of Gadolinium-Enhancing Leukocortical Lesions Josefina Maranzano, MD - - PowerPoint PPT Presentation

Magnetization Transfer Time Courses in the Grey and White Matter Volumes

• f Gadolinium-Enhancing

Leukocortical Lesions

Josefina Maranzano, MD1, Mahsa Dadar, MSc1, Nuha Alkhawajah, MD2, Parya MomayyezSiahkal, PhD1, David A. Rudko, PhD1, Robert Brown, PhD1, Stuart Cook, MD3, Diego Cadavid, MD3, Leo Wolansky, MD4 , Louis D. Collins, PhD1, Douglas L. Arnold, MD1, and Sridar Narayanan, PhD1.

1 Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada 2 King Saud University, King Khalid University Hospital, Riyadh, SA 3 Rutgers-New Jersey Medical School, Newark, New Jersey, USA 4 University of Connecticut, School of Medicine, Farmington, USA

Objective

To compare magnetization transfer evolution in the GM and WM regions of gadolinium-enhancing leukocortical lesions, before and after the gadolinium- enhancement event.

Background: Our previous work has shown that Gd+ LCLs, although not frequent (6% of all enhancing lesions) do affect a considerable number of recently diagnosed relapsing-remitting MS patients (36% in our cohort)1

1. Maranzano J, Rudko DA, Nakamura K, Cook S, Cadavid D, Wolansky L, Arnold DL, Narayanan S. MRI evidence of acute inflammation in leukocortical lesions of patients with early multiple sclerosis. Neurology 2017; 89 (7) 714-721.

Methods

25 early-stage MS patients with 3T MRI monthly scans with triple dose gadolinium 78 Gd+ LCLs separated into WM and GM ROIs

Fat Sat MTR T1-w Post- Gad T0 = gd+ timepoint

Propagation forward Propagation backward

T+1 T+1 T+2 T+2 T-1 T-1 T-2 T-2

Results: GM & WM Gd+ lesion MTR time courses

Matlab R 2017a. Mixed effect model Mean MTR ~ 1 + TissueType * Event + TissueType * Resolution + Time : Event + (1 | subjectID) + (1 | LesionID)

Fat Sat MTR

(mean) Gd+ WM ROI + Gd+ GM ROI NAWM ROI NAGM ROI

Post-hoc single factor analysis in different tissue types of resolved and non-resolved lesions. Mean MTR ~ 1 + Event + (1 | subjectID) + (1 | LesionID) Lesions that resolve Lesions that do not resolve Fat Sat MTR

(mean) Gd+ WM ROI + Gd+ GM ROI NAWM ROI NAGM ROI

Results: Gd+ lesions that resolve or not on T2/FLAIR

Conclusion

MTR decreases in the GM portion of LCLs after Gd enhancement suggest that at least some cortical demyelination is due to BBB breakdown The persistence of the MTR decreases over time, even in LCLs that resolve on conventional MRI, may underlie observations of low normal-appearing cortical MTR in MS patients

Acknowledgements

• Sridar Narayanan, PhD
• Douglas Arnold, MD
• David Rudko, PhD
• Kunio Nakamura, PhD
• Nuha Alkhawajah, MD
• Robert Brown, PhD
• Parya Momayyezsiahkal, PhD
• Dante Dinigris, PhD
• Simon Francis, MSc
• Haz-Edine Assemlal, PhD
• Dumitru Fetco, MD
• Aki Caramanos, MSc
• Rozie Arnaoutelis

Magnetic Resonance Studies Laboratory, Montreal Neurological Institute, McGill University

• Mahsa Dadar, MSc
• Louis Collins, PhD

NeuroImaging and Surgical Tools Laboratory, Montreal Neurological Institute, McGill University

• Stuart Cook, MD
• Diego Cadavid, MD

Rutgers-New Jersey Medical School, Newark, New Jersey, USA

• Leo Wolansky, MD

University of Connecticut, School of Medicine, Farmington, CT, USA

The BECOME study was supported by Bayer Schering Pharma, but was investigator-initiated and remains the intellectual property of Rutgers–New Jersey Medical School, Newark, New Jersey. John McCrae Fellowship, Faculty of Medicine of McGill University supports Josefina Maranzano