THE CONTRIBUTION OF DIFFUSION TENSOR IMAGING TO CONVENTIONAL MAGNETIC RESONANCE IMAGING IN THE DIAGNOSIS OF MULTIPLE SCLEROSIS PATIENTS

Yıl 2023, Cilt: 13 Sayı: 2, 170 - 175, 22.03.2023

Gülay Maçin , Fuldem Yıldırım Dönmez , Eda Derle , Ülkü Sibel Benli , A. Muhtesem Agıldere

https://doi.org/10.16899/jcm.1213743

Öz

Aim: The aim of this study is to investigate whether anisotropic diffusion is superior to conventional magnetic resonance imaging for understanding the pathophysiology of multiple sclerosis (MS) disease by Fractional anisotropy (FA) measurements.
Material and Methods: In our study, FA measurements were made from the plaque, the periplaque area, the normal appeared white matter contralateral to the plaque and normal appearing white matter areas in MS patients and from the normal white matter in the control group. 3D trography maps were made in all MS patients and it was evaluated whether white pathways were affected by MS disease.
Results: When the degree of anisotropy was compared to the control group, the degree of plaques was found lowest. Increase was observed in periplaque, the normal appeared white matter contralateral to the plaque and normal appearing white matter, respectively. The active plaque FA value was found to be lower than the chronic plaque FA value, and the chronic plaque FA was found to be lower than the normal white matter FA value. It has been shown that plaques traced along axonal pathways in MS patients cause interruption in axonal pathways.
Conclusion: Progressive decrease in anisotropy from normal appearing white matter to periplaque white matter and plaque level indicates myelin damage. This suggests that the white matter that appears normal on T2 images on conventional MR is not actually normal. Based on these results, it was thought that diffusion tensor imaging would be useful in evaluating the burden of disease in MS patients.

Anahtar Kelimeler

Multiple Sclerosis, Diffusion Tensor Imaging, Fractional Anisotropy, Magnetic Resonance Imaging

MULTİPL SKLEROZ HASTALARININ TANISINDA DİFÜZYON TENSÖR GÖRÜNTÜLEMENİN KONVANSİYONEL MANYETİK REZONANS GÖRÜNTÜLEMEYE KATKISI

Öz

Amaç: Bu çalışmanın amacı Fraksiyonel anizotropi (FA) ölçümleri ile multipl skleroz (MS) hastalığının patofizyolojisini anlamada anizotropik difüzyonun konvansiyonel manyetik rezonans görüntülemeye üstün olup olmadığını araştırmaktır.
Gereç ve yöntem: Çalışmamızda MS hastalarında plak, periplak alanı, plağın kontralateralinde normal görünen beyaz cevher ve normal görünen beyaz cevher alanlarından, kontrol grubunda ise normal beyaz cevherden FA ölçümleri yapıldı. Tüm MS hastalarında 3 boyutlu trografi haritaları yapıldı ve beyaz yolakların MS hastalığından etkilenip etkilenmediği değerlendirildi.
Bulgular: Anizotropinin derecesi kontrol grubu ile karşılaştırıldığında en düşük değer plakta saptanırken; periplak, plağın karşısında normal görünen beyaz cevher ve normal görünen beyaz cevherde anizotropinin sırasıyla arttığı izlenmiştir. Aktif plak FA, kronik plak FA’dan; kronik plak FA, normal beyaz cevherde FA’dan düşük saptanmıştır. MS hastalarında aksonal yollar boyunca izlenen plakların aksonal yollarda kesintiye neden olduğu gösterilmiştir.
Tartışma: Normal görünen beyaz cevherden plak düzeyine doğru anizotropideki progresif artış myelin hasarını göstermektedir. Bu da konvansiyonel MR'da T2 görüntülerde normal görünen beyaz cevherin aslında normal olmadığını düşündürmektedir.
Bu sonuçlara dayanarak MS hastalarında hastalık yükünün değerlendirilmesinde Difüzyon tensör görüntülemenin faydalı olacağı düşünülmüştür.

Anahtar Kelimeler

Multiple Sclerosis, Diffusion Tensor Imaging, Fractional Anisotropy, Magnetic Resonance Imaging

Kaynakça

• 1. Goldschmidt C, McGinley MP. Advances in the Treatment of Multiple Sclerosis. Neurol Clin. 2021; 39:21-33.
• 2. De Santis S, Granberg T, Ouellette R, Treaba CA, Herranz E, Fan Q, et.al. Evidence of early microstructural white matter abnormalities in multiple sclerosis from multi-shell diffusion MRI. NeuroImage Clin. 2019;22,101699.
• 3. Cunniffe N, Coles A. Promoting remyelination in multiple sclerosis. J Neurol. 2021; 268:30-44.
• 4. Haacke EM, Bernitsas E, Subramanian K, Utriainen D, Palutla VK, Yerramsetty K, et.al. A Comparison of Magnetic Resonance Imaging Methods to Assess Multiple Sclerosis Lesions: Implications for Patient Characterization and Clinical Trial Design. Diagnostics. 2021;12(1), 77.
• 5. Zollinger LV, Kim TH, Hill K, Jeong EK, Rose JW, et al. Using diffusion tensor imaging and immunofluorescent assay to evaluate the pathology of multiple sclerosis. J Magn Reson Imaging. 2011;33:557–64.
• 6. Zhou F, Zee CS, Gong H, Shiroishi M, Li J. Differential changes in deep and cortical gray matters of patients with multiple sclerosis: a quantitative magnetic resonance imaging study. J Comput Assist Tomogr. 2010;34:431–6.
• 7. Filippi M, Agosta F. Diffusion tensor imaging and functional MRI. Handb Clin Neurol. 2016;136:1065-87. 8. Taylor WD, Hsu E, Krishnan KR, MacFall JR. Diffusion tensor imaging: Background, potential, and utility in psychiatric research. Biol Psychiatry. 2004;55:201-7.
• 9. Harris AD, Pereira RS, Mitchell JR, Hill MD, Sevick RJ, Frayne R. A comparison of images generated from diffusion-weighted and diffusion-tensor imaging data in hyper-acute stroke. J Magn Reson Imaging. 2004;20:193-200.
• 10. Filippi M, Inglese M. Overview of diffusionweighted magnetic resonance studies in multiple sclerosis. J Neurol Sci. 2001;186:37-43.
• 11. Andrade RE, Gasparetto EL, Cruz LC Jr, Ferreira FB, Domingues RC, Marchiori E, et al. Evaluation of white matter in patients with multiple sclerosis through diffusion tensor magnetic resonance imaging. Arq Neuropsiquiatr. 2007; 65:561-4.
• 12. Guo AC, MacFall JR, Provenzale JM. Multiple Sclerosis: Diffusion Tensor MR Imaging for Evaluation of Normal-appearing White Matter. Radiology. 2002;222:729–36.
• 13. Guo AC, Jewells VL, Provenzale JM. Analysis of normal-appearing white matter in multiple sclerosis: comparison of diffusion tensor MR imaging and magnetization transfer imaging. AJNR Am J Neuroradiol. 2001;22:1893-900.
• 14. Sijens PE, Irwan R, Potze JH, Mostert JP, De Keyser J, Oudkerk M. Relationships between brain water content and diffusion tensor imaging parameters (apparent diffusion coefficient and fractional anisotropy) in multiplesclerosis. Eur Radiol. 2006; 16:898–904.
• 15. Hu B, Ye B, Yang Y, Zhu K, Kang Z, Kuang S, et al. Quantitative diffusion tensor deterministic and probabilistic fiber tractography in relapsing–remitting multiplesclerosis. Eur J Radiol. 2011;79:101–7.
• 16. Filippi M, Iannucci G, Cercignani M. A quantitative study of water diffusion in multiple sclerosis lesions and normal-appearing white matter using echo-planar imaging. Arch Neurol. 2000;57:1017-21.
• 17. Liu Y, Duan Y, He Y, Yu C, Wang J, Huang J, et al. Whole brain white matter changes revealed by multiple diffusion metrics in multiple sclerosis: a TBSS study. Eur J Radiol. 2012; 81:2826-32.
• 18. Rocca MA, Filippi M. Diffusion tensor and magnetization transfer MR imaging of early-onset multiple sclerosis. Neurol Sci. 2004;25:344-5.
• 19. Lipp I, Jones DK, Bells S, Sgarlata E, Foster C, Stickland R, et al. Comparing MRI metrics to quantify white matter microstructural damage in multiple sclerosis. Hum Brain Mapp. 2019;40(:2917-32.
• 20. Cassol E, Ranjeva JP, Ibarrola D, Mékies C, Manelfe C, Clanet M, et al. Diffusion tensor imaging in multiple sclerosis: a tool for monitoring changes in normal-appearing white matter. Mult Scler. 2004;10:188-96.
• 21. Castriota-Scanderbeg A, Fasano F, Hagberg G, Nocentini U, Filippi M, Caltagirone C. Coefficient D(av) is more sensitive than fractional anisotropy in monitoring progression of irreversible tissue damage in focal nonactive multiple sclerosis lesions. AJNR Am J Neuroradiol. 2003;24:663-70.
• 22. Tievsky AL, Ptak T, Farkas J. Investigation of apparent diffusion coefficient and diffusion tensor anisotrophy in acute and chronic 48 multiple sclerosis lesions. AJNR Am J Neuroradiol. 1999;20:1491-9.
• 23. Lorenzo T, Caporali L, Venditti E, Grillea G, Colonnese C. Diffusion tensor imaging applications in multiplesclerosis patients using 3T magnetic resonance: a preliminary study. Eur Radiol. 2012;22:990-7.