1
|
O'Neill J, Diaz MP, Alger JR, Pochon JB, Ghahremani D, Dean AC, Tyndale RF, Petersen N, Marohnic S, Karaiskaki A, London ED. Smoking, tobacco dependence, and neurometabolites in the dorsal anterior cingulate cortex. Mol Psychiatry 2023; 28:4756-4765. [PMID: 37749232 PMCID: PMC10914613 DOI: 10.1038/s41380-023-02247-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 08/24/2023] [Accepted: 08/29/2023] [Indexed: 09/27/2023]
Abstract
Cigarette smoking has a major impact on global health and morbidity, and positron emission tomographic research has provided evidence for reduced inflammation in the human brain associated with cigarette smoking. Given the consequences of inflammatory dysfunction for health, the question of whether cigarette smoking affects neuroinflammation warrants further investigation. The goal of this project therefore was to validate and extend evidence of hypoinflammation related to smoking, and to examine the potential contribution of inflammation to clinical features of smoking. Using magnetic resonance spectroscopy, we measured levels of neurometabolites that are putative neuroinflammatory markers. N-acetyl compounds (N-acetylaspartate + N-acetylaspartylglutamate), glutamate, creatine, choline-compounds (phosphocholine + glycerophosphocholine), and myo-inositol, have all been linked to neuroinflammation, but they have not been examined as such with respect to smoking. We tested whether people who smoke cigarettes have brain levels of these metabolites consistent with decreased neuroinflammation, and whether clinical features of smoking are associated with levels of these metabolites. The dorsal anterior cingulate cortex was chosen as the region-of-interest because of previous evidence linking it to smoking and related states. Fifty-four adults who smoked daily maintained overnight smoking abstinence before testing and were compared with 37 nonsmoking participants. Among the smoking participants, we tested for associations of metabolite levels with tobacco dependence, smoking history, craving, and withdrawal. Levels of N-acetyl compounds and glutamate were higher, whereas levels of creatine and choline compounds were lower in the smoking group as compared with the nonsmoking group. In the smoking group, glutamate and creatine levels correlated negatively with tobacco dependence, and creatine correlated negatively with lifetime smoking, but none of the metabolite levels correlated with craving or withdrawal. The findings indicate a link between smoking and a hypoinflammatory state in the brain, specifically in the dorsal anterior cingulate cortex. Smoking may thereby increase vulnerability to infection and brain injury.
Collapse
Affiliation(s)
- Joseph O'Neill
- Division of Child & Adolescent Psychiatry, Department of Psychiatry, University of California at Los Angeles, Los Angeles, CA, USA
- Brain Research Institute, University of California at Los Angeles, Los Angeles, CA, USA
| | - Maylen Perez Diaz
- Jane and Terry Semel Institute for Neuroscience and Human Behavior and the Department of Psychiatry, University of California at Los Angeles, Los Angeles, CA, USA
- Biogen, Inc., Nashville, TN, USA
| | - Jeffry R Alger
- Department of Neurology, University of California at Los Angeles, Los Angeles, CA, USA
| | - Jean-Baptiste Pochon
- Jane and Terry Semel Institute for Neuroscience and Human Behavior and the Department of Psychiatry, University of California at Los Angeles, Los Angeles, CA, USA
| | - Dara Ghahremani
- Jane and Terry Semel Institute for Neuroscience and Human Behavior and the Department of Psychiatry, University of California at Los Angeles, Los Angeles, CA, USA
| | - Andrew C Dean
- Jane and Terry Semel Institute for Neuroscience and Human Behavior and the Department of Psychiatry, University of California at Los Angeles, Los Angeles, CA, USA
| | - Rachel F Tyndale
- Department of Pharmacology & Toxicology, and Department of Psychiatry, University of Toronto, and Campbell Family Mental Health Research Institute, Centre for Addiction & Mental Health, Toronto, ON, Canada
| | - Nicole Petersen
- Jane and Terry Semel Institute for Neuroscience and Human Behavior and the Department of Psychiatry, University of California at Los Angeles, Los Angeles, CA, USA
| | - Shane Marohnic
- Jane and Terry Semel Institute for Neuroscience and Human Behavior and the Department of Psychiatry, University of California at Los Angeles, Los Angeles, CA, USA
| | - Andrea Karaiskaki
- Jane and Terry Semel Institute for Neuroscience and Human Behavior and the Department of Psychiatry, University of California at Los Angeles, Los Angeles, CA, USA
| | - Edythe D London
- Brain Research Institute, University of California at Los Angeles, Los Angeles, CA, USA.
- Jane and Terry Semel Institute for Neuroscience and Human Behavior and the Department of Psychiatry, University of California at Los Angeles, Los Angeles, CA, USA.
| |
Collapse
|
2
|
Malloy CR, Sherry AD, Alger JR, Jin ES. Recent progress in analysis of intermediary metabolism by ex vivo 13 C NMR. NMR Biomed 2023; 36:e4817. [PMID: 35997012 DOI: 10.1002/nbm.4817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 08/03/2022] [Accepted: 08/16/2022] [Indexed: 06/15/2023]
Abstract
Advanced imaging technologies, large-scale metabolomics, and the measurement of gene transcripts or enzyme expression all enable investigations of intermediary metabolism in human patients. Complementary information about fluxes in individual metabolic pathways may be obtained by ex vivo 13 C NMR of blood or tissue biopsies. Simple molecules such as 13 C-labeled glucose are readily administered to patients prior to surgical biopsies, and 13 C-labeled glycerol is easily administered orally to outpatients. Here, we review recent progress in practical applications of 13 C NMR to study cancer biology, the response to oxidative stress, gluconeogenesis, triglyceride synthesis in patients, as well as new insights into compartmentation of metabolism in the cytosol. The technical aspects of obtaining the sample, preparing material for analysis, and acquiring the spectra are relatively simple. This approach enables convenient, valuable, and quantitative insights into intermediary metabolism in patients.
Collapse
Affiliation(s)
- Craig R Malloy
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Veterans Affairs North Texas Healthcare System, Dallas, Texas, USA
| | - A Dean Sherry
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Chemistry, University of Texas at Dallas, Richardson, Texas, USA
| | - Jeffry R Alger
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Neurology, Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - Eunsook S Jin
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| |
Collapse
|
3
|
O’Connor MJ, Dillon A, Best KM, O’Neill J, Kilpatrick LA, Joshi SH, Alger JR, Levitt JG. Identification of Seminal Physical Features of Prenatal Alcohol Exposure by Child Psychologists. J Pediatr Neuropsychol 2022. [DOI: 10.1007/s40817-022-00123-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Abstract
Introduction
Prenatal alcohol exposure (PAE) impacts an estimated 5% or more children born in the USA and is associated with life-long neuropsychological deficits. Early identification is essential but access to diagnostic evaluation is limited. This study reports on the effectiveness of training child psychologists to identify and measure the salient physical features of PAE.
Methods
Children, 8–13 years, were divided into two groups: (1) children meeting criteria for PAE (n = 46) and (2) typically developing controls without PAE (TD; n = 36). Child psychologists were trained to reliability measure height, weight, occipital frontal circumference (OFC), and the characteristic facial features of FASD independent of knowledge of PAE history.
Results
Groups differed significantly on meeting the diagnostic criteria proposed by Hoyme et al. (Pediatrics, 138:e20154256, 2016) on height, OFC, upper vermillion border, philtrum, and palpebral fissure length. They did not differ on weight. All children in the alcohol exposed group could be classified as meeting criteria for an FASD whereas none in the unexposed group met criteria.
Discussion
This study demonstrated that child psychologists, blind to PAE history, could be reliably trained to assess the physical features of children with PAE. Because early diagnosis and intervention is of paramount importance, we propose that inclusive diagnostic criteria for FASD and the use of psychologists and other allied health professionals, trained to screen for the diagnosis, should be expanded in clinical practice.
Collapse
|
4
|
Donahue EK, Bui V, Foreman RP, Duran JJ, Venkadesh S, Choupan J, Van Horn JD, Alger JR, Jakowec MW, Petzinger GM, O'Neill J. Magnetic resonance spectroscopy shows associations between neurometabolite levels and perivascular space volume in Parkinson's disease: a pilot and feasibility study. Neuroreport 2022; 33:291-296. [PMID: 35594442 DOI: 10.1097/wnr.0000000000001781] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Higher volume fraction of perivascular space (PVS) has recently been reported in Parkinson's disease (PD) and related disorders. Both elevated PVS and altered levels of neurometabolites, assayed by proton magnetic resonance spectroscopy (MRS), are suspected indicators of neuroinflammation, but no published reports have concurrently examined PVS and MRS neurometabolites. METHODS In an exploratory pilot study, we acquired multivoxel 3-T MRS using a semi-Localization by Adiabatic SElective Refocusing (sLASER) pulse-sequence (repetition time/echo time = 2810/60 ms, voxels 10 × 10 × 10 mm3) from a 2D slab sampling bilateral frontal white matter (FWM) and anterior middle cingulate cortex (aMCC). PVS maps obtained from high-resolution (0.8 × 0.8 × 0.8 mm3) T1-weighted MRI were co-registered with MRS. In each MRS voxel, PVS volume and neurometabolite levels were measured. RESULTS Linear regression accounting for age, sex, and BMI found greater PVS volume for higher levels of choline-containing compounds (Cho; P = 0.047) in FWM and lower PVS volume for higher levels of N-acetyl compounds (NAA; P = 0.012) in aMCC. Since (putatively) higher Cho is associated with inflammation while NAA has anti-inflammatory properties, these observations add to evidence that higher PVS load is a sign of inflammation. Additionally, lower Montreal Cognitive Assessment scores were associated with lower NAA in aMCC (P = 0.002), suggesting that local neuronal dysfunction and inflammation contribute to cognitive impairment in PD. CONCLUSION These exploratory findings indicate that co-analysis of PVS and MRS is feasible and may help elucidate the cellular and metabolic substrates of glymphatic and inflammatory processes in PD.
Collapse
Affiliation(s)
- Erin K Donahue
- Department of Neurology, University of Southern California
- Neuroscience Graduate Program, University of Southern California, Los Angeles, California
| | - Vy Bui
- Department of Neurology, University of Southern California
| | - Ryan P Foreman
- Department of Neurology, University of Southern California
| | - Jared J Duran
- Department of Neurology, University of Southern California
| | - Siva Venkadesh
- Department of Psychology, University of Virginia, Charlottesville, Virginia
| | - Jeiran Choupan
- Laboratory of NeuroImaging, USC Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles, California
| | - John D Van Horn
- Department of Psychology, University of Virginia, Charlottesville, Virginia
- School of Data Science, University of Virginia, Charlottesville, Virginia
| | - Jeffry R Alger
- Department of Neurology, University of California, Los Angeles
| | | | | | - Joseph O'Neill
- Division of Child Psychiatry, UCLA Semel Institute for Neuroscience, Los Angeles, California, USA
| |
Collapse
|
5
|
Kilpatrick LA, Alger JR, O’Neill J, Joshi SH, Narr KL, Levitt JG, O’Connor MJ. Impact of prenatal alcohol exposure on intracortical myelination and deep white matter in children with attention deficit hyperactivity disorder. Neuroimage Rep 2022; 2:100082. [PMID: 37284413 PMCID: PMC10243188 DOI: 10.1016/j.ynirp.2022.100082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
White matter alterations have been reported in children with prenatal alcohol exposure (PAE) and in children with attention deficit hyperactivity disorder (ADHD); however, as children with PAE often present with ADHD, covert PAE may have contributed to previous ADHD findings. Additionally, data regarding intracortical myelination in ADHD are lacking. Therefore, we evaluated intracortical myelination (assessed as the T1w/T2w ratio at 4 cortical ribbon levels) and myelin-related deep white matter features in children (aged 8-13 years) with ADHD with PAE (ADHD + PAE), children with familial ADHD without PAE (ADHD-PAE), and typically developing (TD) children. In widespread tracts, ADHD + PAE children showed higher mean and radial diffusivity than TD and ADHD-PAE children and lower fractional anisotropy than ADHD-PAE children; ADHD-PAE and TD children did not differ significantly. Compared to TD children, ADHD + PAE children had lower intracortical myelination only at the deepest cortical level (mainly in right insula and cingulate cortices), while ADHD-PAE children had lower intracortical myelination at multiple cortical levels (mainly in right insula, sensorimotor, and cingulate cortices); ADHD + PAE and ADHD-PAE children did not differ significantly in intracortical myelination. Considering the two ADHD groups jointly (via non-parametric combination) revealed common reductions in intracortical myelination, but no common deep white matter abnormalities. These results suggest the importance of considering PAE in ADHD studies of white matter pathology. ADHD + PAE may be associated with deeper, white matter abnormalities, while familial ADHD without PAE may be associated with more superficial, cortical abnormalities. This may be relevant to the different treatment response observed in these two ADHD etiologies.
Collapse
Affiliation(s)
- Lisa A. Kilpatrick
- G. Oppenheimer Family Center for Neurobiology of Stress and Resilience, Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine at University of California, Los Angeles, CA, USA
| | - Jeffry R. Alger
- Department of Neurology, University of California, Los Angeles, CA, USA
- Neurospectroscopics, LLC., Sherman Oaks, CA, USA
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Joseph O’Neill
- Division of Child & Adolescent Psychiatry, Jane & Terry Semel Institute for Neuroscience, University of California Los Angeles, CA, USA
| | - Shantanu H. Joshi
- Department of Neurology, University of California, Los Angeles, CA, USA
- Department of Bioengineering, University of California, Los Angeles, CA, USA
| | - Katherine L. Narr
- Department of Neurology, University of California, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Jennifer G. Levitt
- Division of Child & Adolescent Psychiatry, Jane & Terry Semel Institute for Neuroscience, University of California Los Angeles, CA, USA
| | - Mary J. O’Connor
- Division of Child & Adolescent Psychiatry, Jane & Terry Semel Institute for Neuroscience, University of California Los Angeles, CA, USA
| |
Collapse
|
6
|
O'Neill J, O'Connor MJ, Kalender G, Ly R, Ng A, Dillon A, Narr KL, Loo SK, Alger JR, Levitt JG. Combining neuroimaging and behavior to discriminate children with attention deficit-hyperactivity disorder with and without prenatal alcohol exposure. Brain Imaging Behav 2022; 16:69-77. [PMID: 34089460 PMCID: PMC8643366 DOI: 10.1007/s11682-021-00477-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2021] [Indexed: 02/03/2023]
Abstract
In many patients, ostensible idiopathic attention deficit-hyperactivity disorder (ADHD) may actually stem from covert prenatal alcohol exposure (PAE), a treatment-relevant distinction. This study attempted a receiver-operator characteristic (ROC) classification of children with ADHD into those with PAE (ADHD+PAE) and those without (ADHD-PAE) using neurobehavioral instruments alongside magnetic resonance spectroscopy (MRS) and diffusion tensor imaging (DTI) of supraventricular brain white matter. Neurobehavioral, MRS, and DTI endpoints had been suggested by prior findings. Participants included children aged 8-13 years, 23 with ADHD+PAE, 19 with familial ADHD-PAE, and 28 typically developing (TD) controls. With area-under-the-curve (AUC) >0.90, the Conners 3 Parent Rating Scale Inattention (CIn) and Hyperactivity/Impulsivity (CHp) scores and the Behavioral Regulation Index (BRI) of the Behavior Rating Inventory of Executive Function (BRIEF2) excellently distinguished the clinical groups from TD, but not from each other (AUC < 0.70). Combinations of MRS glutamate (Glu) and N-acetyl-compounds (NAA) and DTI mean diffusivity (MD), axial diffusivity (AD), radial diffusivity (RD), and fractional anisotropy (FA) yielded "good" (AUC > 0.80) discrimination. Neuroimaging combined with CIn and BRI achieved AUC 0.72 and AUC 0.84, respectively. But neuroimaging combined with CHp yielded 14 excellent combinations with AUC ≥ 0.90 (all p < 0.0005), the best being Glu·AD·RD·CHp/(NAA·FA) (AUC 0.92, sensitivity 1.00, specificity 0.82, p < 0.0005). Using Cho in lieu of Glu yielded AUC 0.83. White-matter microstructure and metabolism may assist efforts to discriminate ADHD etiologies and to detect PAE, beyond the ability of commonly used neurobehavioral measures alone.
Collapse
Affiliation(s)
- Joseph O'Neill
- Division of Child & Adolescent Psychiatry, Jane & Terry Semel Institute for Neuroscience, University of California Los Angeles, Los Angeles, CA, USA.
| | - Mary J O'Connor
- Division of Child & Adolescent Psychiatry, Jane & Terry Semel Institute for Neuroscience, University of California Los Angeles, Los Angeles, CA, USA
| | - Guldamla Kalender
- Division of Child & Adolescent Psychiatry, Jane & Terry Semel Institute for Neuroscience, University of California Los Angeles, Los Angeles, CA, USA
| | - Ronald Ly
- Division of Child & Adolescent Psychiatry, Jane & Terry Semel Institute for Neuroscience, University of California Los Angeles, Los Angeles, CA, USA
| | - Andrea Ng
- Division of Child & Adolescent Psychiatry, Jane & Terry Semel Institute for Neuroscience, University of California Los Angeles, Los Angeles, CA, USA
| | - Andrea Dillon
- Division of Child & Adolescent Psychiatry, Jane & Terry Semel Institute for Neuroscience, University of California Los Angeles, Los Angeles, CA, USA
| | - Katherine L Narr
- Department of Neurology, University of California Los Angeles, Los Angeles, CA, USA
| | - Sandra K Loo
- Division of Child & Adolescent Psychiatry, Jane & Terry Semel Institute for Neuroscience, University of California Los Angeles, Los Angeles, CA, USA
| | - Jeffry R Alger
- Department of Neurology, University of California Los Angeles, Los Angeles, CA, USA
- Neurospectroscopics, LLC, Sherman Oaks, CA, USA
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jennifer G Levitt
- Division of Child & Adolescent Psychiatry, Jane & Terry Semel Institute for Neuroscience, University of California Los Angeles, Los Angeles, CA, USA
| |
Collapse
|
7
|
Chen J, LaGue E, Li J, Yang C, Hackett EP, Mendoza M, Alger JR, DeBerardinis RJ, Corbin IR, Billingsley KL, Park JM. Profiling Carbohydrate Metabolism in Liver and Hepatocellular Carcinoma with [ 13C]-Glycerate Probes. Anal Sens 2021; 1:196-202. [PMID: 35693130 PMCID: PMC9187054 DOI: 10.1002/anse.202100034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
The interplay between glycolysis and gluconeogenesis is central to carbohydrate metabolism. Here, we describe novel methods to assess carbohydrate metabolism using [13C]-probes derived from glycerate, a molecule whose metabolic fate in mammals remains underexplored. Isotope-based studies were conducted via NMR and mass spectrometry analyses of freeze-clamped liver tissue extracts after [2,3-13C2]glycerate infusion. The ex vivo investigations were correlated with in vivo measurements using hyperpolarized [1-13C]glycerate. Application of [13C]glycerate to N-nitrosodiethylamine (DEN)-treated rats provided further assessments of intermediary carbohydrate metabolism in hepatocellular carcinoma. This method afforded direct analyses of control versus DEN tissues, and altered ratios of 13C metabolic products as well as unique glycolysis intermediates were observed in the DEN liver/tumor. Isotopomer studies showed increased glycerate uptake and altered carbohydrate metabolism in the DEN rats.
Collapse
Affiliation(s)
- Jun Chen
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-8568 (USA)
| | - Evan LaGue
- Department of Chemistry and Biochemistry, California State University, Fullerton, 800 State College Blvd. Fullerton, CA 92834-6866 (USA)
| | - Junjie Li
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-8568 (USA)
| | - Chendong Yang
- Howard Hughes Medical Institute and Children's Medical Center Research Institute, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-8502 (USA)
| | - Edward P Hackett
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-8568 (USA)
| | - Manuel Mendoza
- Department of Chemistry and Biochemistry, California State University, Fullerton, 800 State College Blvd. Fullerton, CA 92834-6866 (USA)
| | - Jeffry R Alger
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-8568 (USA)
| | - Ralph J DeBerardinis
- Howard Hughes Medical Institute and Children's Medical Center Research Institute, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-8502 (USA)
| | - Ian R Corbin
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-8568 (USA)
| | - Kelvin L Billingsley
- Department of Chemistry and Biochemistry, California State University, Fullerton, 800 State College Blvd. Fullerton, CA 92834-6866 (USA)
| | - Jae Mo Park
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-8568 (USA)
| |
Collapse
|
8
|
Alger JR, O'Neill J, O'Connor MJ, Kalender G, Ly R, Ng A, Dillon A, Narr KL, Loo SK, Levitt JG. Neuroimaging of Supraventricular Frontal White Matter in Children with Familial Attention-Deficit Hyperactivity Disorder and Attention-Deficit Hyperactivity Disorder Due to Prenatal Alcohol Exposure. Neurotox Res 2021; 39:1054-1075. [PMID: 33751467 PMCID: PMC8442735 DOI: 10.1007/s12640-021-00342-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 02/15/2021] [Accepted: 02/17/2021] [Indexed: 10/21/2022]
Abstract
Attention-deficit hyperactivity disorder (ADHD) is common in patients with (ADHD+PAE) and without (ADHD-PAE) prenatal alcohol exposure (PAE). Many patients diagnosed with idiopathic ADHD actually have covert PAE, a treatment-relevant distinction. To improve differential diagnosis, we sought to identify brain differences between ADHD+PAE and ADHD-PAE using neurobehavioral, magnetic resonance spectroscopy, and diffusion tensor imaging metrics that had shown promise in past research. Children 8-13 were recruited in three groups: 23 ADHD+PAE, 19 familial ADHD-PAE, and 28 typically developing controls (TD). Neurobehavioral instruments included the Conners 3 Parent Behavior Rating Scale and the Delis-Kaplan Executive Function System (D-KEFS). Two dimensional magnetic resonance spectroscopic imaging was acquired from supraventricular white matter to measure N-acetylaspartate compounds, glutamate, creatine + phosphocreatine (creatine), and choline-compounds (choline). Whole brain diffusion tensor imaging was acquired and used to to calculate fractional anisotropy, mean diffusivity, axial diffusivity, and radial diffusivity from the same superventricular white matter regions that produced magnetic resonance spectroscopy data. The Conners 3 Parent Hyperactivity/Impulsivity Score, glutamate, mean diffusivity, axial diffusivity, and radial diffusivity were all higher in ADHD+PAE than ADHD-PAE. Glutamate was lower in ADHD-PAE than TD. Within ADHD+PAE, inferior performance on the D-KEFS Tower Test correlated with higher neurometabolite levels. These findings suggest white matter differences between the PAE and familial etiologies of ADHD. Abnormalities detected by magnetic resonance spectroscopy and diffusion tensor imaging co-localize in supraventricular white matter and are relevant to executive function symptoms of ADHD.
Collapse
Affiliation(s)
- Jeffry R Alger
- Department of Neurology, University of California Los Angeles, MC 708522, Los Angeles, CA, 90024, USA.
- Neurospectroscopics, LLC, Sherman Oaks, CA, USA.
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, TX, USA.
- Hura Imaging Inc, Calabas, CA, USA.
| | - Joseph O'Neill
- Division of Child & Adolescent Psychiatry, Jane & Terry Semel Instutute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Mary J O'Connor
- Division of Child & Adolescent Psychiatry, Jane & Terry Semel Instutute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Guldamla Kalender
- Division of Child & Adolescent Psychiatry, Jane & Terry Semel Instutute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Ronald Ly
- Division of Child & Adolescent Psychiatry, Jane & Terry Semel Instutute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Andrea Ng
- Division of Child & Adolescent Psychiatry, Jane & Terry Semel Instutute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Andrea Dillon
- Division of Child & Adolescent Psychiatry, Jane & Terry Semel Instutute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Katherine L Narr
- Department of Neurology, University of California Los Angeles, MC 708522, Los Angeles, CA, 90024, USA
- Division of Child & Adolescent Psychiatry, Jane & Terry Semel Instutute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Sandra K Loo
- Division of Child & Adolescent Psychiatry, Jane & Terry Semel Instutute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Jennifer G Levitt
- Division of Child & Adolescent Psychiatry, Jane & Terry Semel Instutute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| |
Collapse
|
9
|
Alger JR, Minhajuddin A, Dean Sherry A, Malloy CR. Analysis of steady-state carbon tracer experiments using akaike information criteria. Metabolomics 2021; 17:61. [PMID: 34148138 DOI: 10.1007/s11306-021-01807-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 05/29/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Carbon isotope tracers have been used to determine relative rates of tricarboxylic acid cycle (TCA) cycle pathways since the 1950s. Steady-state experimental data are typically fit to a single mathematical model of metabolism to determine metabolic fluxes. Whether the chosen model is appropriate for the biological system has generally not been evaluated systematically. An overly-simple model omits known pathways while an overly-complex model may produce incorrect results due to overfitting. OBJECTIVES The objectives were to develop and study a method that systematically evaluates multiple TCA cycle mathematical models as part of the fitting process. METHODS The problem of choosing overly-simple or overly-complex models was approached by developing software that automatically explores all possible combinations of flux through pyruvate dehydrogenase, pyruvate kinase, pyruvate carboxylase and anaplerosis at propionyl-CoA carboxylase, and equivalent pathways, all relative to TCA cycle flux. Typical TCA cycle metabolic tracer experiments that use 13C nuclear magnetic resonance for detection and quantification of 13C-enriched glutamate products were simulated and analyzed. By evaluating the multiple model fits with both the conventional sum-of-squares residual error (SSRE) and the Akaike Information Criterion (AIC), the software helps the investigator understand the interaction between model complexity and goodness of fit. RESULTS When fitting alternative models of the TCA cycle metabolism, the SSRE may identify more than one model that fits the data well. Among those models, the AIC provides guidance as to which is the simplest of the candidate models is sufficient to describe the observed data. However under some conditions, AIC used alone inappropriately discriminates against necessary metabolic complexity. CONCLUSION In combination, the SSRE and AIC help the investigator identify the model that best describes the metabolism of a biological system.
Collapse
Affiliation(s)
- Jeffry R Alger
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, TX, USA.
- NeuroSpectroScopics LLC, Sherman Oaks, CA, USA.
- Department of Neurology, Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA.
- Hura Imaging Inc, Calabasas, CA, USA.
| | - Abu Minhajuddin
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - A Dean Sherry
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Chemistry, University of Texas at Dallas, Richardson, TX, USA
| | - Craig R Malloy
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Veterans Affairs North Texas Healthcare System, Dallas, TX, USA
| |
Collapse
|
10
|
Bartnik-Olson BL, Alger JR, Babikian T, Harris AD, Holshouser B, Kirov II, Maudsley AA, Thompson PM, Dennis EL, Tate DF, Wilde EA, Lin A. The clinical utility of proton magnetic resonance spectroscopy in traumatic brain injury: recommendations from the ENIGMA MRS working group. Brain Imaging Behav 2021; 15:504-525. [PMID: 32797399 PMCID: PMC7882010 DOI: 10.1007/s11682-020-00330-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Proton (1H) magnetic resonance spectroscopy provides a non-invasive and quantitative measure of brain metabolites. Traumatic brain injury impacts cerebral metabolism and a number of research groups have successfully used this technique as a biomarker of injury and/or outcome in both pediatric and adult TBI populations. However, this technique is underutilized, with studies being performed primarily at centers with access to MR research support. In this paper we present a technical introduction to the acquisition and analysis of in vivo 1H magnetic resonance spectroscopy and review 1H magnetic resonance spectroscopy findings in different injury populations. In addition, we propose a basic 1H magnetic resonance spectroscopy data acquisition scheme (Supplemental Information) that can be added to any imaging protocol, regardless of clinical magnetic resonance platform. We outline a number of considerations for study design as a way of encouraging the use of 1H magnetic resonance spectroscopy in the study of traumatic brain injury, as well as recommendations to improve data harmonization across groups already using this technique.
Collapse
Affiliation(s)
| | - Jeffry R Alger
- Departments of Neurology and Radiology, University of California Los Angeles, Los Angeles, CA, USA
- NeuroSpectroScopics LLC, Sherman Oaks, Los Angeles, CA, USA
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Talin Babikian
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, CA, USA
- UCLA Steve Tisch BrainSPORT Program, Los Angeles, CA, USA
| | - Ashley D Harris
- Department of Radiology, University of Calgary, Calgary, Canada
- Child and Adolescent Imaging Research Program, Alberta Children's Hospital Research Institute and the Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
| | - Barbara Holshouser
- Department of Radiology, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Ivan I Kirov
- Bernard and Irene Schwartz Center for Biomedical Imaging, Center for Advanced Imaging Innovation and Research (CAI2R), Department of Radiology, New York University School of Medicine, New York, NY, USA
| | - Andrew A Maudsley
- Department of Radiology, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Paul M Thompson
- Imaging Genetics Center, Stevens Neuroimaging & Informatics Institute, Keck School of Medicine of USC, Marina del Rey, Los Angeles, CA, USA
- Departments of Neurology, Pediatrics, Psychiatry, Radiology, Engineering, and Ophthalmology, USC, Los Angeles, CA, USA
| | - Emily L Dennis
- Imaging Genetics Center, Stevens Neuroimaging & Informatics Institute, Keck School of Medicine of USC, Marina del Rey, Los Angeles, CA, USA
- Department of Neurology, University of Utah, Salt Lake City, UT, USA
- Psychiatry Neuroimaging Laboratory, Brigham & Women's Hospital, Boston, MA, USA
| | - David F Tate
- Department of Neurology, University of Utah, Salt Lake City, UT, USA
- George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT, USA
| | - Elisabeth A Wilde
- Department of Neurology, University of Utah, Salt Lake City, UT, USA
- George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT, USA
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
| | - Alexander Lin
- Center for Clinical Spectroscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
11
|
Zhao C, Martin T, Shao X, Alger JR, Duddalwar V, Wang DJJ. Low Dose CT Perfusion With K-Space Weighted Image Average (KWIA). IEEE Trans Med Imaging 2020; 39:3879-3890. [PMID: 32746131 PMCID: PMC7704693 DOI: 10.1109/tmi.2020.3006461] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
CTP (Computed Tomography Perfusion) is widely used in clinical practice for the evaluation of cerebrovascular disorders. However, CTP involves high radiation dose (≥~200mGy) as the X-ray source remains continuously on during the passage of contrast media. The purpose of this study is to present a low dose CTP technique termed K-space Weighted Image Average (KWIA) using a novel projection view-shared averaging algorithm with reduced tube current. KWIA takes advantage of k-space signal property that the image contrast is primarily determined by the k-space center with low spatial frequencies and oversampled projections. KWIA divides each 2D Fourier transform (FT) or k-space CTP data into multiple rings. The outer rings are averaged with neighboring time frames to achieve adequate signal-to-noise ratio (SNR), while the center region of k-space remains unchanged to preserve high temporal resolution. Reduced dose sinogram data were simulated by adding Poisson distributed noise with zero mean on digital phantom and clinical CTP scans. A physical CTP phantom study was also performed with different X-ray tube currents. The sinogram data with simulated and real low doses were then reconstructed with KWIA, and compared with those reconstructed by standard filtered back projection (FBP) and simultaneous algebraic reconstruction with regularization of total variation (SART-TV). Evaluation of image quality and perfusion metrics using parameters including SNR, CNR (contrast-to-noise ratio), AUC (area-under-the-curve), and CBF (cerebral blood flow) demonstrated that KWIA is able to preserve the image quality, spatial and temporal resolution, as well as the accuracy of perfusion quantification of CTP scans with considerable (50-75%) dose-savings.
Collapse
|
12
|
Levitt JG, Kalender G, O’Neill J, Diaz JP, Cook IA, Ginder N, Krantz D, Minzenberg MJ, Vince-Cruz N, Nguyen LD, Alger JR, Leuchter AF. Dorsolateral prefrontal γ-aminobutyric acid in patients with treatment-resistant depression after transcranial magnetic stimulation measured with magnetic resonance spectroscopy. J Psychiatry Neurosci 2019; 44:386-394. [PMID: 31199104 PMCID: PMC6821508 DOI: 10.1503/jpn.180230] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The therapeutic mechanism of repetitive transcranial magnetic stimulation (rTMS) for treatment-resistant depression (TRD) may involve modulation of γ-aminobutyric acid (GABA) levels. We used proton magnetic resonance spectroscopy (MRS) to assess changes in GABA levels at the site of rTMS in the left dorsolateral prefrontal cortex (DLPFC). METHODS In 26 adults with TRD, we used Mescher–Garwood point-resolved spectroscopy (MEGA-PRESS) spectral-editing MRS to measure GABA in the left DLPFC before and after standard clinical treatment with rTMS. All participants but 1 were medicated, including 12 patients on GABA agonist agents. RESULTS Mean GABA in the DLPFC increased 10.0% (p = 0.017) post-rTMS in the overall sample. As well, GABA increased significantly in rTMS responders (n = 12; 23.6%, p = 0.015) but not in nonresponders (n = 14; 4.1%, p = not significant). Changes in GABA were not significantly affected by GABAergic agonists, but clinical response was less frequent (p = 0.005) and weaker (p = 0.035) in the 12 participants who were receiving GABA agonists concomitant with rTMS treatment. LIMITATIONS This study had an open-label design in a population receiving naturalistic treatment. CONCLUSION Treatment using rTMS was associated with increases in GABA levels at the stimulation site in the left DLPFC, and the degree of GABA change was related to clinical improvement. Participants receiving concomitant treatment with a GABA agonist were less likely to respond to rTMS. These findings were consistent with earlier studies showing the effects of rTMS on GABA levels and support a GABAergic model of depression.
Collapse
Affiliation(s)
- Jennifer G. Levitt
- From the Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles (Levitt, Diaz, Cook, Ginder, Krantz, Minzenberg, Vince-Cruz, Nguyen, Leuchter); the Department of Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles (Levitt, Kalender, O’Neill, Cook, Krantz, Minzenberg, Leuchter); the Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles (Kalender); the Division of Child and Adolescent Psychiatry, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles (Levitt, O’Neill); the Department of Bioengineering, Henry Samueli School of Engineering at Applied Science at UCLA, Los Angeles (Cook); the Department of Neurology, UCLA David Geffen School of Medicine at UCLA, Los Angeles (Alger); the Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Texas (Alger); and the NeuroSpectroScopics, LCC, Sherman Oaks, California (Alger)
| | - Guldamla Kalender
- From the Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles (Levitt, Diaz, Cook, Ginder, Krantz, Minzenberg, Vince-Cruz, Nguyen, Leuchter); the Department of Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles (Levitt, Kalender, O’Neill, Cook, Krantz, Minzenberg, Leuchter); the Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles (Kalender); the Division of Child and Adolescent Psychiatry, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles (Levitt, O’Neill); the Department of Bioengineering, Henry Samueli School of Engineering at Applied Science at UCLA, Los Angeles (Cook); the Department of Neurology, UCLA David Geffen School of Medicine at UCLA, Los Angeles (Alger); the Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Texas (Alger); and the NeuroSpectroScopics, LCC, Sherman Oaks, California (Alger)
| | - Joseph O’Neill
- From the Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles (Levitt, Diaz, Cook, Ginder, Krantz, Minzenberg, Vince-Cruz, Nguyen, Leuchter); the Department of Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles (Levitt, Kalender, O’Neill, Cook, Krantz, Minzenberg, Leuchter); the Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles (Kalender); the Division of Child and Adolescent Psychiatry, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles (Levitt, O’Neill); the Department of Bioengineering, Henry Samueli School of Engineering at Applied Science at UCLA, Los Angeles (Cook); the Department of Neurology, UCLA David Geffen School of Medicine at UCLA, Los Angeles (Alger); the Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Texas (Alger); and the NeuroSpectroScopics, LCC, Sherman Oaks, California (Alger)
| | - Joel P. Diaz
- From the Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles (Levitt, Diaz, Cook, Ginder, Krantz, Minzenberg, Vince-Cruz, Nguyen, Leuchter); the Department of Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles (Levitt, Kalender, O’Neill, Cook, Krantz, Minzenberg, Leuchter); the Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles (Kalender); the Division of Child and Adolescent Psychiatry, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles (Levitt, O’Neill); the Department of Bioengineering, Henry Samueli School of Engineering at Applied Science at UCLA, Los Angeles (Cook); the Department of Neurology, UCLA David Geffen School of Medicine at UCLA, Los Angeles (Alger); the Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Texas (Alger); and the NeuroSpectroScopics, LCC, Sherman Oaks, California (Alger)
| | - Ian A. Cook
- From the Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles (Levitt, Diaz, Cook, Ginder, Krantz, Minzenberg, Vince-Cruz, Nguyen, Leuchter); the Department of Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles (Levitt, Kalender, O’Neill, Cook, Krantz, Minzenberg, Leuchter); the Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles (Kalender); the Division of Child and Adolescent Psychiatry, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles (Levitt, O’Neill); the Department of Bioengineering, Henry Samueli School of Engineering at Applied Science at UCLA, Los Angeles (Cook); the Department of Neurology, UCLA David Geffen School of Medicine at UCLA, Los Angeles (Alger); the Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Texas (Alger); and the NeuroSpectroScopics, LCC, Sherman Oaks, California (Alger)
| | - Nathaniel Ginder
- From the Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles (Levitt, Diaz, Cook, Ginder, Krantz, Minzenberg, Vince-Cruz, Nguyen, Leuchter); the Department of Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles (Levitt, Kalender, O’Neill, Cook, Krantz, Minzenberg, Leuchter); the Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles (Kalender); the Division of Child and Adolescent Psychiatry, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles (Levitt, O’Neill); the Department of Bioengineering, Henry Samueli School of Engineering at Applied Science at UCLA, Los Angeles (Cook); the Department of Neurology, UCLA David Geffen School of Medicine at UCLA, Los Angeles (Alger); the Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Texas (Alger); and the NeuroSpectroScopics, LCC, Sherman Oaks, California (Alger)
| | - David Krantz
- From the Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles (Levitt, Diaz, Cook, Ginder, Krantz, Minzenberg, Vince-Cruz, Nguyen, Leuchter); the Department of Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles (Levitt, Kalender, O’Neill, Cook, Krantz, Minzenberg, Leuchter); the Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles (Kalender); the Division of Child and Adolescent Psychiatry, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles (Levitt, O’Neill); the Department of Bioengineering, Henry Samueli School of Engineering at Applied Science at UCLA, Los Angeles (Cook); the Department of Neurology, UCLA David Geffen School of Medicine at UCLA, Los Angeles (Alger); the Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Texas (Alger); and the NeuroSpectroScopics, LCC, Sherman Oaks, California (Alger)
| | - Michael J. Minzenberg
- From the Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles (Levitt, Diaz, Cook, Ginder, Krantz, Minzenberg, Vince-Cruz, Nguyen, Leuchter); the Department of Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles (Levitt, Kalender, O’Neill, Cook, Krantz, Minzenberg, Leuchter); the Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles (Kalender); the Division of Child and Adolescent Psychiatry, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles (Levitt, O’Neill); the Department of Bioengineering, Henry Samueli School of Engineering at Applied Science at UCLA, Los Angeles (Cook); the Department of Neurology, UCLA David Geffen School of Medicine at UCLA, Los Angeles (Alger); the Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Texas (Alger); and the NeuroSpectroScopics, LCC, Sherman Oaks, California (Alger)
| | - Nikita Vince-Cruz
- From the Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles (Levitt, Diaz, Cook, Ginder, Krantz, Minzenberg, Vince-Cruz, Nguyen, Leuchter); the Department of Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles (Levitt, Kalender, O’Neill, Cook, Krantz, Minzenberg, Leuchter); the Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles (Kalender); the Division of Child and Adolescent Psychiatry, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles (Levitt, O’Neill); the Department of Bioengineering, Henry Samueli School of Engineering at Applied Science at UCLA, Los Angeles (Cook); the Department of Neurology, UCLA David Geffen School of Medicine at UCLA, Los Angeles (Alger); the Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Texas (Alger); and the NeuroSpectroScopics, LCC, Sherman Oaks, California (Alger)
| | - Lydia D. Nguyen
- From the Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles (Levitt, Diaz, Cook, Ginder, Krantz, Minzenberg, Vince-Cruz, Nguyen, Leuchter); the Department of Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles (Levitt, Kalender, O’Neill, Cook, Krantz, Minzenberg, Leuchter); the Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles (Kalender); the Division of Child and Adolescent Psychiatry, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles (Levitt, O’Neill); the Department of Bioengineering, Henry Samueli School of Engineering at Applied Science at UCLA, Los Angeles (Cook); the Department of Neurology, UCLA David Geffen School of Medicine at UCLA, Los Angeles (Alger); the Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Texas (Alger); and the NeuroSpectroScopics, LCC, Sherman Oaks, California (Alger)
| | - Jeffry R. Alger
- From the Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles (Levitt, Diaz, Cook, Ginder, Krantz, Minzenberg, Vince-Cruz, Nguyen, Leuchter); the Department of Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles (Levitt, Kalender, O’Neill, Cook, Krantz, Minzenberg, Leuchter); the Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles (Kalender); the Division of Child and Adolescent Psychiatry, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles (Levitt, O’Neill); the Department of Bioengineering, Henry Samueli School of Engineering at Applied Science at UCLA, Los Angeles (Cook); the Department of Neurology, UCLA David Geffen School of Medicine at UCLA, Los Angeles (Alger); the Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Texas (Alger); and the NeuroSpectroScopics, LCC, Sherman Oaks, California (Alger)
| | - Andrew F. Leuchter
- From the Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles (Levitt, Diaz, Cook, Ginder, Krantz, Minzenberg, Vince-Cruz, Nguyen, Leuchter); the Department of Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles (Levitt, Kalender, O’Neill, Cook, Krantz, Minzenberg, Leuchter); the Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles (Kalender); the Division of Child and Adolescent Psychiatry, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles (Levitt, O’Neill); the Department of Bioengineering, Henry Samueli School of Engineering at Applied Science at UCLA, Los Angeles (Cook); the Department of Neurology, UCLA David Geffen School of Medicine at UCLA, Los Angeles (Alger); the Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Texas (Alger); and the NeuroSpectroScopics, LCC, Sherman Oaks, California (Alger)
| |
Collapse
|
13
|
Nir TM, Jahanshad N, Ching CRK, Cohen RA, Harezlak J, Schifitto G, Lam HY, Hua X, Zhong J, Zhu T, Taylor MJ, Campbell TB, Daar ES, Singer EJ, Alger JR, Thompson PM, Navia BA. Progressive brain atrophy in chronically infected and treated HIV+ individuals. J Neurovirol 2019; 25:342-353. [PMID: 30767174 PMCID: PMC6635004 DOI: 10.1007/s13365-019-00723-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 12/25/2018] [Accepted: 01/07/2019] [Indexed: 01/19/2023]
Abstract
Growing evidence points to persistent neurological injury in chronic HIV infection. It remains unclear whether chronically HIV-infected individuals on combined antiretroviral therapy (cART) develop progressive brain injury and impaired neurocognitive function despite successful viral suppression and immunological restoration. In a longitudinal neuroimaging study for the HIV Neuroimaging Consortium (HIVNC), we used tensor-based morphometry to map the annual rate of change of regional brain volumes (mean time interval 1.0 ± 0.5 yrs), in 155 chronically infected and treated HIV+ participants (mean age 48.0 ± 8.9 years; 83.9% male) . We tested for associations between rates of brain tissue loss and clinical measures of infection severity (nadir or baseline CD4+ cell count and baseline HIV plasma RNA concentration), HIV duration, cART CNS penetration-effectiveness scores, age, as well as change in AIDS Dementia Complex stage. We found significant brain tissue loss across HIV+ participants, including those neuro-asymptomatic with undetectable viral loads, largely localized to subcortical regions. Measures of disease severity, age, and neurocognitive decline were associated with greater atrophy. Chronically HIV-infected and treated individuals may undergo progressive brain tissue loss despite stable and effective cART, which may contribute to neurocognitive decline. Understanding neurological complications of chronic infection and identifying factors associated with atrophy may help inform strategies to maintain brain health in people living with HIV.
Collapse
Affiliation(s)
- Talia M Nir
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, 4676 Admiralty Way Suite 200, Marina del Rey, Los Angeles, CA, 90292, USA
| | - Neda Jahanshad
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, 4676 Admiralty Way Suite 200, Marina del Rey, Los Angeles, CA, 90292, USA
| | - Christopher R K Ching
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, 4676 Admiralty Way Suite 200, Marina del Rey, Los Angeles, CA, 90292, USA
- Graduate Interdepartmental Program in Neuroscience, UCLA School of Medicine, Los Angeles, CA, USA
| | - Ronald A Cohen
- Department of Aging and Geriatric Research, University of Florida, Gainesville, FL, USA
| | | | | | - Hei Y Lam
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, 4676 Admiralty Way Suite 200, Marina del Rey, Los Angeles, CA, 90292, USA
| | - Xue Hua
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, 4676 Admiralty Way Suite 200, Marina del Rey, Los Angeles, CA, 90292, USA
| | - Jianhui Zhong
- Department of Imaging Sciences, University of Rochester, Rochester, NY, USA
| | - Tong Zhu
- Department Radiation Oncology, University of North Carolina, Chapel Hill, NC, USA
| | - Michael J Taylor
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Thomas B Campbell
- Medicine/Infectious Diseases, University of Colorado Denver, Aurora, CO, USA
| | - Eric S Daar
- Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, University of California, Los Angeles, CA, USA
| | - Elyse J Singer
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Jeffry R Alger
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Paul M Thompson
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, 4676 Admiralty Way Suite 200, Marina del Rey, Los Angeles, CA, 90292, USA.
| | - Bradford A Navia
- Department of Public Health, Infection Unit, Tufts University School of Medicine, Boston, MA, USA
| |
Collapse
|
14
|
Alger JR, Sherry AD, Malloy CR. tcaSIM: A Simulation Program for Optimal Design of 13C Tracer Experiments for Analysis of Metabolic Flux by NMR and Mass Spectroscopy. ACTA ACUST UNITED AC 2019; 6:176-187. [PMID: 31745452 DOI: 10.2174/2213235x07666181219115856] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Increasingly sophisticated instrumentation for chemical separations and identification has facilitated rapid advancements in our understanding of the metabolome. Since many analyses are performed using either mass spectroscopy (MS) or nuclear magnetic resonance (NMR) spectroscopy, the spin ½ stable 13C isotope is now widely used as a metabolic tracer. There is strong interest in quantitative analysis of metabolic flux through pathways in vivo, particularly in human patients. Although instrumentation advances and scientific interests in metabolism are increasing in parallel, a practical and rational design of a 13C tracer study can be challenging. Prior to planning the details of a tracer experiment, is it important to consider whether the analytical results will be sensitive to flux through the pathways of interest. Here, we briefly summarize the various approaches that have been used to design carbon tracer experiments, outline the sources of complexity, and illustrate the use of a software tool, tcaSIM, to aid in the experimental design of both MS and NMR data in complex systems including patients.
Collapse
Affiliation(s)
- Jeffry R Alger
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Texas.,NeuroSpectroScopics LLC, Sherman Oaks, California
| | - A Dean Sherry
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Texas.,Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas.,Department of Chemistry, University of Texas at Dallas, Richardson, Texas
| | - Craig R Malloy
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Texas.,Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas.,Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.,Veterans Affairs North Texas Healthcare System, Dallas, Texas
| |
Collapse
|
15
|
Tang J, O’Neill J, Alger JR, Shen Z, Johnson MC, London ED. N-Acetyl and Glutamatergic Neurometabolites in Perisylvian Brain Regions of Methamphetamine Users. Int J Neuropsychopharmacol 2019; 22:1-9. [PMID: 29788422 PMCID: PMC6313110 DOI: 10.1093/ijnp/pyy042] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 03/21/2018] [Accepted: 05/15/2018] [Indexed: 02/05/2023] Open
Abstract
Background Methamphetamine induces neuronal N-acetyl-aspartate synthesis in preclinical studies. In a preliminary human proton magnetic resonance spectroscopic imaging investigation, we also observed that N-acetyl-aspartate+N-acetyl-aspartyl-glutamate in right inferior frontal cortex correlated with years of heavy methamphetamine abuse. In the same brain region, glutamate+glutamine is lower in methamphetamine users than in controls and is negatively correlated with depression. N-acetyl and glutamatergic neurochemistries therefore merit further investigation in methamphetamine abuse and the associated mood symptoms. Methods Magnetic resonance spectroscopic imaging was used to measure N-acetyl-aspartate+N-acetyl-aspartyl-glutamate and glutamate+glutamine in bilateral inferior frontal cortex and insula, a neighboring perisylvian region affected by methamphetamine, of 45 abstinent methamphetamine-dependent and 45 healthy control participants. Regional neurometabolite levels were tested for group differences and associations with duration of heavy methamphetamine use, depressive symptoms, and state anxiety. Results In right inferior frontal cortex, N-acetyl-aspartate+N-acetyl-aspartyl-glutamate correlated with years of heavy methamphetamine use (r = +0.45); glutamate+glutamine was lower in methamphetamine users than in controls (9.3%) and correlated negatively with depressive symptoms (r = -0.44). In left insula, N-acetyl-aspartate+N-acetyl-aspartyl-glutamate was 9.1% higher in methamphetamine users than controls. In right insula, glutamate+glutamine was 12.3% lower in methamphetamine users than controls and correlated negatively with depressive symptoms (r = -0.51) and state anxiety (r = -0.47). Conclusions The inferior frontal cortex and insula show methamphetamine-related abnormalities, consistent with prior observations of increased cortical N-acetyl-aspartate in methamphetamine-exposed animal models and associations between cortical glutamate and mood in human methamphetamine users.
Collapse
Affiliation(s)
- Jinsong Tang
- Laboratory of Molecular Neuroimaging, Semel Institute for Neuroscience and Human Behavior and Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California
- Second Xiangya Hospital, Central South University, Changsha, China
| | - Joseph O’Neill
- Division of Child and Adolescent Psychiatry, Semel Institute for Neuroscience and Human Behavior and Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California
| | | | - Zhiwei Shen
- The Second Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Maritza C Johnson
- Laboratory of Molecular Neuroimaging, Semel Institute for Neuroscience and Human Behavior and Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California
| | - Edythe D London
- Laboratory of Molecular Neuroimaging, Semel Institute for Neuroscience and Human Behavior and Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California
- Department of Molecular and Medical Pharmacology, University of California, Los Angeles, California
- Brain Research Institute, University of California, Los Angeles, California
| |
Collapse
|
16
|
Babikian T, Alger JR, Ellis-Blied MU, Giza CC, Dennis E, Olsen A, Mink R, Babbitt C, Johnson J, Thompson PM, Asarnow RF. Whole Brain Magnetic Resonance Spectroscopic Determinants of Functional Outcomes in Pediatric Moderate/Severe Traumatic Brain Injury. J Neurotrauma 2018; 35:1637-1645. [PMID: 29649959 DOI: 10.1089/neu.2017.5366] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Diffuse axonal injury contributes to the long-term functional morbidity observed after pediatric moderate/severe traumatic brain injury (msTBI). Whole-brain proton magnetic resonance echo-planar spectroscopic imaging was used to measure the neurometabolite levels in the brain to delineate the course of disruption/repair during the first year post-msTBI. The association between metabolite biomarkers and functional measures (cognitive functioning and corpus callosum [CC] function assessed by interhemispheric transfer time [IHTT] using an event related potential paradigm) was also explored. Pediatric patients with msTBI underwent assessments at two times (post-acutely at a mean of three months post-injury, n = 31, and chronically at a mean of 16 months post-injury, n = 24). Healthy controls also underwent two evaluations, approximately 12 months apart. Post-acutely, in patients with msTBI, there were elevations in choline (Cho; marker for inflammation and/or altered membrane metabolism) in all four brain lobes and the CC and decreases in N-acetylaspartate (NAA; marker for neuronal and axonal integrity) in the CC compared with controls, all of which normalized by the chronic time point. Subgroups of TBI showed variable patterns chronically. Patients with slow IHTT had lower lobar Cho chronically than those with normal IHTT; they also did not show normalization in CC NAA whereas those with normal IHTT showed significantly higher levels of CC NAA relative to controls. In the normal IHTT group only, chronic CC Cho and NAA together explained 70% of the variance in long-term cognitive functioning. MR based whole brain metabolic evaluations show different patterns of neurochemistry after msTBI in two subgroups with different outcomes. There is a dynamic relationship between prolonged inflammatory responses to brain damage, reparative processes/remyelination, and subsequent neurobehavioral outcomes. Multimodal studies allow us to test hypotheses about degenerative and reparative processes in patient groups that have divergent functional outcome, with the ultimate goal of developing targeted therapeutic agents.
Collapse
Affiliation(s)
- Talin Babikian
- 1 Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior , Mattel Children's Hospital at UCLA, and the UCLA Steve Tisch BrainSPORT Program, Los Angeles, California
| | | | - Monica U Ellis-Blied
- 3 Health Promotion and Disease Prevention Program, VA Loma Linda Healthcare System , Redlands, California
| | - Christopher C Giza
- 4 UCLA Brain Injury Research Center , Department of Neurosurgery, and Division of Pediatric Neurology, Mattel Children's Hospital, UCLA Steve Tisch BrainSPORT Program, Los Angeles, California
| | - Emily Dennis
- 5 Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California , Marina del Rey, California
| | - Alexander Olsen
- 6 Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway; Department of Physical Medicine and Rehabilitation, St. Olavs Hospital, Trondheim University Hospital , Trondheim, Norway
| | - Richard Mink
- 7 Pediatric Critical Care Medicine, Harbor-UCLA Medical Center; Los Angeles BioMedical Research Institute , Department of Pediatrics, Torrance, California
| | - Christopher Babbitt
- 8 Miller Children's and Women's Hospital of Long Beach , Long Beach, California
| | - Jeff Johnson
- 9 LAC+USC Medical Center , Department of Pediatrics, Los Angeles, California
| | - Paul M Thompson
- 10 Imaging Genetics Center, Mary and Mark Stevens Institute for Neuroimaging and Informatics, Keck School of Medicine, University of Southern California , Marina del Rey, California; Departments of Neurology, Pediatrics, Psychiatry, Radiology, Engineering, and Ophthalmology, USC, Los Angeles, California
| | - Robert F Asarnow
- 11 Departments of Psychology and Psychiatry and Brain Research Institute , David Geffen School of Medicine, Los Angeles, California
| |
Collapse
|
17
|
O'Neill J, Piacentini J, Chang S, Ly R, Lai TM, Armstrong CC, Bergman L, Rozenman M, Peris T, Vreeland A, Mudgway R, Levitt JG, Salamon N, Posse S, Hellemann GS, Alger JR, McCracken JT, Nurmi EL. Glutamate in Pediatric Obsessive-Compulsive Disorder and Response to Cognitive-Behavioral Therapy: Randomized Clinical Trial. Neuropsychopharmacology 2017; 42:2414-2422. [PMID: 28409563 PMCID: PMC5645751 DOI: 10.1038/npp.2017.77] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 03/27/2017] [Accepted: 04/10/2017] [Indexed: 02/04/2023]
Abstract
Cognitive-behavioral therapy (CBT) is effective for pediatric obsessive-compulsive disorder (OCD), but non-response is common. Brain glutamate (Glu) signaling may contribute to OCD pathophysiology and moderate CBT outcomes. We assessed whether Glu measured with magnetic resonance spectroscopy (MRS) was associated with OCD and/or CBT response. Youths aged 7-17 years with DSM-IV OCD and typically developing controls underwent 3 T proton echo-planar spectroscopic imaging (PEPSI) MRS scans of pregenual anterior cingulate cortex (pACC) and ventral posterior cingulate cortex (vPCC)-regions possibly affected by OCD-at baseline. Controls returned for re-scan after 8 weeks. OCD youth-in a randomized rater-blinded trial-were re-scanned after 12-14 weeks of CBT or after 8 weeks of minimal-contact waitlist; waitlist participants underwent a third scan after crossover to 12-14 weeks of CBT. Forty-nine children with OCD (mean age 12.2±2.9 years) and 29 controls (13.2±2.2 years) provided at least one MRS scan. At baseline, Glu did not differ significantly between OCD and controls in pACC or vPCC. Within controls, Glu was stable from scan-to-scan. Within OCD subjects, a treatment-by-scan interaction (p=0.034) was observed, driven by pACC Glu dropping 19.5% from scan-to-scan for patients randomized to CBT, with minor increases (3.8%) for waitlist participants. The combined OCD participants (CBT-only plus waitlist-CBT) also showed a 16.2% (p=0.004) post-CBT decrease in pACC Glu. In the combined OCD group, within vPCC, lower pre-CBT Glu predicted greater post-CBT improvement in symptoms (CY-BOCS; r=0.81, p=0.00025). Glu may be involved in the pathophysiology of OCD and may moderate response to CBT.
Collapse
Affiliation(s)
- Joseph O'Neill
- Division of Child and Adolescent Psychiatry, UCLA Semel Institute for Neuroscience, Los Angeles, CA, USA,Division of Child and Adolescent Psychiatry, UCLA Semel Institute for Neuroscience, 760 Westwood Plaza 58-557A, Los Angeles, CA 90024-1759, USA, Tel: 310 825 5709, Fax: 310 206 4446, E-mail:
| | - John Piacentini
- Division of Child and Adolescent Psychiatry, UCLA Semel Institute for Neuroscience, Los Angeles, CA, USA
| | - Susanna Chang
- Division of Child and Adolescent Psychiatry, UCLA Semel Institute for Neuroscience, Los Angeles, CA, USA
| | - Ronald Ly
- Division of Child and Adolescent Psychiatry, UCLA Semel Institute for Neuroscience, Los Angeles, CA, USA
| | - Tsz M Lai
- Division of Child and Adolescent Psychiatry, UCLA Semel Institute for Neuroscience, Los Angeles, CA, USA
| | - Casey C Armstrong
- Division of Child and Adolescent Psychiatry, UCLA Semel Institute for Neuroscience, Los Angeles, CA, USA
| | - Lindsey Bergman
- Division of Child and Adolescent Psychiatry, UCLA Semel Institute for Neuroscience, Los Angeles, CA, USA
| | - Michelle Rozenman
- Division of Child and Adolescent Psychiatry, UCLA Semel Institute for Neuroscience, Los Angeles, CA, USA
| | - Tara Peris
- Division of Child and Adolescent Psychiatry, UCLA Semel Institute for Neuroscience, Los Angeles, CA, USA
| | - Allison Vreeland
- Division of Child and Adolescent Psychiatry, UCLA Semel Institute for Neuroscience, Los Angeles, CA, USA
| | - Ross Mudgway
- Division of Child and Adolescent Psychiatry, UCLA Semel Institute for Neuroscience, Los Angeles, CA, USA
| | - Jennifer G Levitt
- Division of Child and Adolescent Psychiatry, UCLA Semel Institute for Neuroscience, Los Angeles, CA, USA
| | - Noriko Salamon
- UCLA Department of Radiological Sciences, UCLA Medical Center, Los Angeles, CA, USA
| | - Stefan Posse
- Department of Neurology, University of New Mexico, Albuquerque, NM, USA,Department of Physics & Astronomy, University of New Mexico, Albuquerque, NM, USA,Department of Electrical and Computer Engineering, University of New Mexico, Albuquerque, NM, USA
| | - Gerhard S Hellemann
- Division of Child and Adolescent Psychiatry, UCLA Semel Institute for Neuroscience, Los Angeles, CA, USA
| | - Jeffry R Alger
- UCLA Department of Radiological Sciences, UCLA Medical Center, Los Angeles, CA, USA,UCLA Department of Neurology, UCLA Medical Center, Los Angeles, CA, USA
| | - James T McCracken
- Division of Child and Adolescent Psychiatry, UCLA Semel Institute for Neuroscience, Los Angeles, CA, USA
| | - Erika L Nurmi
- Division of Child and Adolescent Psychiatry, UCLA Semel Institute for Neuroscience, Los Angeles, CA, USA
| |
Collapse
|
18
|
Dai Y, Zhao Y, Tomi M, Shin BC, Thamotharan S, Mazarati A, Sankar R, Wang EA, Cepeda C, Levine MS, Zhang J, Frew A, Alger JR, Clark PM, Sondhi M, Kositamongkol S, Leibovitch L, Devaskar SU. Sex-Specific Life Course Changes in the Neuro-Metabolic Phenotype of Glut3 Null Heterozygous Mice: Ketogenic Diet Ameliorates Electroencephalographic Seizures and Improves Sociability. Endocrinology 2017; 158:936-949. [PMID: 28324109 PMCID: PMC5460805 DOI: 10.1210/en.2016-1816] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 01/18/2017] [Indexed: 01/13/2023]
Abstract
We tested the hypothesis that exposure of glut3+/- mice to a ketogenic diet ameliorates autism-like features, which include aberrant behavior and electrographic seizures. We first investigated the life course sex-specific changes in basal plasma-cerebrospinal fluid (CSF)-brain metabolic profile, brain glucose transport/uptake, glucose and monocarboxylate transporter proteins, and adenosine triphosphate (ATP) in the presence or absence of systemic insulin administration. Glut3+/- male but not female mice (5 months of age) displayed reduced CSF glucose/lactate concentrations with no change in brain Glut1, Mct2, glucose uptake or ATP. Exogenous insulin-induced hypoglycemia increased brain glucose uptake in glut3+/- males alone. Higher plasma-CSF ketones (β-hydroxybutyrate) and lower brain Glut3 in females vs males proved protective in the former while enhancing vulnerability in the latter. As a consequence, increased synaptic proteins (neuroligin4 and SAPAP1) with spontaneous excitatory postsynaptic activity subsequently reduced hippocampal glucose content and increased brain amyloid β1-40 deposition in an age-dependent manner in glut3+/- males but not females (4 to 24 months of age). We then explored the protective effect of a ketogenic diet on ultrasonic vocalization, sociability, spatial learning and memory, and electroencephalogram seizures in male mice (7 days to 6 to 8 months of age) alone. A ketogenic diet partially restored sociability without affecting perturbed vocalization, spatial learning and memory, and reduced seizure events. We conclude that (1) sex-specific and age-dependent perturbations underlie the phenotype of glut3+/- mice, and (2) a ketogenic diet ameliorates seizures caused by increased cortical excitation and improves sociability, but fails to rescue vocalization and cognitive deficits in glut3+/- male mice.
Collapse
Affiliation(s)
- Yun Dai
- Department of Pediatrics, Division of Neonatology & Developmental Biology, Neonatal Research Center at the UCLA Children’s Discovery and Innovation Institute
| | - Yuanzi Zhao
- Department of Pediatrics, Division of Neonatology & Developmental Biology, Neonatal Research Center at the UCLA Children’s Discovery and Innovation Institute
| | - Masatoshi Tomi
- Department of Pediatrics, Division of Neonatology & Developmental Biology, Neonatal Research Center at the UCLA Children’s Discovery and Innovation Institute
| | - Bo-Chul Shin
- Department of Pediatrics, Division of Neonatology & Developmental Biology, Neonatal Research Center at the UCLA Children’s Discovery and Innovation Institute
| | - Shanthie Thamotharan
- Department of Pediatrics, Division of Neonatology & Developmental Biology, Neonatal Research Center at the UCLA Children’s Discovery and Innovation Institute
| | | | - Raman Sankar
- Department of Pediatrics, Division of Neurology
- Department of Neurology
| | - Elizabeth A. Wang
- Intellectual and Developmental Disabilities Research Center and Brain Research Institute
| | - Carlos Cepeda
- Intellectual and Developmental Disabilities Research Center and Brain Research Institute
| | - Michael S. Levine
- Intellectual and Developmental Disabilities Research Center and Brain Research Institute
| | - Jingjing Zhang
- Department of Neurology
- Intellectual and Developmental Disabilities Research Center and Brain Research Institute
| | - Andrew Frew
- Department of Neurology
- Ahmanson-Lovelace Brain Mapping Center
| | - Jeffry R. Alger
- Department of Neurology
- Ahmanson-Lovelace Brain Mapping Center
| | - Peter M. Clark
- Department of Molecular and Medical Pharmacology and Crump Institute for Molecular Imaging, David Geffen School of Medicine at UCLA, Los Angeles, California 90095
| | - Monica Sondhi
- Department of Pediatrics, Division of Neonatology & Developmental Biology, Neonatal Research Center at the UCLA Children’s Discovery and Innovation Institute
| | - Sudatip Kositamongkol
- Department of Pediatrics, Division of Neonatology & Developmental Biology, Neonatal Research Center at the UCLA Children’s Discovery and Innovation Institute
| | - Leah Leibovitch
- Department of Pediatrics, Division of Neonatology & Developmental Biology, Neonatal Research Center at the UCLA Children’s Discovery and Innovation Institute
| | - Sherin U. Devaskar
- Department of Pediatrics, Division of Neonatology & Developmental Biology, Neonatal Research Center at the UCLA Children’s Discovery and Innovation Institute
| |
Collapse
|
19
|
Martin RM, Wright MJ, Lutkenhoff ES, Ellingson BM, Van Horn JD, Tubi M, Alger JR, McArthur DL, Vespa PM. Traumatic hemorrhagic brain injury: impact of location and resorption on cognitive outcome. J Neurosurg 2017; 126:796-804. [DOI: 10.3171/2016.3.jns151781] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE
Hemorrhagic contusions are often the most visible lesions following traumatic brain injury. However, the incidence, location, and natural history of traumatic parenchymal hemorrhage and its impact on neurological outcome have been understudied. The authors sought to examine the location and longitudinal evolution of traumatic parenchymal hemorrhage and its association with cognitive outcome.
METHODS
Sixteen patients with hemorrhagic contusions due to acceleration-deceleration injuries underwent MRI in the acute (mean 6.3 days postinjury) and chronic (mean 192.9 days postinjury) phases. ImageJ was used to generate GRE and FLAIR volumes. To account for the effect of head-size variability across individuals, the authors calculated each patient's total brain tissue volume using SIENAX. GRE and FLAIR volumes were normalized to the total brain tissue volume, and values for absolute and percent lesion volume and total brain volume change were generated. Spearman's rank correlations were computed to determine associations between neuroimaging and 6-month postinjury neuropsychological testing of attention (Symbol Digit Modalities Test [SDMT], oral [O] and written [W] versions), memory (Selective Reminding Test, total learning and delayed recall), and executive function (Trail Making Test Part B [TMT-B]).
RESULTS
The patients' mean age was 31.4 ± 14.0 years and their mean Glasgow Coma Scale score at admission was 7.9 ± 2.8. Lesions were predominantly localized to the frontal (11 lesions) and temporal (9 lesions) lobes. The average percent reductions in GRE and FLAIR volumes were 44.2% ± 46.1% and 80.5% ± 26.3%, respectively. While total brain and frontal lesion volumes did not correlate with brain atrophy, larger temporal lobe GRE and FLAIR volumes were associated with larger volumes of atrophy (GRE: acute, −0.87, p < 0.01, chronic, −0.78, p < 0.01; FLAIR: acute, −0.81, p < 0.01, chronic, −0.88, p < 0.01). Total percent volume change of GRE lesions correlated with TMT-B (0.53, p < 0.05) and SDMT-O (0.62, p < 0.05) scores. Frontal lobe lesion volume did not correlate with neuropsychological outcome. However, robust relationships were seen in the temporal lobe, with larger acute temporal lobe GRE volumes were associated with worse scores on both oral and written versions of the SDMT (SDMT-W, −0.85, p < 0.01; SDMT-O, −0.73, p < 0.05). Larger absolute change in temporal GRE volume was strongly associated with worse SDMT scores (SDMT-W, 0.88, p < 0.01; SDMT-O, 0.75, p < 0.05). The same relationships were also seen between temporal FLAIR lesion volumes and neuropsychological outcome.
CONCLUSIONS
Traumatic parenchymal hemorrhages are largely clustered in the frontal and temporal lobes, and significant residual blood products are present at 6 months postinjury, a potential source of ongoing secondary brain injury. Neuropsychological outcome is closely tied to lesion volume size, particularly in the temporal lobe, where larger GRE and FLAIR volumes are associated with more brain atrophy and worse SDMT scores. Interestingly, larger volumes of hemorrhage resorption were associated with worse SDMT and TMT-B scores, suggesting that the initial tissue damage had a lasting impact on attention and executive function.
Collapse
Affiliation(s)
| | | | | | | | - John D. Van Horn
- 6Department of Neurology, University of Southern California, Los Angeles, California
| | | | | | | | | |
Collapse
|
20
|
O'Neill J, Lai TM, Sheen C, Salgari GC, Ly R, Armstrong C, Chang S, Levitt JG, Salamon N, Alger JR, Feusner JD. Cingulate and thalamic metabolites in obsessive-compulsive disorder. Psychiatry Res 2016; 254:34-40. [PMID: 27317876 PMCID: PMC5780184 DOI: 10.1016/j.pscychresns.2016.05.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 03/28/2016] [Accepted: 05/23/2016] [Indexed: 12/18/2022]
Abstract
Focal brain metabolic effects detected by proton magnetic resonance spectroscopy (MRS) in obsessive-compulsive disorder (OCD) represent prospective indices of clinical status and guides to treatment design. Sampling bilateral pregenual anterior cingulate cortex (pACC), anterior middle cingulate cortex (aMCC), and thalamus in 40 adult patients and 16 healthy controls, we examined relationships of the neurometabolites glutamate+glutamine (Glx), creatine+phosphocreatine (Cr), and choline-compounds (Cho) with OCD diagnosis and multiple symptom types. The latter included OC core symptoms (Yale-Brown Obsessive-Compulsive Scale - YBOCS), depressive symptoms (Montgomery-Åsberg Depression Rating Scale - MADRS), and general functioning (Global Assessment Scale - GAS). pACC Glx was 9.7% higher in patients than controls. Within patients, Cr and Cho correlated negatively with YBOCS and MADRS, while Cr correlated positively with the GAS. In aMCC, Cr and Cho correlated negatively with MADRS, while Cr in thalamus correlated positively with GAS. These findings present moderate support for glutamatergic and cingulocentric perspectives on OCD. Based on our prior metabolic model of OCD, we offer one possible interpretation of these group and correlational effects as consequences of a corticothalamic state of elevated glutamatergic receptor activity alongside below-normal glutamatergic transporter activity.
Collapse
Affiliation(s)
- Joseph O'Neill
- Division of Child and Adolescent Psychiatry, UCLA Semel Institute for Neuroscience, Los Angeles, CA, United States.
| | - Tsz M Lai
- Division of Adult Psychiatry, UCLA Semel Institute for Neuroscience, Los Angeles, CA, United States
| | - Courtney Sheen
- Division of Adult Psychiatry, UCLA Semel Institute for Neuroscience, Los Angeles, CA, United States
| | - Giulia C Salgari
- Division of Child and Adolescent Psychiatry, UCLA Semel Institute for Neuroscience, Los Angeles, CA, United States
| | - Ronald Ly
- Division of Child and Adolescent Psychiatry, UCLA Semel Institute for Neuroscience, Los Angeles, CA, United States
| | - Casey Armstrong
- Division of Child and Adolescent Psychiatry, UCLA Semel Institute for Neuroscience, Los Angeles, CA, United States
| | - Susanna Chang
- Division of Adult Psychiatry, UCLA Semel Institute for Neuroscience, Los Angeles, CA, United States
| | - Jennifer G Levitt
- Division of Adult Psychiatry, UCLA Semel Institute for Neuroscience, Los Angeles, CA, United States
| | - Noriko Salamon
- UCLA Department of Radiological Sciences, Los Angeles, CA, United States
| | - Jeffry R Alger
- UCLA Department of Radiological Sciences, Los Angeles, CA, United States; UCLA Department of Neurology, Los Angeles, CA, United States
| | - Jamie D Feusner
- Division of Adult Psychiatry, UCLA Semel Institute for Neuroscience, Los Angeles, CA, United States
| |
Collapse
|
21
|
Nael K, Knitter J, Jahan R, Alger JR, Nenov V, Ajani Z, Feng L, Meyer BC, Olson S, Schwamm LH, Yoo AJ, Marshall RS, Meyers PM, Yavagal DR, Wintermark M, Liebeskind DS, Guzy J, Saver JL, Kidwell CS. Abstract 161: Prediction of Thrombolysis-induced Parenchymal Hemorrhage in Patients With Acute Ischemic Stroke: Use of MR Perfusion and Diffusion Biomarkers. Stroke 2016. [DOI: 10.1161/str.47.suppl_1.161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose:
Ischemic stroke patients with low cerebral blood volume (CBV), low apparent diffusion coefficient (ADC) and increased microvascular permeability (K2) have increased risk of parenchymal hemorrhage (PH) after recanalization therapies. We have developed a predictive model to examine the risk of PH following revascularization therapies using combined MR perfusion and diffusion biomarkers.
Methods:
Voxel-based values of rCBV, K2, and ADC from the infarction core were obtained using pre-treatment MRI data from patients enrolled in the Mechanical Retrieval and Recanalization of Stroke Clots Using Embolectomy (MR RESCUE) clinical trial. Using histogram analyses the 10
th
and 90
th
percentile values were calculated for the rCBV, ADC, and K2 variables for each patient. The associations between PH and extreme values of CBV (10%rCBV), ADC (10%ADC), and K2 (90%K2) in each patient were assessed in univariate and multivariate analyses. Receiver operating characteristic (ROC) analysis was performed to determine the optimal parameter/s and threshold for predicting PH.
Results:
In 83 patients included in this analysis, 20 (24%, 13 PH1, 7 PH2) developed PH. Univariate analysis showed significantly lower 10%rCBV and 10%ADC values and significantly higher 90%K2 values in patients with PH. After controlling for age, baseline NIHSS, infarct volume, and status of recanalization, multivariate logistic regression analysis identified 10%rCBV (p=0.002) and 90%K2 (p=0.03), but not 10%ADC (p=0.07), as independent predictors of PH. For 10%RCBV, ROC analysis showed the greatest AUC (0.87) at a threshold < 0.45 with sensitivity/specificity of 95%70%. For 90%K2, the greatest AUC (0.75) was obtained at a threshold of > 0.27 with sensitivity/specificity of 90%/60%. In a separate model, a combined K2-rCBV classifier remained the single independent predictor of PH (OR=33).
Conclusion:
Our results suggest that combined increased permeability and decreased rCBV derived from MR perfusion can be used for risk stratification in patients with AIS before undergoing revascularization therapies.
Collapse
Affiliation(s)
- Kambiz Nael
- Radiology, Icahn Sch of Medicine at Mount Sinai, New York, NY
| | | | - Reza Jahan
- Radiology, Univ of California Los Angeles, Los Angeles, CA
| | - Jeffry R Alger
- Radiology, Univ of California Los Angeles, Los Angeles, CA
| | - Val Nenov
- Univ of California Los Angeles, Los Angeles, CA
| | | | - Lei Feng
- Kaiser Permanente, Los Angeles, CA
| | | | | | | | | | | | - Philip M Meyers
- Columbia Univ, Coll of Physicians and Surgeons, New York, NY
| | | | | | | | - Judy Guzy
- Univ of California Los Angeles, Los Angeles, CA
| | | | | |
Collapse
|
22
|
Yu S, Liebeskind DS, Dua S, Wilhalme H, Elashoff D, Qiao XJ, Alger JR, Sanossian N, Starkman S, Ali LK, Scalzo F, Lou X, Yoo B, Saver JL, Salamon N, Wang DJJ. Postischemic hyperperfusion on arterial spin labeled perfusion MRI is linked to hemorrhagic transformation in stroke. J Cereb Blood Flow Metab 2015; 35:630-7. [PMID: 25564233 PMCID: PMC4420881 DOI: 10.1038/jcbfm.2014.238] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Revised: 12/02/2014] [Accepted: 12/03/2014] [Indexed: 12/21/2022]
Abstract
The purpose of this study was to investigate the relationship between hyperperfusion and hemorrhagic transformation (HT) in acute ischemic stroke (AIS). Pseudo-continuous arterial spin labeling (ASL) with background suppressed 3D GRASE was performed during routine clinical magnetic resonance imaging (MRI) on AIS patients at various time points. Arterial spin labeling cerebral blood flow (CBF) maps were visually inspected for the presence of hyperperfusion. Hemorrhagic transformation was followed during hospitalization and was graded on gradient recalled echo (GRE) scans into hemorrhagic infarction (HI) and parenchymal hematoma (PH). A total of 361 ASL scans were collected from 221 consecutive patients with middle cerebral artery stroke from May 2010 to September 2013. Hyperperfusion was more frequently detected posttreatment (odds ratio (OR) = 4.8, 95% confidence interval (CI) 2.5 to 8.9, P < 0.001) and with high National Institutes of Health Stroke Scale (NIHSS) scores at admission (P<0.001). There was a significant association between having hyperperfusion at any time point and HT (OR = 3.5, 95% CI 2.0 to 6.3, P < 0.001). There was a positive relationship between the grade of HT and time-hyperperfusion with the Spearman's rank correlation of 0.44 (P = 0.003). Arterial spin labeling hyperperfusion may provide an imaging marker of HT, which may guide the management of AIS patients post tissue-type plasminogen activator (tPA) and/or endovascular treatments. Late hyperperfusion should be given more attention to prevent high-grade HT.
Collapse
Affiliation(s)
- Songlin Yu
- Department of Neurology, UCLA, Los Angeles, California, USA
| | | | - Sumit Dua
- Department of Radiology, UCLA, Los Angeles, California, USA
| | - Holly Wilhalme
- Department of Medicine Statistics Core, UCLA, Los Angeles, California, USA
| | - David Elashoff
- Department of Medicine Statistics Core, UCLA, Los Angeles, California, USA
| | - Xin J Qiao
- Department of Radiology, UCLA, Los Angeles, California, USA
| | - Jeffry R Alger
- 1] Department of Neurology, UCLA, Los Angeles, California, USA [2] Department of Radiology, UCLA, Los Angeles, California, USA
| | | | - Sidney Starkman
- 1] Department of Neurology, UCLA, Los Angeles, California, USA [2] Department of Emergency Medicine, UCLA, Los Angeles, California, USA
| | - Latisha K Ali
- Department of Neurology, UCLA, Los Angeles, California, USA
| | - Fabien Scalzo
- Department of Neurology, UCLA, Los Angeles, California, USA
| | - Xin Lou
- 1] Department of Neurology, UCLA, Los Angeles, California, USA [2] Department of Radiology, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Bryan Yoo
- Department of Radiology, UCLA, Los Angeles, California, USA
| | | | - Noriko Salamon
- Department of Radiology, UCLA, Los Angeles, California, USA
| | - Danny J J Wang
- 1] Department of Neurology, UCLA, Los Angeles, California, USA [2] Department of Radiology, UCLA, Los Angeles, California, USA
| | | |
Collapse
|
23
|
Liebeskind DS, Ichwan DJ, Yu S, Scalzo F, Johnson MS, Qiao JX, Alger JR, Ali LK, Kim D, Hinman JD, Rao NM, Saver JL, Yoo B, Vespa PM, Sanossian N, Blanco MB, Wang DJ. Abstract T P297: Arterial Spin Labeled MRI Quantifies Cerebral Blood Flow Changes with Blood Pressure from Acute to Subacute Stroke. Stroke 2015. [DOI: 10.1161/str.46.suppl_1.tp297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Hemodynamic interventions, such as blood pressure (BP) manipulation, are often utilized to optimize perfusion of the ischemic territory. Scant data support theoretical effects of permissive hypertension or BP reduction, yet arterial-spin labeled (ASL) MRI may chronicle quantitative cerebral blood flow (CBF) changes. We used serial ASL to measure CBF changes associated with hemodynamic interventions, based on arterial occlusion site and collaterals.
Methods:
Serial ASL acquired in 148 consecutive cases of acute ischemic stroke at a single center during a 3-year period. A pseudo-continuous ASL pulse sequence with background suppressed 3D GRASE (gradient and spin echo) readout with 4 post-labeling delays was used, with normalization of quantitative CBF on a standard neurovascular template. CBF values and relative changes were measured in the affected hemisphere and in discrete regions of infarct core and collateral territories.
Results:
148 cases (median age 68 years (IQR 62-82), 73 women) were studied. Overall, CBF (ml/100g/min) was related to age (r=-0.40, p<0.001) but not gender (male: 39±9.7, female: 40.6±8.2; r=.05, p=NS). Serial studies were obtained in 126 cases, including 2 studies in 91, 3 in 32, and 4 in 3. Median time to 1
st
, 2
nd
, 3
rd
, and 4
th
ASL study was 11.3, 39.7, 140.7, and 121.3 hrs and median CBF at these timepoints was 39.9 (IQR 28-48); 42.2 (IQR 29-52); 47.1 (IQR 36-56); and 35.6 (IQR 34-41). Average changes in CBF from study 1 to 2, 2 to 3, 3 to 4 were +2.2; +3.4; -14.8. Average CBF ratio between leptomeningeal and perforating MCA regions was 1.1. The correlation of initial delta CBF (study 1 to 2) with initial delta BP (1 to 2) was r=-0.1, p=NS. Average delta CBF/delta mmHg SBP was 0.25. At studies 1 and 2, lower BP was related to higher CBF (r=-0.148, p=0.102). Overall, delta BP was not linked with CBF (r=0.002, p=NS) or delta CBF (r=-0.108, p=NS). For those with low initial CBF (<40), positive delta BP was strongly associated with lower CBF at study 2 (r=-0.552, p=0.006).
Conclusions:
Blood pressure modification, permissive or interventional, may differentially affect CBF in the ischemic core and collateral regions. ASL provides a novel method for non-invasive mapping of serial changes in absolute CBF quantification in the ICU and beyond.
Collapse
Affiliation(s)
| | | | | | - Fabien Scalzo
- Neurovascular Imaging Rsch Core, UCLA, Los Angeles, CA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Kidwell CS, Jahan R, Gornbein J, Alger JR, Nenov V, Norato G, Ajani Z, Feng L, Meyer BC, Olson S, Schwamm LH, Yoo AJ, Marshall RS, Meyers PM, Yavagal DR, Wintermark M, Liebeskind DS, Guzy J, Starkman S, Saver JL. Abstract T P26: Combining Clinical and Imaging Data to Develop a Highly Predictive Model of Outcomes in the MR RESCUE Trial. Stroke 2015. [DOI: 10.1161/str.46.suppl_1.tp26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Identifying patient characteristics that predict outcomes in acute ischemic stroke may assist in triaging those who are candidates for endovascular therapies. We sought to identify predictors of outcome in the overall Mechanical Retrieval and Recanalization of Stroke Clots Using Embolectomy (MR RESCUE) cohort and compare results to the previously validated Totaled Health Risks in Vascular Events (THRIVE) score.
Methods:
MR RESCUE randomized 118 acute ischemic stroke patients with multimodal imaging to embolectomy or standard care within 8 hours of onset. For this analysis, we investigated 17 baseline variables (e.g. age, predicted core volume, time to enrollment) and 8 intermediate variables (e.g. hemorrhagic transformation, day 7 recanalization, final infarct volume) with the potential to impact outcomes (day 90 mRS). The baseline variables were analyzed employing bivariate and multivariate methods (random forest and logistic regression). Two models were developed, one including only significant baseline variables, and the second also incorporating significant intermediate variables.
Results:
A multivariate model (Table) employing only baseline covariates achieved an overall accuracy (C statistic) of 85% in predicting poor outcome (day 90 mRS 3-6) compared to 80.5% for the THRIVE score. A second model (Table) adding significant intermediate variables achieved 89% accuracy in predicting day 90 mRS.
Conclusions:
In the MR RESCUE trial, advanced imaging variables, including predicted core volume and site of vessel occlusion, contributed to a highly accurate multivariable model of outcome. In the development phase, this model achieved higher accuracy than the THRIVE score. Future studies are needed to validate this model in an independent cohort.
Collapse
Affiliation(s)
| | - Reza Jahan
- Radiology, Univ of California, Los Angeles, Los Angeles, CA
| | | | | | - Val Nenov
- Univ of California, Los Angeles, Los Angeles, CA
| | - Gina Norato
- Dept of Neurology, Univ of Arizona, Tucson, AZ
| | | | - Lei Feng
- Kaiser Permanente, Los Angeles, CA
| | | | - Scott Olson
- Univ of California, San Diego, San Diego, CA
| | - Lee H Schwamm
- Harvard Med Sch, Massachusetts General Hosp, Boston, MA
| | - Albert J Yoo
- Harvard Med Sch, Massachusetts General Hosp, Boston, MA
| | | | - Philip M Meyers
- Columbia Univ, College of Physicians and Surgeons, New York, NY
| | | | | | | | - Judy Guzy
- Univ of California, Los Angeles, Los Angeles, CA
| | | | | | | |
Collapse
|
25
|
Apostolova LG, Zarow C, Biado K, Hurtz S, Boccardi M, Somme J, Honarpisheh H, Blanken AE, Brook J, Tung S, Lo D, Ng D, Alger JR, Vinters HV, Bocchetta M, Duvernoy H, Jack CR, Frisoni GB. Relationship between hippocampal atrophy and neuropathology markers: a 7T MRI validation study of the EADC-ADNI Harmonized Hippocampal Segmentation Protocol. Alzheimers Dement 2015; 11:139-50. [PMID: 25620800 PMCID: PMC4348340 DOI: 10.1016/j.jalz.2015.01.001] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2013] [Revised: 11/15/2014] [Accepted: 01/06/2015] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The pathologic validation of European Alzheimer's Disease Consortium Alzheimer's Disease Neuroimaging Initiative Center Harmonized Hippocampal Segmentation Protocol (HarP). METHODS Temporal lobes of nine Alzheimer's disease (AD) and seven cognitively normal subjects were scanned post-mortem at 7 Tesla. Hippocampal volumes were obtained with HarP. Six-micrometer-thick hippocampal slices were stained for amyloid beta (Aβ), tau, and cresyl violet. Hippocampal subfields were manually traced. Neuronal counts, Aβ, and tau burden for each hippocampal subfield were obtained. RESULTS We found significant correlations between hippocampal volume and Braak and Braak staging (ρ = -0.75, P = .001), tau (ρ = -0.53, P = .034), Aβ burden (ρ = -0.61, P = .012), and neuronal count (ρ = 0.77, P < .001). Exploratory subfield-wise significant associations were found for Aβ in Cornu Ammonis (CA)1 (ρ = -0.58, P = .019) and subiculum (ρ = -0.75, P = .001), tau in CA2 (ρ = -0.59, P = .016), and CA3 (ρ = -0.5, P = .047), and neuronal count in CA1 (ρ = 0.55, P = .028), CA3 (ρ = 0.65, P = .006), and CA4 (ρ = 0.76, P = .001). CONCLUSIONS The observed associations provide pathological confirmation of hippocampal morphometry as a valid biomarker for AD and pathologic validation of HarP.
Collapse
Affiliation(s)
| | - Chris Zarow
- Department of Neurology, USC, Los Angeles, CA, USA
| | - Kristina Biado
- Department of Pathology & Laboratory Medicine, UCLA, Los Angeles, CA, USA
| | - Sona Hurtz
- San Francisco State University, San Francisco, CA, USA
| | - Marina Boccardi
- LENITEM (Laboratory of Epidemiology, Neuroimaging and Telemedicine), IRCCS S.Giovanni di Dio- Fatebenefratelli, Brescia, Italy
| | - Johanne Somme
- Department of Neurology, Alava University Hospital, Victoria-Gasteiz, Spain
| | - Hedieh Honarpisheh
- Department of Pathology, Yale University School of Medicine, New Haven, CT, USA
| | | | - Jenny Brook
- Department of Medicine Statistics Core, UCLA, Los Angeles, CA, USA
| | - Spencer Tung
- Department of Pathology & Laboratory Medicine, UCLA, Los Angeles, CA, USA
| | - Darrick Lo
- Department of Pathology & Laboratory Medicine, UCLA, Los Angeles, CA, USA
| | - Denise Ng
- Department of Pathology & Laboratory Medicine, UCLA, Los Angeles, CA, USA
| | | | - Harry V Vinters
- Department of Neurology, UCLA, Los Angeles, CA, USA; Department of Pathology & Laboratory Medicine, UCLA, Los Angeles, CA, USA
| | - Martina Bocchetta
- LENITEM (Laboratory of Epidemiology, Neuroimaging and Telemedicine), IRCCS S.Giovanni di Dio- Fatebenefratelli, Brescia, Italy; Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | | | - Clifford R Jack
- Department of Diagnostic Radiology, Mayo Clinic and Foundation, Rochester, MN, USA
| | - Giovanni B Frisoni
- LENITEM (Laboratory of Epidemiology, Neuroimaging and Telemedicine), IRCCS S.Giovanni di Dio- Fatebenefratelli, Brescia, Italy; University Hospitals and University of Geneva, Geneva, Switzerland
| |
Collapse
|
26
|
Tarpley J, Scalzo F, Alger JR, Aghaebrahim A, Liang C, Sheth S, Noorian R, Ng K, Jovin T, Duckwiler G, Liebeskind DS. Abstract W MP20: Automation and Quantification of the Angiographic Capillary Blush in Patients with Acute Ischemic Stroke undergoing Endovascular Intervention. Stroke 2015. [DOI: 10.1161/str.46.suppl_1.wmp20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
In acute ischemic stroke, non-invasive perfusion imaging can guide the decision to perform endovascular intervention. A subset of these patients who are ineligible for IV TPA or for whom it has failed may benefit by going directly to endovascular intervention without delays imposed by non-invasive imaging. In these patients, an angiographic biomarker of viable brain tissue such as the capillary blush described by the Capillary Index Score (CIS) will be important for decision making in the angiography suite. Indeed, a favorable CIS score is associated with good outcomes when recanalization is achieved. However, any ordinal angiographic scale is observer dependent and limited by scale properties.
Methods:
Here we used our novel perfusion angiography software (PerfAngio) to extract cerebral blood volume (CBV) maps from conventional angiograms acquired during endovascular intervention at either UPMC or UCLA. Areas of angiographic blush were selected manually from a subset of the angiograms. These blush areas trained a machine learning model to identify features of angiographic blush from CBV maps to produce blush maps.
Results:
In the figure, we show PerfAngio’s blush map in a patient with acute proximal MCA occlusion prior to endovascular recanalization. At each pixel cool colors represent low likelihood of capillary blush and hotter colors represent higher likelihood of blush. These color maps allow for spatial characterization of the blush and quantifies it as a continuous variable rather than according to an ordinal scale.
Conclusions:
PerfAngio blush maps allow for automation and quantification of the blush seen during conventional angiography. These maps render data that does not depend on observer interpretation and provide spatial information about the capillary blush that is not captured by the CIS. Since PerfAngio blush maps can be acquired in real time, they are amenable for use in the angiography suite to inform the decision to recanalize or not.
Collapse
Affiliation(s)
| | - Fabien Scalzo
- Neurology, Neurovascular Imaging Rsch Core, UCLA, Los Angeles, CA
| | | | | | | | | | | | - Kwan Ng
- Neurology, UCLA, Los Angeles, CA
| | | | | | | | | |
Collapse
|
27
|
Ali LK, Alger JR, Johnson MS, Yoo B, Scalzo F, Liebeskind DS. Abstract T P173: Cerebral Oxygen Extraction Fraction MRI to Assess Metabolic Changes in Acute Ischemic Stroke. Stroke 2015. [DOI: 10.1161/str.46.suppl_1.tp173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
In acute cerebral ischemia, there is an imbalance between oxygen tissue consumption and delivery and oxygen extraction fraction (OEF) from the circulation increases to maintain normal oxygen metabolism and neuronal function. Detecting such metabolic changes may provide important data to inform decisions on therapeutic interventions such as patient selection for reperfusion or identification of futile therapeutic situations. We used serial OEF MRI to assess metabolic changes in brain tissue associated with reperfusion interventions.
Methods:
Serial OEF acquired in 10 consecutive cases of acute anterior circulation ischemic stroke at a single center during a 12 month period. Transverse relaxation and static magnetic field inhomogeneity driven relaxation was mapped using multislice gradient echo planar imaging. Data are fitted on a voxel-by-voxel basis to the Yablonskiy and Haacke model to map deoxyhemoglobin concentration and cerebral blood volume.
Results:
10 cases (median age 72 years (IQR 62-77), 5 women) were studied. Median NIHSS score 15.5 (IQR 9-25). 3 patients received no intervention as last known well time exceeded a treatment window. 3 patients received intravenous thrombolysis (IV), 3 patients received IV and mechanical thrombectomy (MT), and 1 patient received MT only. In the IV treated patients, median time to therapy 110. 5 minutes (IQR 80-132). In the MT treated patients, median time to therapy 257 minutes (IQR 234-331). In the untreated patients, the OEF was elevated in the ischemic territory and this appeared to persist at 24 hours. In the treated patients, those who had at least partial recanalization, demonstrated improved OEF in the ischemic territory at 24 hours.
Conclusions:
OEF provides a novel method for non-invasive detection of tissue with impaired oxygen delivery in acute stroke patients and is a novel tool for imaging metabolic changes in pathophysiology and disclosing therapeutic opportunities.
Collapse
Affiliation(s)
| | | | - Mark S Johnson
- Neurology, Neurovascular Imaging Rsch Core, UCLA, Los Angeles, CA
| | - Bryan Yoo
- Radiology, UCLA Stroke Cntr, Los Angeles, CA
| | - Fabien Scalzo
- Neurology, Neurovascular Imaging Rsch Core, UCLA, Los Angeles, CA
| | | |
Collapse
|
28
|
Sabati M, Sheriff S, Gu M, Wei J, Zhu H, Barker PB, Spielman DM, Alger JR, Maudsley AA. Multivendor implementation and comparison of volumetric whole-brain echo-planar MR spectroscopic imaging. Magn Reson Med 2014; 74:1209-20. [PMID: 25354190 DOI: 10.1002/mrm.25510] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Revised: 10/02/2014] [Accepted: 10/03/2014] [Indexed: 12/14/2022]
Abstract
PURPOSE To assess volumetric proton MR spectroscopic imaging (MRSI) of the human brain on multivendor MRI instruments. METHODS Echo-planar spectroscopic imaging was developed on instruments from three manufacturers, with matched specifications and acquisition protocols that accounted for differences in sampling performance, radiofrequency (RF) power, and data formats. Intersite reproducibility was evaluated for signal-normalized maps of N-acetylaspartate (NAA), creatine (Cre), and choline using phantom and human subject measurements. Comparative analyses included metrics for spectral quality, spatial coverage, and mean values in atlas-registered brain regions. RESULTS Intersite differences for phantom measurements were less than 1.7% for individual metabolites and less than 0.2% for ratio measurements. Spatial uniformity ranged from 79% to 91%. The human studies found differences of mean values in the temporal lobe, but good agreement in other white matter regions, with maximum differences relative to their mean of under 3.2%. For NAA/Cre, the maximum difference was 1.8%. In gray matter, a significant difference was observed for frontal lobe NAA. Primary causes of intersite differences were attributed to shim quality, B0 drift, and accuracy of RF excitation. Correlation coefficients for measurements at each site were over 0.60, indicating good reliability. CONCLUSION A volumetric intensity-normalized MRSI acquisition can be implemented in a comparable manner across multivendor MR instruments.
Collapse
Affiliation(s)
- Mohammad Sabati
- Department of Radiology, University of Miami, Miami, Florida, USA.,Department of Radiology, University of Calgary, Calgary, Canada
| | - Sulaiman Sheriff
- Department of Radiology, University of Miami, Miami, Florida, USA
| | - Meng Gu
- Department of Radiology, Stanford University, Stanford, California, USA
| | - Juan Wei
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, and the F.M. Kirby Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland, USA
| | - Henry Zhu
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, and the F.M. Kirby Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland, USA
| | - Peter B Barker
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, and the F.M. Kirby Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland, USA
| | - Daniel M Spielman
- Department of Radiology, Stanford University, Stanford, California, USA
| | - Jeffry R Alger
- Neurology and Radiological Sciences, University of California, Los Angeles, California, USA
| | | |
Collapse
|
29
|
Harezlak J, Cohen R, Gongvatana A, Taylor M, Buchthal S, Schifitto G, Zhong J, Daar ES, Alger JR, Brown M, Singer EJ, Campbell TB, McMahon D, So YT, Yiannoutsos CT, Navia BA. Predictors of CNS injury as measured by proton magnetic resonance spectroscopy in the setting of chronic HIV infection and CART. J Neurovirol 2014; 20:294-303. [PMID: 24696364 DOI: 10.1007/s13365-014-0246-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Revised: 03/07/2014] [Accepted: 03/13/2014] [Indexed: 11/26/2022]
Abstract
The reasons for persistent brain dysfunction in chronically HIV-infected persons on stable combined antiretroviral therapies (CART) remain unclear. Host and viral factors along with their interactions were examined in 260 HIV-infected subjects who underwent magnetic resonance spectroscopy (MRS). Metabolite concentrations (NAA/Cr, Cho/Cr, MI/Cr, and Glx/Cr) were measured in the basal ganglia, the frontal white matter, and gray matter, and the best predictive models were selected using a bootstrap-enhanced Akaike information criterion (AIC). Depending on the metabolite and brain region, age, race, HIV RNA concentration, ADC stage, duration of HIV infection, nadir CD4, and/or their interactions were predictive of metabolite concentrations, particularly the basal ganglia NAA/Cr and the mid-frontal NAA/Cr and Glx/Cr, whereas current CD4 and the CPE index rarely or did not predict these changes. These results show for the first time that host and viral factors related to both current and past HIV status contribute to persisting cerebral metabolite abnormalities and provide a framework for further understanding neurological injury in the setting of chronic and stable disease.
Collapse
Affiliation(s)
- J Harezlak
- Indiana University Fairbanks School of Public Health, 410 W 10th St., Suite 3000, Indianapolis, IN, 46202, USA,
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Huo J, Okada K, van Rikxoort EM, Kim HJ, Alger JR, Pope WB, Goldin JG, Brown MS. Ensemble segmentation for GBM brain tumors on MR images using confidence-based averaging. Med Phys 2014; 40:093502. [PMID: 24007185 DOI: 10.1118/1.4817475] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE Ensemble segmentation methods combine the segmentation results of individual methods into a final one, with the goal of achieving greater robustness and accuracy. The goal of this study was to develop an ensemble segmentation framework for glioblastoma multiforme tumors on single-channel T1w postcontrast magnetic resonance images. METHODS Three base methods were evaluated in the framework: fuzzy connectedness, GrowCut, and voxel classification using support vector machine. A confidence map averaging (CMA) method was used as the ensemble rule. RESULTS The performance is evaluated on a comprehensive dataset of 46 cases including different tumor appearances. The accuracy of the segmentation result was evaluated using the F1-measure between the semiautomated segmentation result and the ground truth. CONCLUSIONS The results showed that the CMA ensemble result statistically approximates the best segmentation result of all the base methods for each case.
Collapse
Affiliation(s)
- Jing Huo
- TeraRecon Inc., 4000 East 3rd Avenue, Suite 200, Foster City, California 94404, USA.
| | | | | | | | | | | | | | | |
Collapse
|
31
|
Öz G, Alger JR, Barker PB, Bartha R, Bizzi A, Boesch C, Bolan PJ, Brindle KM, Cudalbu C, Dinçer A, Dydak U, Emir UE, Frahm J, González RG, Gruber S, Gruetter R, Gupta RK, Heerschap A, Henning A, Hetherington HP, Howe FA, Hüppi PS, Hurd RE, Kantarci K, Klomp DWJ, Kreis R, Kruiskamp MJ, Leach MO, Lin AP, Luijten PR, Marjańska M, Maudsley AA, Meyerhoff DJ, Mountford CE, Nelson SJ, Pamir MN, Pan JW, Peet AC, Poptani H, Posse S, Pouwels PJW, Ratai EM, Ross BD, Scheenen TWJ, Schuster C, Smith ICP, Soher BJ, Tkáč I, Vigneron DB, Kauppinen RA. Clinical proton MR spectroscopy in central nervous system disorders. Radiology 2014; 270:658-79. [PMID: 24568703 PMCID: PMC4263653 DOI: 10.1148/radiol.13130531] [Citation(s) in RCA: 411] [Impact Index Per Article: 41.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
A large body of published work shows that proton (hydrogen 1 [(1)H]) magnetic resonance (MR) spectroscopy has evolved from a research tool into a clinical neuroimaging modality. Herein, the authors present a summary of brain disorders in which MR spectroscopy has an impact on patient management, together with a critical consideration of common data acquisition and processing procedures. The article documents the impact of (1)H MR spectroscopy in the clinical evaluation of disorders of the central nervous system. The clinical usefulness of (1)H MR spectroscopy has been established for brain neoplasms, neonatal and pediatric disorders (hypoxia-ischemia, inherited metabolic diseases, and traumatic brain injury), demyelinating disorders, and infectious brain lesions. The growing list of disorders for which (1)H MR spectroscopy may contribute to patient management extends to neurodegenerative diseases, epilepsy, and stroke. To facilitate expanded clinical acceptance and standardization of MR spectroscopy methodology, guidelines are provided for data acquisition and analysis, quality assessment, and interpretation. Finally, the authors offer recommendations to expedite the use of robust MR spectroscopy methodology in the clinical setting, including incorporation of technical advances on clinical units.
Collapse
Affiliation(s)
- Gülin Öz
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Jeffry R. Alger
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Peter B. Barker
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Robert Bartha
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Alberto Bizzi
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Chris Boesch
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Patrick J. Bolan
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Kevin M. Brindle
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Cristina Cudalbu
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Alp Dinçer
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Ulrike Dydak
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Uzay E. Emir
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Jens Frahm
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Ramón Gilberto González
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Stephan Gruber
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Rolf Gruetter
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Rakesh K. Gupta
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Arend Heerschap
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Anke Henning
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Hoby P. Hetherington
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Franklyn A. Howe
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Petra S. Hüppi
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Ralph E. Hurd
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Kejal Kantarci
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Dennis W. J. Klomp
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Roland Kreis
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Marijn J. Kruiskamp
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Martin O. Leach
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Alexander P. Lin
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Peter R. Luijten
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Małgorzata Marjańska
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Andrew A. Maudsley
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Dieter J. Meyerhoff
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Carolyn E. Mountford
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Sarah J. Nelson
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - M. Necmettin Pamir
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Jullie W. Pan
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Andrew C. Peet
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Harish Poptani
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Stefan Posse
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Petra J. W. Pouwels
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Eva-Maria Ratai
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Brian D. Ross
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Tom W. J. Scheenen
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Christian Schuster
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Ian C. P. Smith
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Brian J. Soher
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Ivan Tkáč
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Daniel B. Vigneron
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | | |
Collapse
|
32
|
Wang R, Yu S, Alger JR, Zuo Z, Chen J, Wang R, An J, Wang B, Zhao J, Xue R, Wang DJJ. Multi-delay arterial spin labeling perfusion MRI in moyamoya disease--comparison with CT perfusion imaging. Eur Radiol 2014; 24:1135-44. [PMID: 24557051 DOI: 10.1007/s00330-014-3098-9] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Revised: 11/27/2013] [Accepted: 01/14/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To present a multi-delay pseudo-continuous ASL (pCASL) protocol that offers simultaneous measurements of cerebral blood flow (CBF) and arterial transit time (ATT), and to study correlations between multi-delay pCASL and CT perfusion in moyamoya disease. METHODS A 4 post-labeling delay (PLD) pCASL protocol was applied on 17 patients with moyamoya disease who also underwent CT perfusion imaging. ATT was estimated using the multi-delay protocol and included in the calculation of CBF. ASL and CT perfusion images were rated for lesion severity/conspicuity. Pearson correlation coefficients were calculated across voxels between the two modalities in grey and white matter of each subject respectively and between normalized mean values of ASL and CT perfusion measures in major vascular territories. RESULTS Significant associations between ASL and CT perfusion were detected using subjective ratings, voxel-wise analysis in grey and white matter and region of interest (ROI)-based analysis of normalized mean perfusion. The correlation between ASL CBF and CT perfusion was improved using the multi-delay pCASL protocol compared to CBF acquired at a single PLD of 2 s (P < 0.05). CONCLUSIONS There is a correlation between perfusion data from ASL and CT perfusion imaging in patients with moyamoya disease. Multi-delay ASL can improve CBF quantification, which could be a prognostic imaging biomarker in patients with moyamoya disease. KEY POINTS • Simultaneous measurements of CBF and ATT can be achieved using multi-delay pCASL. • Multi-delay ASL was compared with CT perfusion in patients with moyamoya disease. • Statistical analyses showed significant associations between multi-delay ASL and CT perfusion. • Multi-delay ASL can improve CBF quantification in moyamoya disease.
Collapse
Affiliation(s)
- Rui Wang
- State Key Laboratory of Brain and Cognitive Science, Beijing MRI Center for Brain Research, Institute of Biophysics, Chinese Academy of Sciences, 15 Datun Road, Chaoyang District, Beijing, 100101, China
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Liebeskind DS, Sanossian N, Alger JR, Qiao JX, Scalzo F, Johnson MS, Starkman S, Ali LK, Kim D, Rao NM, Hinman JD, Tansy AP, Calderon-Arnulphi M, Modir RF, Vespa PM, Blanco MB, Jahan R, Tateshima S, Gonzalez NR, Duckwiler GR, Viñuela F, Saver JL, Yoo B, Salamon N, Wang DJ. Abstract T P29: Arterial-Spin Labeled MRI After Endovascular Stroke Therapy: Validation of a Novel Scale to Quantify the Degree and Heterogeneity of Reperfusion. Stroke 2014. [DOI: 10.1161/str.45.suppl_1.tp29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
The degree of reperfusion in acute stroke is a key predictor of clinical outcome, yet validation of a noninvasive imaging technique such as arterial spin-labeled MRI (ASL) that can quantify both hypo- and hyperperfusion is needed.
Methods:
Consecutive series of endovascular therapy for acute stroke and ASL-MRI within 36 hours after treatment start during a 3-year period were analyzed. Reperfusion on DSA was scored with TICI and mTICI (2b definitions of 2/3 and ½, respectively). ASL cerebral blood flow was graded with a scale analogous to mTICI (0=none, 1=< ½, 2=>½, 3=complete) separately for hypo- and hyperperfusion based on occlusion site, yet blinded to TICI/mTICI results.
Results:
64 patients (mean age 67.7 ± 13.9 years; 53% women; median baseline NIHSS 15 (2-38)) had ASL acquired within 36 hours (median 7.07 hours (2.69-33.08)) from start of IV thrombolysis or thrombectomy over a 3-year period. 31/64 (48%) patients received IV tPA before endovascular therapy. DSA revealed 32 M1, 18 ICA, 10 M2, and 4 basilar occlusions. After endovascular treatment, TICI0/mTICI0 (6%), TICI1/mTICI1 (2%), TICI2a/mTICI2a (30%), TICI2a/mTICI2b (22%), TICI2b/mTICI2b (39%) and TICI3/mTICI3 (2%) results were noted. ASL revealed hypoperfusion (0 (19%); 1 (59%); 2 (14%); 3 (8%)) and hyperperfusion (0 (69%); 1 (27%); 3 (5%)). 7 combined patterns of hypo- and hyperperfusion were noted on ASL, all unrelated to baseline clinical variables. ASL mTICI hypoperfusion strongly correlated with DSA mTICI (R=-0.77, p<0.001) and TICI (R=-0.71, p<0.001). ASL hyperperfusion was noted only with TICI2a/mTICI2a (9%), TICI2a/mTICI2b (14%), TICI2b/mTICI2b (9%) and was more common with increased time from DSA to ASL (p=0.017).
Conclusions:
ASL hypoperfusion within 36 hours of acute stroke therapy strongly correlates with reperfusion scores on DSA, providing a novel means to accurately quantify degree of reperfusion. ASL hyperperfusion, concomitant with hypoperfusion, affects a substantial number of cases, predominantly affecting the TICI2a/mTICI2b reperfusion category on DSA.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Bryan Yoo
- Div of Neuroradiology, UCLA, Los Angeles, CA
| | | | | | | |
Collapse
|
34
|
Tarpley JW, Scalzo F, Jovin T, Aghaebrahim A, Alger JR, Duckwiler GR, Liebeskind DS. Abstract 119: Serial Analysis of Perfusion Angiography in Endovascular Intervention for Acute Stroke With Proximal Middle Cerebral Artery Occlusion. Stroke 2014. [DOI: 10.1161/str.45.suppl_1.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Perfusion imaging is often used to predict tissue fate during acute stroke in clinical practice and in research trials. During endovascular interventions, conventional angiography provides perfusion information at the actual time of reperfusion therapy yet scoring reperfusion remains operator-dependent and limited by scale properties. Here, a quantitative analysis was conducted to evaluate serial changes in perfusion during treatment.
Methods:
Angiography was analyzed from 118 acute MCA occlusion cases with attempted endovascular reperfusion at UPMC or UCLA. Parametric maps for MTT, TTP, Tmax, CBV, and CBF were extracted with perfusion angiography software (PerfAngio) from angiograms acquired at the time of treatment. Delta maps were created representing the serial change in perfusion parameters across treatment. Region of interest analysis (ROI) performed on the MCA distribution quantified the average change in perfusion.
Results:
Delta maps allowed for spatial characterization of the change in perfusion that occurs as a consequence of endovascular therapy as shown in the figure. ROI analysis performed for the first 35 cases demonstrated a wide variance in perfusion change ranging from 52% decrease in CBF to 476% increase in CBF.
Conclusions:
Serial changes extracted using perfusion angiography provide a quantitative, continuous measure of tissue reperfusion resulting from an endovascular therapy. Such perfusion data are more spatially informative and may be more amenable to statistical analysis than the standard categorical scale of reperfusion (TICI) following endovascular intervention.
Collapse
|
35
|
Kidwell CS, Jahan R, Gornbein J, Alger JR, Nenov V, Ajani Z, Feng L, Meyer BC, Olson S, Schwamm LH, Yoo AJ, Marshall RS, Meyer PM, Yavagal DR, Wintermark M, Norato G, Russell L, Hsieh C, Guzy J, Starkman S, Saver JL. Abstract T MP9: Analysis of MR RESCUE Dataset Employing DEFUSE 2 Target Mismatch Criteria for Defining Penumbra. Stroke 2014. [DOI: 10.1161/str.45.suppl_1.tmp9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
The MR RESCUE trial failed to show a benefit of endovascular therapy over standard medical care for first generation thrombectomy devices within 8 hours of onset of acute ischemic stroke. We now report a subset analysis of patients enrolled with MRI, employing DEFUSE 2 criteria to define favorable penumbral pattern (target mismatch) which differed from MR RESCUE penumbral prediction criteria.
Methods:
Patients with large vessel, anterior circulation strokes were randomized to mechanical embolectomy (Merci Retriever or Penumbra System) or standard care. Patients were categorized as having a favorable penumbral or non-penumbral pattern employing the DEFUSE 2 criteria for target mismatch ([Tmax > 6s / thresholded ADC < 600 х 10
−6
mm
2
/s] > 1.8, thresholded ADC < 70 cc, and Tmax > 10 s < 100 cc).
Results:
Among 118 total patients, 94 qualified for this analysis. Mean age was 65.8, mean time to enrollment 5.6 hours, median NIHSS 17, and 47% had target mismatch. Predicted core volume using DEFUSE 2 criteria (thresholded ADC volume < 600 х 10
−6
mm
2
/s) was 18.8 cc (target mismatch) and 64.3 cc (non-target mismatch; p<0.001). Revascularization in the embolectomy group was achieved in 62% (TICI 2a-3), and 21% (TICI 2b-3). Among all patients, mean 90-day mRS scores did not differ between embolectomy and standard care (3.8 vs 3.8; p=0.92). In patients with target mismatch, embolectomy was not superior to standard care (mean mRS 3.5 vs 3.3, p=0.78). Similarly, in patients without target mismatch, embolectomy was not superior (4.1 vs 4.3, p=0.67). Furthermore, there was no interaction between pretreatment penumbral imaging pattern employing DEFUSE 2 target mismatch criteria and treatment assignment in these 90-day mRS scores (p=0.11).
Conclusions:
In this analysis MR RESCUE patients enrolled with pretreatment MRI, use of the DEFUSE 2 criteria for target mismatch as a definition of penumbral pattern failed to identify a subset of patients with improved outcomes when treated with embolectomy. Further randomized, controlled studies employing new generation thrombectomy devices are needed to validate target mismatch as a selection criterion for acute stroke treatments.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Lei Feng
- Kaiser Permanente Med Cntr, Los Angeles, CA
| | | | | | - Lee H Schwamm
- Harvard Med Sch and Massachusetts General Hosp, Boston, MA
| | - Albert J Yoo
- Harvard Med Sch and Massachusetts General Hosp, Boston, MA
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Ng KL, Saver JL, Alger JR, Scalzo F, Salamon N, Yoo B, Starkman S, Ali LK, Rao N, Hinman J, Calderon-Arnulphi M, Modir R, Tansy A, Liang CW, Sheth SA, Noorian AR, Vespa P, Blanco MB, Jahan R, Vinuela F, Duckwiler GR, Tateshima S, Gonzalez N, Liebeskind DS. Abstract T P33: Collateral Grade on MRI - Validation With Conventional Angiography is Key. Stroke 2014. [DOI: 10.1161/str.45.suppl_1.tp33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Collateral status may predict outcomes after endovascular therapy, yet a reliable noninvasive technique prior to angiography is needed. We developed a novel method for projection of perfusion imaging data and validated it with respect to DSA acquired immediately afterwards.
Methods:
Consecutive acute ischemic stroke patients with M1 MCA occlusions with perfusion MR imaging prior to endovascular revascularization therapy were included. Collateral status on DSA was graded with the ASITN/SIR scale (0-4). 4-D dynamic susceptibility contrast concentration time images were constructed and projected in 2-D axial and sagittal planes at each time point. Independent review of the resulting MRI-based collateral sequences was conducted to generate a score analogous to the ASITN/SIR scale, followed by correlation studies between the two techniques.
Results:
47 patients were included with mean age 68.5 ± 16.3, 76.5% were female, baseline NIHSS was median 14 (range 3-31), and mean time from MRI to groin puncture was 109 min ± 95.5. DSA collateral grade was (0 (n=3); 1 (n=9); 2 (n=12); 3 (n=21); 4 (n=2)) with MRI collateral grade (0 (n=2); 1 (n=11); 2 (n=13); 3 (n=18); 4 (n=2)). MRI and DSA collateral scores were closely correlated, Spearman's rho = 0.91, weighted kappa = 0.82 (P <0.00001). Poor collateral status on MRI showed correlations with moderate to severe NIHSS (Spearman's rho = -0.31 (p< 0.039)). Figure depicts a panel version of MRI-based collateral sequences from a patient with a left M1 occlusion with a MR collateral grade of 1.
Conclusions:
Novel post-processing of noninvasive MRI perfusion data based on routine acquisitions can reliably measure the degree of collaterals on DSA.
Collapse
Affiliation(s)
- Kwan L Ng
- Neurology, UCLA Med Cntr, Los Angeles, CA
| | | | | | | | | | - Bryan Yoo
- Neuroradiology, UCLA Med Cntr, Los Angeles, CA
| | | | | | - Neal Rao
- Neurology, UCLA Med Cntr, Los Angeles, CA
| | | | | | | | | | | | | | | | - Paul Vespa
- Neurology, UCLA Med Cntr, Los Angeles, CA
| | | | - Reza Jahan
- Neurology, UCLA Med Cntr, Los Angeles, CA
| | | | | | | | | | | |
Collapse
|
37
|
Torgerson CM, Irimia A, Leow AD, Bartzokis G, Moody TD, Jennings RG, Alger JR, Van Horn JD, Altshuler LL. DTI tractography and white matter fiber tract characteristics in euthymic bipolar I patients and healthy control subjects. Brain Imaging Behav 2013; 7:129-39. [PMID: 23070746 DOI: 10.1007/s11682-012-9202-3] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
With the introduction of diffusion tensor imaging (DTI), structural differences in white matter (WM) architecture between psychiatric populations and healthy controls can be systematically observed and measured. In particular, DTI-tractography can be used to assess WM characteristics over the entire extent of WM tracts and aggregated fiber bundles. Using 64-direction DTI scanning in 27 participants with bipolar disorder (BD) and 26 age-and-gender-matched healthy control subjects, we compared relative length, density, and fractional anisotrophy (FA) of WM tracts involved in emotion regulation or theorized to be important neural components in BD neuropathology. We interactively isolated 22 known white matter tracts using region-of-interest placement (TrackVis software program) and then computed relative tract length, density, and integrity. BD subjects demonstrated significantly shorter WM tracts in the genu, body and splenium of the corpus callosum compared to healthy controls. Additionally, bipolar subjects exhibited reduced fiber density in the genu and body of the corpus callosum, and in the inferior longitudinal fasciculus bilaterally. In the left uncinate fasciculus, however, BD subjects exhibited significantly greater fiber density than healthy controls. There were no significant differences between groups in WM tract FA for those tracts that began and ended in the brain. The significance of differences in tract length and fiber density in BD is discussed.
Collapse
Affiliation(s)
- Carinna M Torgerson
- Laboratory of Neuro Imaging LONI, Department of Neurology, David Geffen School of Medicine, University of California Los Angeles, 635 Charles E. Young Dr. S, Los Angeles, CA 90095, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Hua X, Boyle CP, Harezlak J, Tate DF, Yiannoutsos CT, Cohen R, Schifitto G, Gongvatana A, Zhong J, Zhu T, Taylor MJ, Campbell TB, Daar ES, Alger JR, Singer E, Buchthal S, Toga AW, Navia B, Thompson PM. Disrupted cerebral metabolite levels and lower nadir CD4 + counts are linked to brain volume deficits in 210 HIV-infected patients on stable treatment. Neuroimage Clin 2013; 3:132-42. [PMID: 24179857 PMCID: PMC3791291 DOI: 10.1016/j.nicl.2013.07.009] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Revised: 07/03/2013] [Accepted: 07/25/2013] [Indexed: 12/18/2022]
Abstract
Cognitive impairment and brain injury are common in people with HIV/AIDS, even when viral replication is effectively suppressed with combined antiretroviral therapies (cART). Metabolic and structural abnormalities may promote cognitive decline, but we know little about how these measures relate in people on stable cART. Here we used tensor-based morphometry (TBM) to reveal the 3D profile of regional brain volume variations in 210 HIV + patients scanned with whole-brain MRI at 1.5 T (mean age: 48.6 ± 8.4 years; all receiving cART). We identified brain regions where the degree of atrophy was related to HIV clinical measures and cerebral metabolite levels assessed with magnetic resonance spectroscopy (MRS). Regional brain volume reduction was linked to lower nadir CD4 + count, with a 1–2% white matter volume reduction for each 25-point reduction in nadir CD4 +. Even so, brain volume measured by TBM showed no detectable association with current CD4 + count, AIDS Dementia Complex (ADC) stage, HIV RNA load in plasma or cerebrospinal fluid (CSF), duration of HIV infection, antiretroviral CNS penetration-effectiveness (CPE) scores, or years on cART, after controlling for demographic factors, and for multiple comparisons. Elevated glutamate and glutamine (Glx) and lower N-acetylaspartate (NAA) in the frontal white matter, basal ganglia, and mid frontal cortex — were associated with lower white matter, putamen and thalamus volumes, and ventricular and CSF space expansion. Reductions in brain volumes in the setting of chronic and stable disease are strongly linked to a history of immunosuppression, suggesting that delays in initiating cART may result in imminent and irreversible brain damage. We mapped the 3D pattern of brain abnormalities in 210 HIV patients on stable cART. Brain atrophy was linked to MRS metabolite disturbances reflecting neuronal injury. Lower nadir CD4 + count was associated with greater white matter atrophy.
Collapse
Affiliation(s)
- Xue Hua
- Imaging Genetics Center, Laboratory of Neuro Imaging, Dept. of Neurology, UCLA School of Medicine, Los Angeles, CA, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Wintermark M, Albers GW, Broderick JP, Demchuk AM, Fiebach JB, Fiehler J, Grotta JC, Houser G, Jovin TG, Lees KR, Lev MH, Liebeskind DS, Luby M, Muir KW, Parsons MW, von Kummer R, Wardlaw JM, Wu O, Yoo AJ, Alexandrov AV, Alger JR, Aviv RI, Bammer R, Baron JC, Calamante F, Campbell BCV, Carpenter TC, Christensen S, Copen WA, Derdeyn CP, Haley EC, Khatri P, Kudo K, Lansberg MG, Latour LL, Lee TY, Leigh R, Lin W, Lyden P, Mair G, Menon BK, Michel P, Mikulik R, Nogueira RG, Ostergaard L, Pedraza S, Riedel CH, Rowley HA, Sanelli PC, Sasaki M, Saver JL, Schaefer PW, Schellinger PD, Tsivgoulis G, Wechsler LR, White PM, Zaharchuk G, Zaidat OO, Davis SM, Donnan GA, Furlan AJ, Hacke W, Kang DW, Kidwell C, Thijs VN, Thomalla G, Warach SJ. Acute Stroke Imaging Research Roadmap II. Stroke 2013; 44:2628-39. [PMID: 23860298 DOI: 10.1161/strokeaha.113.002015] [Citation(s) in RCA: 139] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Max Wintermark
- Department of Radiology, University of Virginia, Charlottesville, VA, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Wang DJJ, Alger JR, Qiao JX, Gunther M, Pope WB, Saver JL, Salamon N, Liebeskind DS. Multi-delay multi-parametric arterial spin-labeled perfusion MRI in acute ischemic stroke - Comparison with dynamic susceptibility contrast enhanced perfusion imaging. Neuroimage Clin 2013; 3:1-7. [PMID: 24159561 PMCID: PMC3791289 DOI: 10.1016/j.nicl.2013.06.017] [Citation(s) in RCA: 151] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Revised: 06/26/2013] [Accepted: 06/26/2013] [Indexed: 11/12/2022]
Abstract
The purpose of the present study was to present a multi-delay multi-parametric pseudo-continuous arterial spin labeling (pCASL) protocol with background suppressed 3D GRASE (gradient and spin echo) readout for perfusion imaging in acute ischemic stroke. PCASL data at 4 post-labeling delay times (PLD = 1.5, 2, 2.5, 3 s) were acquired within 4.5 min in 24 patients (mean age 79.7 ± 11.4 years; 11 men) with acute middle cerebral artery (MCA) stroke who also underwent dynamic susceptibility contrast (DSC) enhanced perfusion imaging. Arterial transit times (ATT) were estimated through the calculation of weighted delays across the 4 PLDs, which were included in the calculation of cerebral blood flow (CBF) and arterial cerebral blood volume (CBV). Mean perfusion parameters derived using pCASL and DSC were measured within MCA territories and infarct regions identified on diffusion weighted MRI. The results showed highly significant correlations between pCASL and DSC CBF measurements (r > = 0.70, p < = 0.0001) and moderately significant correlations between pCASL and DSC CBV measurements (r > = 0.45, p < = 0.027) in both MCA territories and infarct regions. ASL ATT showed correlations with DSC time to the maximum of tissue residual function (Tmax)(r = 0.66, p = 0.0005) and mean transit time (MTT)(r = 0.59, p = 0.0023) in leptomeningeal MCA territories. The present study demonstrated the feasibility for noninvasive multi-parametric perfusion imaging using ASL for acute stroke imaging. A multi-delay multi-parametric pCASL GRASE protocol was developed. The pCASL protocol showed consistent results with DSC perfusion MRI in acute stroke patients. The capability for multi-parametric perfusion imaging using ASL offers numerous potentials.
Collapse
Affiliation(s)
- Danny J J Wang
- Department of Neurology, UCLA, Los Angeles, CA, USA ; Department of Radiology, UCLA, Los Angeles, CA, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Roy B, Gupta RK, Maudsley AA, Awasthi R, Sheriff S, Gu M, Husain N, Mohakud S, Behari S, Pandey CM, Rathore RKS, Spielman DM, Alger JR. Utility of multiparametric 3-T MRI for glioma characterization. Neuroradiology 2013; 55:603-13. [PMID: 23377234 PMCID: PMC4209475 DOI: 10.1007/s00234-013-1145-x] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Accepted: 01/21/2013] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Accurate grading of cerebral glioma using conventional structural imaging techniques remains challenging due to the relatively poor sensitivity and specificity of these methods. The purpose of this study was to evaluate the relative sensitivity and specificity of structural magnetic resonance imaging and MR measurements of perfusion, diffusion, and whole-brain spectroscopic parameters for glioma grading. METHODS Fifty-six patients with radiologically suspected untreated glioma were studied with T1- and T2-weighted MR imaging, dynamic contrast-enhanced MR imaging, diffusion tensor imaging, and volumetric whole-brain MR spectroscopic imaging. Receiver-operating characteristic analysis was performed using the relative cerebral blood volume (rCBV), apparent diffusion coefficient, fractional anisotropy, and multiple spectroscopic parameters to determine optimum thresholds for tumor grading and to obtain the sensitivity, specificity, and positive and negative predictive values for identifying high-grade gliomas. Logistic regression was performed to analyze all the parameters together. RESULTS The rCBV individually classified glioma as low and high grade with a sensitivity and specificity of 100 and 88 %, respectively, based on a threshold value of 3.34. On combining all parameters under consideration, the classification was achieved with 2 % error and sensitivity and specificity of 100 and 96 %, respectively. CONCLUSION Individually, CBV measurement provides the greatest diagnostic performance for predicting glioma grade; however, the most accurate classification can be achieved by combining all of the imaging parameters.
Collapse
Affiliation(s)
- Bhaswati Roy
- Department of Radiology & Imaging, Fortis Memorial Research Institute, Gurgaon, Haryana, India 122002
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Scalzo F, Alger JR, Hu X, Saver JL, Dani KA, Muir KW, Demchuk AM, Coutts SB, Luby M, Warach S, Liebeskind DS. Multi-center prediction of hemorrhagic transformation in acute ischemic stroke using permeability imaging features. Magn Reson Imaging 2013; 31:961-9. [PMID: 23587928 DOI: 10.1016/j.mri.2013.03.013] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Revised: 02/01/2013] [Accepted: 03/09/2013] [Indexed: 10/27/2022]
Abstract
Permeability images derived from magnetic resonance (MR) perfusion images are sensitive to blood-brain barrier derangement of the brain tissue and have been shown to correlate with subsequent development of hemorrhagic transformation (HT) in acute ischemic stroke. This paper presents a multi-center retrospective study that evaluates the predictive power in terms of HT of six permeability MRI measures including contrast slope (CS), final contrast (FC), maximum peak bolus concentration (MPB), peak bolus area (PB), relative recirculation (rR), and percentage recovery (%R). Dynamic T2*-weighted perfusion MR images were collected from 263 acute ischemic stroke patients from four medical centers. An essential aspect of this study is to exploit a classifier-based framework to automatically identify predictive patterns in the overall intensity distribution of the permeability maps. The model is based on normalized intensity histograms that are used as input features to the predictive model. Linear and nonlinear predictive models are evaluated using a cross-validation to measure generalization power on new patients and a comparative analysis is provided for the different types of parameters. Results demonstrate that perfusion imaging in acute ischemic stroke can predict HT with an average accuracy of more than 85% using a predictive model based on a nonlinear regression model. Results also indicate that the permeability feature based on the percentage of recovery performs significantly better than the other features. This novel model may be used to refine treatment decisions in acute stroke.
Collapse
Affiliation(s)
- Fabien Scalzo
- Department of Neurology, University of California, LA, USA.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Tafazoli S, O'Neill J, Bejjani A, Ly R, Salamon N, McCracken JT, Alger JR, Levitt JG. 1H MRSI of middle frontal gyrus in pediatric ADHD. J Psychiatr Res 2013; 47:505-12. [PMID: 23273650 PMCID: PMC3609653 DOI: 10.1016/j.jpsychires.2012.11.011] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Revised: 11/13/2012] [Accepted: 11/21/2012] [Indexed: 01/18/2023]
Abstract
Neuroimaging studies in multiple modalities have implicated the left or right dorsolateral prefrontal cortex (here, middle frontal gyrus) in attentional functions, in ADHD, and in dopamine agonist treatment of ADHD. The far lateral location of this cortex in the brain, however, has made it difficult to study with magnetic resonance spectroscopy (MRS). We used the smaller voxel sizes of the magnetic resonance spectroscopic imaging (MRSI) variant of MRS, acquired at a steep coronal-oblique angle to sample bilateral middle frontal gyrus in 13 children and adolescents with ADHD and 13 age- and sex-matched healthy controls. Within a subsample of the ADHD patients, aspects of attention were also assessed with the Trail Making Task. In right middle frontal gyrus only, mean levels of N-acetyl-aspartate + N-acetyl-aspartyl-glutamate (tNAA), creatine + phosphocreatine (Cr), choline-compounds (Cho), and myo-inositol (mI) were significantly lower in the ADHD than in the control sample. In the ADHD patients, lower right middle frontal Cr was associated with worse performance on Trails A and B (focused attention, concentration, set-shifting), while the opposite relationship held true for the control group on Trails B. These findings add to evidence implicating right middle frontal cortex in ADHD. Lower levels of these multiple species may reflect osmotic adjustment to elevated prefrontal cortical perfusion in ADHD and/or a previously hypothesized defect in astrocytic production of lactate in ADHD resulting in decelerated energetic metabolism (Cr), membrane synthesis (Cho, mI), and acetyl-CoA substrate for NAA synthesis. Lower Cr levels may indicate attentional or executive impairments.
Collapse
Affiliation(s)
- Sharwin Tafazoli
- Ahmanson-Lovelace Brain Mapping Center in the Department of Neurology, 660 Charles Young Dr. So. Los Angeles, CA 90095, USA
| | - Joseph O'Neill
- Division of Child & Adolescent Psychiatry, UCLA Semel Institute for Neuroscience and Human Behavior, 760 Westwood Plaza, Los Angeles, CA 90024, USA
| | - Anthony Bejjani
- Division of Child & Adolescent Psychiatry, UCLA Semel Institute for Neuroscience and Human Behavior, 760 Westwood Plaza, Los Angeles, CA 90024, USA
| | - Ronald Ly
- Division of Child & Adolescent Psychiatry, UCLA Semel Institute for Neuroscience and Human Behavior, 760 Westwood Plaza, Los Angeles, CA 90024, USA
| | - Noriko Salamon
- Department of Radiological Sciences, UCLA Medical Center, Box 951721, Los Angeles, CA 90095-1721, USA
| | - James T. McCracken
- Department of Radiological Sciences, UCLA Medical Center, Box 951721, Los Angeles, CA 90095-1721, USA
| | - Jeffry R. Alger
- Department of Radiological Sciences, UCLA Medical Center, Box 951721, Los Angeles, CA 90095-1721, USA,Interdepartmental Program in Biomedical Engineering, 5121 Engineering V, Los Angeles, CA 90095, USA
| | - Jennifer G. Levitt
- Division of Child & Adolescent Psychiatry, UCLA Semel Institute for Neuroscience and Human Behavior, 760 Westwood Plaza, Los Angeles, CA 90024, USA
| |
Collapse
|
44
|
Kidwell CS, Jahan R, Gornbein J, Alger JR, Nenov V, Ajani Z, Feng L, Meyer BC, Olson S, Schwamm LH, Yoo AJ, Marshall RS, Meyers PM, Yavagal DR, Wintermark M, Guzy J, Starkman S, Saver JL. A trial of imaging selection and endovascular treatment for ischemic stroke. N Engl J Med 2013; 368:914-23. [PMID: 23394476 PMCID: PMC3690785 DOI: 10.1056/nejmoa1212793] [Citation(s) in RCA: 992] [Impact Index Per Article: 90.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Whether brain imaging can identify patients who are most likely to benefit from therapies for acute ischemic stroke and whether endovascular thrombectomy improves clinical outcomes in such patients remains unclear. METHODS In this study, we randomly assigned patients within 8 hours after the onset of large-vessel, anterior-circulation strokes to undergo mechanical embolectomy (Merci Retriever or Penumbra System) or receive standard care. All patients underwent pretreatment computed tomography or magnetic resonance imaging of the brain. Randomization was stratified according to whether the patient had a favorable penumbral pattern (substantial salvageable tissue and small infarct core) or a nonpenumbral pattern (large core or small or absent penumbra). We assessed outcomes using the 90-day modified Rankin scale, ranging from 0 (no symptoms) to 6 (dead). RESULTS Among 118 eligible patients, the mean age was 65.5 years, the mean time to enrollment was 5.5 hours, and 58% had a favorable penumbral pattern. Revascularization in the embolectomy group was achieved in 67% of the patients. Ninety-day mortality was 21%, and the rate of symptomatic intracranial hemorrhage was 4%; neither rate differed across groups. Among all patients, mean scores on the modified Rankin scale did not differ between embolectomy and standard care (3.9 vs. 3.9, P=0.99). Embolectomy was not superior to standard care in patients with either a favorable penumbral pattern (mean score, 3.9 vs. 3.4; P=0.23) or a nonpenumbral pattern (mean score, 4.0 vs. 4.4; P=0.32). In the primary analysis of scores on the 90-day modified Rankin scale, there was no interaction between the pretreatment imaging pattern and treatment assignment (P=0.14). CONCLUSIONS A favorable penumbral pattern on neuroimaging did not identify patients who would differentially benefit from endovascular therapy for acute ischemic stroke, nor was embolectomy shown to be superior to standard care. (Funded by the National Institute of Neurological Disorders and Stroke; MR RESCUE ClinicalTrials.gov number, NCT00389467.).
Collapse
Affiliation(s)
- Chelsea S Kidwell
- Department of Neurology and the Stroke Center, Georgetown University, Washington, DC 20007, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Liebeskind DS, Scalzo F, Sanossian N, Starkman S, Johnson MS, Ali LK, Kim D, Vespa PM, Rao NM, Yallapragada A, Jahan R, Tateshima S, Gonzalez NR, Duckwiler GR, Viñuela F, Alger JR, Salamon N, Saver JL. Abstract TP35: Reperfusion? Angiography and Serial Perfusion MRI Reveal Distinct Features of Endovascular Therapy for Middle Cerebral Artery Stroke. Stroke 2013. [DOI: 10.1161/str.44.suppl_1.atp35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
TICI scores are routinely used to measure reperfusion on angiography after endovascular therapies for acute stroke. Reperfusion may also be quantified by Tmax parameter changes on serial perfusion MRI before and after treatment. Such definitions of reperfusion used in trials may vary and we therefore investigated the correlation between TICI and quantification of Tmax changes on serial MRI in proximal middle cerebral artery (MCA) stroke cases treated with endovascular therapy.
Methods:
Consecutive acute ischemic stroke patients treated with endovascular therapy for proximal or M1 MCA occlusions with serial perfusion MRI at baseline and 3-6 hours after treatment were analyzed. TICI scores were noted for reperfusion on angiography. Reperfusion on serial MRI was separately defined as interval volume of Tmax>6s lesion size, dichotomous change by > 70% reduction in Tmax>6s, and voxel-wise changes across all Tmax values.
Results:
57 stroke patients (mean age 64±20 years, 68% female) with M1 MCA occlusions imaged with perfusion MRI both before and after treatment with endovascular therapy were studied. TICI angiographic outcomes included 8 TICI 0, 4 TICI 1, 22 TICI 2a, 22 TICI 2b and 1 TICI 3. Both the interval volume of Tmax>6s lesion size and voxel-wise changes across all Tmax values varied extensively. Dichotomous reduction in Tmax>6s lesion volume by 70% was noted in only 12.9% of cases, with reduction by 60% in 19.4%, and by 50% in 30.6%. TICI reperfusion did not correlate with either: interval volume of Tmax>6s lesion size, dichotomous change by > 70% reduction in Tmax>6s, or voxel-wise changes across all Tmax values. Even when only TICI 2a/2b/3 or TICI 2b/3 cases were analyzed, no correlation could be established between the TICI angiographic measure of reperfusion at post-procedure with the change in Tmax lesion from baseline to 3-6 hours after revascularization.
Conclusions:
Reperfusion measured by TICI at angiography and changes in Tmax on serial perfusion MRI provide distinct information, likely reflecting heterogeneity and different vascular phases (arterial vs. microcirculation). Determining the clinical impact of such reperfusion measures on recovery after stroke remains paramount.
Collapse
|
46
|
Liebeskind DS, Qiao JX, Günther M, Scalzo F, Johnson MS, Starkman S, Ali LK, Kim D, Rao NM, Yallapragada A, Saver JL, Alger JR, Salamon N, Wang DJ. Abstract TP41: Arterial Spin-Labeled Perfusion MRI with Multi-Delay: Expanding Beyond CBF in Acute Ischemic Stroke. Stroke 2013. [DOI: 10.1161/str.44.suppl_1.atp41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Arterial spin-labeled (ASL) perfusion MRI can measure cerebral blood flow (CBF), yet the prolonged delays of collateral perfusion in acute ischemic stroke may impose limitations. Multiparametric maps of perfusion, including transit times and cerebral blood volume (CBV), may reveal important hemodynamic features before CBF collapse. We implemented a novel multi-delay ASL sequence to investigate multiparametric perfusion changes in acute stroke.
Methods:
Consecutive acute ischemic stroke patients admitted during an 8-month period were evaluated with pseudo-continuous ASL on Siemens 1.5 T and 3 T scanners within 12 hours of symptom onset. ASL was acquired using a 4-delay pCASL protocol with background suppressed 3D GRASE (postlabeling delay (PLD)=1.5/2/2.5/3s, FOV=22cm, matrix=64x64, 16x8mm slices, rate-2 GRAPPA, TE=22ms, 8 pairs of tag and control for each delay, total scan time 4min). After motion correction, arterial transit time (ATT), CBF, and arterial CBV (aCBV) maps were generated from the 4 PLDs.
Results:
A total of 161 ASL multi-delay perfusion MRI studies were performed in 130 acute ischemic stroke patients (mean age was 71±18 years and 56% were female). Repeated multi-delay ASL or serial studies were acquired in 19 cases, including 11 cases with 2 MRIs, 7 with 3, and 1 with 6 MRIs, depicting multiparametric blood flow changes after treatment. Correlation of multi-delay ASL (4 PLDs) and DSC MRI CBF asymmetry measures in MCA stroke patients (when available) was r=0.785 (p<0.001) and r=0.683 (p=0.003) for CBV measures with limited correlation for ATT.
Conclusions:
Multidelay ASL with 4 PLDs is feasible in the setting of acute stroke, providing multiparametric perfusion measures (CBF, CBV, ATT) of blood flow changes with treatment.
Collapse
|
47
|
Liebeskind DS, Sanossian N, Starkman S, Scalzo F, Alfonso R, Johnson MS, Ali LK, Kim D, Vespa PM, Rao NM, Yallapragada A, Alger JR, Salamon N, Saver JL. Abstract TP33: Early DWI Changes in the Thrombolysis Time Window: From DWI-Negative to Malignant Stroke in More than 300 Cases. Stroke 2013. [DOI: 10.1161/str.44.suppl_1.atp33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Thrombolysis for acute stroke is routinely based on time from last known well (TLKW) as the extent of ischemic injury during early epochs is assumed to be minimal. DWI is extremely sensitive, yet rarely acquired prior to thrombolysis and the nature of DWI lesions is largely unknown during this time window. Large or malignant strokes on DWI, however, result in poor outcome after thrombolysis. We retrospectively analyzed a large cohort of DWI acquired as part of a standard MRI protocol for triage of patients at a single center over 8 years.
Methods:
Consecutive patients with discharge diagnosis of ischemic stroke and documented time last known well to DWI MRI acquisition < 4.5 hours were identified. An imaging expert outlined DWI lesions on every axial slice for all MRIs to calculate corresponding lesion volumes as often-subtle changes may evade automated detection. Total DWI volumes were analyzed with respect to age, gender, TLKW and time of day.
Results:
307 stroke patients (mean age 69±17 years, 51% female) from 2004-2012 had DWI with TLKW < 4.5 hours (mean 147±62 min). DWI lesion volume (median 3.67cc) in each case varied extensively (TLKW-DWI < 1 hour (n=8) 0.40cc (0-93cc), 1-2 hours (n=126) 3.02 (0-265), 2-3 hours (n=78) 2.18 (0-103), 3-4.5 hours (n=95) 6.96 (0-227)). Only slight or negligible correlation (r=0.175, p=0.002) was noted between DWI lesion volume and TLKW-DWI time duration. DWI-negative findings < 4.5 hours occurred in 8.5% of stroke cases. Malignant strokes (>70cc) were noted in 7.5%. Older age was associated with DWI-negative strokes (mean 77 vs. 68 years, p=0.013). TLKW-DWI time duration was unrelated to DWI-negative strokes, yet malignant stroke was more common later (p=0.009). Interestingly, the majority of malignant strokes on DWI had TLKW during the daytime.
Conclusions:
DWI changes are extremely variable within 4.5 hours. Most lesions are small, yet malignant strokes are not uncommon. Further work should delineate the clinical determinants of these early malignant strokes to optimize outcomes in acute ischemic stroke.
Collapse
|
48
|
Hua X, Thompson PM, Leow AD, Madsen SK, Caplan R, Alger JR, O'Neill J, Joshi K, Smalley SL, Toga AW, Levitt JG. Brain growth rate abnormalities visualized in adolescents with autism. Hum Brain Mapp 2013; 34:425-36. [PMID: 22021093 PMCID: PMC4144412 DOI: 10.1002/hbm.21441] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2010] [Accepted: 07/27/2011] [Indexed: 11/10/2022] Open
Abstract
Autism spectrum disorder is a heterogeneous disorder of brain development with wide ranging cognitive deficits. Typically diagnosed before age 3, autism spectrum disorder is behaviorally defined but patients are thought to have protracted alterations in brain maturation. With longitudinal magnetic resonance imaging (MRI), we mapped an anomalous developmental trajectory of the brains of autistic compared with those of typically developing children and adolescents. Using tensor-based morphometry, we created 3D maps visualizing regional tissue growth rates based on longitudinal brain MRI scans of 13 autistic and seven typically developing boys (mean age/interscan interval: autism 12.0 ± 2.3 years/2.9 ± 0.9 years; control 12.3 ± 2.4/2.8 ± 0.8). The typically developing boys demonstrated strong whole brain white matter growth during this period, but the autistic boys showed abnormally slowed white matter development (P = 0.03, corrected), especially in the parietal (P = 0.008), temporal (P = 0.03), and occipital lobes (P = 0.02). We also visualized abnormal overgrowth in autism in gray matter structures such as the putamen and anterior cingulate cortex. Our findings reveal aberrant growth rates in brain regions implicated in social impairment, communication deficits and repetitive behaviors in autism, suggesting that growth rate abnormalities persist into adolescence. Tensor-based morphometry revealed persisting growth rate anomalies long after diagnosis, which has implications for evaluation of therapeutic effects.
Collapse
Affiliation(s)
- Xue Hua
- Laboratory of Neuro Imaging, University of California Los Angeles School of Medicine, Los Angeles, California
| | - Paul M. Thompson
- Laboratory of Neuro Imaging, University of California Los Angeles School of Medicine, Los Angeles, California
| | - Alex D. Leow
- Laboratory of Neuro Imaging, University of California Los Angeles School of Medicine, Los Angeles, California
- Semel Institute of Neuroscience, University of California Los Angeles School of Medicine, Los Angeles, California
| | - Sarah K. Madsen
- Laboratory of Neuro Imaging, University of California Los Angeles School of Medicine, Los Angeles, California
| | - Rochelle Caplan
- Department of Psychiatry and Biobehavioral Sciences, Division of Child Psychiatry, University of California Los Angeles School of Medicine, Los Angeles, California
| | - Jeffry R. Alger
- Ahmanson‐Lovelace Brain Mapping Center, Department of Neurology, University of California Los Angeles School of Medicine, Los Angeles, California
| | - Joseph O'Neill
- Department of Psychiatry and Biobehavioral Sciences, Division of Child Psychiatry, University of California Los Angeles School of Medicine, Los Angeles, California
| | - Kishori Joshi
- Department of Psychiatry and Biobehavioral Sciences, Division of Child Psychiatry, University of California Los Angeles School of Medicine, Los Angeles, California
| | - Susan L. Smalley
- Department of Psychiatry and Biobehavioral Sciences, Division of Child Psychiatry, University of California Los Angeles School of Medicine, Los Angeles, California
| | - Arthur W. Toga
- Laboratory of Neuro Imaging, University of California Los Angeles School of Medicine, Los Angeles, California
| | - Jennifer G. Levitt
- Department of Psychiatry and Biobehavioral Sciences, Division of Child Psychiatry, University of California Los Angeles School of Medicine, Los Angeles, California
| |
Collapse
|
49
|
Bartzokis G, Lu PH, Heydari P, Couvrette A, Lee GJ, Kalashyan G, Freeman F, Grinstead JW, Villablanca P, Finn JP, Mintz J, Alger JR, Altshuler LL. Multimodal magnetic resonance imaging assessment of white matter aging trajectories over the lifespan of healthy individuals. Biol Psychiatry 2012; 72:1026-34. [PMID: 23017471 DOI: 10.1016/j.biopsych.2012.07.010] [Citation(s) in RCA: 114] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2012] [Revised: 06/08/2012] [Accepted: 07/01/2012] [Indexed: 01/23/2023]
Abstract
BACKGROUND Postmortem and volumetric imaging data suggest that brain myelination is a dynamic lifelong process that, in vulnerable late-myelinating regions, peaks in middle age. We examined whether known regional differences in axon size and age at myelination influence the timing and rates of development and degeneration/repair trajectories of white matter (WM) microstructure biomarkers. METHODS Healthy subjects (n = 171) 14-93 years of age were examined with transverse relaxation rate (R(2)) and four diffusion tensor imaging measures (fractional anisotropy [FA] and radial, axial, and mean diffusivity [RD, AxD, MD, respectively]) of frontal lobe, genu, and splenium of the corpus callosum WM (FWM, GWM, and SWM, respectively). RESULTS Only R(2) reflected known levels of myelin content with high values in late-myelinating FWM and GWM regions and low ones in early-myelinating SWM. In FWM and GWM, all metrics except FA had significant quadratic components that peaked at different ages (R(2) < RD < MD < AxD), with FWM peaking later than GWM. Factor analysis revealed that, although they defined different factors, R(2) and RD were the metrics most closely associated with each other and differed from AxD, which entered into a third factor. CONCLUSIONS The R(2) and RD trajectories were most dynamic in late-myelinating regions and reflect age-related differences in myelination, whereas AxD reflects axonal size and extra-axonal space. The FA and MD had limited specificity. The data suggest that the healthy adult brain undergoes continual change driven by development and repair processes devoted to creating and maintaining synchronous function among neural networks on which optimal cognition and behavior depend.
Collapse
Affiliation(s)
- George Bartzokis
- Department of Psychiatry, The David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
50
|
Kidwell CS, Wintermark M, De Silva DA, Schaewe TJ, Jahan R, Starkman S, Jovin T, Hom J, Jumaa M, Schreier J, Gornbein J, Liebeskind DS, Alger JR, Saver JL. Multiparametric MRI and CT models of infarct core and favorable penumbral imaging patterns in acute ischemic stroke. Stroke 2012; 44:73-9. [PMID: 23233383 DOI: 10.1161/strokeaha.112.670034] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Objective imaging methods to identify optimal candidates for late recanalization therapies are needed. The study goals were (1) to develop magnetic resonance imaging (MRI) and computed tomography (CT) multiparametric, voxel-based predictive models of infarct core and penumbra in acute ischemic stroke patients, and (2) to develop patient-level imaging criteria for favorable penumbral pattern based on good clinical outcome in response to successful recanalization. METHODS An analysis of imaging and clinical data was performed on 2 cohorts of patients (one screened with CT, the other with MRI) who underwent successful treatment for large vessel, anterior circulation stroke. Subjects were divided 2:1 into derivation and validation cohorts. Pretreatment imaging parameters independently predicting final tissue infarct and final clinical outcome were identified. RESULTS The MRI and CT models were developed and validated from 34 and 32 patients, using 943 320 and 1 236 917 voxels, respectively. The derivation MRI and 2-branch CT models had an overall accuracy of 74% and 80%, respectively, and were independently validated with an accuracy of 71% and 79%, respectively. The imaging criteria of (1) predicted infarct core ≤90 mL and (2) ratio of predicted infarct tissue within the at-risk region ≤70% identified patients as having a favorable penumbral pattern with 78% to 100% accuracy. CONCLUSIONS Multiparametric voxel-based MRI and CT models were developed to predict the extent of infarct core and overall penumbral pattern status in patients with acute ischemic stroke who may be candidates for late recanalization therapies. These models provide an alternative approach to mismatch in predicting ultimate tissue fate.
Collapse
Affiliation(s)
- Chelsea S Kidwell
- Building D, Suite 150, Georgetown University, 4000 Reservoir Road NW, Washington, DC 20007, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|