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

Chawla, Sanjeev; Kister, Ilya; Wuerfel, Jens; Brisset, Jean-Christophe; Liu, S.; Sinnecker, Tim; Dušek, Petr; Haacke, E. Mark; Paul, Friedemann; Ge, Yulin

doi:10.3174/ajnr.a4729

Cited by 68 publications

(77 citation statements)

References 35 publications

(48 reference statements)

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“…25 Unfortunately, we did not have SWI imaging available on all cases. Prior studies have shown that 10–15% of MS lesions have iron accumulation at the edge, 23,26 which is lower than the frequency of our rim detection. Additional studies are needed to determine whether detected rims are the consequence of opposed magnetization effects, due to iron deposition or explained by other mechanisms.…”

Section: Discussioncontrasting

confidence: 76%

Dark Rims: Novel Sequence Enhances Diagnostic Specificity in Multiple Sclerosis

Tillema¹,

Weigand²,

Dayan³

et al. 2018

AJNR Am J Neuroradiol

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Background and Purpose To determine whether a novel double inversion recovery MRI technique has the potential to increase the specificity of diagnostic criteria distinguishing MS from non-MS white matter lesions. Materials and Methods This is a cross-sectional observational study. MRI data were acquired between 2011 and 2016. A novel double-inversion-recovery sequence that suppresses CSF and GM signal was used (GM-DIR). We compared WM lesions in a group of patients with multiple sclerosis and in a second group of positive controls (PC) with white matter lesions that did not have a diagnosis of MS. The presence of a rim on GM-DIR MRI sequence was combined with the 2001 and 2010 McDonald DIS criteria. Multiple MRI markers including lesion location, size and presence of rim were compared between groups as well as quantitative measure of lesion T1-hypointensity. Results MRI scans from 107 patients with RRMS (median age 32) and 36 positive control (PC, median age 39) subjects were analyzed. No significant differences were present in age and sex. In MS, 1120/3211 lesions (35%) had a rim on GM-DIR; the PC group had only 9/893 rim lesions (1%). Rims were associated with a decrease in lesion T1-ratio. Using the 2010 MRI criteria plus the presence of rims on GM-DIR, we achieved 78% and 97% specificity in subjects with ≥ 1 and ≥ 2 rim-lesions respectively. Conclusion The addition of a novel GM-DIR technique enhanced specificity for diagnosing MS compared to established MRI criteria.

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Section: Discussioncontrasting

confidence: 76%

Dark Rims: Novel Sequence Enhances Diagnostic Specificity in Multiple Sclerosis

Tillema¹,

Weigand²,

Dayan³

et al. 2018

AJNR Am J Neuroradiol

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“…Still, a subset of lesions was shown to accumulate iron across the lesion area (around 8% of WM lesions ) or at the lesion border (slowly expanding lesions, see below). A way to more specifically identify these two distinct morphological patterns of iron accumulation (nodular or ring‐like iron accumulation) in MS lesions is the combination of gradient‐echo T2* imaging with QSM . Applying this combination, 16.5% of MS lesions were classified as showing iron accumulation , which well matches neuropathological data.…”

Section: Visualization Of Iron By Ultra‐high‐field (7t) Mrimentioning

confidence: 59%

Iron related changes in MS lesions and their validity to characterize MS lesion types and dynamics with Ultra‐high field magnetic resonance imaging

et al. 2018

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Iron accumulates with age in the normal human brain. This process is altered at several levels in the brain of multiple sclerosis (MS) patients. Since iron is mainly stored in oligodendrocytes and myelin in the normal brain, its liberation in demyelinating lesions may amplify tissue damage in demyelinating lesions and its uptake in macrophages and microglia may help to more precisely define activity stages of the lesions. In addition, glia cells change their iron import, export and storage properties in MS lesions, which is reflected by alterations in the expression of iron transport molecules. Changes of iron distribution in the brain can be reliably detected by MRI, particularly upon application of Ultra-high magnetic field (7 Tesla). Iron-sensitive MRI allows to more accurately distinguish the lesions in MS from those in other inflammatory brain diseases, to visualize a subset of slowly expanding lesions in the progressive stage of MS and to increase the sensitivity for lesion detection in the gray matter, such as the cerebral cortex or deep gray matter nuclei.

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“…A recent study of 21 MS patients and 21 NMO patients showed that all but one MS patient had iron‐containing lesions, while none of the NMO patients had iron‐containing lesions. This suggests that QSM may be used to differentiate MS from NMO .…”

Section: Qsm For Diagnosing Neurodegenerative Diseasesmentioning

confidence: 99%

The clinical utility of QSM: disease diagnosis, medical management, and surgical planning

Eskreis‐Winkler

Zhang

et al. 2016

NMR in Biomedicine

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Quantitative susceptibility mapping (QSM) is an MR technique that depicts and quantifies magnetic susceptibility sources. Mapping iron, the dominant susceptibility source in the brain, has many important clinical applications. Herein, we review QSM applications in the diagnosis, medical management, and surgical treatment of disease. To assist in early disease diagnosis, QSM can identify elevated iron levels in the motor cortex of amyotrophic lateral sclerosis patients, in the substantia nigra of Parkinson's disease (PD) patients, in the globus pallidus, putamen, and caudate of Huntington's disease patients, and in the basal ganglia of Wilson's disease patients. Additionally, QSM can distinguish between hemorrhage and calcification, which could prove useful in tumor subclassification, and can measure microbleeds in traumatic brain injury patients. In guiding medical management, QSM can be used to monitor iron chelation therapy in PD patients, to monitor smoldering inflammation of multiple sclerosis (MS) lesions after the blood-brain barrier (BBB) seals, to monitor active inflammation of MS lesions before the BBB seals without using gadolinium, and to monitor hematoma volume in intracerebral hemorrhage. QSM can also guide neurosurgical treatment. Neurosurgeons require accurate depiction of the subthalamic nucleus, a tiny deep gray matter nucleus, prior to inserting deep brain stimulation electrodes into the brains of PD patients. QSM is arguably the best imaging tool for depiction of the subthalamic nucleus. Finally, we discuss future directions, including bone QSM, cardiac QSM, and using QSM to map cerebral metabolic rate of oxygen. Copyright © 2016 John Wiley & Sons, Ltd.

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

Cited by 68 publications

References 35 publications

Dark Rims: Novel Sequence Enhances Diagnostic Specificity in Multiple Sclerosis

Dark Rims: Novel Sequence Enhances Diagnostic Specificity in Multiple Sclerosis

Iron related changes in MS lesions and their validity to characterize MS lesion types and dynamics with Ultra‐high field magnetic resonance imaging

The clinical utility of QSM: disease diagnosis, medical management, and surgical planning

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