Correlating MRI and clinical disease activity in multiple sclerosis

Walderveen, M.A.A. van; Barkhof, Frederik; Hommes, O. R.; Polman, Chris H.; Tobi, Hilde; Frequin, S.T.F.M.; Valk, Jacob

doi:10.1212/wnl.45.9.1684

Cited by 261 publications

(167 citation statements)

References 33 publications

(3 reference statements)

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“…Hyper-and hypointensities were manually identified by the same neuroradiologist using the high-resolution T 1 and T 2 /PDweighted scans. T 1 hypointense lesions (T 1 black holes) were identified and defined on high-resolution T 1 -weighted scans, based on established criteria (34). Any visible low signal on T 1 -weighted images was deemed a T 1 lesion, with the additional condition that the hypointense lesion had to correspond to a region of high signal intensity on the T 2 -weighted images.…”

Section: Discussionmentioning

confidence: 99%

The role of edema and demyelination in chronic T₁ black holes: A quantitative magnetization transfer study

Levesque

Sled

Narayanan

et al. 2005

Magnetic Resonance Imaging

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Purpose: To use quantitative magnetization transfer imaging (qMTI) in an investigation of T 1 -weighted hypointensity observed in clinical magnetic resonance imaging (MRI) scans of multiple sclerosis (MS) patients, which has previously been proposed as a more specific indicator of tissue damage than the more commonly detected T 2 hyperintensity. Materials and Methods:A cross-sectional study of 10 MS patients was performed using qMTI. A total of 60 MTI measurements were collected in each patient at a resolution of 2 ϫ 2 ϫ 7 mm, over a range of saturation pulses. The observed T 1 and T 2 were also measured. qMT model parameters were estimated using a voxel-by-voxel fit.Results: A total of 65 T 2 -hyperintense lesions were identified; 53 were also T 1 hypointense. In these black holes, the qMTI-derived semisolid pool fraction F correlated negatively with T 1,obs (r 2 ϭ 0.76; P Ͻ 0.0001). The water pool absolute size (PD f ) showed a weaker correlation with T 1,obs (positive, r 2 ϭ 0.53; P Ͻ 0.0001). The magnetization transfer ratio (MTR) showed a similarly strong correlation with F and a weaker correlation with PD f (r 2 ϭ 0.18; P Ͻ 0.04).Conclusion: T 1 increases in chronic black holes strongly correlated with the decline in semisolid pool size, and somewhat less to the confounding effect of edema. MTR was less sensitive than T 1,obs to liquid pool changes associated with edema.

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Section: Discussionmentioning

confidence: 99%

The role of edema and demyelination in chronic T₁ black holes: A quantitative magnetization transfer study

Levesque

Sled

Narayanan

et al. 2005

Magnetic Resonance Imaging

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“…[21][22][23][24][25][26][27][28][29] A relationship between the burden of chronic black holes and increasing disability has been established, supporting its clinical relevance. [30][31][32][33] DTI may provide complementary and additional information to other MRI techniques in clinical practice. Whereas T1 hypointensities and T2 hyperintensities are indicative of a threshold of increased water content, DTI can assess structural hindrances to the Brownian motion of water, providing information more specific for tissue breakdown.…”

Section: Demographicsmentioning

confidence: 99%

Increased diffusivity in acute multiple sclerosis lesions predicts risk of black hole

Naismith¹,

Xu²,

Tutlam³

et al. 2010

Neurology

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Objective: Diffusion tensor imaging (DTI) quantifies Brownian motion of water within tissue. Inflammation leads to tissue injury, resulting in increased diffusivity and decreased directionality. We hypothesize that DTI can quantify the damage within acute multiple sclerosis (MS) white matter lesions to predict gadolinium (Gd)-enhancing lesions that will persist 12 months later as T1 hypointensities.Methods: A cohort of 22 individuals underwent 7 brain MRI scans over 15 months. DTI parameters were temporally quantified within regions of Gd enhancement. Comparison to the homologous region in the hemisphere contralateral to the Gd-enhancing lesion was also performed to standardize individual lesion DTI parameters. Results:After classifying each Gd-enhancing region as to black hole outcome, radial diffusivity, mean diffusivity, and fractional anisotropy, along with their standardized values, were significantly altered for persistent black holes (PBHs), and remained elevated throughout the study. A Gd-enhancing region with a 40% elevation in radial diffusivity had a 5.4-fold (95% confidence interval [CI]: 2.1, 13.8) increased risk of becoming a PBH, with 70% (95% CI: 51%, 85%) sensitivity and 69% (95% CI: 57%, 80%) specificity. A model of radial diffusivity, with volume and length of Gd enhancement, was associated with a risk of becoming a PBH of 5.0 (95% CI: 2.6, 9.9). Altered DTI parameters displayed a dose relationship to duration of black hole persistence. Conclusions:Elevated radial diffusivity during gadolinium enhancement was associated with increased risk for development of a persistent black hole, a surrogate of severe demyelination and axonal injury. An elevated radial diffusivity within active multiple sclerosis lesions may be indicative of more severe tissue injury. Neurology ® 2010;74:1694 -1701 GLOSSARY ABH ϭ acute black hole; CBH ϭ chronic black hole; DTI ϭ diffusion tensor imaging; FLAIR ϭ fluid-attenuated inversion recovery; Gd ϭ gadolinium; MS ϭ multiple sclerosis; NAWM ϭ normal-appearing white matter; PBH ϭ persistent black hole; RD ϭ radial diffusivity; ROI ϭ region of interest; T1H ϭ chronic T1 hypointensity; TBH ϭ transient black hole.

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“…This suggests that T1 in chronic lesions may be a marker of axonal integrity. Furthermore, assessments of T1-weighted chronic lesions have been shown to correlate with disease progression (178,179).…”

Section: Qmri In Msmentioning

confidence: 99%

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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Correlating MRI and clinical disease activity in multiple sclerosis

Cited by 261 publications

References 33 publications

The role of edema and demyelination in chronic T₁ black holes: A quantitative magnetization transfer study

The role of edema and demyelination in chronic T₁ black holes: A quantitative magnetization transfer study

Increased diffusivity in acute multiple sclerosis lesions predicts risk of black hole

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

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Correlating MRI and clinical disease activity in multiple sclerosis

Cited by 261 publications

References 33 publications

The role of edema and demyelination in chronic T1 black holes: A quantitative magnetization transfer study

The role of edema and demyelination in chronic T1 black holes: A quantitative magnetization transfer study

Increased diffusivity in acute multiple sclerosis lesions predicts risk of black hole

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

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The role of edema and demyelination in chronic T₁ black holes: A quantitative magnetization transfer study

The role of edema and demyelination in chronic T₁ black holes: A quantitative magnetization transfer study