Covarying patterns of white matter lesions and cortical atrophy predict progression in early MS

ObjectiveWe applied longitudinal 3T MRI and advanced computational models in 2 independent cohorts of patients with early MS to investigate how white matter (WM) lesion distribution and cortical atrophy topographically interrelate and affect functional disability.MethodsClinical disability was measured using the Expanded Disability Status Scale Score at baseline and at 1-year follow-up in a cohort of 119 patients with early relapsing-remitting MS and in a replication cohort of 81 patients. Covarying patterns of cortical atrophy and baseline lesion distribution were extracted by parallel independent component analysis. Predictive power of covarying patterns for disability progression was tested by receiver operating characteristic analysis at the group level and support vector machine for individual patient outcome.ResultsIn the study cohort, we identified 3 distinct distribution types of WM lesions (cerebellar, bihemispheric, and left lateralized) that were associated with characteristic cortical atrophy distributions. The cerebellar and left-lateralized patterns were reproducibly detected in the second cohort. Each of the patterns predicted to different extents, short-term disability progression, whereas the cerebellar pattern was associated with the highest risk of clinical worsening, predicting individual disability progression with an accuracy of 88% (study cohort) and 89% (replication cohort), respectively.ConclusionThese findings highlight the role of distinct spatial distribution of cortical atrophy and WM lesions predicting disability. The cerebellar involvement is shown as a key determinant of rapid clinical deterioration.

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Neurosyphilis: mighty imitator forays with benign presentation and unique neuroimaging findings

Sexual Health ◽

10.1071/sh17088 ◽

2018 ◽

Vol 15 (4) ◽

pp. 358 ◽

Cited By ~ 2

Author(s):

Harmanpreet Tiwana ◽

Aiesha Ahmed

Keyword(s):

White Matter ◽

Temporal Lobe ◽

Tertiary Care ◽

Laboratory Data ◽

Treponema Pallidum ◽

White Matter Lesions ◽

Vascular Pathology ◽

Cortical Atrophy ◽

Neck Stiffness ◽

Fluid Attenuated Inversion Recovery

Background Common causes of temporal lobe hyper intensities are central nervous system infections like herpes simplex encephalitis, Lyme disease, limbic encephalitis and vascular pathology like Cerebral Autosomal Dominant Arteriopathy with Subcortical infarcts and Leukoencephalopathy. Methods: Personal assessment, laboratory data analysis and neuroimaging for the patient who was admitted to a central Pennsylvania tertiary care referral centre were conducted. Results: A 52-year-old male presented with a 1-year history of diffuse dysesthesia in upper and lower extremities with associated intermittent headaches and neck stiffness. Evaluation with lumbar puncture revealed increased nucleated cells (50 ul) with lymphocytic predominance (96%) and an elevated protein level of 109 mg/dl. Magnetic resonance imaging (MRI) of the brain showed T2/FLAIR hyper intensity in bilateral subcortical temporal white matter, left-greater-than-right and associated volume loss in cerebral parenchyma. Additional abnormal work up included reactive serum reactive plasma regain and Treponema pallidum antibody particle agglutination. Diagnosis of neurosyphilis was made and the patient was treated with intramuscular (IM) penicillin for 3 weeks. At the time of discharge, his headache and neck stiffness resolved and dysesthesias were decreased in intensity. Conclusions: The diagnosis of neurosyphilis is intricate, and no reference standard exists. Neuroimaging findings of neurosyphilis commonly are cerebral infarctions, leptomeningeal enhancement or non-specific white matter lesions. Less common features on fluid-attenuated inversion recovery (FLAIR) sequences are cortical atrophy and mesial temporal parenchymal signal changes. It is prudent to keep neurosyphilis in differential of mesial temporal lobe white matter changes, as early diagnosis and treatment results in better prognosis.

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Age Dependent White Matter Lesions and Brain Volume Changes in Healthy Volunteers

Acta Radiologica ◽

10.1177/028418519403500203 ◽

1994 ◽

Vol 35 (2) ◽

pp. 117-122 ◽

Cited By ~ 29

Author(s):

P. Christiansen ◽

H. B. W. Larsson ◽

C. Thomsen ◽

S. B. Wieslander ◽

O. Henriksen

Keyword(s):

White Matter ◽

Healthy Volunteers ◽

White Matter Lesions ◽

Linear Increase ◽

Cerebral Hemispheres ◽

Cortical Atrophy ◽

White Matter Hyperintensity ◽

Lateral Ventricles ◽

Males And Females ◽

Hyperintensity Lesions

The brain of 142 healthy volunteers aged 21 to 80 years were investigated using MR imaging. The number and size of the white matter hyperintensity lesions (WMHL) in the cerebral hemispheres were determined. Furthermore, the volume of the cerebral hemispheres and of the lateral ventricles was measured. An almost linear increase in the number of volunteers with WMHL was seen with aging for males and females. With aging a significant decrease in the volume of the cerebral hemispheres was found for males, and a significant increase in the volume of the lateral ventricles was seen for both males and females. Our results suggest that with aging central atrophy increases more (relatively) than cortical atrophy. No correlation was found between the decreasing volume of the cerebral hemispheres and the increasing number and size of WMHL, nor between the increasing volume of the lateral ventricles and the increasing number and size of WMHL.

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O1-02-02 White matter lesions are associated with cortical atrophy more than entorhinal and hippocampal atrophy

Neurobiology of Aging ◽

10.1016/s0197-4580(04)80037-x ◽

2004 ◽

Vol 25 ◽

pp. S11

Author(s):

Antao Du ◽

Norbert Schuff ◽

Linda L. Chao ◽

John Kornak ◽

Frank Ezekiel ◽

...

Keyword(s):

White Matter ◽

White Matter Lesions ◽

Cortical Atrophy ◽

Hippocampal Atrophy

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Risk Factors for Hydrocephalus in Neonatal Purulent Meningitis: A Single-Center Retrospective Analysis

Journal of Child Neurology ◽

10.1177/0883073820978032 ◽

2021 ◽

pp. 088307382097803

Author(s):

Bin Chen ◽

Qian Zhai ◽

Kokwin Ooi ◽

Yun Cao ◽

Zhongwei Qiao

Keyword(s):

Risk Factors ◽

Cerebrospinal Fluid ◽

White Matter ◽

Financial Burden ◽

Periventricular Leukomalacia ◽

White Matter Lesions ◽

Study Cohort ◽

Female Sex ◽

Purulent Meningitis ◽

Discharge Outcomes

Objective: Hydrocephalus is a potentially lethal complication of neonatal purulent meningitis. Early detection of hydrocephalus helps to determine optimal treatment, improve prognosis, and reduce financial burden. We aimed to analyze the risk factors for hydrocephalus in neonates with purulent meningitis and discuss the characteristics of the disease. Methods: The records of neonatal purulent meningitis admitted to the Children Hospital of Fudan University from January 2013 to September 2019 were retrospectively included in the study cohort. The data of clinical, laboratory, and cranial magnetic resonance images (MRIs) were collected and analyzed (except discharge data) by univariate analysis, and P values <.05 were further analyzed by multivariate logistic regression. Results: A total of 197 children who met the inclusion criteria were enrolled in the study cohort. Overall, 39.6% (78/197) of the patients had positive pathogen cultures, and 60.4% (119/197) of patients had clinical diagnosis of meningitis with negative pathogen cultures. Among 197 children, 67 of them experienced hydrocephalus, and the factors that were significantly associated with hydrocephalus in multivariate analysis were female sex, cerebrospinal fluid glucose <2 mmol/L, periventricular leukomalacia, punctate white matter lesions, and pyogenic intraventricular empyema. Children with hydrocephalus had a lower cure rate of meningitis (31.3% vs 75.4%), and poor discharge outcomes. In addition, they had longer length of hospital stay and higher hospital cost. Conclusions: Female sex, cerebrospinal fluid glucose <2 mmol/L, periventricular leukomalacia, punctate white matter lesions, and pyogenic intraventricular empyema were identified as risk factors for hydrocephalus in neonatal purulent meningitis. Children with hydrocephalus had poor discharge outcomes and increased financial burden on their families.

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Cortical Atrophy, White Matter Lesions, and Bulb Configuration in Patients with Idiopathic Olfactory Loss and Other Causes of Olfactory Loss

ORL ◽

10.1159/000520567 ◽

2021 ◽

pp. 1-9

Author(s):

Alexander Wieck Fjaeldstad ◽

Therese Ovesen ◽

Rikke Beese Dalby

Keyword(s):

White Matter ◽

Medial Temporal Lobe ◽

Structural Changes ◽

Structural Integrity ◽

White Matter Lesions ◽

Structural Mri ◽

Cortical Atrophy ◽

Mri Findings ◽

Olfactory Loss ◽

Post Traumatic

Introduction: While magnetic resonance imaging (MRI) is not included in the current guidelines for diagnosing olfactory disorders in the most recent position paper on olfactory dysfunction, both 1.5T and 3T MRI are commonly used in the diagnostic workup of many patients with olfactory loss. Often, MRI is used to rule out intracranial tumours, but other useful information may be obtained from MRI scans in these patients. The potential of MRI in olfactory loss depends on sufficient knowledge of structural changes in different aetiologies of olfactory loss. We present common clinical MRI findings in olfactory loss and evaluate the usefulness of structural integrity scores in differentiating between aetiologies. Methods: In this study, we investigated if white matter hyperintensities (WMHs, measured by Fazekas score), global cortical atrophy (GCA), and medial temporal lobe atrophy (MTA) are more common in patients with idiopathic olfactory loss than in patients with acquired olfactory loss due to other aetiologies. Furthermore, we compared olfactory bulb (OB) configurations in different olfactory loss aetiologies. Results: In 88 patients with olfactory loss, WMHs, GCA, and MTA were not more significant findings on MRI in idiopathic olfactory loss (n = 51) compared with other causes of acquired olfactory loss (Fazekas score p = 0.2977; GCA score p = 0.6748; MTA score p = 0.7851). Bulb configurations differed in patients suffering from post-traumatic olfactory loss and may aid in identifying the underlying aetiology in patients where trauma is among the suspected causes of olfactory loss. Conclusion: We recommend that structural MRI with an OB sequence is included in the diagnostic evaluation of olfactory loss with suspected congenital and post-traumatic aetiology and should be considered in idiopathic olfactory loss with suspected central aetiology (e.g., tumour).

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White matter lesions

Neurology ◽

10.1212/wnl.0000000000006116 ◽

2018 ◽

Vol 91 (10) ◽

pp. e964-e975 ◽

Cited By ~ 26

Author(s):

Mohamad Habes ◽

Aristeidis Sotiras ◽

Guray Erus ◽

Jon B. Toledo ◽

Deborah Janowitz ◽

...

Keyword(s):

White Matter ◽

Regional Distribution ◽

Temporal Trends ◽

White Matter Lesions ◽

Distribution Patterns ◽

The Elderly ◽

Cross Sectional Study ◽

Cortical Atrophy ◽

Polygenic Risk Score ◽

Cross Sectional

ObjectivesTo investigate spatial heterogeneity of white matter lesions or hyperintensities (WMH).MethodsMRI scans of 1,836 participants (median age 52.2 ± 13.16 years) encompassing a wide age range (22–84 years) from the cross-sectional Study of Health in Pomerania (Germany) were included as discovery set identifying spatially distinct components of WMH using a structural covariance approach. Scans of 307 participants (median age 73.8 ± 10.2 years, with 747 observations) from the Baltimore Longitudinal Study of Aging (United States) were included to examine differences in longitudinal progression of these components. The associations of these components with vascular risk factors, cortical atrophy, Alzheimer disease (AD) genetics, and cognition were then investigated using linear regression.ResultsWMH were found to occur nonuniformly, with higher frequency within spatially heterogeneous patterns encoded by 4 components, which were consistent with common categorizations of deep and periventricular WMH, while further dividing the latter into posterior, frontal, and dorsal components. Temporal trends of the components differed both cross-sectionally and longitudinally. Frontal periventricular WMH were most distinctive as they appeared in the fifth decade of life, whereas the other components appeared later in life during the sixth decade. Furthermore, frontal WMH were associated with systolic blood pressure and with pronounced atrophy including AD-related regions. AD polygenic risk score was associated with the dorsal periventricular component in the elderly. Cognitive decline was associated with the dorsal component.ConclusionsThese results support the hypothesis that the appearance of WMH follows age and disease-dependent regional distribution patterns, potentially influenced by differential underlying pathophysiologic mechanisms, and possibly with a differential link to vascular and neurodegenerative changes.

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Computer-Assisted Segmentation of White Matter Lesions in 3D MR Images Using Support Vector Machine

Academic Radiology ◽

10.1016/j.acra.2007.10.012 ◽

2008 ◽

Vol 15 (3) ◽

pp. 300-313 ◽

Cited By ~ 155

Author(s):

Zhiqiang Lao ◽

Dinggang Shen ◽

Dengfeng Liu ◽

Abbas F. Jawad ◽

Elias R. Melhem ◽

...

Keyword(s):

Support Vector Machine ◽

White Matter ◽

White Matter Lesions ◽

Support Vector ◽

Computer Assisted ◽

Mr Images

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White matter lesions are associated with cortical atrophy more than entorhinal and hippocampal atrophy

Neurobiology of Aging ◽

10.1016/j.neurobiolaging.2004.05.002 ◽

2005 ◽

Vol 26 (4) ◽

pp. 553-559 ◽

Cited By ~ 69

Author(s):

An-Tao Du ◽

Norbert Schuff ◽

Linda L. Chao ◽

John Kornak ◽

Frank Ezekiel ◽

...

Keyword(s):

White Matter ◽

White Matter Lesions ◽

Cortical Atrophy ◽

Hippocampal Atrophy

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Multimodal Ensemble-Based Segmentation of White Matter Lesions and Analysis of Their Differential Characteristics across Major Brain Regions

Applied Sciences ◽

10.3390/app10061903 ◽

2020 ◽

Vol 10 (6) ◽

pp. 1903

Author(s):

Saima Rathore ◽

Tamim Niazi ◽

Muhammad Aksam Iftikhar ◽

Ashish Singh ◽

Batool Rathore ◽

...

Keyword(s):

White Matter ◽

White Matter Lesions ◽

Classification Problem ◽

Brain Regions ◽

Majority Voting ◽

Support Vector ◽

Abnormal Signal ◽

Processing Step ◽

Effective Performance

White matter lesions (WML) are common in a variety of brain pathologies, including ischemia affecting blood vessels deeper inside the brain’s white matter, and show an abnormal signal in T1-weighted and FLAIR images. The emergence of personalized medicine requires quantification and analysis of differential characteristics of WML across different brain regions. Manual segmentation and analysis of WMLs is laborious and time-consuming; therefore, automated methods providing robust, reproducible, and fast WML segmentation and analysis are highly desirable. In this study, we tackled the segmentation problem as a voxel-based classification problem. We developed an ensemble of different classification models, including six models of support vector machine, trained on handcrafted and transfer learning features, and five models of Residual neural network, trained on varying window sizes. The output of these models was combined through majority-voting. A series of image processing operations was applied to remove false positives in a post-processing step. Moreover, images were mapped to a standard atlas template to quantify the spatial distribution of WMLs, and a radiomic analysis of all the lesions across different brain regions was carried out. The performance of the method on multi-institutional WML Segmentation Challenge dataset (n = 150) comprising T1-weighted and FLAIR images was >90% within data of each institution, multi-institutional data pooled together, and across-institution training–testing. Forty-five percent of lesions were found in the temporal lobe of the brain, and these lesions were easier to segment (95.67%) compared to lesions in other brain regions. Lesions in different brain regions were characterized by their differential characteristics of signal strength, size/shape, heterogeneity, and texture (p < 0.001). The proposed multimodal ensemble-based segmentation of WML showed effective performance across all scanners. Further, the radiomic characteristics of WMLs of different brain regions provide an in vivo portrait of phenotypic heterogeneity in WMLs, which points to the need for precision diagnostics and personalized treatment.

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