scholarly journals P.071 Multi-parametric MRI at 7 T enables differentiation of MS and age-related white matter lesions

2017 ◽  
Vol 44 (S2) ◽  
pp. S31-S31
Author(s):  
A Wing Marques dos Santos ◽  
Z Hosseini ◽  
M Drangova ◽  
D Rudko ◽  
J Matusinec ◽  
...  
Keyword(s):  
White Matter ◽  
Disease Duration ◽  
White Matter Lesions ◽  
Lesion Load ◽  
Age Related ◽  
Signal Change ◽  
Mri Scans ◽  
Average Size ◽  
Multiple Sclerosis Diagnosis

Background: MRI criteria are used to support multiple sclerosis diagnosis and evolution. However, normal age-related lesions (ARLs) can be cofounded with MS white matter lesion (MSL). Methods: Two Multiparametric 7T MRI scans 4 motnhs apart from 5 relapsing MS (RMS) patients were analyzed and compared to 5 matched healthy controls (HC) aiming to differentiate MSLs from ARLs. Six-echo GRE, FLAIR and MPRAGE sequences were acquired. Results: Average size of ARLs was 51 mm3 and of MSLs was 69 mm3 (p=0.27). Both have the same general appearance on FLAIR and MPRAGE contrasts, but different contrast on the R2* and QS maps. Inter-visit variation on MPRAGE was significantly higher in MSLs. Inter-visit signal change in the other contrasts (QSM, R2* and FLAIR) was not significant. Conclusions: R2*, QS maps and inter-visit variation using MPRAGE allowed differentiating MSLs from ARLs in 5 RMS with mean long term disease duration. This could improve correct early diagnosis and accurate lesion load accumulation evolution.

scholarly journals White Matter Lesion Assessment in Patients with Cognitive Impairment and Healthy Controls: Reliability Comparisons between Visual Rating, a Manual, and an Automatic Volumetrical MRI Method—The Gothenburg MCI Study

2013 ◽  
Vol 2013 ◽  
pp. 1-10 ◽  
Author(s):  
Erik Olsson ◽  
Niklas Klasson ◽  
Josef Berge ◽  
Carl Eckerström ◽  
Åke Edman ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
White Matter ◽  
Rating Scale ◽  
Intensity Variation ◽  
White Matter Lesions ◽  
Volumetric Method ◽  
Visual Rating ◽  
Flair Sequence ◽  
Age Related ◽  
Mri Scans

Age-related white matter lesions (WML) are a risk factor for stroke, cognitive decline, and dementia. Different requirements are imposed on methods for the assessment of WML in clinical settings and for research purposes, but reliability analysis is of major importance. In this study, WML assessment with three different methods was evaluated. In the Gothenburg mild cognitive impairment study, MRI scans from 152 participants were used to assess WML with the Fazekas visual rating scale on T2 images, a manual volumetric method on FLAIR images, and FreeSurfer volumetry on T1 images. Reliability was acceptable for all three methods. For low WML volumes (2/3 of the patients), reliability was overall lower and nonsignificant for the manual volumetric method. Unreliability in the assessment of patients with low WML with manual volumetry may mainly be due to intensity variation in the FLAIR sequence used; hence, intensity standardization and normalization methods must be used for more accurate assessments. The FreeSurfer segmentations resulted in smaller WML volumes than the volumes acquired with the manual method and showed deviations from visible hypointensities in the T1 images, which quite likely reduces validity.

3D GRASE arterial spin labelling reveals an inverse correlation of cortical perfusion with the white matter lesion volume in MS

2012 ◽  
Vol 18 (11) ◽  
pp. 1570-1576 ◽  
Author(s):  
Michael Amann ◽  
Lutz Achtnichts ◽  
Jochen G Hirsch ◽  
Yvonne Naegelin ◽  
Johannes Gregori ◽  
...  
Keyword(s):  
White Matter ◽  
Disease Duration ◽  
Arterial Spin Labelling ◽  
Coefficient Of Determination ◽  
Lesion Volume ◽  
Single Shot ◽  
Lesion Load ◽  
Imaging Characteristics ◽  
Cortical Perfusion ◽  
Spin Labelling

Background: We hypothesized that in multiple sclerosis (MS) patients, reduced cortical perfusion is associated with chronic white matter injury. Objective: To investigate the influence of different clinical and magnetic resonance imaging characteristics on cortical perfusion. Methods: Cerebral blood flow (CBF) was assessed by applying a pulsed arterial spin labelling (ASL) technique combined with single-shot 3D-GRASE (gradient-spin echo) in a cohort of 165 MS patients with a relapsing–remitting ( n=123) or secondary progressive disease course ( n=42). Mean age was 45.4 years (20–68 years), mean disease duration was 14.2 years (1–48 years). Results: Mean cortical CBF was 45.6 ml/100g per min (SD: 7.8 ml/100g per min). Stepwise multiple linear regression models were calculated to investigate the relationship between different factor sets and mean CBF. The model with the highest adjusted coefficient of determination included T2 lesion load, age, gender and disease duration as significant factors. Post-hoc Spearman rank correlation revealed significant correlation of adjusted CBF with T2 lesion load (t=−0.35, p=1*10–6), with age (t =−0.34, p=4*10–6), and with disease duration (t=0.16, p=0.03), while Expanded Disability Status Scale (EDSS) did not reach significance in either model. Conclusion: This study suggests that the amount of white matter lesions indicates a reduced metabolic demand and reduced perfusion at a cortical level.

Abstract 46: Leukoaraiosis Evolves Through Discrete Acute Ischemic Injuries: Weekly Diffusion Tensor Imaging and T2 Relaxometry at 16 Time Points

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
John Conklin ◽  
Frank L Silver ◽  
David J Mikulis ◽  
Daniel M Mandell
Keyword(s):  
Diffusion Tensor Imaging ◽  
White Matter ◽  
Diffusion Tensor ◽  
White Matter Lesions ◽  
Striking Similarity ◽  
Aging Brain ◽  
Large Artery ◽  
Neurology Clinic ◽  
Mri Scans ◽  
The Individual

INTRODUCTION: Leukoaraiosis, the presence of “incidental” white matter lesions in the aging brain, is increasingly recognized as a predictor for dementia, ischemic stroke, intracerebral hemorrhage and vascular death. The pathogenesis of leukoaraiosis remains controversial, with abnormalities of small arterioles hypothesized to play an important role. To investigate this hypothesis, we sought to characterize the temporal evolution of the individual lesions making up leukoaraiosis. HYPOTHESIS: Discrete occlusive events at the level of small arterioles play a key role in the pathogenesis of leukoaraiosis. METHODS: Participants were prospectively recruited through an outpatient neurology clinic (inclusion criteria: age > 60 years, Fazekas grade 3 leukoaraiosis burden; exclusion criteria: cortical infarct, cardioembolic disease, dissection, carotid stenosis > 50%). Subjects underwent an identical MRI protocol in each of 16 consecutive weeks, including diffusion tensor imaging (DTI) and multi-echo T2-weighted imaging. Parametric maps of the apparent diffusion coefficient (ADC), fractional anisotropy (FA) and T2 relaxation time were constructed and coregistered (Analysis of Functional NeuroImages, NIH; 3D Slicer, www.slicer.org; Matlab, The MathWorks). Images were reviewed for new diffusion restricting lesions, and such lesions were manually segmented. Plots of lesion ADC, FA and T2 were generated and temporally aligned to the onset of acute diffusion restriction. RESULTS: Five subjects (mean age 69 ± 8 years) met criteria and completed all 16 MRI scans. There were no lacunar or large artery infarcts during the study period. A total of 9 new diffusion restricting white matter lesions were identified (mean volume 0.06 ± 0.03 cc). Evolution of these lesions showed striking similarity to that of cerebral infarction, with acute reduction in ADC, followed by gradual rise in ADC and T2, and corresponding decline in FA. At 8 weeks, new lesions were indistinguishable from pre-existing white matter disease. CONCLUSION: Leukoaraiosis evolves through temporally and spatially discrete acute ischemic injuries. This supports the hypothesized role of small vessel arteriolar pathology as a key pathogenetic mechanism.

Microstructural fronto-striatal and temporo-insular alterations are associated with fatigue in patients with multiple sclerosis independent of white matter lesion load and depression

2019 ◽  
Vol 26 (13) ◽  
pp. 1708-1718 ◽  
Author(s):  
Miklos Palotai ◽  
Michele Cavallari ◽  
Ismail Koubiyr ◽  
Alfredo Morales Pinzon ◽  
Aria Nazeri ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
White Matter ◽  
Physical Disability ◽  
Disease Duration ◽  
White Matter Lesion ◽  
Brain Magnetic Resonance Imaging ◽  
Brain Regions ◽  
Specific Substrate ◽  
Patient Stratification ◽  
Lesion Load

Background: Fatigue in multiple sclerosis (MS) has been inconsistently associated with disruption of specific brain circuitries. Temporal fluctuations of fatigue have not been considered. Objective: The aim of this study was to investigate the association of fatigue with brain diffusion abnormalities, using robust criteria for patient stratification based on longitudinal patterns of fatigue. Methods: Patient stratification: (1) sustained fatigue (SF, n = 26): latest two Modified Fatigue Impact Scale (MFIS) ⩾ 38; (2) reversible fatigue (RF, n = 25): latest MFIS < 38 and minimum one previous MFIS ⩾ 38; and (3) never fatigued (NF, n = 42): MFIS always < 38 (five assessments minimum). 3T brain magnetic resonance imaging (MRI) was used to perform voxel-wise comparison of fractional anisotropy (FA) between the groups controlling for age, sex, disease duration, physical disability, white matter lesion load (T2LV), and depression. Results: SF and, to a lesser extent, RF patients showed lower FA in multiple brain regions compared to NF patients, independent of age, sex, disease duration, and physical disability. In cingulo-postcommissural-striato-thalamic regions, the differences in FA between SF and NF (but not between RF and NF or SF) patients were independent of T2LV, and in ventromedial prefronto-precommissuro-striatal and temporo-insular areas, independent of T2LV and depression. Conclusion: Damage to ventromedial prefronto-precommissuro-striatal and temporo-insular pathways appears to be a specific substrate of SF in MS.

Brain atrophy evolution and lesion load accrual in multiple sclerosis: a 2-year follow-up study

2008 ◽  
Vol 15 (2) ◽  
pp. 204-211 ◽  
Author(s):  
G Tedeschi ◽  
D Dinacci ◽  
M Comerci ◽  
L Lavorgna ◽  
G Savettieri ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
White Matter ◽  
Disease Progression ◽  
Gray Matter ◽  
Brain Atrophy ◽  
Disease Duration ◽  
Lesion Load ◽  
Whole Brain ◽  
Gray Matter Atrophy

Background To investigate in a large cohort of patients with multiple sclerosis (MS), lesion load and atrophy evolution, and the relationship between clinical and magnetic resonance imaging (MRI) correlates of disease progression. Methods Two hundred and sixty-seven patients with MS were studied at baseline and two years later using the same MRI protocol. Abnormal white matter fraction, normal appearing white matter fraction, global white matter fraction, gray matter fraction and whole brain fraction, T2-hyperintense, and T1-hypointense lesions were measured at both time points. Results The majority of patients were clinically stable, whereas MRI-derived brain tissue fractions were significantly different after 2 years. The correlation between MRI data at baseline and their variation during the follow-up showed that lower basal gray matter atrophy was significantly related with higher progression of gray matter atrophy during follow-up. The correlation between MRI parameters and disease duration showed that gray matter atrophy rate decreased with increasing disease duration, whereas the rate of white matter atrophy had a constant pattern. Lower basal gray matter atrophy was associated with increased probability of developing gray matter atrophy at follow-up, whereas gray matter atrophy progression over 2 years and new T2 lesion load were risk factors for whole brain atrophy progression. Conclusions In MS, brain atrophy occurs even after a relatively short period of time and in patients with limited progression of disability. Short-term brain atrophy progression rates differ across tissue compartments, as gray matter atrophy results more pronounced than white matter atrophy and appears to be a early phenomenon in the MS-related disease progression.

scholarly journals In vivo detection of connectivity between cortical and white matter lesions in early MS

2016 ◽  
Vol 23 (7) ◽  
pp. 973-981 ◽  
Author(s):  
Jan-Mendelt Tillema ◽  
Stephen D Weigand ◽  
Jay Mandrekar ◽  
Yunhong Shu ◽  
Claudia F Lucchinetti ◽  
...  
Keyword(s):  
White Matter ◽  
Diffusion Tensor ◽  
White Matter Lesions ◽  
Cortical Lesion ◽  
In Vivo Detection ◽  
Relapsing Remitting ◽  
Mri Scans ◽  
Healthy Control ◽  
Magnetic Resonance Imaging Mri

Background: The relationship between cortical lesions (CLs) and white matter lesions (WMLs) in multiple sclerosis (MS) is poorly understood. Pathological studies support a topographical association between CLs and underlying subcortical WMLs and suggest CLs may play a role in both disease initiation and progression. We hypothesized that cortical MS lesions are physically connected to white matter MS lesions via axonal connections. Objective: To assess the presence of CL-WML connectivity utilizing novel magnetic resonance imaging (MRI) methodology. Methods: In all, 28 relapsing-remitting MS patients and 25 controls received 3 T MRI scans, including double inversion recovery (DIR) for CL detection coupled with diffusion tensor imaging (DTI). CL and WML maps were created, and DTI was used to calculate inter-lesional connectivity and volumetric connectivity indices. Results: All patients showed inter-lesional WML connectivity (median 76% of WMLs connected to another WML; interquartile range (IQR), 58%–88%). On average, 52% of detected CLs per patient were connected to at least one WML (IQR, 42%–71%). Volumetric connectivity analysis showed significantly elevated cortical lesion ratios in MS patients (median, 2.3; IQR, 1.6–3.3) compared to null MS and healthy control datasets ( p < 0.001). Conclusion: These findings provide strong evidence of inter-lesional connectivity between CLs and WMLs, supporting our hypothesis of intrinsic CL-WML connectivity.

Late-onset major depression is associated with age-related white matter lesions in the brainstem

2016 ◽  
Vol 32 (4) ◽  
pp. 446-454 ◽  
Author(s):  
Johannes Schwichtenberg ◽  
Mansour Al-Zghloul ◽  
Hans U. Kerl ◽  
Holger Wenz ◽  
Lucrezia Hausner ◽  
...  
Keyword(s):  
White Matter ◽  
Major Depression ◽  
Late Onset ◽  
White Matter Lesions ◽  
Age Related

A Long-Term Study of Changes in the Volume of Brain Ventricles and White Matter Lesions After Successful Liver Transplantation

2010 ◽  
Vol 89 (5) ◽  
pp. 589-594 ◽  
Author(s):  
Rita García Martínez ◽  
Alex Rovira ◽  
Juli Alonso ◽  
F. Xavier Aymerich ◽  
Elena Huerga ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
White Matter ◽  
White Matter Lesions ◽  
Term Study ◽  
Brain Ventricles ◽  
Long Term Study

scholarly journals Magnetic resonance imaging correlates of physical disability in relapse onset multiple sclerosis of long disease duration

2013 ◽  
Vol 20 (1) ◽  
pp. 72-80 ◽  
Author(s):  
H Kearney ◽  
MA Rocca ◽  
P Valsasina ◽  
L Balk ◽  
J Sastre-Garriga ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Multiple Sclerosis ◽  
Spinal Cord ◽  
Magnetic Resonance ◽  
Physical Disability ◽  
Disease Duration ◽  
Resonance Imaging ◽  
Lesion Load ◽  
Brain And Spinal Cord

Background: Understanding long-term disability in multiple sclerosis (MS) is a key goal of research; it is relevant to how we monitor and treat the disease. Objectives: The Magnetic Imaging in MS (MAGNIMS) collaborative group sought to determine the relationship of brain lesion load, and brain and spinal cord atrophy, with physical disability in patients with long-established MS. Methods: Patients had a magnetic resonance imaging (MRI) scan of their brain and spinal cord, from which we determined brain grey (GMF) and white matter (WMF) fractional volumes, upper cervical spinal cord cross-sectional area (UCCA) and brain T2-lesion volume (T2LV). We assessed patient disability using the Expanded Disability Status Scale (EDSS). We analysed associations between EDSS and MRI measures, using two regression models (dividing cohort by EDSS into two and four sub-groups). Results: In the binary model, UCCA ( p < 0.01) and T2LV ( p = 0.02) were independently associated with the requirement of a walking aid. In the four-category model UCCA ( p < 0.01), T2LV ( p = 0.02) and GMF ( p = 0.04) were independently associated with disability. Conclusions: Long-term physical disability was independently linked with atrophy of the spinal cord and brain T2 lesion load, and less consistently, with brain grey matter atrophy. Combinations of spinal cord and brain MRI measures may be required to capture clinically-relevant information in people with MS of long disease duration.

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