Heterogeneity of acute multiple sclerosis lesions on sodium (23Na) MRI

2015 ◽  
Vol 22 (8) ◽  
pp. 1040-1047 ◽  
Author(s):  
Philipp Eisele ◽  
Simon Konstandin ◽  
Martin Griebe ◽  
Kristina Szabo ◽  
Marc E Wolf ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Sodium Concentration ◽  
Sodium Mri ◽  
Highly Sensitive ◽  
Apparent Diffusion ◽  
Magnetic Resonance Imaging Mri ◽  
Tissue Abnormalities ◽  
23Na Mri ◽  
Sensitive Marker ◽  
Total Sodium

Background: Advanced magnetic resonance imaging (MRI) techniques provide a window into pathological processes in multiple sclerosis (MS). Nevertheless, to date only few studies have performed sodium MRI in MS. Objectives: We analysed total sodium concentration (TSC) in hyperacute, acute and chronic lesions in MS with 23Na MRI. Methods: 23Na MRI and 1H MRI were performed in 65 MS patients and 10 healthy controls (HC). Mean TSC was quantified in all MS lesions with a diameter of >5 mm and in the normal appearing white and grey matter (NAWM, NAGM). Results: TSC in the NAWM and the NAGM of MS patients was significantly higher compared to HC (WM: 37.51 ± 2.65 mM versus 35.17 ± 3.40 mM; GM: 43.64 ± 2.75 mM versus 40.09 ± 4.64 mM). Acute and chronic MS lesions showed elevated TSC levels of different extent (contrast-enhancing lesions (49.07 ± 6.99 mM), T1 hypointense lesions (45.06 ± 6.26 mM) and remaining T1 isointense lesions (39.88 ± 5.54 mM)). However, non-enhancing hyperacute lesions with a reduced apparent diffusion coefficient showed a TSC comparable to the NAWM (37.22 ± 4.62 mM). Conclusions: TSC is not only a sensitive marker of the severity of chronic tissue abnormalities in MS but is also highly sensitive to opening of the blood–brain barrier and vasogenic tissue oedema in contrast-enhancing lesions.

scholarly journals The Second Canadian Conference on Multiple Sclerosis

1990 ◽  
Vol 17 (1) ◽  
pp. 53-60 ◽  
Author(s):  
Brian G. Weinshenker ◽  
Robert Nelson
Keyword(s):  
Multiple Sclerosis ◽  
Alternative Hypothesis ◽  
Preliminary Evidence ◽  
Strongly Correlated ◽  
Therapeutic Trials ◽  
Highly Sensitive ◽  
Environmental Trigger ◽  
Environmental Disease ◽  
Magnetic Resonance Imaging Mri ◽  
Multigenic Disease

ABSTRACT:The epidemiology of multiple sclerosis (MS) and the planning and interpretation of clinical therapeutic trials were the subjects of a symposium on MS held on June 13, 1989. Several speakers addressed whether MS is a genetic or an environmental disease. An environmental trigger would resolve the relatively low penetrance of the disease in susceptible individuals, although the alternative hypothesis that MS is a multigenic disease would also account for this observation. Clinical trials have to date failed to confirm the efficacy of any immunosuppressive or other agent in the management of progressive MS. Magnetic resonance imaging (MRI) appears to be highly sensitive for monitoring the activity of MS. Preliminary evidence suggests that MRI activity correlates with longitudinal clinical assessments of disability. Immunologic tests, while valuable in determining pathophysiology of MS, have not been strongly correlated with clinical outcome.

Quantitative magnetization transfer imaging of pre-lesional white-matter changes in multiple sclerosis

2002 ◽  
Vol 8 (6) ◽  
pp. 479-484 ◽  
Author(s):  
F Fazekas ◽  
S Ropele ◽  
C Enzinger ◽  
T Seifert ◽  
S Strasser-Fuchs
Keyword(s):  
Multiple Sclerosis ◽  
Exchange Rate ◽  
White Matter ◽  
Time Course ◽  
Magnetization Transfer ◽  
Free Water ◽  
Active Lesion ◽  
Normal Appearing White Matter ◽  
Magnetic Resonance Imaging Mri ◽  
Tissue Abnormalities

Objective: Previous magnetization transfer (MT) studies in multiple sclerosis (MS) suggest a reduction of the MT ratio (MTR) precedes new lesion development. To gain further insight into pre-lesional tissue abnormalities, we investigated the time course of additional quantitative MT parameters. Methods: Serial magnetic resonance imaging (MRI), including a gadolinium-enhanced T1 scan and MT imaging by means of a FastPACE sequence, was performed on 12 patients (4 males, 8 females) with relapsing-remitting MS. Quantitative MT values including the magnetization exchange rate (kfor) and the native relaxation time (T1free) were analysed in the six months prior to the appearance of 44 enhancing lesions and in 88 control regions of persistently normal-appearing white matter (NAWM). Results: Appearance of new active lesions was preceded by a significant decrease of the MTR (F7,166=91.5; p <0.0001) and of kfor (F7,166=105.2; p <0.0001), and by an increase of T1free (F7,166=57.3; p <0.0001). The drop of kfor was the most pronounced pre-lesional change and together with the MTR was statistically significant already four months before the appearance of new lesion. The observed increase of T1free was relatively small. MT variables of reactivated lesions were always different from NAWM but showed no characteristic time course. Conclusions: Multiparametric MT measurements suggest both a reduction of macromolecular material and a focal increase of free water to occur several months before the appearance of an active lesion. Reduction of the magnetization exchange rate, which may result from primary damage to myelin, appears to be the leading event.

scholarly journals Sodium Intensity Changes Differ Between Relaxation- and Density-Weighted MRI in Multiple Sclerosis

2021 ◽  
Vol 12 ◽  
Author(s):  
Robert Stobbe ◽  
Annie Boyd ◽  
Penelope Smyth ◽  
Derek Emery ◽  
Diana Valdés Cabrera ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Auditory Processing ◽  
Internal Capsule ◽  
Sodium Concentration ◽  
Sodium Mri ◽  
Posterior Limb ◽  
Water Fraction ◽  
Normal Appearing White Matter ◽  
Intensity Changes ◽  
Mri Sequences

Introduction: The source of Tissue Sodium Concentration (TSC) increase in Multiple Sclerosis (MS) remains unclear, and could be attributed to altered intracellular sodium concentration or tissue microstructure. This paper investigates sodium in MS using three new MRI sequences.Methods: Three sodium scans were acquired at 4.7 T from 30 patients (11 relapsing-remitting, 10 secondary-progressive, 9 primary-progressive) and 9 healthy controls including: Density-Weighted (NaDW), with very short 30° excitation for more accurate TSC measurement; Projection Acquisition with Coherent MAgNetization (NaPACMAN), designed for enhanced relaxation-based contrast; and Soft Inversion Recovery FLuid Attenuation (NaSIRFLA), developed to reduce fluid space contribution. Signal was measured in both lesions (n = 397) and normal appearing white matter (NAWM) relative to controls in the splenium of corpus callosum and the anterior and posterior limbs of internal capsule. Correlations with clinical and cognitive evaluations were tested over all MS patients.Results: Sodium intensity in MS lesions was elevated over control WM by a greater amount for NaPACMAN (75%) than NaDW (35%), the latter representing TSC. In contrast, NaSIRFLA exhibited lower intensity, but only for region specific analysis in the SCC (−7%). Sodium intensity in average MS NAWM was not significantly different than control WM for either of the three scans. NaSIRFLA in the average NAWM and specifically the posterior limb of internal capsules positively correlated with the Paced Auditory Serial Addition Test (PASAT).Discussion: Lower NaSIRFLA signal in lesions and ~2× greater NaPACMAN signal elevation over control WM than NaDW can be explained with a demyelination model that also includes edema. A NAWM demyelination model that includes tissue atrophy suggests no signal change for NaSIRFLA, and only slightly greater NAWM signal than control WM for both NaDW and NaPACMAN, reflecting experimental results. Models were derived from previous total and myelin water fraction study in MS with T2-relaxometry, and for the first time include sodium within the myelin water space. Reduced auditory processing association with lower signal on NaSIRFLA cannot be explained by greater demyelination and its modeled impact on the three sodium MRI sequences. Alternative explanations include intra- or extracellular sodium concentration change. Relaxation-weighted sodium MRI in combination with sodium-density MRI may help elucidate microstructural and metabolic changes in MS.

Cerebrospinal fluid pleocytosis in multiple sclerosis patients with lesions showing reduced diffusion

2013 ◽  
Vol 20 (10) ◽  
pp. 1391-1395 ◽  
Author(s):  
Philipp Eisele ◽  
Kristina Szabo ◽  
Martin Griebe ◽  
Marc E Wolf ◽  
Michael G Hennerici ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Cerebrospinal Fluid ◽  
Symptom Onset ◽  
Underlying Mechanism ◽  
Adc Value ◽  
Transient Phenomena ◽  
Apparent Diffusion ◽  
Csf Pleocytosis ◽  
Magnetic Resonance Imaging Mri ◽  
Multiple Sclerosis Patients

In multiple sclerosis (MS) occasionally acute lesions show a reduced apparent diffusion coefficient (ADC) on magnetic resonance imaging (MRI); however, the underlying mechanism of this phenomenon is not known. We compared cerebrospinal fluid (CSF) findings with diffusion MRI signal characteristics of acute lesions in 25 patients with MS or a clinically isolated syndrome (CIS) later confirmed as MS. In nine of 25 patients investigated between days 1 and 4 after symptom onset, a reduced intralesional ADC value (–15% to −51%) was accompanied by a marked CSF pleocytosis (11–46 leukocytes/µl). Our results suggest that ADC reduction in acute MS lesions is a phenomenon that is possibly related to an aggressive inflammatory milieu as indirectly indicated by CSF pleocytosis. Furthermore, the ADC reduction and CSF pleocytosis were observed only early after symptom onset, which suggests that both are typically early and transient phenomena.

scholarly journals An algorithm using clinical data to predict the optimal individual glucocorticoid dosage to treat multiple sclerosis relapses

2021 ◽  
Vol 14 ◽  
pp. 175628642110200
Author(s):  
Judit Gili-Kovács ◽  
Robert Hoepner ◽  
Anke Salmen ◽  
Maud Bagnoud ◽  
Ralf Gold ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Optic Neuritis ◽  
Immune Therapy ◽  
Serum Vitamin ◽  
Multivariate Regression Analysis ◽  
Pulse Therapy ◽  
Clinical Routine ◽  
Hydroxyvitamin D ◽  
Serum Vitamin D ◽  
Magnetic Resonance Imaging Mri

Background: Glucocorticoid (GC) pulse therapy is used for multiple sclerosis (MS) relapse treatment; however, GC resistance is a common problem. Considering that GC dosing is individual with several response-influencing factors, establishing a predictive model, which supports clinicians to estimate the maximum GC dose above which no additional therapeutic value can be expected presents a huge clinical need. Method: We established two, independent retrospective cohorts of MS patients. The first was an explorative cohort for model generation, while the second was established for its validation. Using the explorative cohort, a multivariate regression analysis with the GC dose used as the dependent variable and serum vitamin D (25D) concentration, sex, age, EDSS, contrast enhancement on cranial magnetic resonance imaging (MRI), immune therapy, and the involvement of the optic nerve as independent variables was established. Results: In the explorative cohort, 113 MS patients were included. 25-hydroxyvitamin D (25D) serum concentration and the presence of optic neuritis were independent predictors of the GC dose needed to treat MS relapses [(25D): −25.95 (95% confidence interval (CI)): −47.40 to −4.49; p = 0.018; optic neuritis: 2040.51 (95% CI: 584.64–3496.36), p = 0.006]. Validation of the multivariate linear regression model was performed within a second cohort. Here, the predicted GC dose did not differ significantly from the dose administered in clinical routine (mean difference: −843.54; 95% CI: −2078.08–391.00; n = 30, p = 0.173). Conclusion: Our model could predict the GC dose given in clinical, routine MS relapse care, above which clinicians estimate no further benefit. Further studies should validate and improve our algorithm to help the implementation of predictive models in GC dosing.

Mild gray matter atrophy in patients with long-standing multiple sclerosis and favorable clinical course

2021 ◽  
pp. 135245852110196
Author(s):  
Rosa Cortese ◽  
Marco Battaglini ◽  
Francesca Parodi ◽  
Maria Laura Stromillo ◽  
Emilio Portaccio ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Multiple Sclerosis ◽  
Gray Matter ◽  
Clinical Course ◽  
Resonance Imaging ◽  
Volume Changes ◽  
Magnetic Resonance Imaging Mri ◽  
Global Brain ◽  
Diffuse Brain

The mechanisms responsible for the favorable clinical course in multiple sclerosis (MS) remain unclear. In this longitudinal study, we assessed whether magnetic resonance imaging (MRI)-based changes in focal and diffuse brain damage are associated with a long-term favorable MS diseases course. We found that global brain and gray matter (GM) atrophy changes were milder in MS patients with long-standing disease (⩾30 years from onset) and favorable (no/minimal disability) clinical course than in sex-age-matched disable MS patients, independently of lesions accumulation. Data showed that different trajectories of volume changes, as reflected by mild GM atrophy, may characterize patients with long-term favorable evolution.

scholarly journals Cervical cord myelin abnormality is associated with clinical disability in multiple sclerosis

2021 ◽  
pp. 135245852110017
Author(s):  
Lisa Eunyoung Lee ◽  
Irene M Vavasour ◽  
Adam Dvorak ◽  
Hanwen Liu ◽  
Shawna Abel ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Progressive Multiple Sclerosis ◽  
Dorsal Column ◽  
Cervical Cord ◽  
In Vivo Measurement ◽  
Subclinical Disease ◽  
Healthy Control ◽  
Magnetic Resonance Imaging Mri ◽  
Relapsing Remitting Multiple Sclerosis

Background: Myelin water imaging (MWI) was recently optimized to provide quantitative in vivo measurement of spinal cord myelin, which is critically involved in multiple sclerosis (MS) disability. Objective: To assess cervical cord myelin measurements in relapsing-remitting multiple sclerosis (RRMS) and progressive multiple sclerosis (ProgMS) participants and evaluate the correlation between myelin measures and clinical disability. Methods: We used MWI data from 35 RRMS, 30 ProgMS, and 28 healthy control (HC) participants collected at cord level C2/C3 on a 3 T magnetic resonance imaging (MRI) scanner. Myelin heterogeneity index (MHI), a measurement of myelin variability, was calculated for whole cervical cord, global white matter, dorsal column, lateral and ventral funiculi. Correlations were assessed between MHI and Expanded Disability Status Scale (EDSS), 9-Hole Peg Test (9HPT), timed 25-foot walk, and disease duration. Results: In various regions of the cervical cord, ProgMS MHI was higher compared to HC (between 9.5% and 31%, p ⩽ 0.04) and RRMS (between 13% and 26%, p ⩽ 0.02), and ProgMS MHI was associated with EDSS ( r = 0.42–0.52) and 9HPT ( r = 0.45–0.52). Conclusion: Myelin abnormalities within clinically eloquent areas are related to clinical disability. MWI metrics have a potential role for monitoring subclinical disease progression and adjudicating treatment efficacy for new therapies targeting ProgMS.

Characterization of multiple sclerosis neuroinflammation and neurodegeneration with relaxation and diffusion basis spectrum imaging

2021 ◽  
pp. 135245852110233
Author(s):  
Irene M Vavasour ◽  
Peng Sun ◽  
Carina Graf ◽  
Jackie T Yik ◽  
Shannon H Kolind ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Specific Information ◽  
Axonal Loss ◽  
Normal Appearing White Matter ◽  
Relapsing Remitting ◽  
Tissue Changes ◽  
Spectrum Imaging ◽  
Magnetic Resonance Imaging Mri ◽  
And Diffusion

Background: Advanced magnetic resonance imaging (MRI) methods can provide more specific information about various microstructural tissue changes in multiple sclerosis (MS) brain. Quantitative measurement of T1 and T2 relaxation, and diffusion basis spectrum imaging (DBSI) yield metrics related to the pathology of neuroinflammation and neurodegeneration that occurs across the spectrum of MS. Objective: To use relaxation and DBSI MRI metrics to describe measures of neuroinflammation, myelin and axons in different MS subtypes. Methods: 103 participants (20 clinically isolated syndrome (CIS), 33 relapsing-remitting MS (RRMS), 30 secondary progressive MS and 20 primary progressive MS) underwent quantitative T1, T2, DBSI and conventional 3T MRI. Whole brain, normal-appearing white matter, lesion and corpus callosum MRI metrics were compared across MS subtypes. Results: A gradation of MRI metric values was seen from CIS to RRMS to progressive MS. RRMS demonstrated large oedema-related differences, while progressive MS had the most extensive abnormalities in myelin and axonal measures. Conclusion: Relaxation and DBSI-derived MRI measures show differences between MS subtypes related to the severity and composition of underlying tissue damage. RRMS showed oedema, demyelination and axonal loss compared with CIS. Progressive MS had even more evidence of increased oedema, demyelination and axonal loss compared with CIS and RRMS.

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