82 research outputs found
Ultrahigh field MRI in clinical neuroimmunology: a potential contribution to improved diagnostics and personalised disease management
No full textConventional magnetic resonance imaging (MRI) at 1.5 Tesla (T) is limited by modest spatial resolution and signal-to-noise ratio (SNR), impeding the identification and classification of inflammatory central nervous system changes in current clinical practice. Gaining from enhanced susceptibility effects and improved SNR, ultrahigh field MRI at 7 T depicts inflammatory brain lesions in great detail. This review summarises recent reports on 7 T MRI in neuroinflammatory diseases and addresses the question as to whether ultrahigh field MRI may eventually improve clinical decision-making and personalised disease management
Progressive Multifocal Leukoencephalopathy in a Multiple Sclerosis Patient Diagnosed after Switching from Natalizumab to Fingolimod
No full textBackground. Natalizumab- (NTZ-) associated progressive multifocal leukoencephalopathy (PML) is a severe and often disabling infectious central nervous system disease that can become evident in multiple sclerosis (MS) patients after NTZ discontinuation. Recently, novel diagnostic biomarkers for the assessment of PML risk in NTZ treated MS patients such as the anti-JC virus antibody index have been reported, and the clinical relevance of milky-way lesions detectable by MRI has been discussed. Case Presentation and Conclusion. We report a MS patient in whom PML was highly suspected solely based on MRI findings after switching from NTZ to fingolimod despite repeatedly negative (ultrasensitive) polymerase chain reaction (PCR) testing for JC virus DNA in cerebrospinal fluid. The PML diagnosis was histopathologically confirmed by brain biopsy. The occurrence of an immune reconstitution inflammatory syndrome (IRIS) during fingolimod therapy, elevated measures of JCV antibody indices, and the relevance of milky-way-like lesions detectable by (7 T) MRI are discussed
sj-docx-1-eso-10.1177_23969873231151488 – Supplemental material for Apical pulmonary lesions suspected of malignancy visible on neck CT angiography performed for acute stroke: Prevalence, treatment, and clinical implications – the PLEURA study
No full textSupplemental material, sj-docx-1-eso-10.1177_23969873231151488 for Apical pulmonary lesions suspected of malignancy visible on neck CT angiography performed for acute stroke: Prevalence, treatment, and clinical implications – the PLEURA study by Tolga D Dittrich, Mara Aujesky, Salome Rudin, Annaelle Zietz, Benjamin Wagner, Alexandros Polymeris, Valerian L Altersberger, Tim Sinnecker, Henrik Gensicke, Stefan T Engelter, Philippe Lyrer, Viviane Hess, Raoul Sutter, Christian H Nickel, Leo H Bonati, Urs Fischer, Marios Psychogios, Mira Katan and Gian Marco De Marchis in European Stroke Journal</p
sj-doc-2-eso-10.1177_23969873231151488 – Supplemental material for Apical pulmonary lesions suspected of malignancy visible on neck CT angiography performed for acute stroke: Prevalence, treatment, and clinical implications – the PLEURA study
No full textSupplemental material, sj-doc-2-eso-10.1177_23969873231151488 for Apical pulmonary lesions suspected of malignancy visible on neck CT angiography performed for acute stroke: Prevalence, treatment, and clinical implications – the PLEURA study by Tolga D Dittrich, Mara Aujesky, Salome Rudin, Annaelle Zietz, Benjamin Wagner, Alexandros Polymeris, Valerian L Altersberger, Tim Sinnecker, Henrik Gensicke, Stefan T Engelter, Philippe Lyrer, Viviane Hess, Raoul Sutter, Christian H Nickel, Leo H Bonati, Urs Fischer, Marios Psychogios, Mira Katan and Gian Marco De Marchis in European Stroke Journal</p
Identical lesion morphology in primary progressive and relapsing-remitting MS -an ultrahigh field MRI study
No full textPotential differences between primary progressive (PP) and relapsing-remitting (RR) multiple sclerosis (MS) have been controversially discussed. In this study, we compared lesion morphology and distribution in patients with PPMS and RRMS (nine in each group) using 7 T MRI. We found that gray and white matter lesions in PPMS and RRMS patients did not differ in their respective morphological characteristics (e.g. perivascular p = 0.863, hypointense rim p = 0.796, cortical lesion count p = 0.436). Although limited by a small sample size, our study results suggest that PPMS and RRMS, despite differences in disease course and clinical characteristics, exhibit identical lesion morphology under ultrahigh field MRI
Ultrahochfeld-MRT im Kontext neurologischer Erkrankungen [Ultrahigh field MRI in context of neurological diseases]
No full textUltrahigh field magnetic resonance imaging (UHF-MRI) has recently gained substantial scientific interest. At field strengths of 7 Tesla (T) and higher UHF-MRI provides unprecedented spatial resolution due to an increased signal-to-noise ratio (SNR). The UHF-MRI method has been successfully applied in various neurological disorders. In neuroinflammatory diseases UHF-MRI has already provided a detailed insight into individual pathological disease processes and elucidated differential diagnoses of several disease entities, e.g. multiple sclerosis (MS), neuromyelitis optica (NMO) and Susac's syndrome. The excellent depiction of normal blood vessels, vessel abnormalities and infarct morphology by UHF-MRI can be utilized in vascular diseases. Detailed imaging of the hippocampus in Alzheimer's disease and the substantia nigra in Parkinson's disease as well as sensitivity to iron depositions could be valuable in neurodegenerative diseases. Current UHF-MRI studies still suffer from small sample sizes, selection bias or propensity to image artefacts. In addition, the increasing clinical relevance of 3T-MRI has not been sufficiently appreciated in previous studies. Although UHF-MRI is only available at a small number of medical research centers it could provide a high-end diagnostic tool for healthcare optimization in the foreseeable future. The potential of UHF-MRI still has to be carefully validated by profound prospective research to define its place in future medicine
Iron and non-iron-related characteristics of multiple sclerosis and neuromyelitis optica lesions at 7T MRI
No full textBACKGROUND AND PURPOSE: Characterization of iron deposition associated with demyelinating lesions of multiple sclerosis and neuromyelitis optica has not been well studied. Our aim was to investigate the potential of ultra-high-field MR imaging to distinguish MS from neuromyelitis optica and to characterize tissue injury associated with iron pathology within lesions. MATERIALS AND METHODS: Twenty-one patients with MS and 21 patients with neuromyelitis optica underwent 7T high-resolution 2D-gradient-echo-T2* and 3D-susceptibility-weighted imaging. An in-house-developed algorithm was used to reconstruct quantitative susceptibility mapping from SWI. Lesions were classified as "iron-laden" if they demonstrated hypointensity on gradient-echo-T2*-weighted images and/or SWI and hyperintensity on quantitative susceptibility mapping. Lesions were considered "non-iron-laden" if they were hyperintense on gradient-echo-T2* and isointense or hyperintense on quantitative susceptibility mapping. RESULTS: Of 21 patients with MS, 19 (90.5%) demonstrated at least 1 quantitative susceptibility mapping–hyperintense lesion, and 11/21 (52.4%) had iron-laden lesions. No quantitative susceptibility mapping–hyperintense or iron-laden lesions were observed in any patients with neuromyelitis optica. Iron-laden and non-iron-laden lesions could each be further characterized into 2 distinct patterns based on lesion signal and morphology on gradient-echo-T2*/SWI and quantitative susceptibility mapping. In MS, most lesions (n = 262, 75.9% of all lesions) were hyperintense on gradient-echo T2* and isointense on quantitative susceptibility mapping (pattern A), while a small minority (n = 26, 7.5% of all lesions) were hyperintense on both gradient-echo-T2* and quantitative susceptibility mapping (pattern B). Iron-laden lesions (n = 57, 16.5% of all lesions) were further classified as nodular (n = 22, 6.4%, pattern C) or ringlike (n = 35, 10.1%, pattern D). CONCLUSIONS: Ultra-high-field MR imaging may be useful in distinguishing MS from neuromyelitis optica. Different patterns related to iron and noniron pathology may provide in vivo insight into the pathophysiology of lesions in MS
Periventricular venous density is normal in neuromyelitis optica - preliminary data from a 7T MRI study
No full textsj-docx-1-wso-10.1177_17474930231181010 – Supplemental material for Association of statin use and lipid levels with cerebral microbleeds and intracranial hemorrhage in patients with atrial fibrillation: A prospective cohort study
No full textSupplemental material, sj-docx-1-wso-10.1177_17474930231181010 for Association of statin use and lipid levels with cerebral microbleeds and intracranial hemorrhage in patients with atrial fibrillation: A prospective cohort study by Elisavet Moutzouri, Matthias Glutz, Nazanin Abolhassani, Martin Feller, Luise Adam, Baris Gencer, Cinzia Del Giovane, Sylvain Bétrisey, Rebecca E Paladini, Elisa Hennings, Stefanie Aeschbacher, Jürg H Beer, Giorgio Moschovitis, David Seiffge, Gian Marco De Marchis, Michael Coslovsky, Tobias Reichlin, Giulio Conte, Tim Sinnecker, Matthias Schwenkglenks, Leo H Bonati, Peter Kastner, Drahomir Aujesky, Michael Kühne, Stefan Osswald, Urs Fischer, David Conen and Nicolas Rodondi in International Journal of Stroke</p
Ultrahigh field MRI in Multiple sclerosis and Susac syndrome
No full textEinleitung: In der klinischen Praxis spielt die Magnetresonanztomographie
(MRT) seit Jahrzehnten bezüglich Diagnostik und Therapiekontrolle der
Multiplen Sklerose (MS) eine zentrale Rolle. Dennoch korrelieren geläufige MR-
Messwerte nur bedingt mit klinischen Parametern und es bestehen oft
differentialdiagnostische Unsicherheiten. Seit kurzem ermöglicht die
Ultrahochfeld-MRT-Bildgebung bei einer Feldstärke von 7 Tesla (T) die
Darstellung kleinster anatomischer Details in vivo. Zielsetzung der folgenden
Originalarbeiten war es, den Nutzen der 7T-MRT-Bildgebung im Rahmen i) der
Darstellung von Schädigungen der weißen und grauen Substanz, ii) der
differentialdiagnostischen und pathophysiologischen Abgrenzung des Susac-
Syndroms gegenüber der MS und iii) der Evaluation frühzeitiger venöser
Alterationen im Kontext des MS-Krankheitsprozesses zu untersuchen. Methoden:
Zunächst wurden 20 MS und 14 gesunde Probanden bei Feldstärken von 7T und 1,5T
(18 Patienten) untersucht. Eine Subkohorte (8 Patienten) wurde über median
13,8 Monate beobachtet. Die einzelnen MR-Untersuchungen wurden jeweils i)
verblindet und unabhängig voneinander sowie ii) retrospektiv-vergleichend
analysiert. In einer weiteren Studie wurden 5 Patienten mit Susac-Syndrom, 10
MS-Patienten und 15 gesunde Probanden bezüglich der Morphologie von Läsionen
und der Atrophie des Corpus callosum verglichen. Zuletzt dienten zwei neu
entwickelte Verfahren der Quantifizierung der periventrikulären Venendichte
bei 38 MS-Patienten und 22 gesunden Probanden. Ergebnisse: Jede im
T2-gewichteten Bild (T2) hyperintense MS-Läsion (n=604) stellte sich im
direkten Vergleich hypointens auf korrespondierenden 7T T1-gewichteten Bildern
(T1) dar. Dagegen imponierten nur 452 von 561 T2-Plaques hypointens auf 1,5T
T1-gewichteten Bildern. Dieser Effekt war bei der verblindeten Analyse noch
deutlicher (7T T1 n=728, 1,5T T1 n=399) und auch in einer Subanalyse
kortikaler Läsionen feststellbar (7T T1 n=58, 1,5T T1 n=15). Ferner zeigten
sich Unterschiede in Bezug auf die Morphologie von 273 Susac-Läsionen (54%
perivaskulär; 4% hypointense Ringe) gegenüber 354 MS-Plaques (92%
perivaskulär, p=0,002; 41% hypointense Ringe, p=0,004) sowie Unterschiede in
Form und Ausmaß der Balkenschädigung. Weiterhin war eine signifikante
Reduktion der periventrikulären Venendichte bei Patienten mit MS (jeweils
p<0,001), früher MS (p<0,001 und p=0,001) und klinisch isoliertem Syndrom
(KIS; p=0,03 und p=0,11) gegenüber gesunden Probanden feststellbar. Deren
Ausmaß korrelierte eng mit der Krankheitsdauer (p<0,001) und der
T2-Läsionslast (p<0,001). Zusammenfassung: Die Ergebnisse deuten auf eine
strukturelle Gewebeschädigung in jeder dargestellten (kortikalen) MS-Läsion
hin, welche über den Prozess der Demyelinisierung hinausgeht.
Bildmorphologische Unterschiede zwischen dem Susac-Syndrom und der MS können
differentialdiagnostischen Nutzen haben und reflektieren die verschiedenen
Pathomechanismen (Mikroinfarkte versus Demyelinisierung) beider Entitäten.
Vaskuläre Alterationen sind, vermutlich im Kontext von metabolischen und
hämodynamischen Veränderungen, bereits in frühen Stadien der MS nachweisbar.Introduction: Magnetic resonance imaging (MRI) revolutionized diagnosis and
therapeutic drug monitoring in multiple sclerosis (MS). However, the
correlation of MR-variables with clinical parameters is modest and in some
cases an increased diagnostic specificity is highly warranted. Today,
ultrahigh field MRI at 7 Tesla (T) visualizes anatomical details with near
microscopic resolution in vivo. The aim of this study was to determine the
potential of 7T MRI i) to characterize and detect white and gray matter
pathology, and ii) to differentiate between Susac syndrome and MS. Finally,
the high spatial resolution of 7T MRI was utilized to describe venous
alterations in (early) MS. Methods: Twenty patients with MS and 14 healthy
controls (HC) underwent 7T and 1.5T (18 MS patients) MRI to characterize brain
damage. Eight patients were reassessed after a median interval of 13.8 months.
MRI data was analyzed in a separate-and-blinded approach as well as in a side-
by-side comparison of all sequences. Furthermore, MRI data derived from 5
patients with Susac syndrome, 10 MS patients and 15 HC was analyzed with
regard to atrophy of the corpus callosum and (callosal) lesion morphology. To
quantify periventricular venous density in 38 MS patients and 22 HC two novel
algorithms were applied. Results: Every hyperintensive lesion on T2 weighted
(T2w) images (n=604) depicted on 7T MRI images was also clearly delineated on
T1 weighted (T1w) images. Contrarily, 1.5T T1w MRI only visualized 452 of 561
T2w hyperintense MS lesions. Corresponding T1w hypointensity of T2w
hyperintense lesions was also detectable in cortical lesions (7T T1w n=58,
1.5T T1w n=15), and when analyzing each sequence independently (7T T1w n=728,
1.5T T1w n=399). 7T MRI revealed differences in callosal damage and the
morphology of Susac syndrome lesions (54% perivascular; 4% hypointense rim)
compared with MS plaques (92% perivascular, p=0.002; 41% hypointense rim,
p=0.004). Venous density was reduced in MS (p<0.001, p<0.001), early MS
(p<0.001, p=0.001) as well as clinical isolated syndrome (CIS, p=0.03 and
p=0.11) patients compared with HC, and correlated inversely with T2 lesion
count (p<0.001) and disease duration (p<0.001). Conclusion: Findings on T1w
hypointensity indicate structural damage beyond demyelination in every
(cortical) MS plaque depicted. Furthermore, 7T MRI revealed substantial
differences in lesion morphology between Susac syndrome and MS that may
facilitate differentiation between both entities and - in contrast to MS -
suggest microinfarction rather than demyelination underlying Susac syndrome.
On the background of hemodynamic and metabolic alterations in MS, vascular
abnormalities are detectable from the earliest clinical stages
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