Heterogeneity of multiple sclerosis lesions in fast diffusional kurtosis imaging.

Christian Thaler,Maxim Bester,Sune Jespersen,Maria Stark,Brian Hansen,Jens Fiehler,Jan-Patrick Stellmann,Marie T Nawka,Susanne Gellißen,Anna A Kyselyova,Klarissa H Stürner,Christoph Heesen,Tobias D Faizy

doi:10.1371/journal.pone.0245844

Abstract

Mean kurtosis (MK), one of the parameters derived from diffusion kurtosis imaging (DKI), has shown increased sensitivity to tissue microstructure damage in several neurological disorders. Thirty-seven patients with relapsing-remitting MS and eleven healthy controls (HC) received brain imaging on a 3T MR scanner, including a fast DKI sequence. MK and mean diffusivity (MD) were measured in the white matter of HC, normal-appearing white matter (NAWM) of MS patients, contrast-enhancing lesions (CE-L), FLAIR lesions (FLAIR-L) and black holes (BH). Overall 1529 lesions were analyzed, including 30 CE-L, 832 FLAIR-L and 667 BH. Highest MK values were obtained in the white matter of HC (0.814 ± 0.129), followed by NAWM (0.724 ± 0.137), CE-L (0.619 ± 0.096), FLAIR-L (0.565 ± 0.123) and BH (0.549 ± 0.12). Lowest MD values were obtained in the white matter of HC (0.747 ± 0.068 10-3mm2/sec), followed by NAWM (0.808 ± 0.163 10-3mm2/sec), CE-L (0.853 ± 0.211 10-3mm2/sec), BH (0.957 ± 0.304 10-3mm2/sec) and FLAIR-L (0.976 ± 0.35 10-3mm2/sec). While MK differed significantly between CE-L and non-enhancing lesions, MD did not. MK adds predictive value to differentiate between MS lesions and might provide further information about diffuse white matter injury and lesion microstructure.

Highlights

Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system, presenting a broad spectrum of histopathological processes, such as inflammation, demyelination, axonal loss and the formation of astrocytic scars [1,2,3]
Highest Mean kurtosis (MK) values were obtained in the white matter of healthy controls (HC) (0.814 ± 0.129), followed by normal-appearing white matter (NAWM) (0.724 ± 0.137), contrast-enhancing lesions (CE-L) (0.619 ± 0.096), FLAIR lesions (FLAIR-L) (0.565 ± 0.123) and black holes (BH) (0.549 ± 0.12)
Lowest mean diffusivity (MD) values were obtained in the white matter of HC (0.747 ± 0.068 10−3mm2/sec), followed by NAWM (0.808 ± 0.163 10−3mm2/sec), CE-L (0.853 ± 0.211 10−3mm2/sec), BH (0.957 ± 0.304 10−3mm2/sec) and FLAIR-L (0.976 ± 0.35 10−3mm2/sec)

Summary

Introduction

Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system, presenting a broad spectrum of histopathological processes, such as inflammation, demyelination, axonal loss and the formation of astrocytic scars [1,2,3]. While conventional MRI techniques are mostly limited to quantify lesion count, lesion volume and the detection of contrast-enhancing lesions (CE-L), quantitative MRI techniques allow the detection of diffuse white and gray matter injury [4,5,6] Advanced techniques such as diffusion tensor imaging (DTI) have shown promising results to identify blood-brainbarrier breakdown in lesions without the application of gadolinium [7, 8]. Mean kurtosis (MK), one of the parameters derived from DKI, has shown increased sensitivity to tissue microstructure in several neurological disorders such as stroke, head trauma, glioma and neurodegenerative diseases [12,13,14,15]. Mean kurtosis (MK), one of the parameters derived from diffusion kurtosis imaging (DKI), has shown increased sensitivity to tissue microstructure damage in several neurological disorders

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