Person: Stankiewicz, James
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Stankiewicz
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James
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Stankiewicz, James
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Publication 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, AntoniaThe 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.Publication 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, HowardPublication 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, RohitBackground 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.Publication 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, RohitBackground/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.Publication Normal Findings on Brain Fluid-Attenuated Inversion Recovery MR Images at 3T(American Society of Neuroradiology (ASNR), 2009) Neema, M; Guss, Z.D.; Stankiewicz, James; Arora, A; Healy, Brian; Bakshi, RohitBackground and Purpose: Fluid attenuated inversion recovery (FLAIR) MR imaging of the brain has become a routine tool for assessing lesions in patients with suspected neurologic disorders. There is growing interest in 3T brain FLAIR MR imaging but little normative data are available. The purpose of this study was to evaluate the frequency and topography of cerebral hyperintensities seen with FLAIR MR imaging of the brain at 3T in a normal population and compare those findings to 1.5T.Materials and Methods: Whole-brain 2D FLAIR MR imaging was performed in 22 healthy controls (mean age, 44 ± 8 years; range, 30–53 years) at 3T. Fifteen of these subjects also underwent 2D FLAIR at 1.5T, with similar optimized parameters and voxel size. Cerebral hyperintense areas, including discrete foci, anterior and posterior periventricular capping, diffuse parenchymal hyperintensity, septal hyperintensity, corticospinal tract hyperintensity, and CSF flow artifacts were assessed. The Spearman rank test assessed the correlation between discrete hyperintense foci and age. The Wilcoxon signed rank test compared foci detectability at 3T versus 1.5T. Results: FLAIR at 3T commonly showed hyperintensities such as discrete foci (mean, 10.68 per subject; at least 1 present in 68% of subjects), anterior and posterior periventricular capping, diffuse posterior white matter hyperintensity, septal hyperintensity, corticospinal tract hyperintensity, and ventricular CSF flow artifacts. FLAIR at 3T showed a higher hyperintense foci volume (170 ± 243 versus 93 ± 152 mm3, P < .01) and number (9.4 ± 13 versus 5.5 ± 9.2, P < .01) than at 1.5T. No significant differences (P = .68) in the length/diameter of individual discrete hyperintense foci were seen between 3T and 1.5T. Discrete foci volume (r = 0.72 at 3T, r = 0.70 at 1.5T) and number (r = 0.74 at 3T; r = 0.69 at 1.5T) correlated with age to a similar degree on both platforms. All discrete foci were confined to the noncallosal supratentorial white matter. The other nonfocal hyperintensities (anterior and posterior periventricular capping, diffuse parenchymal hyperintensity, septal hyperintensity, corticospinal tract hyperintensity, and CSF flow artifacts) were generally more common and prominent at 3T than at 1.5T. Conclusions: Discrete and diffuse parenchymal brain white matter FLAIR hyperintensities are more common and prominent at 3T than at 1.5T in healthy volunteers.Publication Spinal Cord Lesions and Clinical Status in Multiple Sclerosis: A 1.5 T and 3 T MRI Study(Elsevier BV, 2009-04-15) Stankiewicz, James; Neema, Mohit; Alsop, David; Healy, Brian; Arora, Ashish; Buckle, Guy J.; Chitnis, Tanuja; Guttmann, Charles; Hackney, David; Bakshi, RohitObjective Assess the relationship between spinal cord T2 hyperintense lesions and clinical status in multiple sclerosis (MS) with 1.5 and 3T MRI. Methods Whole cord T2-weighted fast spin-echo MRI was performed in 32 MS patients [Expanded Disability Status Scale (EDSS) score (mean±SD: 2±1.9), range 0–6.5]. Protocols at 1.5T and 3T were optimized and matched on voxel size. Results Moderate correlations were found between whole cord lesion volume and EDSS score at 1.5T (rs =.36, p=0.04), but not at 3T (rs =0.13, p=0.46). Pyramidal Functional System Score (FSS) correlated with thoracic T2 lesion number (rs=.46, p=0.01) and total spinal cord lesion number (rs=0.37, p=0.04) and volume (rs=0.37, p=0.04) at 1.5T. Bowel/bladder FSS correlated with T2 lesion volume and number in the cervical, thoracic, and total spine at 1.5T (rs 0.400.57, all p<0.05). These MRI-FSS correlations were non-significant at 3T. However, these correlation coefficients did not differ significantly between platforms (Choi’s test p>0.05). Correlations between whole cord lesion volume and timed 25-foot walk were non-significant at 1.5T and 3T (p>0.05). Lesion number and volume did not differ between MRI platforms in the MS group (p>0.05). Conclusions Despite the use of higher field MRI strength, the link between spinal lesions and MS disability remains weak. The 1.5T and 3T protocols yielded similar results for many comparisons.