Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 140
Filtrar
1.
Brain ; 2021 Nov 16.
Artigo em Inglês | MEDLINE | ID: mdl-34791056

RESUMO

Progressive multifocal leukoencephalopathy (PML) is an opportunistic infection of the central nervous system caused by the JC virus, which infects white and grey matter cells and leads to irreversible demyelination and neuroaxonal damage. Brain magnetic resonance imaging (MRI), in addition to the clinical presentation and demonstration of JC virus DNA either in the CSF or by histopathology, is an important tool in the detection of PML. In clinical practice, standard MRI pulse sequences are utilized for screening, diagnosis, and monitoring of PML, but validated imaging-based outcome measures for use in prospective, interventional clinical trials for PML have yet to be established. We review the existing literature regarding the use of MRI and positron emission tomography imaging in PML and discuss the implications of PML histopathology for neuroradiology. MRI not only demonstrates the localization and extent of PML lesions, but also mirrors the tissue destruction, ongoing viral spread, and resulting inflammation. Finally, we explore the potential for imaging measures to serve as an outcome in PML clinical trials and provide recommendations for current and future imaging outcome measure development in this area.

2.
Mult Scler ; : 13524585211045545, 2021 Oct 04.
Artigo em Inglês | MEDLINE | ID: mdl-34605323

RESUMO

BACKGROUND: Spatio-temporal evolution of cord atrophy in multiple sclerosis (MS) has not been investigated yet. OBJECTIVE: To evaluate voxel-wise distribution and 1-year changes of cervical cord atrophy in a multicentre MS cohort. METHODS: Baseline and 1-year 3D T1-weighted cervical cord scans and clinical evaluations of 54 healthy controls (HC) and 113 MS patients (14 clinically isolated syndromes (CIS), 77 relapsing-remitting (RR), 22 progressive (P)) were used to investigate voxel-wise cord volume loss in patients versus HC, 1-year volume changes and clinical correlations (SPM12). RESULTS: MS patients exhibited baseline cord atrophy versus HC at anterior and posterior/lateral C1/C2 and C4-C6 (p < 0.05, corrected). While CIS patients showed baseline volume increase at C4 versus HC (p < 0.001, uncorrected), RRMS exhibited posterior/lateral C1/C2 atrophy versus CIS, and PMS showed widespread cord atrophy versus RRMS (p < 0.05, corrected). At 1 year, 13 patients had clinically worsened. Cord atrophy progressed in MS, driven by RRMS, at posterior/lateral C2 and C3-C6 (p < 0.05, corrected). CIS patients showed no volume changes, while PMS showed circumscribed atrophy progression. Baseline cord atrophy at posterior/lateral C1/C2 and C3-C6 correlated with concomitant and 1-year disability (r = -0.40/-0.62, p < 0.05, corrected). CONCLUSIONS: Voxel-wise analysis characterized spinal cord neurodegeneration over 1 year across MS phenotypes and helped to explain baseline and 1-year disability.

3.
Eur Radiol ; 2021 Sep 22.
Artigo em Inglês | MEDLINE | ID: mdl-34549326

RESUMO

OBJECTIVES: In multiple sclerosis (MS), iron rim lesions (IRLs) are indicators of chronic low-grade inflammation and ongoing tissue destruction. The aim of this study was to assess the relationship of IRLs with clinical measures and magnetic resonance imaging (MRI) markers, in particular brain and cervical cord volume. METHODS: Clinical and MRI parameters from 102 relapsing MS patients (no relapses for at least 6 months, no contrast-enhancing lesions) were included; follow-up data obtained after 12 months was available in 49 patients. IRLs were identified on susceptibility-weighted images (SWIs). In addition to standard brain and spinal cord MRI parameters, normalised cross-sectional area (nCSA) of the upper cervical cord was calculated. RESULTS: Thirty-eight patients had at least one IRL on SWI MRI. At baseline, patients with IRLs had higher EDSS scores, higher lesion loads (brain and spinal cord), and lower cortical grey matter volumes and a lower nCSA. At follow-up, brain atrophy rates were higher in patients with IRLs. IRLs correlated spatially with T1-hypointense lesions. CONCLUSIONS: Relapsing MS patients with IRLs showed more aggressive MRI disease characteristics in both the cross-sectional and longitudinal analyses. KEY POINTS: • Multiple sclerosis patients with iron rim lesions had higher EDSS scores, higher brain and spinal cord lesion loads, lower cortical grey matter volumes, and a lower normalised cross-sectional area of the upper cervical spinal cord. • Iron rim lesions are a new lesion descriptor obtained from susceptibility-weighted MRI. Our data suggests that further exploration of this lesion characteristic in regard to a poorer prognosis in multiple sclerosis patients is warranted.

4.
Ther Adv Neurol Disord ; 14: 17562864211039648, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34422112

RESUMO

Multiple sclerosis is a complex, autoimmune-mediated disease of the central nervous system characterized by inflammatory demyelination and axonal/neuronal damage. The approval of various disease-modifying therapies and our increased understanding of disease mechanisms and evolution in recent years have significantly changed the prognosis and course of the disease. This update of the Multiple Sclerosis Therapy Consensus Group treatment recommendation focuses on the most important recommendations for disease-modifying therapies of multiple sclerosis in 2021. Our recommendations are based on current scientific evidence and apply to those medications approved in wide parts of Europe, particularly German-speaking countries (Germany, Austria, and Switzerland).

5.
Nervenarzt ; 92(8): 773-801, 2021 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-34297142

RESUMO

Multiple sclerosis is a complex, autoimmune-mediated disease of the central nervous system characterized by inflammatory demyelination and axonal/neuronal damage. The approval of various disease-modifying therapies and our increased understanding of disease mechanisms and evolution in recent years have significantly changed the prognosis and course of the disease. This update of the Multiple Sclerosis Therapy Consensus Group treatment recommendation focuses on the most important recommendations for disease-modifying therapies of multiple sclerosis in 2021. Our recommendations are based on current scientific evidence and apply to those medications approved in wide parts of Europe, particularly German-speaking countries (Germany, Austria, Switzerland).


Assuntos
Esclerose Múltipla , Sistema Nervoso Central , Consenso , Europa (Continente) , Alemanha , Humanos , Esclerose Múltipla/diagnóstico , Esclerose Múltipla/tratamento farmacológico
6.
BMC Med Imaging ; 21(1): 107, 2021 07 08.
Artigo em Inglês | MEDLINE | ID: mdl-34238246

RESUMO

BACKGROUND: To develop a regression neural network for the reconstruction of lesion probability maps on Magnetic Resonance Fingerprinting using echo-planar imaging (MRF-EPI) in addition to [Formula: see text], [Formula: see text], NAWM, and GM- probability maps. METHODS: We performed MRF-EPI measurements in 42 patients with multiple sclerosis and 6 healthy volunteers along two sites. A U-net was trained to reconstruct the denoised and distortion corrected [Formula: see text] and [Formula: see text] maps, and to additionally generate NAWM-, GM-, and WM lesion probability maps. RESULTS: WM lesions were predicted with a dice coefficient of [Formula: see text] and a lesion detection rate of [Formula: see text] for a threshold of 33%. The network jointly enabled accurate [Formula: see text] and [Formula: see text] times with relative deviations of 5.2% and 5.1% and average dice coefficients of [Formula: see text] and [Formula: see text] for NAWM and GM after binarizing with a threshold of 80%. CONCLUSION: DL is a promising tool for the prediction of lesion probability maps in a fraction of time. These might be of clinical interest for the WM lesion analysis in MS patients.

7.
EMBO Mol Med ; 13(8): e13953, 2021 08 09.
Artigo em Inglês | MEDLINE | ID: mdl-34254741

RESUMO

IgG4-related disease (IgG4-RD) is a fibroinflammatory disorder signified by aberrant infiltration of IgG4-restricted plasma cells into a variety of organs. Clinical presentation is heterogeneous, and pathophysiological mechanisms of IgG4-RD remain elusive. There are very few cases of IgG4-RD with isolated central nervous system manifestation. By leveraging single-cell sequencing of the cerebrospinal fluid (CSF) of a patient with an inflammatory intracranial pseudotumor, we provide novel insights into the immunopathophysiology of IgG4-RD. Our data illustrate an IgG4-RD-associated polyclonal T-cell response in the CSF and an oligoclonal T-cell response in the parenchymal lesions, the latter being the result of a multifaceted cell-cell interaction between immune cell subsets and pathogenic B cells. We demonstrate that CD8+ T effector memory cells might drive and sustain autoimmunity via macrophage migration inhibitory factor (MIF)-CD74 signaling to immature B cells and CC-chemokine ligand 5 (CCL5)-mediated recruitment of cytotoxic CD4+ T cells. These findings highlight the central role of T cells in sustaining IgG4-RD and open novel avenues for targeted therapies.


Assuntos
Doença Relacionada a Imunoglobulina G4 , Linfócitos B , Encéfalo , Linfócitos T CD8-Positivos , Humanos , Memória Imunológica
8.
J Neuroimaging ; 31(3): 471-474, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33793026

RESUMO

BACKGROUND AND PURPOSE: Internuclear ophthalmoplegia is a dysfunction of conjugate eye movements, caused by lesions affecting the medial longitudinal fasciculus (MLF). Multiple sclerosis (MS) and ischemic stroke represent the most common pathophysiologies. While magnetic resonance imaging (MRI) allows for localizing lesions affecting the MLF, comprehensive comparative studies exploring potential different spatial characteristics of lesions affecting the MLF are missing until now. METHODS: We retrospectively investigated MRI examinations of 82 patients (40 patients with MS and 42 patients with ischemic stroke). For lesion localization, the brainstem was segmented into (1) ponto-medullary junction, (2) mid pons, (3) upper pons, and (4) mesencephalon. RESULTS: Corresponding lesions affecting the MLF were observed in 29/40 (72.5%) MS and 38/42 (90.5%) stroke patients. Compared to stroke patients, MS patients had significantly more lesions in multiple locations (P < .001). Stroke patients showed more lesions at the level of the mesencephalon (P < .001), while lesions at the level of the ponto-medullary junction, mid, and upper pons did not statistically differ between the groups. CONCLUSION: Our results demonstrate that multiple lesions affecting the MLF make inflammatory-demyelination due to MS more likely, while lesion localization at the level of the mesencephalon favors ischemia.


Assuntos
Isquemia Encefálica/patologia , AVC Isquêmico/patologia , Esclerose Múltipla/patologia , Transtornos da Motilidade Ocular/diagnóstico por imagem , Transtornos da Motilidade Ocular/patologia , Adulto , Idoso , Isquemia Encefálica/diagnóstico por imagem , Tronco Encefálico/patologia , Feminino , Humanos , AVC Isquêmico/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos , Masculino , Mesencéfalo/patologia , Pessoa de Meia-Idade , Esclerose Múltipla/diagnóstico por imagem , Ponte/patologia , Estudos Retrospectivos
9.
Eur J Neurol ; 28(7): 2392-2395, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33864730

RESUMO

BACKGROUND AND PURPOSE: There has been an increasing interest in chronic active multiple sclerosis (MS) lesions as a new magnetic resonance imaging (MRI) marker of disease progression. Chronic active lesions are characterized by progressive tissue matrix damage, axonal loss and chronic inflammation. Sodium (23 Na) MRI provides a biochemical marker of cell integrity and tissue viability in a quantitative manner. The aim of this study was to investigate with 23 Na MRI tissue abnormalities in chronic active lesions as indicators of tissue destruction. METHODS: To identify chronic active lesions, two 3D magnetization-prepared rapid acquisition gradient-echo datasets obtained 12 months apart were processed using the voxel-guided morphometry algorithm. Cross-sectional 23 Na MRI was performed during the 12-month follow-up period. Total sodium concentration was calculated in chronic active lesions compared to shrinking, chronic stable and acute contrast-enhancing lesions. RESULTS: Overall, 70 MS lesions (21 chronic active, 10 shrinking, 29 chronic stable lesions, 10 acute contrast-enhancing lesions) in 12 patients were included. Total sodium concentration in chronic active lesions (49.57 ± 8.47 mM) was significantly higher than in shrinking (42.16 ± 3.9 mM; p = 0.03) and chronic stable lesions (39.92 ± 4.82 mM; p < 0.001). Chronic active lesions showed similar sodium values compared to acute contrast-enhancing lesions (48.06 ± 6.65 mM; p = 0.97). No differences between shrinking and chronic stable lesions were observed (p = 0.89). CONCLUSION: High sodium values in chronic active MS lesions may be an indicator of ongoing inflammation and tissue damage.


Assuntos
Esclerose Múltipla , Sódio , Encéfalo/diagnóstico por imagem , Estudos Transversais , Progressão da Doença , Humanos , Imageamento por Ressonância Magnética , Esclerose Múltipla/diagnóstico por imagem
10.
Magn Reson Imaging ; 79: 97-102, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33771609

RESUMO

OBJECTIVE: Recently, there has been an increasing interest in "chronic enlarging" or "chronic active" multiple sclerosis (MS) lesions that are associated with clinical disability. However, investigation of dynamic lesion volume changes requires longitudinal MRI data from two or more time points. The aim of this study was to investigate the application of texture analysis (TA) on baseline T1-weighted 3D magnetization-prepared rapid acquisition gradient-echo (MPRAGE) images to differentiate chronic active from chronic stable MS lesions. MATERIAL AND METHODS: To identify chronic active lesions as compared to non-enhancing stable lesions, two MPRAGE datasets acquired on a 3 T MRI at baseline and after 12 months follow-up were applied to the Voxel-Guided Morphometry (VGM) algorithm. TA was performed on the baseline MPRAGE images, 36 texture features were extracted for each lesion. RESULTS: Overall, 374 chronic MS lesions (155 chronic active and 219 chronic stable lesions) from 60 MS patients were included in the final analysis. Multiple texture features including "DISCRETIZED_HISTO_Energy", "GLCM_Energy", "GLCM_Contrast" and "GLCM_Dissimilarity" were significantly higher in chronic active as compared to chronic stable lesions. Partial least squares regression yielded an area under the curve of 0.7 to differentiate both lesion types. CONCLUSION: Our results suggest that multiple texture features extracted from MPRAGE images indicate higher intralesional heterogeneity, however they demonstrate only a fair accuracy to differentiate chronic active from chronic stable MS lesions.


Assuntos
Esclerose Múltipla , Algoritmos , Encéfalo/diagnóstico por imagem , Humanos , Imageamento Tridimensional , Análise dos Mínimos Quadrados , Imageamento por Ressonância Magnética , Esclerose Múltipla/diagnóstico por imagem
11.
Brain ; 144(9): 2683-2695, 2021 Oct 22.
Artigo em Inglês | MEDLINE | ID: mdl-33757118

RESUMO

Progressive multifocal leukoencephalopathy (PML) is a severe infection of the CNS caused by the polyomavirus JC that can occur in multiple sclerosis patients treated with natalizumab. Clinical management of patients with natalizumab-associated PML is challenging not least because current imaging tools for the early detection, longitudinal monitoring and differential diagnosis of PML lesions are limited. Here we evaluate whether translocator protein (TSPO) PET imaging can be applied to monitor the inflammatory activity of PML lesions over time and differentiate them from multiple sclerosis lesions. For this monocentre pilot study we followed eight patients with natalizumab-associated PML with PET imaging using the TSPO radioligand 18F-GE-180 combined with frequent 3 T MRI. In addition we compared TSPO PET signals in PML lesions with the signal pattern of multiple sclerosis lesions from 17 independent multiple sclerosis patients. We evaluated the standardized uptake value ratio as well as the morphometry of the TSPO uptake for putative PML and multiple sclerosis lesions areas compared to a radiologically unaffected pseudo-reference region in the cerebrum. Furthermore, TSPO expression in situ was immunohistochemically verified by determining the density and cellular identity of TSPO-expressing cells in brain sections from four patients with early natalizumab-associated PML as well as five patients with other forms of PML and six patients with inflammatory demyelinating CNS lesions (clinically isolated syndrome/multiple sclerosis). Histological analysis revealed a reticular accumulation of TSPO expressing phagocytes in PML lesions, while such phagocytes showed a more homogeneous distribution in putative multiple sclerosis lesions. TSPO PET imaging showed an enhanced tracer uptake in natalizumab-associated PML lesions that was present from the early to the chronic stages (up to 52 months after PML diagnosis). While gadolinium enhancement on MRI rapidly declined to baseline levels, TSPO tracer uptake followed a slow one phase decay curve. A TSPO-based 3D diagnostic matrix taking into account the uptake levels as well as the shape and texture of the TSPO signal differentiated >96% of PML and multiple sclerosis lesions. Indeed, treatment with rituximab after natalizumab-associated PML in three patients did not affect tracer uptake in the assigned PML lesions but reverted tracer uptake to baseline in the assigned active multiple sclerosis lesions. Taken together our study suggests that TSPO PET imaging can reveal CNS inflammation in natalizumab-associated PML. TSPO PET may facilitate longitudinal monitoring of disease activity and help to distinguish recurrent multiple sclerosis activity from PML progression.

12.
Magn Reson Med ; 86(1): 471-486, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33547656

RESUMO

PURPOSE: To develop an accelerated postprocessing pipeline for reproducible and efficient assessment of white matter lesions using quantitative magnetic resonance fingerprinting (MRF) and deep learning. METHODS: MRF using echo-planar imaging (EPI) scans with varying repetition and echo times were acquired for whole brain quantification of T 1 and T 2 ∗ in 50 subjects with multiple sclerosis (MS) and 10 healthy volunteers along 2 centers. MRF T 1 and T 2 ∗ parametric maps were distortion corrected and denoised. A CNN was trained to reconstruct the T 1 and T 2 ∗ parametric maps, and the WM and GM probability maps. RESULTS: Deep learning-based postprocessing reduced reconstruction and image processing times from hours to a few seconds while maintaining high accuracy, reliability, and precision. Mean absolute error performed the best for T 1 (deviations 5.6%) and the logarithmic hyperbolic cosinus loss the best for T 2 ∗ (deviations 6.0%). CONCLUSIONS: MRF is a fast and robust tool for quantitative T 1 and T 2 ∗ mapping. Its long reconstruction and several postprocessing steps can be facilitated and accelerated using deep learning.


Assuntos
Aprendizado Profundo , Substância Branca , Encéfalo/diagnóstico por imagem , Humanos , Processamento de Imagem Assistida por Computador , Imageamento por Ressonância Magnética , Espectroscopia de Ressonância Magnética , Imagens de Fantasmas , Reprodutibilidade dos Testes , Substância Branca/diagnóstico por imagem
13.
Mult Scler Relat Disord ; 49: 102752, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33486402

RESUMO

BACKGROUND: In multiple sclerosis (MS), magnetic resonance imaging (MRI) frequently shows ill-defined areas with intermediate signal intensity between the normal appearing white matter (NAWM) and focal T2-hyperintense lesions, termed "diffusely appearing white matter" (DAWM). Even though several advanced MRI techniques have shown the potential to detect and quantify subtle commonly not visible microscopic tissue changes, to date only a few advanced MRI studies investigated DAWM changes in a quantitative manner. The aim of this study was to detect and quantify tissue abnormalities in the DAWM in comparison to focal lesions and the NAWM in MS patients by sodium (23Na) MRI. METHODS: 23Na and conventional MRI were performed in 25 MS patients with DAWM (DAWM+) and in 25 sex- and age matched MS patients without DAWM (DAWM-), as well as in ten healthy controls (HC). Mean total sodium concentrations (TSC) were quantified in the DAWM, NAWM, normal appearing grey matter (NAGM) and in focal MS lesions. RESULTS: In MS DAWM+and DAWM-, TSC values were increased in the NAGM (DAWM+: 44.61 ± 4.09 mM; DAWM-: 45.37 ± 3.8 mM) and in the NAWM (DAWM+: 39.85 ± 3.89 mM; DAWM-: 39.82 ± 4.25 mM) compared to normal grey and white matter in HC (GM 40.87 ± 3.25 mM, WM 35.9 ± 1.81 mM; p < 0.05 for all comparisons). Interestingly, the DAWM showed similar sodium concentrations (39.32 ± 4.59 mM) to the NAWM (39.85 ± 3.89 mM), whereas TSC values in T1 hypointense (46.53 ± 7.87 mM) and T1 isointense (41.99 ± 6.10 mM) lesions were significantly higher than in the DAWM (p < 0.001 and 0.017 respectively). CONCLUSION: 23Na MRI is confirmed as a sensitive marker of even subtle tissue abnormalities. DAWM sodium levels are increased and comparable to the abnormalities in NAWM, suggesting pathological changes less severe than in focal lesions comparable to what is expected in the NAWM.


Assuntos
Esclerose Múltipla , Substância Branca , Encéfalo/diagnóstico por imagem , Humanos , Imageamento por Ressonância Magnética , Esclerose Múltipla/diagnóstico por imagem , Sódio , Substância Branca/diagnóstico por imagem
14.
Neurobiol Aging ; 98: 42-51, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33232854

RESUMO

We characterize the whole-brain N-acetyl-aspartate (WBNAA) and brain tissue fractions across the adult lifespan and test the hypothesis that, despite age-related atrophy, neuronal integrity (reflected by WBNAA) is preserved in normal aging. Two-hundred-and-seven participants: 133 cognitively intact older adults (73.6 ± 7.4 mean ± standard deviation, range: 60-90 year old) and 84 young (37.9 ± 11, range: 21-59 year old) were scanned with proton magnetic resonance spectroscopy and T1-weighted MRI. Their WBNAA, fractional brain parenchyma, and gray and white matter volumes (fBPV, fGM, and fWM) were compared and modeled as functions of age and sex. Compared with young, older-adults' WBNAA was lower by ~35%, and fBPV, fGM and fWM were lower by ~10%. Linear regressions found 0.5%/year WBNAA and 0.2%/year fBPV and fGM declines, whereas fWM rose to age ~40 years, and declined thereafter. fBPV and fGM were 1.8% and 4% higher in women, with no sex decline rates difference. We conclude that contrary to our hypothesis, atrophy was accompanied by WBNAA decline. Across the entire age range, women's brains showed less atrophy than men's. Formulas to estimate WBNAA and brain tissue fractions in healthy adults are provided to help differentiate normal from abnormal aging.


Assuntos
Encéfalo/metabolismo , Encéfalo/patologia , Envelhecimento Saudável/metabolismo , Envelhecimento Saudável/patologia , Idoso , Idoso de 80 Anos ou mais , Ácido Aspártico/análogos & derivados , Atrofia , Feminino , Substância Cinzenta/metabolismo , Substância Cinzenta/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão , Caracteres Sexuais
15.
J Neuroimaging ; 31(2): 394-400, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33270952

RESUMO

BACKGROUND AND PURPOSE: To investigate the temporal evolution of venous diameter in chronic active and nonenhancing shrinking multiple sclerosis (MS) lesions in a longitudinal magnetic resonance imaging (MRI) study including susceptibility-weighted images (SWI). METHODS: We compared the venous diameter in chronic active and nonenhancing shrinking lesions to the venous diameter in nonenhancing stable lesions on two 3 T MRI data sets obtained 12 months apart. Chronic active and nonenhancing shrinking lesions were identified by Voxel-Guided Morphometry. Coregistered, overlaid fluid-attenuated inversion recovery/SWI were analyzed for the presence of a central vein. Quantitative calculation of the venous diameter for each time point was performed on the reconstructed veins. RESULTS: Sixty-two relapsing-remitting MS patients (50 women; mean age: 36 ± 11 years; mean disease duration: 4 ± 7 years) were included in the study. Overall, we identified 222 chronic MS lesions (48 chronic active, 48 shrinking, 126 stable) with a corresponding intralesional central vein. On baseline MRI, the mean venous diameter did not statistically differ between all subgroups, whereas on follow-up MRI, the mean intralesional venous diameter was smaller in chronic active (0.92 ± 0.15 mm) and shrinking lesions (0.90 ± 0.19 mm) compared to stable lesions (1.10 ± 0.18 mm; P < .001). CONCLUSION: Our findings demonstrate venous narrowing in chronic active and nonenhancing shrinking MS lesions. The smaller diameter of intralesional veins during follow up in these lesions may reflect structural, degenerative, and metabolic changes due to chronic inflammation, (perivascular) fibrosis, collagenous thickening, and increased levels of oxygenated hemoglobin.


Assuntos
Esclerose Múltipla Recidivante-Remitente/diagnóstico por imagem , Esclerose Múltipla Recidivante-Remitente/patologia , Veias/patologia , Adulto , Doença Crônica , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Veias/diagnóstico por imagem
16.
Neurogastroenterol Motil ; 33(6): e14078, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33368950

RESUMO

BACKGROUND: A growing number of neuroimaging studies suggest distinct neural changes in inflammatory bowel diseases (IBDs). Whether such changes may show similar spatial patterns across distinct neural features within and between specific IBD is unclear. To address this question, we used multivariate multimodal data fusion analysis to investigate structure/function modulation in remitted patients with Crohn's disease (CD) and ulcerative colitis (UC). METHODS: Patients with IBD (n = 46; n = 31 with CD, n = 15 with UC) in stable remission and 17 healthy controls (HC) underwent structural magnetic resonance imaging (sMRI) and resting-state functional magnetic resonance imaging (rs-fMRI) as well as cognitive testing. Anxiety, depression, and fatigue were assessed using self-rating questionnaires. sMRI data were analyzed via voxel-based morphometry (VBM) and rs-fMRI data via amplitude of low-frequency fluctuations (ALFFs) and regional homogeneity (ReHo). Detection of cross-information between VBM, ALFF, and ReHo was conducted by means of a joint independent component analysis (jICA), followed by group-inference statistics. KEY RESULTS: Joint independent component analysis detected structural alterations in middle frontal and temporal regions (VBM), and functional changes in the superior frontal gyrus (ReHo) and the medial as well as inferior frontal, inferior temporal, rectal, and subcallosal gyrus (ALFF). One joint component of extracted features of the three modalities differed significantly between IBD patients and controls (p = 0.03), and most distinctly between HC and patients with UC. CONCLUSIONS AND INFERENCES: Using a multivariate data fusion technique, this study provides further evidence to brain alterations in IBD. The data suggest distinct neural differences between CD and UC, particularly in frontotemporal regions.

17.
Expert Opin Ther Targets ; 24(12): 1211-1224, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33103501

RESUMO

INTRODUCTION: Multiple sclerosis (MS) is a chronic inflammatory-demyelinating disease of the central nervous system associated with lesions of the cortical gray matter and subcortical white matter. Recently, cortical lesions have become a major focus of research because cortical pathology and neuronal damage are critical determinants of irreversible clinical progression. Recent transcriptomic studies point toward cell type-specific changes in cortical neurons in MS with a selective vulnerability of excitatory projection neuron subtypes. AREAS COVERED: We discuss the cortical mapping and the molecular properties of excitatory projection neurons and their role in MS lesion pathology while placing an emphasis on their subtype-specific transcriptomic changes and levels of vulnerability. We also examine the latest magnetic resonance imaging techniques to study cortical MS pathology as a key tool for monitoring disease progression and treatment efficacy. Finally, we consider possible therapeutic avenues and novel strategies to protect excitatory cortical projection neurons. Literature search methodology: PubMed articles from 2000-2020. EXPERT OPINION: Excitatory cortical projection neurons are an emerging therapeutic target in the treatment of progressive MS. Understanding neuron subtype-specific molecular pathologies and their exact spatial mapping will help establish starting points for the development of novel cell type-specific therapies and biomarkers in MS.


Assuntos
Terapia de Alvo Molecular , Esclerose Múltipla/terapia , Neurônios/patologia , Animais , Biomarcadores/metabolismo , Progressão da Doença , Humanos , Imageamento por Ressonância Magnética , Esclerose Múltipla/diagnóstico por imagem , Esclerose Múltipla/fisiopatologia
18.
J Neuroimaging ; 30(6): 766-768, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32857891

RESUMO

BACKGROUND AND PURPOSE: The swallow tail sign describes the physiological appearance of nigrosome-1 within the substantia nigra on high-resolution transverse susceptibility-weighted imaging (SWI). Previous studies demonstrated its absence in Parkinson's disease due to increasing iron content. In multiple sclerosis (MS), increased iron accumulation can be found in the brain tissue including the substantia nigra. METHODS: We investigated the swallow tail sign on high-resolution SWI MRI in 46 MS and 23 age- and sex-matched controls. RESULTS: MS patients demonstrated significantly more often an abnormal swallow tail sign (28/46; 60%) compared to controls (4/23; 17%; P = .001). In MS patients, we found no correlation between an abnormal swallow tail sign and age, disease duration or Expanded Disability Status Scale scores. CONCLUSION: The finding of an abnormal swallow tail sign in MS patients may provide an additional imaging marker even in early MS development.


Assuntos
Esclerose Múltipla/diagnóstico por imagem , Substância Negra/diagnóstico por imagem , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Imageamento por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
19.
Mult Scler Relat Disord ; 45: 102409, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32711298

RESUMO

BACKGROUND: Recently there has been an increasing interest in the "central vein sign" (CVS) in multiple sclerosis (MS) lesions. Infratentorial brain regions represent typical predilection sites for MS lesion development and are part of the current McDonald criteria to demonstrate dissemination in space, but only a few studies investigated the presence of the CVS in infratentorial MS lesions. The aim of this study was to investigate the CVS in infratentorial MS lesions. METHODS: 3T MRI data sets from 119 patients with relapsing MS were analysed. Chronic lesions were identified on T2-weighted images. Co-registered T2 / susceptibility-weighted images (SWI) were analysed for the presence of the CVS. RESULTS: A total of 527 lesions were analysed. A CVS was present in the majority of infratentorial lesions (62/88, 70%). There was no difference in the frequencies of the CVS of infratentorial lesions compared to paraventricular lesions (67/81, 83%; p = 0.06) or subcortical (150/209; 72%; p = 0.82) lesions. Infratentorial lesions showed a CVS more often than juxtacortical lesions (16/34; 47%; p = 0.02), while periventricular lesions showed a CVS more often than infratentorial lesions (97/115; 84%, p = 0.02). CONCLUSION: CVS is a frequent finding in infratentorial MS lesions that may increase the diagnostic value in MS.


Assuntos
Esclerose Múltipla , Encéfalo/diagnóstico por imagem , Humanos , Imageamento por Ressonância Magnética , Esclerose Múltipla/diagnóstico por imagem , Recidiva , Veias
20.
Neurology ; 95(2): e206-e212, 2020 07 14.
Artigo em Inglês | MEDLINE | ID: mdl-32532848

RESUMO

OBJECTIVE: To analyze how the evidence of hippocampal diffusion-weighted imaging (DWI) lesions may support the clinical diagnosis of transient global amnesia (TGA). METHODS: In this retrospective observational study, 390 consecutive patients with isolated TGA were analyzed, who were evaluated at our institution between July 1999 and August 2018. The size, location, and number of lesions and time-dependent lesion detectability were examined. The incidence of DWI lesions was reviewed with regard to different levels of clinical diagnostic certainty upon presentation to the emergency department. RESULTS: Hippocampal DWI lesions were detected in 272 (70.6%) patients with TGA, with a mean of 1.05 ± 0.98 (range 0-6) and a mean lesion size of 4.01 ± 1.22 mm (range 1.7-8.6 mm). In the subgroups of lower diagnostic certainty (amnesia witnessed by layperson or self-reported amnestic gap), DWI was helpful in supporting the diagnosis of TGA in 76 (69.1%) patients. In 187 patients with information about the exact onset, DWI lesions were analyzed in relation to latency between onset and MRI. Lesions could be detected at all time points and up to 6 days after symptom onset in individual patients; the highest rate of DWI-positive MRI (93%) was in the 12-24 hours time window. CONCLUSION: MRI findings can support the diagnosis of TGA and may be particularly valuable in situations of low clinical certainty. DWI-ideally performed with a minimum delay of 20 hours after onset-should therefore be considered a useful adjunct to the diagnosis of TGA.


Assuntos
Amnésia Global Transitória/diagnóstico por imagem , Imagem de Difusão por Ressonância Magnética/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Amnésia Global Transitória/diagnóstico , Amnésia Global Transitória/psicologia , Bases de Dados Factuais , Feminino , Hipocampo/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Estudos Retrospectivos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...