RESUMO
BACKGROUND: Clinical trials for upcoming disease-modifying therapies of spinocerebellar ataxias (SCA), a group of rare movement disorders, lack endpoints sensitive to early disease progression, when therapeutics will be most effective. In addition, regulatory agencies emphasize the importance of biological outcomes. OBJECTIVES: READISCA, a transatlantic clinical trial readiness consortium, investigated whether advanced multimodal magnetic resonance imaging (MRI) detects pathology progression over 6 months in preataxic and early ataxic carriers of SCA mutations. METHODS: A total of 44 participants (10 SCA1, 25 SCA3, and 9 controls) prospectively underwent 3-T MR scanning at baseline and a median [interquartile range] follow-up of 6.2 [5.9-6.7] months; 44% of SCA participants were preataxic. Blinded analyses of annual changes in structural, diffusion MRI, MR spectroscopy, and the Scale for Assessment and Rating of Ataxia (SARA) were compared between groups using nonparametric testing. Sample sizes were estimated for 6-month interventional trials with 50% to 100% treatment effect size, leveraging existing large cohort data (186 SCA1, 272 SCA3) for the SARA estimate. RESULTS: Rate of change in microstructural integrity (decrease in fractional anisotropy, increase in diffusivities) in the middle cerebellar peduncle, corona radiata, and superior longitudinal fasciculus significantly differed in SCAs from controls (P < 0.005), with high effect sizes (Cohen's d = 1-2) and moderate-to-high responsiveness (|standardized response mean| = 0.6-0.9) in SCAs. SARA scores did not change, and their rate of change did not differ between groups. CONCLUSIONS: Diffusion MRI is sensitive to disease progression at very early-stage SCA1 and SCA3 and may provide a >5-fold reduction in sample sizes relative to SARA as endpoint for 6-month-long trials. © 2024 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
Assuntos
Progressão da Doença , Imageamento por Ressonância Magnética , Ataxias Espinocerebelares , Humanos , Ataxias Espinocerebelares/diagnóstico por imagem , Ataxias Espinocerebelares/patologia , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Imageamento por Ressonância Magnética/métodosRESUMO
In this paper, we present a new formulation for recovering the fiber tract geometry within a voxel from diffusion weighted magnetic resonance imaging (MRI) data, in the presence of single or multiple neuronal fibers. To this end, we define a discrete set of diffusion basis functions. The intravoxel information is recovered at voxels containing fiber crossings or bifurcations via the use of a linear combination of the above mentioned basis functions. Then, the parametric representation of the intravoxel fiber geometry is a discrete mixture of Gaussians. Our synthetic experiments depict several advantages by using this discrete schema: the approach uses a small number of diffusion weighted images (23) and relatively small b values (1250 s/mm2), i.e., the intravoxel information can be inferred at a fraction of the acquisition time required for datasets involving a large number of diffusion gradient orientations. Moreover our method is robust in the presence of more than two fibers within a voxel, improving the state-of-the-art of such parametric models. We present two algorithmic solutions to our formulation: by solving a linear program or by minimizing a quadratic cost function (both with non-negativity constraints). Such minimizations are efficiently achieved with standard iterative deterministic algorithms. Finally, we present results of applying the algorithms to synthetic as well as real data.