1
|
Johnson P, Chan JK, Vavasour IM, Abel S, Lee LE, Yong H, Laule C, Li DKB, Tam R, Traboulsee A, Carruthers RL, Kolind SH. Quantitative MRI findings indicate diffuse white matter damage in Susac Syndrome. Mult Scler J Exp Transl Clin 2022; 8:20552173221078834. [PMID: 35186315 PMCID: PMC8851927 DOI: 10.1177/20552173221078834] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 01/21/2022] [Indexed: 11/15/2022] Open
Abstract
Background Susac Syndrome (SuS) is an autoimmune endotheliopathy impacting the brain, retina and cochlea that can clinically mimic multiple sclerosis (MS). Objective To evaluate non-lesional white matter demyelination changes in SuS compared to MS and healthy controls (HC) using quantitative MRI. Methods 3T MRI including myelin water imaging and diffusion basis spectrum imaging were acquired for 7 SuS, 10 MS and 10 HC participants. Non-lesional white matter was analyzed in the corpus callosum (CC) and normal appearing white matter (NAWM). Groups were compared using ANCOVA with Tukey correction. Results SuS CC myelin water fraction (mean 0.092) was lower than MS(0.11, p = 0.01) and HC(0.11, p = 0.04). Another myelin marker, radial diffusivity, was increased in SuS CC(0.27μm2/ms) compared to HC(0.21μm2/ms, p = 0.008) and MS(0.23μm2/ms, p = 0.05). Fractional anisotropy was lower in SuS CC(0.82) than HC(0.86, p = 0.04). Fiber fraction (reflecting axons) did not differ from HC or MS. In NAWM, radial diffusivity and apparent diffusion coefficient were significantly increased in SuS compared to HC(p < 0.001 for both measures) and MS(p = 0.003, p < 0.001 respectively). Conclusions Our results provided evidence of myelin damage in SuS, particularly in the CC, and more extensive microstructural injury in NAWM, supporting the hypothesis that there are widespread microstructural changes in SuS syndrome including diffuse demyelination.
Collapse
Affiliation(s)
| | - JK Chan
- Department of Medicine (Neurology), University of British Columbia, Canada
| | - IM Vavasour
- Department of Radiology, University of British Columbia, Canada
- International Collaboration on Repair Discoveries (ICORD)
| | | | | | - H Yong
- Department of Medicine (Neurology), University of British Columbia, Canada
| | - C Laule
- Department of Radiology, University of British Columbia, Canada
- International Collaboration on Repair Discoveries (ICORD)
- Department of Pathology and Laboratory Medicine, University of British Columbia, Canada
- Department of Physics and Astronomy, University of British Columbia, Canada
| | - DKB Li
- Department of Medicine (Neurology), University of British Columbia, Canada
- Department of Radiology, University of British Columbia, Canada
| | - R Tam
- Department of Radiology, University of British Columbia, Canada
- School of Biomedical Engineering, University of British Columbia, Canada
| | | | - RL Carruthers
- Department of Medicine (Neurology), University of British Columbia, Canada
| | - SH Kolind
- Department of Medicine (Neurology), University of British Columbia, Canada
- Department of Radiology, University of British Columbia, Canada
- International Collaboration on Repair Discoveries (ICORD)
- Department of Physics and Astronomy, University of British Columbia, Canada
| |
Collapse
|
2
|
Vavasour IM, Becquart P, Gill J, Zhao G, Yik JT, Traboulsee A, Carruthers RL, Kolind SH, Schabas AJ, Sayao AL, Devonshire V, Tam R, Moore GRW, Stukas S, Wellington CL, Quandt JA, Li DKB, Laule C. Diffusely abnormal white matter in clinically isolated syndrome is associated with parenchymal loss and elevated neurofilament levels. Mult Scler Relat Disord 2021; 57:103422. [PMID: 34871858 DOI: 10.1016/j.msard.2021.103422] [Citation(s) in RCA: 3] [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] [Received: 05/31/2021] [Revised: 10/23/2021] [Accepted: 11/20/2021] [Indexed: 11/19/2022]
Abstract
We characterized the frequency of diffusely abnormal white matter (DAWM) across a broad spectrum of multiple sclerosis (MS) participants. 35% of clinically isolated syndrome (CIS), 57% of relapsing remitting and 64% of secondary progressive MS participants demonstrated DAWM. CIS with DAWM had decreased cortical thickness, higher lesion load and a higher concentration of serum neurofilament light chain compared to CIS without DAWM. DAWM may be useful in identifying CIS patients with greater injury to their brains. Larger and longitudinal studies are warranted.
Collapse
Affiliation(s)
- I M Vavasour
- Radiology, University of British Columbia, Vancouver, British Columbia, Canada; International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, British Columbia, Canada.
| | - P Becquart
- Pathology & Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - J Gill
- Pathology & Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - G Zhao
- MS/MRI Research Group, University of British Columbia, Vancouver, British Columbia, Canada
| | - J T Yik
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, British Columbia, Canada; Physics & Astronomy, University of British Columbia, Vancouver, British Columbia, Canada
| | - A Traboulsee
- MS/MRI Research Group, University of British Columbia, Vancouver, British Columbia, Canada; Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - R L Carruthers
- Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - S H Kolind
- Radiology, University of British Columbia, Vancouver, British Columbia, Canada; International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, British Columbia, Canada; MS/MRI Research Group, University of British Columbia, Vancouver, British Columbia, Canada; Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Physics & Astronomy, University of British Columbia, Vancouver, British Columbia, Canada
| | - A J Schabas
- Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - A L Sayao
- Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - V Devonshire
- Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - R Tam
- Radiology, University of British Columbia, Vancouver, British Columbia, Canada; MS/MRI Research Group, University of British Columbia, Vancouver, British Columbia, Canada; School of Biomedical Engineering, University of British Columbia, Vancouver, British Columbia, Canada
| | - G R W Moore
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, British Columbia, Canada; Pathology & Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - S Stukas
- Pathology & Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - C L Wellington
- Pathology & Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - J A Quandt
- Pathology & Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - D K B Li
- Radiology, University of British Columbia, Vancouver, British Columbia, Canada; MS/MRI Research Group, University of British Columbia, Vancouver, British Columbia, Canada; Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - C Laule
- Radiology, University of British Columbia, Vancouver, British Columbia, Canada; International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, British Columbia, Canada; Pathology & Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Physics & Astronomy, University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
3
|
Le M, Tang LYW, Hernández-Torres E, Jarrett M, Brosch T, Metz L, Li DKB, Traboulsee A, Tam RC, Rauscher A, Wiggermann V. FLAIR 2 improves LesionTOADS automatic segmentation of multiple sclerosis lesions in non-homogenized, multi-center, 2D clinical magnetic resonance images. Neuroimage Clin 2019; 23:101918. [PMID: 31491827 PMCID: PMC6646743 DOI: 10.1016/j.nicl.2019.101918] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 06/18/2019] [Accepted: 06/30/2019] [Indexed: 11/05/2022]
Abstract
Background Accurate segmentation of MS lesions on MRI is difficult and, if performed manually, time consuming. Automatic segmentations rely strongly on the image contrast and signal-to-noise ratio. Literature examining segmentation tool performances in real-world multi-site data acquisition settings is scarce. Objective FLAIR2, a combination of T2-weighted and fluid attenuated inversion recovery (FLAIR) images, improves tissue contrast while suppressing CSF. We compared the use of FLAIR and FLAIR2 in LesionTOADS, OASIS and the lesion segmentation toolbox (LST) when applied to non-homogenized, multi-center 2D-imaging data. Methods Lesions were segmented on 47 MS patient data sets obtained from 34 sites using LesionTOADS, OASIS and LST, and compared to a semi-automatically generated reference. The performance of FLAIR and FLAIR2 was assessed using the relative lesion volume difference (LVD), Dice coefficient (DSC), sensitivity (SEN) and symmetric surface distance (SSD). Performance improvements related to lesion volumes (LVs) were evaluated for all tools. For comparison, LesionTOADS was also used to segment lesions from 3 T single-center MR data of 40 clinically isolated syndrome (CIS) patients. Results Compared to FLAIR, the use of FLAIR2 in LesionTOADS led to improvements of 31.6% (LVD), 14.0% (DSC), 25.1% (SEN), and 47.0% (SSD) in the multi-center study. DSC and SSD significantly improved for larger LVs, while LVD and SEN were enhanced independent of LV. OASIS showed little difference between FLAIR and FLAIR2, likely due to its inherent use of T2w and FLAIR. LST replicated the benefits of FLAIR2 only in part, indicating that further optimization, particularly at low LVs is needed. In the CIS study, LesionTOADS did not benefit from the use of FLAIR2 as the segmentation performance for both FLAIR and FLAIR2 was heterogeneous. Conclusions In this real-world, multi-center experiment, FLAIR2 outperformed FLAIR in its ability to segment MS lesions with LesionTOADS. The computation of FLAIR2 enhanced lesion detection, at minimally increased computational time or cost, even retrospectively. Further work is needed to determine how LesionTOADS and other tools, such as LST, can optimally benefit from the improved FLAIR2 contrast. FLAIR2 improves automatic MS lesion segmentation with LesionTOADS compared to FLAIR. Segmentation similarity improves for higher lesion volumes, particularly for FLAIR2. FLAIR2 provides greater sensitivity independent of lesion volume than FLAIR alone. Other segmentation tools need further optimization to fully benefit from FLAIR2. FLAIR2 provides immediate benefits at 1.5 T and visually improves segmentation at 3 T.
Collapse
Affiliation(s)
- M Le
- MS/MRI Research Group (Division of Neurology), University of British Columbia, Vancouver, BC, Canada
| | - L Y W Tang
- MS/MRI Research Group (Division of Neurology), University of British Columbia, Vancouver, BC, Canada; Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - E Hernández-Torres
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada; UBC MRI Research Centre, University of British Columbia, Vancouver, BC, Canada; Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - M Jarrett
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada; Population Data BC, Vancouver, BC, Canada
| | - T Brosch
- MS/MRI Research Group (Division of Neurology), University of British Columbia, Vancouver, BC, Canada; Department of Electrical and Computer Engineering, University of British Columbia, Vancouver, BC, Canada; Philips Medical Innovative Technologies, Hamburg, Germany
| | - L Metz
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - D K B Li
- MS/MRI Research Group (Division of Neurology), University of British Columbia, Vancouver, BC, Canada; Department of Radiology, University of British Columbia, Vancouver, BC, Canada; UBC MRI Research Centre, University of British Columbia, Vancouver, BC, Canada
| | - A Traboulsee
- Department of Neurology (Division of Medicine), University of British Columbia, Vancouver, BC, Canada
| | - R C Tam
- MS/MRI Research Group (Division of Neurology), University of British Columbia, Vancouver, BC, Canada; Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - A Rauscher
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada; BC Children's Hospital Research Institute, Canada; Department of Physics and Astronomy, University of British Columbia, Vancouver, BC, Canada
| | - V Wiggermann
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada; UBC MRI Research Centre, University of British Columbia, Vancouver, BC, Canada; Department of Physics and Astronomy, University of British Columbia, Vancouver, BC, Canada.
| |
Collapse
|
4
|
Kang H, Hii M, Le M, Tam R, Riddehough A, Traboulsee A, Kolind S, Freedman MS, Li DKB. Gadolinium Deposition in Deep Brain Structures: Relationship with Dose and Ionization of Linear Gadolinium-Based Contrast Agents. AJNR Am J Neuroradiol 2018; 39:1597-1603. [PMID: 30139752 DOI: 10.3174/ajnr.a5751] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Accepted: 06/20/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Dose-dependent association between hyperintensity in deep brain structures on unenhanced T1WIs and gadolinium-based contrast agent administrations has been demonstrated with subsequent histopathological confirmation of gadolinium deposition. Our aim was to determine whether greater exposure to linear gadolinium-based contrast agent administration is associated with higher signal intensity in deep brain structures on unenhanced T1-weighted MR imaging. Secondary objective was to compare signal intensity differences between ionic and nonionic linear gadolinium-based contrast agents. MATERIALS AND METHODS Subjects with secondary-progressive MS originally enrolled in a multicenter clinical trial were studied retrospectively. Eighty subjects (high-exposure cohort) received 9 linear gadolinium-based contrast agent administrations (30 nonionic/50 ionic) between week -4 and year 1 and a tenth administration by year 2. One hundred fifteen subjects (low-exposure cohort) received 2 administrations (40 nonionic/75 ionic) between week -4 and year 1 and a third administration by year 2. Signal intensities were measured on unenhanced T1WIs by placing sample-points on the dentate nucleus, globus pallidus, caudate, thalamus, pons, and white matter, and they were normalized using the following ratios: dentate/pons, globus pallidus/white matter, caudate/white matter, and thalamus/white matter. RESULTS Between week -4 and year 1, subjects in the high-exposure cohort showed increased signal intensity ratios in all regions (P < .01), while the low-exposure cohort showed only an increase in the dentate nucleus (P = .003). Between years 1 and 2, when both cohorts received only 1 additional gadolinium-based contrast agent, no significant changes were observed. In the high-exposure cohort, significantly higher changes in signal intensity ratios were observed in subjects receiving linear nonionic than in those receiving linear ionic gadolinium-based contrast agents. CONCLUSIONS Hyperintensity in deep brain structures from gadolinium deposition is related to the number of doses and the type of linear gadolinium-based contrast agent (nonionic greater than ionic) administration.
Collapse
Affiliation(s)
- H Kang
- From the Department of Radiology (H.K., M.L., R.T., S.K., D.K.B.L.)
| | - M Hii
- University of British Columbia MS/MRI Research Group (M.H., R.T., A.R., A.T., S.K., D.K.B.L.)
| | - M Le
- From the Department of Radiology (H.K., M.L., R.T., S.K., D.K.B.L.)
| | - R Tam
- From the Department of Radiology (H.K., M.L., R.T., S.K., D.K.B.L.).,University of British Columbia MS/MRI Research Group (M.H., R.T., A.R., A.T., S.K., D.K.B.L.)
| | - A Riddehough
- University of British Columbia MS/MRI Research Group (M.H., R.T., A.R., A.T., S.K., D.K.B.L.)
| | - A Traboulsee
- University of British Columbia MS/MRI Research Group (M.H., R.T., A.R., A.T., S.K., D.K.B.L.).,Department of Medicine and Division of Neurology (A.T., S.K., D.K.B.L.)
| | - S Kolind
- From the Department of Radiology (H.K., M.L., R.T., S.K., D.K.B.L.).,University of British Columbia MS/MRI Research Group (M.H., R.T., A.R., A.T., S.K., D.K.B.L.).,Department of Medicine and Division of Neurology (A.T., S.K., D.K.B.L.).,Department of Physics and Astronomy (S.K.), University of British Columbia, Vancouver, British Columbia, Canada
| | - M S Freedman
- Department of Medicine and Division of Neurology (M.S.F.), University of Ottawa and the Ottawa Hospital Research Institute, Ottawa, Canada
| | - D K B Li
- From the Department of Radiology (H.K., M.L., R.T., S.K., D.K.B.L.).,University of British Columbia MS/MRI Research Group (M.H., R.T., A.R., A.T., S.K., D.K.B.L.).,Department of Medicine and Division of Neurology (A.T., S.K., D.K.B.L.)
| |
Collapse
|
5
|
Abstract
Using MR imaging, perfusion can be assessed either by dynamic susceptibility contrast MR imaging or arterial spin-labeling. Alterations of cerebral perfusion have repeatedly been described in multiple sclerosis compared with healthy controls. Acute lesions exhibit relative hyperperfusion in comparison with normal-appearing white matter, a finding mostly attributed to inflammation in this stage of lesion development. In contrast, normal-appearing white and gray matter of patients with MS has been mostly found to be hypoperfused compared with controls, and correlations with cognitive impairment as well as fatigue in multiple sclerosis have been described. Mitochondrial failure, axonal degeneration, and vascular dysfunction have been hypothesized to underlie the perfusion MR imaging findings. Clinically, perfusion MR imaging could allow earlier detection of the acute focal inflammatory changes underlying relapses and new lesions, and could constitute a marker for cognitive dysfunction in MS. Nevertheless, the clinical relevance and pathogenesis of the brain perfusion changes in MS remain to be clarified.
Collapse
Affiliation(s)
- E Lapointe
- From the Division of Neurology (E.L., A.L.T.) .,Department of Medicine (E.L., A.L.T.)
| | - D K B Li
- Radiology (D.K.B.L.), University of British Columbia, Djavad Mowafaghian Center for Brain Health, Vancouver, British Columbia, Canada
| | - A L Traboulsee
- From the Division of Neurology (E.L., A.L.T.).,Department of Medicine (E.L., A.L.T.)
| | - A Rauscher
- MRI Research Center (A.R.).,Departments of Pediatrics (A.R.)
| |
Collapse
|
6
|
Wiggermann V, Hernández-Torres E, Traboulsee A, Li DKB, Rauscher A. FLAIR2: A Combination of FLAIR and T2 for Improved MS Lesion Detection. AJNR Am J Neuroradiol 2016; 37:259-65. [PMID: 26450539 DOI: 10.3174/ajnr.a4514] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [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: 05/04/2015] [Accepted: 06/21/2015] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND PURPOSE FLAIR and double inversion recovery are important MR imaging scans for MS. The suppression of signal from CSF in FLAIR and the additional suppression of WM signal in double inversion recovery improve contrast between lesions, WM and GM, albeit at a reduced SNR. However, whether the acquisition of double inversion recovery is necessary is still debated. Here, we present an approach that allows obtaining CSF-suppressed images with improved contrast between lesions, WM and GM without strongly penalizing SNR. MATERIALS AND METHODS 3D T2-weighted and 3D-FLAIR data acquired from September 2014 to April 2015 in healthy volunteers (23.4 ± 2.4 years of age; female/male ratio, 3:2) and patients (44.1 ± 14.0 years of age; female/male ratio, 4:5) with MS were coregistered and multiplied (FLAIR(2)). SNR and contrast-to-noise measurements were performed for focal lesions and GM and WM. Furthermore, data from 24 subjects with relapsing-remitting and progressive MS were analyzed retrospectively (52.7 ± 8.1 years of age; female/male ratio, 14:10). RESULTS The GM-WM contrast-to-noise ratio was by 133% higher in FLAIR(2) than in FLAIR and improved between lesions and WM by 31%, 93%, and 158% compared with T2, DIR, and FLAIR, respectively. Cortical and juxtacortical lesions were more conspicuous in FLAIR(2). Furthermore, the 3D nature of FLAIR(2) allowed reliable visualization of callosal and infratentorial lesions. CONCLUSIONS We present a simple approach for obtaining CSF suppression with an improved contrast-to-noise ratio compared with conventional FLAIR and double inversion recovery without the acquisition of additional data. FLAIR(2) can be computed retrospectively if T2 and FLAIR scans are available.
Collapse
Affiliation(s)
- V Wiggermann
- From the Departments of Physics and Astronomy (V.W.) Pediatrics (V.W., E.H.T., A.R.) University of British Columbia MRI Research Centre (V.W., E.H.T., A.R.)
| | - E Hernández-Torres
- Pediatrics (V.W., E.H.T., A.R.) University of British Columbia MRI Research Centre (V.W., E.H.T., A.R.)
| | | | - D K B Li
- Medicine (Neurology) (A.T., D.K.B.L.) Radiology (D.K.B.L.) Centre for Brain Health (D.K.B.L., A.R.)
| | - A Rauscher
- Pediatrics (V.W., E.H.T., A.R.) University of British Columbia MRI Research Centre (V.W., E.H.T., A.R.) Centre for Brain Health (D.K.B.L., A.R.) Child and Family Research Institute (A.R.), University of British Columbia, Vancouver, British Columbia, Canada.
| |
Collapse
|
7
|
MacMillan EL, Tam R, Zhao Y, Vavasour IM, Li DKB, Oger J, Freedman MS, Kolind SH, Traboulsee AL. Progressive multiple sclerosis exhibits decreasing glutamate and glutamine over two years. Mult Scler 2015; 22:112-6. [DOI: 10.1177/1352458515586086] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 04/11/2015] [Indexed: 11/17/2022]
Abstract
Background: Few biomarkers of progressive multiple sclerosis (MS) are sensitive to change within the two-year time frame of a clinical trial. Objective: To identify biomarkers of MS disease progression with magnetic resonance spectroscopy (MRS) in secondary progressive MS (SPMS). Methods: Forty-seven SPMS subjects were scanned at baseline and annually for two years. Concentrations of N-acetylaspartate, total creatine, total choline, myo-inositol, glutamate, glutamine, and the sum glutamate+glutamine were measured in a single white matter voxel. Results: Glutamate and glutamine were the only metabolites to show an effect with time: with annual declines of (95% confidence interval): glutamate −4.2% (−6.2% to −2.2%, p < 10−4), glutamine −7.3% (−11.8% to −2.9%, p = 0.003), and glutamate+glutamine −5.2% (−7.6% to −2.8%, p < 10−4). Metabolite rates of change were more apparent than changes in clinical scores or brain atrophy measures. Conclusions: The high rates of change of both glutamate and glutamine over two years suggest they are promising new biomarkers of MS disease progression.
Collapse
Affiliation(s)
- EL MacMillan
- Division of Neurology, Faculty of Medicine, The University of British Columbia, Vancouver, Canada
| | - R Tam
- Department of Radiology, Faculty of Medicine, The University of British Columbia, Vancouver, Canada/UBC MS/MRI Research Group, The University of British Columbia, Vancouver, Canada
| | - Y Zhao
- UBC MS/MRI Research Group, The University of British Columbia, Vancouver, Canada
| | - IM Vavasour
- Department of Radiology, Faculty of Medicine, The University of British Columbia, Vancouver, Canada
| | - DKB Li
- Department of Radiology, Faculty of Medicine, The University of British Columbia, Vancouver, Canada/UBC MS/MRI Research Group, The University of British Columbia, Vancouver, Canada
| | - J Oger
- Division of Neurology, Faculty of Medicine, The University of British Columbia, Vancouver, Canada
| | - MS Freedman
- Department of Neurology, Faculty of Medicine, The University of Ottawa, Canada
| | - SH Kolind
- Division of Neurology, Faculty of Medicine, The University of British Columbia, Vancouver, Canada
| | - AL Traboulsee
- Division of Neurology, Faculty of Medicine, The University of British Columbia, Vancouver, Canada
| |
Collapse
|
8
|
Kang H, Metz LM, Traboulsee AL, Eliasziw M, Zhao GJ, Cheng Y, Zhao Y, Li DKB, Traboulsee A, Li D, Riddehough A, Cheng Y, Lam K, Lee A, Zhao GJ, Vorobeychik G, Metz L, Yeung M, Yong VW, Hill M, Cerchiaro G, Ma C, Topor T, Blevins G, Marriott J, Kremenchutzky M, Freedman M, Lee L, Duquette P, Antel J, Grand’Maison F, Thibault M, Bhan V, Eliasziw M. Application and a proposed modification of the 2010 McDonald criteria for the diagnosis of multiple sclerosis in a Canadian cohort of patients with clinically isolated syndromes. Mult Scler 2013; 20:458-63. [DOI: 10.1177/1352458513501230] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: The 2005 and 2010 McDonald criteria utilize magnetic resonance imaging (MRI) to provide evidence of disease dissemination in space (DIS) and time (DIT) for the diagnosis of multiple sclerosis (MS) in patients who have clinically isolated syndromes (CIS). Methods: Data from 109 CIS patients not satisfying the 2005 criteria at entry into a randomized controlled minocycline trial were analyzed to determine the proportion who would have been diagnosed with MS at screening based on 2010 criteria. The impact of including symptomatic, as well as asymptomatic, MRI lesions to confirm DIT was also explored. Results: Thirty percent (33/109) of patients, retrospectively, met the 2010 criteria for a diagnosis of MS at baseline. When both symptomatic and asymptomatic lesions were used to confirm DIT, three additional patients met the 2010 criteria. There was a significant 10.1% increase in the proportion of patients who met the 2010 DIS criteria, compared with the 2005 DIS criteria; however, two patients satisfied the 2005 DIS but not 2010 DIS criteria. Conclusion: Using 2010 McDonald criteria, 30% of the CIS patients could be diagnosed with MS using a single MRI scan. Inclusion of symptomatic lesions in the DIT criteria further increases this proportion to 33%.
Collapse
Affiliation(s)
- H Kang
- Department of Radiology, University of British Columbia (UBC), Canada
| | - LM Metz
- Department of Clinical Neurosciences, University of Calgary, Canada
| | - AL Traboulsee
- Division of Neurology, Department of Medicine, University of British Columbia, Canada
- UBC MS/MRI Research Group, Canada
| | - M Eliasziw
- Department of Public Health and Community Medicine, Tufts University, USA
| | - GJ Zhao
- Division of Neurology, Department of Medicine, University of British Columbia, Canada
- UBC MS/MRI Research Group, Canada
| | - Y Cheng
- Department of Radiology, University of British Columbia (UBC), Canada
- UBC MS/MRI Research Group, Canada
| | - Y Zhao
- Division of Neurology, Department of Medicine, University of British Columbia, Canada
- UBC MS/MRI Research Group, Canada
| | - DKB Li
- Department of Radiology, University of British Columbia (UBC), Canada
- Division of Neurology, Department of Medicine, University of British Columbia, Canada
- UBC MS/MRI Research Group, Canada
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
9
|
Riddell CA, Zhao Y, Li DKB, Petkau AJ, Riddehough A, Cutter GR, Traboulsee A. Evaluation of safety monitoring guidelines based on MRI lesion activity in multiple sclerosis. Neurology 2011; 77:2089-96. [DOI: 10.1212/wnl.0b013e31823d762d] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
10
|
Paty DW, Li DKB. Interferon beta-1b is effective in relapsing-remitting multiple-sclerosis: II. MRI analysis results of a multicenter, randomized, double-blind, placebo-controlled trial. Neurology 2011. [DOI: 10.1212/01.wnl.0000407006.93844.fb] [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: 11/15/2022] Open
|
11
|
Brief EE, Vavasour IM, Laule C, Li DKB, Mackay AL. Proton MRS of large multiple sclerosis lesions reveals subtle changes in metabolite T(1) and area. NMR Biomed 2010; 23:1033-1037. [PMID: 20963799 DOI: 10.1002/nbm.1527] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The T(1) values of metabolites were measured in eight subjects with clinically definite multiple sclerosis (MS) having at least one large brain lesion (2.6 ± 0.7 mL) and in eight age- and sex-matched healthy controls. MRS examinations were conducted at 1.5 T using point-resolved spectroscopy (PRESS) (TE = 30 ms, TR = 530, 750, 1200, 1500, 3500, 5000 ms). Spectra were acquired from a voxel placed in the largest lesion in the subject with MS, and in a corresponding voxel (same size and region) in normal white matter (NWM) in the matched control, and were fitted using LCModel. As there are regional variations in metabolite and water T(1) and metabolite signal areas, careful placement of the control voxel was necessary to measure subtle differences between the lesions and NWM. The T(1) and T(1)-corrected signal areas of creatine were the same in MS lesions as in controls. The T(1) values of choline were significantly shorter in MS lesions located in occipital and parietal, but not in frontal, white matter. N-Acetylaspartate (NAA) and myoinositol T(1) values in MS lesions were similar to those in NWM; however, the area of myoinositol correlated directly with lesion water T(1), and the area of NAA correlated inversely with lesion water T(1). MR spectra acquired at short TR require T(1) correction of choline for accurate quantification. Careful voxel placement in controls to match lesion location in subjects with MS enables a clearer view of the subtle changes in lesions.
Collapse
Affiliation(s)
- E E Brief
- Department of Physics and Astronomy, University of British Columbia, Vancouver, Canada
| | | | | | | | | |
Collapse
|
12
|
Laule C, Vavasour IM, Zhao Y, Traboulsee AL, Oger J, Vavasour JD, Mackay AL, Li DKB. Two-year study of cervical cord volume and myelin water in primary progressive multiple sclerosis. Mult Scler 2010; 16:670-7. [PMID: 20558500 DOI: 10.1177/1352458510365586] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Spinal cord involvement in multiple sclerosis (MS) is common and an important element in disability. Previous studies demonstrated smaller cervical cord area at the C2 level in MS compared to controls, and a decrease in cord area over 12 months, most marked in primary progressive MS (PPMS). A subset of subjects participating in a multicentre, double-blind, placebo-controlled clinical trial evaluating the efficacy of glatiramer acetate in PPMS (PROMiSe trial) were followed for 2 years. METHODS 24 PPMS subjects, randomized to placebo (n = 9) and glatiramer acetate (n = 15), and 24 matched controls were studied. Cervical cord volume (CCV) at C2-3 was determined using a 3D inversion recovery (IR)-prepared spoiled-gradient echo sequence. Myelin water fraction (MWF) at C2-3 was obtained using a 32-echo IR-prepared relaxation sequence. Scans were repeated at baseline, years 1 and 2. RESULTS Baseline CCV was significantly smaller for PPMS than controls [median (interquartile range) 951 (829-1043) vs. 1072 (1040-1129) mm(3), p = 0.0004] and MWF trended to be lower in PPMS cord [median (interquartile range) 0.225 (0.187-0.267) vs. 0.253 (0.235-0.266), p = 0.12]. Baseline CCV correlated with baseline Expanded Disability Status Scale, disease duration, brain white and grey matter volume. In PPMS, CCV was significantly decreased at year 1 (-0.83%, p = 0.04) and year 2 (-1.65%, p = 0.02). Baseline MWF correlated with baseline CCV and brain white and grey matter volume. MWF was significantly decreased from baseline for PPMS at year 2 (-10.5%, p = 0.01). Treatment effect was not detected on change in CCV nor MWF. CONCLUSIONS Metrics at the level of the cord, including volume and MWF at C2-3, were lower in PPMS than controls and changed over 2 years only in PPMS.
Collapse
Affiliation(s)
- C Laule
- Radiology, University of British Columbia, Vancouver, BC, Canada.
| | | | | | | | | | | | | | | |
Collapse
|
13
|
Abstract
Background: The rate of new contrast-enhancing lesions (CELs) on monthly magnetic resonance imaging (MRI) scans has been shown to decrease over a 9-month period in placebo-treated patients with relapsing—remitting (RR) multiple sclerosis (RRMS). Objective: We examined this phenomenon in placebo-treated secondary progressive MS (SPMS) patients. Methods: Patients were chosen from two clinical trials. Monthly scans were taken at screening, baseline and months 1—9 for Cohort-1 and months 1—6 for Cohort-2. We examined the monthly new CEL rates according to initial CEL level: 0, 1—3, >3 CELs at screening, and presence and absence of pre-study relapses. Results: Respectively, 59, 21 and 14 of the 94 Cohort-1 patients, and 36, 17 and 9 of the 62 Cohort-2 patients had 0, 1—3 and >3 initial CELs. For Cohort-1, the monthly new CEL rates did not change during follow-up, regardless of initial CEL level. For Cohort-2, the monthly rate was unchanged in the 0 initial CEL subgroup, but decreased 33% (95% confidence interval: 8%, 52%) from months 1—3 to months 4—6 in the other two subgroups. For the combined cohorts, a decreasing rate was observed in the 12 patients with >3 initial CELs and pre-study relapses. Conclusions: The short-term trend of new CEL activity in placebo-treated SPMS patients may vary across cohorts.
Collapse
Affiliation(s)
- Y. Zhao
- MS/MRI Research Group, Department of Medicine, University of British Columbia, Vancouver, Canada,
| | - AJ Petkau
- Department of Statistics, University of British Columbia, Vancouver, Canada
| | - A. Traboulsee
- Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - A. Riddehough
- MS/MRI Research Group, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - DKB Li
- Department of Radiology, University of British Columbia, Vancouver, Canada
| |
Collapse
|
14
|
Brief EE, Moll R, Li DKB, Mackay AL. Absolute metabolite concentrations calibrated using the total water signal in brain (1)H MRS. NMR Biomed 2009; 22:349-354. [PMID: 19107764 DOI: 10.1002/nbm.1349] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Magnetic resonance spectroscopy (MRS) has been coupled with a multi-echo imaging sequence to determine the relaxation corrected signal areas of the metabolites and the tissue water. Stimulated echo acquisition mode (STEAM) spectra (TE/TM/TR 30/13.7/5000 ms) acquired from gray and white matter voxels in 43 healthy volunteers were fit using LCModel. Corresponding water signals, measured using a multi-echo T(2) imaging sequence, were fit with a Non-Negative Least Squares algorithm. Using this approach the water area could be T(1) and T(2) corrected for all three water compartments: cerebrospinal fluid (CSF), intra- and extra-cellular water, and myelin water. The image-based water measurement is an improvement over spectroscopy methods because it can be more sensitive to water changes in diseased tissue. Metabolite areas were also corrected for relaxation losses. In occipital gray matter, the concentrations of Cho, Cr, and N-acetyl aspartate (NAA) were 1.27 (0.06), 8.9 (0.3), and 9.3 (0.3) mmol/L tissue, respectively and in parietal white matter they were 1.90 (0.05), 7.9 (0.2), and 9.8 (0.2) mmol/L tissue. The Cho and Cr concentrations were different in occipital gray compared to parietal white matter (p < 0.0001 and <0.005, respectively).
Collapse
Affiliation(s)
- E E Brief
- Department of Physics and Astronomy, University of British Columbia, Vancouver, Canada.
| | | | | | | |
Collapse
|
15
|
Abstract
This article provides an overview of relaxation times and their application to normal brain and brain and cord affected by multiple sclerosis. The goal is to provide readers with an intuitive understanding of what influences relaxation times, how relaxation times can be accurately measured, and how they provide specific information about the pathology of MS. The article summarizes significant results from relaxation time studies in the normal human brain and cord and from people who have multiple sclerosis. It also reports on studies that have compared relaxation time results with results from other MR techniques.
Collapse
Affiliation(s)
- A L MacKay
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada.
| | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Moore GRW, Laule C, Mackay A, Leung E, Li DKB, Zhao G, Traboulsee AL, Paty DW. Dirty-appearing white matter in multiple sclerosis. J Neurol 2008; 255:1802-11. [PMID: 18821049 DOI: 10.1007/s00415-008-0002-z] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2007] [Revised: 09/12/2007] [Accepted: 10/29/2007] [Indexed: 11/28/2022]
Affiliation(s)
- G R W Moore
- Dept. of Pathology and Laboratory Medicine (Neuropathology), Vancouver General Hospital, 855 West 12th Ave, Vancouver, BC, Canada V5Z 1M9.
| | | | | | | | | | | | | | | |
Collapse
|
17
|
Traboulsee A, Al-Sabbagh A, Bennett R, Chang P, Li DKB. Reduction in magnetic resonance imaging T2 burden of disease in patients with relapsing-remitting multiple sclerosis: analysis of 48-week data from the EVIDENCE (EVidence of Interferon Dose-response: European North American Comparative Efficacy) study. BMC Neurol 2008; 8:11. [PMID: 18426595 PMCID: PMC2374794 DOI: 10.1186/1471-2377-8-11] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [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: 08/10/2007] [Accepted: 04/21/2008] [Indexed: 11/18/2022] Open
Abstract
Background The EVIDENCE (EVidence of Interferon Dose-response: European North American Comparative Efficacy) study was an international, randomized, open-label, assessor-blinded, parallel-group study assessing the efficacy and tolerability of interferon (IFN) beta-1a, 44 mcg subcutaneously (sc) three times weekly (tiw), and IFN beta-1a, 30 mcg intramuscularly (im) once weekly (qw), in patients with relapsing-remitting multiple sclerosis (RRMS). The aim of this analysis was to assess whether reductions in T2 burden of disease (BOD) were greater for patients receiving IFN beta-1a, 44 mcg sc tiw, than for those treated with IFN beta-1a, 30 mcg im qw, and to assess the impact of neutralizing antibodies (NAbs). Methods A post-hoc analysis was performed on magnetic resonance imaging (MRI) data collected prospectively from the EVIDENCE study. The analysis included all patients with evaluable T2 MRI scans at the start of dosing and at week 48, and those who received at least one drug dose (n = 553). Lesions were identified by a radiologist blinded to treatment codes and the total volume of T2 lesions (BOD) was reported in mm3. Results Both median percentage decreases and absolute reduction in BOD were greater in the IFN beta-1a, 44 mcg sc tiw, treatment group. The adjusted mean treatment difference in percentage change in BOD from baseline to week 48 showed a significant treatment benefit for patients treated with IFN beta-1a, 44 mcg sc tiw, over those treated with IFN beta-1a, 30 mcg im qw (-4.6%; standard error: 2.6%; p = 0.002). The presence of NAbs reduced the effect of IFN beta-1a 44, mcg sc tiw, on BOD, but BOD changes were still similar to those seen with IFN beta-1a, 30 mcg im qw. Conclusion Patients with RRMS treated with IFN beta-1a, 44 mcg sc tiw, had greater reduction in T2 BOD after 48 weeks than those treated with IFN beta-1a, 30 mcg im qw, which is consistent with other clinical and MRI outcome measures in the EVIDENCE study. In patients testing positive for NAbs (NAb+) to IFN beta-1a 44 mcg sc tiw, changes in BOD were smaller than in NAb negative (NAb-) patients, but similar to those receiving IFN beta-1a, 30 mcg im qw.
Collapse
Affiliation(s)
- A Traboulsee
- Division of Neurology, Medicine, University of British Columbia, Vancouver, BC, Canada.
| | | | | | | | | | | | | |
Collapse
|
18
|
Vavasour IM, Li DKB, Laule C, Traboulsee AL, Moore GRW, MacKay AL. Multi-parametric MR assessment of T1 black holes in multiple sclerosis. J Neurol 2007; 254:1653-9. [DOI: 10.1007/s00415-007-0604-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2006] [Revised: 01/31/2007] [Accepted: 02/27/2007] [Indexed: 12/19/2022]
|
19
|
Li DKB, Held U, Petkau J, Daumer M, Barkhof F, Fazekas F, Frank JA, Kappos L, Miller DH, Simon JH, Wolinsky JS, Filippi M. MRI T2 lesion burden in multiple sclerosis: a plateauing relationship with clinical disability. Neurology 2006; 66:1384-9. [PMID: 16682671 DOI: 10.1212/01.wnl.0000210506.00078.5c] [Citation(s) in RCA: 147] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Previous studies have shown only modest correlation between multiple sclerosis (MS) lesions on MRI and clinical disability. OBJECTIVE To investigate the relationship between proton density/T2-weighted (T2) burden of disease (BOD) quantitatively measured on MRI scans and clinical determinants including disability. METHODS Using the Sylvia Lawry Centre for Multiple Sclerosis Research (SLCMSR) database, the authors studied baseline T2 BOD data from a pooled subsample of 1,312 placebo MS patients from 11 randomized controlled trials. Univariate comparisons guided development of multiple regression models incorporating the most important clinical predictors. RESULTS Significant, although weak to moderate, correlations were found between T2 BOD and age at disease onset, disease duration, disease course, disability (as measured by the Expanded Disability Status Scale [EDSS]), relapse rate, certain presenting symptoms, and gadolinium enhancement. An unexpected but key finding that persisted in the multiple regression analyses was a plateauing relationship between T2 BOD and disability for EDSS values above 4.5. CONCLUSIONS This study confirmed the limited correlation between clinical manifestations and T2 burden of disease (BOD) but revealed an important plateauing relationship between T2 BOD and disability.
Collapse
Affiliation(s)
- D K B Li
- University of British Columbia, Vancouver, British Columbia, Canada.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Brief EE, Whittall KP, Li DKB, MacKay AL. Proton T2 relaxation of cerebral metabolites of normal human brain over large TE range. NMR Biomed 2005; 18:14-18. [PMID: 15455460 DOI: 10.1002/nbm.916] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
T2 of NAA, creatine and choline-containing compounds were measured in posterior frontal white matter and occipital grey matter in 10 healthy human volunteers. Decay curves comprised signals from eight TE times ranging from 30 to 800 ms with TR 2000 ms acquired with a PRESS sequence on a 1.5 T clinical scanner. Simulations were conducted to assess the precision of T2 estimates from decay curves comprising varying numbers and ranges of TE points. Mean and standard errors for T2s of NAA, creatine and choline-containing compounds were 300(8), 169(3) and 239(4) ms in posterior frontal white matter and 256(6), 159(8) and 249(8) ms in occipital grey matter. In vivo T2s found for choline and NAA were shorter than the T2s in the literature. The elevation of literature T2s is accounted for by the simulation results, which demonstrated that there is a bias towards lengthened T2s when T2 is measured with a maximum TE approximately T2. Concentration estimates are at risk of being underestimated if previously reported T2 corrections are used.
Collapse
Affiliation(s)
- E E Brief
- Department of Physics and Astronomy, University of British Columbia, Vancouver, Canada
| | | | | | | |
Collapse
|
21
|
Laule C, Vavasour IM, Moore GRW, Oger J, Li DKB, Paty DW, MacKay AL. Water content and myelin water fraction in multiple sclerosis. J Neurol 2004; 251:284-93. [PMID: 15015007 DOI: 10.1007/s00415-004-0306-6] [Citation(s) in RCA: 277] [Impact Index Per Article: 13.9] [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: 04/02/2003] [Revised: 09/29/2003] [Accepted: 10/06/2003] [Indexed: 10/26/2022]
Abstract
BACKGROUND Measurements of the T2 decay curve provide estimates of total water content and myelin water fraction in white matter in-vivo, which may help in understanding the pathological progression of multiple sclerosis (MS). METHODS Thirty-three MS patients (24 relapsing remitting, 8 secondary progressive, 1 primary progressive) and 18 controls underwent MR examinations. T2 relaxation data were acquired using a 32-echo measurement. All controls and 18 of the 33 MS patients were scanned in the transverse plane through the genu and splenium of the corpus callosum. Five white matter and 6 grey matter structures were outlined in each of these subjects. The remaining 15 MS patients were scanned in other transverse planes. A total of 189 lesions were outlined in the MS patients. Water content and myelin water fraction were calculated for all regions of interest and all lesions. RESULTS The normal appearing white matter (NAWM) water content was, on average, 2.2% greater than that from controls, with significant differences occurring in the posterior internal capsules, genu and splenium of the corpus callosum, minor forceps and major forceps (p<0.0006). On average, MS lesions had 6.3% higher water content than contralateral NAWM (p<0.0001). Myelin water fraction was 16% lower in NAWM than for controls, with significant differences in the major and minor forceps, internal capsules, and splenium (p<0.05). The myelin water fraction of MS lesions averaged 52 % that of NAWM. CONCLUSIONS NAWM in MS has a higher water content and lower myelin water fraction than control white matter. The cause of the myelin water fraction decrease in NAWM could potentially be due to either diffuse edema, inflammation, demyelination or any combination of these features. We present a simple model which suggests that myelin loss is the dominant feature of NAWM pathology.
Collapse
Affiliation(s)
- C Laule
- Dept of Physics & Astronomy, Magnetic Resonance Imaging, University of British Columbia Hospital, 2211 Wesbrook Mall, Vancouver, BC, V6T 2B5 Canada.
| | | | | | | | | | | | | |
Collapse
|
22
|
Brief EE, Whittall KP, Li DKB, MacKay A. Proton T1 relaxation times of cerebral metabolites differ within and between regions of normal human brain. NMR Biomed 2003; 16:503-509. [PMID: 14696008 DOI: 10.1002/nbm.857] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Saturation recovery spectra (STEAM) were acquired at 1.5 T with 7 TRs ranging from 530 to 5000 ms and a constant TE of 30 ms in voxels (7.2 ml) located in occipital grey, parietal white and frontal white matter (10 subjects each location). Spectra were also acquired at 7, 21 and 37 degrees C from separate 100 mm solutions of inositol (Ins), choline-containing compounds (Cho), N-acetyl-aspartate (NAA) and creatine. Simulations of T(1) fits with 2, 3 and 7 TRs demonstrated that at typical SNR there is potential for both inaccurate and biased results. In vivo, different metabolites had significantly different T(1)s within the same brain volume. The same order from shortest to longest T(1) (Ins, Cho, NAA, creatine) was found for all three brain regions. The order (Ins, NAA, creatine, Cho) was found in the metabolite solutions and was consistent with a simple model in which T(1) is inversely proportional to molecular weight. For all individual metabolites, T(1) increased from occipital grey to parietal white to frontal white matter. This study demonstrates that, in spectra acquired with TR near 1 s, T(1) weightings are substantially different for metabolites within a single tissue and also for the same metabolites in different tissues.
Collapse
Affiliation(s)
- E E Brief
- Department of Physics and Astronomy, University of British Columbia, Vancouver, Canada
| | | | | | | |
Collapse
|
23
|
McDonnell GV, Cabrera-Gomez J, Calne DB, Li DKB, Oger J. Clinical presentation of primary progressive multiple sclerosis 10 years after the incidental finding of typical magnetic resonance imaging brain lesions: the subclinical stage of primary progressive multiple sclerosis may last 10 years. Mult Scler 2003; 9:204-9. [PMID: 12708816 DOI: 10.1191/1352458503ms890cr] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Subclinical multiple sclerosis (MS) has been identified incidentally at autopsy; apparently unaffected individuals with an affected twin have demonstrated magnetic resonance imaging (MRI) changes consistent with MS, and 'MRI relapses' are several times more common than clinical relapses. CASE DESCRIPTION A 39-year-old, right-handed man underwent MRI and PET scanning in 1986 as a 'normal' control in a Parkinson's disease study, where his father was the proband. MRI indicated multiple areas of abnormal signal intensity in a periventricular and grey-white matter junction distribution. Repeated clinical evaluations over the next 10 years were unchanged until 1996, when he complained of progressive weakness of the right foot and clumsiness in the right hand. MRI now indicated a further area of high signal intensity in the right posterior cord at the level of C5/C6. There was mild pyramidal distribution weakness in the right leg with an extensor plantar response on the same side. Over the next five years there has been mild progression in weakness and fatigue and intermittent Lhermitte's phenomenon. At no stage has there been a history of relapse, cerebrospinal fluid examination was normal and evoked responses (visual and somatosensory) are normal. CONCLUSION This case demonstrates the phenomenon of subclinical MS, unusually supported by prolonged clinical and MRI follow-up. The patient eventually became symptomatic nine years after MRI diagnosis and is following a primary progressive course. Although MRI is known to be sensitive in identifying subclinical 'attacks', the pattern illustrated here may actually be quite typical of primary progressive MS and is compatible with the later onset seen in this subgroup of patients.
Collapse
Affiliation(s)
- G V McDonnell
- Multiple Sclerosis Clinic, Vancouver Hospital & Health Sciences Centre at UBC Hospital, Vancouver, BC, Canada
| | | | | | | | | |
Collapse
|