« on: July 20, 2015, 11:56:49 am »
From JAMA Neurology, July 20, 2015:
Association of Cortical Lesion Burden on 7-T Magnetic Resonance Imaging With Cognition and Disability in Multiple Sclerosis
Daniel M. Harrison, MD1,2; Snehashis Roy, PhD3; Jiwon Oh, MD2,4; Izlem Izbudak, MD5; Dzung Pham, PhD3; Susan Courtney, PhD6; Brian Caffo, PhD7; Craig K. Jones, PhD5,8; Peter van Zijl, PhD5,8; Peter A. Calabresi, MD2
Author Affiliations
1Department of Neurology, School of Medicine, University of Maryland, Baltimore
2Department of Neurology, School of Medicine, The Johns Hopkins University, Baltimore, Maryland
3Center for Neuroscience and Regenerative Medicine, Henry Jackson Foundation, Bethesda, Maryland
4Department of Neurology, University of Toronto, Toronto, Ontario, Canada
5Department of Radiology and Radiological Science, School of Medicine, The Johns Hopkins University, Baltimore, Maryland
6Department of Psychological and Brain Sciences, The Johns Hopkins University, Baltimore, Maryland
7Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
8F. M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland
Importance
Cortical lesions (CLs) contribute to physical and cognitive disability in multiple sclerosis (MS). Accurate methods for visualization of CLs are necessary for future clinical studies and the****utic trials in MS.
Objective
To evaluate the clinical relevance of measures of CL burden derived from high-field magnetic resonance imaging (MRI) in MS.
Design, Setting, and Participants
An observational clinical imaging study was conducted at an academic MS center. Participants included 36 individuals with MS (30 relapsing-remitting, 6 secondary or primary progressive) and 15 healthy individuals serving as controls. The study was conducted from March 10, 2010, to November 23, 2012, and analysis was performed from June 1, 2011, to September 30, 2014. Seven-Tesla MRI of the brain was performed with 0.5-mm isotropic resolution magnetization-prepared rapid acquisition gradient echo (MPRAGE) and whole-brain, 3-dimensional, 1.0-mm isotropic resolution magnetization–prepared, fluid-attenuated inversion recovery (MPFLAIR). Cortical lesions, seen as hypointensities on MPRAGE, were manually segmented. Lesions were classified as leukocortical, intracortical, or subpial. Images were segmented using the Lesion-TOADS (Topology-Preserving Anatomical Segmentation) algorithm, and brain structure volumes and white matter (WM) lesion volume were reported. Volumes were normalized to intracranial volume.
Main Outcomes and Measures
Physical disability was measured by the Expanded Disability Status Scale (EDSS). Cognitive disability was measured with the Minimal Assessment of Cognitive Function in MS battery.
Results
Cortical lesions were noted in 35 of 36 participants (97%), with a median of 16 lesions per participant (range, 0-99). Leukocortical lesion volume correlated with WM lesion volume (ρ = 0.50; P = .003) but not with cortical volume; subpial lesion volume inversely correlated with cortical volume (ρ = −0.36; P = .04) but not with WM lesion volume. Total CL count and volume, measured as median (range), were significantly increased in participants with EDSS scores of 5.0 or more vs those with scores less than 5.0 (count: 29 [11-99] vs 13 [0-51]; volume: 2.81 × 10−4 [1.30 × 10−4 to 7.90 × 10−4] vs 1.50 × 10−4 [0 to 1.01 × 10−3]) and in cognitively impaired vs unimpaired individuals (count: 21 [0-99] vs 13 [1-54]; volume: 3.51 × 10−4 [0 to 1.01 × 10−4] vs 1.19 × 10−4 [0 to 7.17 × 10−4]). Cortical lesion volume correlated with EDSS scores more robustly than did WM lesion volume (ρ = 0.59 vs 0.36). Increasing log[CL volume] conferred a 3-fold increase in the odds of cognitive impairment (odds ratio [OR], 3.36; 95% CI, 1.07-10.59; P = .04) after adjustment for age and sex and a 14-fold increase in odds after adjustment for WM lesion volume and atrophy (OR, 14.26; 95% CI, 1.06-192.37; P = .045). Leukocortical lesions had the greatest effect on cognition (OR for log [leukocortical lesion volume], 9.65; 95% CI, 1.70-54.59, P = .01).
Conclusions and Relevance
This study provides in vivo evidence that CLs are associated with cognitive and physical disability in MS and that leukocortical and subpial lesion subtypes have differing clinical relevance. Quantitative assessments of CL burden on high-field MRI may further our understanding of the development of disability and progression in MS and lead to more effective treatments.
The abstract can be seen
here.
« Last Edit: July 24, 2015, 01:55:38 pm by agate »
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SPMS, diagnosed 1980. Avonex 2001-2004. Copaxone 2007-2010. Glatopa (glatiramer acetate 40mg 3 times/week) since 12/16/20.