The evaluation of MRI diffusion values of active demyelinating lesions in multiple sclerosis (original) (raw)
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Diffusion MRI in multiple sclerosis
Neurology, 2005
Background Multiple Sclerosis Multiple sclerosis (MS) is a chronic disease of the CNS that begins most commonly in young adults, and is pathologically characterised by multiple areas of white matter inflammation, demyelination, and gliosis. The clinical course of MS varies from a benign course to a rapidly progressive and disabling disorder. Most patients, however, begin with a relapsing-remitting illness, which is caused by the occurrence of multiple lesions that are disseminated in time as well as in space. However, after 10-20 years or longer, most patients become disabled. MRI is extremely useful in MS, since it can be used to support the diagnosis of MS and to monitor disease evolution in both natural history studies and treatment trials. New MRI techniques Although conventional MRI is the most sensitive paraclinical test in the diagnosis of MS, its specificity is limited. Any pathology from edema and mild demyelination, through to completely necrotic lesions, may show the same abnormal signal. This lack of histopathological specificity accounts, in part, for the modest correlation between clinical disability and MRI parameters, often referred to as the "clinical radiological paradox" [1]. New MRI techniques have been recently developed in order to overcome this limitation, and provide additional in vivo information on the pathological substrates of MS. They showed that MS pathology is not restricted to the demyelinating lesions, but also involves the brain outside the lesions, the so-called normal-appearing white matter (NAWM) and grey matter (NAGM), confirming post-mortem data.
Benha Medical Journal
Background: Magnetic resonance imaging (MRI) is a very vital tool to diagnose and monitor multiple sclerosis (MS). Standard MRI measures lack of pathological specificity and are weakly correlated with MS clinical manifestations. Advanced MRI techniques together with diffusion studies square measure up the understanding of the mechanisms underlying tissue injury, repair and functional adaptation in MS but, they need careful standardization. It doesn't only enhance the understanding of the pathophysiology and evolution of disease, but also to generate research hypotheses, monitor treatment, increase costeffectiveness and power of clinical trials. Aim of the Work: The aim of this study is to evaluate the role of DTI in assessment of MS versus the normally-appearing white matter (NAWM). Patients and Methods: The study included 50 patients, 42 females and 8 males having MS (between 20 and 40 years of age) referred from Neurologists to Radio-diagnosis Department at Benha University hospitals with 5 age-matched control subjects (during the period between Aug. 2018 and Jan. 2020). Each patient included in the study was subjected to full history taking, reviewing medical sheet and MR examination including: Conventional MR examination and Diffusion Tensor imaging. Technique was performed using a standard 1.5 Tesla unit. Results: The study showed that DTI can reveal changes in NAWM in MS cases before visible sizable plaques can be detected by conventional MRI.
Quantitative diffusion weighted imaging measures in patients with multiple sclerosis
NeuroImage, 2007
Diffusion-weighted imaging (DWI) has been proposed as a sensitive measure of disease severity capable of detecting subtle changes in gray matter and white matter brain compartments in patients with multiple sclerosis (MS). However, DWI has been applied to the study of MS clinical subtypes in only a few studies. The objective of this study was to demonstrate the validity of a novel, fully automated method for the calculation of quantitative DWI measures. We also wanted to assess the correlation between whole brain (WB)-DWI variables and clinical and MRI measures of disease severity in a large cohort of MS patients. For this purpose we studied 432 consecutive MS patients (mean age 44.4 ± 10.2 years), 16 patients with clinically isolated syndrome (CIS) and 38 normal controls (NC) using 1.5 T brain MRI. Clinical disease subtypes were as follows: 294 relapsing-remitting (RR), 123 secondary-progressive (SP) and 15 primary-progressive (PP). Mean disease duration was 12 ± 10 years. Mean Expanded Disability Status Scale (EDSS) was 3.3 ± 2.1. Brain parenchymal fraction (BPF), gray matter fraction (GMF) and white matter fraction (WMF) were calculated using a fully automated method. Mean parenchymal diffusivity (MPD) maps were created. DWI indices of peak position (PP), peak height (PH), MPD and entropy (ENT) were obtained. T2and T1-lesion volumes (LV), EDSS, ambulation index (AI) and ninehole peg test (9-HPT) were also assessed. MS patients had significantly lower BPF (d = 1.26; p < 0.001) and GMF (d = 0.61; p = 0.003), and higher ENT (d = 1.2; p < 0.0001), MPD (d = 1.04; p < 0.0001) and PH (d = 0.47; p = 0.045) than NC subjects. A GLM analysis, adjusted for age and multiple comparisons, revealed significant differences between different clinical subtypes for BPF, GMF, ENT, PH, PP, T2-LV and T1-LV (p < 0.0001), WMF (p = 0.001) and MPD (p = 0.023). In RR and SP MS patients, ENT showed a more robust correlation with other MRI (r = 0.54 to 0.67, p < 0.0001) and clinical (r = 0.31 to 0.36, p < 0.0001) variables than MPD (r = 0.23 to 0.41, p < 0.001 for MRI and r = 0.13 to 0.18; p = 0.006 to p < 0.001 for clinical variables). The GMF and BPF showed a slightly stronger relationship with all clinical variables (r = 0.33 to 0.48; p < 0.0001), when compared to both lesion and DWI measures. ENT (R 2 = 0.28; p < 0.0001) and GMF (R 2 = 0.26; p < 0.001) were best related with SP disease course. This study highlights the validity of DWI in discerning differences between NC and MS patients, as well as between different MS subtypes. ENT is a sensitive marker of overall brain damage that is strongly related to clinical impairment in patients with SP MS.
The Egyptian Journal of Hospital Medicine, 2018
Background: Multiple sclerosis (MS) is an inflammatory demyelinating condition of the central nervous system (CNS) that is generally considered to be autoimmune in nature. White matter tracts are affected, including those of the cerebral hemispheres, infratentorium, and spinal cord. Several methods have been proposed, mainly using conventional MR modalities like T1, FLAIR or T2 images and enhanced MRI to delineate lesions. Conventional MR techniques cannot give detailed information about the integrity and location of WM tracts. Diffusion MRI is one of the non-conventional MRI techniques used for assessment of multiple sclerosis. The emergence of diffusion tensor imaging (DTI) is of great interest in MS. DTI probe the details of water diffusion within tissues, and could therefore reveal alterations in normal appearing white matter fibers before being visible in conventional MRI. Fractional anisotropy (FA), is the measure of the portion of the diffusion tensor that results from anisot...
Rivista Di Neuroradiologia, 2013
Multiple sclerosis is a chronic inflammatory demyelinating disease of the central nervous system. Diffusion tensor magnetic resonance imaging (DTI) can yield important information on the in vivo pathological processes affecting water diffusion. The aim of this study was to quantitatively define water diffusion in normal-appearing white matter (NAWM) distant from the plaque, in the plaque, and around the plaque, and to investigate the correlation of these changes with clinical disability. Conventional MRI and DTI scans were conducted in 30 patients with MS and 15 healthy individuals. Fractional anisotropy maps and visible diffusion coefficients were created and integrated with T2-weighted images. Regions of interest (ROIs) were placed on the plaques on the same side, white matter around the plaques and NAWM on the opposite side. Only the white matter of healthy individuals in the control group, and FA and ADC values were obtained for comparison. The highest FA and lowest ADC were detected in the control group at the periventricular region, cerebellar peduncle and at all ROIs irrespective of location. There was a significant difference in comparison to the control group at all ROIs in patients with MS (p < 0.001 for all comparisons). No significant correlation between diffusion parameters and expanded disability state scale (EDSS) scores was found in patients with MS. DTI may provide more accurate information on the damage due to the illness, compared to T2A sequences, but this damage may not be correlated with the clinical disability measured by EDSS score.
The contribution of diffusion-weighted MR imaging in multiple sclerosis during acute attack
European Journal of Radiology, 2008
Purpose: The aims of the study are firstly, to determine the difference in diffusion-weighted imaging (DWI) in normal appearing white matter (NAWM) between patients with acute multiple sclerosis (MS) and controls; secondly, to determine whether there is a correlation between EDSS scores and DWI in acute plaques and also NAWM. Materials and method: Out of 50 patients with acute MS attack, 35 patients had active plaques with diffuse or ring enhancement on postcontrast images. Eighteen healthy volunteers constituted the control group. While 26 of 35 had relapsing-remitting, 9 had secondary progressive MS. Apparent diffusion coefficients (ADC) of the active plaques, NAWM at the level of centrum semiovale and occipital horn of lateral ventricle in the patients and NAWM in control group were measured. ADC values of active plaques were compared with WM of the patients and the control group. The relationship of ADC value of active plaques and WM in MS with expanded disability status scale (EDSS) was investigated by using Mann-Whitney U-test. Results: Of 63 plaques totally, 26 and 37 of the active plaques had diffuse and ring enhancement, respectively. There was no statistically significant difference between ADC value of active plaques and EDSS (p > 0.05). However, there was a statistically significant difference between ADC value of WM occipital horn and EDSS (p < 0.05). ADC value of active plaques were higher than WM in both groups (p < 0.001). The difference between ADC value of WM at the centrum semiovale (p < 0.05) and occipital horns (p < 0.001) in patients and controls was statistically significant. There was no statistically significant difference between EDSS scores, ADC value at centrum semiovale and WM around occipital horn and active plaques in subgroups (p > 0.05). Conclusion: Apparently normal tissue in MS patients may show early abnormalities when investigated carefully enough, and there is an even though moderate correlation between EDSS and ADC values and early alterations of ADC value are starting in the occipital white matter along the ventricles. This has to be verified in larger series.
Egyptian Journal of Radiology and Nuclear Medicine
Background: Conventional MRI provides important morphologic information regarding the brain and spinal cord involvement by demyelinating plaques. However, it is of almost no value in assessing the normal-appearing white matter which has been proved by multiple pathologic studies to be directly and indirectly involved in the process of multiple sclerosis. Diffusion-weighted imaging and diffusion tensor imaging MRI have been widely used in multiple researches as a better solution for studying the normal-appearing white matter. The purpose of this study was to evaluate the role of diffusion tensor imaging examination of the normal-appearing white matter of the brain and spinal cord in patients with multiple sclerosis and to determine the relationship between diffusion tensor imaging metrics and patient's clinical status. Results: The significant negative correlation found between expanded disability status scale score of secondary progressive MS patients and global (brain and spinal cord) average fractional anisotropy values in normal-appearing white matter and tracts (P = 0.000). Correlation between average apparent diffusion coefficient of corpus callosum tract and expanded disability status scale score revealed a significant positive correlation in RRMS (P = 0.001). While in secondary progressive MS, a significant negative correlation between fractional anisotropy average of the corpus callosum tract and expanded disability status scale score was noted (P = 0.015). Conclusion: There is a strong relationship between diffusion tensor imaging readings and clinical status of patients can be used to understand unexplained deterioration over disease course and also can be used when conventional MRI findings are equivocal. Corpus callosum affection in MS patients is intimately related to clinical status and its assessment should be done whenever possible.
Basic and Clinical Neuroscience (BCN), 2021
Despite various imaging methods, the accurate diagnosis of numerous neurodegenerative diseases remains controversial. Using advanced imaging techniques, like diffusion-weighted imaging, can help the early detection of Multiple Sclerosis (MS) and evaluation of the treatment efficacy in these patients. Methods: In total, 24 MS patients with acute attack and 30 healthy subjects were considered in our study. Region of Interest (ROI) was defined for acute and chronic plaques and Normal-Appearing White Matter (NAWM) in the patients' group. In the normal group, ROI only was mapped in the white matter in the same regions of the patient. All MS patients were receiving Methylprednisolone for 3 to 5 days. The rate of clinical disability in these patients was also evaluated based on the Expanded Disability Status Scale (EDSS) index. Finally evaluate changes of ADC values of plaques and NAWM before and after treatment. Results: The Apparent Diffusion Coefficient (ADC) values of acute plaques, the ADC values of NAWM, the number of enhancement in T1w, and EDSS values suggested a significant difference after treatment compared to before treatment. However, the ADC values of chronic plaques revealed no significant difference after treatment. There was a significant positive correlation between the difference in EDSS values before and after treatment. Conclusion: The study results demonstrated that using diffusion technique and ADC values analysis is a proper non-invasive method for MS diagnosis and evaluating treatment efficacy in these patients.