Presently there is no clinically feasible imaging modality that can effectively detect cortical demyelination in patients with multiple sclerosis (MS). The objective of this study is to determine if clinically feasible magnetization transfer ratio (MTR) imaging is sensitive to cortical demyelination in MS.
MRI were acquired in situ on 7 recently deceased patients with MS using clinically feasible sequences at 3 T, including relatively high-resolution T1-weighted and proton density-weighted images with/without a magnetization transfer pulse for calculation of MTR. The brains were rapidly removed and placed in fixative. Multiple cortical regions from each brain were immunostained for myelin proteolipid protein and classified as mostly myelinated (MM(ctx)), mostly demyelinated (MD(ctx)), or intermediately demyelinated (ID(ctx)). MRIs were registered with the cortical sections so that the cortex corresponding to each cortical section could be identified, along with adjacent subcortical white matter (WM). Mean cortical MTR normalized to mean WM MTR was calculated for each cortical region. Linear mixed-effects models were used to test if mean normalized cortical MTR was significantly lower in demyelinated cortex.
We found that mean normalized cortical MTR was significantly lower in cortical tissue with any demyelination (ID(ctx) or MD(ctx)) compared to MM(ctx) (demyelinated cortex: least-squares mean [LSM] = 0.797, SE = 0.007; MM(ctx): LSM = 0.837, SE = 0.006; p = 0.01, n = 89).
This result demonstrates that clinically feasible MTR imaging is sensitive to cortical demyelination and suggests that MTR will be a useful tool to help detect MS cortical lesions in living patients with MS.
"Recently, MTR was mapped in the cortex of MS patients (Chen et al., 2013; Derakhshan et al., 2014) and showed similarities between myelinated regions and high MTR values. However, MTR is only a semi-quantitative metric as it depends on sequence parameters, B1 profile and T 1 relaxation (Berry et al., 1999; Pike Bruce, 1996). "
"MTI is based on the exchange of magnetization between tissue water and protons bound to macromolecules (Graham and Henkelman, 1997). Histopathological correlations demonstrated the association of lower magnetization transfer ratios (MTR) with decreasing myelin content and axonal count in both the white matter (WM) and cortex (Schmierer et al., 2007; Chen et al., 2013). In a previous study of our own group, we found a significant MTR decrease in normal appearing white matter (NAWM) and cortex with advancing age (Fazekas et al., 2005). "
[Show abstract][Hide abstract] ABSTRACT: Magnetization transfer imaging (MTI) can detect microstructural brain tissue changes and may be helpful in determining age-related cerebral damage. We investigated the association between the magnetization transfer ratio (MTR) in gray and white matter (WM) and cognitive functioning in 355 participants of the Austrian stroke prevention family study (ASPS-Fam) aged 38-86 years. MTR maps were generated for the neocortex, deep gray matter structures, WM hyperintensities, and normal appearing WM (NAWM). Adjusted mixed models determined whole brain and lobar cortical MTR to be directly and significantly related to performance on tests of memory, executive function, and motor skills. There existed an almost linear dose-effect relationship. MTR of deep gray matter structures and NAWM correlated to executive functioning. All associations were independent of demographics, vascular risk factors, focal brain lesions, and cortex volume. Further research is needed to understand the basis of this association at the tissue level, and to determine the role of MTR in predicting cognitive decline and dementia.
[Show abstract][Hide abstract] ABSTRACT: Purpose
To assess for associations between hippocampal atrophy and measures of cognitive function, hippocampal magnetization transfer ratio (MTR), and diffusion measures of the fornix, the largest efferent white matter tract from the hippocampus, in patients with multiple sclerosis (MS) and controls.
Materials and Methods
A total of 53 patients with MS and 20 age- and sex-matched healthy controls participated in cognitive testing and scanning including high spatial-resolution diffusion imaging and a T1-MPRAGE scan. Hippocampal volume and fornicial thickness measures were calculated and compared to mean values of fornicial transverse diffusivity, mean diffusivity, longitudinal diffusivity, fractional anisotropy, mean hippocampal MTR, and scores on measures of episodic memory, processing speed, and working memory tasks.
In patients with MS, hippocampal volume was significantly related to fornicial diffusion measures (P < 7 × 10–4) and to measures of verbal (P = 0.030) and visual spatial (P = 0.004) episodic memory and a measure of information processing speed (P < 0.037).
These results highlight the role of the hippocampus in cognitive dysfunction in patients with MS and suggest that measures of hippocampal atrophy could be used to capture aspects of disease progression.
Magnetic Resonance Imaging 01/2013; 32(4). DOI:10.1016/j.mri.2013.12.012 · 2.09 Impact Factor
Egil Røsjø, Linn H. Steffensen, Lone Jørgensen, Jonas C. Lindstrøm, Jūratė Šaltytė Benth, Annika E. Michelsen, Pål Aukrust, Thor Ueland, Margitta T. Kampman, Øivind Torkildsen, Trygve Holmøy
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