FRINK Linked Data Fragments server

Matches in SemOpenAlex for { <https://semopenalex.org/work/W2955621644> ?p ?o ?g. }

• W2955621644 endingPage "722" @default.
• W2955621644 startingPage "721" @default.
• W2955621644 abstract "HomeRadiologyVol. 292, No. 3 PreviousNext Reviews and CommentaryFree AccessEditorialUsing Dynamic Contrast-enhanced MRI as an Imaging Biomarker for Migraine: Proceed with CautionTimothy J. Carroll , Daniel Thomas GinatTimothy J. Carroll , Daniel Thomas GinatAuthor AffiliationsFrom the Department of Radiology, University of Chicago, 5841 S Maryland Ave, Chicago, IL 60637.Address correspondence to T.J.C. (e-mail: [email protected]).Timothy J. Carroll Daniel Thomas GinatPublished Online:Jul 2 2019https://doi.org/10.1148/radiol.2019191159MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In See also the article by Y.S. Kim and M. Kim et al in this issue.IntroductionMigraine and other severe headaches are a common and major public health problem, especially among reproductive-aged women (1). Migraine is an episodic, multifactorial, neurovascular disorder, which is a diagnosis of exclusion. MRI is used in cases of suspected migraine to rule out more serious conditions, such as tumors, aneurysms, infections, and hydrocephalus. There are no known imaging biomarkers specific to migraine despite the development of high–field-strength scanners and advanced physiologic imaging (eg, perfusion, diffusion, functional MRI), although neurovascular abnormalities in large and small vessels are observed in migraine sufferers.In this issue of Radiology, Kim et al found that those with migraines tend to have lower fractional plasma volume (Vp) in the left amygdala in association with heightened permeability in the blood-brain barrier, as depicted on dynamic contrast-enhanced (DCE) MRI (2). This is consistent with the implication of abnormal functional connectivity and gray matter volume of the amygdala in the pathogenesis of migraines (3).The authors prospectively recruited a series of study participants to undergo a DCE MRI to determine the contrast agent kinetics in the brains of those suspected of having migraine. The MRI protocol consisted of a multiphase, highly T1-weighted imaging, which is commonly used to perform pharmacokinetic modeling of parenchyma. The DCE MRI protocols are designed to be optimally sensitive to T1 changes and must be acquired during the intravenous infusion of a gadolinium-based contrast agent (short repetition time, short echo time, low flip angle). Transient signal changes resulting from the leakage of the contrast agent from the intravascular space indicate the pathologic compromise of the patient’s blood-brain barrier. The time series of the images acquired at MRI were subjected to mathematical modeling by using an algorithm that determines the rate of leakage through the blood-brain barrier (denoted Ktrans) and the Vp of the tissue from transient signal changes associated with uptake of the contrast agent. Parametric images that quantify both Ktrans and Vp were then aligned with anatomic images and segmented to determine the average values of Ktrans and Vp over 34 different anatomic regions (see Table E2 [online] in the Kim et al article) by using the Patlak method. They found that Vp values in the left amygdala of migraine sufferers were lower than in control subjects. Their work provides what appears to be the first observation of a potential biomarker for migraine.MRI has been used to study migraine since the 1980s, with indications of cerebrovascular imaging findings as early as 1994 (4). There is a well-known association between migraine, ischemia, and white matter hyperintense lesions. Subclinical white matter and posterior-circulation ischemic infarction are hallmarks of migraine. There have even been reports that arteriole occlusion from microembolism acts as a trigger for migraine. It therefore stands to reason that DCE MRI for the evaluation of perfusion and the breakdown of the blood-brain barrier would be sensitive to migraine.Currently, neuroimaging is not necessary for the workup of patients with episodic migraine with typical headache features (according to the classification of the International Headache Society) and a normal neurologic examination (5). However, neuroimaging has yielded insights into the mechanism of migraines. In particular, there is disrupted connectivity of the pain pathway, with involvement of the brainstem and limbic system, as well as abnormal function of the visual network in patients with aura (6). Of note, the right and left amygdala play distinct roles. Women with higher harm-avoidance scores have greater left amygdala resting-state functional connectivity and show prefrontal cortical regions involved in affective disturbances (7).This work by Kim et al has the potential to change the identification of migraine from a diagnosis of exclusion to a widely available imaging biomarker. However, we need to proceed with caution. This single-center study with a very low number of participants cannot dictate a change in treatment or even recommendations. Furthermore, this study was performed at a high-end, prestigious research institute, and the use of such a biomarker must be easy to implement in other radiology departments. Therefore, the use of contrast kinetics as an imaging biomarker will require the demonstration that Vp of the amygdala be successfully observed at other sites. This is critical for widespread use. In reproducing these findings, great care needs to be taken to avoid preselection bias in follow-up studies. Also, we recommend a double-blinded study toward this end.The long-term goal of any imaging biomarker for disease is to change the treatment of patients and to provide a subclinical target for any intervention. To properly characterize a biomarker of disease, we must not only determine the sensitivity and specificity of the marker as reported by Kim et al, but also establish the accuracy, reproducibility, and reliability in clinical use outside the research setting. We applaud the authors for reporting the test-retest reproducibility; however, we believe the reproducibility of their reported postprocessing is only one component that should be evaluated. The repeatability of the acquisition must also be evaluated. Simply rerunning the postprocessing software is a necessary but insufficient test of reproducibility. Furthermore, the accuracy of the Vp and Ktransmeasurements needs to be quantified. This is not a trivial question since “reference standard” reference values are not readily available to validate the quantification of Ktrans. However, the quantification of plasma volume is possible with dynamic susceptibility contrast MR perfusion scans (8), which could serve as a cross check on the validity of their proposed marker of migraine. Alternatively, the use of internal reference values for normal Vp has been successfully integrated into day-to-day clinical practice when comparing tumor perfusion to that of normal-appearing white matter (9). Finally, future work should focus on use of the marker to improve our understanding of the pathophysiology of migraine.Once confirmed in a larger cohort, MRI permeability could potentially serve as a biomarker for assessing disease status, particularly in conjunction with the development of innovative therapies. The potential of having a diagnostic biomarker for migraine would be transformative to the field. However, the interpretation of these early findings and potential widespread adaptation requires some caution. Although the use of macrocyclic gadolinium-based contrast agents dramatically reduces deposits in the brain, the use of gadolinium-based MRI contrast agent continues to be an issue. Given the chronic nature of migraine, the diagnostic workup must also consider total lifetime dose of gadolinium.The question of how a limited gadolinium-based contrast dose will be allocated raises the issue of how a diagnostic MRI protocol for migraine will be performed. In the future, PET tracers could potentially be integrated into a comprehensive MRI-PET workup that includes high-resolution angiography, dark blood wall imaging, DCE MRI, and post-gadolinium T1 imaging of small vessel disease. The wide range of developed physiologic and neurofunctional MRI and PET scans may need to be examined in a multifactorial study to improve and understand the mechanisms of migraine.The array of scans we propose seems broad, but it is likely that as the mechanism of migraine becomes better understood and individual radiologists improve the identification of markers, simpler, faster scan protocols will be developed. However, we also must consider that the adaptation of dynamic contrast-enhanced MRI for the routine diagnosis of patients with suspected migraines may add to the growing concern that imaging is overutilized for nonacute headache evaluation amid rising health care costs (10).Disclosures of Conflicts of Interest: T.J.C. Activities related to the present article: disclosed no relevant relationships. Activities not related to the present article: disclosed institutional grants from NIH; patents for which no royalties are received; and receipt of payment for travel expenses for a conference. Other relationships: disclosed payment received from SCALE-PWI pulse sequence for issued patent and from Seimens Medical Systems for licensed patent. D.T.G. disclosed no relevant relationships.References1. Smitherman TA, Burch R, Sheikh H, Loder E. The prevalence, impact, and treatment of migraine and severe headaches in the United States: a review of statistics from national surveillance studies. Headache 2013;53(3):427–436. Crossref, Medline, Google Scholar2. Kim YS, Kim M, Choi SH, et al. Altered vascular permeability in migraine-associated brain regions: evaluation with dynamic contrast-enhanced MRI. Radiology 2019;292:713–720. Link, Google Scholar3. Chen Z, Chen X, Liu M, Dong Z, Ma L, Yu S. Altered functional connectivity of amygdala underlying the neuromechanism of migraine pathogenesis. J Headache Pain 2017;18(1):7. Crossref, Medline, Google Scholar4. Pavese N, Canapicchi R, Nuti A, et al. White matter MRI hyperintensities in a hundred and twenty-nine consecutive migraine patients. Cephalalgia 1994;14(5):342–345. Crossref, Medline, Google Scholar5. Holle D, Obermann M. The role of neuroimaging in the diagnosis of headache disorders. Ther Adv Neurol Disorder 2013;6(6):369–374. Crossref, Medline, Google Scholar6. Russo A, Silvestro M, Tedeschi G, Tessitore A. Physiopathology of migraine: what have we learned from functional imaging? Curr Neurol Neurosci Rep 2017;17(12):95. Crossref, Medline, Google Scholar7. Baeken C, Marinazzo D, Van Schuerbeek P, et al. Left and right amygdala - mediofrontal cortical functional connectivity is differentially modulated by harm avoidance. PLoS One 2014;9(4):e95740. Crossref, Medline, Google Scholar8. Shin W, Horowitz S, Ragin A, Chen Y, Walker M, Carroll TJ. Quantitative cerebral perfusion using dynamic susceptibility contrast MRI: evaluation of reproducibility and age- and gender-dependence with fully automatic image postprocessing algorithm. Magn Reson Med 2007;58(6):1232–1241. Crossref, Medline, Google Scholar9. Wetzel SG, Cha S, Johnson G, et al. Relative cerebral blood volume measurements in intracranial mass lesions: interobserver and intraobserver reproducibility study. Radiology 2002;224(3):797–803. Link, Google Scholar10. Sandrini G, Friberg L, Jänig W, et al. Neurophysiological tests and neuroimaging procedures in non-acute headache: guidelines and recommendations. Eur J Neurol 2004;11(4):217–224. Crossref, Medline, Google ScholarArticle HistoryReceived: May 21 2019Revision requested: May 28 2019Revision received: May 28 2019Accepted: May 29 2019Published online: July 02 2019Published in print: Sept 2019 FiguresReferencesRelatedDetailsCited ByCerebral blood flow alterations in migraine patients with and without aura: An arterial spin labeling studyTongFu, LindongLiu, XiaobinHuang, DiZhang, YujiaGao, XindaoYin, HaiLin, YongmingDai, XinyingWu2022 | The Journal of Headache and Pain, Vol. 23, No. 1Accompanying This ArticleAltered Vascular Permeability in Migraine-associated Brain Regions: Evaluation with Dynamic Contrast-enhanced MRIJul 2 2019RadiologyRecommended Articles Altered Vascular Permeability in Migraine-associated Brain Regions: Evaluation with Dynamic Contrast-enhanced MRIRadiology2019Volume: 292Issue: 3pp. 713-720Role of Cerebellar Dentate Functional Connectivity in Balance Deficits in Patients with Multiple SclerosisRadiology2017Volume: 287Issue: 1pp. 267-275Psychoradiology: The Frontier of Neuroimaging in PsychiatryRadiology2016Volume: 281Issue: 2pp. 357-372Identification of the Somatomotor Network from Language Task–based fMRI Compared with Resting-State fMRI in Patients with Brain LesionsRadiology2021Volume: 301Issue: 1pp. 178-184Blood-Brain Barrier Leakage in Patients with Early Alzheimer DiseaseRadiology2016Volume: 281Issue: 2pp. 527-535See More RSNA Education Exhibits Resting-state FMRI Seed-based Connectivity Map as a Diagnostic Visualization Biomarkers in Different Brain DisordersDigital Posters2022Practical Approach To Read A Brain FDG PET Scan In Suspected Dementia.Digital Posters2021What Do We Know About Emerging Methods for Imaging The Glymphatic System?Digital Posters2022 RSNA Case Collection Mesial temporal sclerosisRSNA Case Collection2020Normal Pressure HydrocephalusRSNA Case Collection2021Septo-optic dysplasiaRSNA Case Collection2020 Vol. 292, No. 3 Metrics Altmetric Score PDF download" @default.
• W2955621644 created "2019-07-12" @default.
• W2955621644 creator A5025076266 @default.
• W2955621644 creator A5090718782 @default.
• W2955621644 date "2019-09-01" @default.
• W2955621644 modified "2023-09-28" @default.
• W2955621644 title "Using Dynamic Contrast-enhanced MRI as an Imaging Biomarker for Migraine: Proceed with Caution" @default.
• W2955621644 cites W1973604459 @default.
• W2955621644 cites W1985377697 @default.
• W2955621644 cites W2026904620 @default.
• W2955621644 cites W2061146787 @default.
• W2955621644 cites W2101120359 @default.
• W2955621644 cites W2112338728 @default.
• W2955621644 cites W2163487803 @default.
• W2955621644 cites W2548057738 @default.
• W2955621644 cites W2766503868 @default.
• W2955621644 cites W2955341095 @default.
• W2955621644 doi "https://doi.org/10.1148/radiol.2019191159" @default.
• W2955621644 hasPubMedId "https://pubmed.ncbi.nlm.nih.gov/31268824" @default.
• W2955621644 hasPublicationYear "2019" @default.
• W2955621644 type Work @default.
• W2955621644 sameAs 2955621644 @default.
• W2955621644 citedByCount "3" @default.
• W2955621644 countsByYear W29556216442022 @default.
• W2955621644 countsByYear W29556216442023 @default.
• W2955621644 crossrefType "journal-article" @default.
• W2955621644 hasAuthorship W2955621644A5025076266 @default.
• W2955621644 hasAuthorship W2955621644A5090718782 @default.
• W2955621644 hasBestOaLocation W29556216441 @default.
• W2955621644 hasConcept C126322002 @default.
• W2955621644 hasConcept C126838900 @default.
• W2955621644 hasConcept C143409427 @default.
• W2955621644 hasConcept C154945302 @default.
• W2955621644 hasConcept C185592680 @default.
• W2955621644 hasConcept C2776502983 @default.
• W2955621644 hasConcept C2778541695 @default.
• W2955621644 hasConcept C2781197716 @default.
• W2955621644 hasConcept C2989005 @default.
• W2955621644 hasConcept C2994142346 @default.
• W2955621644 hasConcept C41008148 @default.
• W2955621644 hasConcept C41727105 @default.
• W2955621644 hasConcept C45664433 @default.
• W2955621644 hasConcept C55493867 @default.
• W2955621644 hasConcept C71924100 @default.
• W2955621644 hasConceptScore W2955621644C126322002 @default.
• W2955621644 hasConceptScore W2955621644C126838900 @default.
• W2955621644 hasConceptScore W2955621644C143409427 @default.
• W2955621644 hasConceptScore W2955621644C154945302 @default.
• W2955621644 hasConceptScore W2955621644C185592680 @default.
• W2955621644 hasConceptScore W2955621644C2776502983 @default.
• W2955621644 hasConceptScore W2955621644C2778541695 @default.
• W2955621644 hasConceptScore W2955621644C2781197716 @default.
• W2955621644 hasConceptScore W2955621644C2989005 @default.
• W2955621644 hasConceptScore W2955621644C2994142346 @default.
• W2955621644 hasConceptScore W2955621644C41008148 @default.
• W2955621644 hasConceptScore W2955621644C41727105 @default.
• W2955621644 hasConceptScore W2955621644C45664433 @default.
• W2955621644 hasConceptScore W2955621644C55493867 @default.
• W2955621644 hasConceptScore W2955621644C71924100 @default.
• W2955621644 hasIssue "3" @default.
• W2955621644 hasLocation W29556216441 @default.
• W2955621644 hasLocation W29556216442 @default.
• W2955621644 hasOpenAccess W2955621644 @default.
• W2955621644 hasPrimaryLocation W29556216441 @default.
• W2955621644 hasRelatedWork W1989199855 @default.
• W2955621644 hasRelatedWork W2009208664 @default.
• W2955621644 hasRelatedWork W2035808363 @default.
• W2955621644 hasRelatedWork W2124931441 @default.
• W2955621644 hasRelatedWork W2288638702 @default.
• W2955621644 hasRelatedWork W2378988804 @default.
• W2955621644 hasRelatedWork W2783825050 @default.
• W2955621644 hasRelatedWork W2916725408 @default.
• W2955621644 hasRelatedWork W3135267232 @default.
• W2955621644 hasRelatedWork W3196777194 @default.
• W2955621644 hasVolume "292" @default.
• W2955621644 isParatext "false" @default.
• W2955621644 isRetracted "false" @default.
• W2955621644 magId "2955621644" @default.
• W2955621644 workType "article" @default.