A serial study of new MS lesions and the white matter from which they arise

Goodkin, Donald E.; Rooney, William D.; Sloan, R.; Bacchetti, Peter; Gee, Lauren; Vermathen, Martina; Waubant, Emmanuelle; Abundo, Marco A.; Majumdar, Sharmila; Nelson, Sarah J.; Weiner, Michael W.

doi:10.1212/wnl.51.6.1689

Cited by 191 publications

(127 citation statements)

References 39 publications

(1 reference statement)

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“…Over time, T2 decreases to that of chronic lesions (84,139,170), similar to the behaviour of T1. One study detected monoexponential relaxation in acute WM lesions, which became bi-exponential during remission, and finally returned to mono-exponential as the lesion turned into a chronic lesion (168).…”

Section: Qmri In Mssupporting

confidence: 62%

“…In a similar manner, T2 has been found to be shifted globally in NAWM (169,183,188,189), where the genu and splenium of the corpus callosum had the highest increase (169,189). Furthermore, regions in NAWM that developed lesions had pre-lesional elevated T2 (170). Also the increase of T2 depended on MS subtype (189), similar to the increase in T1.…”

Section: Introductionmentioning

confidence: 76%

“…During remyelination of the lesion, T1 and T2 levels decrease towards that of WM, but never fully recover (170) and finally as the lesion turns into a liquid CSF-filled cavity the T1, T2 and PD levels approach that of CSF.…”

Section: Qmri In Msmentioning

confidence: 95%

“…In acute WM lesions T1, T2 and PD are all substantially increased (73,84,(167)(168)(169) which, during the following months, decreases towards slightly elevated T1, T2 and PD seen in chronic lesions (84,170). The main pathological process in the initial increase is attributed to inflammatory oedema, causing increases in both T1 and T2, as well as PD.…”

Section: Qmri In Msmentioning

confidence: 97%

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Quantitative Magnetic Resonance Imaging of the Brain : Applications for Tissue Segmentation and Multiple Sclerosis

West¹

2014

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Magnetic resonance imaging (MRI) is a sensitive technique for assessing white matter (WM) lesions in multiple sclerosis (MS), but there is a low correlation between MRI findings and clinical disability. Because of this, other pathological changes are of interest, including changes in normal appearing white matter (NAWM) and diffusely abnormal white matter (DAWM). Even so, the mechanisms leading to permanent disability in MS remain unclear. In contrast to conventional MRI, quantitative MRI (qMRI) is aimed at the direct measurement of the physical tissue properties, such as the relaxation times, T1 and T2, as well as the proton density (PD). QMRI is promising for characterising and quantifying changes in MS and for brain tissue segmentation. The present work describes a novel method of qMRI for the human brain (QMAP), and a segmentation method based on this. The developed methods were validated in control subjects and MR phantoms. Furthermore, an application in diseased human brain was demonstrated in MS patients. In all, 50 healthy controls and 35 MS patients were scanned with qMRI in a total of 225 acquisitions. One major finding of this work was that qMRI was able to detect and quantify changes in the MS disease that were not visible using conventional MRI. In particular, it was found that DAWM appears to constitute an intermediate between focal white matter (WM) lesions and NAWM. These changes may be caused by pathological processes that are not entirely attributable to Wallerian degeneration. This study showed that the QMAP method had high accuracy and relatively high precision, within a clinically acceptable time. This work also demonstrated that qMRI could be used for brain tissue segmentation and volume estimation of the whole brain, using pre-defined tissue characteristics. The results showed that brain tissue segmentation had high repeatability, which was somewhat lower when different geometries were acquired or different field strengths used. In particular, small differences were found between 1.5 T and 3.0 T in deep brain structures, the cerebellum and the brain stem. This work leads the way for early clinical applications of qMRI, and the challenge for the years to come is to understand the connection between qMRI properties of the brain and underlying biology.Bildtagning med magnetresonanstomografi (MRT) är en teknik som kan användas för att upptäcka lesioner i vit substans hos patienter med multipel skleros (MS), men sambandet mellan lesioner och klinisk funktionsnedsättning är svagt. På grund av detta har intresset för andra patologiska processer i hjärnan ökat. Exempel är förändringar i vit substans som ser normal ut vid MRT (NAWM) och även så kallad diffus vit vävnad (DAWM). Det är emellertid fortfarande oklart vilka mekanismer i MS som leder till klinisk funktionsnedsättning. Med kvantitativ MRT (qMRT) kan fysiologiska egenskaper i vävnaden, som till exempel relaxationstiderna (T1 och T2) samt protontäthet (PD), mätas. QMRT kan användas för att mäta förändringar i hjärnan hos MS patienter och des...

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Section: Qmri In Mssupporting

confidence: 62%

Section: Introductionmentioning

confidence: 76%

Section: Qmri In Msmentioning

confidence: 95%

Section: Qmri In Msmentioning

confidence: 97%

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Quantitative Magnetic Resonance Imaging of the Brain : Applications for Tissue Segmentation and Multiple Sclerosis

West¹

2014

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“…MS is much more dynamic than clinically apparent. Serial MR studies reveal a high fluctuation of lesions [24, 32, 34], suggesting that more than one destructive and repair process occurs simultaneously. Discrimination between these processes and their dynamics should lead to a better understanding of the disease itself, and the determination of which processes are affected by different drugs should lead to more effective treatment of MS patients.…”

Section: Discussionmentioning

confidence: 99%

New Hypointense Lesions on MRI in Relapsing-Remitting Multiple Sclerosis Patients

Wagner

Adams²,

Sobel³

et al. 2000

Eur Neurol

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Background: Preliminary observational studies with multiple sclerosis (MS) patients have reported strong correlations between an increase in hypointense lesion load (black holes) on T1-weighted spin echo images, and an increase in disability. Objective: We assessed the relationship of hypointense lesions to the clinical course of disease among 50 relapsing-remitting MS patients in the controlled setting of a randomized clinical trial. Methods: Fifty patients with relapsing-remitting disease were enrolled in a randomized double-blind two-arm (cladribine vs. placebo) clinical trial of 1-year duration. All patients had monthly clinical evaluations and MRIs over the course of the trial. Multivariate techniques were used to identify predictors of clinical severity from information on exacerbations, MRIs, baseline clinical parameters, and demographics. Results: At baseline, clinical severity is weakly related to counts of black holes, with rank correlations between counts and clinical scores (EDSS and SNRS) of absolute magnitude 0.3. Rates of appearance of new black holes over the course of the trial are higher for patients with more severe disease at baseline (EDSS ≥ 4) than for the less severe patients. Changes in clinical severity over the course of the trial are best predicted by baseline neurologic scores and numbers of exacerbations, with black holes adding no further improvement in prediction. Conclusions: Numbers of exacerbations seem more critical to short-term clinical outcomes in relapsing-remitting MS, as reflected by patients’ clinical scores, rather than black holes. Various imaging methods and MRI indices capture complementary information relating to MS disease processes. The determination of which processes are affected by different drugs should lead to more effective treatment of MS patients.

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Diffuse Axonal and Tissue Injury in Patients With Multiple Sclerosis With Low Cerebral Lesion Load and No Disability

Stefano

Narayanan²,

Francis³

et al. 2002

Arch Neurol

172

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A serial study of new MS lesions and the white matter from which they arise

Cited by 191 publications

References 39 publications

Quantitative Magnetic Resonance Imaging of the Brain : Applications for Tissue Segmentation and Multiple Sclerosis

Quantitative Magnetic Resonance Imaging of the Brain : Applications for Tissue Segmentation and Multiple Sclerosis

New Hypointense Lesions on MRI in Relapsing-Remitting Multiple Sclerosis Patients

Diffuse Axonal and Tissue Injury in Patients With Multiple Sclerosis With Low Cerebral Lesion Load and No Disability

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