Magnetic Resonance Phase Alterations in Multiple Sclerosis Patients with Short and Long Disease Duration

PLOS ONE, Dec 2019

Objective The analysis of the MR phase provides additional information on the tissue microstructure. In multiple sclerosis (MS) lesions phase alterations may reflect different stages of inflammatory activity. Here we investigated lesion morphology in MS patients with short and long disease duration on T2* weighted, phase, magnitude and susceptibility weighted imaging (SWI) at 7 Tesla (T). Methods 17 MS or clinically isolated syndrome patients with short (<60 months) and 11 with long (>60 months) disease duration underwent 7T MRI. Lesions were subsequently analyzed side-by-side with regard to morphology and visibility on T2* weighted, SWI, magnitude and SWI-filtered phase images. Results 126 of 192 T2* weighted lesions (65.6%) were characterized by a phase alteration pattern, and hence could be differentiated on phase images. In detail, a significantly reduced proportion of lesions showing phase alterations was detectable in patients with longer disease duration (mean±SD 51±37%, range 0–100%) compared to patients with short disease duration (mean±SD 90±19.5%, range 50–100%, p = 0.003). Conclusion This cross-sectional study identified different patterns of phase changes in lesions of MS patients with short and long standing disease. Longitudinal studies are warranted to prove that MR phase imaging is useful in determining the activity and the developmental stage of individual MS plaques.

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Magnetic Resonance Phase Alterations in Multiple Sclerosis Patients with Short and Long Disease Duration

July Magnetic Resonance Phase Alterations in Multiple Sclerosis Patients with Short and Long Disease Duration Ivan Bozin 0 1 2 Yulin Ge 0 1 2 Joseph Kuchling 0 1 2 Petr Dusek 0 1 2 Sanjeev Chawla 0 1 2 Lutz Harms 0 1 2 Klemens Ruprecht 0 1 2 Thoralf Niendorf 0 1 2 Friedemann Paul 0 1 2 Ilya Kister 0 1 2 Tim Sinnecker 0 1 2 Jens Wuerfel 0 1 2 0 1 NeuroCure Clinical Research Center, Charité -Universitaetsmedizin Berlin , Berlin, Germany , 2 Department of Radiology, NYU School of Medicine , New York , New York, United States of America, 3 Institute of Neuroradiology, Universitaetsmedizin Goettingen , Goettingen, Germany , 4 Department of Neurology and Center of Clinical Neuroscience, Charles University in Prague, 1st Faculty of Medicine and General University Hospital in Prague , Prague , Czech Republic , 5 Clinical and Experimental Multiple Sclerosis Research Center, Charité Universitaetsmedizin Berlin , Berlin, Germany , 6 Department of Neurology, Charité-Universitaetsmedizin Berlin , Berlin, Germany, 7 Berlin Ultrahigh Field Facility , Max Delbrueck Center for Molecular Medicine , Berlin, Germany , 8 Experimental and Clinical Research Center, Charité-Universitaetsmedizin Berlin and Max Delbrueck Center for Molecular Medicine , Berlin, Germany , 9 Multiple Sclerosis Care Center, Department of Neurology, NYU School of Medicine , New York , New York, United States of America, 10 Department of Neurology, Asklepios Fachklinikum Teupitz , Teupitz , Germany 1 Funding: This work was supported by the German Research Foundation (DFG Exc 257 to F.P.) and by the German Ministry of Education and Research (Competence Network Multiple Sclerosis KKNMS to F.P. and J.W.) and a research grant from the Guthy Jackson Charitable Foundation/the National Multiple Sclerosis Society of the USA , F.P. and J.W. 2 Editor: Yi Wang, Cornell University , UNITED STATES The analysis of the MR phase provides additional information on the tissue microstructure. - Competing Interests: The authors have declared that no competing interests exist. In multiple sclerosis (MS) lesions phase alterations may reflect different stages of inflammatory activity. Here we investigated lesion morphology in MS patients with short and long disease duration on T2* weighted, phase, magnitude and susceptibility weighted imaging 17 MS or clinically isolated syndrome patients with short (<60 months) and 11 with long (>60 months) disease duration underwent 7T MRI. Lesions were subsequently analyzed side-by-side with regard to morphology and visibility on T2* weighted, SWI, magnitude and 126 of 192 T2* weighted lesions (65.6%) were characterized by a phase alteration pattern, and hence could be differentiated on phase images. In detail, a significantly reduced proportion of lesions showing phase alterations was detectable in patients with longer disease duration (mean±SD 51±37%, range 0–100%) compared to patients with short disease duration (mean±SD 90±19.5%, range 50–100%, p = 0.003). This cross-sectional study identified different patterns of phase changes in lesions of MS patients with short and long standing disease. Longitudinal studies are warranted to prove that MR phase imaging is useful in determining the activity and the developmental stage of individual MS plaques. Multiple Sclerosis (MS) is an inflammatory, demyelinating and neurodegenerative central nervous system disease [1]. Magnetic resonance imaging (MRI) improved early MS diagnosis by demonstrating spatiotemporal lesion dissemination. However, conventional MR parameters are not specific for MS, and correlate moderately with clinical disability—a phenomenon termed “clinico-radiological paradox” [2]. Today, ultrahigh field MRI at 7 Tesla (T) visualizes focal MS lesions in great detail [3–5]. Gaining from increased signal to noise ratio and enhanced susceptibility effects, MS lesions on 7T T2 weighted (T2 w) images frequently display a small central vein. A proportion of lesions also exhibits a hypointense rim. Both characteristics can be used to distinguish MS from other white-matter pathologies such as neuromyelitis optica [5], Susac syndrome [6], and white matter lesions of presumably vascular origin [7,8], which consequently improves the diagnosis of MS [9]. Early reports [9–11] suggested that the T2 hypointense rim surrounding MS plaques is caused by microglia and macrophages containing iron—a paramagnetic metal involved in (repair-) processes that are abnormal within the MS brain [12]. However, the underlying pathomechanism causing susceptibility related signal loss at the edges of such lesions in T2 w MRI is still not fully understood. Recently, rim-like phase abnormalities in MS lesions were correlated with increased inflammatory activity of the evolving MS plaque [13]. Susceptibility induced magnetic resonance (MR) phase alterations may contain additional information on tissue microstructure [14], exceeding alterations in MR signal magnitude. However, the MR phase of the white matt (...truncated)


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Ivan Bozin, Yulin Ge, Joseph Kuchling, Petr Dusek, Sanjeev Chawla, Lutz Harms, Klemens Ruprecht, Thoralf Niendorf, Friedemann Paul, Ilya Kister, Tim Sinnecker, Jens Wuerfel. Magnetic Resonance Phase Alterations in Multiple Sclerosis Patients with Short and Long Disease Duration, PLOS ONE, 2015, 7, DOI: 10.1371/journal.pone.0128386