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Houtchens, Maria

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Houtchens

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Maria

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Houtchens, Maria

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2009 - 200912010 - 20166

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Author's Publications: search.filters.isAuthorOfPublication.cbdf5c8f-dec7-4f48-a94f-cffc17be34d2

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    3 T MRI relaxometry detects T2 prolongation in the cerebral normal-appearing white matter in multiple sclerosis
    (Elsevier BV, 2009-07-01) Neema, Mohit; Goldberg-Zimring, Daniel; Guss, Zachary D.; Healy, Brian; Guttmann, Charles; Houtchens, Maria; Weiner, Howard; Horsfield, Mark A.; Hackney, David; Alsop, David; Bakshi, Rohit
    MRI at 3 T has increased sensitivity in detecting overt multiple sclerosis (MS) brain lesions; a growing body of data suggests clinically relevant damage occurs in the normal-appearing white matter (NAWM). We tested a novel pulse sequence to determine whether 3 T MRI spin–spin relaxometry detected damage in NAWM of MS patients (n = 13) vs. age-matched normal controls [(NL) (n = 11)]. Baseline characteristics of the MS group were: age (mean ± SD) 42.5 ± 5.4 (range 33–51 years), disease duration 9.0 ± 6.4 (range 1–22 years), Expanded Disability Status Scale score 2.5 ± 1.7 (range 1–6.5). Brain MRI measures, obtained at 3 T, included global and regional NAWM transverse relaxation rate [R2 (= 1/T2)], derived from 3D fast spin-echo T2 prepared images, and global white matter volume fraction derived from SPGR images. The regional NAWM areas investigated were the frontal lobe, parietal lobe, and the genu and splenium of the corpus callosum. Mean NAWM R2 was lower (indicating T2 prolongation) in MS than NL in the whole brain (p = 0.00047), frontal NAWM (p = 0.00015), parietal NAWM (p = 0.0069) and callosal genu (p = 0.0019). Similarly, R2 histogram peak position was lower in NAWM in MS than NL in the whole brain (p = 0.019). However, the normalized WM volume fractions were similar in both MS and NL (p > 0.1). This pilot study suggests that a novel 3D fast spin-echo pulse sequence at 3 T, used to derive R2 relaxation maps, can detect tissue damage in the global and regional cerebral NAWM of MS patients that is missed by conventional lesion and atrophy measures. Such findings may represent demyelination, inflammation, glial proliferation and axonal loss.
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    The Relationships among MRI-Defined Spinal Cord Involvement, Brain Involvement, and Disability in Multiple Sclerosis
    (Wiley, 2012-04) Cohen, Adam B.; Neema, Mohit; Arora, Ashish; Dell’Oglio, Elisa; Benedict, Ralph H. B.; Tauhid, Shahamat; Goldberg-Zimring, Daniel; Chavarro-Nieto, Christian; Ceccarelli, Antonella; Klein, Joshua; Stankiewicz, James M.; Houtchens, Maria; Buckle, Guy J.; Alsop, David; Guttmann, Charles; Bakshi, Rohit
    Objective To determine the inter-relationships between MRI-defined lesion and atrophy measures of spinal cord involvement and brain involvement and their relationships to disability in a small cohort of patients with multiple sclerosis (MS). Background Although it is known that cervical spinal cord atrophy correlates with disability in MS, it is unknown whether it is the most important determinant when compared to other regions of the CNS. Furthermore, it is not clear to what extent brain and cord lesions and atrophy are related. Design/methods 3T MRI of the whole brain and whole spinal cord was obtained in 21 patients with MS, including 18 with relapsing-remitting, one with secondary progressive, one with primary progressive, and one with a clinically isolated syndrome. Brain global gray and white matter volumes were segmented with SPM8. Spinal cord contour volume was segmented in whole by a semi-automated method with bins assigned to either the cervical or thoracic regions. All CNS volumes were normalized by the intracranial volume. Brain and cord T2 hyperintense lesions were segmented using a semi-automated edge finding tool. Results Among all MRI measures, only upper cervical spinal cord volume significantly correlated with Expanded Disability Status Scale score (r=−0.515, p=0.020). The brain-cord relationships between whole or regional spinal cord volume or lesions and gray matter, white matter, or whole brain volume or whole brain lesions were generally weak and all non-significant. Conclusions/relevance In this preliminary study of mildly disabled, treated MS patients, cervical spinal cord atrophy most strongly correlates with physical disability in MS when accounting for a wide range of other CNS measures of lesions and atrophy, including thoracic or whole spinal cord volume, and cerebral gray, white or whole brain volume. The weak relationship between spinal cord and brain lesions and atrophy may suggest that they progress rather independently in patients with MS.
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    No sex-specific difference in disease trajectory in multiple sclerosis patients before and after age 50
    (BioMed Central, 2013) Bove, Riley; Musallam, Alexander; Healy, Brian; Houtchens, Maria; Glanz, Bonnie I; Khoury, Samia; Guttmann, Charles; De Jager, Philip; Chitnis, Tanuja
    Background: The disease course in multiple sclerosis (MS) is influenced by many factors, including age, sex, and sex hormones. Little is known about sex-specific changes in disease course around age 50, which may represent a key biological transition period for reproductive aging. Methods: Male and female subjects with no prior chemotherapy exposure were selected from a prospective MS cohort to form groups representing the years before (38–46 years, N=351) and after (54–62 years, N=200)age 50. Primary analysis assessed for interaction between effects of sex and age on clinical (Expanded Disability Status Scale, EDSS; relapse rate) and radiologic (T2 lesion volume, T2LV; brain parenchymal fraction, BPF) outcomes. Secondarily, we explored patient-reported outcomes (PROs). Results: As expected, there were age- and sex- related changes with male and older cohorts showing worse disease severity (EDSS), brain atrophy (BPF), and more progressive course. There was no interaction between age and sex on cross-sectional adjusted clinical (EDSS, relapse rate) or radiologic (BPF, T2LV) measures, or on 2-year trajectories of decline. There was a significant interaction between age and sex for a physical functioning PRO (SF-36): the older female cohort reported lower physical functioning than men (p=0.002). There were no differences in depression (Center for Epidemiological Study – Depression, CES-D) or fatigue (Modified Fatigue Impact Scale, MFIS) scores. Conclusions: There was no interaction between age and sex suggestive of an effect of reproductive aging on clinical or radiologic progression. Prospective analyses across the menopausal transition are needed.
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    An expanded composite scale of MRI-defined disease severity in multiple sclerosis: MRDSS2
    (Lippincott Williams & Wilkins, 2014) Bakshi, Rohit; Neema, M; Tauhid, Shahamat; Healy, Brian C.; Glanz, Bonnie; Kim, Gloria; Miller, Jennifer; Berkowitz, Julia L.; Bove, Riley; Houtchens, Maria; Severson, Christopher; Stankiewicz, James; Stazzone, Lynn; Chitnis, Tanuja; Guttmann, Charles R.G.; Weiner, Howard; Ceccarelli, Antonia
    The objective of this study was to test a new version of the Magnetic Resonance Disease Severity Scale (MRDSS2), incorporating cerebral gray matter (GM) and spinal cord involvement from 3 T MRI, in modeling the relationship between MRI and physical disability or cognitive status in multiple sclerosis (MS). Fifty-five MS patients and 30 normal controls underwent high-resolution 3 T MRI. The patients had an Expanded Disability Status Scale score of 1.6±1.7 (mean±SD). The cerebral normalized GM fraction (GMF), the T2 lesion volume (T2LV), and the ratio of T1 hypointense LV to T2LV (T1/T2) were derived from brain images. Upper cervical spinal cord area (UCCA) was obtained from spinal cord images. A within-subject d-score (difference of MS from normal control) for each MRI component was calculated, equally weighted, and summed to form MRDSS2. With regard to the relationship between physical disability and MRDSS2 or its individual components, MRI–Expanded Disability Status Scale correlations were significant for MRDSS2 (r=0.33, P=0.013) and UCCA (r=−0.33, P=0.015), but not for GMF (P=0.198), T2LV (P=0.707), and T1/T2 (P=0.240). The inclusion of UCCA appeared to drive this MRI–disability relationship in MRDSS2. With regard to cognition, MRDSS2 showed a larger effect size (P=0.035) than its individual components [GMF (P=0.081), T2LV (P=0. 179), T1/T2 (P=0.043), and UCCA (P=0.818)] in comparing cognitively impaired with cognitively preserved patients (defined by the Minimal Assessment of Cognitive Function in MS). Both cerebral lesions (T1/T2) and atrophy (GMF) appeared to drive this relationship. We describe a new version of the MRDSS, which has been expanded to include cerebral GM and spinal cord involvement. MRDSS2 has concurrent validity with clinical status.
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    Quantitative MRI study of Pineal Gland in MS.
    (2016) Egorova, Svetlana; Denes, Palma; Polgar-Turcsanyi, Mariann; Anderson, Mark; Cavallari, Michele; Guttmann, Charles; Glanz, Bonnie; Chitnis, Tanuja; Bove, Riley; Buckle, Guy; De Jager, Philip; Severson, Cristopher; Stankiewicz, James; Houtchens, Maria; Quintana, Francisco; Gandhi, Roopali; Webb, Pia; Meier, Dominik; Healy, Brian; Weiner, Howard
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    A 3T MR Imaging Investigation of the Topography of Whole Spinal Cord Atrophy in Multiple Sclerosis
    (American Society of Neuroradiology (ASNR), 2011) Klein, Joshua; Arora, A.; Neema, M; Healy, Brian; Tauhid, Shahamat; Goldberg-Zimring, D.; Chavarro-Nieto, C.; Stankiewicz, James; Cohen, Adam; Buckle, G. J.; Houtchens, Maria; Ceccarelli, A.; Dell, E.; Guttmann, Charles; Alsop, David; Hackney, David; Bakshi, Rohit
    Background and Purpose: Spinal cord atrophy is a common feature of MS. However, it is unknown which cord levels are most susceptible to atrophy. We performed whole cord imaging to identify the levels most susceptible to atrophy in patients with MS versus controls and also tested for differences among MS clinical phenotypes. Materials and Methods: Thirty-five patients with MS (2 with CIS, 27 with RRMS, 2 with SPMS, and 4 with PPMS phenotypes) and 27 healthy controls underwent whole cord 3T MR imaging. The spinal cord contour was segmented and assigned to bins representing each C1 to T12 vertebral level. Volumes were normalized, and group comparisons were age-adjusted. Results: There was a trend toward decreased spinal cord volume at the upper cervical levels in PPMS/SPMS versus controls. A trend toward increased spinal cord volume throughout the cervical and thoracic cord in RRMS/CIS versus controls reached statistical significance at the T10 vertebral level. A statistically significant decrease was found in spinal cord volume at the upper cervical levels in PPMS/SPMS versus RRMS/CIS. Conclusions: Opposing pathologic factors impact spinal cord volume measures in MS. Patients with PPMS demonstrated a trend toward upper cervical cord atrophy. However patients with RRMS showed a trend toward increased volume at the cervical and thoracic levels, which most likely reflects inflammation or edema-related cord expansion. With the disease causing both expansion and contraction of the cord, the specificity of spinal cord volume measures for neuroprotective therapeutic effect may be limited.
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    Brain MRI Lesion Load at 1.5T and 3T versus Clinical Status in Multiple Sclerosis
    (Wiley-Blackwell, 2011) Stankiewicz, James; Glanz, Bonnie; Healy, Brian; Arora, A; Neema, M; Benedict, Ralph H.B.; Guss, Zachary D.; Tauhid, Shahamat; Buckle, Guy J.; Houtchens, Maria; Khoury, Samia; Weiner, Howard; Guttmann, Charles; Bakshi, Rohit
    Background/Purpose: To assess correlation between brain lesions and clinical status with 1.5T and 3T magnetic resonance imaging (MRI). Methods: Brain MRI fluid-attenuated inversion-recovery (FLAIR) sequences were performed in 32 multiple sclerosis (MS) patients. Expanded Disability Status Scale (EDSS) score (mean ± standard deviation) was 2 ± 2.0 (range 0-8), disease duration 9.3 ± 8.0 (range .8-29) years. Results: FLAIR lesion volume (FLLV) at 3T was higher than at 1.5T (P= .01). Correlation between 1.5T FLLV and EDSS score was poor, while 3T FLLV correlated moderately and significantly (rs= .39, P= .03). When controlling for age and depression, correlations between FLLV and cognitive measures were significant at 1.5T for the Judgment of Line Orientation test (JLO) (rs=−.44, P= .05), the Symbol Digit Modalities Test (SDMT) (rs=−.49, P= .02), and the California Verbal Learning Test Delayed Free Recall (CVLT DR) (rs=−.44, P= .04). Correlations at 3T were also significant for these tests, but of greater magnitude: JLO (rs=−.70, P= .0005), SDMT (rs=−.73, P= .0001), CVLT DR (rs=−.061, P= .003). Additional significant correlations obtained only at 3T included the 2 second-paced auditory serial addition test (rs=−.55, P= .01), the Brief Visuospatial Memory Test-Delayed Free Recall (rs=−.56, P= .007), and the California Verbal Learning Test Total Recall (rs=−.42, P= .05). Conclusion: MRI at 3T may boost sensitivity and improve validity in MS brain lesion assessment.