Ακολουθούν οι περιλήψεις και των υπόλοιπων πόστερ γύρω από τη ΧΕΝΦΑ, στα οποία δεν έγινε αναφορά στη ζωντανή διαδικτυακή παρουσίαση της Τετάρτης (14 Απριλίου 2010) -
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[P03.126] Chronic Cerebrospinal Venous Insufficiency and Iron Deposition on Susceptibility-Weighted Imaging in Patients with Multiple Sclerosis
Michael G. Dwyer, Buffalo, NY, Paolo Zamboni, Ferrera, Italy, Mark Haacke, Detroit, MI, Erica Menegatti, Ferrara, Italy, Bianca Weinstock-Guttman, Claudiu Schirda, Buffalo, NY, Anna M. Malagoni, Ferrara, David Hojnacki, Cheryl Kennedy, Ellen Carl, Niels Bergsland, Sara Hussein, Mari Heininen-Brown, Buffalo, NY, Ilaria Bartolomei, Fabrizio Salvi, Ferrera, Italy , Robert Zivadinov, Buffalo, NY
OBJECTIVE: To investigate the relationship between chronic cerebrospinal venous insufficiency (CCSVI) and iron deposition in the brain of multiple sclerosis (MS) patients by correlating venous hemodynamic (VH) parameters and iron concentration in deep-gray matter (DGM) structures and lesions, as measured by susceptibility-weighted imaging (SWI). To preliminarily define the relationship between iron measures and disability outcomes.
BACKGROUND: CCSVI is a vascular picture recently described in MS patients that is characterized by stenoses affecting the main extracranial venous outflow pathways and by a high rate of cerebral venous reflux that may lead to increased iron deposition in the brain.
DESIGN/METHODS: Sixteen (16) consecutive relapsing-remitting MS patients (mean age 36.1 7.3 yrs, mean disease duration 7.5 1.9 yrs and median EDSS 2.5) and 8 age- and sex-matched normal controls (NC) were scanned on a GE 3T scanner, by using SWI. Iron concentration was measured in the following DGM structures: thalamus, caudate, putamen, globus pallidus, hippocampus, amygdala, nucleus accumbens, red nucleus and substantia nigra. Iron concentration was also measured in T2, T1, SWI phase and SWI magnitude lesions. Diagnosis of the CCSVI was established based on the previously published VH Doppler criteria (Zamboni, JNNP, 2009).
RESULTS: All 16 MS patients fulfilled the diagnosis of CCSVI (median VH=4, median VHISS=9) and none of the NC. There was a significant association between higher number of VH criteria and higher iron concentration in T2 (r=0.64, p=0.007) and T1 (r=0.56, p=0.023) lesion volumes. The only DGM structure that correlated significantly with VH criteria was globus pallidus (r=0.58, p=0.019). No relationship was observed for NC. Higher iron concentration in DGM structures was predictive of higher disability status (EDSS) in almost all examined regions. The highest correlations were detected for thalamus (r=0.79, p<0.0001) and red nucleus (r=0.7, p=0.005).
CONCLUSIONS/RELEVANCE: The findings from this pilot study suggest that CCSVI may be an important mechanism leading to iron deposition in brain parenchyma of MS patients. In turn, iron deposition, as measured by SWI, is a strong predictor of disability progression in patients with MS. Supported by: Hillarescere Foundation and Buffalo Neuroimaging Analysis Center.
Category - MS and Related Diseases - Clinical Science
Wednesday, April 14, 2010 7:30 AM
Poster Session III: Multiple Sclerosis and Related Diseases: MRI/Technique (7:30 AM-12:00 PM)
[P03.128] Hypoperfusion of Brain Parenchyma Is Strongly Associated with the Severity of Chronic Cerebrospinal Venous Insufficiency in Patients with Multiple Sclerosis
Paolo Zamboni, Italy, Eric Menegatti, Ferrera, Italy, Bianca Weinstock-Guttman, Michael G. Dwyer, Claudiu Schirda, Buffalo, NY, Anna Maria Malagoni, Ferrera, NY, Italy, David Hojnacki, Cheryl Kennedy, Ellen Carl, Niels Bergsland, Christopher Magnano, Buffalo, NY, Ilaria Bartolomei, Bologna, Italy, Fabrizio Salvi, Cesena (FC), Italy, Robert Zivadinov, Buffalo, NY
OBJECTIVE: To investigate the relationship between chronic cerebrospinal venous insufficiency (CCSVI) and cerebral perfusion in patients with multiple sclerosis (MS).
BACKGROUND: CCSVI is a vascular condition described in MS patients, characterized by stenoses of the main extracranial veins with hampered cerebral venous outflow. We hypothesized that the impaired venous outflow contributes to hypoperfusion of brain parenchyma.
DESIGN/METHODS: Sixteen consecutive relapsing-remitting MS patients (mean age 36.1yrs, mean disease duration 7.5yrs and median EDSS 2.5) and 8 age- and sex-matched normal controls (NC), were scanned on a GE 3T scanner using dynamic susceptibility contrast enhanced perfusion-weighted imaging (PWI). Cerebral blood flow (CBF), blood volume (CBV) and mean transit time (MTT) were measured in the gray matter (GM), white matter (WM), normal appearing (NA) GM, NAWM, thalamus, caudate, putamen, globus pallidus, hippocampus, amygdala, nucleus accumbens, red nucleus and substantia nigra. Diagnosis of CCSVI was established based on the venous hemodynamic (VH) Doppler criteria (Zamboni, JNNP, 2009) and the severity was based on fulfilled VH criteria (score 0-5) and VH insufficiency severity score (VHISS) (score 0-16).
RESULTS: All 16 MS patients fulfilled the diagnosis of CCSVI (median VH=4, median VHISS=9) and none of the NC. There was a significant association between VH criteria and VHISS, and CBF, CBV and MTT in all examined regions of the brain parenchyma in MS patients. The most robust correlations were observed for lower CBF and higher VHISS in the GM, WM, NAGM and NAWM (r= -0.70 to -0.72, p<0.002), and in the thalamus, caudate, putamen, hippocampus, nucleus accumbens (r= -0.6 to -0.72, p<0.008). The correlation coefficients for CBV and MTT were in a range between r= -0.5 to -0.65. No relationship was observed for NC.
CONCLUSIONS/RELEVANCE: This study demonstrates that severity of CCSVI is directly associated with hypoperfusion of the brain parenchyma in MS. Supported by: Hillarescere Foundation and Buffalo Neuroimaging Analysis Center.
Category - MS and Related Diseases - Clinical Science
Wednesday, April 14, 2010 7:30 AM
Poster Session III: Multiple Sclerosis and Related Diseases: MRI/Technique (7:30 AM-12:00 PM)
[IN7-1.003] Quantitative Venous Vasculature Assessment on Susceptibility-Weighted Imaging Reflects Presence of Severe Chronic Venous Insufficiency in the Brain Parenchyma of Multiple Sclerosis Patients. A Case-Control Study
Guy U. Poloni, Buffalo, NY, Paolo Zamboni, Ferrara, Italy, Mark Haacke, Detroit, MI, Stefano Bastianello, Pavia, Italy, Michael G. Dwyer, Niels Bergsland, Claudiu Schirda, David Wack, Christopher Magnano, Bianca Weinstock-Guttman, Buffalo, NY, Fabrizio Salvi, Ferrara, Italy, David Hojnacki, Robert Zivadinov, Buffalo, NY
OBJECTIVE: To develop an objective method for quantifying venous vasculature in brain parenchyma on susceptibility-weighted imaging (SWI). To apply this technique in multiple sclerosis (MS) patients and in healthy controls (HC).
BACKGROUND: SWI is a MRI application that can directly image cerebral veins by exploiting venous blood oxygenation.
DESIGN/METHODS: Sixty-two (62) MS patients (44 relapsing-remitting and 18 secondary-progressive) and 33 age- and sex-matched HC were imaged on a 3T GE scanner using pre-contrast SWI. A subset of MS patients (50) and HC (7) obtained SWI-post gadolinium contrast sequence (0.1 mMol/Kg Gd-DTPA with 10 min delay). In-house developed segmentation algorithm, based on a 3D multi-scale line filter, was applied for vein segmentation. Absolute volumetric measurement for total vein vasculature was performed in milliliters (ml) and the relative venous intracranial fraction (VIF) was obtained to correct for head size and amount of brain atrophy. The size of individual veins was measured in mm and 4 groups were created according to their mean diameter: <0.3mm, 0.3-0.6mm, 0.6-0.9mm and >0.9 mm. Voxel brain average distance-from-vein maps was also calculated with higher distance indicating fewer veins.
RESULTS: A significantly lower absolute venous volume was detected in MS patients compared to HC, both in pre-contrast (67.5 vs. 82.7ml, -18.3%, p<0.001) and post-contrast (70.4 vs. 87.1ml, -19.1%, p<0.011) images. The VIF was significantly lower in MS patients (p<0.001). The highest mean diameter difference was found for the smallest veins (<0.3 mm), both on pre- (p<0.001) and post-contrast (p<0.018) images. The distance-from-veins was also significantly higher in MS patients (p<0.001).
CONCLUSIONS/RELEVANCE: We developed and validated a quantitative vein segmentation method that showed altered visibility of venous vasculature on SWI pre- and post-contrast images in MS patients. These findings suggest severely compromised brain venous system in MS patients.
Category - MS and Related Diseases - Clinical Science
Wednesday, April 14, 2010 2:30 PM
Platform Session: Integrated Neuroscience: Multiple Sclerosis Imaging (2:00 PM-3:30 PM)
[IN7-2.006] Objective Quantification of Cerebrospinal Fluid (CSF) Flow Rate in Cerebral Aqueduct in Patients with Multiple Sclerosis
Claudiu Schirda, Buffalo, NY, Paolo Zamboni, Ferrera, Italy, Christopher Magnano, Eric Lindzen, David Wack, Bianca Weinstock-Guttman, Deepa Ramasamy, Ellen Carl, David Hojnacki, Cheryl Kennedy, Michael G. Dwyer, Niels Bergsland, Jennifer L. Cox, Buffalo, NY, Fabrizion Salvi, Ferrera, Italy, Robert Zivadinov, Buffalo, NY
OBJECTIVE: To develop an objective MRI technique for quantifying the cerebrospinal fluid (CSF) flow in Sylvius aqueduct. To apply this technique in a pilot study in multiple sclerosis (MS) patients versus normal controls (NC) and provide further correlates with other MRI specific disease metrics.
BACKGROUND: Non-invasive MRI investigation of the CSF dynamics in MS has not been previously reported.
DESIGN/METHODS: For consistency and objective quantification of the antegrade (towards 4th ventricle), retrograde (towards 3rd ventricle) and net CSF flow rates, a semi-automated program was developed. The CSF flow quantification technique was validated on a tube phantom, using a power injector which provided a controlled flow rate. 2 NC and 2 MS patients were scanned and rescanned within a week, to test reproducibility. Sixteen (16) consecutive relapsing-remitting MS patients and 8 age- and sex-matched NC were scanned on a GE 3T scanner using a two-dimensional phase-contrast gradient-echo MR technique with high spatial-temporal resolution (in-plane resolution 0.39x.039mm2 and 32 phases, corresponding to a full cardiac cycle) on one 4mm thick slice positioned perpendicular to the Sylvius aqueduct. In addition to CSF flow measures, lesion volume (LV) and atrophy MRI outcomes were calculated.
RESULTS: Net CSF flow scan-rescan reproducibility was 10.9%. Net CSF flow rate (stroke volume) was significantly lower in MS patients than in NC (p=0.038). In MS patients, T1-LV was strongly correlated with CSF retrograde (r=0.71, p=0.002) and antegrade flow rates (r=-0.64, p=0.008). T2-LV was also related to CSF flow rate (0.58, p=0.019). Lower net CSF flow rate was related to gray matter (r=-0.63, p=0.009), whole brain and cortical atrophy (p<0.037).
CONCLUSIONS/RELEVANCE: CSF flow rate in the Sylvius aqueduct is significantly lower in MS patients than in NC. In MS patients, robust correlations between higher LVs, and advanced atrophy, and altered flow rate measures were found.
Category - MS and Related Diseases - Clinical Science
Wednesday, April 14, 2010 3:30 PM
Poster Session: Integrated Neuroscience: Multiple Sclerosis Imaging (3:30 PM-4:30 PM)
Ντέ και καλά, να με κάτσει στο καροτσάκι... 
" Από τον ...της μυλωνούς, μή ζητάμε και ορθογραφία 
Τού εξήγησα ότι επρόκειτο για σπαστικές παραπαρέσεις, και απάντησε ότι "έγραφαν και τα δύο". Επέμεινα ότι επρόκειτο για σπαστικότητα, και μου είπε να του στείλω ένα μέηλ με αυτά που "ηθελα" να δει ΑΝ μπορεί να μου τα γράψει...
