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Thebault S, R Tessier D, Lee H, Bowman M, Bar-Or A, Arnold DL, L Atkins H, Tabard-Cossa V, Freedman MS. High serum neurofilament light chain normalizes after hematopoietic stem cell transplantation for MS. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2019; 6:e598. [PMID: 31516913 PMCID: PMC6715458 DOI: 10.1212/nxi.0000000000000598] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 04/29/2019] [Indexed: 12/02/2022]
Abstract
Objective To evaluate neurofilament light chain (NfL) levels in serum and CSF of patients with aggressive MS pre- and post-treatment with immunoablation followed by autologous hematopoietic stem cell transplantation (IAHSCT) and examine associations with clinical and MRI outcomes. Methods Paired serum and CSF in addition to MRI and clinical measures were collected on 23 patients with MS at baseline and 1 and 3 years post-IAHSCT. An additional 33 sera and CSF pairs were taken from noninflammatory neurologic controls. NfL levels were quantitated using the Simoa platform (Quanterix). Results Baseline MS NfL levels were significantly elevated relative to controls in serum (p = 0.001) and CSF (p = 0.001). Following IAHSCT, high pretreatment NfL levels significantly reduced in serum (p = 0.0023) and CSF (p = 0.0068) and were not significantly different from controls. Serum and CSF NfL levels highly correlated (r = 0.81, p < 0.0001). Baseline NfL levels were associated with worse pretreatment disease measures (Expanded Disability Status Scale [EDSS], relapses, MRI lesions, and MR spectroscopy (MRS) N-acetylaspartate/creatine). Elevated baseline NfL levels were associated with persistently worse indices of disease burden post-IAHSCT (sustained EDSS progression, cognition, quality of life, T1 and T2 lesion volumes, MRS, and brain atrophy). Conclusion These data substantiate that serum and CSF NfL levels reflect disease severity and treatment response in patients with MS and may therefore be a useful biomarker. Baseline serum levels associated with markers of pretreatment disease severity and post-treatment outcomes. Classification of evidence This study provides Class II evidence that for patients with aggressive MS, serum NfL levels are associated with disease severity.
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Affiliation(s)
- Simon Thebault
- The University of Ottawa and Ottawa Hospital Research Institute (S.T., M.B., H.L.A., M.S.F.); Department of Physics (D.R.T., V.T.-C.), University of Ottawa; Montreal Neurological Institute (H.L., D.L.A.); and Perelman School of Medicine and University of Pennsylvania (A.B.-O.)
| | - Daniel R Tessier
- The University of Ottawa and Ottawa Hospital Research Institute (S.T., M.B., H.L.A., M.S.F.); Department of Physics (D.R.T., V.T.-C.), University of Ottawa; Montreal Neurological Institute (H.L., D.L.A.); and Perelman School of Medicine and University of Pennsylvania (A.B.-O.)
| | - Hyunwoo Lee
- The University of Ottawa and Ottawa Hospital Research Institute (S.T., M.B., H.L.A., M.S.F.); Department of Physics (D.R.T., V.T.-C.), University of Ottawa; Montreal Neurological Institute (H.L., D.L.A.); and Perelman School of Medicine and University of Pennsylvania (A.B.-O.)
| | - Marjorie Bowman
- The University of Ottawa and Ottawa Hospital Research Institute (S.T., M.B., H.L.A., M.S.F.); Department of Physics (D.R.T., V.T.-C.), University of Ottawa; Montreal Neurological Institute (H.L., D.L.A.); and Perelman School of Medicine and University of Pennsylvania (A.B.-O.)
| | - Amit Bar-Or
- The University of Ottawa and Ottawa Hospital Research Institute (S.T., M.B., H.L.A., M.S.F.); Department of Physics (D.R.T., V.T.-C.), University of Ottawa; Montreal Neurological Institute (H.L., D.L.A.); and Perelman School of Medicine and University of Pennsylvania (A.B.-O.)
| | - Douglas L Arnold
- The University of Ottawa and Ottawa Hospital Research Institute (S.T., M.B., H.L.A., M.S.F.); Department of Physics (D.R.T., V.T.-C.), University of Ottawa; Montreal Neurological Institute (H.L., D.L.A.); and Perelman School of Medicine and University of Pennsylvania (A.B.-O.)
| | - Harold L Atkins
- The University of Ottawa and Ottawa Hospital Research Institute (S.T., M.B., H.L.A., M.S.F.); Department of Physics (D.R.T., V.T.-C.), University of Ottawa; Montreal Neurological Institute (H.L., D.L.A.); and Perelman School of Medicine and University of Pennsylvania (A.B.-O.)
| | - Vincent Tabard-Cossa
- The University of Ottawa and Ottawa Hospital Research Institute (S.T., M.B., H.L.A., M.S.F.); Department of Physics (D.R.T., V.T.-C.), University of Ottawa; Montreal Neurological Institute (H.L., D.L.A.); and Perelman School of Medicine and University of Pennsylvania (A.B.-O.)
| | - Mark S Freedman
- The University of Ottawa and Ottawa Hospital Research Institute (S.T., M.B., H.L.A., M.S.F.); Department of Physics (D.R.T., V.T.-C.), University of Ottawa; Montreal Neurological Institute (H.L., D.L.A.); and Perelman School of Medicine and University of Pennsylvania (A.B.-O.)
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Zivadinov R, Bergsland N, Hagemeier J, Ramasamy DP, Dwyer MG, Schweser F, Kolb C, Weinstock-Guttman B, Hojnacki D. Cumulative gadodiamide administration leads to brain gadolinium deposition in early MS. Neurology 2019; 93:e611-e623. [PMID: 31285398 PMCID: PMC6709999 DOI: 10.1212/wnl.0000000000007892] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Accepted: 04/02/2019] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE Frequent administration of gadolinium-based contrast agents in multiple sclerosis (MS) may increase signal intensity (SI) unenhanced T1-weighted imaging MRI throughout the brain. We evaluated the association between lifetime cumulative doses of gadodiamide administration and increased SI within the dentate nucleus (DN), globus pallidus (GP), and thalamus in patients with early MS. METHODS A total of 203 patients with MS (107 with baseline and follow-up MRI assessments) and 262 age- and sex-matched controls were included in this retrospective, longitudinal, 3T MRI-reader-blinded study. Patients with MS had disease duration <2 years at baseline and received exclusively gadodiamide at all MRI time points. SI ratio (SIR) to pons and CSF of lateral ventricle volume (CSF-LVV) were assessed. Analysis of covariance and correlation analyses, adjusted for age, sex, and region of interest volume, were used. RESULTS The mean follow-up time was 55.4 months, and the mean number of gadolinium-based contrast agents administrations was 9.2. At follow-up, 49.3% of patients with MS and no controls showed DN T1 hyperintensity (p < 0.001). The mean SIR of DN (p < 0.001) and of GP (p = 0.005) to pons and the mean SIR of DN, GP, and thalamus to CSF-LVV were higher in patients with MS compared to controls (p < 0.001). SIR of DN to pons was associated with number of gadodiamide doses (p < 0.001). No associations between SIR of DN, GP, and thalamus and clinical and MRI outcomes of disease severity were detected over the follow-up. CONCLUSIONS DN, GP, and thalamus gadolinium deposition in early MS is associated with lifetime cumulative gadodiamide administration without clinical or radiologic correlates of more aggressive disease.
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Affiliation(s)
- Robert Zivadinov
- From the Buffalo Neuroimaging Analysis Center (R.Z., N.B., J.H., D.P.R.) and Jacobs Comprehensive MS Treatment and Research Center (C.K., B.W.-G., D.H.), Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, and Center for Biomedical Imaging at Clinical Translational Science Institute (R.Z., M.G.D., F.S.), University at Buffalo, State University of New York.
| | - Niels Bergsland
- From the Buffalo Neuroimaging Analysis Center (R.Z., N.B., J.H., D.P.R.) and Jacobs Comprehensive MS Treatment and Research Center (C.K., B.W.-G., D.H.), Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, and Center for Biomedical Imaging at Clinical Translational Science Institute (R.Z., M.G.D., F.S.), University at Buffalo, State University of New York
| | - Jesper Hagemeier
- From the Buffalo Neuroimaging Analysis Center (R.Z., N.B., J.H., D.P.R.) and Jacobs Comprehensive MS Treatment and Research Center (C.K., B.W.-G., D.H.), Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, and Center for Biomedical Imaging at Clinical Translational Science Institute (R.Z., M.G.D., F.S.), University at Buffalo, State University of New York
| | - Deepa P Ramasamy
- From the Buffalo Neuroimaging Analysis Center (R.Z., N.B., J.H., D.P.R.) and Jacobs Comprehensive MS Treatment and Research Center (C.K., B.W.-G., D.H.), Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, and Center for Biomedical Imaging at Clinical Translational Science Institute (R.Z., M.G.D., F.S.), University at Buffalo, State University of New York
| | - Michael G Dwyer
- From the Buffalo Neuroimaging Analysis Center (R.Z., N.B., J.H., D.P.R.) and Jacobs Comprehensive MS Treatment and Research Center (C.K., B.W.-G., D.H.), Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, and Center for Biomedical Imaging at Clinical Translational Science Institute (R.Z., M.G.D., F.S.), University at Buffalo, State University of New York
| | - Ferdinand Schweser
- From the Buffalo Neuroimaging Analysis Center (R.Z., N.B., J.H., D.P.R.) and Jacobs Comprehensive MS Treatment and Research Center (C.K., B.W.-G., D.H.), Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, and Center for Biomedical Imaging at Clinical Translational Science Institute (R.Z., M.G.D., F.S.), University at Buffalo, State University of New York
| | - Channa Kolb
- From the Buffalo Neuroimaging Analysis Center (R.Z., N.B., J.H., D.P.R.) and Jacobs Comprehensive MS Treatment and Research Center (C.K., B.W.-G., D.H.), Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, and Center for Biomedical Imaging at Clinical Translational Science Institute (R.Z., M.G.D., F.S.), University at Buffalo, State University of New York
| | - Bianca Weinstock-Guttman
- From the Buffalo Neuroimaging Analysis Center (R.Z., N.B., J.H., D.P.R.) and Jacobs Comprehensive MS Treatment and Research Center (C.K., B.W.-G., D.H.), Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, and Center for Biomedical Imaging at Clinical Translational Science Institute (R.Z., M.G.D., F.S.), University at Buffalo, State University of New York
| | - David Hojnacki
- From the Buffalo Neuroimaging Analysis Center (R.Z., N.B., J.H., D.P.R.) and Jacobs Comprehensive MS Treatment and Research Center (C.K., B.W.-G., D.H.), Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, and Center for Biomedical Imaging at Clinical Translational Science Institute (R.Z., M.G.D., F.S.), University at Buffalo, State University of New York
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Optimizing 3D FLAIR to detect MS lesions: pushing past factory settings for precise results. J Neurol 2019; 266:2786-2795. [PMID: 31372735 DOI: 10.1007/s00415-019-09490-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 07/15/2019] [Accepted: 07/28/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND To assess the diagnostic value of three 3D FLAIR sequences with differing repetition-times (TR) at 3-Tesla when detecting multiple sclerosis (MS) lesions. METHODS In this prospective study, approved by the institutional review board, 27 patients with confirmed MS were prospectively included. One radiologist performed manual segmentations of all high-signal intensity lesions using three 3D FLAIR data sets with different TR of 4800 ms ("FLAIR4800"), 8000 ms ("FLAIR8000") and 10,000 ms ("FLAIR10,000") and two radiologists double-checked it. The main judgment criterion was the overall number of lesions; secondary objectives were the assessment of lesion location, as well as measuring contrast-to-noise ratio (CNR) and signal-to-noise ratio (SNR). A non-parametric Wilcoxon's test was used to compare the differing FLAIR. RESULTS The FLAIR8000 and FLAIR10,000 detected significantly more overall lesions per patient as compared with the FLAIR4800 [116.1 (± 61.7) (p = 0.02) and 115.8 (± 56.3) (p = 0.03) versus 99.2 (± 66.9), respectively]. The FLAIR8000 and FLAIR10,000 detected four and eight times more cortical or juxta-cortical lesions per patient as compared with FLAIR4800 [1.6 (± 2.2) (p = 0.001) and 4.1 (± 5.9) (p = 6 × 10-5) versus 0.4 (± 1.1), respectively]. CNR was significantly correlated to the TR value. It was significantly higher with FLAIR10,000 than it was with FLAIR8000 and FLAIR4800 [16.3 (± 3.5) versus 15 (± 2.4) (p = 0.01) and 12 (± 2.2) (p = 2 × 10-6), respectively] CONCLUSION: An optimized 3D FLAIR with a long TR significantly improved both overall lesion detection and CNR in MS patients as compared to a 3D FLAIR with factory settings.
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154
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Dekker I, Sombekke MH, Balk LJ, Moraal B, Geurts JJ, Barkhof F, Uitdehaag BM, Killestein J, Wattjes MP. Infratentorial and spinal cord lesions: Cumulative predictors of long-term disability? Mult Scler 2019; 26:1381-1391. [PMID: 31373535 PMCID: PMC7543019 DOI: 10.1177/1352458519864933] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Objective: The objective of the study was to determine whether early infratentorial and/or spinal cord lesions are long-term cumulative predictors of disability progression in multiple sclerosis (MS). Methods: We selected 153 MS patients from the longitudinal Amsterdam MS cohort. Lesion analysis was performed at baseline and year 2. Disability progression after 6 and 11 years was measured using the Expanded Disability Status Scale (EDSS) and EDSS-plus (including 25-foot walk and 9-hole peg test). Patients with spinal cord or infratentorial lesions were compared for the risk of 6- and 11-year disability progression to patients without spinal cord or infratentorial lesions, respectively. Subsequently, patients with lesions on both locations were compared to patients with only spinal cord or only infratentorial lesions. Results: Baseline spinal cord lesions show a higher risk of 6-year EDSS progression (odds ratio (OR): 3.6, p = 0.007) and EDSS-plus progression (OR: 2.5, p = 0.028) and 11-year EDSS progression (OR: 2.8, p = 0.047). Patients with both infratentorial and spinal cord lesions did not have a higher risk of 6-year disability progression than patients with only infratentorial or only spinal cord lesions. Conclusion: The presence of early spinal cord lesions seems to be a dominant risk factor of disability progression. Simultaneous presence of early infratentorial and spinal cord lesions did not undisputedly predict disability progression.
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Affiliation(s)
- Iris Dekker
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands/Department of Neurology, Amsterdam UMC, Vrije Universiteit Amsterdam, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Madeleine H Sombekke
- Department of Neurology, Amsterdam UMC, Vrije Universiteit Amsterdam, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Lisanne J Balk
- Department of Neurology, Amsterdam UMC, Vrije Universiteit Amsterdam, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Bastiaan Moraal
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Jeroen Jg Geurts
- Department of Anatomy and Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands/Institutes of Neurology and Healthcare Engineering, University College London, London, UK
| | - Bernard Mj Uitdehaag
- Department of Neurology, Amsterdam UMC, Vrije Universiteit Amsterdam, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Joep Killestein
- Department of Neurology, Amsterdam UMC, Vrije Universiteit Amsterdam, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Mike P Wattjes
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands/Department of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany
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155
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Dekker I, Leurs C, Hagens M, van Kempen Z, Kleerekooper I, Lissenberg-Witte B, Barkhof F, Uitdehaag B, Balk L, Wattjes M, Killestein J. Long-term disease activity and disability progression in relapsing-remitting multiple sclerosis patients on natalizumab. Mult Scler Relat Disord 2019; 33:82-87. [DOI: 10.1016/j.msard.2019.05.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 04/13/2019] [Accepted: 05/24/2019] [Indexed: 12/11/2022]
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156
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Amaral LLFD, Fragoso DC, Rocha AJD. Improving acute demyelinating lesion detection: which T1-weighted magnetic resonance acquisition is more sensitive to gadolinium enhancement? ARQUIVOS DE NEURO-PSIQUIATRIA 2019; 77:485-492. [PMID: 31365640 DOI: 10.1590/0004-282x20190082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 04/14/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Because of the need for a standardized and accurate method for detecting multiple sclerosis (MS) inflammatory activity, different magnetic resonance (MR) acquisitions should be compared in order to choose the most sensitive sequence for clinical routine. To compare the sensitivity of a T1-weighted image to a single dose of gadolinium (Gd) administration both with and without magnetization transfer to detect contrast enhancement in active demyelinating focal lesions. METHODS A sample of relapsing-remitting MS patients were prospectively examined separately by two neuroradiologists using a 1.5 Tesla scanner. The outcome parameters were focused on Gd-enhancement detection attributed to acute demyelination. All MR examinations with at least one Gd-enhancing lesion were considered positive (MR+) and each lesion was analyzed according to its size and contrast ratio. RESULTS Thirty-six MR examinations were analyzed with a high inter-observer agreement for MR+ detection (k coefficient > 0.8), which was excellent for the number of Gd-enhancing lesions (0.91 T1 spin-echo (SE), 0.88 T1 magnetization transfer contrast (MTC) sequence and 0.99 magnetization-prepared rapid acquisition with gradient-echo (MPRAGE). Significantly more MR+ were reported on the T1 MTC scans, followed by the T1 SE, and MPRAGE scans. Confidently, the T1 MTC sequence demonstrated higher accuracy in the detection of Gd-enhancing lesions, followed by the T1 SE and MPRAGE sequences. Further comparisons showed that there was a statistically significant increase in the contrast ratio and area of Gd-enhancement on the T1 MTC images when compared with both the SE and MPRAGE images. CONCLUSION Single-dose Gd T1 MTC sequence was confirmed to be the most sensitive acquisition for predicting inflammatory active lesions using a 1.5 T magnet in this sample of MS patients.
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Affiliation(s)
- Lázaro Luiz Faria do Amaral
- Hospital Beneficência Portuguesa de São Paulo, BP Medicina Diagnóstica, Departamento de Neurorradiologia, São Paulo SP, Brasil.,Irmandade da Santa Casa de Misericórdia de São Paulo, Departamento de Radiologia, São Paulo SP, Brasil
| | - Diego Cardoso Fragoso
- Irmandade da Santa Casa de Misericórdia de São Paulo, Departamento de Radiologia, São Paulo SP, Brasil
| | - Antonio José da Rocha
- Irmandade da Santa Casa de Misericórdia de São Paulo, Departamento de Radiologia, São Paulo SP, Brasil
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High-dimensional detection of imaging response to treatment in multiple sclerosis. NPJ Digit Med 2019; 2:49. [PMID: 31304395 PMCID: PMC6556513 DOI: 10.1038/s41746-019-0127-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 05/15/2019] [Indexed: 12/14/2022] Open
Abstract
Changes on brain imaging may precede clinical manifestations or disclose disease progression opaque to conventional clinical measures. Where, as in multiple sclerosis, the pathological process has a complex anatomical distribution, such changes are not easily detected by low-dimensional models in common use. This hinders our ability to detect treatment effects, both in the management of individual patients and in interventional trials. Here we compared the ability of conventional models to detect an imaging response to treatment against high-dimensional models incorporating a wide multiplicity of imaging factors. We used fully-automated image analysis to extract 144 regional, longitudinal trajectories of pre- and post- treatment changes in brain volume and disconnection in a cohort of 124 natalizumab-treated patients. Low- and high-dimensional models of the relationship between treatment and the trajectories of change were built and evaluated with machine learning, quantifying performance with receiver operating characteristic curves. Simulations of randomised controlled trials enrolling varying numbers of patients were used to quantify the impact of dimensionality on statistical efficiency. Compared to existing methods, high-dimensional models were superior in treatment response detection (area under the receiver operating characteristic curve = 0.890 [95% CI = 0.885–0.895] vs. 0.686 [95% CI = 0.679–0.693], P < 0.01]) and in statistical efficiency (achieved statistical power = 0.806 [95% CI = 0.698–0.872] vs. 0.508 [95% CI = 0.403–0.593] with number of patients enrolled = 50, at α = 0.01). High-dimensional models based on routine, clinical imaging can substantially enhance the detection of the imaging response to treatment in multiple sclerosis, potentially enabling more accurate individual prediction and greater statistical efficiency of randomised controlled trials.
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Fartaria MJ, Kober T, Granziera C, Bach Cuadra M. Longitudinal analysis of white matter and cortical lesions in multiple sclerosis. Neuroimage Clin 2019; 23:101938. [PMID: 31491829 PMCID: PMC6658829 DOI: 10.1016/j.nicl.2019.101938] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 07/10/2019] [Accepted: 07/14/2019] [Indexed: 01/08/2023]
Abstract
PURPOSE The goals of this study were to assess the performance of a novel lesion segmentation tool for longitudinal analyses, as well as to validate the generated lesion progression map between two time points using conventional and non-conventional MR sequences. MATERIAL AND METHODS The lesion segmentation approach was evaluated with (LeMan-PV) and without (LeMan) the partial volume framework using "conventional" and "non-conventional" MR imaging in a two-year follow-up prospective study of 32 early RRMS patients. Manual segmentations of new, enlarged, shrunken, and stable lesions were used to evaluate the performance of the method variants. The true positive rate was estimated for those lesion evolutions in both white matter and cortex. The number of false positives was compared with two strategies for longitudinal analyses. New lesion tissue volume estimation was evaluated using Bland-Altman plots. Wilcoxon signed-rank test was used to evaluate the different setups. RESULTS The best median of the true positive rate was obtained using LeMan-PV with non-conventional sequences (P < .05): 87%, 87%, 100%, 83%, for new, enlarged, shrunken, and stable WM lesions, and 50%, 60%, 50%, 80%, for new, enlarged, shrunken, and stable cortical lesions, respectively. Most of the missed lesions were below the mean lesion size in each category. Lesion progression maps presented a median of 0 false positives (range:0-9) and the partial volume framework improved the volume estimation of new lesion tissue. CONCLUSION LeMan-PV exhibited the best performance in the detection of new, enlarged, shrunken and stable WM lesions. The method showed lower performance in the detection of cortical lesions, likely due to their low occurrence, small size and low contrast with respect to surrounding tissues. The proposed lesion progression map might be useful in clinical trials or clinical routine.
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Affiliation(s)
- Mário João Fartaria
- Advanced Clinical Imaging Technology, Siemens Healthcare AG, Lausanne, Switzerland; Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; Signal Processing Laboratory (LTS 5), Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland.
| | - Tobias Kober
- Advanced Clinical Imaging Technology, Siemens Healthcare AG, Lausanne, Switzerland; Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; Signal Processing Laboratory (LTS 5), Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Cristina Granziera
- Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland; Translational Imaging in Neurology (ThINk) Basel, Department of Medicine and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland; Department of Biomedical Engineering, University of Basel, Switzerland
| | - Meritxell Bach Cuadra
- Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; Signal Processing Laboratory (LTS 5), Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland; Medical Image Analysis Laboratory (MIAL), Centre d'Imagerie BioMédicale (CIBM), Lausanne, Switzerland
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Haider L, Naismith RT, Rovira A. Use of gadolinium for MRI diagnostic or surveillance studies in patients with MS. Neurology 2019; 93:239-240. [PMID: 31285397 DOI: 10.1212/wnl.0000000000007891] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Affiliation(s)
- Lukas Haider
- From the NMR Research Unit (L.H.), Queens Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Science, University College London, UK; Department of Biomedical Imaging and Image Guided Therapy (L.H.), Medical University of Vienna, Austria; Washington University School of Medicine (R.T.N.), Saint Louis, MO; and Section of Neuroradiology, Department of Radiology (A.R.), University Hospital Vall d'Hebron, Barcelona, Spain.
| | - Robert T Naismith
- From the NMR Research Unit (L.H.), Queens Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Science, University College London, UK; Department of Biomedical Imaging and Image Guided Therapy (L.H.), Medical University of Vienna, Austria; Washington University School of Medicine (R.T.N.), Saint Louis, MO; and Section of Neuroradiology, Department of Radiology (A.R.), University Hospital Vall d'Hebron, Barcelona, Spain
| | - Alex Rovira
- From the NMR Research Unit (L.H.), Queens Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Science, University College London, UK; Department of Biomedical Imaging and Image Guided Therapy (L.H.), Medical University of Vienna, Austria; Washington University School of Medicine (R.T.N.), Saint Louis, MO; and Section of Neuroradiology, Department of Radiology (A.R.), University Hospital Vall d'Hebron, Barcelona, Spain
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Ropele S, Fazekas F. Quantification of cortical damage in multiple sclerosis using DTI remains a challenge. Brain 2019; 142:1848-1850. [DOI: 10.1093/brain/awz160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Stefan Ropele
- Department of Neurology, Medical University of Graz, Austria
| | - Franz Fazekas
- Department of Neurology, Medical University of Graz, Austria
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El Khoury Y, Collongues N, De Sèze J, Gulsari V, Patte-Mensah C, Marcou G, Varnek A, Mensah-Nyagan AG, Hellwig P. Serum-based differentiation between multiple sclerosis and amyotrophic lateral sclerosis by Random Forest classification of FTIR spectra. Analyst 2019; 144:4647-4652. [PMID: 31257384 DOI: 10.1039/c9an00754g] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The challenging diagnosis and differentiation between multiple sclerosis and amyotrophic lateral sclerosis relies on the clinical assessment of the symptoms along with magnetic resonance imaging and sampling cerebrospinal fluid for the search of biomarkers for either disease. Despite the progress made in imaging techniques and biomarker identification, misdiagnosis still occurs. Here we used 2.5 μL of serum samples to obtain the infrared spectroscopic signatures of sera of multiple sclerosis and amyotrophic lateral sclerosis patients and compared them to those of healthy controls. The spectra are then classified with the help of a two-fold Random Forest cross-validation algorithm. This approach shows that infrared spectroscopy is powerful in discriminating between the two diseases and healthy controls by offering high specificity for multiple sclerosis (100%) and amyotrophic lateral sclerosis (98%). In addition, data after six and twelve months of treatment of the multiple sclerosis patients with biotin are discussed.
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Affiliation(s)
- Youssef El Khoury
- Laboratory of Bioelectrochemistry and Spectroscopy, UMR 7140 University of Strasbourg/CNRS, 4 rue Blaise Pascal, 67000 Strasbourg, France.
| | - Nicolas Collongues
- Biopathologie de la Myéline, Neuroprotection et Stratégies Thérapeutiques, INSERM U1119, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Bâtiment 3 de la Faculté de Médecine, Strasbourg, France and Department of Neurology, University Hospital of Strasbourg, Strasbourg, France
| | - Jérôme De Sèze
- Biopathologie de la Myéline, Neuroprotection et Stratégies Thérapeutiques, INSERM U1119, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Bâtiment 3 de la Faculté de Médecine, Strasbourg, France and Department of Neurology, University Hospital of Strasbourg, Strasbourg, France
| | - Vildan Gulsari
- Laboratory of Bioelectrochemistry and Spectroscopy, UMR 7140 University of Strasbourg/CNRS, 4 rue Blaise Pascal, 67000 Strasbourg, France.
| | - Christine Patte-Mensah
- Biopathologie de la Myéline, Neuroprotection et Stratégies Thérapeutiques, INSERM U1119, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Bâtiment 3 de la Faculté de Médecine, Strasbourg, France
| | - Gilles Marcou
- Laboratory of Chemoinformatics, UMR 7140 University of Strasbourg/CNRS, 4 rue Blaise Pascal, 67000 Strasbourg, France
| | - Alexandre Varnek
- Laboratory of Chemoinformatics, UMR 7140 University of Strasbourg/CNRS, 4 rue Blaise Pascal, 67000 Strasbourg, France
| | - Ayikoé Guy Mensah-Nyagan
- Biopathologie de la Myéline, Neuroprotection et Stratégies Thérapeutiques, INSERM U1119, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Bâtiment 3 de la Faculté de Médecine, Strasbourg, France
| | - Petra Hellwig
- Laboratory of Bioelectrochemistry and Spectroscopy, UMR 7140 University of Strasbourg/CNRS, 4 rue Blaise Pascal, 67000 Strasbourg, France. and University of Strasbourg Institute for Advanced Study (USIAS), Strasbourg, France
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162
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Lecler A, El Sanharawi I, El Methni J, Gout O, Koskas P, Savatovsky J. Improving Detection of Multiple Sclerosis Lesions in the Posterior Fossa Using an Optimized 3D-FLAIR Sequence at 3T. AJNR Am J Neuroradiol 2019; 40:1170-1176. [PMID: 31248862 DOI: 10.3174/ajnr.a6107] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 05/14/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE There is no consensus regarding the best MR imaging sequence for detecting MS lesions. The aim of our study was to assess the diagnostic value of optimized 3D-FLAIR in the detection of infratentorial MS lesions compared with an axial T2-weighted imaging, a 3D-FLAIR with factory settings, and a 3D double inversion recovery sequence. MATERIALS AND METHODS In this prospective study, 27 patients with confirmed MS were included. Two radiologists blinded to clinical data independently read the following sequences: axial T2WI, 3D double inversion recovery, standard 3D-FLAIR with factory settings, and optimized 3D-FLAIR. The main judgment criterion was the overall number of high-signal-intensity lesions in the posterior fossa; secondary objectives were the assessment of the reading confidence and the measurement of the contrast. A nonparametric Wilcoxon test was used to compare the MR images. RESULTS Twenty-two patients had at least 1 lesion in the posterior fossa. The optimized FLAIR sequence detected significantly more posterior fossa lesions than any other sequence: 7.5 versus 5.8, 4.8, and 4.1 (P values of .04, .03, and .03) with the T2WI, the double inversion recovery, and the standard FLAIR, respectively. The reading confidence index was significantly higher with the optimized FLAIR, and the contrast was significantly higher with the optimized FLAIR than with the standard FLAIR and the double inversion recovery. CONCLUSIONS An optimized 3D-FLAIR sequence improved posterior fossa lesion detection in patients with MS.
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Affiliation(s)
- A Lecler
- From the Departments of Neuroradiology (A.L., I.E.S., P.K., J.S.)
| | - I El Sanharawi
- From the Departments of Neuroradiology (A.L., I.E.S., P.K., J.S.)
| | - J El Methni
- Department of Biostatistics (J.E.M.), MAP5 Laboratory, Unité Mixte de Recherche Centre National de la Recherche Scientifique 8145, Paris Descartes University, Sorbonne Paris Cité, Paris, France
| | - O Gout
- Neurology (O.G.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - P Koskas
- From the Departments of Neuroradiology (A.L., I.E.S., P.K., J.S.)
| | - J Savatovsky
- From the Departments of Neuroradiology (A.L., I.E.S., P.K., J.S.)
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163
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Cortese R, Collorone S, Ciccarelli O, Toosy AT. Advances in brain imaging in multiple sclerosis. Ther Adv Neurol Disord 2019; 12:1756286419859722. [PMID: 31275430 PMCID: PMC6598314 DOI: 10.1177/1756286419859722] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 05/21/2019] [Indexed: 12/31/2022] Open
Abstract
Brain imaging is increasingly used to support clinicians in diagnosing multiple sclerosis (MS) and monitoring its progression. However, the role of magnetic resonance imaging (MRI) in MS goes far beyond its clinical application. Indeed, advanced imaging techniques have helped to detect different components of MS pathogenesis in vivo, which is now considered a heterogeneous process characterized by widespread damage of the central nervous system, rather than multifocal demyelination of white matter. Recently, MRI biomarkers more sensitive to disease activity than clinical disability outcome measures, have been used to monitor response to anti-inflammatory agents in patients with relapsing-remitting MS. Similarly, MRI markers of neurodegeneration exhibit the potential as primary and secondary outcomes in clinical trials for progressive phenotypes. This review will summarize recent advances in brain neuroimaging in MS from the research setting to clinical applications.
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Affiliation(s)
- Rosa Cortese
- Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, Faculty of Brain Sciences, University College London (UCL), London, UK
| | - Sara Collorone
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Institute of Neurology, Russell Square, London WC1B 5EH, UK
| | - Olga Ciccarelli
- Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, Faculty of Brain Sciences, University College London (UCL), London, UK
- National Institute for Health Research, UCL Hospitals, Biomedical Research Centre, London, UK
| | - Ahmed T. Toosy
- Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, Faculty of Brain Sciences, University College London (UCL), London, UK
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164
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Hartung HP, Graf J, Aktas O, Mares J, Barnett MH. Diagnosis of multiple sclerosis: revisions of the McDonald criteria 2017 – continuity and change. Curr Opin Neurol 2019; 32:327-337. [DOI: 10.1097/wco.0000000000000699] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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165
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Rudie JD, Mattay RR, Schindler M, Steingall S, Cook TS, Loevner LA, Schnall MD, Mamourian AC, Bilello M. An Initiative to Reduce Unnecessary Gadolinium-Based Contrast in Multiple Sclerosis Patients. J Am Coll Radiol 2019; 16:1158-1164. [PMID: 31092348 DOI: 10.1016/j.jacr.2019.04.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 04/08/2019] [Accepted: 04/09/2019] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Patients with multiple sclerosis (MS) routinely undergo serial contrast-enhanced MRIs. Given concerns regarding tissue deposition of gadolinium-based contrast agents (GBCAs) and evidence that enhancement of lesions is only seen in patients with new disease activity on noncontrast imaging, we set out to implement a prospective quality improvement project whereby intravenous contrast would be reserved only for patients with evidence of new disease activity on noncontrast images. METHODS To prospectively implement such a protocol, we leveraged our in-house computer-assisted detection (CAD) software and 3-D laboratory radiology technologists to perform real-time preliminary assessments of the CAD-processed T2 fluid attenuated inversion recovery (FLAIR) noncontrast images as a basis for deciding whether to inject contrast. Before implementation, we held multidisciplinary meetings with neurology, neuroradiology, and MR technologists and distributed surveys to objectively assess opinions and obstacles to clinical implementation. We evaluated reduction in GBCA utilization and technologist performance relative to final neuroradiologist interpretations. RESULTS During a 2-month trial period, 153 patients were imaged under the new protocol. Technologists using the CAD software were able to identify patients with new or enlarging lesions on FLAIR images with 95% accuracy and 97% negative predictive value relative to final neuroradiologist interpretations, which allowed us to avoid the use of contrast and additional imaging sequences in 87% of patients. DISCUSSION A multidisciplinary effort to implement a quality improvement project to limit contrast in MS patients receiving follow-up MRIs allowed for improved safety and cost by targeting patients that would benefit from the use of intravenous contrast in real-time.
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Affiliation(s)
- Jeffrey D Rudie
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Raghav R Mattay
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Matthew Schindler
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Samantha Steingall
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Tessa S Cook
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Laurie A Loevner
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Mitchell D Schnall
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Alexander C Mamourian
- Department of Radiology, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Michel Bilello
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
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166
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Gaitán MI, Correale J. Multiple Sclerosis Misdiagnosis: A Persistent Problem to Solve. Front Neurol 2019; 10:466. [PMID: 31133970 PMCID: PMC6514150 DOI: 10.3389/fneur.2019.00466] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 04/17/2019] [Indexed: 01/28/2023] Open
Affiliation(s)
- María I Gaitán
- Neurology Department, Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia (FLENI), Buenos Aires, Argentina
| | - Jorge Correale
- Neurology Department, Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia (FLENI), Buenos Aires, Argentina
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167
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Macías Islas MÁ, Ciampi E. Assessment and Impact of Cognitive Impairment in Multiple Sclerosis: An Overview. Biomedicines 2019; 7:E22. [PMID: 30893874 PMCID: PMC6466345 DOI: 10.3390/biomedicines7010022] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 03/13/2019] [Accepted: 03/14/2019] [Indexed: 12/30/2022] Open
Abstract
Cognitive impairment affects 40⁻60% of patients with multiple sclerosis. It may be present early in the course of the disease and has an impact on a patient's employability, social interactions, and quality of life. In the last three decades, an increasing interest in diagnosis and management of cognitive impairment has arisen. Neuropsychological assessment and neuroimaging studies focusing on cognitive impairment are now being incorporated as primary outcomes in clinical trials. However, there are still key uncertainties concerning the underlying mechanisms of damage, neural basis, sensitivity and validity of neuropsychological tests, and efficacy of pharmacological and non-pharmacological interventions. The present article aimed to present an overview of the assessment, neural correlates, and impact of cognitive impairment in multiple sclerosis.
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Affiliation(s)
| | - Ethel Ciampi
- Neurology, Pontificia Universidad Católica de Chile, Neurology, Hospital Dr. Sótero del Río, Santiago 8320000, Chile.
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168
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Miki Y. Magnetic resonance imaging diagnosis of demyelinating diseases: An update. ACTA ACUST UNITED AC 2019. [DOI: 10.1111/cen3.12501] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Yukio Miki
- Department of Diagnostic and Interventional Radiology Osaka City University Graduate School of Medicine Osaka Japan
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169
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do Amaral LLF, Fragoso DC, Nunes RH, Littig IA, da Rocha AJ. Gadolinium-Enhanced Susceptibility-Weighted Imaging in Multiple Sclerosis: Optimizing the Recognition of Active Plaques for Different MR Imaging Sequences. AJNR Am J Neuroradiol 2019; 40:614-619. [PMID: 30846435 DOI: 10.3174/ajnr.a5997] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 01/24/2019] [Indexed: 01/14/2023]
Abstract
BACKGROUND AND PURPOSE Gadolinium SWI is MR imaging that has recently been reported to be effective in the evaluation of several neurologic disorders, including demyelinating diseases. Our aim was to analyze the accuracy of gadolinium SWI for detecting the imaging evidence of active inflammation on MS plaques when a BBB dysfunction is demonstrated by a focal gadolinium-enhanced lesion and to compare this technique with gadolinium-enhanced T1 spin-echo and T1 spin-echo with magnetization transfer contrast. MATERIALS AND METHODS MR imaging studies of 103 patients (170 examinations) were performed using a 1.5T scanner. Two neuroradiologists scrutinized signal abnormalities of the demyelinating plaques on gadolinium SWI and compared them with gadolinium T1 before and after an additional magnetization transfer pulse. Interrater agreement was evaluated among gadolinium T1 magnetization transfer contrast, gadolinium SWI, and gadolinium T1 spin-echo using the κ coefficient. The T1 magnetization transfer contrast sequence was adopted as the criterion standard in this cohort. Thus, the sensitivity, specificity, positive predictive value, and negative predictive value were calculated for gadolinium T1 spin-echo and gadolinium SWI sequences. RESULTS Differences in BBB dysfunction were evident among gadolinium SWI, gadolinium T1 spin-echo, and gadolinium T1 magnetization transfer contrast. Gadolinium T1 magnetization transfer contrast demonstrated the highest number of active demyelinating plaques. Gadolinium SWI was highly correlated with gadolinium T1 magnetization transfer contrast in depicting acute demyelinating plaques (κ coefficient = 0.860; sensitivity = 0.837), and these techniques provided better performance compared with gadolinium T1 spin-echo (κ coefficient = 0.78; sensitivity = 0.645). CONCLUSIONS Gadolinium SWI was able to better detect BBB dysfunction in MS plaques and had a better performance than gadolinium T1 spin-echo. Increasing SWI sequence applications in clinical practice can improve our knowledge of MS, likely allowing the addition of BBB dysfunction analysis to the striking findings of the previously reported central vein sign.
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Affiliation(s)
- L L F do Amaral
- From the Division of Neuroradiology (L.L.F.A, D.C.F., R.H.N., I.A.L., A.J.R.), Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil .,Neuroradiology Department (L.L.F.A.), BP Medicina Diagnóstica, Hospital BP e BP Mirante da Beneficěncia Portuguesa de São Paulo, São Paulo, Brazil
| | - D C Fragoso
- From the Division of Neuroradiology (L.L.F.A, D.C.F., R.H.N., I.A.L., A.J.R.), Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil.,Division of Neuroradiology (D.C.F., R.H.N., A.J.R.), Diagnósticos da América S.A. - DASA, São Paulo, Brazil.,Division of Neuroradiology (D.C.F.), Fleury S.A., São Paulo, Brazil
| | - R H Nunes
- From the Division of Neuroradiology (L.L.F.A, D.C.F., R.H.N., I.A.L., A.J.R.), Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil.,Division of Neuroradiology (D.C.F., R.H.N., A.J.R.), Diagnósticos da América S.A. - DASA, São Paulo, Brazil
| | - I A Littig
- From the Division of Neuroradiology (L.L.F.A, D.C.F., R.H.N., I.A.L., A.J.R.), Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil
| | - A J da Rocha
- From the Division of Neuroradiology (L.L.F.A, D.C.F., R.H.N., I.A.L., A.J.R.), Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil.,Division of Neuroradiology (D.C.F., R.H.N., A.J.R.), Diagnósticos da América S.A. - DASA, São Paulo, Brazil
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170
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Abstract
PURPOSE OF REVIEW Clinical MRI is of paramount importance for multiple sclerosis diagnosis but lacks the specificity to investigate the pathogenic mechanisms underlying disease onset and progression. The application of advanced MR sequences allows the characterization of diverse and complex pathological mechanisms, granting insights into multiple sclerosis natural history and response to treatment. RECENT FINDINGS This review provides an update on the most recent international guidelines for optimal standard imaging of multiple sclerosis and discusses advantages and limitations of advanced imaging approaches for investigating inflammation, demyelination and neurodegeneration. An overview is provided for methods devoted to imaging leptomeningeal enhancement, microglial activation, demyelination, neuronal metabolic damage and neuronal loss. SUMMARY The application of magnetic resonance (MR) guidelines to standard-of-care MR protocols, although still limited, would substantially contribute to the optimization of multiple sclerosis management. From an academic perspective, different mechanism-specific imaging techniques are available and offer a powerful tool to elucidate multiple sclerosis pathogenesis, monitor disease progression and guide therapeutic choices.
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171
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Wattjes MP, Killestein J. Imaging of meningeal inflammation should become part of the routine MRI protocol - No. Mult Scler 2019; 25:331-333. [PMID: 30179073 DOI: 10.1177/1352458518799642] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Mike P Wattjes
- Department of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany/Department of Radiology and Nuclear Medicine, VU University Medical Center Amsterdam, Amsterdam, The Netherlands/MS Center Amsterdam, VU University Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Joep Killestein
- MS Center Amsterdam, VU University Medical Center Amsterdam, Amsterdam, The Netherlands/Department of Neurology, VU University Medical Center Amsterdam, Amsterdam, The Netherlands
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172
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Leurs C, Lopes Pinheiro M, Wierts L, den Hoedt S, Mulder M, Eijlers A, Schoonheim M, Balk L, Uitdehaag B, Killestein J, de Vries H. Acid sphingomyelinase: No potential as a biomarker for multiple sclerosis. Mult Scler Relat Disord 2019; 28:44-49. [DOI: 10.1016/j.msard.2018.11.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 11/06/2018] [Accepted: 11/23/2018] [Indexed: 01/01/2023]
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173
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Varatharaj A, Liljeroth M, Darekar A, Larsson HB, Galea I, Cramer SP. Blood-brain barrier permeability measured using dynamic contrast-enhanced magnetic resonance imaging: a validation study. J Physiol 2019; 597:699-709. [PMID: 30417928 PMCID: PMC6355631 DOI: 10.1113/jp276887] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Accepted: 11/07/2018] [Indexed: 01/29/2023] Open
Abstract
KEY POINTS The blood-brain barrier (BBB) is an important and dynamic structure which contributes to homeostasis in the central nervous system. BBB permeability changes occur in health and disease but measurement of BBB permeability in humans is not straightforward. Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) can be used to model the movement of gadolinium contrast into the brain, expressed as the influx constant Ki . Here evidence is provided that Ki as measured by DCE-MRI behaves as expected for a marker of overall BBB leakage. These results support the use of DCE-MRI for in vivo studies of human BBB permeability in health and disease. ABSTRACT Blood-brain barrier (BBB) leakage can be measured using dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) as the influx constant Ki . To validate this method we compared measured Ki with biological expectations, namely (1) higher Ki in healthy individual grey matter (GM) versus white matter (WM), (2) GM/WM cerebral blood volume (CBV) ratio close to the histologically established GM/WM vascular density ratio, (3) higher Ki in visibly enhancing multiple sclerosis (MS) lesions versus MS normal appearing white matter (NAWM), and (4) higher Ki in MS NAWM versus healthy individual NAWM. We recruited 13 healthy individuals and 12 patients with MS and performed whole-brain 3D DCE-MRI at 3 T. Ki and CBV were calculated using Patlak modelling for manual regions of interest (ROI) and segmented tissue masks. Ki was higher in control GM versus WM (P = 0.001). CBV was higher in GM versus WM (P = 0.005, mean ratio 1.9). Ki was higher in visibly enhancing MS lesions versus MS NAWM (P = 0.002), and in MS NAWM versus controls (P = 0.014). Bland-Altman analysis showed no significant difference between ROI and segmentation methods (P = 0.638) and an intra-class correlation coefficient showed moderate single measure consistency (0.610). Ki behaves as expected for a compound marker of permeability and surface area. The GM/WM CBV ratio measured by this technique is in agreement with the literature. This adds evidence to the validity of Ki measured by DCE-MRI as a marker of overall BBB leakage.
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Affiliation(s)
- Aravinthan Varatharaj
- Clinical NeurosciencesClinical and Experimental SciencesFaculty of MedicineUniversity of SouthamptonSouthamptonUK
| | - Maria Liljeroth
- Department of Medical PhysicsUniversity Hospital Southampton NHS Foundation TrustSouthamptonUK
| | - Angela Darekar
- Department of Medical PhysicsUniversity Hospital Southampton NHS Foundation TrustSouthamptonUK
| | - Henrik B.W. Larsson
- Functional Imaging UnitDepartment of Clinical PhysiologyNuclear Medicine and PET, RigshospitaletCopenhagenDenmark
| | - Ian Galea
- Clinical NeurosciencesClinical and Experimental SciencesFaculty of MedicineUniversity of SouthamptonSouthamptonUK
| | - Stig P. Cramer
- Functional Imaging UnitDepartment of Clinical PhysiologyNuclear Medicine and PET, RigshospitaletCopenhagenDenmark
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174
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Fechner A, Savatovsky J, El Methni J, Sadik JC, Gout O, Deschamps R, Gueguen A, Lecler A. A 3T Phase-Sensitive Inversion Recovery MRI Sequence Improves Detection of Cervical Spinal Cord Lesions and Shows Active Lesions in Patients with Multiple Sclerosis. AJNR Am J Neuroradiol 2019; 40:370-375. [PMID: 30679225 DOI: 10.3174/ajnr.a5941] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 11/29/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Magnetic Resonance Imaging is the modality of choice to detect spinal cord lesions in patients with Multiple Sclerosis (MS). However, this imaging is challenging. New sequences such as phase-sensitive inversion recovery have been developed to improve detection. Our aim was to compare a 3D phase-sensitive inversion recovery and a conventional imaging dataset including postcontrast T2WI and T1WI to detect MS spinal cord lesions. MATERIALS AND METHODS This retrospective single-center study included 100 consecutive patients with MS (mean age, 41 years) from January 2015 to June 2016. One senior neuroradiologist and 1 junior radiologist blinded to clinical data checked for new spinal cord lesions, individually analyzing conventional and 3D phase-sensitive inversion recovery datasets separately, placing a 3-week delay between the 2 readings. A consensus reading was done with a third senior neuroradiologist. A Wilcoxon test was used to compare the 2 imaging datasets. Intra- and interobserver agreement was assessed by the κ coefficient. RESULTS 3D phase-sensitive inversion recovery detected significantly more lesions than conventional imaging (480 versus 168, P < .001). Eleven patients had no detected lesions on T2WI, whereas 3D phase-sensitive inversion recovery detected at least 1 lesion. All postcontrast T1WI enhancing lesions were also visible on 3D phase-sensitive inversion recovery. The signal-to-noise ratio was significantly higher using 3D phase-sensitive inversion recovery (0.63 versus 0.46, P = .03). Mean reading confidence was significantly higher using 3D phase-sensitive inversion recovery. Inter- and intraobserver agreement was good for both datasets. CONCLUSIONS Our study showed that 3D phase-sensitive inversion recovery significantly improved detection of cervical spinal cord lesions, including both enhancing and nonenhancing lesions in patients with MS.
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Affiliation(s)
- A Fechner
- From the Departments of Neuroradiology (A.F., J.S., J.C.S., A.L.)
| | - J Savatovsky
- From the Departments of Neuroradiology (A.F., J.S., J.C.S., A.L.)
| | - J El Methni
- Laboratoire MAP5, UMR CNRS 8145 (J.E.M.), Université Paris Descartes, Paris, France
| | - J C Sadik
- From the Departments of Neuroradiology (A.F., J.S., J.C.S., A.L.)
| | - O Gout
- Neurology (O.G., R.D., A.G.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - R Deschamps
- Neurology (O.G., R.D., A.G.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - A Gueguen
- Neurology (O.G., R.D., A.G.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - A Lecler
- From the Departments of Neuroradiology (A.F., J.S., J.C.S., A.L.)
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175
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Magnetic resonance imaging in immune-mediated myelopathies. J Neurol 2019; 267:1233-1244. [PMID: 30694379 DOI: 10.1007/s00415-019-09206-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 01/15/2019] [Accepted: 01/18/2019] [Indexed: 10/27/2022]
Abstract
Immune-mediated myelopathies are a heterogeneous group of inflammatory spinal cord disorders including autoimmune disorders with known antibodies, e.g. aquaporin-4 IgG channelopathy or anti-myelin oligodendrocyte glycoprotein-associated myelitis, myelopathies in the context of multiple sclerosis and systemic autoimmune disorders with myelopathy, as well as post-infectious and paraneoplastic myelopathies. Although magnetic resonance imaging of the spinal cord is still challenging due to the small dimension of the cord cross-section and frequent movement and susceptibility artifacts, recent methodological advances have led to improved diagnostic evaluation and characterization of immune-mediated myelopathies. Topography, length and width of the lesion, gadolinium enhancement pattern, and changes in morphology over time help in narrowing the broad differential diagnosis. In this review, we give an overview of recent advances in magnetic resonance imaging of immune-mediated myelopathies and its role in the differential diagnosis and monitoring of this heterogeneous group of disorders.
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Standardizing Magnetic Resonance Imaging Protocols, Requisitions, and Reports in Multiple Sclerosis: An Update for Radiologist Based on 2017 Magnetic Resonance Imaging in Multiple Sclerosis and 2018 Consortium of Multiple Sclerosis Centers Consensus Guidelines. J Comput Assist Tomogr 2019; 43:1-12. [PMID: 30015803 DOI: 10.1097/rct.0000000000000767] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The advent of magnetic resonance imaging has improved our understanding of the pathophysiology and natural course of multiple sclerosis (MS). The ability of magnetic resonance imaging to show the evolution of MS lesions on sequential scans has brought it to be one of the endpoints in clinical trials for disease-modifying therapies. Based on the most updated consensus guidelines from the American (Consortium of MS Centers) and European (Magnetic Resonance Imaging in MS) boards of experts in MS, this document shows the most relevant landmarks related to imaging findings, diagnostic criteria, indications to obtain a magnetic resonance, scan protocols and sequence options for patients with MS. Although incorporating the knowledge derived from the research arena into the daily clinical practice is always challenging, in this article, the authors provide useful recommendations to improve the information contained in the magnetic resonance report oriented to facilitate communication between radiologists and specialized medical teams involved in MS patients' multidisciplinary care.
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Hartung HP, Graf J, Kremer D. Long-term follow-up of multiple sclerosis studies and outcomes from early treatment of clinically isolated syndrome in the BENEFIT 11 study. J Neurol 2019; 267:308-316. [PMID: 30610426 DOI: 10.1007/s00415-018-09169-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 12/21/2018] [Accepted: 12/21/2018] [Indexed: 01/03/2023]
Abstract
Multiple sclerosis (MS) is an autoimmune disease of the central nervous system (CNS) with a diverse disease course involving inflammation and degeneration of neurons and axons. Multiple sclerosis results from a complex interaction of genetic and environmental factors and clinically several disease subtypes with marked variation in symptoms can be discerned. Disease-modifying therapies (DMTs) impact disease activity and outcome. Long-term follow-up studies of DMTs in MS have generally shown that the short-term effects in clinical trials are maintained for up to 21 years, e.g. in the case of interferon beta-1b. However, attainment can be a problem in these studies. On the one hand, so-called real-world studies can augment clinical trials by providing data on the long-term effectiveness and safety of DMTs but lack, on the other hand, randomization and may, in addition, also yield biased findings as a result of compliance issues. Long-term data from clinical trials in clinically isolated syndrome (CIS) patients have been limited but in the case of interferon beta-1b this aspect has been addressed over 11 years in the BENEFIT 11 trial. The results suggest that early treatment results in persistent long-term benefits including conversion to clinically definite MS (CDMS) as well as time to and risk of a first relapse. Here we primarily review the findings of the BENEFIT 11 trial in the context of long-term studies.
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Affiliation(s)
- Hans-Peter Hartung
- Department of Neurology, UKD, Center for Neurology and Neuropsychiatry, LVR Klinikum Heinrich-Heine-University Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany.
| | - Jonas Graf
- Department of Neurology, UKD, Center for Neurology and Neuropsychiatry, LVR Klinikum Heinrich-Heine-University Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - David Kremer
- Department of Neurology, UKD, Center for Neurology and Neuropsychiatry, LVR Klinikum Heinrich-Heine-University Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
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Rahn AC, Köpke S, Stellmann JP, Schiffmann I, Lukas C, Chard D, Heesen C. Magnetic resonance imaging as a prognostic disability marker in clinically isolated syndrome: A systematic review. Acta Neurol Scand 2019; 139:18-32. [PMID: 30091223 DOI: 10.1111/ane.13010] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 07/30/2018] [Indexed: 11/30/2022]
Abstract
Magnetic resonance imaging (MRI) is the key prognostic tool in people with a clinically isolated syndrome (CIS). There is increasing interest in treating people following a CIS in the hope that conversion to multiple sclerosis (MS) will be prevented and future disability reduced. So far, the prognostic value of MRI for disability following a CIS has not been evaluated systematically. We systematically searched MEDLINE and EMBASE. Cohort studies were selected if they reported associations of MRI and disability following a CIS, included at least 50 people with a CIS at baseline, had at least 5 years of follow-up and obtained at least one structural MRI measurement (T1 lesions, T2 lesions, T1 contrast-enhancing lesions or brain atrophy). We assessed the studies for quality and rated the completeness of MRI reporting. In total, 13 studies were identified reporting on the following: T2 lesion number and volume, T2 infratentorial lesion number and volume, T1 contrast-enhancing lesions and grey matter fraction. T2 brain lesion number determined soon after the occurrence of a CIS was associated with disability progression after 5-7 years, with an increased risk when 10 or more lesions were present. Infratentorial lesions were also associated with a higher risk of subsequent disability. The number and distribution of MRI-visible lesions soon after a CIS are associated with disability later on, and may offer additional useful information when making treatment decisions in people with early MS. Further work is required to determine whether other measures have a higher predictive potential.
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Affiliation(s)
- Anne C. Rahn
- Institute of Neuroimmunology and Multiple Sclerosis; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - Sascha Köpke
- Nursing Research Unit; University of Lübeck; Lübeck Germany
| | - Jan-Patrick Stellmann
- Institute of Neuroimmunology and Multiple Sclerosis; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - Insa Schiffmann
- Institute of Neuroimmunology and Multiple Sclerosis; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - Carsten Lukas
- Department of Radiology; St. Josef Hospital Bochum; Ruhr University; Bochum Germany
| | - Declan Chard
- NMR Research Unit; Queen Square Multiple Sclerosis Centre; University College London (UCL); Institute of Neurology; London UK
- National Institute for Health Research (NIHR); University College London Hospitals (UCLH); Biomedical Research Centre; London UK
| | - Christoph Heesen
- Institute of Neuroimmunology and Multiple Sclerosis; University Medical Center Hamburg-Eppendorf; Hamburg Germany
- Department of Neurology; University Medical Center Hamburg-Eppendorf; Hamburg Germany
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Impact of fingolimod on clinical and magnetic resonance imaging outcomes in routine clinical practice: A retrospective analysis of the multiple sclerosis, clinical and MRI outcomes in the USA (MS-MRIUS) study. Mult Scler Relat Disord 2019; 27:65-73. [DOI: 10.1016/j.msard.2018.09.037] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 08/31/2018] [Accepted: 09/29/2018] [Indexed: 11/23/2022]
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180
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Sriram S, Shaginurova G, Tossberg JT, Natarajan C, Spurlock CF, Aune TM. Longitudinal changes in the expression of IL-33 and IL-33 regulated genes in relapsing remitting MS. PLoS One 2018; 13:e0208755. [PMID: 30562364 PMCID: PMC6298727 DOI: 10.1371/journal.pone.0208755] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 11/20/2018] [Indexed: 12/03/2022] Open
Abstract
Objective We tested the hypothesis that the expression of IL-33 in MS is dynamic and is likely to reflect the clinical and radiological changes during the course of RRMS. Methods MS with either clinical or radiological relapses were recruited for the study and followed for one year. IL-33 and a panel of genes was measured by q PCR and flow cytometry at different time points. Results Among 22 RRMS patients, 4 patients showed highest levels of IL-33 at the time they were recruited to the study (Month 0); in 14 patients highest levels of IL-33 were seen between 6–11 months after relapse and in 4 patients maximal levels of IL-33 were seen 12 months after relapse. A similar pattern of IL-33 kinetics was seen when IL-33 was measured by flow cytometry in an additional cohort of 12 patients. The timing of the improvement clinically did not correlate with IL-33 expression with highest expression levels either preceding or following clinical recovery. From our whole genome RNA-sequencing data we found a strong correlation between expression levels of IL-33 and a ~2000 mRNA genes. However, none of these genes encoded proteins involved in either innate or adaptive immunity. Rather, many of the genes that correlated highly with IL-33 encoded to proteins involved in DNA repair or mitochondrial function and mRNA splicing pathways. Interpretation Given the neuro-reparative and remodeling functions attributed to IL-33, it is likely that some of the novel genes we have uncovered may be involved in repair and recovery of the CNS in MS.
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Affiliation(s)
- Subramaniam Sriram
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, United States of America
- * E-mail:
| | - Guzel Shaginurova
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States of America
- IQuity, Inc., Nashville, TN, United States of America
| | | | - Chandramohan Natarajan
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Charles F. Spurlock
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Thomas M. Aune
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States of America
- Department of Pathology, Microbiology & Immunology, Vanderbilt University Medical Center, Nashville, TN, United States of America
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One-shot domain adaptation in multiple sclerosis lesion segmentation using convolutional neural networks. NEUROIMAGE-CLINICAL 2018; 21:101638. [PMID: 30555005 PMCID: PMC6413299 DOI: 10.1016/j.nicl.2018.101638] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 11/30/2018] [Accepted: 12/09/2018] [Indexed: 11/29/2022]
Abstract
In recent years, several convolutional neural network (CNN) methods have been proposed for the automated white matter lesion segmentation of multiple sclerosis (MS) patient images, due to their superior performance compared with those of other state-of-the-art methods. However, the accuracies of CNN methods tend to decrease significantly when evaluated on different image domains compared with those used for training, which demonstrates the lack of adaptability of CNNs to unseen imaging data. In this study, we analyzed the effect of intensity domain adaptation on our recently proposed CNN-based MS lesion segmentation method. Given a source model trained on two public MS datasets, we investigated the transferability of the CNN model when applied to other MRI scanners and protocols, evaluating the minimum number of annotated images needed from the new domain and the minimum number of layers needed to re-train to obtain comparable accuracy. Our analysis comprised MS patient data from both a clinical center and the public ISBI2015 challenge database, which permitted us to compare the domain adaptation capability of our model to that of other state-of-the-art methods. In both datasets, our results showed the effectiveness of the proposed model in adapting previously acquired knowledge to new image domains, even when a reduced number of training samples was available in the target dataset. For the ISBI2015 challenge, our one-shot domain adaptation model trained using only a single case showed a performance similar to that of other CNN methods that were fully trained using the entire available training set, yielding a comparable human expert rater performance. We believe that our experiments will encourage the MS community to incorporate its use in different clinical settings with reduced amounts of annotated data. This approach could be meaningful not only in terms of the accuracy in delineating MS lesions but also in the related reductions in time and economic costs derived from manual lesion labeling. We analyzed the effect of intensity domain adaptation on CNN MS lesion segmentation. We evaluated the minimum number of images and layers needed to re-train the model. The model showed good adaptation even when trained on very few or a single case. The performance of models trained on one case was similar to other fully-trained CNN. On ISBI0215, our model trained on one case was comparable to human rate performance.
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182
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Petracca M, Margoni M, Bommarito G, Inglese M. Monitoring Progressive Multiple Sclerosis with Novel Imaging Techniques. Neurol Ther 2018; 7:265-285. [PMID: 29956263 PMCID: PMC6283788 DOI: 10.1007/s40120-018-0103-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Indexed: 02/04/2023] Open
Abstract
Imaging markers for monitoring disease progression in progressive multiple sclerosis (PMS) are scarce, thereby limiting the possibility to monitor disease evolution and to test effective treatments in clinical trials. Advanced imaging techniques that have the advantage of metrics with increased sensitivity to short-term tissue changes and increased specificity to the structural abnormalities characteristic of PMS have recently been applied in clinical trials of PMS. In this review, we (1) provide an overview of the pathological features of PMS, (2) summarize the findings of research and clinical trials conducted in PMS which have applied conventional and advanced magnetic resonance imaging techniques and (3) discuss recent advancements and future perspectives in monitoring PMS with imaging techniques.
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Affiliation(s)
- Maria Petracca
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Monica Margoni
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Multiple Sclerosis Centre, Department of Neurosciences DNS, University Hospital, University of Padua, Padua, Italy
| | - Giulia Bommarito
- Department of Neuroscience, Rehabilitation, Genetics and Maternal and Perinatal Sciences, University of Genoa, Genoa, Italy
| | - Matilde Inglese
- Department of Neuroscience, Rehabilitation, Genetics and Maternal and Perinatal Sciences, University of Genoa, Genoa, Italy.
- Departments of Neurology, Radiology and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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184
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Evan JR, Bozkurt SB, Thomas NC, Bagnato F. Alemtuzumab for the treatment of multiple sclerosis. Expert Opin Biol Ther 2018; 18:323-334. [PMID: 29309202 DOI: 10.1080/14712598.2018.1425388] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Alemtuzumab is a monoclonal antibody that targets for the destruction CD52+ cells, particularly B and T cells. Alemtuzumab is approved in more than 50 countries around the world for the treatment of adult patients with relapsing remitting multiple sclerosis (MS). Areas covered: In this review, the authors summarize biological, clinical and safety data related to the use of alemtuzumab in patients with MS. The authors then provide their expert opinion on alemtuzumab and the field as of whole before providing their perspectives for the future. Expert opinion: Alemtuzumab is highly efficacious; more so than first line treatments but comparable to natalizumab. Treatment schedule makes alemtuzumab administration easy and attractive to patients. However, its safety profile makes it a choice for a very limited number of patients, in a specific disease window. As of now, a cure for MS remains elusive and there is an unmet need for a safe and highly potent agent at the level of and beyond the blood brain barrier.
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Affiliation(s)
- Jennifer R Evan
- a Department of Neurology, Neuroimmunology Division/Neuroimaging Unit , Vanderbilt University Medical Center , Nashville , TN , USA.,b MedStar Health Union Memorial Hospital , Baltimore , MD , USA
| | - Subutay B Bozkurt
- a Department of Neurology, Neuroimmunology Division/Neuroimaging Unit , Vanderbilt University Medical Center , Nashville , TN , USA.,c University of Szeged Medical School , Szeged , Hungary
| | - Nikita C Thomas
- a Department of Neurology, Neuroimmunology Division/Neuroimaging Unit , Vanderbilt University Medical Center , Nashville , TN , USA
| | - Francesca Bagnato
- a Department of Neurology, Neuroimmunology Division/Neuroimaging Unit , Vanderbilt University Medical Center , Nashville , TN , USA
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185
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Hagens MHJ, Golla SV, Wijburg MT, Yaqub M, Heijtel D, Steenwijk MD, Schober P, Brevé JJP, Schuit RC, Reekie TA, Kassiou M, van Dam AM, Windhorst AD, Killestein J, Barkhof F, van Berckel BNM, Lammertsma AA. In vivo assessment of neuroinflammation in progressive multiple sclerosis: a proof of concept study with [ 18F]DPA714 PET. J Neuroinflammation 2018; 15:314. [PMID: 30424780 PMCID: PMC6234549 DOI: 10.1186/s12974-018-1352-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 10/30/2018] [Indexed: 12/21/2022] Open
Abstract
Background Over the past decades, positron emission tomography (PET) imaging has become an increasingly useful research modality in the field of multiple sclerosis (MS) research, as PET can visualise molecular processes, such as neuroinflammation, in vivo. The second generation PET radioligand [18F]DPA714 binds with high affinity to the 18-kDa translocator-protein (TSPO), which is mainly expressed on activated microglia. The aim of this proof of concept study was to evaluate this in vivo marker of neuroinflammation in primary and secondary progressive MS. Methods All subjects were genotyped for the rs6971 polymorphism within the TSPO gene, and low-affinity binders were excluded from participation in this study. Eight patients with progressive MS and seven age and genetic binding status matched healthy controls underwent a 60 min dynamic PET scan using [18F]DPA714, including both continuous on-line and manual arterial blood sampling to obtain metabolite-corrected arterial plasma input functions. Results The optimal model for quantification of [18F]DPA714 kinetics was a reversible two-tissue compartment model with additional blood volume parameter. For genetic high-affinity binders, a clear increase in binding potential was observed in patients with MS compared with age-matched controls. For both high and medium affinity binders, a further increase in binding potential was observed in T2 white matter lesions compared with non-lesional white matter. Volume of distribution, however, did not differentiate patients from healthy controls, as the large non-displaceable compartment of [18F]DPA714 masks its relatively small specific signal. Conclusion The TSPO radioligand [18F]DPA714 can reliably identify increased focal and diffuse neuroinflammation in progressive MS when using plasma input-derived binding potential, but observed differences were predominantly visible in high-affinity binders. Electronic supplementary material The online version of this article (10.1186/s12974-018-1352-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Marloes H J Hagens
- VUmc MS Center Amsterdam, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands. .,Department of Neurology, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands.
| | - Sandeep V Golla
- Department of Radiology and Nuclear Medicine, VU University Medical Center Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands
| | - Martijn T Wijburg
- VUmc MS Center Amsterdam, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands.,Department of Neurology, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands
| | - Maqsood Yaqub
- Department of Radiology and Nuclear Medicine, VU University Medical Center Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands
| | - Dennis Heijtel
- Department of Radiology and Nuclear Medicine, VU University Medical Center Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands.,Philips Healthcare, Best, the Netherlands, Veenpluis 4, 5684 PC, Best, the Netherlands
| | - Martijn D Steenwijk
- VUmc MS Center Amsterdam, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands.,Department of Anatomy and Neurosciences, VU University Medical Center Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands
| | - Patrick Schober
- Department of Anaesthesiology, VU University Medical Center Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands
| | - John J P Brevé
- Department of Anatomy and Neurosciences, VU University Medical Center Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands
| | - Robert C Schuit
- Department of Radiology and Nuclear Medicine, VU University Medical Center Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands
| | - Tristan A Reekie
- School of Chemistry, University of Sydney, F11, Eastern Ave, Sydney, NSW, 2006, Australia
| | - Michael Kassiou
- School of Chemistry, University of Sydney, F11, Eastern Ave, Sydney, NSW, 2006, Australia
| | - Anne-Marie van Dam
- VUmc MS Center Amsterdam, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands.,Department of Anatomy and Neurosciences, VU University Medical Center Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands
| | - Albert D Windhorst
- Department of Radiology and Nuclear Medicine, VU University Medical Center Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands
| | - Joep Killestein
- VUmc MS Center Amsterdam, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands.,Department of Neurology, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands
| | - Frederik Barkhof
- VUmc MS Center Amsterdam, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands.,Department of Radiology and Nuclear Medicine, VU University Medical Center Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands.,Institutes of Neurology and Healthcare Engineering, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Bart N M van Berckel
- Department of Radiology and Nuclear Medicine, VU University Medical Center Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands
| | - Adriaan A Lammertsma
- Department of Radiology and Nuclear Medicine, VU University Medical Center Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands
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Abstract
Multiple sclerosis (MS) is the most common chronic inflammatory, demyelinating and neurodegenerative disease of the central nervous system in young adults. This disorder is a heterogeneous, multifactorial, immune-mediated disease that is influenced by both genetic and environmental factors. In most patients, reversible episodes of neurological dysfunction lasting several days or weeks characterize the initial stages of the disease (that is, clinically isolated syndrome and relapsing-remitting MS). Over time, irreversible clinical and cognitive deficits develop. A minority of patients have a progressive disease course from the onset. The pathological hallmark of MS is the formation of demyelinating lesions in the brain and spinal cord, which can be associated with neuro-axonal damage. Focal lesions are thought to be caused by the infiltration of immune cells, including T cells, B cells and myeloid cells, into the central nervous system parenchyma, with associated injury. MS is associated with a substantial burden on society owing to the high cost of the available treatments and poorer employment prospects and job retention for patients and their caregivers.
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Affiliation(s)
- Massimo Filippi
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy. .,Department of Neurology, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.
| | - Amit Bar-Or
- Department of Neurology and Center for Neuroinflammation and Experimental Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Fredrik Piehl
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.,Department of Neurology, Karolinska University Hospital, Stockholm, Sweden.,Neuroimmunology Unit, Center for Molecular Medicine, Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden
| | - Paolo Preziosa
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.,Department of Neurology, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Alessandra Solari
- Unit of Neuroepidemiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Sandra Vukusic
- Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Fondation Eugène Devic EDMUS Contre la Sclérose en Plaques, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
| | - Maria A Rocca
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.,Department of Neurology, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
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Validation of CSF free light chain in diagnosis and prognosis of multiple sclerosis and clinically isolated syndrome: prospective cohort study in Buenos Aires. J Neurol 2018; 266:112-118. [PMID: 30386877 DOI: 10.1007/s00415-018-9106-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 10/26/2018] [Accepted: 10/27/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND The objective was to evaluate the precision of kappa and lambda free light chains (KFLC and LFLC) in CSF for the diagnosis of multiple sclerosis (MS) and prognosis of clinically isolated syndrome (CIS). METHODS CSF and serum samples from CIS, MS and other neurological non-MS disease were collected between 2015 and 2017. FLC concentrations were measured using immunoassay Freelite™. Results were correlated with the patients' diagnoses and ROC curve analysis was used to determine accuracy. In CIS patients, analysis of FLC were compared in CIS converters vs. non-converter during follow-up. RESULTS In the MS group (n = 41), the optimal cut-off for KFLC determined was 7 mg/L, with a diagnostic sensitivity and specificity of 95% and 97%, respectively. The optimal cut-off for LFLC was 0.7 mg/L, with a diagnostic sensitivity and specificity of 71% and 81%, respectively. 36 CIS patients were included; mean follow-up time was 28 ± 9 months, and 22 (61.1%) patients converted to MS. The median concentration of CSF K and LFLCs at CIS diagnosis was slightly higher in CIS-converters compared to non-converters, but this did not reach statistical significance (KFLC: median 7 ± 5.3 mg/L vs. 5 ± 2.3 mg/L, p = 0.11; LFLC 0.7 ± 0.33 mg/L vs. 0.5 ± 0.23 mg/L p = 0.16). A strong correlation was observed between the concentration of K and L FLCs at diagnosis and the change in PBVC during follow-up (r = 0.72 and r = 0.65, respectively). CONCLUSION KFLCs have a high sensitivity and specificity for the diagnosis of MS. FLC concentrations at CIS diagnosis were not significantly higher in CIS-converters.
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Mattay RR, Davtyan K, Bilello M, Mamourian AC. Do All Patients with Multiple Sclerosis Benefit from the Use of Contrast on Serial Follow-Up MR Imaging? A Retrospective Analysis. AJNR Am J Neuroradiol 2018; 39:2001-2006. [PMID: 30287455 DOI: 10.3174/ajnr.a5828] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 07/26/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Patients with multiple sclerosis routinely have MR imaging with contrast every 6-12 months to assess response to medication. Multiple recent studies provide evidence of tissue deposition of MR imaging contrast agents, questioning the long-term safety of these agents. The goal of this retrospective image-analysis study was to determine whether contrast could be reserved for only those patients who show new MS lesions on follow-up examinations. MATERIALS AND METHODS We retrospectively reviewed brain MRIs of 138 patients. To increase our sensitivity, we used a previously described computerized image-comparison software to evaluate the stability or progression of multiple sclerosis white matter lesions in noncontrast FLAIR sequences. We correlated these findings with evidence of contrast-enhancing lesions on the enhanced T1 sequence from the same scan. RESULTS Thirty-three scans showed an increase in white matter lesion burden. Among those 33 patients, 14 examinations also demonstrated enhancing new lesions. While we found a single example of enhancement of a pre-existing white matter lesion that appeared unchanged in size, that same examination showed an overall increase in lesion burden with enhancement of other, new lesions. Thus, we found that all patients with enhancing lesions had evidence of progression on their noncontrast imaging. CONCLUSIONS Because all enhancing lesions were associated with new lesions on unenhanced imaging and progression was only evident in 24% of patients, in patients with relapsing-remitting MS, it is reasonable to consider reserving contrast for only those patients with evidence of progression on noncontrast MR images.
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Affiliation(s)
- R R Mattay
- From the Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
| | - K Davtyan
- From the Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - M Bilello
- From the Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - A C Mamourian
- From the Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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189
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Consensus recommendations for the diagnosis and treatment of primary progressive multiple sclerosis in Latin America. J Neurol Sci 2018; 393:4-13. [DOI: 10.1016/j.jns.2018.07.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 07/26/2018] [Accepted: 07/30/2018] [Indexed: 11/21/2022]
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190
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Bonzano L, Bove M, Sormani MP, Stromillo ML, Giorgio A, Amato MP, Tacchino A, Mancardi GL, De Stefano N. Subclinical motor impairment assessed with an engineered glove correlates with magnetic resonance imaging tissue damage in radiologically isolated syndrome. Eur J Neurol 2018; 26:162-167. [PMID: 30133054 DOI: 10.1111/ene.13789] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 08/17/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND An engineered glove measuring finger motor performance previously showed ability to discriminate early-stage multiple sclerosis (MS) patients from healthy controls (HCs). Radiologically isolated syndrome (RIS) classifies asymptomatic subjects with brain magnetic resonance imaging (MRI) abnormalities suggestive of multiple sclerosis. METHODS Seventeen asymptomatic subjects with RIS and 17 HCs were assessed. They performed finger-to-thumb opposition sequences at their maximal velocity, metronome-paced bimanual movements and conventional and diffusion tensor MRI. RESULTS Subjects with RIS showed lower (P = 0.005) maximal velocity and higher (P = 0.006) bimanual coordination impairment than HCs. In RIS, bimanual coordination correlated with T2-lesion volume, fractional anisotropy and radial diffusivity in the white matter. CONCLUSIONS These findings point out the relevance of fine hand measures as a robust marker of subclinical disability.
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Affiliation(s)
- L Bonzano
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - M Bove
- Section of Human Physiology, Department of Experimental Medicine, University of Genoa, Genoa, Italy
| | - M P Sormani
- Biostatistics Unit, Department of Health Sciences, University of Genoa, Genoa, Italy
| | - M L Stromillo
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - A Giorgio
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - M P Amato
- Neuroscience Division, Department of NEUROFARBA, University of Florence, Florence, Italy
| | - A Tacchino
- Section of Human Physiology, Department of Experimental Medicine, University of Genoa, Genoa, Italy
| | - G L Mancardi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - N De Stefano
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
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191
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Rovira À. Imaging of meningeal inflammation should become part of the routine MRI protocol - Commentary. Mult Scler 2018; 25:333-335. [PMID: 30179069 DOI: 10.1177/1352458518799590] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Àlex Rovira
- Section of Neuroradiology, Department of Radiology, Autonomous University of Barcelona and Hospital Vall d'Hebron, Barcelona, Spain
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192
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Gabr RE, Pednekar AS, Kamali A, Lincoln JA, Nelson FM, Wolinsky JS, Narayana PA. Interleaved susceptibility-weighted and FLAIR MRI for imaging lesion-penetrating veins in multiple sclerosis. Magn Reson Med 2018; 80:1132-1137. [PMID: 29334139 PMCID: PMC5980669 DOI: 10.1002/mrm.27091] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 12/27/2017] [Indexed: 11/10/2022]
Abstract
Purpose To simultaneously image brain lesions and veins in multiple sclerosis. Methods An interleaved sequence was developed to simultaneously acquire 3D T2*-weighted (or susceptibility-weighted, SW) and fluid-attenuated inversion recovery (FLAIR) images on a 3.0T MRI system. The pulse sequence parameters were calculated to minimize signal perturbation from steady state while maintaining acceptable image contrast and scan time. Fifteen multiple sclerosis patients were enrolled in this prospective study and underwent a standard MS imaging protocol. In addition, SW and FLAIR images were acquired separately and also in an interleaved manner. The SW and FLAIR images were combined into one image to visualize lesions and penetrating veins. The contrast ratios between white matter lesions and penetrating veins were compared between the interleaved sequence and the individual non-interleaved acquisitions. Results Interleaved scanning of the FLAIR and the SW pulse sequences was achieved, producing aligned images, and with similar image contrast as in the non-interleaved images. A total of 1076 lesions were identified in all patients on the combined SW-FLAIR image, of which 968 lesions (90%) had visible penetrating veins. Lesion-to-vein contrast ratio was 32.7 ± 17.9 (mean ± standard deviation) for the interleaved sequence compared to 28.1 ± 13.7 using the separate acquisitions (P<0.001). Conclusion The feasibility of interleaved acquisition of susceptibility-weighted and FLAIR images was demonstrated. This sequence provides self-registered images and facilitates the visualization of veins in brain lesions.
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Affiliation(s)
- Refaat E. Gabr
- Department of Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston, Houston, TX
| | - Amol S. Pednekar
- Philips Healthcare, Cleveland, OH
- Texas Children’s Hospital, Houston, TX
| | - Arash Kamali
- Department of Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston, Houston, TX
| | - John A Lincoln
- Department of Neurology, University of Texas Health Science Center at Houston, Houston, TX
| | - Flavia M. Nelson
- Department of Neurology, University of Texas Health Science Center at Houston, Houston, TX
| | - Jerry S. Wolinsky
- Department of Neurology, University of Texas Health Science Center at Houston, Houston, TX
| | - Ponnada A. Narayana
- Department of Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston, Houston, TX
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193
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Foxley S, Karczmar GS, Takahashi K. The effects of variations in tissue microstructure from postmortem rat brain on the asymmetry of the water proton resonance. Magn Reson Med 2018; 81:79-89. [PMID: 30014543 DOI: 10.1002/mrm.27338] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 03/23/2018] [Accepted: 04/10/2018] [Indexed: 12/13/2022]
Abstract
PURPOSE This work was performed to investigate the effects of tissue microstructure from postmortem rat brain on the shape of the water proton spectrum. METHODS Perfusion-fixed, resected rat brains (N = 4) were imaged at 9.4T. 3D DTI and 3D echo-planar spectroscopic imaging (EPSI) data were acquired with 150 μm isotropic resolution. DTI data were acquired over 60 directions with b = 3000 s/mm2 . Water spectra were produced from EPSI data acquired over 128 echoes, with 2.9 Hz spectral resolution. A voxel-wise metric reflecting spectral asymmetry about the peak of the resonance was computed and compared with orientation estimates from DTI data by fitting data with the susceptibility anisotropy model. RESULTS Asymmetric broadening of the water resonance was computed for mixed populations of grey and/or white matter as determined by thresholding the fractional anisotropy. Asymmetry was shown to be differentially affected by tract orientation relative to B0 in high FA voxels, whereas low FA voxels exhibited little sensitivity. Anatomic structures in the hippocampus were also found to produce distinct changes in the water resonance. CONCLUSION Present results demonstrate that structural variations in tissue architecture cause characteristic, reproducible changes in the water resonance shape. This suggests that water spectra are sensitive to cytoarchitectural variations in brain tissue.
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Affiliation(s)
- Sean Foxley
- MRI Research Center, Department of Radiology, University of Chicago, Chicago, Illinois
| | - Gregory S Karczmar
- MRI Research Center, Department of Radiology, University of Chicago, Chicago, Illinois
| | - Kazutaka Takahashi
- Department of Organismal Biology and Anatomy, University of Chicago, Chicago, Illinois
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194
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Hagens MHJ, Burggraaff J, Kilsdonk ID, de Vos ML, Cawley N, Sbardella E, Andelova M, Amann M, Lieb JM, Pantano P, Lissenberg-Witte BI, Killestein J, Oreja-Guevara C, Ciccarelli O, Gasperini C, Lukas C, Wattjes MP, Barkhof F. Three-Tesla MRI does not improve the diagnosis of multiple sclerosis: A multicenter study. Neurology 2018; 91:e249-e257. [PMID: 29925550 PMCID: PMC6059032 DOI: 10.1212/wnl.0000000000005825] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 04/13/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE In the work-up of patients presenting with a clinically isolated syndrome (CIS), 3T MRI might offer a higher lesion detection than 1.5T, but it remains unclear whether this affects the fulfilment of the diagnostic criteria for multiple sclerosis (MS). METHODS We recruited 66 patients with CIS within 6 months from symptom onset and 26 healthy controls in 6 MS centers. All participants underwent 1.5T and 3T brain and spinal cord MRI at baseline according to local optimized protocols and the MAGNIMS guidelines. Patients who had not converted to MS during follow-up received repeat brain MRI at 3-6 months and 12-15 months. The number of lesions per anatomical region was scored by 3 raters in consensus. Criteria for dissemination in space (DIS) and dissemination in time (DIT) were determined according to the 2017 revisions of the McDonald criteria. RESULTS Three-Tesla MRI detected 15% more T2 brain lesions compared to 1.5T (p < 0.001), which was driven by an increase in baseline detection of periventricular (12%, p = 0.015), (juxta)cortical (21%, p = 0.005), and deep white matter lesions (21%, p < 0.001). The detection rate of spinal cord lesions and gadolinium-enhancing lesions did not differ between field strengths. Three-Tesla MRI did not lead to a higher number of patients fulfilling the criteria for DIS or DIT, or subsequent diagnosis of MS, at any of the 3 time points. CONCLUSION Scanning at 3T does not influence the diagnosis of MS according to McDonald diagnostic criteria.
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Affiliation(s)
- Marloes H J Hagens
- From the Departments of Neurology (M.H.J.H., J.B., J.K.) and Radiology and Nuclear Medicine (I.D.K., M.L.d.V., M.P.W., F.B.), MS Centre Amsterdam, and Department of Epidemiology and Biostatistics (B.I.L.-W.), VU University Medical Centre; Department of Radiology and Nuclear Medicine (I.D.K.), Onze Lieve Vrouwen Gasthuis, Amsterdam, the Netherlands; Queen Square Multiple Sclerosis Centre (N.C., O.C.) and Institutes of Neurology & Healthcare Engineering (F.B.), UCL Institute of Neurology, London, UK; Department of Neurology and Psychiatry (E.S., P.P.), Sapienza University of Rome, Italy; Department of Neurology (M. Andelova, M. Amann) and Division of Neuroradiology, Department of Radiology (M. Amann, J.M.L.), University Hospital Basel; Medical Image Analysis Centre (M. Amann), Basel, Switzerland; Istituto Neurologico Mediterraneo (P.P.), Neuromed, Pozzilli (IS), Italy; Department of Neurology (C.O.-G.), Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain; National Institute for Health Research (O.C., F.B.), University College London Hospitals (UCLH) Biomedical Research Centre (BRC), UK; Department of Neurosciences (C.G.), San Camillo-Forlanini Hospital, Rome, Italy; and Department of Diagnostic and Interventional Radiology and Nuclear Medicine (C.L.), St. Josef Hospital, Ruhr University, Bochum, Germany.
| | - Jessica Burggraaff
- From the Departments of Neurology (M.H.J.H., J.B., J.K.) and Radiology and Nuclear Medicine (I.D.K., M.L.d.V., M.P.W., F.B.), MS Centre Amsterdam, and Department of Epidemiology and Biostatistics (B.I.L.-W.), VU University Medical Centre; Department of Radiology and Nuclear Medicine (I.D.K.), Onze Lieve Vrouwen Gasthuis, Amsterdam, the Netherlands; Queen Square Multiple Sclerosis Centre (N.C., O.C.) and Institutes of Neurology & Healthcare Engineering (F.B.), UCL Institute of Neurology, London, UK; Department of Neurology and Psychiatry (E.S., P.P.), Sapienza University of Rome, Italy; Department of Neurology (M. Andelova, M. Amann) and Division of Neuroradiology, Department of Radiology (M. Amann, J.M.L.), University Hospital Basel; Medical Image Analysis Centre (M. Amann), Basel, Switzerland; Istituto Neurologico Mediterraneo (P.P.), Neuromed, Pozzilli (IS), Italy; Department of Neurology (C.O.-G.), Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain; National Institute for Health Research (O.C., F.B.), University College London Hospitals (UCLH) Biomedical Research Centre (BRC), UK; Department of Neurosciences (C.G.), San Camillo-Forlanini Hospital, Rome, Italy; and Department of Diagnostic and Interventional Radiology and Nuclear Medicine (C.L.), St. Josef Hospital, Ruhr University, Bochum, Germany
| | - Iris D Kilsdonk
- From the Departments of Neurology (M.H.J.H., J.B., J.K.) and Radiology and Nuclear Medicine (I.D.K., M.L.d.V., M.P.W., F.B.), MS Centre Amsterdam, and Department of Epidemiology and Biostatistics (B.I.L.-W.), VU University Medical Centre; Department of Radiology and Nuclear Medicine (I.D.K.), Onze Lieve Vrouwen Gasthuis, Amsterdam, the Netherlands; Queen Square Multiple Sclerosis Centre (N.C., O.C.) and Institutes of Neurology & Healthcare Engineering (F.B.), UCL Institute of Neurology, London, UK; Department of Neurology and Psychiatry (E.S., P.P.), Sapienza University of Rome, Italy; Department of Neurology (M. Andelova, M. Amann) and Division of Neuroradiology, Department of Radiology (M. Amann, J.M.L.), University Hospital Basel; Medical Image Analysis Centre (M. Amann), Basel, Switzerland; Istituto Neurologico Mediterraneo (P.P.), Neuromed, Pozzilli (IS), Italy; Department of Neurology (C.O.-G.), Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain; National Institute for Health Research (O.C., F.B.), University College London Hospitals (UCLH) Biomedical Research Centre (BRC), UK; Department of Neurosciences (C.G.), San Camillo-Forlanini Hospital, Rome, Italy; and Department of Diagnostic and Interventional Radiology and Nuclear Medicine (C.L.), St. Josef Hospital, Ruhr University, Bochum, Germany
| | - Marlieke L de Vos
- From the Departments of Neurology (M.H.J.H., J.B., J.K.) and Radiology and Nuclear Medicine (I.D.K., M.L.d.V., M.P.W., F.B.), MS Centre Amsterdam, and Department of Epidemiology and Biostatistics (B.I.L.-W.), VU University Medical Centre; Department of Radiology and Nuclear Medicine (I.D.K.), Onze Lieve Vrouwen Gasthuis, Amsterdam, the Netherlands; Queen Square Multiple Sclerosis Centre (N.C., O.C.) and Institutes of Neurology & Healthcare Engineering (F.B.), UCL Institute of Neurology, London, UK; Department of Neurology and Psychiatry (E.S., P.P.), Sapienza University of Rome, Italy; Department of Neurology (M. Andelova, M. Amann) and Division of Neuroradiology, Department of Radiology (M. Amann, J.M.L.), University Hospital Basel; Medical Image Analysis Centre (M. Amann), Basel, Switzerland; Istituto Neurologico Mediterraneo (P.P.), Neuromed, Pozzilli (IS), Italy; Department of Neurology (C.O.-G.), Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain; National Institute for Health Research (O.C., F.B.), University College London Hospitals (UCLH) Biomedical Research Centre (BRC), UK; Department of Neurosciences (C.G.), San Camillo-Forlanini Hospital, Rome, Italy; and Department of Diagnostic and Interventional Radiology and Nuclear Medicine (C.L.), St. Josef Hospital, Ruhr University, Bochum, Germany
| | - Niamh Cawley
- From the Departments of Neurology (M.H.J.H., J.B., J.K.) and Radiology and Nuclear Medicine (I.D.K., M.L.d.V., M.P.W., F.B.), MS Centre Amsterdam, and Department of Epidemiology and Biostatistics (B.I.L.-W.), VU University Medical Centre; Department of Radiology and Nuclear Medicine (I.D.K.), Onze Lieve Vrouwen Gasthuis, Amsterdam, the Netherlands; Queen Square Multiple Sclerosis Centre (N.C., O.C.) and Institutes of Neurology & Healthcare Engineering (F.B.), UCL Institute of Neurology, London, UK; Department of Neurology and Psychiatry (E.S., P.P.), Sapienza University of Rome, Italy; Department of Neurology (M. Andelova, M. Amann) and Division of Neuroradiology, Department of Radiology (M. Amann, J.M.L.), University Hospital Basel; Medical Image Analysis Centre (M. Amann), Basel, Switzerland; Istituto Neurologico Mediterraneo (P.P.), Neuromed, Pozzilli (IS), Italy; Department of Neurology (C.O.-G.), Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain; National Institute for Health Research (O.C., F.B.), University College London Hospitals (UCLH) Biomedical Research Centre (BRC), UK; Department of Neurosciences (C.G.), San Camillo-Forlanini Hospital, Rome, Italy; and Department of Diagnostic and Interventional Radiology and Nuclear Medicine (C.L.), St. Josef Hospital, Ruhr University, Bochum, Germany
| | - Emilia Sbardella
- From the Departments of Neurology (M.H.J.H., J.B., J.K.) and Radiology and Nuclear Medicine (I.D.K., M.L.d.V., M.P.W., F.B.), MS Centre Amsterdam, and Department of Epidemiology and Biostatistics (B.I.L.-W.), VU University Medical Centre; Department of Radiology and Nuclear Medicine (I.D.K.), Onze Lieve Vrouwen Gasthuis, Amsterdam, the Netherlands; Queen Square Multiple Sclerosis Centre (N.C., O.C.) and Institutes of Neurology & Healthcare Engineering (F.B.), UCL Institute of Neurology, London, UK; Department of Neurology and Psychiatry (E.S., P.P.), Sapienza University of Rome, Italy; Department of Neurology (M. Andelova, M. Amann) and Division of Neuroradiology, Department of Radiology (M. Amann, J.M.L.), University Hospital Basel; Medical Image Analysis Centre (M. Amann), Basel, Switzerland; Istituto Neurologico Mediterraneo (P.P.), Neuromed, Pozzilli (IS), Italy; Department of Neurology (C.O.-G.), Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain; National Institute for Health Research (O.C., F.B.), University College London Hospitals (UCLH) Biomedical Research Centre (BRC), UK; Department of Neurosciences (C.G.), San Camillo-Forlanini Hospital, Rome, Italy; and Department of Diagnostic and Interventional Radiology and Nuclear Medicine (C.L.), St. Josef Hospital, Ruhr University, Bochum, Germany
| | - Michaela Andelova
- From the Departments of Neurology (M.H.J.H., J.B., J.K.) and Radiology and Nuclear Medicine (I.D.K., M.L.d.V., M.P.W., F.B.), MS Centre Amsterdam, and Department of Epidemiology and Biostatistics (B.I.L.-W.), VU University Medical Centre; Department of Radiology and Nuclear Medicine (I.D.K.), Onze Lieve Vrouwen Gasthuis, Amsterdam, the Netherlands; Queen Square Multiple Sclerosis Centre (N.C., O.C.) and Institutes of Neurology & Healthcare Engineering (F.B.), UCL Institute of Neurology, London, UK; Department of Neurology and Psychiatry (E.S., P.P.), Sapienza University of Rome, Italy; Department of Neurology (M. Andelova, M. Amann) and Division of Neuroradiology, Department of Radiology (M. Amann, J.M.L.), University Hospital Basel; Medical Image Analysis Centre (M. Amann), Basel, Switzerland; Istituto Neurologico Mediterraneo (P.P.), Neuromed, Pozzilli (IS), Italy; Department of Neurology (C.O.-G.), Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain; National Institute for Health Research (O.C., F.B.), University College London Hospitals (UCLH) Biomedical Research Centre (BRC), UK; Department of Neurosciences (C.G.), San Camillo-Forlanini Hospital, Rome, Italy; and Department of Diagnostic and Interventional Radiology and Nuclear Medicine (C.L.), St. Josef Hospital, Ruhr University, Bochum, Germany
| | - Michael Amann
- From the Departments of Neurology (M.H.J.H., J.B., J.K.) and Radiology and Nuclear Medicine (I.D.K., M.L.d.V., M.P.W., F.B.), MS Centre Amsterdam, and Department of Epidemiology and Biostatistics (B.I.L.-W.), VU University Medical Centre; Department of Radiology and Nuclear Medicine (I.D.K.), Onze Lieve Vrouwen Gasthuis, Amsterdam, the Netherlands; Queen Square Multiple Sclerosis Centre (N.C., O.C.) and Institutes of Neurology & Healthcare Engineering (F.B.), UCL Institute of Neurology, London, UK; Department of Neurology and Psychiatry (E.S., P.P.), Sapienza University of Rome, Italy; Department of Neurology (M. Andelova, M. Amann) and Division of Neuroradiology, Department of Radiology (M. Amann, J.M.L.), University Hospital Basel; Medical Image Analysis Centre (M. Amann), Basel, Switzerland; Istituto Neurologico Mediterraneo (P.P.), Neuromed, Pozzilli (IS), Italy; Department of Neurology (C.O.-G.), Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain; National Institute for Health Research (O.C., F.B.), University College London Hospitals (UCLH) Biomedical Research Centre (BRC), UK; Department of Neurosciences (C.G.), San Camillo-Forlanini Hospital, Rome, Italy; and Department of Diagnostic and Interventional Radiology and Nuclear Medicine (C.L.), St. Josef Hospital, Ruhr University, Bochum, Germany
| | - Johanna M Lieb
- From the Departments of Neurology (M.H.J.H., J.B., J.K.) and Radiology and Nuclear Medicine (I.D.K., M.L.d.V., M.P.W., F.B.), MS Centre Amsterdam, and Department of Epidemiology and Biostatistics (B.I.L.-W.), VU University Medical Centre; Department of Radiology and Nuclear Medicine (I.D.K.), Onze Lieve Vrouwen Gasthuis, Amsterdam, the Netherlands; Queen Square Multiple Sclerosis Centre (N.C., O.C.) and Institutes of Neurology & Healthcare Engineering (F.B.), UCL Institute of Neurology, London, UK; Department of Neurology and Psychiatry (E.S., P.P.), Sapienza University of Rome, Italy; Department of Neurology (M. Andelova, M. Amann) and Division of Neuroradiology, Department of Radiology (M. Amann, J.M.L.), University Hospital Basel; Medical Image Analysis Centre (M. Amann), Basel, Switzerland; Istituto Neurologico Mediterraneo (P.P.), Neuromed, Pozzilli (IS), Italy; Department of Neurology (C.O.-G.), Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain; National Institute for Health Research (O.C., F.B.), University College London Hospitals (UCLH) Biomedical Research Centre (BRC), UK; Department of Neurosciences (C.G.), San Camillo-Forlanini Hospital, Rome, Italy; and Department of Diagnostic and Interventional Radiology and Nuclear Medicine (C.L.), St. Josef Hospital, Ruhr University, Bochum, Germany
| | - Patrizia Pantano
- From the Departments of Neurology (M.H.J.H., J.B., J.K.) and Radiology and Nuclear Medicine (I.D.K., M.L.d.V., M.P.W., F.B.), MS Centre Amsterdam, and Department of Epidemiology and Biostatistics (B.I.L.-W.), VU University Medical Centre; Department of Radiology and Nuclear Medicine (I.D.K.), Onze Lieve Vrouwen Gasthuis, Amsterdam, the Netherlands; Queen Square Multiple Sclerosis Centre (N.C., O.C.) and Institutes of Neurology & Healthcare Engineering (F.B.), UCL Institute of Neurology, London, UK; Department of Neurology and Psychiatry (E.S., P.P.), Sapienza University of Rome, Italy; Department of Neurology (M. Andelova, M. Amann) and Division of Neuroradiology, Department of Radiology (M. Amann, J.M.L.), University Hospital Basel; Medical Image Analysis Centre (M. Amann), Basel, Switzerland; Istituto Neurologico Mediterraneo (P.P.), Neuromed, Pozzilli (IS), Italy; Department of Neurology (C.O.-G.), Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain; National Institute for Health Research (O.C., F.B.), University College London Hospitals (UCLH) Biomedical Research Centre (BRC), UK; Department of Neurosciences (C.G.), San Camillo-Forlanini Hospital, Rome, Italy; and Department of Diagnostic and Interventional Radiology and Nuclear Medicine (C.L.), St. Josef Hospital, Ruhr University, Bochum, Germany
| | - Birgit I Lissenberg-Witte
- From the Departments of Neurology (M.H.J.H., J.B., J.K.) and Radiology and Nuclear Medicine (I.D.K., M.L.d.V., M.P.W., F.B.), MS Centre Amsterdam, and Department of Epidemiology and Biostatistics (B.I.L.-W.), VU University Medical Centre; Department of Radiology and Nuclear Medicine (I.D.K.), Onze Lieve Vrouwen Gasthuis, Amsterdam, the Netherlands; Queen Square Multiple Sclerosis Centre (N.C., O.C.) and Institutes of Neurology & Healthcare Engineering (F.B.), UCL Institute of Neurology, London, UK; Department of Neurology and Psychiatry (E.S., P.P.), Sapienza University of Rome, Italy; Department of Neurology (M. Andelova, M. Amann) and Division of Neuroradiology, Department of Radiology (M. Amann, J.M.L.), University Hospital Basel; Medical Image Analysis Centre (M. Amann), Basel, Switzerland; Istituto Neurologico Mediterraneo (P.P.), Neuromed, Pozzilli (IS), Italy; Department of Neurology (C.O.-G.), Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain; National Institute for Health Research (O.C., F.B.), University College London Hospitals (UCLH) Biomedical Research Centre (BRC), UK; Department of Neurosciences (C.G.), San Camillo-Forlanini Hospital, Rome, Italy; and Department of Diagnostic and Interventional Radiology and Nuclear Medicine (C.L.), St. Josef Hospital, Ruhr University, Bochum, Germany
| | - Joep Killestein
- From the Departments of Neurology (M.H.J.H., J.B., J.K.) and Radiology and Nuclear Medicine (I.D.K., M.L.d.V., M.P.W., F.B.), MS Centre Amsterdam, and Department of Epidemiology and Biostatistics (B.I.L.-W.), VU University Medical Centre; Department of Radiology and Nuclear Medicine (I.D.K.), Onze Lieve Vrouwen Gasthuis, Amsterdam, the Netherlands; Queen Square Multiple Sclerosis Centre (N.C., O.C.) and Institutes of Neurology & Healthcare Engineering (F.B.), UCL Institute of Neurology, London, UK; Department of Neurology and Psychiatry (E.S., P.P.), Sapienza University of Rome, Italy; Department of Neurology (M. Andelova, M. Amann) and Division of Neuroradiology, Department of Radiology (M. Amann, J.M.L.), University Hospital Basel; Medical Image Analysis Centre (M. Amann), Basel, Switzerland; Istituto Neurologico Mediterraneo (P.P.), Neuromed, Pozzilli (IS), Italy; Department of Neurology (C.O.-G.), Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain; National Institute for Health Research (O.C., F.B.), University College London Hospitals (UCLH) Biomedical Research Centre (BRC), UK; Department of Neurosciences (C.G.), San Camillo-Forlanini Hospital, Rome, Italy; and Department of Diagnostic and Interventional Radiology and Nuclear Medicine (C.L.), St. Josef Hospital, Ruhr University, Bochum, Germany
| | - Celia Oreja-Guevara
- From the Departments of Neurology (M.H.J.H., J.B., J.K.) and Radiology and Nuclear Medicine (I.D.K., M.L.d.V., M.P.W., F.B.), MS Centre Amsterdam, and Department of Epidemiology and Biostatistics (B.I.L.-W.), VU University Medical Centre; Department of Radiology and Nuclear Medicine (I.D.K.), Onze Lieve Vrouwen Gasthuis, Amsterdam, the Netherlands; Queen Square Multiple Sclerosis Centre (N.C., O.C.) and Institutes of Neurology & Healthcare Engineering (F.B.), UCL Institute of Neurology, London, UK; Department of Neurology and Psychiatry (E.S., P.P.), Sapienza University of Rome, Italy; Department of Neurology (M. Andelova, M. Amann) and Division of Neuroradiology, Department of Radiology (M. Amann, J.M.L.), University Hospital Basel; Medical Image Analysis Centre (M. Amann), Basel, Switzerland; Istituto Neurologico Mediterraneo (P.P.), Neuromed, Pozzilli (IS), Italy; Department of Neurology (C.O.-G.), Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain; National Institute for Health Research (O.C., F.B.), University College London Hospitals (UCLH) Biomedical Research Centre (BRC), UK; Department of Neurosciences (C.G.), San Camillo-Forlanini Hospital, Rome, Italy; and Department of Diagnostic and Interventional Radiology and Nuclear Medicine (C.L.), St. Josef Hospital, Ruhr University, Bochum, Germany
| | - Olga Ciccarelli
- From the Departments of Neurology (M.H.J.H., J.B., J.K.) and Radiology and Nuclear Medicine (I.D.K., M.L.d.V., M.P.W., F.B.), MS Centre Amsterdam, and Department of Epidemiology and Biostatistics (B.I.L.-W.), VU University Medical Centre; Department of Radiology and Nuclear Medicine (I.D.K.), Onze Lieve Vrouwen Gasthuis, Amsterdam, the Netherlands; Queen Square Multiple Sclerosis Centre (N.C., O.C.) and Institutes of Neurology & Healthcare Engineering (F.B.), UCL Institute of Neurology, London, UK; Department of Neurology and Psychiatry (E.S., P.P.), Sapienza University of Rome, Italy; Department of Neurology (M. Andelova, M. Amann) and Division of Neuroradiology, Department of Radiology (M. Amann, J.M.L.), University Hospital Basel; Medical Image Analysis Centre (M. Amann), Basel, Switzerland; Istituto Neurologico Mediterraneo (P.P.), Neuromed, Pozzilli (IS), Italy; Department of Neurology (C.O.-G.), Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain; National Institute for Health Research (O.C., F.B.), University College London Hospitals (UCLH) Biomedical Research Centre (BRC), UK; Department of Neurosciences (C.G.), San Camillo-Forlanini Hospital, Rome, Italy; and Department of Diagnostic and Interventional Radiology and Nuclear Medicine (C.L.), St. Josef Hospital, Ruhr University, Bochum, Germany
| | - Claudio Gasperini
- From the Departments of Neurology (M.H.J.H., J.B., J.K.) and Radiology and Nuclear Medicine (I.D.K., M.L.d.V., M.P.W., F.B.), MS Centre Amsterdam, and Department of Epidemiology and Biostatistics (B.I.L.-W.), VU University Medical Centre; Department of Radiology and Nuclear Medicine (I.D.K.), Onze Lieve Vrouwen Gasthuis, Amsterdam, the Netherlands; Queen Square Multiple Sclerosis Centre (N.C., O.C.) and Institutes of Neurology & Healthcare Engineering (F.B.), UCL Institute of Neurology, London, UK; Department of Neurology and Psychiatry (E.S., P.P.), Sapienza University of Rome, Italy; Department of Neurology (M. Andelova, M. Amann) and Division of Neuroradiology, Department of Radiology (M. Amann, J.M.L.), University Hospital Basel; Medical Image Analysis Centre (M. Amann), Basel, Switzerland; Istituto Neurologico Mediterraneo (P.P.), Neuromed, Pozzilli (IS), Italy; Department of Neurology (C.O.-G.), Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain; National Institute for Health Research (O.C., F.B.), University College London Hospitals (UCLH) Biomedical Research Centre (BRC), UK; Department of Neurosciences (C.G.), San Camillo-Forlanini Hospital, Rome, Italy; and Department of Diagnostic and Interventional Radiology and Nuclear Medicine (C.L.), St. Josef Hospital, Ruhr University, Bochum, Germany
| | - Carsten Lukas
- From the Departments of Neurology (M.H.J.H., J.B., J.K.) and Radiology and Nuclear Medicine (I.D.K., M.L.d.V., M.P.W., F.B.), MS Centre Amsterdam, and Department of Epidemiology and Biostatistics (B.I.L.-W.), VU University Medical Centre; Department of Radiology and Nuclear Medicine (I.D.K.), Onze Lieve Vrouwen Gasthuis, Amsterdam, the Netherlands; Queen Square Multiple Sclerosis Centre (N.C., O.C.) and Institutes of Neurology & Healthcare Engineering (F.B.), UCL Institute of Neurology, London, UK; Department of Neurology and Psychiatry (E.S., P.P.), Sapienza University of Rome, Italy; Department of Neurology (M. Andelova, M. Amann) and Division of Neuroradiology, Department of Radiology (M. Amann, J.M.L.), University Hospital Basel; Medical Image Analysis Centre (M. Amann), Basel, Switzerland; Istituto Neurologico Mediterraneo (P.P.), Neuromed, Pozzilli (IS), Italy; Department of Neurology (C.O.-G.), Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain; National Institute for Health Research (O.C., F.B.), University College London Hospitals (UCLH) Biomedical Research Centre (BRC), UK; Department of Neurosciences (C.G.), San Camillo-Forlanini Hospital, Rome, Italy; and Department of Diagnostic and Interventional Radiology and Nuclear Medicine (C.L.), St. Josef Hospital, Ruhr University, Bochum, Germany
| | - Mike P Wattjes
- From the Departments of Neurology (M.H.J.H., J.B., J.K.) and Radiology and Nuclear Medicine (I.D.K., M.L.d.V., M.P.W., F.B.), MS Centre Amsterdam, and Department of Epidemiology and Biostatistics (B.I.L.-W.), VU University Medical Centre; Department of Radiology and Nuclear Medicine (I.D.K.), Onze Lieve Vrouwen Gasthuis, Amsterdam, the Netherlands; Queen Square Multiple Sclerosis Centre (N.C., O.C.) and Institutes of Neurology & Healthcare Engineering (F.B.), UCL Institute of Neurology, London, UK; Department of Neurology and Psychiatry (E.S., P.P.), Sapienza University of Rome, Italy; Department of Neurology (M. Andelova, M. Amann) and Division of Neuroradiology, Department of Radiology (M. Amann, J.M.L.), University Hospital Basel; Medical Image Analysis Centre (M. Amann), Basel, Switzerland; Istituto Neurologico Mediterraneo (P.P.), Neuromed, Pozzilli (IS), Italy; Department of Neurology (C.O.-G.), Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain; National Institute for Health Research (O.C., F.B.), University College London Hospitals (UCLH) Biomedical Research Centre (BRC), UK; Department of Neurosciences (C.G.), San Camillo-Forlanini Hospital, Rome, Italy; and Department of Diagnostic and Interventional Radiology and Nuclear Medicine (C.L.), St. Josef Hospital, Ruhr University, Bochum, Germany
| | - Frederik Barkhof
- From the Departments of Neurology (M.H.J.H., J.B., J.K.) and Radiology and Nuclear Medicine (I.D.K., M.L.d.V., M.P.W., F.B.), MS Centre Amsterdam, and Department of Epidemiology and Biostatistics (B.I.L.-W.), VU University Medical Centre; Department of Radiology and Nuclear Medicine (I.D.K.), Onze Lieve Vrouwen Gasthuis, Amsterdam, the Netherlands; Queen Square Multiple Sclerosis Centre (N.C., O.C.) and Institutes of Neurology & Healthcare Engineering (F.B.), UCL Institute of Neurology, London, UK; Department of Neurology and Psychiatry (E.S., P.P.), Sapienza University of Rome, Italy; Department of Neurology (M. Andelova, M. Amann) and Division of Neuroradiology, Department of Radiology (M. Amann, J.M.L.), University Hospital Basel; Medical Image Analysis Centre (M. Amann), Basel, Switzerland; Istituto Neurologico Mediterraneo (P.P.), Neuromed, Pozzilli (IS), Italy; Department of Neurology (C.O.-G.), Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain; National Institute for Health Research (O.C., F.B.), University College London Hospitals (UCLH) Biomedical Research Centre (BRC), UK; Department of Neurosciences (C.G.), San Camillo-Forlanini Hospital, Rome, Italy; and Department of Diagnostic and Interventional Radiology and Nuclear Medicine (C.L.), St. Josef Hospital, Ruhr University, Bochum, Germany
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Mamlouk MD, Chang PC, Saket RR. Contextual Radiology Reporting: A New Approach to Neuroradiology Structured Templates. AJNR Am J Neuroradiol 2018; 39:1406-1414. [PMID: 29903922 DOI: 10.3174/ajnr.a5697] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 04/20/2018] [Indexed: 01/01/2023]
Abstract
Structured reporting has many advantages over conventional narrative reporting and has been advocated for standard usage by radiologic societies and literature. Traditional structured reports though are often not tailored to the appropriate clinical situation, are generic, and can be overly constraining. Contextual reporting is an alternative method of structured reporting that is specifically related to the disease or examination indication. Herein, we create a library of 50 contextual structured reports for neuroradiologists and emphasize their clinical value over noncontextual structured reporting. These templates are located in the On-line Appendix, and a downloadable PowerScribe 360 file may be accessed at https://drive.google.com/open?id=1AlPUmfAXPzjkMFcHf7vGKF4Q-vIdpflT.
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Affiliation(s)
- M D Mamlouk
- From the Department of Radiology (M.D.M., R.R.S.), The Permanente Medical Group, Kaiser Permanente Medical Center Santa Clara, Santa Clara, California .,Department of Radiology and Biomedical Imaging (M.D.M., R.R.S.), University of California, San Francisco, San Francisco, California
| | - P C Chang
- Department of Radiology (P.C.C.), The Permanente Medical Group, Kaiser Permanente Medical Center South San Francisco, South San Francisco, California
| | - R R Saket
- From the Department of Radiology (M.D.M., R.R.S.), The Permanente Medical Group, Kaiser Permanente Medical Center Santa Clara, Santa Clara, California.,Department of Radiology and Biomedical Imaging (M.D.M., R.R.S.), University of California, San Francisco, San Francisco, California
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196
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Aktas O, Wattjes MP, Stangel M, Hartung HP. Diagnose der Multiplen Sklerose: Revision der McDonald-Kriterien 2017. DER NERVENARZT 2018; 89:1344-1354. [DOI: 10.1007/s00115-018-0550-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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197
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Gamage SMK, Wijeweera I, Wijesinghe P, Adikari SB, Fink K, Sominanda HMA. Applicability of McDonald 2010 and Magnetic Resonance Imaging in Multiple Sclerosis (MAGNIMS) 2016 Magnetic Resonance Imaging Criteria for the Diagnosis of Multiple Sclerosis in Sri Lanka. J Clin Neurol 2018; 14:339-344. [PMID: 29856160 PMCID: PMC6031983 DOI: 10.3988/jcn.2018.14.3.339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 03/09/2018] [Accepted: 03/12/2018] [Indexed: 12/15/2022] Open
Abstract
Background and Purpose The magnetic resonance imaging in multiple sclerosis (MAGNIMS) group recently proposed guidelines to replace the existing dissemination-in-space criteria in McDonald 2010 magnetic resonance imaging (MRI) criteria for diagnosing multiple sclerosis. There has been insufficient research regarding their applicability in Asians. Objective of this study was to determine the sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) of McDonald 2010 and MAGNIMS 2016 MRI criteria with the aim of verifying their applicability in Sri Lankan patients. Methods Patients with clinically isolated syndrome diagnosed by consultant neurologists were recruited from five major neurology centers. Baseline and follow-up MRI scans were performed within 3 months from the initial presentation and at one year after baseline MRI, respectively. McDonald 2010 and MAGNIMS 2016 MRI criteria were applied to all MRI scans. Patients were followed-up for 2 years to assess the conversion to clinically definite multiple sclerosis (CDMS). The sensitivity, specificity, accuracy, PPV, and NPV for predicting the conversion to CDMS were calculated. Results Forty-two of 66 patients converted to CDMS. Thirty-seven fulfilled the McDonald 2010 MRI criteria, and 33 converted to CDMS. MAGNIMS 2016 MRI criteria were fulfilled by 29, with 28 converting to CDMS. The sensitivity, specificity, accuracy, PPV, and NPV were 78%, 83%, 64%, 89%, and 69%, respectively, for the McDonald 2010 criteria, and 67%, 96%, 77%, 96%, and 62% for the MAGNIMS 2016 MRI criteria. Conclusions MAGNIMS 2016 MRI criteria were superior to McDonald 2010 MRI criteria in specificity, accuracy, and PPV, but inferior in sensitivity and NPV.
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Affiliation(s)
| | | | - Priyangi Wijesinghe
- Radiology Unit, Sirimavo Bandaranayaka Specialized Children's Hospital, Peradeniya, Sri Lanka
| | | | - Katharina Fink
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
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Sati P. Diagnosis of multiple sclerosis through the lens of ultra-high-field MRI. JOURNAL OF MAGNETIC RESONANCE (SAN DIEGO, CALIF. : 1997) 2018; 291:101-109. [PMID: 29705032 PMCID: PMC6022748 DOI: 10.1016/j.jmr.2018.01.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 01/26/2018] [Accepted: 01/29/2018] [Indexed: 06/08/2023]
Abstract
The long-standing relationship between ultra-high-field (7 T) MRI and multiple sclerosis (MS) has brought new insights to our understanding of lesion evolution and its associated pathology. With the recent FDA approval of a commercially available scanner, 7 T MRI is finally entering the clinic with great expectations about its potential added value. By looking through the prism of MS diagnosis, this perspective article discusses current limitations and prospects of 7 T MRI techniques relevant to helping clinicians diagnose patients encountered in daily practice.
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Affiliation(s)
- Pascal Sati
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, 10 Center Drive MSC 1400, Building 10 Room 5C103, Bethesda, MD 20852, USA.
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Laureys G, Willekens B, Vanopdenbosch L, Deryck O, Selleslag D, D'Haeseleer M, De Becker A, Dubois B, Dierickx D, Perrotta G, De Wilde V, van Pesch V, Straetmans N, Dive D, Beguin Y, Van Wijmeersch B, Theunissen K, Kerre T, Van de Velde A. A Belgian consensus protocol for autologous hematopoietic stem cell transplantation in multiple sclerosis. Acta Neurol Belg 2018. [PMID: 29536270 DOI: 10.1007/s13760-018-0905-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Multiple sclerosis is considered to be an immune mediated inflammatory disorder of the central nervous system. It mainly affects young, socioeconomic active patients. Although our armamentarium for this disease has significantly evolved in recent years some patients remain refractory to conventional therapies. In these cases, autologous hematopoietic stem cell transplantation can be considered as a therapeutic option. Decreasing morbidity, mortality, and increasing patient awareness have led to rising inquiry by our patients about this treatment option. With the aim of a standardized protocol and data registration, a Belgian working party on stem cell therapy in multiple sclerosis was established. In this paper, we report the consensus protocol of this working party on autologous hematopoietic stem cell transplantation in multiple sclerosis.
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Affiliation(s)
- Guy Laureys
- Department of Neurology, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium.
| | - Barbara Willekens
- Department of Neurology, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Belgium
| | - Ludo Vanopdenbosch
- Department of Neurology, AZ Sint Jan Brugge Oostende, Ruddershove 10, 8000, Brugge, Belgium
| | - Olivier Deryck
- Department of Neurology, AZ Sint Jan Brugge Oostende, Ruddershove 10, 8000, Brugge, Belgium
| | - Dominik Selleslag
- Department of Hematology, AZ Sint Jan Brugge Oostende, Ruddershove 10, 8000, Brugge, Belgium
| | - Miguel D'Haeseleer
- Department of Neurology, Center for Neurosciences, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Ann De Becker
- Department of Hematology, UZ Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Bénédicte Dubois
- Department of Neurology, UZ Leuven, Herestraat 49, 3000, Louvain, Belgium
| | - Daan Dierickx
- Department of Hematology, UZ Leuven, Herestraat 49, 3000, Louvain, Belgium
| | - Gaetano Perrotta
- Unité de neuroimmunologie, Service de Neurologie, Hôpital Erasme-Université Libre de Bruxelles, Brussels, Belgium
| | - Virginie De Wilde
- Department of Hematology, Hôpital Erasme-Université Libre de Bruxelles, Brussels, Belgium
| | - Vincent van Pesch
- Department of Neurology, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Avenue Hippocrate 10, 1200, Brussels, Belgium
| | - Nicole Straetmans
- Department of Hematology, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Avenue Hippocrate 10, 1200, Brussels, Belgium
| | - Dominique Dive
- Department of Neurology, University Hospital of Liege, Rue Grandfosse 31-33, 4130, Esneux, Belgium
| | - Yves Beguin
- Department of Hematology, University of Liège, CHU Sart Tilman, 4000, Liège, Belgium
| | - Bart Van Wijmeersch
- Biomedical Institute, Hasselt University and Rehabilitation and MS-Centre Overpelt, Agoralaan Gebouw A, 3590, Diepenbeek, Belgium
| | - Koen Theunissen
- Department of Hematology, Jessa Ziekenhuis, Stadsomvaart 11, 3500, Hasselt, Belgium
| | - Tessa Kerre
- Department of Hematology, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium
| | - Ann Van de Velde
- Department of Hematology, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Belgium
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Conventional and advanced MRI in multiple sclerosis. Rev Neurol (Paris) 2018; 174:391-397. [DOI: 10.1016/j.neurol.2018.03.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Revised: 03/08/2018] [Accepted: 03/08/2018] [Indexed: 12/28/2022]
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