Grussu, F;
(2016)
Microstructural imaging of the human spinal cord with advanced diffusion MRI.
Doctoral thesis , UCL (University College London).
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Abstract
The aim of this PhD thesis is to advance the state-of-the-art of spinal cord magnetic resonance imaging (MRI) in multiple sclerosis (MS), a demyelinating, inflammatory and neurodegenerative disease of the central nervous system. Neurite orientation dispersion and density imaging (NODDI) is a recent diffusion-weighted (DW) MRI technique that provides indices of density and orientation dispersion of neuronal processes. These could be new useful biomarkers for the spinal cord, since they could better characterise overall, widespread MS pathology than conventional metrics. In this thesis, we test innovative clinically feasible acquisitions as well as signal analysis methods to study the potential of NODDI for the spinal cord. We also design and run computer simulations that corroborate our in vivo findings. Furthermore, we compare NODDI metrics to quantitative histological features, with the aim of validating their specificity. The thesis is divided in two parts. In the first part, in vivo experiments are described. Specific objectives are: i) to demonstrate the feasibility of performing NODDI in the spinal cord and in clinical settings; ii) to study the possibility of extracting with new approaches such as NODDI more specific microstructural information from standard DW acquisitions; iii) to assess how features typical of spinal cord microstructure, such as presence of large axons, influence NODDI metrics. In the second part of the thesis, ex vivo experiments are discussed. Their objective is the validation of the specificity of NODDI metrics via comparison to quantitative histology in post mortem spinal cord tissue. The experiments required the implementation of high-field DW scans as well as histological procedures and complex analysis pipelines. The results of this thesis contribute to current scientific knowledge. They prove that NODDI offers new opportunities to study how neurodegenerative diseases such as MS alter neural tissue complexity. We showed for the first time that NODDI can be performed in the spinal cord in vivo and in clinical scans. We also demonstrated that NODDI analysis of standard DW data is challenging, and quantified how the presence of large axons in the spinal cord influences NODDI metrics. Lastly, our ex vivo data highlight that unlike routine DW MRI methods, NODDI can detect reliably pathological variations of neurite orientation dispersion. NODDI is also sensitive to the density of axons and dendrites, but can not fully resolve axonal loss and demyelination in MS. We believe that the technique is a key element of a more general multi-modal MRI approach, which is necessary to obtain a complete description of complex diseases such as MS.
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