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Sodium Intensity Changes Differ Between Relaxation- and Density-Weighted MRI in Multiple Sclerosis

Introduction: The source of Tissue Sodium Concentration (TSC) increase in Multiple Sclerosis (MS) remains unclear, and could be attributed to altered intracellular sodium concentration or tissue microstructure. This paper investigates sodium in MS using three new MRI sequences. Methods: Three sodium...

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Autores principales: Stobbe, Robert, Boyd, Annie, Smyth, Penelope, Emery, Derek, Valdés Cabrera, Diana, Beaulieu, Christian
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8323606/
https://www.ncbi.nlm.nih.gov/pubmed/34335450
http://dx.doi.org/10.3389/fneur.2021.693447
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author Stobbe, Robert
Boyd, Annie
Smyth, Penelope
Emery, Derek
Valdés Cabrera, Diana
Beaulieu, Christian
author_facet Stobbe, Robert
Boyd, Annie
Smyth, Penelope
Emery, Derek
Valdés Cabrera, Diana
Beaulieu, Christian
author_sort Stobbe, Robert
collection PubMed
description Introduction: The source of Tissue Sodium Concentration (TSC) increase in Multiple Sclerosis (MS) remains unclear, and could be attributed to altered intracellular sodium concentration or tissue microstructure. This paper investigates sodium in MS using three new MRI sequences. Methods: Three sodium scans were acquired at 4.7 T from 30 patients (11 relapsing-remitting, 10 secondary-progressive, 9 primary-progressive) and 9 healthy controls including: Density-Weighted (NaDW), with very short 30° excitation for more accurate TSC measurement; Projection Acquisition with Coherent MAgNetization (NaPACMAN), designed for enhanced relaxation-based contrast; and Soft Inversion Recovery FLuid Attenuation (NaSIRFLA), developed to reduce fluid space contribution. Signal was measured in both lesions (n = 397) and normal appearing white matter (NAWM) relative to controls in the splenium of corpus callosum and the anterior and posterior limbs of internal capsule. Correlations with clinical and cognitive evaluations were tested over all MS patients. Results: Sodium intensity in MS lesions was elevated over control WM by a greater amount for NaPACMAN (75%) than NaDW (35%), the latter representing TSC. In contrast, NaSIRFLA exhibited lower intensity, but only for region specific analysis in the SCC (−7%). Sodium intensity in average MS NAWM was not significantly different than control WM for either of the three scans. NaSIRFLA in the average NAWM and specifically the posterior limb of internal capsules positively correlated with the Paced Auditory Serial Addition Test (PASAT). Discussion: Lower NaSIRFLA signal in lesions and ~2× greater NaPACMAN signal elevation over control WM than NaDW can be explained with a demyelination model that also includes edema. A NAWM demyelination model that includes tissue atrophy suggests no signal change for NaSIRFLA, and only slightly greater NAWM signal than control WM for both NaDW and NaPACMAN, reflecting experimental results. Models were derived from previous total and myelin water fraction study in MS with T2-relaxometry, and for the first time include sodium within the myelin water space. Reduced auditory processing association with lower signal on NaSIRFLA cannot be explained by greater demyelination and its modeled impact on the three sodium MRI sequences. Alternative explanations include intra- or extracellular sodium concentration change. Relaxation-weighted sodium MRI in combination with sodium-density MRI may help elucidate microstructural and metabolic changes in MS.
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spelling pubmed-83236062021-07-31 Sodium Intensity Changes Differ Between Relaxation- and Density-Weighted MRI in Multiple Sclerosis Stobbe, Robert Boyd, Annie Smyth, Penelope Emery, Derek Valdés Cabrera, Diana Beaulieu, Christian Front Neurol Neurology Introduction: The source of Tissue Sodium Concentration (TSC) increase in Multiple Sclerosis (MS) remains unclear, and could be attributed to altered intracellular sodium concentration or tissue microstructure. This paper investigates sodium in MS using three new MRI sequences. Methods: Three sodium scans were acquired at 4.7 T from 30 patients (11 relapsing-remitting, 10 secondary-progressive, 9 primary-progressive) and 9 healthy controls including: Density-Weighted (NaDW), with very short 30° excitation for more accurate TSC measurement; Projection Acquisition with Coherent MAgNetization (NaPACMAN), designed for enhanced relaxation-based contrast; and Soft Inversion Recovery FLuid Attenuation (NaSIRFLA), developed to reduce fluid space contribution. Signal was measured in both lesions (n = 397) and normal appearing white matter (NAWM) relative to controls in the splenium of corpus callosum and the anterior and posterior limbs of internal capsule. Correlations with clinical and cognitive evaluations were tested over all MS patients. Results: Sodium intensity in MS lesions was elevated over control WM by a greater amount for NaPACMAN (75%) than NaDW (35%), the latter representing TSC. In contrast, NaSIRFLA exhibited lower intensity, but only for region specific analysis in the SCC (−7%). Sodium intensity in average MS NAWM was not significantly different than control WM for either of the three scans. NaSIRFLA in the average NAWM and specifically the posterior limb of internal capsules positively correlated with the Paced Auditory Serial Addition Test (PASAT). Discussion: Lower NaSIRFLA signal in lesions and ~2× greater NaPACMAN signal elevation over control WM than NaDW can be explained with a demyelination model that also includes edema. A NAWM demyelination model that includes tissue atrophy suggests no signal change for NaSIRFLA, and only slightly greater NAWM signal than control WM for both NaDW and NaPACMAN, reflecting experimental results. Models were derived from previous total and myelin water fraction study in MS with T2-relaxometry, and for the first time include sodium within the myelin water space. Reduced auditory processing association with lower signal on NaSIRFLA cannot be explained by greater demyelination and its modeled impact on the three sodium MRI sequences. Alternative explanations include intra- or extracellular sodium concentration change. Relaxation-weighted sodium MRI in combination with sodium-density MRI may help elucidate microstructural and metabolic changes in MS. Frontiers Media S.A. 2021-07-14 /pmc/articles/PMC8323606/ /pubmed/34335450 http://dx.doi.org/10.3389/fneur.2021.693447 Text en Copyright © 2021 Stobbe, Boyd, Smyth, Emery, Valdés Cabrera and Beaulieu. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Neurology
Stobbe, Robert
Boyd, Annie
Smyth, Penelope
Emery, Derek
Valdés Cabrera, Diana
Beaulieu, Christian
Sodium Intensity Changes Differ Between Relaxation- and Density-Weighted MRI in Multiple Sclerosis
title Sodium Intensity Changes Differ Between Relaxation- and Density-Weighted MRI in Multiple Sclerosis
title_full Sodium Intensity Changes Differ Between Relaxation- and Density-Weighted MRI in Multiple Sclerosis
title_fullStr Sodium Intensity Changes Differ Between Relaxation- and Density-Weighted MRI in Multiple Sclerosis
title_full_unstemmed Sodium Intensity Changes Differ Between Relaxation- and Density-Weighted MRI in Multiple Sclerosis
title_short Sodium Intensity Changes Differ Between Relaxation- and Density-Weighted MRI in Multiple Sclerosis
title_sort sodium intensity changes differ between relaxation- and density-weighted mri in multiple sclerosis
topic Neurology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8323606/
https://www.ncbi.nlm.nih.gov/pubmed/34335450
http://dx.doi.org/10.3389/fneur.2021.693447
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