigata University; Niigata Japan
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Gray matters in multiple sclerosis: cognitive impairment and structural MRI. Mult Scler Int 2014; 2014:609694. [PMID: 24587905 PMCID: PMC3920616 DOI: 10.1155/2014/609694] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2013] [Revised: 09/30/2013] [Accepted: 10/29/2013] [Indexed: 01/11/2023] Open
Abstract
Multiple sclerosis (MS) is an immune-mediated disease affecting central nervous system (CNS). Although MS is classically considered a white matter (WM) disease, the involvement of gray matter (GM) in the pathogenic process has been confirmed by pathology studies and MRI studies. Impairment of cognitive domains such as memory, mental processing speed, attention, and executive function can occur from the early stage of the disease and tends to worsen over time, despite stable physical symptoms. WM demyelination is moderately correlated with CI, suggesting that probably WM abnormalities alone cannot fully explain the extent of clinical symptoms in MS, including CI. Several MRI techniques have shown the involvement of GM in MS and the association between GM damage, physical disability, and CI. The aim of this review is to provide an overview of CI and GM damage assessed by structural brain MRI.
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