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Preziosa P, Rocca MA, Filippi M. Radiologically isolated syndromes: to treat or not to treat? J Neurol 2024; 271:2370-2378. [PMID: 38502339 DOI: 10.1007/s00415-024-12294-4] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 02/29/2024] [Accepted: 02/29/2024] [Indexed: 03/21/2024]
Abstract
The widespread use of magnetic resonance imaging (MRI) has led to increased detection of individuals exhibiting asymptomatic brain and spinal cord lesions suggestive of multiple sclerosis (MS), defined as "radiologically isolated syndrome" (RIS). Specific criteria have been proposed and updated over time to identify individuals with RIS. Moreover, a younger age, the presence of infratentorial, spinal cord or gadolinium-enhancing lesions, as well as of cerebrospinal fluid-specific oligoclonal bands have been recognized as relevant risk factors for the occurrence of a first clinical event. Recent randomized controlled trials conducted in individuals with RIS have shown that dimethyl fumarate and teriflunomide significantly reduce the occurrence of clinical events in this population. These findings support the notion that early treatment initiation may positively influence the prognosis of these patients. However, several aspects should be taken into account before treating individuals with RIS in the real-world clinical setting, including an accurate identification of individuals with RIS to avoid misdiagnosis, a precise stratification of their risk of experiencing a first clinical event and further data supporting favorable balance between benefits and risks, even in the long term. This commentary provides an overview of the latest updates in RIS diagnosis, prognosis, and emerging treatment evidence.
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Affiliation(s)
- Paolo Preziosa
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Maria A Rocca
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy.
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy.
- Vita-Salute San Raffaele University, Milan, Italy.
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Guerrieri S, Rubin M, Gattuso I, Zanetta C, Genchi A, Preziosa P, Rocca MA, Filippi M, Moiola L. Can treatment adverse events be optimized by switching between different sphingosine 1-phosphate receptor modulators in multiple sclerosis? A case series. J Neurol 2024:10.1007/s00415-024-12342-z. [PMID: 38564055 DOI: 10.1007/s00415-024-12342-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 03/18/2024] [Accepted: 03/19/2024] [Indexed: 04/04/2024]
Affiliation(s)
- Simone Guerrieri
- Multiple Sclerosis Center, Neurology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
| | - Martina Rubin
- Multiple Sclerosis Center, Neurology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Irene Gattuso
- Multiple Sclerosis Center, Neurology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Chiara Zanetta
- Multiple Sclerosis Center, Neurology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
| | - Angela Genchi
- Multiple Sclerosis Center, Neurology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Paolo Preziosa
- Multiple Sclerosis Center, Neurology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Maria Assunta Rocca
- Multiple Sclerosis Center, Neurology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Massimo Filippi
- Multiple Sclerosis Center, Neurology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy.
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Vita-Salute San Raffaele University, Milan, Italy.
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Lucia Moiola
- Multiple Sclerosis Center, Neurology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
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Margoni M, Valsasina P, Bacchetti A, Mistri D, Preziosa P, Rocca MA, Filippi M. Resting state functional connectivity modifications in monoaminergic circuits underpin fatigue development in patients with multiple sclerosis. Mol Psychiatry 2024:10.1038/s41380-024-02532-6. [PMID: 38528072 DOI: 10.1038/s41380-024-02532-6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 03/13/2024] [Accepted: 03/13/2024] [Indexed: 03/27/2024]
Abstract
Dysregulation of monoaminergic networks might have a role in the pathogenesis of fatigue in multiple sclerosis (MS). We investigated longitudinal changes of resting state (RS) functional connectivity (FC) in monoaminergic networks and their association with the development of fatigue in MS. Eighty-nine MS patients and 49 age- and sex-matched healthy controls (HC) underwent neurological, fatigue, and RS functional MRI assessment at baseline and after a median follow-up of 1.3 years (interquartile range = 1.01-2.01 years). Monoaminergic-related RS FC was estimated with an independent component analysis constrained to PET atlases for dopamine (DA), noradrenaline (NA), and serotonin (5-HT) transporters. At baseline, 24 (27%) MS patients were fatigued (F) and 65 were not fatigued (NF). Of these, 22 (34%) developed fatigue (DEV-FAT) at follow-up and 43 remained not fatigued (NO-FAT). At baseline, F-MS patients showed increased monoaminergic-related RS FC in the caudate nucleus vs NF-MS and in the hippocampal, postcentral, temporal, and occipital cortices vs NF-MS and HC. Moreover, F-MS patients exhibited decreased RS FC in the frontal cortex vs NF-MS and HC, and in the thalamus vs NF-MS. During the follow-up, no RS FC changes were observed in HC. NO-FAT patients showed limited DA-related RS FC modifications, whereas DEV-FAT MS patients showed increased DA-related RS FC in the left hippocampus, significant at time-by-group interaction analysis. In the NA-related network, NO-FAT patients showed decreased RS FC over time in the left superior frontal gyrus. This region showed increased RS FC in both DEV-FAT and F-MS patients; this divergent behavior was significant at time-by-group interaction analysis. Finally, DEV-FAT MS patients presented increased 5-HT-related RS FC in the angular and middle occipital gyri, while this latter region showed decreased 5-HT-related RS FC during the follow-up in F-MS patients. In MS patients, distinct patterns of alterations were observed in monoaminergic networks based on their fatigue status. Fatigue was closely linked to specific changes in the basal ganglia and hippocampal, superior frontal, and middle occipital cortices.
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Affiliation(s)
- Monica Margoni
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paola Valsasina
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Anna Bacchetti
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Damiano Mistri
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Preziosa
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Maria A Rocca
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Vita-Salute San Raffaele University, Milan, Italy.
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy.
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Albergoni M, Pagani E, Preziosa P, Meani A, Margoni M, Rocca MA, Filippi M. Thalamic nuclei volume partially mediates the effects of aerobic capacity on fatigue in people with multiple sclerosis. J Neurol 2024:10.1007/s00415-024-12277-5. [PMID: 38507073 DOI: 10.1007/s00415-024-12277-5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 02/01/2024] [Accepted: 02/25/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND Fatigue is frequent in people with multiple sclerosis (pwMS) impacting physical and cognitive functions. Lower aerobic capacity and regional thalamic volume may be involved in the pathophysiology of fatigue in pwMS. OBJECTIVES To identify associations between thalamic nuclei volumes, aerobic capacity and fatigue and to investigate whether the influence of aerobic capacity on fatigue in pwMS is mediated by thalamic integrity. METHODS Eighty-three pwMS underwent a clinical evaluation with assessment of fatigue (Modified Fatigue Impact Scale [MFIS]), including physical (pMFIS) and cognitive (cMFIS) components, and peak of oxygen uptake (VO2peak). PwMS and 63 sex- and age-matched healthy controls (HC) underwent a 3 T brain MRI to quantify volume of the whole thalamus and its nuclei. RESULTS Compared to HC, pwMS showed higher global MFIS, pMFIS and cMFIS scores, and lower VO2peak and thalamic volumes (p < 0.001). In pwMS, higher VO2peak was significantly associated with lower MFIS and pMFIS scores (r value = - 0.326 and - 0.356; pFDR ≤ 0.046) and higher laterodorsal thalamic nucleus (Dor) cluster volume (r value = 0.300; pFDR = 0.047). Moreover, lower Dor thalamic cluster volume was significantly associated with higher MFIS, pMFIS and cMFIS scores (r value range = - 0.305; - 0.293; pFDR ≤ 0.049). The volume of Dor thalamic cluster partially mediated the positive effects of VO2peak on both MFIS and cMFIS, with relative indirect effects of 21% and 32% respectively. No mediation was found for pMFIS. CONCLUSIONS Higher VO2peak is associated with lower fatigue in pwMS, likely acting on Dor thalamic cluster volume integrity. Such an effect might be different according to the type of fatigue (cognitive or physical).
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Affiliation(s)
- Matteo Albergoni
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
| | - Elisabetta Pagani
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
| | - Paolo Preziosa
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Alessandro Meani
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
| | - Monica Margoni
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria A Rocca
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy.
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Vita-Salute San Raffaele University, Milan, Italy.
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy.
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Preziosa P, Pagani E, Meani A, Storelli L, Margoni M, Yudin Y, Tedone N, Biondi D, Rubin M, Rocca MA, Filippi M. Chronic Active Lesions and Larger Choroid Plexus Explain Cognition and Fatigue in Multiple Sclerosis. Neurol Neuroimmunol Neuroinflamm 2024; 11:e200205. [PMID: 38350048 DOI: 10.1212/nxi.0000000000200205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 12/18/2023] [Indexed: 02/15/2024]
Abstract
BACKGROUND AND OBJECTIVES Chronic inflammation may contribute to cognitive dysfunction and fatigue in patients with multiple sclerosis (MS). Paramagnetic rim lesions (PRLs) and choroid plexus (CP) enlargement have been proposed as markers of chronic inflammation in MS being associated with a more severe disease course. However, their relation with cognitive impairment and fatigue has not been fully explored yet. Here, we investigated the contribution of PRL number and volume and CP enlargement to cognitive impairment and fatigue in patients with MS. METHODS Brain 3T MRI, neurologic evaluation, and neuropsychological assessment, including the Brief Repeatable Battery of Neuropsychological Tests and Modified Fatigue Impact Scale, were obtained from 129 patients with MS and 73 age-matched and sex-matched healthy controls (HC). PRLs were identified on phase images of susceptibility-weighted imaging, whereas CP volume was quantified using a fully automatic method on brain three-dimensional T1-weighted and fluid-attenuated inversion recovery MRI sequences. Predictors of cognitive impairment and fatigue were identified using random forest. RESULTS Thirty-six (27.9%) patients with MS were cognitively impaired, and 31/113 (27.4%) patients had fatigue. Fifty-nine (45.7%) patients with MS had ≥1 PRLs (median = 0, interquartile range = 0;2). Compared with HC, patients with MS showed significantly higher T2-hyperintense white matter lesion (WM) volume; lower normalized brain, thalamic, hippocampal, caudate, cortical, and WM volumes; and higher normalized CP volume (p from <0.001 to 0.040). The predictors of cognitive impairment (relative importance) (out-of-bag area under the curve [OOB-AUC] = 0.707) were normalized brain volume (100%), normalized caudate volume (89.1%), normalized CP volume (80.3%), normalized cortical volume (70.3%), number (67.3%) and volume (66.7%) of PRLs, and T2-hyperintense WM lesion volume (64.0%). Normalized CP volume was the only predictor of the presence of fatigue (OOB-AUC = 0.563). DISCUSSION Chronic inflammation, with higher number and volume of PRLs and enlarged CP, may contribute to cognitive impairment in MS in addition to gray matter atrophy. The contribution of enlarged CP in explaining fatigue supports the relevance of immune-related processes in determining this manifestation independently of disease severity. PRLs and CP enlargement may contribute to the pathophysiology of cognitive impairment and fatigue in MS, and they may represent clinically relevant therapeutic targets to limit the impact of these clinical manifestations in MS.
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Affiliation(s)
- Paolo Preziosa
- From the Neuroimaging Research Unit (P.P., E.P., A.M., L.S., M.M., Y.Y., N.T., D.B., M.R., M.A.R., M.F.), Division of Neuroscience; Neurology Unit (P.P., M.M., M.R., M.A.R., M.F.), IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (P.P., M.R., M.A.R., M.F.); Neurorehabilitation Unit (M.M., M.F.); and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Elisabetta Pagani
- From the Neuroimaging Research Unit (P.P., E.P., A.M., L.S., M.M., Y.Y., N.T., D.B., M.R., M.A.R., M.F.), Division of Neuroscience; Neurology Unit (P.P., M.M., M.R., M.A.R., M.F.), IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (P.P., M.R., M.A.R., M.F.); Neurorehabilitation Unit (M.M., M.F.); and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alessandro Meani
- From the Neuroimaging Research Unit (P.P., E.P., A.M., L.S., M.M., Y.Y., N.T., D.B., M.R., M.A.R., M.F.), Division of Neuroscience; Neurology Unit (P.P., M.M., M.R., M.A.R., M.F.), IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (P.P., M.R., M.A.R., M.F.); Neurorehabilitation Unit (M.M., M.F.); and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Loredana Storelli
- From the Neuroimaging Research Unit (P.P., E.P., A.M., L.S., M.M., Y.Y., N.T., D.B., M.R., M.A.R., M.F.), Division of Neuroscience; Neurology Unit (P.P., M.M., M.R., M.A.R., M.F.), IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (P.P., M.R., M.A.R., M.F.); Neurorehabilitation Unit (M.M., M.F.); and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Monica Margoni
- From the Neuroimaging Research Unit (P.P., E.P., A.M., L.S., M.M., Y.Y., N.T., D.B., M.R., M.A.R., M.F.), Division of Neuroscience; Neurology Unit (P.P., M.M., M.R., M.A.R., M.F.), IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (P.P., M.R., M.A.R., M.F.); Neurorehabilitation Unit (M.M., M.F.); and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Yury Yudin
- From the Neuroimaging Research Unit (P.P., E.P., A.M., L.S., M.M., Y.Y., N.T., D.B., M.R., M.A.R., M.F.), Division of Neuroscience; Neurology Unit (P.P., M.M., M.R., M.A.R., M.F.), IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (P.P., M.R., M.A.R., M.F.); Neurorehabilitation Unit (M.M., M.F.); and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Nicolò Tedone
- From the Neuroimaging Research Unit (P.P., E.P., A.M., L.S., M.M., Y.Y., N.T., D.B., M.R., M.A.R., M.F.), Division of Neuroscience; Neurology Unit (P.P., M.M., M.R., M.A.R., M.F.), IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (P.P., M.R., M.A.R., M.F.); Neurorehabilitation Unit (M.M., M.F.); and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Diana Biondi
- From the Neuroimaging Research Unit (P.P., E.P., A.M., L.S., M.M., Y.Y., N.T., D.B., M.R., M.A.R., M.F.), Division of Neuroscience; Neurology Unit (P.P., M.M., M.R., M.A.R., M.F.), IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (P.P., M.R., M.A.R., M.F.); Neurorehabilitation Unit (M.M., M.F.); and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Martina Rubin
- From the Neuroimaging Research Unit (P.P., E.P., A.M., L.S., M.M., Y.Y., N.T., D.B., M.R., M.A.R., M.F.), Division of Neuroscience; Neurology Unit (P.P., M.M., M.R., M.A.R., M.F.), IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (P.P., M.R., M.A.R., M.F.); Neurorehabilitation Unit (M.M., M.F.); and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria A Rocca
- From the Neuroimaging Research Unit (P.P., E.P., A.M., L.S., M.M., Y.Y., N.T., D.B., M.R., M.A.R., M.F.), Division of Neuroscience; Neurology Unit (P.P., M.M., M.R., M.A.R., M.F.), IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (P.P., M.R., M.A.R., M.F.); Neurorehabilitation Unit (M.M., M.F.); and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Filippi
- From the Neuroimaging Research Unit (P.P., E.P., A.M., L.S., M.M., Y.Y., N.T., D.B., M.R., M.A.R., M.F.), Division of Neuroscience; Neurology Unit (P.P., M.M., M.R., M.A.R., M.F.), IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (P.P., M.R., M.A.R., M.F.); Neurorehabilitation Unit (M.M., M.F.); and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy
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Rocca MA, Preziosa P, Filippi M. Juxtacortical Paramagnetic Rim: A New MRI Marker to Characterize Focal Cortical Pathology in Multiple Sclerosis? Neurology 2024; 102:e208085. [PMID: 38165304 DOI: 10.1212/wnl.0000000000208085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 11/09/2023] [Indexed: 01/03/2024] Open
Abstract
The accumulation of focal white matter and cortical inflammatory demyelinating lesions represents the pathologic hallmark of multiple sclerosis (MS).1 Typically, acute white matter lesions are characterized by an increased blood-brain barrier (BBB) permeability, an inflammatory infiltrate, and ongoing demyelination and axonal transection.2 In the chronic phase, a substantial proportion of white matter lesions, known as chronic active lesions, exhibit a hypocellular core with a rim of iron-laden activated microglia/macrophages, with no abnormal BBB permeability.2 Some of these lesions can be identified on susceptibility-based MRI as exhibiting a paramagnetic rim, and they are, therefore, referred to as "paramagnetic rim lesions" (PRLs).3.
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Affiliation(s)
- Maria A Rocca
- From the Neuroimaging Research Unit (M.A.R., P.P., M.F.), Division of Neuroscience; Neurology Unit (M.A.R., P.P., M.F.), IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (M.A.R., P.P., M.F.); Neurorehabilitation Unit (M.F.); and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Preziosa
- From the Neuroimaging Research Unit (M.A.R., P.P., M.F.), Division of Neuroscience; Neurology Unit (M.A.R., P.P., M.F.), IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (M.A.R., P.P., M.F.); Neurorehabilitation Unit (M.F.); and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Filippi
- From the Neuroimaging Research Unit (M.A.R., P.P., M.F.), Division of Neuroscience; Neurology Unit (M.A.R., P.P., M.F.), IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (M.A.R., P.P., M.F.); Neurorehabilitation Unit (M.F.); and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy
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Preziosa P, Storelli L, Tedone N, Margoni M, Mistri D, Azzimonti M, Filippi M, Rocca MA. Spatial correspondence among regional gene expressions and gray matter volume loss in multiple sclerosis. Mol Psychiatry 2024:10.1038/s41380-024-02452-5. [PMID: 38326561 DOI: 10.1038/s41380-024-02452-5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 01/22/2024] [Accepted: 01/23/2024] [Indexed: 02/09/2024]
Abstract
In multiple sclerosis (MS), a non-random and clinically relevant pattern of gray matter (GM) volume loss has been described. Whether differences in regional gene expression might underlay distinctive pathological processes contributing to this regional variability has not been explored yet. Two hundred eighty-six MS patients and 172 healthy controls (HC) underwent a brain 3T MRI, a complete neurological evaluation and a neuropsychological assessment. Using Allen Human Brain Atlas, voxel-based morphometry and MENGA platform, we integrated brain transcriptome and neuroimaging data to explore the spatial cross-correlations between regional GM volume loss and expressions of 2710 genes involved in MS (p < 0.05, family-wise error-corrected). Enrichment analyses were performed to evaluate overrepresented molecular functions, biological processes and cellular components involving genes significantly associated with voxel-based morphometry-derived GM maps (p < 0.05, Bonferroni-corrected). A diffuse GM volume loss was found in MS patients compared to HC and it was spatially correlated with 74 genes involved in GABA neurotransmission and mitochondrial oxidoreductase activity mainly expressed in neurons and astrocytes. A more severe GM volume loss was spatially associated, in more disabled MS patients, with 44 genes involved in mitochondrial integrity of all resident cells of the central nervous system (CNS) and, in cognitively impaired MS patients, with 64 genes involved in mitochondrial protein heterodimerization and oxidoreductase activities expressed also in microglia and endothelial cells. Specific differences in the expressions of genes involved in synaptic GABA receptor activities and mitochondrial functions in resident CNS cells may influence regional susceptibility to MS-related excitatory/inhibitory imbalance and oxidative stress, and subsequently, to GM volume loss.
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Affiliation(s)
- Paolo Preziosa
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Loredana Storelli
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Nicolò Tedone
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Monica Margoni
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Damiano Mistri
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Matteo Azzimonti
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria A Rocca
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Vita-Salute San Raffaele University, Milan, Italy.
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8
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Ruggieri S, Prosperini L, Al-Araji S, Annovazzi PO, Bisecco A, Ciccarelli O, De Stefano N, Filippi M, Fleischer V, Evangelou N, Enzinger C, Gallo A, Garjani A, Groppa S, Haggiag S, Khalil M, Lucchini M, Mirabella M, Montalban X, Pozzilli C, Preziosa P, Río J, Rocca MA, Rovira A, Stromillo ML, Zaffaroni M, Tortorella C, Gasperini C. Assessing treatment response to oral drugs for multiple sclerosis in real-world setting: a MAGNIMS Study. J Neurol Neurosurg Psychiatry 2024; 95:142-150. [PMID: 37775266 DOI: 10.1136/jnnp-2023-331920] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 08/09/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND The assessment of treatment response is a crucial step for patients with relapsing-remitting multiple sclerosis on disease-modifying therapies (DMTs). We explored whether a scoring system developed within the MAGNIMS (MRI in Multiple Sclerosis) network to evaluate treatment response to injectable drugs can be adopted also to oral DMTs. METHODS A multicentre dataset of 1200 patients who started three oral DMTs (fingolimod, teriflunomide and dimethyl fumarate) was collected within the MAGNIMS network. Disease activity after the first year was classified by the 'MAGNIMS' score based on the combination of relapses (0-≥2) and/or new T2 lesions (<3 or ≥3) on brain MRI. We explored the association of this score with the following 3-year outcomes: (1) confirmed disability worsening (CDW); (2) treatment failure (TFL); (3) relapse count between years 1 and 3. The additional value of contrast-enhancing lesions (CELs) and lesion location was explored. RESULTS At 3 years, 160 patients experienced CDW: 12% of them scored '0' (reference), 18% scored '1' (HR=1.82, 95% CI 1.20 to 2.76, p=0.005) and 37% scored '2' (HR=2.74, 95% CI 1.41 to 5.36, p=0.003) at 1 year. The analysis of other outcomes provided similar findings. Considering the location of new T2 lesions (supratentorial vs infratentorial/spinal cord) and the presence of CELs improved the prediction of CDW and TFL, respectively, in patients with minimal MRI activity alone (one or two new T2 lesions). CONCLUSIONS Early relapses and substantial MRI activity in the first year of treatment are associated with worse short-term outcomes in patients treated with some of the oral DMTs.
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Affiliation(s)
- Serena Ruggieri
- Department of Neurosciences, San Camillo Forlanini Hospital, Rome, Italy
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Luca Prosperini
- Department of Neurosciences, San Camillo Forlanini Hospital, Rome, Italy
| | - Sarmad Al-Araji
- Department of Neuroinflammation, Queen Square MS Centre, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
| | - Pietro Osvaldo Annovazzi
- Neuroimmunology Unit-Multiple Sclerosis Center, Hospital of Gallarate, ASST della Valle Olona, Gallarate, Italy
| | - Alvino Bisecco
- Department of Advanced Medical and Surgical Sciences, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Olga Ciccarelli
- Department of Neuroinflammation, Queen Square MS Centre, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
- National Institute for Health Research Biomedical Research Centre, University College London Hospitals, London, UK
| | - Nicola De Stefano
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Massimo Filippi
- Neurology Unit and Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Vinzenz Fleischer
- Department of Neurology and Neuroimaging Center (NIC) of the Focus Program Translational Neuroscience (FTN), University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Nikos Evangelou
- Mental Health & Clinical Neuroscience Unit, University of Nottingham, Nottingham, UK
- Department of Neurology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Christian Enzinger
- Department of Neurology, Medical University of Graz, Graz, Austria
- Department of Radiology (Division of Neuroradiology, Vascular and Interventional Radiology), Medical University of Graz, Graz, Austria
| | - Antonio Gallo
- Department of Advanced Medical and Surgical Sciences, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Afagh Garjani
- Mental Health & Clinical Neuroscience Unit, University of Nottingham, Nottingham, UK
- Department of Neurology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Sergiu Groppa
- Department of Neurology and Neuroimaging Center (NIC) of the Focus Program Translational Neuroscience (FTN), University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Shalom Haggiag
- Department of Neurosciences, San Camillo Forlanini Hospital, Rome, Italy
| | - Michael Khalil
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Matteo Lucchini
- Multiple Sclerosis Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Centro di ricerca Sclerosi Multipla (CERSM), Università Cattolica del Sacro Cuore, Rome, Italy
| | - Massimiliano Mirabella
- Multiple Sclerosis Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Centro di ricerca Sclerosi Multipla (CERSM), Università Cattolica del Sacro Cuore, Rome, Italy
| | - Xavier Montalban
- Centre d'Esclerosi Multiple de Catalunya (Cemcat), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Carlo Pozzilli
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Paolo Preziosa
- Neurology Unit and Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Jordi Río
- Centre d'Esclerosi Multiple de Catalunya (Cemcat), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Maria A Rocca
- Neurology Unit and Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Alex Rovira
- Section of Neuroradiology, Department of Radiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Maria L Stromillo
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Mauro Zaffaroni
- Neuroimmunology Unit-Multiple Sclerosis Center, Hospital of Gallarate, ASST della Valle Olona, Gallarate, Italy
| | - Carla Tortorella
- Department of Neurosciences, San Camillo Forlanini Hospital, Rome, Italy
| | - Claudio Gasperini
- Department of Neurosciences, San Camillo Forlanini Hospital, Rome, Italy
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9
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Morozumi T, Preziosa P, Meani A, Albergoni M, Margoni M, Pagani E, Filippi M, Rocca MA. Influence of cardiorespiratory fitness and MRI measures of neuroinflammation on hippocampal volume in multiple sclerosis. J Neurol Neurosurg Psychiatry 2023; 95:29-36. [PMID: 37468307 DOI: 10.1136/jnnp-2023-331482] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 03/15/2023] [Accepted: 07/10/2023] [Indexed: 07/21/2023]
Abstract
BACKGROUND The hippocampus is a clinically relevant region where neurogenesis and neuroplasticity occur throughout the whole lifespan. Neuroinflammation and cardiorespiratory fitness (CRF) may influence hippocampal integrity by modulating the processes promoting neurogenesis and neuroprotection that contribute to the preservation of functions. This study aimed to investigate the effects of neuroinflammation and CRF on hippocampal volume in multiple sclerosis (MS) patients with relapsing-remitting (RR) and progressive (P) clinical phenotypes. The influence of neuroinflammation and CRF on brain, grey matter (GM) and thalamic volumes was also assessed to determine whether the effects were specific for the hippocampus. METHOD Brain 3T structural MRI scans and maximum oxygen consumption (VO2max), a proxy of CRF, were acquired from 81 MS patients (27 RR and 54 P) and 45 age-matched and sex-matched healthy controls. T2-hyperintense white matter lesion volume (T2-LV) and choroid plexuses volume (CPV) were quantified as neuroinflammatory measures. Associations of demographic, clinical, neuroinflammatory and CRF measures with normalised brain, GM, hippocampal and thalamic volumes in relapsing-remitting MS (RRMS) and progressive MS patients were assessed using Shapley and best subset selection regression. RESULTS For most volumetric measures, the largest portions of variance were explained by T2-LV (variable importance (VI)=9.4-39.4) and CPV (VI=4.5-26.2). VO2max explained the largest portion of variance of normalised hippocampal volume only in RRMS patients (VI=16.9) and was retained as relevant predictor (standardised β=0.374, p=0.023) with T2-LV (standardised β=-0.330, p=0.016). CONCLUSIONS A higher CRF may play a specific neuroprotective role on MS patients' hippocampal integrity, but only in the RR phase of the disease.
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Affiliation(s)
- Tetsu Morozumi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milano, Italy
| | - Paolo Preziosa
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milano, Italy
- Vita-Salute San Raffaele University, Milano, Italy
- Neurology Unit, IRCCS Ospedale San Raffaele, Milano, Italy
| | - Alessandro Meani
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milano, Italy
| | - Matteo Albergoni
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milano, Italy
| | - Monica Margoni
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milano, Italy
| | - Elisabetta Pagani
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milano, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milano, Italy
- Vita-Salute San Raffaele University, Milano, Italy
- Neurology Unit, IRCCS Ospedale San Raffaele, Milano, Italy
- Neurorehabilitation Unit, IRCCS Ospedale San Raffaele, Milano, Italy
- Neurophysiology Service, IRCCS Ospedale San Raffaele, Milano, Italy
| | - Maria A Rocca
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milano, Italy
- Vita-Salute San Raffaele University, Milano, Italy
- Neurology Unit, IRCCS Ospedale San Raffaele, Milano, Italy
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10
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Gueye M, Preziosa P, Ramirez GA, Bozzolo EP, Canti V, Margoni M, Meani A, Moiola L, Rovere-Querini P, Manfredi AA, Filippi M, Rocca MA. Choroid plexus and perivascular space enlargement in neuropsychiatric systemic lupus erythematosus. Mol Psychiatry 2023:10.1038/s41380-023-02332-4. [PMID: 38036603 DOI: 10.1038/s41380-023-02332-4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 11/08/2023] [Accepted: 11/15/2023] [Indexed: 12/02/2023]
Abstract
Choroid plexus (CP) enlargement is proposed as a marker of neuroinflammation in immune-mediated conditions. CP involvement has also been hypothesized in the immunopathology of systemic lupus erythematosus (SLE). We investigated whether CP enlargement occurs in SLE patients and its association with neuropsychiatric involvement. Additionally, we explored abnormalities along the glymphatic system in SLE patients through enlarged perivascular space (PVS) quantification. Clinical assessment and 3 Tesla brain dual-echo and T1-weighted MRI scans were obtained from 32 SLE patients and 32 sex and age-matched healthy controls (HC). CPs were manually segmented on 3D T1-weighted sequence and enlarged PVS (ePVS) were assessed through Potter's score. Compared to HC, SLE patients showed higher normalized CP volume (nCPV) (p = 0.023), with higher CP enlargement in neuropsychiatric SLE (NPSLE) (n = 12) vs. non-NPSLE (p = 0.027) patients. SLE patients with antiphospholipid antibodies (APA) positivity (n = 18) had higher nCPV compared to HC (p = 0.012), while APA negative ones did not. SLE patients also had higher Potter's score than HC (p < 0.001), with a tendency towards a higher number of basal ganglia ePVS in NPSLE vs. non-NPSLE patients. Using a random forest analysis, nCPV emerged as a significant predictor of NPSLE, together with T2-hyperintense white matter (WM) lesion volume (LV) and APA positivity (out-of-bag AUC 0.81). Our findings support the hypothesis of a role exerted by the CP in SLE physiopathology, especially in patients with neuropsychiatric involvement. The higher prevalence of ePVS in SLE patients, compared to HC, suggests the presence of glymphatic system impairment in this population.
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Affiliation(s)
- Mor Gueye
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Preziosa
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Giuseppe A Ramirez
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases & Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Enrica P Bozzolo
- Unit of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Valentina Canti
- Unit of Internal Medicine & Division of Immunology, Transplantation and Infectious diseases, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Monica Margoni
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alessandro Meani
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Lucia Moiola
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Patrizia Rovere-Querini
- Vita-Salute San Raffaele University, Milan, Italy
- Unit of Internal Medicine & Division of Immunology, Transplantation and Infectious diseases, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Angelo A Manfredi
- Vita-Salute San Raffaele University, Milan, Italy
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases & Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria A Rocca
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Vita-Salute San Raffaele University, Milan, Italy.
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11
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Bonacchi R, Valsasina P, Pagani E, Meani A, Preziosa P, Rocca MA, Filippi M. Sex-related differences in upper limb motor function in healthy subjects and multiple sclerosis patients: a multiparametric MRI study. J Neurol 2023; 270:5235-5250. [PMID: 37639018 DOI: 10.1007/s00415-023-11948-z] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 08/16/2023] [Accepted: 08/17/2023] [Indexed: 08/29/2023]
Abstract
BACKGROUND We investigated sex-related differences in upper limb motor performance tested with the 9-Hole Peg Test (9HPT) in healthy controls (HC) and multiple sclerosis (MS) patients and their MRI substrates. MATERIALS AND METHODS We enrolled 94 HC and 133 MS patients, who underwent neurological examination, 9HPT and brain 3T MRI, with sequences for regional grey matter volume (GMV), white matter (WM) fractional anisotropy (FA) and resting state (RS) functional connectivity (FC) analysis. Associations between MRI variables and 9HPT performance were analyzed with general linear models. RESULTS 9HPT performance was better in HC vs MS patients, and in female vs male HC. Regional GMV analysis showed: associations between better 9HPT performance and higher GMV in motor and cognitive cortical areas in HC, with stronger positive correlations in females vs males. In MS, worse 9HPT performance correlated with lower volume in motor and cognitive areas. Sex-related differences were minimal and mostly found in cerebellar areas. WM FA analysis disclosed neither associations with 9HPT performance in HC, nor sex-related differences in MS. RS FC analysis showed: in the sensorimotor network, stronger associations of RS FC with 9HPT performance in female vs male HC and no sex-related differences in MS; in the cerebellar network, no sex-related differences in HC but stronger negative correlation in left cerebellum in male vs female MS patients. CONCLUSIONS Sex influences 9HPT performance in HC, mainly through differences in volume and RS FC of motor and cognitive areas. Sex-related effects on motor performance become secondary but still present in MS.
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Affiliation(s)
- Raffaello Bonacchi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Paola Valsasina
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
| | - Elisabetta Pagani
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
| | - Alessandro Meani
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
| | - Paolo Preziosa
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria A Rocca
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy.
- Vita-Salute San Raffaele University, Milan, Italy.
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy.
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12
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Margoni M, Preziosa P, Storelli L, Gueye M, Moiola L, Filippi M, Rocca MA. Paramagnetic rim and core sign lesions in paediatric multiple sclerosis patients. J Neurol Neurosurg Psychiatry 2023; 94:873-876. [PMID: 36990675 DOI: 10.1136/jnnp-2022-331027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 03/20/2023] [Indexed: 03/31/2023]
Affiliation(s)
- Monica Margoni
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milano, Italy
- Neurology Unit, IRCCS Ospedale San Raffaele, Milano, Italy
| | - Paolo Preziosa
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milano, Italy
- Neurology Unit, IRCCS Ospedale San Raffaele, Milano, Italy
- Vita-Salute San Raffaele University, Milano, Italy
| | - Loredana Storelli
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milano, Italy
| | - Mor Gueye
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milano, Italy
- Neurology Unit, IRCCS Ospedale San Raffaele, Milano, Italy
| | - Lucia Moiola
- Neurology Unit, IRCCS Ospedale San Raffaele, Milano, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milano, Italy
- Neurology Unit, IRCCS Ospedale San Raffaele, Milano, Italy
- Vita-Salute San Raffaele University, Milano, Italy
- Neurorehabilitation Unit, IRCCS Ospedale San Raffaele, Milano, Italy
- Neurophysiology Service, IRCCS Ospedale San Raffaele, Milano, Italy
| | - Maria A Rocca
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milano, Italy
- Neurology Unit, IRCCS Ospedale San Raffaele, Milano, Italy
- Vita-Salute San Raffaele University, Milano, Italy
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13
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Azzimonti M, Preziosa P, Pagani E, Valsasina P, Tedone N, Vizzino C, Rocca MA, Filippi M. Functional and structural brain MRI changes associated with cognitive worsening in multiple sclerosis: a 3-year longitudinal study. J Neurol 2023; 270:4296-4308. [PMID: 37202603 DOI: 10.1007/s00415-023-11778-z] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 05/08/2023] [Accepted: 05/11/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND Heterogeneous processes may contribute to cognitive impairment in multiple sclerosis (MS). OBJECTIVE To apply a longitudinal multiparametric MRI approach to identify mechanisms associated with cognitive worsening in MS patients. METHODS 3 T brain functional and structural MRI scans were acquired at baseline and after a median follow-up of 3.4 years in 35 MS patients and 22 healthy controls (HC). Associations between cognitive worsening (reliable change index score < - 1.25 at the Rao's battery) and longitudinal changes in regional T2-hyperintense white matter (WM) lesions, diffusion tensor microstructural WM damage, gray matter (GM) atrophy and resting state (RS) functional connectivity (FC) were explored. RESULTS At follow-up, HC showed no clusters of significant microstructural WM damage progression, GM atrophy or changes in RS FC. At follow-up, 10 MS patients (29%) showed cognitive worsening. Compared to cognitively stable, cognitively worsened MS patients showed more severe GM atrophy of the right anterior cingulate cortex and bilateral supplementary motor area (p < 0.001). Cognitively worsened vs cognitively stable MS patients showed also decreased RS FC in the right hippocampus of the right working memory network and in the right insula of the default mode network. Increased RS FC in the left insula of the executive control network was found in the opposite comparison (p < 0.001). No significant regional accumulation of focal WM lesions nor microstructural WM abnormalities occurred in both patients' groups. CONCLUSIONS GM atrophy progression in cognitively relevant brain regions combined with functional impoverishment in networks involved in cognitive functions may represent the substrates underlying cognitive worsening in MS.
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Affiliation(s)
- Matteo Azzimonti
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Preziosa
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Elisabetta Pagani
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
| | - Paola Valsasina
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
| | - Nicolò Tedone
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
| | - Carmen Vizzino
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
| | - Maria A Rocca
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy.
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Vita-Salute San Raffaele University, Milan, Italy.
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Margoni M, Preziosa P, Rocca MA, Filippi M. Depressive symptoms, anxiety and cognitive impairment: emerging evidence in multiple sclerosis. Transl Psychiatry 2023; 13:264. [PMID: 37468462 PMCID: PMC10356956 DOI: 10.1038/s41398-023-02555-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 02/15/2023] [Revised: 06/28/2023] [Accepted: 06/30/2023] [Indexed: 07/21/2023] Open
Abstract
Neuropsychiatric abnormalities may be broadly divided in two categories: disorders of mood, affect, and behavior and abnormalities affecting cognition. Among these conditions, clinical depression, anxiety and neurocognitive disorders are the most common in multiple sclerosis (MS), with a substantial impact on patients' quality of life and adherence to treatments. Such manifestations may occur from the earliest phases of the disease but become more frequent in MS patients with a progressive disease course and more severe clinical disability. Although the pathogenesis of these neuropsychiatric manifestations has not been fully defined yet, brain structural and functional abnormalities, consistently observed with magnetic resonance imaging (MRI), together with genetic and immunologic factors, have been suggested to be key players. Even though the detrimental clinical impact of such manifestations in MS patients is a matter of crucial importance, at present, they are often overlooked in the clinical setting. Moreover, the efficacy of pharmacologic and non-pharmacologic approaches for their amelioration has been poorly investigated, with the majority of studies showing marginal or no beneficial effect of different therapeutic approaches, possibly due to the presence of multiple and heterogeneous underlying pathological mechanisms and intrinsic methodological limitations. A better evaluation of these manifestations in the clinical setting and improvements in the understanding of their pathophysiology may offer the potential to develop tools for differentiating these mechanisms in individual patients and ultimately provide a principled basis for treatment selection. This review provides an updated overview regarding the pathophysiology of the most common neuropsychiatric symptoms in MS, the clinical and MRI characteristics that have been associated with mood disorders (i.e., depression and anxiety) and cognitive impairment, and the treatment approaches currently available or under investigation.
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Affiliation(s)
- Monica Margoni
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Preziosa
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Maria A Rocca
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Vita-Salute San Raffaele University, Milan, Italy.
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy.
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15
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Rocca MA, Margoni M, Battaglini M, Eshaghi A, Iliff J, Pagani E, Preziosa P, Storelli L, Taoka T, Valsasina P, Filippi M. Emerging Perspectives on MRI Application in Multiple Sclerosis: Moving from Pathophysiology to Clinical Practice. Radiology 2023; 307:e221512. [PMID: 37278626 DOI: 10.1148/radiol.221512] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
MRI plays a central role in the diagnosis of multiple sclerosis (MS) and in the monitoring of disease course and treatment response. Advanced MRI techniques have shed light on MS biology and facilitated the search for neuroimaging markers that may be applicable in clinical practice. MRI has led to improvements in the accuracy of MS diagnosis and a deeper understanding of disease progression. This has also resulted in a plethora of potential MRI markers, the importance and validity of which remain to be proven. Here, five recent emerging perspectives arising from the use of MRI in MS, from pathophysiology to clinical application, will be discussed. These are the feasibility of noninvasive MRI-based approaches to measure glymphatic function and its impairment; T1-weighted to T2-weighted intensity ratio to quantify myelin content; classification of MS phenotypes based on their MRI features rather than on their clinical features; clinical relevance of gray matter atrophy versus white matter atrophy; and time-varying versus static resting-state functional connectivity in evaluating brain functional organization. These topics are critically discussed, which may guide future applications in the field.
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Affiliation(s)
- Maria Assunta Rocca
- From the Neuroimaging Research Unit, Division of Neuroscience (M.A.R., M.M., E.P., P.P., L.S., P.V., M.F.), Neurology Unit (M.A.R., M.M., P.P., M.F.), Neurorehabilitation Unit (M.F.), and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy (M.A.R., P.P., M.F.); Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy (M.B.); Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK (A.E.); Centre for Medical Image Computing, Department of Computer Science, University College London, London, UK (A.E.); VISN20 NW Mental Illness Research, Education, and Clinical Center, VA Puget Sound Healthcare System, Seattle, Wash (J.I.); Department of Psychiatry and Behavioral Sciences and Department of Neurology, University of Washington School of Medicine, Seattle, Wash (J.I.); and Department of Innovative Biomedical Visualization (iBMV), Department of Radiology, Nagoya University Graduate School of Medicine, Aichi, Japan (T.T.)
| | - Monica Margoni
- From the Neuroimaging Research Unit, Division of Neuroscience (M.A.R., M.M., E.P., P.P., L.S., P.V., M.F.), Neurology Unit (M.A.R., M.M., P.P., M.F.), Neurorehabilitation Unit (M.F.), and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy (M.A.R., P.P., M.F.); Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy (M.B.); Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK (A.E.); Centre for Medical Image Computing, Department of Computer Science, University College London, London, UK (A.E.); VISN20 NW Mental Illness Research, Education, and Clinical Center, VA Puget Sound Healthcare System, Seattle, Wash (J.I.); Department of Psychiatry and Behavioral Sciences and Department of Neurology, University of Washington School of Medicine, Seattle, Wash (J.I.); and Department of Innovative Biomedical Visualization (iBMV), Department of Radiology, Nagoya University Graduate School of Medicine, Aichi, Japan (T.T.)
| | - Marco Battaglini
- From the Neuroimaging Research Unit, Division of Neuroscience (M.A.R., M.M., E.P., P.P., L.S., P.V., M.F.), Neurology Unit (M.A.R., M.M., P.P., M.F.), Neurorehabilitation Unit (M.F.), and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy (M.A.R., P.P., M.F.); Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy (M.B.); Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK (A.E.); Centre for Medical Image Computing, Department of Computer Science, University College London, London, UK (A.E.); VISN20 NW Mental Illness Research, Education, and Clinical Center, VA Puget Sound Healthcare System, Seattle, Wash (J.I.); Department of Psychiatry and Behavioral Sciences and Department of Neurology, University of Washington School of Medicine, Seattle, Wash (J.I.); and Department of Innovative Biomedical Visualization (iBMV), Department of Radiology, Nagoya University Graduate School of Medicine, Aichi, Japan (T.T.)
| | - Arman Eshaghi
- From the Neuroimaging Research Unit, Division of Neuroscience (M.A.R., M.M., E.P., P.P., L.S., P.V., M.F.), Neurology Unit (M.A.R., M.M., P.P., M.F.), Neurorehabilitation Unit (M.F.), and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy (M.A.R., P.P., M.F.); Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy (M.B.); Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK (A.E.); Centre for Medical Image Computing, Department of Computer Science, University College London, London, UK (A.E.); VISN20 NW Mental Illness Research, Education, and Clinical Center, VA Puget Sound Healthcare System, Seattle, Wash (J.I.); Department of Psychiatry and Behavioral Sciences and Department of Neurology, University of Washington School of Medicine, Seattle, Wash (J.I.); and Department of Innovative Biomedical Visualization (iBMV), Department of Radiology, Nagoya University Graduate School of Medicine, Aichi, Japan (T.T.)
| | - Jeffrey Iliff
- From the Neuroimaging Research Unit, Division of Neuroscience (M.A.R., M.M., E.P., P.P., L.S., P.V., M.F.), Neurology Unit (M.A.R., M.M., P.P., M.F.), Neurorehabilitation Unit (M.F.), and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy (M.A.R., P.P., M.F.); Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy (M.B.); Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK (A.E.); Centre for Medical Image Computing, Department of Computer Science, University College London, London, UK (A.E.); VISN20 NW Mental Illness Research, Education, and Clinical Center, VA Puget Sound Healthcare System, Seattle, Wash (J.I.); Department of Psychiatry and Behavioral Sciences and Department of Neurology, University of Washington School of Medicine, Seattle, Wash (J.I.); and Department of Innovative Biomedical Visualization (iBMV), Department of Radiology, Nagoya University Graduate School of Medicine, Aichi, Japan (T.T.)
| | - Elisabetta Pagani
- From the Neuroimaging Research Unit, Division of Neuroscience (M.A.R., M.M., E.P., P.P., L.S., P.V., M.F.), Neurology Unit (M.A.R., M.M., P.P., M.F.), Neurorehabilitation Unit (M.F.), and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy (M.A.R., P.P., M.F.); Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy (M.B.); Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK (A.E.); Centre for Medical Image Computing, Department of Computer Science, University College London, London, UK (A.E.); VISN20 NW Mental Illness Research, Education, and Clinical Center, VA Puget Sound Healthcare System, Seattle, Wash (J.I.); Department of Psychiatry and Behavioral Sciences and Department of Neurology, University of Washington School of Medicine, Seattle, Wash (J.I.); and Department of Innovative Biomedical Visualization (iBMV), Department of Radiology, Nagoya University Graduate School of Medicine, Aichi, Japan (T.T.)
| | - Paolo Preziosa
- From the Neuroimaging Research Unit, Division of Neuroscience (M.A.R., M.M., E.P., P.P., L.S., P.V., M.F.), Neurology Unit (M.A.R., M.M., P.P., M.F.), Neurorehabilitation Unit (M.F.), and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy (M.A.R., P.P., M.F.); Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy (M.B.); Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK (A.E.); Centre for Medical Image Computing, Department of Computer Science, University College London, London, UK (A.E.); VISN20 NW Mental Illness Research, Education, and Clinical Center, VA Puget Sound Healthcare System, Seattle, Wash (J.I.); Department of Psychiatry and Behavioral Sciences and Department of Neurology, University of Washington School of Medicine, Seattle, Wash (J.I.); and Department of Innovative Biomedical Visualization (iBMV), Department of Radiology, Nagoya University Graduate School of Medicine, Aichi, Japan (T.T.)
| | - Loredana Storelli
- From the Neuroimaging Research Unit, Division of Neuroscience (M.A.R., M.M., E.P., P.P., L.S., P.V., M.F.), Neurology Unit (M.A.R., M.M., P.P., M.F.), Neurorehabilitation Unit (M.F.), and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy (M.A.R., P.P., M.F.); Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy (M.B.); Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK (A.E.); Centre for Medical Image Computing, Department of Computer Science, University College London, London, UK (A.E.); VISN20 NW Mental Illness Research, Education, and Clinical Center, VA Puget Sound Healthcare System, Seattle, Wash (J.I.); Department of Psychiatry and Behavioral Sciences and Department of Neurology, University of Washington School of Medicine, Seattle, Wash (J.I.); and Department of Innovative Biomedical Visualization (iBMV), Department of Radiology, Nagoya University Graduate School of Medicine, Aichi, Japan (T.T.)
| | - Toshiaki Taoka
- From the Neuroimaging Research Unit, Division of Neuroscience (M.A.R., M.M., E.P., P.P., L.S., P.V., M.F.), Neurology Unit (M.A.R., M.M., P.P., M.F.), Neurorehabilitation Unit (M.F.), and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy (M.A.R., P.P., M.F.); Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy (M.B.); Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK (A.E.); Centre for Medical Image Computing, Department of Computer Science, University College London, London, UK (A.E.); VISN20 NW Mental Illness Research, Education, and Clinical Center, VA Puget Sound Healthcare System, Seattle, Wash (J.I.); Department of Psychiatry and Behavioral Sciences and Department of Neurology, University of Washington School of Medicine, Seattle, Wash (J.I.); and Department of Innovative Biomedical Visualization (iBMV), Department of Radiology, Nagoya University Graduate School of Medicine, Aichi, Japan (T.T.)
| | - Paola Valsasina
- From the Neuroimaging Research Unit, Division of Neuroscience (M.A.R., M.M., E.P., P.P., L.S., P.V., M.F.), Neurology Unit (M.A.R., M.M., P.P., M.F.), Neurorehabilitation Unit (M.F.), and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy (M.A.R., P.P., M.F.); Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy (M.B.); Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK (A.E.); Centre for Medical Image Computing, Department of Computer Science, University College London, London, UK (A.E.); VISN20 NW Mental Illness Research, Education, and Clinical Center, VA Puget Sound Healthcare System, Seattle, Wash (J.I.); Department of Psychiatry and Behavioral Sciences and Department of Neurology, University of Washington School of Medicine, Seattle, Wash (J.I.); and Department of Innovative Biomedical Visualization (iBMV), Department of Radiology, Nagoya University Graduate School of Medicine, Aichi, Japan (T.T.)
| | - Massimo Filippi
- From the Neuroimaging Research Unit, Division of Neuroscience (M.A.R., M.M., E.P., P.P., L.S., P.V., M.F.), Neurology Unit (M.A.R., M.M., P.P., M.F.), Neurorehabilitation Unit (M.F.), and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy (M.A.R., P.P., M.F.); Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy (M.B.); Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK (A.E.); Centre for Medical Image Computing, Department of Computer Science, University College London, London, UK (A.E.); VISN20 NW Mental Illness Research, Education, and Clinical Center, VA Puget Sound Healthcare System, Seattle, Wash (J.I.); Department of Psychiatry and Behavioral Sciences and Department of Neurology, University of Washington School of Medicine, Seattle, Wash (J.I.); and Department of Innovative Biomedical Visualization (iBMV), Department of Radiology, Nagoya University Graduate School of Medicine, Aichi, Japan (T.T.)
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16
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Margoni M, Pagani E, Preziosa P, Gueye M, Azzimonti M, Rocca MA, Filippi M. Unraveling the heterogeneous pathological substrates of relapse-onset multiple sclerosis: a multiparametric voxel-wise 3 T MRI study. J Neurol 2023:10.1007/s00415-023-11736-9. [PMID: 37093395 DOI: 10.1007/s00415-023-11736-9] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 04/17/2023] [Accepted: 04/17/2023] [Indexed: 04/25/2023]
Abstract
BACKGROUND In multiple sclerosis (MS), pathological processes affecting brain gray (GM) and white matter (WM) are heterogeneous. OBJECTIVE To apply a multimodal MRI approach to investigate the regional distribution of the different pathological processes occurring in the brain WM and GM of relapse-onset MS patients. METHODS Fifty-seven MS patients (forty-two relapsing remitting [RR], fifteen secondary progressive [SP]) and forty-seven age- and sex-matched healthy controls (HC) underwent a multimodal 3 T MRI acquisition. Between-group voxel-wise differences of brain WM and GM volumes, magnetization transfer ratio (MTR), T1-weighted(w)/T2w ratio, intracellular volume fraction (ICV_f), and quantitative susceptibility mapping (QSM) maps were investigated. RESULTS Compared to HC, RRMS showed significant WM, deep GM and cortical atrophy, significantly lower MTR and T1w/T2w ratio of periventricular and infratentorial WM, deep GM and several cortical areas, lower ICV_f in supratentorial and cerebellar WM and in some cortical areas, and lower QSM values in bilateral periventricular WM (p < 0.001). Compared to RRMS, SPMS patients showed significant deep GM and widespread cortical atrophy, significantly lower MTR of periventricular WM, deep GM and cerebellum, lower T1w/T2w ratio of fronto-temporal WM regions, lower ICV_f of some fronto-tempo-occipital WM and cortical areas. They also had increased QSM and T1w/T2w ratio in the pallidum, bilaterally (p < 0.001). CONCLUSION A periventricular pattern of demyelination and widespread GM and WM neuro-axonal loss are detectable in RRMS and are more severe in SPMS. Higher T1w/T2w ratio and QSM in the pallidum, possibly reflecting iron accumulation and neurodegeneration, may represent a relevant MRI marker to differentiate SPMS from RRMS.
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Affiliation(s)
- Monica Margoni
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Elisabetta Pagani
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
| | - Paolo Preziosa
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Mor Gueye
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Matteo Azzimonti
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria A Rocca
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy.
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Vita-Salute San Raffaele University, Milan, Italy.
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy.
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17
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Bouman PM, Noteboom S, Nobrega Santos FA, Beck ES, Bliault G, Castellaro M, Calabrese M, Chard DT, Eichinger P, Filippi M, Inglese M, Lapucci C, Marciniak A, Moraal B, Morales Pinzon A, Mühlau M, Preziosa P, Reich DS, Rocca MA, Schoonheim MM, Twisk JWR, Wiestler B, Jonkman LE, Guttmann CRG, Geurts JJG, Steenwijk MD. Multicenter Evaluation of AI-generated DIR and PSIR for Cortical and Juxtacortical Multiple Sclerosis Lesion Detection. Radiology 2023; 307:e221425. [PMID: 36749211 PMCID: PMC10102645 DOI: 10.1148/radiol.221425] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 06/07/2022] [Revised: 11/18/2022] [Accepted: 11/28/2022] [Indexed: 02/08/2023]
Abstract
Background Cortical multiple sclerosis lesions are clinically relevant but inconspicuous at conventional clinical MRI. Double inversion recovery (DIR) and phase-sensitive inversion recovery (PSIR) are more sensitive but often unavailable. In the past 2 years, artificial intelligence (AI) was used to generate DIR and PSIR from standard clinical sequences (eg, T1-weighted, T2-weighted, and fluid-attenuated inversion-recovery sequences), but multicenter validation is crucial for further implementation. Purpose To evaluate cortical and juxtacortical multiple sclerosis lesion detection for diagnostic and disease monitoring purposes on AI-generated DIR and PSIR images compared with MRI-acquired DIR and PSIR images in a multicenter setting. Materials and Methods Generative adversarial networks were used to generate AI-based DIR (n = 50) and PSIR (n = 43) images. The number of detected lesions between AI-generated images and MRI-acquired (reference) images was compared by randomized blinded scoring by seven readers (all with >10 years of experience in lesion assessment). Reliability was expressed as the intraclass correlation coefficient (ICC). Differences in lesion subtype were determined using Wilcoxon signed-rank tests. Results MRI scans of 202 patients with multiple sclerosis (mean age, 46 years ± 11 [SD]; 127 women) were retrospectively collected from seven centers (February 2020 to January 2021). In total, 1154 lesions were detected on AI-generated DIR images versus 855 on MRI-acquired DIR images (mean difference per reader, 35.0% ± 22.8; P < .001). On AI-generated PSIR images, 803 lesions were detected versus 814 on MRI-acquired PSIR images (98.9% ± 19.4; P = .87). Reliability was good for both DIR (ICC, 0.81) and PSIR (ICC, 0.75) across centers. Regionally, more juxtacortical lesions were detected on AI-generated DIR images than on MRI-acquired DIR images (495 [42.9%] vs 338 [39.5%]; P < .001). On AI-generated PSIR images, fewer juxtacortical lesions were detected than on MRI-acquired PSIR images (232 [28.9%] vs 282 [34.6%]; P = .02). Conclusion Artificial intelligence-generated double inversion-recovery and phase-sensitive inversion-recovery images performed well compared with their MRI-acquired counterparts and can be considered reliable in a multicenter setting, with good between-reader and between-center interpretative agreement. Published under a CC BY 4.0 license. Supplemental material is available for this article. See also the editorial by Zivadinov and Dwyer in this issue.
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Affiliation(s)
- Piet M. Bouman
- From the MS Center Amsterdam, Anatomy & Neurosciences,
Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, De
Boelelaan 1117, Amsterdam, the Netherlands (P.M.B., S.N., F.A.N.S., M.M.S.,
J.J.G.G., M.D.S.); Translational Neuroradiology Section, National Institute of
Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Md
(E.S.B., D.S.R.); Department of Neurology, Icahn School of Medicine at Mount
Sinai, New York, NY (E.S.B.); Bio-imaging Institute, University of Bordeaux,
Bordeaux, France (G.B.); Neurology Section, Department of Neuroscience,
Biomedicine and Movement Sciences, University of Verona, Verona, Italy (M.
Castellaro, M. Calabrese); Department of Information Engineering, University of
Padova, Padova, Italy (M. Castellaro); NMR Research Unit, Queen Square MS
Centre, Department of Neuroinflammation, UCL Queen Square Institute of
Neurology, Faculty of Brain Sciences, University College London, London, UK
(D.T.C.); National Institute for Health Research University College London
Hospitals Biomedical Research Centre, London, UK (D.T.C.); Departments of
Neuroradiology (P.E., B.W.) and Neurology (M.M.), School of Medicine, Klinikum
Rechts der Isar, Technical University of Munich, Munich, Germany; Neuroimaging
Research Unit, Division of Neuroscience Neurology Unit, IRCCS San Raffaele
Scientific Institute Vita-Salute San Raffaele University, Milan, Italy (M.F.,
P.P., M.A.R.); Department of Neuroscience, Rehabilitation, Ophthalmology,
Genetics, Maternal and Child Health, University of Genova, Genoa, Italy (M.I.,
C.L.); IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genoa, Italy
(M.I., C.L.); Center for Neurologic Imaging, Department of Radiology, Brigham
and Women’s Hospital, Harvard Medical School, Boston, Mass (A.M., A.M.P.,
C.R.G.G.); Department of Radiology and Nuclear Medicine, MS Center Amsterdam,
Amsterdam Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (B.M.); Department of Epidemiology and Data Science, Amsterdam
University Medical Center, Amsterdam, the Netherlands (J.W.R.T.); Anatomy
& Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (L.E.J.); and Amsterdam Neuroscience, Brain Imaging and
Neurodegeneration, Amsterdam, the Netherlands (L.E.J.)
| | - Samantha Noteboom
- From the MS Center Amsterdam, Anatomy & Neurosciences,
Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, De
Boelelaan 1117, Amsterdam, the Netherlands (P.M.B., S.N., F.A.N.S., M.M.S.,
J.J.G.G., M.D.S.); Translational Neuroradiology Section, National Institute of
Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Md
(E.S.B., D.S.R.); Department of Neurology, Icahn School of Medicine at Mount
Sinai, New York, NY (E.S.B.); Bio-imaging Institute, University of Bordeaux,
Bordeaux, France (G.B.); Neurology Section, Department of Neuroscience,
Biomedicine and Movement Sciences, University of Verona, Verona, Italy (M.
Castellaro, M. Calabrese); Department of Information Engineering, University of
Padova, Padova, Italy (M. Castellaro); NMR Research Unit, Queen Square MS
Centre, Department of Neuroinflammation, UCL Queen Square Institute of
Neurology, Faculty of Brain Sciences, University College London, London, UK
(D.T.C.); National Institute for Health Research University College London
Hospitals Biomedical Research Centre, London, UK (D.T.C.); Departments of
Neuroradiology (P.E., B.W.) and Neurology (M.M.), School of Medicine, Klinikum
Rechts der Isar, Technical University of Munich, Munich, Germany; Neuroimaging
Research Unit, Division of Neuroscience Neurology Unit, IRCCS San Raffaele
Scientific Institute Vita-Salute San Raffaele University, Milan, Italy (M.F.,
P.P., M.A.R.); Department of Neuroscience, Rehabilitation, Ophthalmology,
Genetics, Maternal and Child Health, University of Genova, Genoa, Italy (M.I.,
C.L.); IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genoa, Italy
(M.I., C.L.); Center for Neurologic Imaging, Department of Radiology, Brigham
and Women’s Hospital, Harvard Medical School, Boston, Mass (A.M., A.M.P.,
C.R.G.G.); Department of Radiology and Nuclear Medicine, MS Center Amsterdam,
Amsterdam Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (B.M.); Department of Epidemiology and Data Science, Amsterdam
University Medical Center, Amsterdam, the Netherlands (J.W.R.T.); Anatomy
& Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (L.E.J.); and Amsterdam Neuroscience, Brain Imaging and
Neurodegeneration, Amsterdam, the Netherlands (L.E.J.)
| | - Fernando A. Nobrega Santos
- From the MS Center Amsterdam, Anatomy & Neurosciences,
Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, De
Boelelaan 1117, Amsterdam, the Netherlands (P.M.B., S.N., F.A.N.S., M.M.S.,
J.J.G.G., M.D.S.); Translational Neuroradiology Section, National Institute of
Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Md
(E.S.B., D.S.R.); Department of Neurology, Icahn School of Medicine at Mount
Sinai, New York, NY (E.S.B.); Bio-imaging Institute, University of Bordeaux,
Bordeaux, France (G.B.); Neurology Section, Department of Neuroscience,
Biomedicine and Movement Sciences, University of Verona, Verona, Italy (M.
Castellaro, M. Calabrese); Department of Information Engineering, University of
Padova, Padova, Italy (M. Castellaro); NMR Research Unit, Queen Square MS
Centre, Department of Neuroinflammation, UCL Queen Square Institute of
Neurology, Faculty of Brain Sciences, University College London, London, UK
(D.T.C.); National Institute for Health Research University College London
Hospitals Biomedical Research Centre, London, UK (D.T.C.); Departments of
Neuroradiology (P.E., B.W.) and Neurology (M.M.), School of Medicine, Klinikum
Rechts der Isar, Technical University of Munich, Munich, Germany; Neuroimaging
Research Unit, Division of Neuroscience Neurology Unit, IRCCS San Raffaele
Scientific Institute Vita-Salute San Raffaele University, Milan, Italy (M.F.,
P.P., M.A.R.); Department of Neuroscience, Rehabilitation, Ophthalmology,
Genetics, Maternal and Child Health, University of Genova, Genoa, Italy (M.I.,
C.L.); IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genoa, Italy
(M.I., C.L.); Center for Neurologic Imaging, Department of Radiology, Brigham
and Women’s Hospital, Harvard Medical School, Boston, Mass (A.M., A.M.P.,
C.R.G.G.); Department of Radiology and Nuclear Medicine, MS Center Amsterdam,
Amsterdam Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (B.M.); Department of Epidemiology and Data Science, Amsterdam
University Medical Center, Amsterdam, the Netherlands (J.W.R.T.); Anatomy
& Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (L.E.J.); and Amsterdam Neuroscience, Brain Imaging and
Neurodegeneration, Amsterdam, the Netherlands (L.E.J.)
| | - Erin S. Beck
- From the MS Center Amsterdam, Anatomy & Neurosciences,
Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, De
Boelelaan 1117, Amsterdam, the Netherlands (P.M.B., S.N., F.A.N.S., M.M.S.,
J.J.G.G., M.D.S.); Translational Neuroradiology Section, National Institute of
Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Md
(E.S.B., D.S.R.); Department of Neurology, Icahn School of Medicine at Mount
Sinai, New York, NY (E.S.B.); Bio-imaging Institute, University of Bordeaux,
Bordeaux, France (G.B.); Neurology Section, Department of Neuroscience,
Biomedicine and Movement Sciences, University of Verona, Verona, Italy (M.
Castellaro, M. Calabrese); Department of Information Engineering, University of
Padova, Padova, Italy (M. Castellaro); NMR Research Unit, Queen Square MS
Centre, Department of Neuroinflammation, UCL Queen Square Institute of
Neurology, Faculty of Brain Sciences, University College London, London, UK
(D.T.C.); National Institute for Health Research University College London
Hospitals Biomedical Research Centre, London, UK (D.T.C.); Departments of
Neuroradiology (P.E., B.W.) and Neurology (M.M.), School of Medicine, Klinikum
Rechts der Isar, Technical University of Munich, Munich, Germany; Neuroimaging
Research Unit, Division of Neuroscience Neurology Unit, IRCCS San Raffaele
Scientific Institute Vita-Salute San Raffaele University, Milan, Italy (M.F.,
P.P., M.A.R.); Department of Neuroscience, Rehabilitation, Ophthalmology,
Genetics, Maternal and Child Health, University of Genova, Genoa, Italy (M.I.,
C.L.); IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genoa, Italy
(M.I., C.L.); Center for Neurologic Imaging, Department of Radiology, Brigham
and Women’s Hospital, Harvard Medical School, Boston, Mass (A.M., A.M.P.,
C.R.G.G.); Department of Radiology and Nuclear Medicine, MS Center Amsterdam,
Amsterdam Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (B.M.); Department of Epidemiology and Data Science, Amsterdam
University Medical Center, Amsterdam, the Netherlands (J.W.R.T.); Anatomy
& Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (L.E.J.); and Amsterdam Neuroscience, Brain Imaging and
Neurodegeneration, Amsterdam, the Netherlands (L.E.J.)
| | - Gregory Bliault
- From the MS Center Amsterdam, Anatomy & Neurosciences,
Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, De
Boelelaan 1117, Amsterdam, the Netherlands (P.M.B., S.N., F.A.N.S., M.M.S.,
J.J.G.G., M.D.S.); Translational Neuroradiology Section, National Institute of
Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Md
(E.S.B., D.S.R.); Department of Neurology, Icahn School of Medicine at Mount
Sinai, New York, NY (E.S.B.); Bio-imaging Institute, University of Bordeaux,
Bordeaux, France (G.B.); Neurology Section, Department of Neuroscience,
Biomedicine and Movement Sciences, University of Verona, Verona, Italy (M.
Castellaro, M. Calabrese); Department of Information Engineering, University of
Padova, Padova, Italy (M. Castellaro); NMR Research Unit, Queen Square MS
Centre, Department of Neuroinflammation, UCL Queen Square Institute of
Neurology, Faculty of Brain Sciences, University College London, London, UK
(D.T.C.); National Institute for Health Research University College London
Hospitals Biomedical Research Centre, London, UK (D.T.C.); Departments of
Neuroradiology (P.E., B.W.) and Neurology (M.M.), School of Medicine, Klinikum
Rechts der Isar, Technical University of Munich, Munich, Germany; Neuroimaging
Research Unit, Division of Neuroscience Neurology Unit, IRCCS San Raffaele
Scientific Institute Vita-Salute San Raffaele University, Milan, Italy (M.F.,
P.P., M.A.R.); Department of Neuroscience, Rehabilitation, Ophthalmology,
Genetics, Maternal and Child Health, University of Genova, Genoa, Italy (M.I.,
C.L.); IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genoa, Italy
(M.I., C.L.); Center for Neurologic Imaging, Department of Radiology, Brigham
and Women’s Hospital, Harvard Medical School, Boston, Mass (A.M., A.M.P.,
C.R.G.G.); Department of Radiology and Nuclear Medicine, MS Center Amsterdam,
Amsterdam Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (B.M.); Department of Epidemiology and Data Science, Amsterdam
University Medical Center, Amsterdam, the Netherlands (J.W.R.T.); Anatomy
& Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (L.E.J.); and Amsterdam Neuroscience, Brain Imaging and
Neurodegeneration, Amsterdam, the Netherlands (L.E.J.)
| | - Marco Castellaro
- From the MS Center Amsterdam, Anatomy & Neurosciences,
Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, De
Boelelaan 1117, Amsterdam, the Netherlands (P.M.B., S.N., F.A.N.S., M.M.S.,
J.J.G.G., M.D.S.); Translational Neuroradiology Section, National Institute of
Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Md
(E.S.B., D.S.R.); Department of Neurology, Icahn School of Medicine at Mount
Sinai, New York, NY (E.S.B.); Bio-imaging Institute, University of Bordeaux,
Bordeaux, France (G.B.); Neurology Section, Department of Neuroscience,
Biomedicine and Movement Sciences, University of Verona, Verona, Italy (M.
Castellaro, M. Calabrese); Department of Information Engineering, University of
Padova, Padova, Italy (M. Castellaro); NMR Research Unit, Queen Square MS
Centre, Department of Neuroinflammation, UCL Queen Square Institute of
Neurology, Faculty of Brain Sciences, University College London, London, UK
(D.T.C.); National Institute for Health Research University College London
Hospitals Biomedical Research Centre, London, UK (D.T.C.); Departments of
Neuroradiology (P.E., B.W.) and Neurology (M.M.), School of Medicine, Klinikum
Rechts der Isar, Technical University of Munich, Munich, Germany; Neuroimaging
Research Unit, Division of Neuroscience Neurology Unit, IRCCS San Raffaele
Scientific Institute Vita-Salute San Raffaele University, Milan, Italy (M.F.,
P.P., M.A.R.); Department of Neuroscience, Rehabilitation, Ophthalmology,
Genetics, Maternal and Child Health, University of Genova, Genoa, Italy (M.I.,
C.L.); IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genoa, Italy
(M.I., C.L.); Center for Neurologic Imaging, Department of Radiology, Brigham
and Women’s Hospital, Harvard Medical School, Boston, Mass (A.M., A.M.P.,
C.R.G.G.); Department of Radiology and Nuclear Medicine, MS Center Amsterdam,
Amsterdam Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (B.M.); Department of Epidemiology and Data Science, Amsterdam
University Medical Center, Amsterdam, the Netherlands (J.W.R.T.); Anatomy
& Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (L.E.J.); and Amsterdam Neuroscience, Brain Imaging and
Neurodegeneration, Amsterdam, the Netherlands (L.E.J.)
| | - Massimiliano Calabrese
- From the MS Center Amsterdam, Anatomy & Neurosciences,
Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, De
Boelelaan 1117, Amsterdam, the Netherlands (P.M.B., S.N., F.A.N.S., M.M.S.,
J.J.G.G., M.D.S.); Translational Neuroradiology Section, National Institute of
Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Md
(E.S.B., D.S.R.); Department of Neurology, Icahn School of Medicine at Mount
Sinai, New York, NY (E.S.B.); Bio-imaging Institute, University of Bordeaux,
Bordeaux, France (G.B.); Neurology Section, Department of Neuroscience,
Biomedicine and Movement Sciences, University of Verona, Verona, Italy (M.
Castellaro, M. Calabrese); Department of Information Engineering, University of
Padova, Padova, Italy (M. Castellaro); NMR Research Unit, Queen Square MS
Centre, Department of Neuroinflammation, UCL Queen Square Institute of
Neurology, Faculty of Brain Sciences, University College London, London, UK
(D.T.C.); National Institute for Health Research University College London
Hospitals Biomedical Research Centre, London, UK (D.T.C.); Departments of
Neuroradiology (P.E., B.W.) and Neurology (M.M.), School of Medicine, Klinikum
Rechts der Isar, Technical University of Munich, Munich, Germany; Neuroimaging
Research Unit, Division of Neuroscience Neurology Unit, IRCCS San Raffaele
Scientific Institute Vita-Salute San Raffaele University, Milan, Italy (M.F.,
P.P., M.A.R.); Department of Neuroscience, Rehabilitation, Ophthalmology,
Genetics, Maternal and Child Health, University of Genova, Genoa, Italy (M.I.,
C.L.); IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genoa, Italy
(M.I., C.L.); Center for Neurologic Imaging, Department of Radiology, Brigham
and Women’s Hospital, Harvard Medical School, Boston, Mass (A.M., A.M.P.,
C.R.G.G.); Department of Radiology and Nuclear Medicine, MS Center Amsterdam,
Amsterdam Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (B.M.); Department of Epidemiology and Data Science, Amsterdam
University Medical Center, Amsterdam, the Netherlands (J.W.R.T.); Anatomy
& Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (L.E.J.); and Amsterdam Neuroscience, Brain Imaging and
Neurodegeneration, Amsterdam, the Netherlands (L.E.J.)
| | - Declan T. Chard
- From the MS Center Amsterdam, Anatomy & Neurosciences,
Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, De
Boelelaan 1117, Amsterdam, the Netherlands (P.M.B., S.N., F.A.N.S., M.M.S.,
J.J.G.G., M.D.S.); Translational Neuroradiology Section, National Institute of
Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Md
(E.S.B., D.S.R.); Department of Neurology, Icahn School of Medicine at Mount
Sinai, New York, NY (E.S.B.); Bio-imaging Institute, University of Bordeaux,
Bordeaux, France (G.B.); Neurology Section, Department of Neuroscience,
Biomedicine and Movement Sciences, University of Verona, Verona, Italy (M.
Castellaro, M. Calabrese); Department of Information Engineering, University of
Padova, Padova, Italy (M. Castellaro); NMR Research Unit, Queen Square MS
Centre, Department of Neuroinflammation, UCL Queen Square Institute of
Neurology, Faculty of Brain Sciences, University College London, London, UK
(D.T.C.); National Institute for Health Research University College London
Hospitals Biomedical Research Centre, London, UK (D.T.C.); Departments of
Neuroradiology (P.E., B.W.) and Neurology (M.M.), School of Medicine, Klinikum
Rechts der Isar, Technical University of Munich, Munich, Germany; Neuroimaging
Research Unit, Division of Neuroscience Neurology Unit, IRCCS San Raffaele
Scientific Institute Vita-Salute San Raffaele University, Milan, Italy (M.F.,
P.P., M.A.R.); Department of Neuroscience, Rehabilitation, Ophthalmology,
Genetics, Maternal and Child Health, University of Genova, Genoa, Italy (M.I.,
C.L.); IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genoa, Italy
(M.I., C.L.); Center for Neurologic Imaging, Department of Radiology, Brigham
and Women’s Hospital, Harvard Medical School, Boston, Mass (A.M., A.M.P.,
C.R.G.G.); Department of Radiology and Nuclear Medicine, MS Center Amsterdam,
Amsterdam Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (B.M.); Department of Epidemiology and Data Science, Amsterdam
University Medical Center, Amsterdam, the Netherlands (J.W.R.T.); Anatomy
& Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (L.E.J.); and Amsterdam Neuroscience, Brain Imaging and
Neurodegeneration, Amsterdam, the Netherlands (L.E.J.)
| | - Paul Eichinger
- From the MS Center Amsterdam, Anatomy & Neurosciences,
Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, De
Boelelaan 1117, Amsterdam, the Netherlands (P.M.B., S.N., F.A.N.S., M.M.S.,
J.J.G.G., M.D.S.); Translational Neuroradiology Section, National Institute of
Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Md
(E.S.B., D.S.R.); Department of Neurology, Icahn School of Medicine at Mount
Sinai, New York, NY (E.S.B.); Bio-imaging Institute, University of Bordeaux,
Bordeaux, France (G.B.); Neurology Section, Department of Neuroscience,
Biomedicine and Movement Sciences, University of Verona, Verona, Italy (M.
Castellaro, M. Calabrese); Department of Information Engineering, University of
Padova, Padova, Italy (M. Castellaro); NMR Research Unit, Queen Square MS
Centre, Department of Neuroinflammation, UCL Queen Square Institute of
Neurology, Faculty of Brain Sciences, University College London, London, UK
(D.T.C.); National Institute for Health Research University College London
Hospitals Biomedical Research Centre, London, UK (D.T.C.); Departments of
Neuroradiology (P.E., B.W.) and Neurology (M.M.), School of Medicine, Klinikum
Rechts der Isar, Technical University of Munich, Munich, Germany; Neuroimaging
Research Unit, Division of Neuroscience Neurology Unit, IRCCS San Raffaele
Scientific Institute Vita-Salute San Raffaele University, Milan, Italy (M.F.,
P.P., M.A.R.); Department of Neuroscience, Rehabilitation, Ophthalmology,
Genetics, Maternal and Child Health, University of Genova, Genoa, Italy (M.I.,
C.L.); IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genoa, Italy
(M.I., C.L.); Center for Neurologic Imaging, Department of Radiology, Brigham
and Women’s Hospital, Harvard Medical School, Boston, Mass (A.M., A.M.P.,
C.R.G.G.); Department of Radiology and Nuclear Medicine, MS Center Amsterdam,
Amsterdam Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (B.M.); Department of Epidemiology and Data Science, Amsterdam
University Medical Center, Amsterdam, the Netherlands (J.W.R.T.); Anatomy
& Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (L.E.J.); and Amsterdam Neuroscience, Brain Imaging and
Neurodegeneration, Amsterdam, the Netherlands (L.E.J.)
| | - Massimo Filippi
- From the MS Center Amsterdam, Anatomy & Neurosciences,
Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, De
Boelelaan 1117, Amsterdam, the Netherlands (P.M.B., S.N., F.A.N.S., M.M.S.,
J.J.G.G., M.D.S.); Translational Neuroradiology Section, National Institute of
Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Md
(E.S.B., D.S.R.); Department of Neurology, Icahn School of Medicine at Mount
Sinai, New York, NY (E.S.B.); Bio-imaging Institute, University of Bordeaux,
Bordeaux, France (G.B.); Neurology Section, Department of Neuroscience,
Biomedicine and Movement Sciences, University of Verona, Verona, Italy (M.
Castellaro, M. Calabrese); Department of Information Engineering, University of
Padova, Padova, Italy (M. Castellaro); NMR Research Unit, Queen Square MS
Centre, Department of Neuroinflammation, UCL Queen Square Institute of
Neurology, Faculty of Brain Sciences, University College London, London, UK
(D.T.C.); National Institute for Health Research University College London
Hospitals Biomedical Research Centre, London, UK (D.T.C.); Departments of
Neuroradiology (P.E., B.W.) and Neurology (M.M.), School of Medicine, Klinikum
Rechts der Isar, Technical University of Munich, Munich, Germany; Neuroimaging
Research Unit, Division of Neuroscience Neurology Unit, IRCCS San Raffaele
Scientific Institute Vita-Salute San Raffaele University, Milan, Italy (M.F.,
P.P., M.A.R.); Department of Neuroscience, Rehabilitation, Ophthalmology,
Genetics, Maternal and Child Health, University of Genova, Genoa, Italy (M.I.,
C.L.); IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genoa, Italy
(M.I., C.L.); Center for Neurologic Imaging, Department of Radiology, Brigham
and Women’s Hospital, Harvard Medical School, Boston, Mass (A.M., A.M.P.,
C.R.G.G.); Department of Radiology and Nuclear Medicine, MS Center Amsterdam,
Amsterdam Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (B.M.); Department of Epidemiology and Data Science, Amsterdam
University Medical Center, Amsterdam, the Netherlands (J.W.R.T.); Anatomy
& Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (L.E.J.); and Amsterdam Neuroscience, Brain Imaging and
Neurodegeneration, Amsterdam, the Netherlands (L.E.J.)
| | - Matilde Inglese
- From the MS Center Amsterdam, Anatomy & Neurosciences,
Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, De
Boelelaan 1117, Amsterdam, the Netherlands (P.M.B., S.N., F.A.N.S., M.M.S.,
J.J.G.G., M.D.S.); Translational Neuroradiology Section, National Institute of
Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Md
(E.S.B., D.S.R.); Department of Neurology, Icahn School of Medicine at Mount
Sinai, New York, NY (E.S.B.); Bio-imaging Institute, University of Bordeaux,
Bordeaux, France (G.B.); Neurology Section, Department of Neuroscience,
Biomedicine and Movement Sciences, University of Verona, Verona, Italy (M.
Castellaro, M. Calabrese); Department of Information Engineering, University of
Padova, Padova, Italy (M. Castellaro); NMR Research Unit, Queen Square MS
Centre, Department of Neuroinflammation, UCL Queen Square Institute of
Neurology, Faculty of Brain Sciences, University College London, London, UK
(D.T.C.); National Institute for Health Research University College London
Hospitals Biomedical Research Centre, London, UK (D.T.C.); Departments of
Neuroradiology (P.E., B.W.) and Neurology (M.M.), School of Medicine, Klinikum
Rechts der Isar, Technical University of Munich, Munich, Germany; Neuroimaging
Research Unit, Division of Neuroscience Neurology Unit, IRCCS San Raffaele
Scientific Institute Vita-Salute San Raffaele University, Milan, Italy (M.F.,
P.P., M.A.R.); Department of Neuroscience, Rehabilitation, Ophthalmology,
Genetics, Maternal and Child Health, University of Genova, Genoa, Italy (M.I.,
C.L.); IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genoa, Italy
(M.I., C.L.); Center for Neurologic Imaging, Department of Radiology, Brigham
and Women’s Hospital, Harvard Medical School, Boston, Mass (A.M., A.M.P.,
C.R.G.G.); Department of Radiology and Nuclear Medicine, MS Center Amsterdam,
Amsterdam Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (B.M.); Department of Epidemiology and Data Science, Amsterdam
University Medical Center, Amsterdam, the Netherlands (J.W.R.T.); Anatomy
& Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (L.E.J.); and Amsterdam Neuroscience, Brain Imaging and
Neurodegeneration, Amsterdam, the Netherlands (L.E.J.)
| | - Caterina Lapucci
- From the MS Center Amsterdam, Anatomy & Neurosciences,
Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, De
Boelelaan 1117, Amsterdam, the Netherlands (P.M.B., S.N., F.A.N.S., M.M.S.,
J.J.G.G., M.D.S.); Translational Neuroradiology Section, National Institute of
Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Md
(E.S.B., D.S.R.); Department of Neurology, Icahn School of Medicine at Mount
Sinai, New York, NY (E.S.B.); Bio-imaging Institute, University of Bordeaux,
Bordeaux, France (G.B.); Neurology Section, Department of Neuroscience,
Biomedicine and Movement Sciences, University of Verona, Verona, Italy (M.
Castellaro, M. Calabrese); Department of Information Engineering, University of
Padova, Padova, Italy (M. Castellaro); NMR Research Unit, Queen Square MS
Centre, Department of Neuroinflammation, UCL Queen Square Institute of
Neurology, Faculty of Brain Sciences, University College London, London, UK
(D.T.C.); National Institute for Health Research University College London
Hospitals Biomedical Research Centre, London, UK (D.T.C.); Departments of
Neuroradiology (P.E., B.W.) and Neurology (M.M.), School of Medicine, Klinikum
Rechts der Isar, Technical University of Munich, Munich, Germany; Neuroimaging
Research Unit, Division of Neuroscience Neurology Unit, IRCCS San Raffaele
Scientific Institute Vita-Salute San Raffaele University, Milan, Italy (M.F.,
P.P., M.A.R.); Department of Neuroscience, Rehabilitation, Ophthalmology,
Genetics, Maternal and Child Health, University of Genova, Genoa, Italy (M.I.,
C.L.); IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genoa, Italy
(M.I., C.L.); Center for Neurologic Imaging, Department of Radiology, Brigham
and Women’s Hospital, Harvard Medical School, Boston, Mass (A.M., A.M.P.,
C.R.G.G.); Department of Radiology and Nuclear Medicine, MS Center Amsterdam,
Amsterdam Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (B.M.); Department of Epidemiology and Data Science, Amsterdam
University Medical Center, Amsterdam, the Netherlands (J.W.R.T.); Anatomy
& Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (L.E.J.); and Amsterdam Neuroscience, Brain Imaging and
Neurodegeneration, Amsterdam, the Netherlands (L.E.J.)
| | - Andrzej Marciniak
- From the MS Center Amsterdam, Anatomy & Neurosciences,
Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, De
Boelelaan 1117, Amsterdam, the Netherlands (P.M.B., S.N., F.A.N.S., M.M.S.,
J.J.G.G., M.D.S.); Translational Neuroradiology Section, National Institute of
Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Md
(E.S.B., D.S.R.); Department of Neurology, Icahn School of Medicine at Mount
Sinai, New York, NY (E.S.B.); Bio-imaging Institute, University of Bordeaux,
Bordeaux, France (G.B.); Neurology Section, Department of Neuroscience,
Biomedicine and Movement Sciences, University of Verona, Verona, Italy (M.
Castellaro, M. Calabrese); Department of Information Engineering, University of
Padova, Padova, Italy (M. Castellaro); NMR Research Unit, Queen Square MS
Centre, Department of Neuroinflammation, UCL Queen Square Institute of
Neurology, Faculty of Brain Sciences, University College London, London, UK
(D.T.C.); National Institute for Health Research University College London
Hospitals Biomedical Research Centre, London, UK (D.T.C.); Departments of
Neuroradiology (P.E., B.W.) and Neurology (M.M.), School of Medicine, Klinikum
Rechts der Isar, Technical University of Munich, Munich, Germany; Neuroimaging
Research Unit, Division of Neuroscience Neurology Unit, IRCCS San Raffaele
Scientific Institute Vita-Salute San Raffaele University, Milan, Italy (M.F.,
P.P., M.A.R.); Department of Neuroscience, Rehabilitation, Ophthalmology,
Genetics, Maternal and Child Health, University of Genova, Genoa, Italy (M.I.,
C.L.); IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genoa, Italy
(M.I., C.L.); Center for Neurologic Imaging, Department of Radiology, Brigham
and Women’s Hospital, Harvard Medical School, Boston, Mass (A.M., A.M.P.,
C.R.G.G.); Department of Radiology and Nuclear Medicine, MS Center Amsterdam,
Amsterdam Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (B.M.); Department of Epidemiology and Data Science, Amsterdam
University Medical Center, Amsterdam, the Netherlands (J.W.R.T.); Anatomy
& Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (L.E.J.); and Amsterdam Neuroscience, Brain Imaging and
Neurodegeneration, Amsterdam, the Netherlands (L.E.J.)
| | - Bastiaan Moraal
- From the MS Center Amsterdam, Anatomy & Neurosciences,
Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, De
Boelelaan 1117, Amsterdam, the Netherlands (P.M.B., S.N., F.A.N.S., M.M.S.,
J.J.G.G., M.D.S.); Translational Neuroradiology Section, National Institute of
Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Md
(E.S.B., D.S.R.); Department of Neurology, Icahn School of Medicine at Mount
Sinai, New York, NY (E.S.B.); Bio-imaging Institute, University of Bordeaux,
Bordeaux, France (G.B.); Neurology Section, Department of Neuroscience,
Biomedicine and Movement Sciences, University of Verona, Verona, Italy (M.
Castellaro, M. Calabrese); Department of Information Engineering, University of
Padova, Padova, Italy (M. Castellaro); NMR Research Unit, Queen Square MS
Centre, Department of Neuroinflammation, UCL Queen Square Institute of
Neurology, Faculty of Brain Sciences, University College London, London, UK
(D.T.C.); National Institute for Health Research University College London
Hospitals Biomedical Research Centre, London, UK (D.T.C.); Departments of
Neuroradiology (P.E., B.W.) and Neurology (M.M.), School of Medicine, Klinikum
Rechts der Isar, Technical University of Munich, Munich, Germany; Neuroimaging
Research Unit, Division of Neuroscience Neurology Unit, IRCCS San Raffaele
Scientific Institute Vita-Salute San Raffaele University, Milan, Italy (M.F.,
P.P., M.A.R.); Department of Neuroscience, Rehabilitation, Ophthalmology,
Genetics, Maternal and Child Health, University of Genova, Genoa, Italy (M.I.,
C.L.); IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genoa, Italy
(M.I., C.L.); Center for Neurologic Imaging, Department of Radiology, Brigham
and Women’s Hospital, Harvard Medical School, Boston, Mass (A.M., A.M.P.,
C.R.G.G.); Department of Radiology and Nuclear Medicine, MS Center Amsterdam,
Amsterdam Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (B.M.); Department of Epidemiology and Data Science, Amsterdam
University Medical Center, Amsterdam, the Netherlands (J.W.R.T.); Anatomy
& Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (L.E.J.); and Amsterdam Neuroscience, Brain Imaging and
Neurodegeneration, Amsterdam, the Netherlands (L.E.J.)
| | - Alfredo Morales Pinzon
- From the MS Center Amsterdam, Anatomy & Neurosciences,
Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, De
Boelelaan 1117, Amsterdam, the Netherlands (P.M.B., S.N., F.A.N.S., M.M.S.,
J.J.G.G., M.D.S.); Translational Neuroradiology Section, National Institute of
Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Md
(E.S.B., D.S.R.); Department of Neurology, Icahn School of Medicine at Mount
Sinai, New York, NY (E.S.B.); Bio-imaging Institute, University of Bordeaux,
Bordeaux, France (G.B.); Neurology Section, Department of Neuroscience,
Biomedicine and Movement Sciences, University of Verona, Verona, Italy (M.
Castellaro, M. Calabrese); Department of Information Engineering, University of
Padova, Padova, Italy (M. Castellaro); NMR Research Unit, Queen Square MS
Centre, Department of Neuroinflammation, UCL Queen Square Institute of
Neurology, Faculty of Brain Sciences, University College London, London, UK
(D.T.C.); National Institute for Health Research University College London
Hospitals Biomedical Research Centre, London, UK (D.T.C.); Departments of
Neuroradiology (P.E., B.W.) and Neurology (M.M.), School of Medicine, Klinikum
Rechts der Isar, Technical University of Munich, Munich, Germany; Neuroimaging
Research Unit, Division of Neuroscience Neurology Unit, IRCCS San Raffaele
Scientific Institute Vita-Salute San Raffaele University, Milan, Italy (M.F.,
P.P., M.A.R.); Department of Neuroscience, Rehabilitation, Ophthalmology,
Genetics, Maternal and Child Health, University of Genova, Genoa, Italy (M.I.,
C.L.); IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genoa, Italy
(M.I., C.L.); Center for Neurologic Imaging, Department of Radiology, Brigham
and Women’s Hospital, Harvard Medical School, Boston, Mass (A.M., A.M.P.,
C.R.G.G.); Department of Radiology and Nuclear Medicine, MS Center Amsterdam,
Amsterdam Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (B.M.); Department of Epidemiology and Data Science, Amsterdam
University Medical Center, Amsterdam, the Netherlands (J.W.R.T.); Anatomy
& Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (L.E.J.); and Amsterdam Neuroscience, Brain Imaging and
Neurodegeneration, Amsterdam, the Netherlands (L.E.J.)
| | - Mark Mühlau
- From the MS Center Amsterdam, Anatomy & Neurosciences,
Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, De
Boelelaan 1117, Amsterdam, the Netherlands (P.M.B., S.N., F.A.N.S., M.M.S.,
J.J.G.G., M.D.S.); Translational Neuroradiology Section, National Institute of
Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Md
(E.S.B., D.S.R.); Department of Neurology, Icahn School of Medicine at Mount
Sinai, New York, NY (E.S.B.); Bio-imaging Institute, University of Bordeaux,
Bordeaux, France (G.B.); Neurology Section, Department of Neuroscience,
Biomedicine and Movement Sciences, University of Verona, Verona, Italy (M.
Castellaro, M. Calabrese); Department of Information Engineering, University of
Padova, Padova, Italy (M. Castellaro); NMR Research Unit, Queen Square MS
Centre, Department of Neuroinflammation, UCL Queen Square Institute of
Neurology, Faculty of Brain Sciences, University College London, London, UK
(D.T.C.); National Institute for Health Research University College London
Hospitals Biomedical Research Centre, London, UK (D.T.C.); Departments of
Neuroradiology (P.E., B.W.) and Neurology (M.M.), School of Medicine, Klinikum
Rechts der Isar, Technical University of Munich, Munich, Germany; Neuroimaging
Research Unit, Division of Neuroscience Neurology Unit, IRCCS San Raffaele
Scientific Institute Vita-Salute San Raffaele University, Milan, Italy (M.F.,
P.P., M.A.R.); Department of Neuroscience, Rehabilitation, Ophthalmology,
Genetics, Maternal and Child Health, University of Genova, Genoa, Italy (M.I.,
C.L.); IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genoa, Italy
(M.I., C.L.); Center for Neurologic Imaging, Department of Radiology, Brigham
and Women’s Hospital, Harvard Medical School, Boston, Mass (A.M., A.M.P.,
C.R.G.G.); Department of Radiology and Nuclear Medicine, MS Center Amsterdam,
Amsterdam Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (B.M.); Department of Epidemiology and Data Science, Amsterdam
University Medical Center, Amsterdam, the Netherlands (J.W.R.T.); Anatomy
& Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (L.E.J.); and Amsterdam Neuroscience, Brain Imaging and
Neurodegeneration, Amsterdam, the Netherlands (L.E.J.)
| | - Paolo Preziosa
- From the MS Center Amsterdam, Anatomy & Neurosciences,
Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, De
Boelelaan 1117, Amsterdam, the Netherlands (P.M.B., S.N., F.A.N.S., M.M.S.,
J.J.G.G., M.D.S.); Translational Neuroradiology Section, National Institute of
Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Md
(E.S.B., D.S.R.); Department of Neurology, Icahn School of Medicine at Mount
Sinai, New York, NY (E.S.B.); Bio-imaging Institute, University of Bordeaux,
Bordeaux, France (G.B.); Neurology Section, Department of Neuroscience,
Biomedicine and Movement Sciences, University of Verona, Verona, Italy (M.
Castellaro, M. Calabrese); Department of Information Engineering, University of
Padova, Padova, Italy (M. Castellaro); NMR Research Unit, Queen Square MS
Centre, Department of Neuroinflammation, UCL Queen Square Institute of
Neurology, Faculty of Brain Sciences, University College London, London, UK
(D.T.C.); National Institute for Health Research University College London
Hospitals Biomedical Research Centre, London, UK (D.T.C.); Departments of
Neuroradiology (P.E., B.W.) and Neurology (M.M.), School of Medicine, Klinikum
Rechts der Isar, Technical University of Munich, Munich, Germany; Neuroimaging
Research Unit, Division of Neuroscience Neurology Unit, IRCCS San Raffaele
Scientific Institute Vita-Salute San Raffaele University, Milan, Italy (M.F.,
P.P., M.A.R.); Department of Neuroscience, Rehabilitation, Ophthalmology,
Genetics, Maternal and Child Health, University of Genova, Genoa, Italy (M.I.,
C.L.); IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genoa, Italy
(M.I., C.L.); Center for Neurologic Imaging, Department of Radiology, Brigham
and Women’s Hospital, Harvard Medical School, Boston, Mass (A.M., A.M.P.,
C.R.G.G.); Department of Radiology and Nuclear Medicine, MS Center Amsterdam,
Amsterdam Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (B.M.); Department of Epidemiology and Data Science, Amsterdam
University Medical Center, Amsterdam, the Netherlands (J.W.R.T.); Anatomy
& Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (L.E.J.); and Amsterdam Neuroscience, Brain Imaging and
Neurodegeneration, Amsterdam, the Netherlands (L.E.J.)
| | - Daniel S. Reich
- From the MS Center Amsterdam, Anatomy & Neurosciences,
Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, De
Boelelaan 1117, Amsterdam, the Netherlands (P.M.B., S.N., F.A.N.S., M.M.S.,
J.J.G.G., M.D.S.); Translational Neuroradiology Section, National Institute of
Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Md
(E.S.B., D.S.R.); Department of Neurology, Icahn School of Medicine at Mount
Sinai, New York, NY (E.S.B.); Bio-imaging Institute, University of Bordeaux,
Bordeaux, France (G.B.); Neurology Section, Department of Neuroscience,
Biomedicine and Movement Sciences, University of Verona, Verona, Italy (M.
Castellaro, M. Calabrese); Department of Information Engineering, University of
Padova, Padova, Italy (M. Castellaro); NMR Research Unit, Queen Square MS
Centre, Department of Neuroinflammation, UCL Queen Square Institute of
Neurology, Faculty of Brain Sciences, University College London, London, UK
(D.T.C.); National Institute for Health Research University College London
Hospitals Biomedical Research Centre, London, UK (D.T.C.); Departments of
Neuroradiology (P.E., B.W.) and Neurology (M.M.), School of Medicine, Klinikum
Rechts der Isar, Technical University of Munich, Munich, Germany; Neuroimaging
Research Unit, Division of Neuroscience Neurology Unit, IRCCS San Raffaele
Scientific Institute Vita-Salute San Raffaele University, Milan, Italy (M.F.,
P.P., M.A.R.); Department of Neuroscience, Rehabilitation, Ophthalmology,
Genetics, Maternal and Child Health, University of Genova, Genoa, Italy (M.I.,
C.L.); IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genoa, Italy
(M.I., C.L.); Center for Neurologic Imaging, Department of Radiology, Brigham
and Women’s Hospital, Harvard Medical School, Boston, Mass (A.M., A.M.P.,
C.R.G.G.); Department of Radiology and Nuclear Medicine, MS Center Amsterdam,
Amsterdam Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (B.M.); Department of Epidemiology and Data Science, Amsterdam
University Medical Center, Amsterdam, the Netherlands (J.W.R.T.); Anatomy
& Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (L.E.J.); and Amsterdam Neuroscience, Brain Imaging and
Neurodegeneration, Amsterdam, the Netherlands (L.E.J.)
| | - Maria A. Rocca
- From the MS Center Amsterdam, Anatomy & Neurosciences,
Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, De
Boelelaan 1117, Amsterdam, the Netherlands (P.M.B., S.N., F.A.N.S., M.M.S.,
J.J.G.G., M.D.S.); Translational Neuroradiology Section, National Institute of
Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Md
(E.S.B., D.S.R.); Department of Neurology, Icahn School of Medicine at Mount
Sinai, New York, NY (E.S.B.); Bio-imaging Institute, University of Bordeaux,
Bordeaux, France (G.B.); Neurology Section, Department of Neuroscience,
Biomedicine and Movement Sciences, University of Verona, Verona, Italy (M.
Castellaro, M. Calabrese); Department of Information Engineering, University of
Padova, Padova, Italy (M. Castellaro); NMR Research Unit, Queen Square MS
Centre, Department of Neuroinflammation, UCL Queen Square Institute of
Neurology, Faculty of Brain Sciences, University College London, London, UK
(D.T.C.); National Institute for Health Research University College London
Hospitals Biomedical Research Centre, London, UK (D.T.C.); Departments of
Neuroradiology (P.E., B.W.) and Neurology (M.M.), School of Medicine, Klinikum
Rechts der Isar, Technical University of Munich, Munich, Germany; Neuroimaging
Research Unit, Division of Neuroscience Neurology Unit, IRCCS San Raffaele
Scientific Institute Vita-Salute San Raffaele University, Milan, Italy (M.F.,
P.P., M.A.R.); Department of Neuroscience, Rehabilitation, Ophthalmology,
Genetics, Maternal and Child Health, University of Genova, Genoa, Italy (M.I.,
C.L.); IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genoa, Italy
(M.I., C.L.); Center for Neurologic Imaging, Department of Radiology, Brigham
and Women’s Hospital, Harvard Medical School, Boston, Mass (A.M., A.M.P.,
C.R.G.G.); Department of Radiology and Nuclear Medicine, MS Center Amsterdam,
Amsterdam Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (B.M.); Department of Epidemiology and Data Science, Amsterdam
University Medical Center, Amsterdam, the Netherlands (J.W.R.T.); Anatomy
& Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (L.E.J.); and Amsterdam Neuroscience, Brain Imaging and
Neurodegeneration, Amsterdam, the Netherlands (L.E.J.)
| | - Menno M. Schoonheim
- From the MS Center Amsterdam, Anatomy & Neurosciences,
Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, De
Boelelaan 1117, Amsterdam, the Netherlands (P.M.B., S.N., F.A.N.S., M.M.S.,
J.J.G.G., M.D.S.); Translational Neuroradiology Section, National Institute of
Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Md
(E.S.B., D.S.R.); Department of Neurology, Icahn School of Medicine at Mount
Sinai, New York, NY (E.S.B.); Bio-imaging Institute, University of Bordeaux,
Bordeaux, France (G.B.); Neurology Section, Department of Neuroscience,
Biomedicine and Movement Sciences, University of Verona, Verona, Italy (M.
Castellaro, M. Calabrese); Department of Information Engineering, University of
Padova, Padova, Italy (M. Castellaro); NMR Research Unit, Queen Square MS
Centre, Department of Neuroinflammation, UCL Queen Square Institute of
Neurology, Faculty of Brain Sciences, University College London, London, UK
(D.T.C.); National Institute for Health Research University College London
Hospitals Biomedical Research Centre, London, UK (D.T.C.); Departments of
Neuroradiology (P.E., B.W.) and Neurology (M.M.), School of Medicine, Klinikum
Rechts der Isar, Technical University of Munich, Munich, Germany; Neuroimaging
Research Unit, Division of Neuroscience Neurology Unit, IRCCS San Raffaele
Scientific Institute Vita-Salute San Raffaele University, Milan, Italy (M.F.,
P.P., M.A.R.); Department of Neuroscience, Rehabilitation, Ophthalmology,
Genetics, Maternal and Child Health, University of Genova, Genoa, Italy (M.I.,
C.L.); IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genoa, Italy
(M.I., C.L.); Center for Neurologic Imaging, Department of Radiology, Brigham
and Women’s Hospital, Harvard Medical School, Boston, Mass (A.M., A.M.P.,
C.R.G.G.); Department of Radiology and Nuclear Medicine, MS Center Amsterdam,
Amsterdam Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (B.M.); Department of Epidemiology and Data Science, Amsterdam
University Medical Center, Amsterdam, the Netherlands (J.W.R.T.); Anatomy
& Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (L.E.J.); and Amsterdam Neuroscience, Brain Imaging and
Neurodegeneration, Amsterdam, the Netherlands (L.E.J.)
| | - Jos W. R. Twisk
- From the MS Center Amsterdam, Anatomy & Neurosciences,
Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, De
Boelelaan 1117, Amsterdam, the Netherlands (P.M.B., S.N., F.A.N.S., M.M.S.,
J.J.G.G., M.D.S.); Translational Neuroradiology Section, National Institute of
Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Md
(E.S.B., D.S.R.); Department of Neurology, Icahn School of Medicine at Mount
Sinai, New York, NY (E.S.B.); Bio-imaging Institute, University of Bordeaux,
Bordeaux, France (G.B.); Neurology Section, Department of Neuroscience,
Biomedicine and Movement Sciences, University of Verona, Verona, Italy (M.
Castellaro, M. Calabrese); Department of Information Engineering, University of
Padova, Padova, Italy (M. Castellaro); NMR Research Unit, Queen Square MS
Centre, Department of Neuroinflammation, UCL Queen Square Institute of
Neurology, Faculty of Brain Sciences, University College London, London, UK
(D.T.C.); National Institute for Health Research University College London
Hospitals Biomedical Research Centre, London, UK (D.T.C.); Departments of
Neuroradiology (P.E., B.W.) and Neurology (M.M.), School of Medicine, Klinikum
Rechts der Isar, Technical University of Munich, Munich, Germany; Neuroimaging
Research Unit, Division of Neuroscience Neurology Unit, IRCCS San Raffaele
Scientific Institute Vita-Salute San Raffaele University, Milan, Italy (M.F.,
P.P., M.A.R.); Department of Neuroscience, Rehabilitation, Ophthalmology,
Genetics, Maternal and Child Health, University of Genova, Genoa, Italy (M.I.,
C.L.); IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genoa, Italy
(M.I., C.L.); Center for Neurologic Imaging, Department of Radiology, Brigham
and Women’s Hospital, Harvard Medical School, Boston, Mass (A.M., A.M.P.,
C.R.G.G.); Department of Radiology and Nuclear Medicine, MS Center Amsterdam,
Amsterdam Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (B.M.); Department of Epidemiology and Data Science, Amsterdam
University Medical Center, Amsterdam, the Netherlands (J.W.R.T.); Anatomy
& Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (L.E.J.); and Amsterdam Neuroscience, Brain Imaging and
Neurodegeneration, Amsterdam, the Netherlands (L.E.J.)
| | - Benedict Wiestler
- From the MS Center Amsterdam, Anatomy & Neurosciences,
Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, De
Boelelaan 1117, Amsterdam, the Netherlands (P.M.B., S.N., F.A.N.S., M.M.S.,
J.J.G.G., M.D.S.); Translational Neuroradiology Section, National Institute of
Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Md
(E.S.B., D.S.R.); Department of Neurology, Icahn School of Medicine at Mount
Sinai, New York, NY (E.S.B.); Bio-imaging Institute, University of Bordeaux,
Bordeaux, France (G.B.); Neurology Section, Department of Neuroscience,
Biomedicine and Movement Sciences, University of Verona, Verona, Italy (M.
Castellaro, M. Calabrese); Department of Information Engineering, University of
Padova, Padova, Italy (M. Castellaro); NMR Research Unit, Queen Square MS
Centre, Department of Neuroinflammation, UCL Queen Square Institute of
Neurology, Faculty of Brain Sciences, University College London, London, UK
(D.T.C.); National Institute for Health Research University College London
Hospitals Biomedical Research Centre, London, UK (D.T.C.); Departments of
Neuroradiology (P.E., B.W.) and Neurology (M.M.), School of Medicine, Klinikum
Rechts der Isar, Technical University of Munich, Munich, Germany; Neuroimaging
Research Unit, Division of Neuroscience Neurology Unit, IRCCS San Raffaele
Scientific Institute Vita-Salute San Raffaele University, Milan, Italy (M.F.,
P.P., M.A.R.); Department of Neuroscience, Rehabilitation, Ophthalmology,
Genetics, Maternal and Child Health, University of Genova, Genoa, Italy (M.I.,
C.L.); IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genoa, Italy
(M.I., C.L.); Center for Neurologic Imaging, Department of Radiology, Brigham
and Women’s Hospital, Harvard Medical School, Boston, Mass (A.M., A.M.P.,
C.R.G.G.); Department of Radiology and Nuclear Medicine, MS Center Amsterdam,
Amsterdam Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (B.M.); Department of Epidemiology and Data Science, Amsterdam
University Medical Center, Amsterdam, the Netherlands (J.W.R.T.); Anatomy
& Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (L.E.J.); and Amsterdam Neuroscience, Brain Imaging and
Neurodegeneration, Amsterdam, the Netherlands (L.E.J.)
| | - Laura E. Jonkman
- From the MS Center Amsterdam, Anatomy & Neurosciences,
Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, De
Boelelaan 1117, Amsterdam, the Netherlands (P.M.B., S.N., F.A.N.S., M.M.S.,
J.J.G.G., M.D.S.); Translational Neuroradiology Section, National Institute of
Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Md
(E.S.B., D.S.R.); Department of Neurology, Icahn School of Medicine at Mount
Sinai, New York, NY (E.S.B.); Bio-imaging Institute, University of Bordeaux,
Bordeaux, France (G.B.); Neurology Section, Department of Neuroscience,
Biomedicine and Movement Sciences, University of Verona, Verona, Italy (M.
Castellaro, M. Calabrese); Department of Information Engineering, University of
Padova, Padova, Italy (M. Castellaro); NMR Research Unit, Queen Square MS
Centre, Department of Neuroinflammation, UCL Queen Square Institute of
Neurology, Faculty of Brain Sciences, University College London, London, UK
(D.T.C.); National Institute for Health Research University College London
Hospitals Biomedical Research Centre, London, UK (D.T.C.); Departments of
Neuroradiology (P.E., B.W.) and Neurology (M.M.), School of Medicine, Klinikum
Rechts der Isar, Technical University of Munich, Munich, Germany; Neuroimaging
Research Unit, Division of Neuroscience Neurology Unit, IRCCS San Raffaele
Scientific Institute Vita-Salute San Raffaele University, Milan, Italy (M.F.,
P.P., M.A.R.); Department of Neuroscience, Rehabilitation, Ophthalmology,
Genetics, Maternal and Child Health, University of Genova, Genoa, Italy (M.I.,
C.L.); IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genoa, Italy
(M.I., C.L.); Center for Neurologic Imaging, Department of Radiology, Brigham
and Women’s Hospital, Harvard Medical School, Boston, Mass (A.M., A.M.P.,
C.R.G.G.); Department of Radiology and Nuclear Medicine, MS Center Amsterdam,
Amsterdam Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (B.M.); Department of Epidemiology and Data Science, Amsterdam
University Medical Center, Amsterdam, the Netherlands (J.W.R.T.); Anatomy
& Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (L.E.J.); and Amsterdam Neuroscience, Brain Imaging and
Neurodegeneration, Amsterdam, the Netherlands (L.E.J.)
| | - Charles R. G. Guttmann
- From the MS Center Amsterdam, Anatomy & Neurosciences,
Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, De
Boelelaan 1117, Amsterdam, the Netherlands (P.M.B., S.N., F.A.N.S., M.M.S.,
J.J.G.G., M.D.S.); Translational Neuroradiology Section, National Institute of
Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Md
(E.S.B., D.S.R.); Department of Neurology, Icahn School of Medicine at Mount
Sinai, New York, NY (E.S.B.); Bio-imaging Institute, University of Bordeaux,
Bordeaux, France (G.B.); Neurology Section, Department of Neuroscience,
Biomedicine and Movement Sciences, University of Verona, Verona, Italy (M.
Castellaro, M. Calabrese); Department of Information Engineering, University of
Padova, Padova, Italy (M. Castellaro); NMR Research Unit, Queen Square MS
Centre, Department of Neuroinflammation, UCL Queen Square Institute of
Neurology, Faculty of Brain Sciences, University College London, London, UK
(D.T.C.); National Institute for Health Research University College London
Hospitals Biomedical Research Centre, London, UK (D.T.C.); Departments of
Neuroradiology (P.E., B.W.) and Neurology (M.M.), School of Medicine, Klinikum
Rechts der Isar, Technical University of Munich, Munich, Germany; Neuroimaging
Research Unit, Division of Neuroscience Neurology Unit, IRCCS San Raffaele
Scientific Institute Vita-Salute San Raffaele University, Milan, Italy (M.F.,
P.P., M.A.R.); Department of Neuroscience, Rehabilitation, Ophthalmology,
Genetics, Maternal and Child Health, University of Genova, Genoa, Italy (M.I.,
C.L.); IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genoa, Italy
(M.I., C.L.); Center for Neurologic Imaging, Department of Radiology, Brigham
and Women’s Hospital, Harvard Medical School, Boston, Mass (A.M., A.M.P.,
C.R.G.G.); Department of Radiology and Nuclear Medicine, MS Center Amsterdam,
Amsterdam Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (B.M.); Department of Epidemiology and Data Science, Amsterdam
University Medical Center, Amsterdam, the Netherlands (J.W.R.T.); Anatomy
& Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (L.E.J.); and Amsterdam Neuroscience, Brain Imaging and
Neurodegeneration, Amsterdam, the Netherlands (L.E.J.)
| | - Jeroen J. G. Geurts
- From the MS Center Amsterdam, Anatomy & Neurosciences,
Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, De
Boelelaan 1117, Amsterdam, the Netherlands (P.M.B., S.N., F.A.N.S., M.M.S.,
J.J.G.G., M.D.S.); Translational Neuroradiology Section, National Institute of
Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Md
(E.S.B., D.S.R.); Department of Neurology, Icahn School of Medicine at Mount
Sinai, New York, NY (E.S.B.); Bio-imaging Institute, University of Bordeaux,
Bordeaux, France (G.B.); Neurology Section, Department of Neuroscience,
Biomedicine and Movement Sciences, University of Verona, Verona, Italy (M.
Castellaro, M. Calabrese); Department of Information Engineering, University of
Padova, Padova, Italy (M. Castellaro); NMR Research Unit, Queen Square MS
Centre, Department of Neuroinflammation, UCL Queen Square Institute of
Neurology, Faculty of Brain Sciences, University College London, London, UK
(D.T.C.); National Institute for Health Research University College London
Hospitals Biomedical Research Centre, London, UK (D.T.C.); Departments of
Neuroradiology (P.E., B.W.) and Neurology (M.M.), School of Medicine, Klinikum
Rechts der Isar, Technical University of Munich, Munich, Germany; Neuroimaging
Research Unit, Division of Neuroscience Neurology Unit, IRCCS San Raffaele
Scientific Institute Vita-Salute San Raffaele University, Milan, Italy (M.F.,
P.P., M.A.R.); Department of Neuroscience, Rehabilitation, Ophthalmology,
Genetics, Maternal and Child Health, University of Genova, Genoa, Italy (M.I.,
C.L.); IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genoa, Italy
(M.I., C.L.); Center for Neurologic Imaging, Department of Radiology, Brigham
and Women’s Hospital, Harvard Medical School, Boston, Mass (A.M., A.M.P.,
C.R.G.G.); Department of Radiology and Nuclear Medicine, MS Center Amsterdam,
Amsterdam Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (B.M.); Department of Epidemiology and Data Science, Amsterdam
University Medical Center, Amsterdam, the Netherlands (J.W.R.T.); Anatomy
& Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (L.E.J.); and Amsterdam Neuroscience, Brain Imaging and
Neurodegeneration, Amsterdam, the Netherlands (L.E.J.)
| | - Martijn D. Steenwijk
- From the MS Center Amsterdam, Anatomy & Neurosciences,
Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, De
Boelelaan 1117, Amsterdam, the Netherlands (P.M.B., S.N., F.A.N.S., M.M.S.,
J.J.G.G., M.D.S.); Translational Neuroradiology Section, National Institute of
Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Md
(E.S.B., D.S.R.); Department of Neurology, Icahn School of Medicine at Mount
Sinai, New York, NY (E.S.B.); Bio-imaging Institute, University of Bordeaux,
Bordeaux, France (G.B.); Neurology Section, Department of Neuroscience,
Biomedicine and Movement Sciences, University of Verona, Verona, Italy (M.
Castellaro, M. Calabrese); Department of Information Engineering, University of
Padova, Padova, Italy (M. Castellaro); NMR Research Unit, Queen Square MS
Centre, Department of Neuroinflammation, UCL Queen Square Institute of
Neurology, Faculty of Brain Sciences, University College London, London, UK
(D.T.C.); National Institute for Health Research University College London
Hospitals Biomedical Research Centre, London, UK (D.T.C.); Departments of
Neuroradiology (P.E., B.W.) and Neurology (M.M.), School of Medicine, Klinikum
Rechts der Isar, Technical University of Munich, Munich, Germany; Neuroimaging
Research Unit, Division of Neuroscience Neurology Unit, IRCCS San Raffaele
Scientific Institute Vita-Salute San Raffaele University, Milan, Italy (M.F.,
P.P., M.A.R.); Department of Neuroscience, Rehabilitation, Ophthalmology,
Genetics, Maternal and Child Health, University of Genova, Genoa, Italy (M.I.,
C.L.); IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genoa, Italy
(M.I., C.L.); Center for Neurologic Imaging, Department of Radiology, Brigham
and Women’s Hospital, Harvard Medical School, Boston, Mass (A.M., A.M.P.,
C.R.G.G.); Department of Radiology and Nuclear Medicine, MS Center Amsterdam,
Amsterdam Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (B.M.); Department of Epidemiology and Data Science, Amsterdam
University Medical Center, Amsterdam, the Netherlands (J.W.R.T.); Anatomy
& Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
the Netherlands (L.E.J.); and Amsterdam Neuroscience, Brain Imaging and
Neurodegeneration, Amsterdam, the Netherlands (L.E.J.)
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18
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Margoni M, Gueye M, Meani A, Pagani E, Moiola L, Preziosa P, Filippi M, Rocca MA. Choroid plexus enlargement in paediatric multiple sclerosis: clinical relevance and effect of sex. J Neurol Neurosurg Psychiatry 2023; 94:181-188. [PMID: 36351790 DOI: 10.1136/jnnp-2022-330343] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [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: 09/05/2022] [Accepted: 10/18/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Choroid plexus (CP) enlargement has been suggested as a reliable marker of neuroinflammation in adult multiple sclerosis (MS). We investigated CP volume in patients with paediatric MS compared with matched healthy controls (HC), possible sex-related effect, and the associations with clinical and structural MRI variables. METHODS Brain 3.0 T dual-echo and three-dimensional (3D) T1-weighted sequences were selected retrospectively from 69 patients with paediatric MS and 23 age-matched and sex-matched HC. CP volume was manually obtained from 3D T1-weighted scans by two expert raters. RESULTS CP segmentation was highly reproducible (intraobserver agreement: rater I=0.963, rater II=0.958; interobserver agreement=0.968). Compared with HC, patients with paediatric MS showed higher normalised CP volume (p<0.001). Both female and male patients with paediatric MS showed higher normalised CP volume compared with sex-matched HC (women: p<0.001 and men: p=0.021), with a significant disease×sex interaction (p=0.040). In patients with MS, a higher normalised CP volume was significantly associated with higher brain lesional volume (β=0.252, p=0.017), larger lateral ventricle volume (β=0.470, false discovery rate (FDR)-p<0.001), lower normalised brain volume (β=-0.413, FDR-p=0.002) and lower normalised thalamic volume (β=0.291, FDR-p=0.046). No associations with disease duration, Expanded Disability Status Scale score, normalised cortical and white matter volumes were found (FDR-p≥0.172). A significant effect of the disease in the negative association between normalised volumes of CP and thalami was observed (FDR-p=0.046). CONCLUSIONS CP enlargement occurs in paediatric MS, suggesting its early involvement in the pathophysiology of the disease. The higher CP volume, which is found especially in female patients, supports the hypothesis of sex-related differences occurring already in paediatric MS.
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Affiliation(s)
- Monica Margoni
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milan, Italy.,Neurology Unit, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Mor Gueye
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Alessandro Meani
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Elisabetta Pagani
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Lucia Moiola
- Neurology Unit, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Paolo Preziosa
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milan, Italy.,Neurology Unit, IRCCS Ospedale San Raffaele, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milan, Italy.,Neurology Unit, IRCCS Ospedale San Raffaele, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy.,Neurorehabilitation Unit, IRCCS Ospedale San Raffaele, Milan, Italy.,Neurophysiology Service, IRCCS Osepdale San raffaele, Milan, Italy
| | - Maria A Rocca
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milan, Italy .,Neurology Unit, IRCCS Ospedale San Raffaele, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
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19
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Preziosa P, Rocca MA, Pagani E, Valsasina P, Amato MP, Brichetto G, Bruschi N, Chataway J, Chiaravalloti ND, Cutter G, Dalgas U, DeLuca J, Farrell R, Feys P, Freeman J, Inglese M, Meani A, Meza C, Motl RW, Salter A, Sandroff BM, Feinstein A, Filippi M. Structural and functional magnetic resonance imaging correlates of fatigue and dual-task performance in progressive multiple sclerosis. J Neurol 2023; 270:1543-1563. [PMID: 36436069 DOI: 10.1007/s00415-022-11486-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 09/28/2022] [Revised: 11/09/2022] [Accepted: 11/10/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Frontal cortico-subcortical dysfunction may contribute to fatigue and dual-task impairment of walking and cognition in progressive multiple sclerosis (PMS). PURPOSE To explore the associations among fatigue, dual-task performance and structural and functional abnormalities of frontal cortico-subcortical network in PMS. METHODS Brain 3 T structural and functional MRI sequences, Modified Fatigue Impact Scale (MFIS), dual-task motor and cognitive performances were obtained from 57 PMS patients and 10 healthy controls (HC). The associations of thalamic, caudate nucleus and dorsolateral prefrontal cortex (DLPFC) atrophy, microstructural abnormalities of their connections and their resting state effective connectivity (RS-EC) with fatigue and dual-task performance were investigated using random forest. RESULTS Thirty-seven PMS patients were fatigued (F) (MFIS ≥ 38). Compared to HC, non-fatigued (nF) and F-PMS patients had significantly worse dual-task performance (p ≤ 0.002). Predictors of fatigue (out-of-bag [OOB]-accuracy = 0.754) and its severity (OOB-R2 = 0.247) were higher Expanded Disability Status scale (EDSS) score, lower RS-EC from left-caudate nucleus to left-DLPFC, lower fractional anisotropy between left-caudate nucleus and left-thalamus, higher mean diffusivity between right-caudate nucleus and right-thalamus, and longer disease duration. Microstructural abnormalities in connections among thalami, caudate nuclei and DLPFC, mainly left-lateralized in nF-PMS and more bilateral in F-PMS, higher RS-EC from left-DLPFC to right-DLPFC in nF-PMS and lower RS-EC from left-caudate nucleus to left-DLPFC in F-PMS, higher EDSS score, higher WM lesion volume, and lower cortical volume predicted worse dual-task performances (OOB-R2 from 0.426 to 0.530). CONCLUSIONS In PMS, structural and functional frontal cortico-subcortical abnormalities contribute to fatigue and worse dual-task performance, with different patterns according to the presence of fatigue.
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Affiliation(s)
- Paolo Preziosa
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Maria A Rocca
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Elisabetta Pagani
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paola Valsasina
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria Pia Amato
- Department NEUROFARBA, Section Neurosciences, University of Florence, Florence, Italy.,IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - Giampaolo Brichetto
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy.,AISM Rehabilitation Service, Italian Multiple Sclerosis Society, Genoa, Italy
| | - Nicolò Bruschi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, and Center of Excellence for Biomedical Research, University of Genoa, Genoa, Italy
| | - Jeremy Chataway
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK.,National Institute for Health Research, Biomedical Research Centre, University College London Hospitals, London, UK
| | - Nancy D Chiaravalloti
- Kessler Foundation, West Orange, NJ, USA.,Department of Physical Medicine and Rehabilitation, Rutgers NJ Medical School, Newark, NJ, USA
| | - Gary Cutter
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ulrik Dalgas
- Exercise Biology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - John DeLuca
- Kessler Foundation, West Orange, NJ, USA.,Department of Physical Medicine and Rehabilitation, Rutgers NJ Medical School, Newark, NJ, USA
| | - Rachel Farrell
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK.,National Institute for Health Research, Biomedical Research Centre, University College London Hospitals, London, UK
| | - Peter Feys
- REVAL, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | - Jennifer Freeman
- Faculty of Health, School of Health Professions, University of Plymouth, Plymouth, UK
| | - Matilde Inglese
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, and Center of Excellence for Biomedical Research, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Alessandro Meani
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Cecilia Meza
- Department of Psychiatry, University of Toronto and Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Robert W Motl
- Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, IL, USA
| | - Amber Salter
- Department of Neurology, Section on Statistical Planning and Analysis, UT Southwestern Medical Center, Dallas, TX, USA
| | - Brian M Sandroff
- Kessler Foundation, West Orange, NJ, USA.,Department of Physical Medicine and Rehabilitation, Rutgers NJ Medical School, Newark, NJ, USA
| | - Anthony Feinstein
- Department of Psychiatry, University of Toronto and Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy. .,Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy. .,Vita-Salute San Raffaele University, Milan, Italy.
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20
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Tedone N, Preziosa P, Meani A, Pagani E, Vizzino C, Filippi M, Rocca MA. Regional white matter and gray matter damage and cognitive performances in multiple sclerosis according to sex. Mol Psychiatry 2023; 28:1783-1792. [PMID: 36806391 DOI: 10.1038/s41380-023-01996-2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 02/08/2023] [Accepted: 02/09/2023] [Indexed: 02/22/2023]
Abstract
In this study, we investigated whether regional distribution of white matter (WM) lesions, normal-appearing [NA] WM microstructural abnormalities and gray matter (GM) atrophy may differently contribute to cognitive performance in multiple sclerosis (MS) patients according to sex. Using the same scanner, brain 3.0T MRI was acquired for 287 MS patients (females = 173; mean age = 42.1 [standard deviation, SD = 12.7] years; relapsing-remitting = 196, progressive = 91; median Expanded Disability Status Scale = 2.5 [interquartile range, IQR = 1.5-5.0]; median disease duration = 12.1 [IQR = 6.3-19.0] years; treatment: none = 70, first-line = 130, second-line = 87) and 172 healthy controls (HC) (females = 92; mean age = 39.3 [SD = 14.8] years). MS patients underwent also Rao's neuropsychological battery. Using voxel-wise analyses, we investigated in patients sex-related differences in the association of cognitive performances with WM lesions, NAWM fractional anisotropy (FA) and GM volumes (p < 0.01, family-wise error [FWE]). Sixty-six female (38%) and 48 male (42%) MS patients were cognitively impaired, with no significant between-group difference (p = 0.704). However, verbal memory performance was worse in males (p = 0.001), whereas verbal fluency performance was worse in females (p = 0.004). In both sexes, a higher T2-hyperintense lesion prevalence in cognitively-relevant WM tracts was significantly associated with worse cognitive performance (p ≤ 0.006), with stronger associations in females than males in global cognition (p ≤ 0.004). Compared to sex-matched HC, male and female MS patients had widespread lower NAWM FA and GM volume (p < 0.01). In both sexes, worse cognitive performance was associated with widespread reduced NAWM FA (p < 0.01), with stronger associations in females than males in global cognition and verbal memory (p ≤ 0.009). Worse cognitive performance was significantly associated with clusters of cortical GM atrophy in males (p ≤ 0.007) and mainly with deep GM atrophy in females (p ≤ 0.006). In this study, only limited differences in cognitive performances were found between male and female MS patients. A disconnection syndrome due to focal WM lesions and diffuse NAWM microstructural abnormalities seems to be more relevant in female MS patients to explain cognitive impairment.
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Affiliation(s)
- Nicolò Tedone
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Preziosa
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Alessandro Meani
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Elisabetta Pagani
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Carmen Vizzino
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy.,Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria A Rocca
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy. .,Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy. .,Vita-Salute San Raffaele University, Milan, Italy.
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21
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Carotenuto A, Valsasina P, Preziosa P, Mistri D, Filippi M, Rocca MA. Monoaminergic network abnormalities: a marker for multiple sclerosis-related fatigue and depression. J Neurol Neurosurg Psychiatry 2023; 94:94-101. [PMID: 36229193 DOI: 10.1136/jnnp-2022-330109] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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: 08/05/2022] [Accepted: 10/01/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To investigate monoaminergic network abnormalities in patients with multiple sclerosis (MS) according to their fatigue and depressive status through a positron emission tomography (PET)-based constrained independent component analysis (ICA) on resting state (RS) functional MRI (fMRI). METHODS In this prospective study, 213 patients with MS (mean age=40.6±12.5 years; 94/119 men/women; 153 relapsing-remitting; 60 progressive) and 62 healthy controls (HCs, mean age=39.0±10.4 years; 30/32 men/women) underwent neurological, fatigue, depression and RS fMRI assessment. Patterns of dopamine, norepinephrine-related and serotonin-related RS functional connectivity (FC) were derived by ICA, constrained to PET atlases for dopamine, norepinephrine and serotonin transporters, obtained in HCs' brain. RESULTS Compared with HCs, patients with MS showed abnormalities in all three explored monoaminergic networks, mostly with decreased RS FC within PET-guided monoaminergic networks in frontal regions and subcortical areas including the cerebellum and thalamus, and increased RS FC in temporo-parieto-occipital cortical areas, including bilateral precunei.MS-related fatigue was associated with decreased RS FC within the PET-guided dopamine network in the left thalamus and left cerebellum, and with increased RS FC within the PET-guided serotonin network in the left middle occipital gyrus. MS-related depression was associated with more distributed abnormalities involving the three explored monoaminergic networks, resulting in overall reduced RS FC in the frontal lobe, limbic areas and the precuneus. CONCLUSIONS Patients with MS present diffuse dysregulation in the monoaminergic networks. Specific alterations in these networks were associated with fatigue and depression, providing a pathological marker for these bothersome symptoms and putative targets for their treatment.
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Affiliation(s)
- Antonio Carotenuto
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Paola Valsasina
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Paolo Preziosa
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milan, Italy.,Neurology Unit, IRCCS Ospedale San Raffaele, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Damiano Mistri
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milan, Italy.,Neurology Unit, IRCCS Ospedale San Raffaele, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy.,Neurorehabilitation Unit, IRCCS Ospedale San Raffaele, Milan, Italy.,Neurophysiology Service, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Maria A Rocca
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milan, Italy .,Neurology Unit, IRCCS Ospedale San Raffaele, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
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22
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Preziosa P, Pagani E, Meani A, Marchesi O, Conti L, Falini A, Rocca MA, Filippi M. NODDI, diffusion tensor microstructural abnormalities and atrophy of brain white matter and gray matter contribute to cognitive impairment in multiple sclerosis. J Neurol 2023; 270:810-823. [PMID: 36201016 DOI: 10.1007/s00415-022-11415-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 08/16/2022] [Revised: 09/29/2022] [Accepted: 09/30/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Pathologically specific MRI measures may elucidate in-vivo the heterogeneous processes contributing to cognitive impairment in multiple sclerosis (MS). PURPOSE Using diffusion tensor and neurite orientation dispersion and density imaging (NODDI), we explored the contribution of focal lesions and normal-appearing (NA) tissue microstructural abnormalities to cognitive impairment in MS. METHODS One hundred and fifty-two MS patients underwent 3 T brain MRI and a neuropsychological evaluation. Forty-eight healthy controls (HC) were also scanned. Fractional anisotropy (FA), mean diffusivity (MD), intracellular volume fraction (ICV_f) and orientation dispersion index (ODI) were assessed in cortical and white matter (WM) lesions, thalamus, NA cortex and NAWM. Predictors of cognitive impairment were identified using random forest. RESULTS Fifty-two MS patients were cognitively impaired. Compared to cognitively preserved, impaired MS patients had higher WM lesion volume (LV), lower normalized brain volume (NBV), cortical volume (NCV), thalamic volume (NTV), and WM volume (p ≤ 0.021). They also showed lower NAWM FA, higher NAWM, NA cortex and thalamic MD, lower NAWM ICV_f, lower WM lesion ODI, and higher NAWM ODI (false discovery rate-p ≤ 0.026). Cortical lesion number and microstructural abnormalities were not significantly different. The best MRI predictors of cognitive impairment (relative importance) (out-of-bag area under the curve = 0.727) were NAWM FA (100%), NTV (96.0%), NBV (84.7%), thalamic MD (43.4%), NCV (40.6%), NA cortex MD (26.0%), WM LV (23.2%) and WM lesion ODI (17.9%). CONCLUSIONS Our multiparametric MRI study including NODDI measures suggested that neuro-axonal damage and loss of microarchitecture integrity in focal WM lesions, NAWM, and GM contribute to cognitive impairment in MS.
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Affiliation(s)
- Paolo Preziosa
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy.,Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Elisabetta Pagani
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
| | - Alessandro Meani
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
| | - Olga Marchesi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
| | - Lorenzo Conti
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
| | - Andrea Falini
- Neuroradiology Unit and CERMAC, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Maria A Rocca
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy.,Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy. .,Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy. .,Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy. .,Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy. .,Vita-Salute San Raffaele University, Milan, Italy.
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23
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Margoni M, Pagani E, Preziosa P, Palombo M, Gueye M, Azzimonti M, Filippi M, Rocca MA. In vivo quantification of brain soma and neurite density abnormalities in multiple sclerosis. J Neurol 2023; 270:433-445. [PMID: 36153468 DOI: 10.1007/s00415-022-11386-3] [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] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/12/2022] [Accepted: 09/13/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Soma and neurite density imaging (SANDI) is a new biophysical model that incorporates soma in addition to neurite density, thus possibly providing more specific information about the complex pathological processes of multiple sclerosis (MS). PURPOSE To discriminate the pathological abnormalities of MS white matter (WM) lesions, normal-appearing (NA) WM and cortex and to evaluate the associations among SANDI-derived measures, clinical disability, and conventional MRI variables. METHODS Twenty healthy controls (HC) and 23 MS underwent a 3 T brain MRI. Using SANDI on diffusion-weighted sequence, the fractions of neurite (fneurite) and soma (fsoma) were assessed in WM lesions, NAWM, and cortex. RESULTS Compared to HC WM, MS NAWM showed lower fneurite (false discovery rate [FDR]-p = 0.011). In MS patients, WM lesions showed lower fneurite and fsoma compared to both HC and MS NAWM (FDR-p < 0.001 for all). In the cortex, MS patients had lower fneurite and fsoma compared to HC (FDR-p ≤ 0.009). Compared to both HC and RRMS, PMS patients had lower fneurite in NAWM (vs HC: FDR-p < 0.001; vs RRMS: FDR-p = 0.003) and cortex (vs HC: FDR-p < 0.001; vs RRMS: p = 0.031, not surviving FDR correction), and lower cortical fsoma (vs HC: FDR-p < 0.001; vs RRMS: FDR-p = 0.009). Compared to HC, PMS also showed a higher fsoma in NAWM (FDR-p = 0.015). Fneurite and fsoma in the different brain compartments were correlated with age, phenotype, disease duration, disability, WM lesion volumes, normalized brain, cortical, and WM volumes (r from - 0.761 to 0.821, FDR-p ≤ 0.4). CONCLUSIONS SANDI may represent a clinically relevant model to discriminate different neurodegenerative phenomena that gradually accumulate through MS disease course.
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Affiliation(s)
- Monica Margoni
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Elisabetta Pagani
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Preziosa
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marco Palombo
- Cardiff University Brain Research Imaging Centre, School of Psychology, Cardiff University, Cardiff, UK
- School of Computer Science and Informatics, Cardiff University, Cardiff, UK
| | - Mor Gueye
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Matteo Azzimonti
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Maria Assunta Rocca
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Vita-Salute San Raffaele University, Milan, Italy.
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Rocca MA, Valsasina P, Meani A, Gobbi C, Zecca C, Barkhof F, Schoonheim MM, Strijbis EM, Vrenken H, Gallo A, Bisecco A, Ciccarelli O, Yiannakas M, Rovira A, Sastre-Garriga J, Palace J, Matthews L, Gass A, Eisele P, Lukas C, Bellenberg B, Margoni M, Preziosa P, Filippi M. Spinal cord lesions and brain grey matter atrophy independently predict clinical worsening in definite multiple sclerosis: a 5-year, multicentre study. J Neurol Neurosurg Psychiatry 2023; 94:10-18. [PMID: 36171105 DOI: 10.1136/jnnp-2022-329854] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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: 06/24/2022] [Accepted: 09/05/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To evaluate the combined contribution of brain and cervical cord damage in predicting 5-year clinical worsening in a multicentre cohort of definite multiple sclerosis (MS) patients. METHODS Baseline 3.0T brain and cervical cord T2-weighted and three-dimensional T1-weighted MRI was acquired in 367 patients with MS (326 relapse-onset and 41 progressive-onset) and 179 healthy controls. Expanded Disability Status Scale (EDSS) score was obtained at baseline and after a median follow-up of 5.1 years (IQR=4.8-5.2). At follow-up, patients were classified as clinically stable/worsened according to EDSS changes. Generalised linear mixed models identified predictors of clinical worsening, evolution to secondary progressive (SP) MS and reaching EDSS=3.0, 4.0 and 6.0 milestones at 5 years. RESULTS At follow-up, 120/367 (33%) patients with MS worsened clinically; 36/256 (14%) patients with relapsing-remitting evolved to SPMS. Baseline predictors of EDSS worsening were progressive-onset versus relapse-onset MS (standardised beta (β)=0.97), higher EDSS (β=0.41), higher cord lesion number (β=0.41), lower normalised cortical volume (β=-0.15) and lower cord area (β=-0.28) (C-index=0.81). Older age (β=0.86), higher EDSS (β=1.40) and cord lesion number (β=0.87) independently predicted SPMS conversion (C-index=0.91). Predictors of reaching EDSS=3.0 after 5 years were higher baseline EDSS (β=1.49), cord lesion number (β=1.02) and lower normalised cortical volume (β=-0.56) (C-index=0.88). Baseline age (β=0.30), higher EDSS (β=2.03), higher cord lesion number (β=0.66) and lower cord area (β=-0.41) predicted EDSS=4.0 (C-index=0.92). Finally, higher baseline EDSS (β=1.87) and cord lesion number (β=0.54) predicted EDSS=6.0 (C-index=0.91). CONCLUSIONS Spinal cord damage and, to a lesser extent, cortical volume loss helped predicting worse 5-year clinical outcomes in MS.
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Affiliation(s)
- Maria A Rocca
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milano, Italy .,Neurology Unit, IRCCS Ospedale San Raffaele, Milano, Italy.,Vita-Salute San Raffaele University, Milano, Italy
| | - Paola Valsasina
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milano, Italy
| | - Alessandro Meani
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milano, Italy
| | - Claudio Gobbi
- Neurology Clinic, MS Center/Headache Center, Neurocenter of Southern Switzerland EOC, Lugano, Switzerland.,Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Chiara Zecca
- Neurology Clinic, MS Center/Headache Center, Neurocenter of Southern Switzerland EOC, Lugano, Switzerland.,Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Frederik Barkhof
- Radiology and Nuclear Medicine, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC - Locatie VUMC, Amsterdam, Netherlands.,Department of Neurology, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC - Locatie VUMC, Amsterdam, Netherlands
| | - Menno M Schoonheim
- Department of Anatomy and Neurosciences, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC Locatie VUmc, Amsterdam, Netherlands
| | - Eva M Strijbis
- Department of Neurology, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC - Locatie VUMC, Amsterdam, Netherlands
| | - Hugo Vrenken
- Radiology and Nuclear Medicine, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC - Locatie VUMC, Amsterdam, Netherlands.,Department of Neurology, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC - Locatie VUMC, Amsterdam, Netherlands
| | - Antonio Gallo
- Department of Advanced Medical and Surgical Sciences, and 3T MRI-Center, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Alvino Bisecco
- Department of Advanced Medical and Surgical Sciences, and 3T MRI-Center, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Olga Ciccarelli
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, London, UK
| | - Marios Yiannakas
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, London, UK
| | - Alex Rovira
- Section of Neuroradiology, Department of Radiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Jaume Sastre-Garriga
- Department of Neurology/Neuroimmunology, Multiple Sclerosis Centre of Catalonia, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Jacqueline Palace
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Lucy Matthews
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Achim Gass
- Department of Neurology, and Mannheim Center of Translational Neurosciences (MCTN), Ruprecht Karls University Heidelberg Faculty of Medicine Mannheim, Mannheim, Germany
| | - Philipp Eisele
- Department of Neurology, and Mannheim Center of Translational Neurosciences (MCTN), Ruprecht Karls University Heidelberg Faculty of Medicine Mannheim, Mannheim, Germany
| | - Carsten Lukas
- Institute of Neuroradiology, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany.,Department of Radiology and Nuclear Medicine, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Barbara Bellenberg
- Institute of Neuroradiology, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Monica Margoni
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milano, Italy
| | - Paolo Preziosa
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milano, Italy.,Neurology Unit, IRCCS Ospedale San Raffaele, Milano, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milano, Italy.,Neurology Unit, IRCCS Ospedale San Raffaele, Milano, Italy.,Vita-Salute San Raffaele University, Milano, Italy.,Neurorehabilitation Unit, IRCCS Ospedale San Raffaele, Milano, Italy.,Neurophysiology Service, IRCCS Ospedale San Raffaele, Milano, Italy
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25
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Albergoni M, Storelli L, Preziosa P, Rocca MA, Filippi M. The insula modulates the effects of aerobic training on cardiovascular function and ambulation in multiple sclerosis. J Neurol 2023; 270:1672-1681. [PMID: 36509982 PMCID: PMC9744365 DOI: 10.1007/s00415-022-11513-0] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 11/30/2022] [Accepted: 12/01/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Impairment of cardiovascular control is common in multiple sclerosis (MS), possibly due to damage of strategic brain regions such as the insula. Aerobic training (AT) targets cardiopulmonary system and may represent a neuroprotective strategy. PURPOSE To investigate whether insular damage (T2-hyperintense lesions and volume) is associated with cardiovascular fitness (CF) and influences AT effects in MS. METHODS Sixty-one MS patients were randomized to an AT intervention group (MS-AT) and a motor training control group (MS-C). At baseline and after training (24 sessions over 2-3 months), peak of oxygen consumption (VO2max), heart rate reserve (HRR), 6-min walk test (6MWT) and whole brain and insula MRI data were collected. Two healthy control (HC) groups were enrolled for CF and MRI data analysis. RESULTS At baseline, MS patients vs HC showed impaired VO2max, HRR and 6MWT (p < 0.001) and widespread gray matter atrophy, including bilateral insula. In MS patients, left insula T2-lesion volume correlated with HRR (r = 0.27, p = 0.042). After training, MS-AT, especially those without insular T2-hyperintense lesions, showed 6MWT improvement (p < 0.05) and a stable insular volume, whereas MS-C showed left insular volume loss (p < 0.001). CONCLUSIONS By increasing 6MWT performance, our results suggest that AT may improve walking capacity and submaximal measure of CF in MS patients. Such beneficial effect may be modulated by insula integrity.
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Affiliation(s)
- Matteo Albergoni
- grid.18887.3e0000000417581884Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132 Milan, Italy
| | - Loredana Storelli
- grid.18887.3e0000000417581884Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132 Milan, Italy
| | - Paolo Preziosa
- grid.18887.3e0000000417581884Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132 Milan, Italy ,grid.18887.3e0000000417581884Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy ,grid.15496.3f0000 0001 0439 0892Vita-Salute San Raffaele University, Milan, Italy
| | - Maria A. Rocca
- grid.18887.3e0000000417581884Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132 Milan, Italy ,grid.18887.3e0000000417581884Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy ,grid.15496.3f0000 0001 0439 0892Vita-Salute San Raffaele University, Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy. .,Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy. .,Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy. .,Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy. .,Vita-Salute San Raffaele University, Milan, Italy.
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26
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Pantzaris MC, Bakirtzis C, Grigoriadis N, Hadjigeorgiou G, Dardiotis E, Loucaides G, Ntzani E, Markozannes G, Omorfos S, Valsasina P, Messina R, Preziosa P, Rocca MA, Patrikios I. Phase III, randomised, double-blind, placebo-controlled trial of Neuroaspis plp10 as an adjuvant treatment for relapsing multiple sclerosis: the MINERAL Study. BMJ Neurol Open 2022; 4:e000334. [PMID: 36353267 PMCID: PMC9639060 DOI: 10.1136/bmjno-2022-000334] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 10/03/2022] [Indexed: 11/06/2022] Open
Abstract
Objectives To assess the effectiveness of Neuroaspis plp10 nutritional supplement when added to interferon (IFN)-β treatment in patients with relapsing-remitting multiple sclerosis (RRMS). Design A 30-month phase III multicentre, randomised, double-blind, placebo-controlled trial. Randomisation stratified by centre using a computer-generated procedure with Neuroaspis plp10 versus placebo in 1:1 ratio. The first 6 months were used as both the pre-entry and normalisation period. Setting 3 teaching hospitals in Greece and 1 Neurology Institute in Cyprus. Participants 61 patients with RRMS on IFN-β were randomly assigned to receive Neuroaspis plp10 (n=32) or placebo (n=29), 20 mL, orally, once daily, for 30 months. Intervention Neuroaspis plp10, a cocktail mixture, containing specific PUFA (12 150 mg) and γ-tocopherol (760 mg) versus virgin olive oil (placebo). Main outcome measure The primary end point was the annual relapse rate (ARR) whereas the secondary ones were the rate of sustained progression of disability, as measured by the Expanded Disability Status Scale (EDSS) and the brain T2 and gadolinium-enhancing lesions, at 2 years. Results For the intention-to-treat analyses Neuroaspis plp10 significantly reduced the ARR by 80%, (RRR, 0.20; 95% CI: 0.09 to 0.45; p=0.0001) and the risk of sustained progression of disability by 73% (HR, 0.27; 95% CI: 0.09 to 0.83; p=0.022) versus placebo, at 2 years. The number of T1 gadolinium-enhancing lesions and the number of new/enlarged T2-hyperintense lesions were significantly reduced (p=0.01 and p<0.0001, respectively). Both T1-enhancing and new/enlarging T2-hyperintense lesions were significantly reduced (p=0.05 and p<0.0001, respectively). No significant adverse events were reported. Conclusions Neuroaspis plp10 added to IFN-β was significantly more effective than IFN-β alone in patients with RRMS. Trial registration number ISRCTN06166891.
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Affiliation(s)
- Marios C Pantzaris
- Neurology Clinic C, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
| | - Christos Bakirtzis
- Department of Neurology Laboratory of Experimental Neurology and Neuroimmunology and the Multiple Sclerosis Center, AHEPA University Hospital, Aristotle University, Thessaloniki, Greece
| | - Nikolaos Grigoriadis
- Department of Neurology Laboratory of Experimental Neurology and Neuroimmunology and the Multiple Sclerosis Center, AHEPA University Hospital, Aristotle University, Thessaloniki, Greece
| | - Georgios Hadjigeorgiou
- Medical School, University of Cyprus, Nicosia, Cyprus
- Department of Neurology, General University Hospital of Larissa, Larissa, Greece
| | - Efthimos Dardiotis
- Department of Neurology, General University Hospital of Larissa, Larissa, Greece
| | - George Loucaides
- Neurology Clinic C, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
| | - Evangelia Ntzani
- Department of Neurology, Clinical and Molecular Epidemiology Unit, Department of Hygiene and Epidemiology, University of Ioannina School of Medicine (UISM), Ioannina, Greece
| | - Georgios Markozannes
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
| | - Savvas Omorfos
- School of Medicine, European University Cyprus, Nicosia, Cyprus
| | - Paola Valsasina
- Division of Neuroscience, Neuroimaging Research Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Roberta Messina
- Division of Neuroscience, Neuroimaging Research Unit, San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Preziosa
- Division of Neuroscience, Neuroimaging Research Unit, San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria A Rocca
- Division of Neuroscience, Neuroimaging Research Unit, San Raffaele Scientific Institute, Milan, Italy
- Division of Neuroscience, Universita Vita Salute San Raffaele, Milano, Lombardia, Italy
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27
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Filippi M, Amato MP, Centonze D, Gallo P, Gasperini C, Inglese M, Patti F, Pozzilli C, Preziosa P, Trojano M. Correction to: Early use of high-efficacy disease-modifying therapies makes the difference in people with multiple sclerosis: an expert opinion. J Neurol 2022; 269:6690-6691. [PMID: 36138162 PMCID: PMC9618484 DOI: 10.1007/s00415-022-11385-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy.
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy.
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy.
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy.
- Vita-Salute San Raffaele University, Milan, Italy.
| | - Maria Pia Amato
- Department NEUROFARBA, University of Florence, Florence, Italy
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - Diego Centonze
- Department of Systems Medicine, Tor Vergata University, Rome, Italy
- Unit of Neurology, IRCCS Neuromed, Pozzilli, IS, Italy
| | - Paolo Gallo
- Department of Neuroscience, University of Padova, Padua, Italy
| | - Claudio Gasperini
- Department of Neurosciences, S Camillo Forlanini Hospital Rome, Rome, Italy
| | - Matilde Inglese
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Francesco Patti
- Department GF Ingrassia, Medical, Surgical Science and Advanced Technologies, University of Catania, Catania, Italy
- Center for Multiple Sclerosis, Policlinico "G Rodolico", University of Catania, Catania, Italy
| | | | - Paolo Preziosa
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
| | - Maria Trojano
- Department of Basic Medical Sciences, Neuroscience, and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
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Affiliation(s)
- Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Paolo Preziosa
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
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29
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Margoni M, Pagani E, Meani A, Storelli L, Mesaros S, Drulovic J, Barkhof F, Vrenken H, Strijbis E, Gallo A, Bisecco A, Pareto D, Sastre-Garriga J, Ciccarelli O, Yiannakas M, Palace J, Preziosa P, Rocca MA, Filippi M. Exploring in vivo multiple sclerosis brain microstructural damage through T1w/T2w ratio: a multicentre study. J Neurol Neurosurg Psychiatry 2022; 93:741-752. [PMID: 35580993 DOI: 10.1136/jnnp-2022-328908] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [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: 01/20/2022] [Accepted: 03/29/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To evaluate white matter and grey matter T1-weighted (w)/T2w ratio (T1w/T2w ratio) in healthy controls and patients with multiple sclerosis, and its association with clinical disability. METHODS In this cross-sectional study, 270 healthy controls and 434 patients with multiple sclerosis were retrospectively selected from 7 European sites. T1w/T2w ratio was obtained from brain T2w and T1w scans after intensity calibration using eyes and temporal muscle. RESULTS In healthy controls, T1w/T2w ratio increased until 50-60 years both in white and grey matter. Compared with healthy controls, T1w/T2w ratio was significantly lower in white matter lesions of all multiple sclerosis phenotypes, and in normal-appearing white matter and cortex of patients with relapsing-remitting and secondary progressive multiple sclerosis (p≤0.026), but it was significantly higher in the striatum and pallidum of patients with relapsing-remitting, secondary progressive and primary progressive multiple sclerosis (p≤0.042). In relapse-onset multiple sclerosis, T1w/T2w ratio was significantly lower in white matter lesions and normal-appearing white matter already at Expanded Disability Status Scale (EDSS) <3.0 and in the cortex only for EDSS ≥3.0 (p≤0.023). Conversely, T1w/T2w ratio was significantly higher in the striatum and pallidum for EDSS ≥4.0 (p≤0.005). In primary progressive multiple sclerosis, striatum and pallidum showed significantly higher T1w/T2w ratio beyond EDSS=6.0 (p≤0.001). In multiple sclerosis, longer disease duration, higher EDSS, higher brain lesional volume and lower normalised brain volume were associated with lower lesional and cortical T1w/T2w ratio and a higher T1w/T2w ratio in the striatum and pallidum (β from -1.168 to 0.286, p≤0.040). CONCLUSIONS T1w/T2w ratio may represent a clinically relevant marker sensitive to demyelination, neurodegeneration and iron accumulation occurring at the different multiple sclerosis phases.
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Affiliation(s)
- Monica Margoni
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Elisabetta Pagani
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alessandro Meani
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Loredana Storelli
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Sarlota Mesaros
- Clinic of Neurology, Faculty of Medicine, University of Belgrade, Beograd, Serbia
| | - Jelena Drulovic
- Clinic of Neurology, Faculty of Medicine, University of Belgrade, Beograd, Serbia
| | - Frederik Barkhof
- Radiology and Nuclear Medicine, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,MS Center, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, London, UK
| | - Hugo Vrenken
- Radiology and Nuclear Medicine, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,MS Center, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Eva Strijbis
- MS Center, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Antonio Gallo
- Department of Advanced Medical and Surgical Sciences, and 3T MRI-Center, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Alvino Bisecco
- Department of Advanced Medical and Surgical Sciences, and 3T MRI-Center, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Deborah Pareto
- Section of Neuroradiology, Department of Radiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Jaume Sastre-Garriga
- Department of Neurology/Neuroimmunology, Multiple Sclerosis Centre of Catalonia, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Olga Ciccarelli
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, London, UK
| | - Marios Yiannakas
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, London, UK
| | - Jacqueline Palace
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Paolo Preziosa
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurology Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Maria A Rocca
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurology Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy.,Vita-Salute San Raffaele University, Milano, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy .,Neurology Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy.,Vita-Salute San Raffaele University, Milano, Italy.,Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Margoni M, Preziosa P, Tortorella P, Filippi M, Rocca MA. Does Ocrelizumab Limit Multiple Sclerosis Progression? Current Evidence from Clinical, MRI, and Fluid Biomarkers. Neurotherapeutics 2022; 19:1216-1228. [PMID: 35668317 PMCID: PMC9587174 DOI: 10.1007/s13311-022-01252-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2022] [Indexed: 12/14/2022] Open
Abstract
Multiple sclerosis (MS) is a chronic inflammatory, demyelinating, and neurodegenerative disease affecting the central nervous system, often characterized by the accumulation of irreversible clinical disability over time. In recent years, there has been a dramatic evolution in several key concepts of MS treatment. The demonstration of the effects of ocrelizumab, a selective monoclonal antibody against CD20+ B cells, has significantly modified our knowledge of the immune-pathophysiology of MS and has provided a new therapeutic target for relapsing and progressive MS patients. Emerging findings suggest that, besides its strong anti-inflammatory activity, ocrelizumab may limit disability progression and may exert beneficial effects on cognitive function, fatigue, and quality of life of MS patients. The significant reductions of the rate of global and regional brain atrophy and of serum neurofilament light chain levels, which were found to be partially independent of overt inflammatory activity, suggest that this treatment may also limit neuro-axonal damage. By discussing the most recent evidence regarding the effects of ocrelizumab on clinical measures as well as on magnetic resonance imaging and fluid biomarkers, this review summarizes current knowledge on the possible mechanisms underlying the effects of ocrelizumab in limiting MS progression and neurodegeneration.
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Affiliation(s)
- Monica Margoni
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Department of Neurosciences, Multiple Sclerosis Center of the Veneto Region, University Hospital-School of Medicine, Padua, Italy
| | - Paolo Preziosa
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Maria A Rocca
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Vita-Salute San Raffaele University, Milan, Italy.
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Preziosa P, Pagani E, Bonacchi R, Cacciaguerra L, Falini A, Rocca MA, Filippi M. In vivo detection of damage in multiple sclerosis cortex and cortical lesions using NODDI. J Neurol Neurosurg Psychiatry 2022; 93:628-636. [PMID: 34799405 DOI: 10.1136/jnnp-2021-327803] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 10/28/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To characterise in vivo the microstructural abnormalities of multiple sclerosis (MS) normal-appearing (NA) cortex and cortical lesions (CLs) and their relations with clinical phenotypes and disability using neurite orientation dispersion and density imaging (NODDI). METHODS One hundred and seventy-two patients with MS (101 relapsing-remitting multiple sclerosis (RRMS), 71 progressive multiple sclerosis (PMS)) and 62 healthy controls (HCs) underwent a brain 3T MRI. Brain cortex and CLs were segmented from three-dimensional T1-weighted and double inversion recovery sequences. Using NODDI on diffusion-weighted sequence, intracellular volume fraction (ICV_f) and Orientation Dispersion Index (ODI) were assessed in NA cortex and CLs with default or optimised parallel diffusivity for the cortex (D//=1.7 or 1.2 µm2/ms, respectively). RESULTS The NA cortex of patients with MS had significantly lower ICV_f versus HCs' cortex with both D// values (false discovery rate (FDR)-p <0.001). CLs showed significantly decreased ICV_f and ODI versus NA cortex of both HCs and patients with MS with both D// values (FDR-p ≤0.008). Patients with PMS versus RRMS had significantly decreased NA cortex ICV_f and ODI (FDR-p=0.050 and FDR-p=0.032) with only D//=1.7 µm2/ms. No CL microstructural differences were found between MS clinical phenotypes. MS NA cortex ICV_f and ODI were significantly correlated with disease duration, clinical disability, lesion burden and global and regional brain atrophy (r from -0.51 to 0.71, FDR-p from <0.001 to 0.045). CONCLUSIONS A significant neurite loss occurs in MS NA cortex. CLs show a further neurite density reduction and a reduced ODI suggesting a simplification of neurite complexity. NODDI is relevant to investigate in vivo the heterogeneous pathology affecting the MS cortex.
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Affiliation(s)
- Paolo Preziosa
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milano, Italy.,Neurology Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Elisabetta Pagani
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Raffaello Bonacchi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milano, Italy.,Neurology Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Laura Cacciaguerra
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milano, Italy.,Neurology Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy.,Vita-Salute San Raffaele University, Milano, Italy
| | - Andrea Falini
- Vita-Salute San Raffaele University, Milano, Italy.,Department of Neuroradiology, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Maria A Rocca
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milano, Italy.,Neurology Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy.,Vita-Salute San Raffaele University, Milano, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milano, Italy .,Neurology Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy.,Vita-Salute San Raffaele University, Milano, Italy.,Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy.,Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milano, Italy
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Filippi M, Amato MP, Centonze D, Gallo P, Gasperini C, Inglese M, Patti F, Pozzilli C, Preziosa P, Trojano M. Early use of high-efficacy disease‑modifying therapies makes the difference in people with multiple sclerosis: an expert opinion. J Neurol 2022; 269:5382-5394. [PMID: 35608658 PMCID: PMC9489547 DOI: 10.1007/s00415-022-11193-w] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 05/12/2022] [Accepted: 05/13/2022] [Indexed: 11/05/2022]
Abstract
Multiple sclerosis (MS) is a chronic and progressive neurological disease that is characterized by neuroinflammation, demyelination and neurodegeneration occurring from the earliest phases of the disease and that may be underestimated. MS patients accumulate disability through relapse-associated worsening or progression independent of relapse activity. Early intervention with high-efficacy disease-modifying therapies (HE-DMTs) may represent the best window of opportunity to delay irreversible central nervous system damage and MS-related disability progression by hindering underlying heterogeneous pathophysiological processes contributing to disability progression. In line with this, growing evidence suggests that early use of HE-DMTs is associated with a significant greater reduction not only of inflammatory activity (clinical relapses and new lesion formation at magnetic resonance imaging) but also of disease progression, in terms of accumulation of irreversible clinical disability and neurodegeneration compared to delayed HE-DMT use or escalation strategy. These beneficial effects seem to be associated with acceptable long-term safety risks, thus configuring this treatment approach as that with the most positive benefit/risk profile. Accordingly, it should be mandatory to treat people with MS early with HE-DMTs in case of prognostic factors suggestive of aggressive disease, and it may be advisable to offer an HE-DMT to MS patients early after diagnosis, taking into account drug safety profile, disease severity, clinical and/or radiological activity, and patient-related factors, including possible comorbidities, family planning, and patients’ preference in agreement with the EAN/ECTRIMS and AAN guidelines. Barriers for an early use of HE-DMTs include concerns for long-term safety, challenges in the management of treatment initiation and monitoring, negative MS patients’ preferences, restricted access to HE-DMTs according to guidelines and regulatory rules, and sustainability. However, these barriers do not apply to each HE-DMT and none of these appear insuperable.
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Affiliation(s)
- Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy. .,Neurology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy. .,Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy. .,Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy. .,Vita-Salute San Raffaele University, Milan, Italy.
| | - Maria Pia Amato
- Department NEUROFARBA, University of Florence, Florence, Italy.,IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - Diego Centonze
- Department of Systems Medicine, Tor Vergata University, Rome, Italy.,Unit of Neurology, IRCCS Neuromed, Pozzilli, IS, Italy
| | - Paolo Gallo
- Department of Neuroscience, University of Padova, Padua, Italy
| | - Claudio Gasperini
- Department of Neurosciences, S Camillo Forlanini Hospital Rome, Rome, Italy
| | - Matilde Inglese
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Francesco Patti
- Department GF Ingrassia, Medical, Surgical Science and Advanced Technologies, University of Catania, Catania, Italy.,Center for Multiple Sclerosis, Policlinico "G Rodolico", University of Catania, Catania, Italy
| | | | - Paolo Preziosa
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy.,Neurology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
| | - Maria Trojano
- Department of Basic Medical Sciences, Neuroscience, and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
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Margoni M, Preziosa P, Rocca MA, Filippi M. Pediatric multiple sclerosis: developments in timely diagnosis and prognostication. Expert Rev Neurother 2022; 22:393-403. [PMID: 35400266 DOI: 10.1080/14737175.2022.2064743] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Pediatric-onset (PO) multiple sclerosis (MS) accounts for about 2-10% of the total MS cases. Recently, a greater attention has been given to POMS, with substantial improvements in the understanding of its pathophysiology, in the diagnostic work-up and in the identification of reliable prognosticators associated with long-term disability in these patients. AREAS COVERED This review summarizes the most recent updates regarding the pathophysiology of POMS, the current diagnostic criteria and the clinical, neuroradiological and laboratoristic markers that have been associated with disease progression (i.e. occurrence of a second clinical attack at disease onset and accumulation of disability in definite MS). EXPERT OPINION The study of POMS, where the clinical onset is closer to the biological onset of MS, may contribute to better understand how the different pathological processes impact brain maturation and contribute to disease progression, but also how brain plasticity may counterbalance structural damage accumulation. Although rare, POMS is a severe disease, characterized by a prominent clinical and radiological activity at disease onset and by the accumulation of physical and cognitive disability at a younger age compared to the adult counterpart, with significant detrimental consequences at long-term. Early and accurate diagnosis, together with early treatment, is highly warranted.
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Affiliation(s)
- Monica Margoni
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Multiple Sclerosis Center of the Veneto Region, Department of Neurosciences, University Hospital - School of Medicine, Padua, Italy
| | - Paolo Preziosa
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria A Rocca
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy.,Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Cordani C, Preziosa P, Gatti R, Castellani C, Filippi M, Rocca MA. Mapping brain structure and function in professional fencers: A model to study training effects on central nervous system plasticity. Hum Brain Mapp 2022; 43:3375-3385. [PMID: 35362649 PMCID: PMC9248301 DOI: 10.1002/hbm.25854] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 01/10/2022] [Accepted: 03/16/2022] [Indexed: 11/12/2022] Open
Abstract
Brain magnetic resonance imaging (MRI) studies have shown different patterns of structural and functional reorganization in high‐level athletes compared with controls, but little is known about their relationship with interlimb coordination mechanisms. To this aim, we investigated brain structural and functional differences in high‐level fencers compared with nonathlete controls and the MRI substrates of interlimb coordination in elite athletes. Fourteen right‐handed male fencers (median age = 22.3 years) and 15 right‐handed age‐ and sex‐matched healthy subjects (median age = 22.4 years) underwent structural and functional MRI acquisition during the execution of cyclic bimanual‐movements as well as during in‐phase and antiphase hand/foot‐movements of the dominant‐right limbs. No between‐group differences were found in gray matter volumes and white matter architecture. Active‐fMRI showed that controls versus fencers had higher activations in parietal and temporal areas during bimanual‐task; whereas fencers versus controls had higher activations in the basal ganglia. During in‐phase task, controls versus fencers showed higher activation of right cerebellum, whereas fencers had higher activity mainly in frontal areas. The functional‐connectivity (FC) analysis showed that fencers versus controls had an increased FC between left motor cortex and fronto‐temporal areas as well as bilateral thalami during the different tasks. Intensive and prolonged fencing activity is associated with brain functional changes mainly involving frontal regions related to high‐level motor control and planning of complex tasks. These modifications are likely to reflect an optimization of brain networks involved in motor activities, including interlimb coordination tasks, occurring after intensive training.
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Affiliation(s)
- Claudio Cordani
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Preziosa
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Roberto Gatti
- Humanitas Clinical and Research Center, IRCCS and Department of Biomedical Sciences, Humanitas University, Rozzano, Italy
| | | | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Maria Assunta Rocca
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
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Preziosa P, Pagani E, Meani A, Moiola L, Rodegher M, Filippi M, Rocca MA. Slowly Expanding Lesions Predict 9-Year Multiple Sclerosis Disease Progression. Neurol Neuroimmunol Neuroinflamm 2022; 9:9/2/e1139. [PMID: 35105685 PMCID: PMC8808355 DOI: 10.1212/nxi.0000000000001139] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 12/15/2021] [Indexed: 11/15/2022]
Abstract
Background and Objectives Chronic active lesions contribute to multiple sclerosis (MS) severity, but their association with long-term disease progression has not been evaluated yet. White matter (WM) lesions showing linear expansion over time on serial T1- and T2-weighted scans (i.e., slowly expanding lesions [SELs]) have been proposed as a marker of chronic inflammation. In this study, we assessed whether SEL burden and microstructural abnormalities were associated with Expanded Disability Status Scale (EDSS) score worsening and secondary progressive (SP) conversion at 9.1-year follow-up in patients with relapsing-remitting (RR) MS. Methods In 52 patients with RRMS, SELs were identified among WM lesions by linearly fitting the Jacobian of the nonlinear deformation field between time points obtained combining 3T brain T1- and T2-weighted scans acquired at baseline and months 6, 12, and 24. Logistic regression analysis was applied to investigate the associations of SEL number, volume, magnetization transfer ratio (MTR), and T1-weighted signal intensity with disability worsening (i.e., EDSS score increase) and SP conversion after a median follow-up of 9.1 years. Results At follow-up, 20/52 (38%) patients with MS showed EDSS score worsening; 13/52 (25%) showed SP conversion. A higher baseline EDSS score (for each point higher: OR = 3.15 [95% CI = 1.61; 8.38], p = 0.003), a higher proportion of SELs among baseline lesions (for each % increase: OR = 1.22 [1.04; 1.58], p = 0.04), and lower baseline MTR values of SELs (for each % higher: OR = 0.66 [0.41; 0.92], p = 0.033) were significant independent predictors of EDSS score worsening at follow-up (C-index = 0.892). A higher baseline EDSS score (for each point higher: OR = 6.37 [1.98; 20.53], p = 0.002) and lower baseline MTR values of SELs (for each % higher: OR = 0.48 [0.25; 0.89], p = 0.02) independently predicted SPMS conversion (C-index = 0.947). Discussion The proportion of SELs is associated with MS progression after 9 years. More severe SEL microstructural abnormalities independently predict EDSS score worsening and SPMS conversion. The quantification of SEL burden and damage using T1-, T2-weighted, and MTR sequences may identify patients with RRMS at a higher risk of long-term disability progression and SPMS conversion. Classification of Evidence This study provides Class III evidence that in patients with RRMS starting treatment with natalizumab or fingolimod, the proportion of SELs on brain MRI was associated with EDSS score worsening and SPMS conversion at 9-year follow-up.
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Affiliation(s)
- Paolo Preziosa
- From the Neuroimaging Research Unit (P.P., E.P., A.M., M.F., M.A.R.), Division of Neuroscience; Neurology Unit (P.P., L.M., M.R., M.F., M.A.R.); Neurorehabilitation Unit (M.F.); Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute; and Vita-Salute San Raffaele University (M.F., M.A.R.); Milan, Italy
| | - Elisabetta Pagani
- From the Neuroimaging Research Unit (P.P., E.P., A.M., M.F., M.A.R.), Division of Neuroscience; Neurology Unit (P.P., L.M., M.R., M.F., M.A.R.); Neurorehabilitation Unit (M.F.); Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute; and Vita-Salute San Raffaele University (M.F., M.A.R.); Milan, Italy
| | - Alessandro Meani
- From the Neuroimaging Research Unit (P.P., E.P., A.M., M.F., M.A.R.), Division of Neuroscience; Neurology Unit (P.P., L.M., M.R., M.F., M.A.R.); Neurorehabilitation Unit (M.F.); Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute; and Vita-Salute San Raffaele University (M.F., M.A.R.); Milan, Italy
| | - Lucia Moiola
- From the Neuroimaging Research Unit (P.P., E.P., A.M., M.F., M.A.R.), Division of Neuroscience; Neurology Unit (P.P., L.M., M.R., M.F., M.A.R.); Neurorehabilitation Unit (M.F.); Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute; and Vita-Salute San Raffaele University (M.F., M.A.R.); Milan, Italy
| | - Mariaemma Rodegher
- From the Neuroimaging Research Unit (P.P., E.P., A.M., M.F., M.A.R.), Division of Neuroscience; Neurology Unit (P.P., L.M., M.R., M.F., M.A.R.); Neurorehabilitation Unit (M.F.); Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute; and Vita-Salute San Raffaele University (M.F., M.A.R.); Milan, Italy
| | - Massimo Filippi
- From the Neuroimaging Research Unit (P.P., E.P., A.M., M.F., M.A.R.), Division of Neuroscience; Neurology Unit (P.P., L.M., M.R., M.F., M.A.R.); Neurorehabilitation Unit (M.F.); Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute; and Vita-Salute San Raffaele University (M.F., M.A.R.); Milan, Italy
| | - Maria A Rocca
- From the Neuroimaging Research Unit (P.P., E.P., A.M., M.F., M.A.R.), Division of Neuroscience; Neurology Unit (P.P., L.M., M.R., M.F., M.A.R.); Neurorehabilitation Unit (M.F.); Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute; and Vita-Salute San Raffaele University (M.F., M.A.R.); Milan, Italy.
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Carotenuto A, Cacciaguerra L, Pagani E, Preziosa P, Filippi M, Rocca MA. Glymphatic system impairment in multiple sclerosis: relation with brain damage and disability. Brain 2021; 145:2785-2795. [DOI: 10.1093/brain/awab454] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 11/17/2021] [Accepted: 11/23/2021] [Indexed: 11/13/2022] Open
Abstract
Abstract
Recent evidences showed the existence of a central nervous system ‘waste clearance’ system, defined as glymphatic system. Glymphatic abnormalities have been described in several neurodegenerative conditions, including Alzheimer’s and Parkinson’s disease. Glymphatic function has not been thoroughly explored in multiple sclerosis, where neurodegenerative processes are intermingled with inflammatory processes.
We aimed to investigate glymphatic system function in multiple sclerosis and to evaluate its association with clinical disability, disease course, demyelination and neurodegeneration, quantified using different MRI techniques.
In this retrospective study, we enrolled 71 multiple sclerosis patients (49 relapsing-remitting and 22 progressive multiple sclerosis) and 32 age- and sex- matched healthy controls. All subjects underwent neurological and MRI assessment including high-resolution T1, T2 and double inversion recovery sequences, diffusion- and susceptibility weighted imaging. We calculated the diffusion along perivascular space index, a proxy for glymphatic function, cortical and deep gray matter volume, white and cortical gray matter lesion volume and normal appearing white matter microstructural damage.
Multiple sclerosis patients showed an overall lower diffusion along perivascular space index vs healthy controls (estimated mean difference: −0.09, P = 0.01). Both relapsing-remitting and progressive multiple sclerosis patients had lower diffusion along perivascular space index vs healthy controls (estimated mean difference: −0.06, P = 0.04 for relapsing-remitting and −0.19, P = 0.001 for progressive multiple sclerosis patients). Progressive multiple sclerosis patients showed lower diffusion along perivascular space index vs relapsing-remitting multiple sclerosis patients (estimated mean difference: −0.09, P = 0.03). In multiple sclerosis patients, lower diffusion along perivascular space index was associated with more severe clinical disability (r = −0.45, P = 0.001) and longer disease duration (r = −0.37, P = 0.002). Interestingly, we detected a negative association between diffusion along perivascular space index and disease duration in the first 4.13 years of the disease course (r = −0.38, P = 0.04) without any association thereafter (up to 34 years of disease duration). Lower diffusion along perivascular space index was associated with higher white (r = −0.36, P = 0.003) and cortical (r = −0.41, P = 0.001) lesion volume, more severe cortical (r = 0.30, P = 0.007) and deep (r = 0.42, P = 0.001) gray matter atrophy, reduced fractional anisotropy (r = 0.42, P = 0.001) and increased mean diffusivity (r = −0.45, P = 0.001) in the normal-appearing white matter.
Our results suggest that the glymphatic system is impaired in multiple sclerosis, especially in progressive stages. Impaired glymphatic function was associated with measures of both demyelination and neurodegeneration and reflects a more severe clinical disability. These findings suggest that glymphatic impairment may be a pathological mechanism underpinning multiple sclerosis. The dynamic interplay with other pathological substrates of the disease deserves further investigation.
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Affiliation(s)
- Antonio Carotenuto
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, 20132, Milan, Italy
| | - Laura Cacciaguerra
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, 20132, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, 20132, Milan, Italy
- Vita-Salute San Raffaele University, 20132, Milan, Italy
| | - Elisabetta Pagani
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, 20132, Milan, Italy
| | - Paolo Preziosa
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, 20132, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, 20132, Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, 20132, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, 20132, Milan, Italy
- Vita-Salute San Raffaele University, 20132, Milan, Italy
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, 20132, Milan, Italy
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, 20132, Milan, Italy
| | - Maria A. Rocca
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, 20132, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, 20132, Milan, Italy
- Vita-Salute San Raffaele University, 20132, Milan, Italy
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Cordani C, Preziosa P, Valsasina P, Meani A, Pagani E, Morozumi T, Rocca MA, Filippi M. MRI of Transcallosal White Matter Helps to Predict Motor Impairment in Multiple Sclerosis. Radiology 2021; 302:639-649. [PMID: 34846201 DOI: 10.1148/radiol.2021210922] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Altered callosal integrity has been associated with motor deficits in patients with multiple sclerosis (MS), but its contribution to disability has, to the knowledge of the authors, not been investigated by using multiparametric MRI approaches. Purpose To investigate structural and functional interhemispheric MRI substrates of global disability at different milestones and upper limb motor impairment in MS. Materials and Methods In this cross-sectional study, healthy control patients and patients with MS (between January 1, 2008, and December 31, 2016) were retrospectively selected from our hospital database. Clinical assessment included Expanded Disability Status Scale (EDSS), nine-hole peg test, and digital finger tapping test. By using structural and resting-state functional MRI sequences, probabilistic tractography of hand corticospinal tract fibers, and transcallosal fibers between hand-motor cortices (hereafter, referred to as hand-M1), supplementary motor areas (SMAs), premotor cortices (PMCs), and voxel-mirror homotopic connectivity (VMHC) were analyzed. Random forest analyses identified the MRI predictors of clinical disability at different milestones (EDSS scores of 3.0, 4.0, 6.0) and upper limb motor impairment (nine-hole peg test and finger tapping test z scores < healthy control patients 5th percentile). Results One-hundred thirty healthy control patients (median age, 39 years; interquartile range, 31-50 years; 70 women) and 340 patients with MS (median age, 43 years; interquartile range, 33-51 years; 213 women) were studied. EDSS 3.0 predictors (n = 159) were global measures of atrophy and lesions together with damage measures of corticospinal tracts and transcallosal fibers between PMCs and SMAs (accuracy, 86%; P = .001-.01). For EDSS 4.0 (n = 131), similar predictors were found in addition to damage in transcallosal fibers between hand-M1 (accuracy, 89%; P = .001-.049). No MRI predictors were found for EDSS 6.0 (n = 70). Nine-hole peg test (right, n = 161; left, n = 166) and finger tapping test (right, n = 117; left, n = 111) impairments were predicted by damage in transcallosal fibers between SMAs and PMCs (accuracy range, 69%-77%; P = .001-.049). VMHC abnormalities did not explain clinical outcomes. Conclusion Structural, not functional, abnormalities at MRI in transcallosal premotor and motor white matter fibers predicted severity of global disability and upper limb motor impairment in patients with multiple sclerosis. The informative role of such predictors appeared less evident at higher disability levels. © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Barkhof and Pontillo in this issue.
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Affiliation(s)
- Claudio Cordani
- From the Neuroimaging Research Unit, Division of Neuroscience (C.C., P.P., P.V., A.M., E.P., T.M., M.A.R., M.F.), Neurology Unit (P.P., M.A.R., M.F.), Neurorehabilitation Unit (M.F.), and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy; and Vita-Salute San Raffaele University, Milan, Italy (M.A.R., M.F.)
| | - Paolo Preziosa
- From the Neuroimaging Research Unit, Division of Neuroscience (C.C., P.P., P.V., A.M., E.P., T.M., M.A.R., M.F.), Neurology Unit (P.P., M.A.R., M.F.), Neurorehabilitation Unit (M.F.), and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy; and Vita-Salute San Raffaele University, Milan, Italy (M.A.R., M.F.)
| | - Paola Valsasina
- From the Neuroimaging Research Unit, Division of Neuroscience (C.C., P.P., P.V., A.M., E.P., T.M., M.A.R., M.F.), Neurology Unit (P.P., M.A.R., M.F.), Neurorehabilitation Unit (M.F.), and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy; and Vita-Salute San Raffaele University, Milan, Italy (M.A.R., M.F.)
| | - Alessandro Meani
- From the Neuroimaging Research Unit, Division of Neuroscience (C.C., P.P., P.V., A.M., E.P., T.M., M.A.R., M.F.), Neurology Unit (P.P., M.A.R., M.F.), Neurorehabilitation Unit (M.F.), and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy; and Vita-Salute San Raffaele University, Milan, Italy (M.A.R., M.F.)
| | - Elisabetta Pagani
- From the Neuroimaging Research Unit, Division of Neuroscience (C.C., P.P., P.V., A.M., E.P., T.M., M.A.R., M.F.), Neurology Unit (P.P., M.A.R., M.F.), Neurorehabilitation Unit (M.F.), and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy; and Vita-Salute San Raffaele University, Milan, Italy (M.A.R., M.F.)
| | - Tetsu Morozumi
- From the Neuroimaging Research Unit, Division of Neuroscience (C.C., P.P., P.V., A.M., E.P., T.M., M.A.R., M.F.), Neurology Unit (P.P., M.A.R., M.F.), Neurorehabilitation Unit (M.F.), and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy; and Vita-Salute San Raffaele University, Milan, Italy (M.A.R., M.F.)
| | - Maria Assunta Rocca
- From the Neuroimaging Research Unit, Division of Neuroscience (C.C., P.P., P.V., A.M., E.P., T.M., M.A.R., M.F.), Neurology Unit (P.P., M.A.R., M.F.), Neurorehabilitation Unit (M.F.), and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy; and Vita-Salute San Raffaele University, Milan, Italy (M.A.R., M.F.)
| | - Massimo Filippi
- From the Neuroimaging Research Unit, Division of Neuroscience (C.C., P.P., P.V., A.M., E.P., T.M., M.A.R., M.F.), Neurology Unit (P.P., M.A.R., M.F.), Neurorehabilitation Unit (M.F.), and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy; and Vita-Salute San Raffaele University, Milan, Italy (M.A.R., M.F.)
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Frigerio I, Boon BDC, Lin CP, Galis-de Graaf Y, Bol J, Preziosa P, Twisk J, Barkhof F, Hoozemans JJM, Bouwman FH, Rozemuller AJM, van de Berg WDJ, Jonkman LE. Amyloid-β, p-tau and reactive microglia are pathological correlates of MRI cortical atrophy in Alzheimer’s disease. Brain Commun 2021; 3:fcab281. [PMID: 34927073 PMCID: PMC8677327 DOI: 10.1093/braincomms/fcab281] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 10/14/2021] [Accepted: 10/21/2021] [Indexed: 12/15/2022] Open
Abstract
Alzheimer’s disease is characterized by cortical atrophy on MRI and abnormal depositions of amyloid-beta, phosphorylated-tau and inflammation pathologically. However, the relative contribution of these pathological hallmarks to cortical atrophy, a widely used MRI biomarker in Alzheimer’s disease, is yet to be defined. Therefore, the aim of this study was to identify the histopathological correlates of MRI cortical atrophy in Alzheimer’s disease donors, and its typical amnestic and atypical non-amnestic phenotypes. Nineteen Alzheimer’s disease (of which 10 typical and 9 atypical) and 10 non-neurological control brain donors underwent post-mortem in situ 3T 3D-T1, from which cortical thickness was calculated with Freesurfer. Upon subsequent autopsy, 12 cortical brain regions from the right hemisphere and 9 from the left hemisphere were dissected and immunostained for amyloid-beta, phosphorylated-tau and reactive microglia, and percentage area load was calculated for each marker using ImageJ. In addition, post-mortem MRI was compared to ante-mortem MRI of the same Alzheimer’s disease donors when available. MRI-pathology associations were assessed using linear mixed models. Higher amyloid-beta load weakly correlated with higher cortical thickness globally (r = 0.22, P = 0.022). Phosphorylated-tau strongly correlated with cortical atrophy in temporal and frontal regions (−0.76 < r < −1.00, all P < 0.05). Reactive microglia load strongly correlated with cortical atrophy in the parietal region (r = −0.94, P < 0.001). Moreover, post-mortem MRI scans showed high concordance with ante-mortem scans acquired <1 year before death. In conclusion, distinct histopathological markers differently correlated with cortical atrophy, highlighting their different roles in the neurodegenerative process, and therefore contributing to the understanding of the pathological underpinnings of MRI atrophic patterns in Alzheimer’s disease. In our cohort, no or only subtle differences were found in MRI-pathology associations in Alzheimer’s disease phenotypes, indicating that the histopathological correlates of cortical atrophy in typical and atypical phenotypes might be similar. Moreover, we show that post-mortem in situ MRI can be used as proxy for ante-mortem in vivo MRI.
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Affiliation(s)
- Irene Frigerio
- Section Clinical Neuroanatomy and Biobanking, Department of Anatomy and Neurosciences, Amsterdam UMC, Location VUmc, Amsterdam Neuroscience, Vrije Universiteit, 1081 HV Amsterdam, the Netherlands
| | - Baayla D C Boon
- Department of Pathology, Amsterdam Neuroscience, Amsterdam UMC, Location VUmc, 1081 HV Amsterdam, the Netherlands
| | - Chen-Pei Lin
- Section Clinical Neuroanatomy and Biobanking, Department of Anatomy and Neurosciences, Amsterdam UMC, Location VUmc, Amsterdam Neuroscience, Vrije Universiteit, 1081 HV Amsterdam, the Netherlands
| | - Yvon Galis-de Graaf
- Section Clinical Neuroanatomy and Biobanking, Department of Anatomy and Neurosciences, Amsterdam UMC, Location VUmc, Amsterdam Neuroscience, Vrije Universiteit, 1081 HV Amsterdam, the Netherlands
| | - John Bol
- Section Clinical Neuroanatomy and Biobanking, Department of Anatomy and Neurosciences, Amsterdam UMC, Location VUmc, Amsterdam Neuroscience, Vrije Universiteit, 1081 HV Amsterdam, the Netherlands
| | - Paolo Preziosa
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, 60-20132 Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, 60-20132 Milan, Italy
| | - Jos Twisk
- Department of Epidemiology and Biostatistics, Vrije Universiteit, 1081 HV Amsterdam, the Netherlands
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, Amsterdam UMC, Location VUmc, 1081 HV Amsterdam, the Netherlands
- Institutes of Neurology and Healthcare Engineering, University College London, London WC1E, UK
| | - Jeroen J M Hoozemans
- Department of Pathology, Amsterdam Neuroscience, Amsterdam UMC, Location VUmc, 1081 HV Amsterdam, the Netherlands
| | - Femke H Bouwman
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Location VUmc, Alzheimer Centrum Amsterdam, 1081 HV Amsterdam, the Netherlands
| | - Annemieke J M Rozemuller
- Department of Pathology, Amsterdam Neuroscience, Amsterdam UMC, Location VUmc, 1081 HV Amsterdam, the Netherlands
| | - Wilma D J van de Berg
- Section Clinical Neuroanatomy and Biobanking, Department of Anatomy and Neurosciences, Amsterdam UMC, Location VUmc, Amsterdam Neuroscience, Vrije Universiteit, 1081 HV Amsterdam, the Netherlands
| | - Laura E Jonkman
- Section Clinical Neuroanatomy and Biobanking, Department of Anatomy and Neurosciences, Amsterdam UMC, Location VUmc, Amsterdam Neuroscience, Vrije Universiteit, 1081 HV Amsterdam, the Netherlands
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Filippi M, Preziosa P, Meani A, Costa GD, Mesaros S, Drulovic J, Ivanovic J, Rovira A, Tintorè M, Montalban X, Ciccarelli O, Brownlee W, Miszkiel K, Enzinger C, Khalil M, Barkhof F, Strijbis EMM, Frederiksen JL, Cramer SP, Fainardi E, Amato MP, Gasperini C, Ruggieri S, Martinelli V, Comi G, Rocca MA. Performance of the 2017 and 2010 Revised McDonald Criteria in Predicting MS Diagnosis After a Clinically Isolated Syndrome: A MAGNIMS Study. Neurology 2021; 98:e1-e14. [PMID: 34716250 DOI: 10.1212/wnl.0000000000013016] [Citation(s) in RCA: 24] [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: 03/08/2021] [Accepted: 09/30/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES To compare the performance of the 2017 revisions to the McDonald criteria with the 2010 McDonald criteria in establishing MS diagnosis and predicting prognosis in patients with clinically isolated syndrome (CIS) suggestive of multiple sclerosis (MS). METHODS CSF examination, brain and spinal cord MRI obtained ≤5 months from CIS onset, and a follow-up brain MRI acquired within 15 months from CIS onset were evaluated in 785 CIS patients from 9 European centers. Date of second clinical attack and of reaching Expanded Disability Status Score (EDSS) ≥ 3.0, if they occurred, were also collected. Performance of the 2017 and 2010 McDonald criteria for dissemination in space (DIS), time (DIT) (including oligoclonal bands assessment) and DIS + DIT for predicting a second clinical attack (clinically definite [CD] MS) and EDSS ≥ 3.0 at follow-up was evaluated. Time to MS diagnosis for the different criteria was also estimated. RESULTS At follow-up (median = 69.1 months), 406/785 CIS patients developed CDMS. At 36 months, the 2017 DIS + DIT criteria had higher sensitivity (0.83 vs 0.66), lower specificity (0.39 vs 0.60) and similar area under the curve values (0.61 vs 0.63). Median time to MS diagnosis was shorter with the 2017 vs the 2010 or CDMS criteria (2017 revision = 3.2; 2010 revision = 13.0; CDMS = 58.5 months). The 2 sets of criteria similarly predicted EDSS ≥ 3.0 milestone. Three periventricular lesions improved specificity in patients ≥45 years. DISCUSSION The 2017 McDonald criteria showed higher sensitivity, lower specificity and similar accuracy in predicting CDMS compared to 2010 McDonald criteria, while shortening time to diagnosis of MS. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that the 2017 McDonald Criteria more accurately distinguish CDMS in patients early after a CIS when compared to the 2010 McDonald criteria.
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Affiliation(s)
- Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy .,Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurorehabilitation Unit IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Paolo Preziosa
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alessandro Meani
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Gloria Dalla Costa
- Neurorehabilitation Unit IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Sarlota Mesaros
- Clinic of Neurology, Faculty of Medicine, University of Belgrade, Serbia
| | - Jelena Drulovic
- Clinic of Neurology, Faculty of Medicine, University of Belgrade, Serbia
| | - Jovana Ivanovic
- Clinic of Neurology, Faculty of Medicine, University of Belgrade, Serbia
| | - Alex Rovira
- Section of Neuroradiology, Department of Radiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Mar Tintorè
- Department of Neurology/Neuroimmunology, Multiple Sclerosis Center of Catalonia, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Xavier Montalban
- Department of Neurology/Neuroimmunology, Multiple Sclerosis Center of Catalonia, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Olga Ciccarelli
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, London, UK
| | - Wallace Brownlee
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, London, UK
| | - Katherine Miszkiel
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, London, UK
| | | | - Michael Khalil
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, MS Center Amsterdam, Amsterdam Neuroscience Amsterdam UMC, location VUmc, Amsterdam, The Netherlands.,Institutes of Neurology and Healthcare Engineering, University College London, London, UK
| | - Eva M M Strijbis
- Department of Neurology, MS Center Amsterdam, Amsterdam Neuroscience Amsterdam UMC, location VUmc, Amsterdam, The Netherlands
| | - Jette L Frederiksen
- Clinic of Optic Neuritis and Clinic of Multiple Sclerosis, Department of Neurology, Rigshospitalet - Glostrup, University of Copenhagen, Copenhagen, Denmark
| | - Stig P Cramer
- Department of Clinical Physiology, Nuclear Medicine and PET, FIU unit, Rigshospitalet Glostrup, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Clinical Physiology and Nuclear Medicine, Centre for Functional and Diagnostic Imaging and Research, Hvidovre Hospital, Hvidovre, Denmark
| | - Enrico Fainardi
- Neuroradiology Unit, Department of Experimental and Clinical Biomedical Sciences 'Mario Serio', University of Florence, Florence, Italy
| | - Maria Pia Amato
- Department of Neurofarba, University of Florence, Florence, Italy.,IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - Claudio Gasperini
- Department of Neurosciences, San Camillo Forlanini Hospital, Rome, Italy
| | - Serena Ruggieri
- Department of Neurosciences, San Camillo Forlanini Hospital, Rome, Italy
| | | | | | - Maria A Rocca
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
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Carotenuto A, Valsasina P, De La Cruz MH, Cacciaguerra L, Preziosa P, Marchesi O, Filippi M, Rocca M. Dynamic functional connectivity analysis in thalamic sub-regions shows divergent patterns in multiple sclerosis phenotypes. J Neurol Sci 2021. [DOI: 10.1016/j.jns.2021.118084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Cordani C, Valsasina P, Meani A, Pagani E, Morozumi T, Preziosa P, Filippi M, Rocca M. Interhemispherical predictors of disability and upper limb motor impairment in patients with multiple sclerosis: A structural and functional MRI study. J Neurol Sci 2021. [DOI: 10.1016/j.jns.2021.117667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Ramirez GA, Rocca MA, Preziosa P, Bozzolo EP, Pagani E, Canti V, Moiola L, Rovere-Querini P, Manfredi AA, Filippi M. Quantitative MRI adds to neuropsychiatric lupus diagnostics. Rheumatology (Oxford) 2021; 60:3278-3288. [PMID: 33367829 DOI: 10.1093/rheumatology/keaa779] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 11/02/2020] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVE Attributing neuropsychiatric manifestations to SLE is often challenging. Brain white matter lesions are frequent in SLE at MRI, but their diagnostic role is unclear. Here, we assessed whether white matter lesions count, volume and distribution measurement can help in the diagnosis of neuropsychiatric systemic lupus erythematosus (NPSLE). METHODS Brain dual-echo and 3D T1-weighted sequences were acquired from 32 patients with SLE and 32 healthy controls with a 3 T-scanner and employed to derive T2-hyperintense lesion volume (T2LV), number (T2LN) and probability maps (LPM) using a semi-automatic local thresholding segmentation technique. NPSLE was classified as per the ACR nomenclature, the Italian Society for Rheumatology algorithm and by clinical impression. Clinical descriptors including the SLE International Collaborating Clinics/ACR damage index (SDI) were also recorded. RESULTS Higher T2LV were observed in SLE vs healthy controls (P < 0.001) and in NPSLE vs other SLE (P =0.006). Patients with NPSLE also had higher T2LN (P =0.003) compared with other SLE. In SLE, T2LPM revealed a high prevalence of lesions in the splenium of the corpus callosum, right superior longitudinal fasciculus and right corona radiata. T2LV and T2LN correlated with SLE duration (rho = 0.606; P <0.001 and rho = 0.483; P =0.005, respectively) and age (rho = 0.478; P =0.006 and rho = 0.362; P = 0.042, respectively). T2LV also correlated with SDI (rho = 0.352; P =0.048). SLE patients with fatigue had lower T2LN (P =0.038) compared with patients without fatigue. Thresholds of T2LV ≥ 0.423 cm3 or of T2LN ≥ 12 were associated with definite NPSLE and improved the classification of patients with possible NPSLE per clinical impression. CONCLUSION Brain white matter lesions (WML) quantitation adds to NPSLE diagnostics.
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Affiliation(s)
- Giuseppe A Ramirez
- Università Vita-Salute San Raffaele.,Unit of Immunology, Rheumatology, Allergy and Rare Diseases.,Division of Immunogy, Transplantation & Infectious Diseases
| | | | | | | | | | | | | | - Patrizia Rovere-Querini
- Università Vita-Salute San Raffaele.,Division of Immunogy, Transplantation & Infectious Diseases
| | - Angelo A Manfredi
- Università Vita-Salute San Raffaele.,Unit of Immunology, Rheumatology, Allergy and Rare Diseases.,Division of Immunogy, Transplantation & Infectious Diseases
| | - Massimo Filippi
- Università Vita-Salute San Raffaele.,Neuroimaging Research Unit.,Neurology Unit.,Neurophysiology Unit, IRCCS Ospedale San Raffaele, Milan, Italy
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Marchesi O, Bonacchi R, Valsasina P, Preziosa P, Pagani E, Cacciaguerra L, Meani A, Conti L, Mistri D, Rocca MA, Filippi M. Functional and structural MRI correlates of executive functions in multiple sclerosis. Mult Scler 2021; 28:742-756. [PMID: 34387534 DOI: 10.1177/13524585211033184] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 11/16/2022]
Abstract
BACKGROUND Executive dysfunctions, including difficulties in attention, working memory, planning, and inhibition affect 15%-28% of multiple sclerosis (MS) patients. OBJECTIVES To investigate structural and functional magnetic resonance imaging (MRI) abnormalities underlying executive function (EF) in MS patients. METHODS A total 116 MS patients and 65 controls underwent resting-state (RS) and diffusion-weighted sequences and neuropsychological examination, including Wisconsin Card Sorting Test (WCST) to test EF. Brain RS cognitive networks and fractional anisotropy (FA) from a priori selected white matter tracts were derived. Associations of WCST scores with RS functional connectivity (FC) and FA abnormalities were investigated. RESULTS In MS patients, predictors of working memory/updating were: lower corpus callosum (CC) FA, lower left working-memory network (WMN), right WMN RS FC for worse performance; lower executive control network (ECN), higher default-mode network (DMN), and salience network (SN) RS FC for better performance (R2 = 0.35). Predictors of attention were lower CC genu FA, lower left WMN, and DMN RS FC for worse performance; higher left WMN and ECN RS FC for better performance (R2 = 0.24). Predictors of worse shifting/inhibition were lower CC genu and superior cerebellar peduncle (SCP) FA, lower left WMN RS FC for worse performance; and higher ECN RS FC for better performance (R2 = 0.24). CONCLUSIONS CC and SCP microstructural damage and RS FC abnormalities in cognitive networks underlie EF frailty in MS.
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Affiliation(s)
- Olga Marchesi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Raffaello Bonacchi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy/Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paola Valsasina
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Preziosa
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy/Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Elisabetta Pagani
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Laura Cacciaguerra
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy/Vita-Salute San Raffaele University, Milan, Italy
| | - Alessandro Meani
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Lorenzo Conti
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Damiano Mistri
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria A Rocca
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy/Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy/Vita-Salute San Raffaele University, Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy/Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy/Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy/Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy/Vita-Salute San Raffaele University, Milan, Italy
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Margoni M, Preziosa P, Filippi M, Rocca MA. Anti-CD20 therapies for multiple sclerosis: current status and future perspectives. J Neurol 2021; 269:1316-1334. [PMID: 34382120 PMCID: PMC8356891 DOI: 10.1007/s00415-021-10744-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 08/02/2021] [Accepted: 08/03/2021] [Indexed: 12/26/2022]
Abstract
Multiple sclerosis (MS) is a chronic inflammatory, demyelinating and neurodegenerative disease affecting the central nervous system (CNS), often characterized by the accumulation of irreversible clinical disability over time. During last years, there has been a dramatic evolution in several key concepts of immune pathophysiology of MS and in the treatment of this disease. The demonstration of the strong efficacy and good safety profile of selective B-cell-depleting therapies (such as anti-CD20 monoclonal antibodies) has significantly expanded the therapeutic scenario for both relapsing and progressive MS patients with the identification of a new therapeutic target. The key role of B cells in triggering MS disease has been also pointed out, determining a shift from the traditional view of MS activity as largely being ‘T-cell mediated’ to the notion that MS-related pathological processes involve bi-directional interactions between several immune cell types, including B cells, both in the periphery and in the CNS. This review provides an updated overview of the involvement of B cells in the immune pathophysiology and pathology of MS. We summarize the rationale regarding the use of anti-CD20 therapies and the results of the main randomized controlled trials and observational studies investigating the efficacy and safety profile of rituximab, ocrelizumab, ofatumumab and ublituximab. Suggestions regarding vaccinations and management of MS patients during COVID-19 pandemic with anti-CD20 therapies are also discussed. Finally, therapies under investigation and future perspectives of anti-CD20 therapies are taken into consideration.
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Affiliation(s)
- Monica Margoni
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Multiple Sclerosis Center of the Veneto Region, Department of Neurosciences, University Hospital-School of Medicine, Padua, Italy
| | - Paolo Preziosa
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, 20132, Milan, Italy
| | - Maria A Rocca
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy. .,Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy. .,Vita-Salute San Raffaele University, 20132, Milan, Italy.
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Affiliation(s)
- Paolo Preziosa
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Maria A Rocca
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
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Conti L, Preziosa P, Meani A, Pagani E, Valsasina P, Marchesi O, Vizzino C, Rocca MA, Filippi M. Unraveling the substrates of cognitive impairment in multiple sclerosis: A multiparametric structural and functional magnetic resonance imaging study. Eur J Neurol 2021; 28:3749-3759. [PMID: 34255918 DOI: 10.1111/ene.15023] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 07/09/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cognitive impairment frequently affects multiple sclerosis (MS) patients. However, its neuroanatomical correlates still need to be fully explored. We investigated the contribution of structural and functional magnetic resonance imaging (MRI) abnormalities in explaining cognitive impairment in MS. METHODS Brain dual-echo, diffusion tensor, 3D T1-weighted and resting-state (RS) MRI sequences were acquired from 276 MS patients and 102 healthy controls. Using random forest analysis, the contribution of regional white matter (WM) lesions, WM fractional anisotropy (FA) abnormalities, gray matter (GM) atrophy and RS functional connectivity (FC) alterations to cognitive impairment in MS patients was investigated. RESULTS Eighty-four MS patients (30.4%) were cognitively impaired. The best MRI predictors of cognitive impairment (relative importance [%]) (out-of-bag area under the curve [AUC] = 0.795) were (a) WM lesions in the right superior longitudinal fasciculus (100%), left anterior thalamic radiation (93.4%), left posterior corona radiata (78.5%), left medial lemniscus (74.2%), left inferior longitudinal fasciculus (70.4%), left optic radiation (68.7%), right middle cerebellar peduncle (60.6%) and right optic radiation (53.5%); (b) decreased FA in the splenium of the corpus callosum (64.3%), left optic radiation (61.0%), body of the corpus callosum (51.9%) and fornix (50.9%); and (c) atrophy of the left precuneus (91.4%), right cerebellum crus I (84.4%), right caudate nucleus (78.6%), left thalamus (76.2%) and left supplementary motor area (59.8%). The relevance of these MRI measures in explaining cognitive impairment was confirmed in a cross-validation analysis (AUC =0.765). CONCLUSION Structural damage in strategic WM and GM regions explains cognitive impairment in MS patients more than RS FC abnormalities.
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Affiliation(s)
- Lorenzo Conti
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Preziosa
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alessandro Meani
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Elisabetta Pagani
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paola Valsasina
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Olga Marchesi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Carmen Vizzino
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria A Rocca
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy.,Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Preziosa P, Bouman PM, Kiljan S, Steenwijk MD, Meani A, Pouwels PJ, Rocca MA, Filippi M, Geurts JJG, Jonkman LE. Neurite density explains cortical T1-weighted/T2-weighted ratio in multiple sclerosis. J Neurol Neurosurg Psychiatry 2021; 92:790-792. [PMID: 33436500 DOI: 10.1136/jnnp-2020-324391] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 11/16/2020] [Accepted: 12/16/2020] [Indexed: 11/03/2022]
Affiliation(s)
- Paolo Preziosa
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy .,Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Piet M Bouman
- Department of Anatomy & Neurosciences, Amsterdam UMC, Location VU University Medical Center, Amsterdam, The Netherlands
| | - Svenja Kiljan
- Department of Anatomy & Neurosciences, Amsterdam UMC, Location VU University Medical Center, Amsterdam, The Netherlands
| | - Martijn D Steenwijk
- Department of Anatomy & Neurosciences, Amsterdam UMC, Location VU University Medical Center, Amsterdam, The Netherlands
| | - Alessandro Meani
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Petra J Pouwels
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location VU University Medical Center, Amsterdam, The Netherlands
| | - Maria A Rocca
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy.,Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Jeroen J G Geurts
- Department of Anatomy & Neurosciences, Amsterdam UMC, Location VU University Medical Center, Amsterdam, The Netherlands
| | - Laura E Jonkman
- Department of Anatomy & Neurosciences, Amsterdam UMC, Location VU University Medical Center, Amsterdam, The Netherlands
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Bonacchi R, Rocca MA, Ramirez GA, Bozzolo EP, Canti V, Preziosa P, Valsasina P, Riccitelli GC, Meani A, Moiola L, Rovere-Querini P, Manfredi AA, Filippi M. Resting state network functional connectivity abnormalities in systemic lupus erythematosus: correlations with neuropsychiatric impairment. Mol Psychiatry 2021; 26:3634-3645. [PMID: 33051605 DOI: 10.1038/s41380-020-00907-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [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: 04/14/2020] [Revised: 09/16/2020] [Accepted: 10/01/2020] [Indexed: 02/08/2023]
Abstract
Neuropsychiatric manifestations are highly prevalent in systemic lupus erythematosus (SLE)-patients. We aimed to unravel the substrates of these manifestations by investigating abnormalities of resting state (RS) functional connectivity (FC) and their correlations with neuropsychiatric variables in SLE-patients. Thirty-two SLE-patients and 32 age- and sex-matched healthy controls (HC) underwent brain 3T RS fMRI. Neuropsychological assessment was performed for all SLE-patients. The main large-scale cognitive and psychiatric functional networks were derived and between-group comparisons and correlations with neuropsychological measures were performed. Compared to HC, SLE-patients exhibited increased RS FC in the right middle cingulate cortex and decreased RS FC in the left precuneus within default-mode network (DMN). They also showed increased RS FC in the left cerebellar crus I and left posterior cingulate cortex, and decreased RS FC in the left angular gyrus within working-memory networks (WMN). Compared to HC, SLE-patients exhibited increased RS FC in the left insular cortex and decreased RS FC in the right anterior cingulate cortex within salience network (SN), as well as decreased RS FC in the right middle frontal gyrus within executive-control network (ECN). Correlation analysis indicated a maladaptive role for left angular gyrus and cerebellar RS FC abnormalities in WMN, affecting memory and executive functions; and for precuneus and insular abnormalities in DMN and SN for psychiatric symptoms. Cingulate cortex modifications within DMN and SN correlated with better memory and global cognitive performance. Significant RS FC alterations in relevant cognitive and psychiatric networks occur in SLE-patients and participate in the pathophysiology of neuropsychiatric symptoms.
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Affiliation(s)
- Raffaello Bonacchi
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria A Rocca
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giuseppe A Ramirez
- Vita-Salute San Raffaele University, Milan, Italy.,Unit of Immunology, Rheumatology, Allergy and Rare Diseases & Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Enrica P Bozzolo
- Unit of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Valentina Canti
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases & Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Preziosa
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paola Valsasina
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Gianna C Riccitelli
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alessandro Meani
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Lucia Moiola
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Patrizia Rovere-Querini
- Vita-Salute San Raffaele University, Milan, Italy.,Unit of Immunology, Rheumatology, Allergy and Rare Diseases & Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Angelo A Manfredi
- Vita-Salute San Raffaele University, Milan, Italy.,Unit of Immunology, Rheumatology, Allergy and Rare Diseases & Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy. .,Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy. .,Vita-Salute San Raffaele University, Milan, Italy. .,Neurophysiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
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Preziosa P, Schoonheim MM. Ongoing Axonal Injury in Chronic Active Lesions in Multiple Sclerosis: In Vivo Quantification Using Serum Neurofilament. Neurology 2021; 97:257-258. [PMID: 34088879 DOI: 10.1212/wnl.0000000000012331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Paolo Preziosa
- From the Neuroimaging Research Unit, Division of Neuroscience (P.P.), and Neurology Unite (P.P.), IRCCS San Raffaele Scientific Institute, Milan, Italy; and Department of Anatomy and Neurosciences (M.M.S.), MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands
| | - Menno M Schoonheim
- From the Neuroimaging Research Unit, Division of Neuroscience (P.P.), and Neurology Unite (P.P.), IRCCS San Raffaele Scientific Institute, Milan, Italy; and Department of Anatomy and Neurosciences (M.M.S.), MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands.
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50
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Preziosa P, Storelli L, Meani A, Moiola L, Rodegher M, Filippi M, Rocca MA. Effects of Fingolimod and Natalizumab on Brain T1-/T2-Weighted and Magnetization Transfer Ratios: a 2-Year Study. Neurotherapeutics 2021; 18:878-888. [PMID: 33483938 PMCID: PMC8423925 DOI: 10.1007/s13311-020-00997-1] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2020] [Indexed: 11/26/2022] Open
Abstract
Fingolimod and natalizumab significantly reduce disease activity in relapsing-remitting multiple sclerosis (RRMS) and could promote tissue repair and neuroprotection. The ratio between conventional T1- and T2-weighted sequences (T1w/T2w-ratio) and magnetization transfer ratio (MTR) allow to quantify brain microstructural tissue abnormalities. Here, we compared fingolimod and natalizumab effects on brain T1w/T2w-ratio and MTR in RRMS over 2 years of treatment. RRMS patients starting fingolimod (n = 25) or natalizumab (n = 30) underwent 3T brain MRI scans at baseline (T0), month 6 (M6), month 12 (M12), and month 24 (M24). White matter (WM) lesions, normal-appearing (NA) WM, and gray matter (GM) T1w/T2w-ratio and MTR were estimated and compared between groups using linear mixed models. No baseline demographic, clinical, and MRI difference was found between groups. In natalizumab patients, lesion T1w/T2w-ratio and MTR significantly increased at M6 vs. T0 (p ≤ 0.035) and decreased at subsequent timepoints (p ≤ 0.037). In fingolimod patients, lesion T1w/T2w-ratio increased at M12 vs. T0 (p = 0.010), while MTR gradually increased at subsequent timepoints vs. T0 (p ≤ 0.027). Natalizumab stabilized NAWM and GM T1w/T2w-ratio and MTR. In fingolimod patients, NAWM T1w/T2w-ratio and MTR significantly increased at M24 vs. M12 (p ≤ 0.001). A significant GM T1w/T2w-ratio decrease at M6 vs. T0 (p = 0.014) and increase at M24 vs. M6 (p = 0.008) occurred, whereas GM MTR was significantly higher at M24 vs. previous timepoints (p ≤ 0.017) with significant between-group differences (p ≤ 0.034). Natalizumab may promote an early recovery of lesional damage and prevent microstructural damage accumulation in NAWM and GM during the first 2 years of treatment. Fingolimod enhances tissue damage recovery being visible after 6 months in lesions and after 2 years in NAWM and GM.
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Affiliation(s)
- Paolo Preziosa
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Loredana Storelli
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alessandro Meani
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Lucia Moiola
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Via Olgettina, 60, 20132, Milan, Italy
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria A Rocca
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Vita-Salute San Raffaele University, Via Olgettina, 60, 20132, Milan, Italy.
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