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From the NMR Research Unit, Institute of Neurology, the National Hospital for Neurology and Neurosurgery, London, UK.
Address correspondence and reprint requests to Prof. D.H. Miller, NMR Research Unit, Institute of Neurology, The National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK; e-mail: d.miller{at}ion.ucl.ac.uk
OBJECTIVE: To determine whether diffusion tensor imaging (DTI) can detect structural changes in normal-appearing white matter, and to distinguish between plaques of different pathologic severity, in patients with MS.
BACKGROUND: Conventional MRI detects lesions sensitively in MS but has limited pathologic specificity. The diffusion of water molecules in brain tissue, most fully expressed mathematically by a tensor quantity, reflects its intrinsic microstructure. It is now possible to estimate the diffusion tensor noninvasively in the human brain using MR DTI. This method is unique in providing precise and rotationally invariant measurements of the amount and directional bias (anisotropy) of diffusion in white matter tracts relating to tissue integrity and orientation.
METHODS: DTI was performed in six patients with MS and in six age-matched control subjects. Diffusion was characterized in normal-appearing white matter in both groups, and in lesions of different pathologic subtypes (inflammatory, noninflammatory, T1 hypointense, and T1 isointense).
RESULTS: DTI identified significantly altered water diffusion properties in the normal-appearing white matter of patients compared with control subjects (p < 0.001), and distinguished between lesion types. The highest diffusion was seen in destructive (T1 hypointense) lesions, whereas the greatest change in anisotropy was found in inflammatory (gadolinium-enhancing) lesions.
CONCLUSIONS: DTI detects diffuse abnormalities in the normal-appearing white matter of MS patients, and the findings in lesions appear to relate to pathologic severity. Its use in serial studies and in larger clinical cohorts may increase our understanding of pathogenetic mechanisms of reversible and persistent disability.
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D. J Werring, A. T Toosy, C. A Clark, G. J. Parker, G. J Barker, D. H Miller, and A. J Thompson Diffusion tensor imaging can detect and quantify corticospinal tract degeneration after stroke J. Neurol. Neurosurg. Psychiatry, August 1, 2000; 69(2): 269 - 272. [Abstract] [Full Text] [PDF]
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D. J. Werring, D. Brassat, A. G. Droogan, C. A. Clark, M. R. Symms, G. J Barker, D. G. MacManus, A. J. Thompson, and D. H. Miller The pathogenesis of lesions and normal-appearing white matter changes in multiple sclerosis: A serial diffusion MRI study Brain, August 1, 2000; 123(8): 1667 - 1676. [Abstract] [Full Text] [PDF]
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M. Filippi, G. Iannucci, M. Cercignani, M. Assunta Rocca, A. Pratesi, and G. Comi A Quantitative Study of Water Diffusion in Multiple Sclerosis Lesions and Normal-Appearing White Matter Using Echo-Planar Imaging Arch Neurol, July 1, 2000; 57(7): 1017 - 1021. [Abstract] [Full Text] [PDF]
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L. Ferini-Strambi, M. Bozzali, M. Cercignani, A. Oldani, M. Zucconi, and M. Filippi Magnetization transfer and diffusion-weighted imaging in nocturnal frontal lobe epilepsy Neurology, June 27, 2000; 54(12): 2331 - 2333. [Abstract] [Full Text] [PDF]
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A. J. Barkovich Concepts of Myelin and Myelination in Neuroradiology AJNR Am. J. Neuroradiol., June 1, 2000; 21(6): 1099 - 1109. [Full Text]
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A. C. Scanderbeg, F. Tomaiuolo, U. Sabatini, U. Nocentini, M. G. Grasso, and C. Caltagirone Demyelinating Plaques in Relapsing-remitting and Secondary-progressive Multiple Sclerosis: Assessment with Diffusion MR Imaging AJNR Am. J. Neuroradiol., May 1, 2000; 21(5): 862 - 868. [Abstract] [Full Text]
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U C Wieshmann, M R Symms, G J M Parker, C A Clark, L Lemieux, G J Barker, and S D Shorvon Diffusion tensor imaging demonstrates deviation of fibres in normal appearing white matter adjacent to a brain tumour J. Neurol. Neurosurg. Psychiatry, April 1, 2000; 68(4): 501 - 503. [Abstract] [Full Text] [PDF]
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M. Cercignani, G. Iannucci, M. A. Rocca, G. Comi, M. A. Horsfield, and M. Filippi Pathologic damage in MS assessed by diffusion-weighted and magnetization transfer MRI Neurology, March 14, 2000; 54(5): 1139 - 1144. [Abstract] [Full Text] [PDF]
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H. Chabriat, S. Pappata, C. Poupon, C. A. Clark, K. Vahedi, F. Poupon, J. F. Mangin, M. Pachot-Clouard, A. Jobert, D. Le Bihan, et al. Clinical Severity in CADASIL Related to Ultrastructural Damage in White Matter : In Vivo Study With Diffusion Tensor MRI Stroke, December 1, 1999; 30(12): 2637 - 2643. [Abstract] [Full Text] [PDF]
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S. Hunsche, M. E. Moseley, P. Stoeter, and M. Hedehus Diffusion-Tensor MR Imaging at 1.5 and 3.0 T: Initial Observations Radiology, November 1, 2001; 221(2): 550 - 556. [Abstract] [Full Text] [PDF]
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