Recent reviews (Peyser & Poser, 1986; Rao, 1986) suggest that Multiple Sclerosis results in cognitive impairments in the areas of learning and memory, abstract reasoning, information processing efficiency, and, often, visual-spatial ability. Whether this pattern applies to the individual with MS is unclear. Due to the disseminated distribution of MS neuropathology, patients may undergo idiosyncratic cognitive changes dependent upon the site of white matter lesions. The present study explored this question using cluster analysis on the neuropsychological data from a group of mildly disabled MS patients (n = 177) and a well-matched control group (n=89). In a group of MS patients who were identified with unequivocal cognitive impairment, the resultant clusters indicated that MS does not result in a characteristic pattern of impairment. Two clusters were obtained that resembled the pattern described in the literature, while the majority of patients clustered into groups with specific deficits in one or two areas, with normal performance in others. In order to identify associations between cluster groups and lesion sites, frequency tables were constructed for the presence of a lesion on Magnetic Resonance Imaging in 24 brain sites. An association was obtained between two lesion sites and two cognitive tests. Visual-spatial impairment, as assessed by the Benton Visual Retention test, was associated with lesions in the genu of the corpus callosum and with more lesions throughout the corpus callosum. Impaired performance on Paired Associates, a test of learning and memory for novel verbal associations, was associated with a lesion in the deep white matter of the left parietal lobe. The results support the hypothesis that MS results in multiple patterns of cognitive impairment depending on the individual placement of white matter lesions. Identifying and characterizing the heterogeneity of the impairment may greatly increase our understanding of the role of myelin in cognition and the functions of white matter tracts in the brain.

T2 relaxation imaging can be used to measure signal from water trapped between myelin bilayers; the ratio of myelin water signal to total water is termed the myelin water fraction (MWF). First, results from multi-component T2 relaxation and diffusion tensor imaging (DTI) were compared for 19 multiple sclerosis (MS) subjects at 1.5 T to better understand how each measure is affected by pathology. In particular, it was determined that the detection of a long-T2 signal within an MS lesion may be indicative of a different underlying pathology than is present in lesions without long-T2 signal. Next, the single-slice T2 relaxation measurement was implemented, refined, and validated at 3.0 T. Scan parameters were varied for phantoms and in-vivo brain, and changes in multi-exponential fit residuals and T2 distribution-derived parameters such as MWF were monitored to determine which scan parameters minimized artifacts. Measurements were compared between 1.5 T and 3.0 T for 10 healthy volunteers. MWF maps were qualitatively similar between field strengths. MWFs were significantly higher at 3.0 T than at 1.5 T, but with a strong correlation between measurements at the different field strengths. Due to long acquisition times, multi-component T2 relaxation has thus far been clinically infeasible. The next study aimed to validate a new 3D multi-component T2 relaxation imaging technique against the 2D single-slice technique most commonly used. Ten healthy volunteers were scanned with both the 2D single-slice and 3D techniques. MWF maps were qualitatively similar between scans. MWF values were highly correlated between the acquisition methods. Although MWF values were generally lower using the 3D technique, they were only significantly so for peripheral brain structures, likely due to increased sensitivity of slab-selective refocusing pulses used for the 3D approach. The 3D T2 relaxation sequence was then applied to the study of MS to take advantage of the increased brain coverage. Thirteen MS subjects and 11 controls underwent T2 relaxation and DTI examinations to produce histograms of MWF and several DTI-derived metrics. MS MWF histograms differed considerably from those of controls, and differences in MS MWF histograms did not mirror differences in DTI histograms relative to matched controls.

A novel framework for quantitative analysis of shape and function in magnetic resonance imaging (MRI) of the brain is proposed. First, an efficient method to compute invariant spherical harmonics (SPHARM) based feature representation for real valued 3D functions was developed. This method addressed previous limitations of obtaining unique feature representations using a radial transform. The scale, rotation and translation invariance of these features enables direct comparisons across subjects. This eliminates need for spatial normalization or manually placed landmarks required in most conventional methods [1-6], thereby simplifying the analysis procedure while avoiding potential errors due to misregistration. The proposed approach was tested on synthetic data to evaluate its improved sensitivity. Application on real clinical data showed that this method was able to detect clinically relevant shape changes in the thalami and brain ventricles of Parkinson's disease patients. This framework was then extended to generate functional features that characterize 3D spatial activation patterns within ROIs in functional magnetic resonance imaging (fMRI). To tackle the issue of intersubject structural variability while performing group studies in functional data, current state-of-the-art methods use spatial normalization techniques to warp the brain to a common atlas, a practice criticized for its accuracy and reliability, especially when pathological or aged brains are involved [7-11]. To circumvent these issues, a novel principal component subspace was developed to reduce the influence of anatomical variations on the functional features. Synthetic data tests demonstrate the improved sensitivity of this approach over the conventional normalization approach in the presence of intersubject variability. Furthermore, application to real fMRI data collected from Parkinson's disease patients revealed significant differences in patterns of activation in regions undetected by conventional means. This heightened sensitivity of the proposed features would be very beneficial in performing group analysis in functional data, since potential false negatives can significantly alter the medical inference. The proposed framework for reducing effects of intersubject anatomical variations is not limited to functional analysis and can be extended to any quantitative observation in ROIs such as diffusion anisotropy in diffusion tensor imaging (DTI), thus providing researchers with a robust alternative to the controversial normalization approach.

Multi-echo T2 relaxation measurements of the human spinal cord (SC) reveal a short T2 pool of water believed to arise from water trapped between myelin bilayers, where the proportion of this water to the total water signal is called the myelin water fraction (MWF). In the present study, MWF were measured in the healthy human cervical spine at the C4-C6 vertebral levels in vivo using a 3D modified 32 echo CPMG sequence to acquire axial slices perpendicular to the cord. Volunteers were recruited in two age ranges, under 30 years old and over 50 years old, and a subset of both groups were scanned twice to test reproducibility. Mean MWF in the dorsal and lateral column WM of the group under 30 years of age was 0.29 (0.01) (mean(SE)), which agrees with previously reported MWF values in the cervical spine. The mean absolute difference between two scans was 0.06 or 26%. A negative correlation between WM MWF and age was hinted at in these findings, however more subjects are required to improve statistical power. This study paves the way for the use of 3D myelin water imaging in the cervical spine at 3.0T for the assessment of SC WM pathology.

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This doctoral dissertation presents a series of studies that were conducted to investigate the relationship between morphological, as well as functional, changes and clinical disability in multiple sclerosis (MS) using magnetic resonance imaging (MRI) and functional MRI (fMRI). / The extent of macroscopic brain tissue damage, as seen on T2-weighted MRI scans, is poorly correlated with measures of functional impairment in MS. We hypothesized that this might be due to the failure to take lesion location into account. By combining sophisticated lesion segmentation tools with the statistical and stereotaxic techniques of functional neuroimaging, we have shown a relationship between lesion location and the extent and type of physical and cognitive disability. / Brain atrophy is another manifestation of MS. We conducted the first large-scale study of focal cortical atrophy in MS that uses cortical thickness measurements across the entire cortex. We present evidence that cortical atrophy occurs relatively early in the course of the disease, despite the lack of severe disability in MS patients, as assessed by the Expanded Disability Status Scale (EDSS), and follows a pattern of focal thinning that is more pronounced in areas that are heavily inter-connected with other brain regions, such as anterior cingulate cortex and association areas, suggesting that interruption of white matter tracts by MS plaques might play a causative role in cortical atrophy. / Finally, we conducted an fMRI study of working memory in controls, cognitively unimpaired and impaired MS patients that revealed significant differences in the regions that were activated between the groups. Most interestingly, while both cognitively unimpaired MS patients and control subjects significantly activated the left dorsolateral prefrontal cortex and the left thalamus, cognitively impaired MS patients failed to significantly activate these areas. Levels of deactivation within the medial prefrontal/anterior cingulate cortices and posterior cingulate cortex were inferior in MS patients than in controls. This study suggests that with an increased white matter lesion volume there is an increased damage to a number of afferents and efferents to and from the thalamus (cortico-basal ganglia-thalamo-cortical loops and other thalamo-cortical projections) that ultimately causes the observed cognitive deficits. These cognitive deficits seem also to be dependent on a reduced capacity of MS patients to show task-related deactivations.

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