Multiple sclerosis lesion geometry in quantitative susceptibility mapping (QSM) and phase imaging

Eskreis‐Winkler, Sarah; Deh, Kofi; Gupta, Ajay; Liu, Tian; Wisnieff, Cynthia; Jin, Moonsoo M.; Gauthier, Susan A.; Spincemaille, Pascal

doi:10.1002/jmri.24745

Cited by 56 publications

(72 citation statements)

References 30 publications

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“…39 One previous study demonstrated a vast difference among QSM and phase results, wherein the authors concluded QSM was superior to depiction of spatial susceptibility patterns in MS lesions. 15 Similarly, we found wide-ranging differences in lesion classification based upon QSM versus phase images (data not shown). A major contributing factor to the difficulty of identifying and quantifying rim+ lesions has been the choice of susceptibility reference tissue.…”

Section: Discussionmentioning

confidence: 55%

“…17 We identify QSM rim+ lesions as having a rim of iron based upon the susceptibility gradient between the rim and core regions. Support of this approach is based upon three factors: 1) known pattern of demyelination found within chronic active MS lesions (dense loss of myelin in core), 3, 6, 12 2) histological studies demonstrating that GRE can detect iron within activated m/M at the edge of chronic active MS lesions 1, 3, 4, 11, 14, 15 and 3) our own data, demonstrating a decrease in both susceptibility and MWF from rim to core, which can only be explained by iron deposition. Thus we conclude that iron is contributing, at least in part, to the signal at the rim but importantly, we are not quantifying the absolute extent that iron or myelin is contributing to the QSM signal.…”

Section: Discussionmentioning

confidence: 99%

“…13, 14 However, because the local phase is affected by magnetic sources in the surrounding tissue, the phase pattern may not represent the true magnetic susceptibility pattern. 15 Quantitative susceptibility mapping (QSM) 16 is a phase-based magnetic field deconvolution technique that overcomes the blooming artifacts and provides more accurate quantification and localization of the magnetic sources. 17, 18 QSM has been established as a more sensitive and quantitative technique for measuring the brain iron as compared to T2 * , R2 and R2 * .…”

Section: Introductionmentioning

confidence: 99%

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Combining Quantitative Susceptibility Mapping with Automatic Zero Reference (QSM0) and Myelin Water Fraction Imaging to Quantify Iron-Related Myelin Damage in Chronic Active MS Lesions

Yao

Nguyen²,

Pandya³

et al. 2017

AJNR Am J Neuroradiol

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Background and Purpose To quantify iron related myelin damage in chronic multiple sclerosis lesions with hyperintense susceptibility rim consistent with iron deposition compared to those without rim. Methods Forty-six patients had two longitudinal quantitative susceptibility mapping (QSM) with automatic zero reference (QSM0) scans with a mean interval of 28.9 ± 11.4 months. Myelin water fraction (MWF) mapping using fast acquisition with spiral trajectory and T2prep (FAST-T2) was obtained at the second time point to measure myelin damage. Mixed-effects models were utilized to assess lesion QSM and MWF values. Results QSM were on average 6.8 ppb higher in 116 rim+ lesions compared to 441 rim− lesions, p<0.0001. All rim+ lesions retained hyperintense rim over time, with increasing QSM values of both rim and core regions, p<0.0001. QSM and MWF in rim+ lesions decreased from rim to core, which is consistent with rim iron deposition. Whole lesion MWF for rim+ and rim− lesions was 0.055 ± 0.07 and 0.066 ± 0.04, respectively. In the mixed-effects model, rim+ lesions had on average 0.01 lower MWF as compared to rim−, p<0.0001. The volume of the rim at initial QSM was negatively associated with follow-up MWF, p=0.0015. Conclusion QSM rim+ lesions maintained a hyperintense rim, increased in susceptibility and had more myelin damage compared to rim− lesions. Our results are consistent with identification of chronic active MS lesions and may provide a target for therapeutic interventions to reduce myelin damage.

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Section: Discussionmentioning

confidence: 55%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Combining Quantitative Susceptibility Mapping with Automatic Zero Reference (QSM0) and Myelin Water Fraction Imaging to Quantify Iron-Related Myelin Damage in Chronic Active MS Lesions

Yao

Nguyen²,

Pandya³

et al. 2017

AJNR Am J Neuroradiol

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“…(11, 12) Since phase is a non-local measure, phase contrast can be influenced by the magnetic susceptibility of adjacent tissues, orientation of the head in the magnetic field, and the shape of a lesion, resulting in unreliable quantification of phase shifts and artifacts such as false rims around lesions. (13)…”

Section: Introductionmentioning

confidence: 99%

Lesion Heterogeneity on High-Field Susceptibility MRI Is Associated with Multiple Sclerosis Severity

Harrison

Liu

et al. 2016

American Journal of Neuroradiology

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Background and Purpose Susceptibility MRI contrast variations reflect alterations in brain iron and myelin content- making this imaging tool relevant to studies of multiple sclerosis lesion heterogeneity. In this study we aimed to characterize the relationship of high-field, susceptibility contrasts in multiple sclerosis lesions to clinical outcomes. Materials and Methods Twenty-four subjects with multiple sclerosis underwent 7-tesla MRI of the brain, disability exams, and a fatigue inventory. R2*, frequency, and relative susceptibility (from quantitative susceptibility mapping) were analyzed in 306 white matter lesions. Results Most lesions were hypointense on R2* (88% without a rim, 5% with). Lesions that were hyperintense on quantitative susceptibility mapping were more frequent in relapsing-remitting than progressive multiple sclerosis (54% vs. 35%, p = 0.018). Hyperintense lesion rims on quantitative susceptibility maps were more common in progressive multiple sclerosis and higher levels of disability and fatigue. Mean lesion R2* was inversely related to disability and fatigue and significantly reduced in progressive multiple sclerosis. Relative susceptibility was lower lesions in progressive multiple sclerosis (median -0.018 ppm, range -0.070 – 0.022) than relapsing-remitting (median -0.010 ppm, range -0.062 – 0.052, p = 0.003). Conclusion A progressive clinical phenotype, greater disability, and fatigue were associated with lower R2* and relative susceptibility values (suggestive of low iron due to oligodendrocyte loss) and rimmed lesions (suggestive of chronic inflammation) in this multiple sclerosis cohort. Lesion heterogeneity on susceptibility MRI may help explain disability in multiple sclerosis and provide a window into the processes of demyelination, oligodendrocyte loss, and chronic lesion inflammation.

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“…Moreover, QSM improves the detection and spatial distribution of subtle iron deposition that are not seen on conventional T2* imaging. 20 This makes it possible to describe patterns of iron deposition within lesions (eg. nodular vs. ring-like) based on their 7T MRI findings, which have been rarely described in the literature.…”

Section: Introductionmentioning

confidence: 99%

Iron and Non-Iron-Related Characteristics of Multiple Sclerosis and Neuromyelitis Optica Lesions at 7T MRI

Chawla

Kister

Wuerfel

et al. 2016

American Journal of Neuroradiology

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Background and Purpose To investigate the potential of ultra-high field MR imaging to distinguish multiple sclerosis (MS) from neuromyelitis optica (NMO) and to characterize tissue injury associated with iron pathology within lesions. Methods Twenty-one MS and 21 NMO patients underwent 7T high-resolution 2D-gradient-echo (GRE-T2*) and 3D-susceptibility weighted imaging (SWI). An in-house developed algorithm was used to reconstruct quantitative susceptibility mapping (QSM) from SWI. Lesions were classified as ‘iron laden’ if they demonstrated hypointensity on GRE-T2*- weighted images and/or SWI, and hyperintensity on QSM. Lesions were considered ‘non-iron laden’ if they were hyperintense on GRE-T2* and isointense or hyperintense on QSM. Results Of 21 MS patients, 19 (90.5%) demonstrated atleast one QSM-hyperintense lesion and 11/21 (52.4%) patients harbored iron-laden lesions. No QSM-hyperintense or iron-laden lesions were observed in any of the NMO patients. Iron-laden and non iron-laden lesions could each be further characterized into two distinct patterns based on lesion signal and morphology on GRE-T2*/SWI and QSM. In MS, the majority of lesions (n=262, 75.9% of all lesions) were hyperintense on GRE-T2* and isointense on QSM (Pattern A), while a small minority (n=26, 7.5% of all lesions) were hyperintense on both GRE-T2* and QSM (Pattern B). Iron laden lesions (n=57, 16.5% of all lesions) were further classified as ‘nodular’ (n=22, 6.4%, Pattern C) or ‘ring-like’ (n=35, 10.1%, Pattern D). Conclusions Ultra-high field MRI may be useful in distinguishing MS from NMO. Different patterns related to iron and non-iron pathology may provide in vivo insights into pathophysiology of lesions in MS.

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Multiple sclerosis lesion geometry in quantitative susceptibility mapping (QSM) and phase imaging

Cited by 56 publications

References 30 publications

Combining Quantitative Susceptibility Mapping with Automatic Zero Reference (QSM0) and Myelin Water Fraction Imaging to Quantify Iron-Related Myelin Damage in Chronic Active MS Lesions

Combining Quantitative Susceptibility Mapping with Automatic Zero Reference (QSM0) and Myelin Water Fraction Imaging to Quantify Iron-Related Myelin Damage in Chronic Active MS Lesions

Lesion Heterogeneity on High-Field Susceptibility MRI Is Associated with Multiple Sclerosis Severity

Iron and Non-Iron-Related Characteristics of Multiple Sclerosis and Neuromyelitis Optica Lesions at 7T MRI

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