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Pfeuffer S, Wolff S, Aslan D, Rolfes L, Korsen M, Pawlitzki M, Albrecht P, Havla J, Huttner HB, Kleinschnitz C, Meuth SG, Pul R, Ruck T. Association of Clinical Relapses With Disease Outcomes in Multiple Sclerosis Patients Older Than 50 Years. Neurology 2024; 103:e209574. [PMID: 38870471 DOI: 10.1212/wnl.0000000000209574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Relapse and MRI activity usually decline with aging but are replaced by progression independent of relapse activity (PIRA) in patients with multiple sclerosis (PwMS). However, several older PwMS continue to experience clinical relapses, and the impact on their disease remains undetermined. We aimed to determine the impact of an index relapse on disease outcomes in patients older than 50 years and to identify risk factors of disadvantageous outcomes. METHODS We performed a secondary analysis from 3 prospective cohorts in Germany. We evaluated all PwMS 50 years and older with a relapse ≤60 days before a baseline visit and at least 18 months of follow-up compared with a control cohort of PwMS without a relapse. Patients were stratified according to age ("50-54" vs "55-59" vs "60+") or disease outcomes ("stable" vs "active" vs "progressive," according to the Lublin criteria). We analyzed relapses, MRI activity, relapse-associated worsening, and PIRA. Regression analysis was performed to evaluate the association of specific baseline risk factors and treatment regimen changes with disease outcomes at month 18. RESULTS A total of 681 patients were included in the "relapse cohort" (50+: 361; 55+: 220; 60+: 100). The "control cohort" comprised 232 patients (50+: 117; 55+: 71; 60+: 44). Baseline epidemiologic parameters were balanced among cohorts and subgroups. We observed increased abundance of inflammatory activity and relapse-independent disability progression in the "relapse" vs "control" cohort. In the "relapse" cohort, we identified 273 patients as "stable" (59.7%), 114 patients as "active" (24.9%), and 70 patients as "progressive" (15.3%) during follow-up. Cardiovascular risk factors (CVRFs) and older age at baseline were identified as risk factors of progressive, whereas disease-modifying treatment (DMT) administration at baseline favored stable disease. DMT during follow-up was associated with stable over active, but not over progressive disease. DISCUSSION A relapse-suggesting underlying active disease-in PwMS older than 50 years was associated with continued disease activity and increased risk of PIRA. Presence of CVRF and absence of DMT at baseline appeared as risk factors of disadvantageous disease courses. An escalation of DMT switch was associated with stable over active but not progressive disease.
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Affiliation(s)
- Steffen Pfeuffer
- From the Department of Neurology (S.P., S.W., H.B.H.), University Hospital Giessen, Justus-Liebig-University Giessen; Department of Neurology (D.A., C.K., R.P.), University Hospital Essen, University Duisburg-Essen; Department of Neurology (L.R., M.K., M.P., S.G.M., T.R.), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurology (P.A.), Medical Faculty, Heinrich Department of Neurology, Maria-Hilf-Clinic, Mönchengladbach; and Institute of Clinical Neuroimmunology (J.H.), LMU Hospital, Ludwig-Maximilians University Munich, Germany
| | - Stephanie Wolff
- From the Department of Neurology (S.P., S.W., H.B.H.), University Hospital Giessen, Justus-Liebig-University Giessen; Department of Neurology (D.A., C.K., R.P.), University Hospital Essen, University Duisburg-Essen; Department of Neurology (L.R., M.K., M.P., S.G.M., T.R.), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurology (P.A.), Medical Faculty, Heinrich Department of Neurology, Maria-Hilf-Clinic, Mönchengladbach; and Institute of Clinical Neuroimmunology (J.H.), LMU Hospital, Ludwig-Maximilians University Munich, Germany
| | - Derya Aslan
- From the Department of Neurology (S.P., S.W., H.B.H.), University Hospital Giessen, Justus-Liebig-University Giessen; Department of Neurology (D.A., C.K., R.P.), University Hospital Essen, University Duisburg-Essen; Department of Neurology (L.R., M.K., M.P., S.G.M., T.R.), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurology (P.A.), Medical Faculty, Heinrich Department of Neurology, Maria-Hilf-Clinic, Mönchengladbach; and Institute of Clinical Neuroimmunology (J.H.), LMU Hospital, Ludwig-Maximilians University Munich, Germany
| | - Leoni Rolfes
- From the Department of Neurology (S.P., S.W., H.B.H.), University Hospital Giessen, Justus-Liebig-University Giessen; Department of Neurology (D.A., C.K., R.P.), University Hospital Essen, University Duisburg-Essen; Department of Neurology (L.R., M.K., M.P., S.G.M., T.R.), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurology (P.A.), Medical Faculty, Heinrich Department of Neurology, Maria-Hilf-Clinic, Mönchengladbach; and Institute of Clinical Neuroimmunology (J.H.), LMU Hospital, Ludwig-Maximilians University Munich, Germany
| | - Melanie Korsen
- From the Department of Neurology (S.P., S.W., H.B.H.), University Hospital Giessen, Justus-Liebig-University Giessen; Department of Neurology (D.A., C.K., R.P.), University Hospital Essen, University Duisburg-Essen; Department of Neurology (L.R., M.K., M.P., S.G.M., T.R.), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurology (P.A.), Medical Faculty, Heinrich Department of Neurology, Maria-Hilf-Clinic, Mönchengladbach; and Institute of Clinical Neuroimmunology (J.H.), LMU Hospital, Ludwig-Maximilians University Munich, Germany
| | - Marc Pawlitzki
- From the Department of Neurology (S.P., S.W., H.B.H.), University Hospital Giessen, Justus-Liebig-University Giessen; Department of Neurology (D.A., C.K., R.P.), University Hospital Essen, University Duisburg-Essen; Department of Neurology (L.R., M.K., M.P., S.G.M., T.R.), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurology (P.A.), Medical Faculty, Heinrich Department of Neurology, Maria-Hilf-Clinic, Mönchengladbach; and Institute of Clinical Neuroimmunology (J.H.), LMU Hospital, Ludwig-Maximilians University Munich, Germany
| | - Philipp Albrecht
- From the Department of Neurology (S.P., S.W., H.B.H.), University Hospital Giessen, Justus-Liebig-University Giessen; Department of Neurology (D.A., C.K., R.P.), University Hospital Essen, University Duisburg-Essen; Department of Neurology (L.R., M.K., M.P., S.G.M., T.R.), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurology (P.A.), Medical Faculty, Heinrich Department of Neurology, Maria-Hilf-Clinic, Mönchengladbach; and Institute of Clinical Neuroimmunology (J.H.), LMU Hospital, Ludwig-Maximilians University Munich, Germany
| | - Joachim Havla
- From the Department of Neurology (S.P., S.W., H.B.H.), University Hospital Giessen, Justus-Liebig-University Giessen; Department of Neurology (D.A., C.K., R.P.), University Hospital Essen, University Duisburg-Essen; Department of Neurology (L.R., M.K., M.P., S.G.M., T.R.), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurology (P.A.), Medical Faculty, Heinrich Department of Neurology, Maria-Hilf-Clinic, Mönchengladbach; and Institute of Clinical Neuroimmunology (J.H.), LMU Hospital, Ludwig-Maximilians University Munich, Germany
| | - Hagen B Huttner
- From the Department of Neurology (S.P., S.W., H.B.H.), University Hospital Giessen, Justus-Liebig-University Giessen; Department of Neurology (D.A., C.K., R.P.), University Hospital Essen, University Duisburg-Essen; Department of Neurology (L.R., M.K., M.P., S.G.M., T.R.), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurology (P.A.), Medical Faculty, Heinrich Department of Neurology, Maria-Hilf-Clinic, Mönchengladbach; and Institute of Clinical Neuroimmunology (J.H.), LMU Hospital, Ludwig-Maximilians University Munich, Germany
| | - Christoph Kleinschnitz
- From the Department of Neurology (S.P., S.W., H.B.H.), University Hospital Giessen, Justus-Liebig-University Giessen; Department of Neurology (D.A., C.K., R.P.), University Hospital Essen, University Duisburg-Essen; Department of Neurology (L.R., M.K., M.P., S.G.M., T.R.), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurology (P.A.), Medical Faculty, Heinrich Department of Neurology, Maria-Hilf-Clinic, Mönchengladbach; and Institute of Clinical Neuroimmunology (J.H.), LMU Hospital, Ludwig-Maximilians University Munich, Germany
| | - Sven G Meuth
- From the Department of Neurology (S.P., S.W., H.B.H.), University Hospital Giessen, Justus-Liebig-University Giessen; Department of Neurology (D.A., C.K., R.P.), University Hospital Essen, University Duisburg-Essen; Department of Neurology (L.R., M.K., M.P., S.G.M., T.R.), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurology (P.A.), Medical Faculty, Heinrich Department of Neurology, Maria-Hilf-Clinic, Mönchengladbach; and Institute of Clinical Neuroimmunology (J.H.), LMU Hospital, Ludwig-Maximilians University Munich, Germany
| | - Refik Pul
- From the Department of Neurology (S.P., S.W., H.B.H.), University Hospital Giessen, Justus-Liebig-University Giessen; Department of Neurology (D.A., C.K., R.P.), University Hospital Essen, University Duisburg-Essen; Department of Neurology (L.R., M.K., M.P., S.G.M., T.R.), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurology (P.A.), Medical Faculty, Heinrich Department of Neurology, Maria-Hilf-Clinic, Mönchengladbach; and Institute of Clinical Neuroimmunology (J.H.), LMU Hospital, Ludwig-Maximilians University Munich, Germany
| | - Tobias Ruck
- From the Department of Neurology (S.P., S.W., H.B.H.), University Hospital Giessen, Justus-Liebig-University Giessen; Department of Neurology (D.A., C.K., R.P.), University Hospital Essen, University Duisburg-Essen; Department of Neurology (L.R., M.K., M.P., S.G.M., T.R.), Medical Faculty, Heinrich Heine University Düsseldorf; Department of Neurology (P.A.), Medical Faculty, Heinrich Department of Neurology, Maria-Hilf-Clinic, Mönchengladbach; and Institute of Clinical Neuroimmunology (J.H.), LMU Hospital, Ludwig-Maximilians University Munich, Germany
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Borrelli S, Martire MS, Stölting A, Vanden Bulcke C, Pedrini E, Guisset F, Bugli C, Yildiz H, Pothen L, Elands S, Martinelli V, Smith B, Jacobson S, Du Pasquier RA, Van Pesch V, Filippi M, Reich DS, Absinta M, Maggi P. Central Vein Sign, Cortical Lesions, and Paramagnetic Rim Lesions for the Diagnostic and Prognostic Workup of Multiple Sclerosis. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2024; 11:e200253. [PMID: 38788180 PMCID: PMC11129678 DOI: 10.1212/nxi.0000000000200253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 03/13/2024] [Indexed: 05/26/2024]
Abstract
BACKGROUND AND OBJECTIVES The diagnosis of multiple sclerosis (MS) can be challenging in clinical practice because MS presentation can be atypical and mimicked by other diseases. We evaluated the diagnostic performance, alone or in combination, of the central vein sign (CVS), paramagnetic rim lesion (PRL), and cortical lesion (CL), as well as their association with clinical outcomes. METHODS In this multicenter observational study, we first conducted a cross-sectional analysis of the CVS (proportion of CVS-positive lesions or simplified determination of CVS in 3/6 lesions-Select3*/Select6*), PRL, and CL in MS and non-MS cases on 3T-MRI brain images, including 3D T2-FLAIR, T2*-echo-planar imaging magnitude and phase, double inversion recovery, and magnetization prepared rapid gradient echo image sequences. Then, we longitudinally analyzed the progression independent of relapse and MRI activity (PIRA) in MS cases over the 2 years after study entry. Receiver operating characteristic curves were used to test diagnostic performance and regression models to predict diagnosis and clinical outcomes. RESULTS The presence of ≥41% CVS-positive lesions/≥1 CL/≥1 PRL (optimal cutoffs) had 96%/90%/93% specificity, 97%/84%/60% sensitivity, and 0.99/0.90/0.77 area under the curve (AUC), respectively, to distinguish MS (n = 185) from non-MS (n = 100) cases. The Select3*/Select6* algorithms showed 93%/95% specificity, 97%/89% sensitivity, and 0.95/0.92 AUC. The combination of CVS, CL, and PRL improved the diagnostic performance, especially when Select3*/Select6* were used (93%/94% specificity, 98%/96% sensitivity, 0.99/0.98 AUC; p = 0.002/p < 0.001). In MS cases (n = 185), both CL and PRL were associated with higher MS disability and severity. Longitudinal analysis (n = 61) showed that MS cases with >4 PRL at baseline were more likely to experience PIRA at 2-year follow-up (odds ratio 17.0, 95% confidence interval: 2.1-138.5; p = 0.008), whereas no association was observed between other baseline MRI measures and PIRA, including the number of CL. DISCUSSION The combination of CVS, CL, and PRL can improve MS differential diagnosis. CL and PRL also correlated with clinical measures of poor prognosis, with PRL being a predictor of disability accrual independent of clinical/MRI activity.
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Affiliation(s)
- Serena Borrelli
- From the Neuroinflammation Imaging Lab (NIL) (S.B., A.S., C.V.B., F.G., P.M.), Institute of NeuroScience, Université catholique de Louvain; Department of Neurology (S.B., S.E.), Hôpital Erasme, Hôpital Universitaire de Bruxelles; Department of Neurology (S.B.), Centre Hospitalier Universitaire Brugmann, Université Libre de Brussels, Belgium; Neurology Unit (M.S.M., V.M., M.F.), IRCCS San Raffaele Hospital, Milan, Italy; ICTEAM Institute (C.V.B.), Université catholique de Louvain, Louvain-la-Neuve, Belgium; Vita-Salute San Raffaele University (E.P., M.F., M.A.); Translational Neuropathology Unit (E.P., M.A.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Plateforme technologique de Support en Méthodologie et Calcul Statistique (C.B.); Department of Internal Medicine and Infectious Diseases (H.Y., L.P.), Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Section of Infections of the Nervous System (B.S.); Viral Immunology Section (S.J.), National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD; Neurology Service (R.A.D.P., P.M.), Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Switzerland; Department of Neurology (V.V.P., P.M.), Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Neuroimaging Research Unit (M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Translational Neuroradiology Section (D.S.R.), National Institute of Neurological Disorders and Stroke (NINDS), National In-stitutes of Health (NIH); and Department of Neurology (M.A.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Maria Sofia Martire
- From the Neuroinflammation Imaging Lab (NIL) (S.B., A.S., C.V.B., F.G., P.M.), Institute of NeuroScience, Université catholique de Louvain; Department of Neurology (S.B., S.E.), Hôpital Erasme, Hôpital Universitaire de Bruxelles; Department of Neurology (S.B.), Centre Hospitalier Universitaire Brugmann, Université Libre de Brussels, Belgium; Neurology Unit (M.S.M., V.M., M.F.), IRCCS San Raffaele Hospital, Milan, Italy; ICTEAM Institute (C.V.B.), Université catholique de Louvain, Louvain-la-Neuve, Belgium; Vita-Salute San Raffaele University (E.P., M.F., M.A.); Translational Neuropathology Unit (E.P., M.A.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Plateforme technologique de Support en Méthodologie et Calcul Statistique (C.B.); Department of Internal Medicine and Infectious Diseases (H.Y., L.P.), Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Section of Infections of the Nervous System (B.S.); Viral Immunology Section (S.J.), National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD; Neurology Service (R.A.D.P., P.M.), Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Switzerland; Department of Neurology (V.V.P., P.M.), Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Neuroimaging Research Unit (M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Translational Neuroradiology Section (D.S.R.), National Institute of Neurological Disorders and Stroke (NINDS), National In-stitutes of Health (NIH); and Department of Neurology (M.A.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Anna Stölting
- From the Neuroinflammation Imaging Lab (NIL) (S.B., A.S., C.V.B., F.G., P.M.), Institute of NeuroScience, Université catholique de Louvain; Department of Neurology (S.B., S.E.), Hôpital Erasme, Hôpital Universitaire de Bruxelles; Department of Neurology (S.B.), Centre Hospitalier Universitaire Brugmann, Université Libre de Brussels, Belgium; Neurology Unit (M.S.M., V.M., M.F.), IRCCS San Raffaele Hospital, Milan, Italy; ICTEAM Institute (C.V.B.), Université catholique de Louvain, Louvain-la-Neuve, Belgium; Vita-Salute San Raffaele University (E.P., M.F., M.A.); Translational Neuropathology Unit (E.P., M.A.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Plateforme technologique de Support en Méthodologie et Calcul Statistique (C.B.); Department of Internal Medicine and Infectious Diseases (H.Y., L.P.), Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Section of Infections of the Nervous System (B.S.); Viral Immunology Section (S.J.), National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD; Neurology Service (R.A.D.P., P.M.), Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Switzerland; Department of Neurology (V.V.P., P.M.), Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Neuroimaging Research Unit (M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Translational Neuroradiology Section (D.S.R.), National Institute of Neurological Disorders and Stroke (NINDS), National In-stitutes of Health (NIH); and Department of Neurology (M.A.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Colin Vanden Bulcke
- From the Neuroinflammation Imaging Lab (NIL) (S.B., A.S., C.V.B., F.G., P.M.), Institute of NeuroScience, Université catholique de Louvain; Department of Neurology (S.B., S.E.), Hôpital Erasme, Hôpital Universitaire de Bruxelles; Department of Neurology (S.B.), Centre Hospitalier Universitaire Brugmann, Université Libre de Brussels, Belgium; Neurology Unit (M.S.M., V.M., M.F.), IRCCS San Raffaele Hospital, Milan, Italy; ICTEAM Institute (C.V.B.), Université catholique de Louvain, Louvain-la-Neuve, Belgium; Vita-Salute San Raffaele University (E.P., M.F., M.A.); Translational Neuropathology Unit (E.P., M.A.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Plateforme technologique de Support en Méthodologie et Calcul Statistique (C.B.); Department of Internal Medicine and Infectious Diseases (H.Y., L.P.), Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Section of Infections of the Nervous System (B.S.); Viral Immunology Section (S.J.), National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD; Neurology Service (R.A.D.P., P.M.), Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Switzerland; Department of Neurology (V.V.P., P.M.), Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Neuroimaging Research Unit (M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Translational Neuroradiology Section (D.S.R.), National Institute of Neurological Disorders and Stroke (NINDS), National In-stitutes of Health (NIH); and Department of Neurology (M.A.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Edoardo Pedrini
- From the Neuroinflammation Imaging Lab (NIL) (S.B., A.S., C.V.B., F.G., P.M.), Institute of NeuroScience, Université catholique de Louvain; Department of Neurology (S.B., S.E.), Hôpital Erasme, Hôpital Universitaire de Bruxelles; Department of Neurology (S.B.), Centre Hospitalier Universitaire Brugmann, Université Libre de Brussels, Belgium; Neurology Unit (M.S.M., V.M., M.F.), IRCCS San Raffaele Hospital, Milan, Italy; ICTEAM Institute (C.V.B.), Université catholique de Louvain, Louvain-la-Neuve, Belgium; Vita-Salute San Raffaele University (E.P., M.F., M.A.); Translational Neuropathology Unit (E.P., M.A.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Plateforme technologique de Support en Méthodologie et Calcul Statistique (C.B.); Department of Internal Medicine and Infectious Diseases (H.Y., L.P.), Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Section of Infections of the Nervous System (B.S.); Viral Immunology Section (S.J.), National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD; Neurology Service (R.A.D.P., P.M.), Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Switzerland; Department of Neurology (V.V.P., P.M.), Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Neuroimaging Research Unit (M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Translational Neuroradiology Section (D.S.R.), National Institute of Neurological Disorders and Stroke (NINDS), National In-stitutes of Health (NIH); and Department of Neurology (M.A.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - François Guisset
- From the Neuroinflammation Imaging Lab (NIL) (S.B., A.S., C.V.B., F.G., P.M.), Institute of NeuroScience, Université catholique de Louvain; Department of Neurology (S.B., S.E.), Hôpital Erasme, Hôpital Universitaire de Bruxelles; Department of Neurology (S.B.), Centre Hospitalier Universitaire Brugmann, Université Libre de Brussels, Belgium; Neurology Unit (M.S.M., V.M., M.F.), IRCCS San Raffaele Hospital, Milan, Italy; ICTEAM Institute (C.V.B.), Université catholique de Louvain, Louvain-la-Neuve, Belgium; Vita-Salute San Raffaele University (E.P., M.F., M.A.); Translational Neuropathology Unit (E.P., M.A.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Plateforme technologique de Support en Méthodologie et Calcul Statistique (C.B.); Department of Internal Medicine and Infectious Diseases (H.Y., L.P.), Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Section of Infections of the Nervous System (B.S.); Viral Immunology Section (S.J.), National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD; Neurology Service (R.A.D.P., P.M.), Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Switzerland; Department of Neurology (V.V.P., P.M.), Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Neuroimaging Research Unit (M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Translational Neuroradiology Section (D.S.R.), National Institute of Neurological Disorders and Stroke (NINDS), National In-stitutes of Health (NIH); and Department of Neurology (M.A.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Céline Bugli
- From the Neuroinflammation Imaging Lab (NIL) (S.B., A.S., C.V.B., F.G., P.M.), Institute of NeuroScience, Université catholique de Louvain; Department of Neurology (S.B., S.E.), Hôpital Erasme, Hôpital Universitaire de Bruxelles; Department of Neurology (S.B.), Centre Hospitalier Universitaire Brugmann, Université Libre de Brussels, Belgium; Neurology Unit (M.S.M., V.M., M.F.), IRCCS San Raffaele Hospital, Milan, Italy; ICTEAM Institute (C.V.B.), Université catholique de Louvain, Louvain-la-Neuve, Belgium; Vita-Salute San Raffaele University (E.P., M.F., M.A.); Translational Neuropathology Unit (E.P., M.A.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Plateforme technologique de Support en Méthodologie et Calcul Statistique (C.B.); Department of Internal Medicine and Infectious Diseases (H.Y., L.P.), Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Section of Infections of the Nervous System (B.S.); Viral Immunology Section (S.J.), National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD; Neurology Service (R.A.D.P., P.M.), Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Switzerland; Department of Neurology (V.V.P., P.M.), Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Neuroimaging Research Unit (M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Translational Neuroradiology Section (D.S.R.), National Institute of Neurological Disorders and Stroke (NINDS), National In-stitutes of Health (NIH); and Department of Neurology (M.A.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Halil Yildiz
- From the Neuroinflammation Imaging Lab (NIL) (S.B., A.S., C.V.B., F.G., P.M.), Institute of NeuroScience, Université catholique de Louvain; Department of Neurology (S.B., S.E.), Hôpital Erasme, Hôpital Universitaire de Bruxelles; Department of Neurology (S.B.), Centre Hospitalier Universitaire Brugmann, Université Libre de Brussels, Belgium; Neurology Unit (M.S.M., V.M., M.F.), IRCCS San Raffaele Hospital, Milan, Italy; ICTEAM Institute (C.V.B.), Université catholique de Louvain, Louvain-la-Neuve, Belgium; Vita-Salute San Raffaele University (E.P., M.F., M.A.); Translational Neuropathology Unit (E.P., M.A.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Plateforme technologique de Support en Méthodologie et Calcul Statistique (C.B.); Department of Internal Medicine and Infectious Diseases (H.Y., L.P.), Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Section of Infections of the Nervous System (B.S.); Viral Immunology Section (S.J.), National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD; Neurology Service (R.A.D.P., P.M.), Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Switzerland; Department of Neurology (V.V.P., P.M.), Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Neuroimaging Research Unit (M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Translational Neuroradiology Section (D.S.R.), National Institute of Neurological Disorders and Stroke (NINDS), National In-stitutes of Health (NIH); and Department of Neurology (M.A.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Lucie Pothen
- From the Neuroinflammation Imaging Lab (NIL) (S.B., A.S., C.V.B., F.G., P.M.), Institute of NeuroScience, Université catholique de Louvain; Department of Neurology (S.B., S.E.), Hôpital Erasme, Hôpital Universitaire de Bruxelles; Department of Neurology (S.B.), Centre Hospitalier Universitaire Brugmann, Université Libre de Brussels, Belgium; Neurology Unit (M.S.M., V.M., M.F.), IRCCS San Raffaele Hospital, Milan, Italy; ICTEAM Institute (C.V.B.), Université catholique de Louvain, Louvain-la-Neuve, Belgium; Vita-Salute San Raffaele University (E.P., M.F., M.A.); Translational Neuropathology Unit (E.P., M.A.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Plateforme technologique de Support en Méthodologie et Calcul Statistique (C.B.); Department of Internal Medicine and Infectious Diseases (H.Y., L.P.), Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Section of Infections of the Nervous System (B.S.); Viral Immunology Section (S.J.), National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD; Neurology Service (R.A.D.P., P.M.), Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Switzerland; Department of Neurology (V.V.P., P.M.), Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Neuroimaging Research Unit (M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Translational Neuroradiology Section (D.S.R.), National Institute of Neurological Disorders and Stroke (NINDS), National In-stitutes of Health (NIH); and Department of Neurology (M.A.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Sophie Elands
- From the Neuroinflammation Imaging Lab (NIL) (S.B., A.S., C.V.B., F.G., P.M.), Institute of NeuroScience, Université catholique de Louvain; Department of Neurology (S.B., S.E.), Hôpital Erasme, Hôpital Universitaire de Bruxelles; Department of Neurology (S.B.), Centre Hospitalier Universitaire Brugmann, Université Libre de Brussels, Belgium; Neurology Unit (M.S.M., V.M., M.F.), IRCCS San Raffaele Hospital, Milan, Italy; ICTEAM Institute (C.V.B.), Université catholique de Louvain, Louvain-la-Neuve, Belgium; Vita-Salute San Raffaele University (E.P., M.F., M.A.); Translational Neuropathology Unit (E.P., M.A.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Plateforme technologique de Support en Méthodologie et Calcul Statistique (C.B.); Department of Internal Medicine and Infectious Diseases (H.Y., L.P.), Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Section of Infections of the Nervous System (B.S.); Viral Immunology Section (S.J.), National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD; Neurology Service (R.A.D.P., P.M.), Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Switzerland; Department of Neurology (V.V.P., P.M.), Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Neuroimaging Research Unit (M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Translational Neuroradiology Section (D.S.R.), National Institute of Neurological Disorders and Stroke (NINDS), National In-stitutes of Health (NIH); and Department of Neurology (M.A.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Vittorio Martinelli
- From the Neuroinflammation Imaging Lab (NIL) (S.B., A.S., C.V.B., F.G., P.M.), Institute of NeuroScience, Université catholique de Louvain; Department of Neurology (S.B., S.E.), Hôpital Erasme, Hôpital Universitaire de Bruxelles; Department of Neurology (S.B.), Centre Hospitalier Universitaire Brugmann, Université Libre de Brussels, Belgium; Neurology Unit (M.S.M., V.M., M.F.), IRCCS San Raffaele Hospital, Milan, Italy; ICTEAM Institute (C.V.B.), Université catholique de Louvain, Louvain-la-Neuve, Belgium; Vita-Salute San Raffaele University (E.P., M.F., M.A.); Translational Neuropathology Unit (E.P., M.A.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Plateforme technologique de Support en Méthodologie et Calcul Statistique (C.B.); Department of Internal Medicine and Infectious Diseases (H.Y., L.P.), Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Section of Infections of the Nervous System (B.S.); Viral Immunology Section (S.J.), National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD; Neurology Service (R.A.D.P., P.M.), Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Switzerland; Department of Neurology (V.V.P., P.M.), Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Neuroimaging Research Unit (M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Translational Neuroradiology Section (D.S.R.), National Institute of Neurological Disorders and Stroke (NINDS), National In-stitutes of Health (NIH); and Department of Neurology (M.A.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Bryan Smith
- From the Neuroinflammation Imaging Lab (NIL) (S.B., A.S., C.V.B., F.G., P.M.), Institute of NeuroScience, Université catholique de Louvain; Department of Neurology (S.B., S.E.), Hôpital Erasme, Hôpital Universitaire de Bruxelles; Department of Neurology (S.B.), Centre Hospitalier Universitaire Brugmann, Université Libre de Brussels, Belgium; Neurology Unit (M.S.M., V.M., M.F.), IRCCS San Raffaele Hospital, Milan, Italy; ICTEAM Institute (C.V.B.), Université catholique de Louvain, Louvain-la-Neuve, Belgium; Vita-Salute San Raffaele University (E.P., M.F., M.A.); Translational Neuropathology Unit (E.P., M.A.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Plateforme technologique de Support en Méthodologie et Calcul Statistique (C.B.); Department of Internal Medicine and Infectious Diseases (H.Y., L.P.), Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Section of Infections of the Nervous System (B.S.); Viral Immunology Section (S.J.), National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD; Neurology Service (R.A.D.P., P.M.), Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Switzerland; Department of Neurology (V.V.P., P.M.), Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Neuroimaging Research Unit (M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Translational Neuroradiology Section (D.S.R.), National Institute of Neurological Disorders and Stroke (NINDS), National In-stitutes of Health (NIH); and Department of Neurology (M.A.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Steven Jacobson
- From the Neuroinflammation Imaging Lab (NIL) (S.B., A.S., C.V.B., F.G., P.M.), Institute of NeuroScience, Université catholique de Louvain; Department of Neurology (S.B., S.E.), Hôpital Erasme, Hôpital Universitaire de Bruxelles; Department of Neurology (S.B.), Centre Hospitalier Universitaire Brugmann, Université Libre de Brussels, Belgium; Neurology Unit (M.S.M., V.M., M.F.), IRCCS San Raffaele Hospital, Milan, Italy; ICTEAM Institute (C.V.B.), Université catholique de Louvain, Louvain-la-Neuve, Belgium; Vita-Salute San Raffaele University (E.P., M.F., M.A.); Translational Neuropathology Unit (E.P., M.A.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Plateforme technologique de Support en Méthodologie et Calcul Statistique (C.B.); Department of Internal Medicine and Infectious Diseases (H.Y., L.P.), Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Section of Infections of the Nervous System (B.S.); Viral Immunology Section (S.J.), National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD; Neurology Service (R.A.D.P., P.M.), Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Switzerland; Department of Neurology (V.V.P., P.M.), Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Neuroimaging Research Unit (M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Translational Neuroradiology Section (D.S.R.), National Institute of Neurological Disorders and Stroke (NINDS), National In-stitutes of Health (NIH); and Department of Neurology (M.A.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Renaud A Du Pasquier
- From the Neuroinflammation Imaging Lab (NIL) (S.B., A.S., C.V.B., F.G., P.M.), Institute of NeuroScience, Université catholique de Louvain; Department of Neurology (S.B., S.E.), Hôpital Erasme, Hôpital Universitaire de Bruxelles; Department of Neurology (S.B.), Centre Hospitalier Universitaire Brugmann, Université Libre de Brussels, Belgium; Neurology Unit (M.S.M., V.M., M.F.), IRCCS San Raffaele Hospital, Milan, Italy; ICTEAM Institute (C.V.B.), Université catholique de Louvain, Louvain-la-Neuve, Belgium; Vita-Salute San Raffaele University (E.P., M.F., M.A.); Translational Neuropathology Unit (E.P., M.A.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Plateforme technologique de Support en Méthodologie et Calcul Statistique (C.B.); Department of Internal Medicine and Infectious Diseases (H.Y., L.P.), Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Section of Infections of the Nervous System (B.S.); Viral Immunology Section (S.J.), National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD; Neurology Service (R.A.D.P., P.M.), Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Switzerland; Department of Neurology (V.V.P., P.M.), Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Neuroimaging Research Unit (M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Translational Neuroradiology Section (D.S.R.), National Institute of Neurological Disorders and Stroke (NINDS), National In-stitutes of Health (NIH); and Department of Neurology (M.A.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Vincent Van Pesch
- From the Neuroinflammation Imaging Lab (NIL) (S.B., A.S., C.V.B., F.G., P.M.), Institute of NeuroScience, Université catholique de Louvain; Department of Neurology (S.B., S.E.), Hôpital Erasme, Hôpital Universitaire de Bruxelles; Department of Neurology (S.B.), Centre Hospitalier Universitaire Brugmann, Université Libre de Brussels, Belgium; Neurology Unit (M.S.M., V.M., M.F.), IRCCS San Raffaele Hospital, Milan, Italy; ICTEAM Institute (C.V.B.), Université catholique de Louvain, Louvain-la-Neuve, Belgium; Vita-Salute San Raffaele University (E.P., M.F., M.A.); Translational Neuropathology Unit (E.P., M.A.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Plateforme technologique de Support en Méthodologie et Calcul Statistique (C.B.); Department of Internal Medicine and Infectious Diseases (H.Y., L.P.), Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Section of Infections of the Nervous System (B.S.); Viral Immunology Section (S.J.), National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD; Neurology Service (R.A.D.P., P.M.), Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Switzerland; Department of Neurology (V.V.P., P.M.), Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Neuroimaging Research Unit (M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Translational Neuroradiology Section (D.S.R.), National Institute of Neurological Disorders and Stroke (NINDS), National In-stitutes of Health (NIH); and Department of Neurology (M.A.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Massimo Filippi
- From the Neuroinflammation Imaging Lab (NIL) (S.B., A.S., C.V.B., F.G., P.M.), Institute of NeuroScience, Université catholique de Louvain; Department of Neurology (S.B., S.E.), Hôpital Erasme, Hôpital Universitaire de Bruxelles; Department of Neurology (S.B.), Centre Hospitalier Universitaire Brugmann, Université Libre de Brussels, Belgium; Neurology Unit (M.S.M., V.M., M.F.), IRCCS San Raffaele Hospital, Milan, Italy; ICTEAM Institute (C.V.B.), Université catholique de Louvain, Louvain-la-Neuve, Belgium; Vita-Salute San Raffaele University (E.P., M.F., M.A.); Translational Neuropathology Unit (E.P., M.A.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Plateforme technologique de Support en Méthodologie et Calcul Statistique (C.B.); Department of Internal Medicine and Infectious Diseases (H.Y., L.P.), Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Section of Infections of the Nervous System (B.S.); Viral Immunology Section (S.J.), National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD; Neurology Service (R.A.D.P., P.M.), Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Switzerland; Department of Neurology (V.V.P., P.M.), Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Neuroimaging Research Unit (M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Translational Neuroradiology Section (D.S.R.), National Institute of Neurological Disorders and Stroke (NINDS), National In-stitutes of Health (NIH); and Department of Neurology (M.A.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Daniel S Reich
- From the Neuroinflammation Imaging Lab (NIL) (S.B., A.S., C.V.B., F.G., P.M.), Institute of NeuroScience, Université catholique de Louvain; Department of Neurology (S.B., S.E.), Hôpital Erasme, Hôpital Universitaire de Bruxelles; Department of Neurology (S.B.), Centre Hospitalier Universitaire Brugmann, Université Libre de Brussels, Belgium; Neurology Unit (M.S.M., V.M., M.F.), IRCCS San Raffaele Hospital, Milan, Italy; ICTEAM Institute (C.V.B.), Université catholique de Louvain, Louvain-la-Neuve, Belgium; Vita-Salute San Raffaele University (E.P., M.F., M.A.); Translational Neuropathology Unit (E.P., M.A.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Plateforme technologique de Support en Méthodologie et Calcul Statistique (C.B.); Department of Internal Medicine and Infectious Diseases (H.Y., L.P.), Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Section of Infections of the Nervous System (B.S.); Viral Immunology Section (S.J.), National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD; Neurology Service (R.A.D.P., P.M.), Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Switzerland; Department of Neurology (V.V.P., P.M.), Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Neuroimaging Research Unit (M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Translational Neuroradiology Section (D.S.R.), National Institute of Neurological Disorders and Stroke (NINDS), National In-stitutes of Health (NIH); and Department of Neurology (M.A.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Martina Absinta
- From the Neuroinflammation Imaging Lab (NIL) (S.B., A.S., C.V.B., F.G., P.M.), Institute of NeuroScience, Université catholique de Louvain; Department of Neurology (S.B., S.E.), Hôpital Erasme, Hôpital Universitaire de Bruxelles; Department of Neurology (S.B.), Centre Hospitalier Universitaire Brugmann, Université Libre de Brussels, Belgium; Neurology Unit (M.S.M., V.M., M.F.), IRCCS San Raffaele Hospital, Milan, Italy; ICTEAM Institute (C.V.B.), Université catholique de Louvain, Louvain-la-Neuve, Belgium; Vita-Salute San Raffaele University (E.P., M.F., M.A.); Translational Neuropathology Unit (E.P., M.A.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Plateforme technologique de Support en Méthodologie et Calcul Statistique (C.B.); Department of Internal Medicine and Infectious Diseases (H.Y., L.P.), Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Section of Infections of the Nervous System (B.S.); Viral Immunology Section (S.J.), National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD; Neurology Service (R.A.D.P., P.M.), Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Switzerland; Department of Neurology (V.V.P., P.M.), Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Neuroimaging Research Unit (M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Translational Neuroradiology Section (D.S.R.), National Institute of Neurological Disorders and Stroke (NINDS), National In-stitutes of Health (NIH); and Department of Neurology (M.A.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Pietro Maggi
- From the Neuroinflammation Imaging Lab (NIL) (S.B., A.S., C.V.B., F.G., P.M.), Institute of NeuroScience, Université catholique de Louvain; Department of Neurology (S.B., S.E.), Hôpital Erasme, Hôpital Universitaire de Bruxelles; Department of Neurology (S.B.), Centre Hospitalier Universitaire Brugmann, Université Libre de Brussels, Belgium; Neurology Unit (M.S.M., V.M., M.F.), IRCCS San Raffaele Hospital, Milan, Italy; ICTEAM Institute (C.V.B.), Université catholique de Louvain, Louvain-la-Neuve, Belgium; Vita-Salute San Raffaele University (E.P., M.F., M.A.); Translational Neuropathology Unit (E.P., M.A.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Plateforme technologique de Support en Méthodologie et Calcul Statistique (C.B.); Department of Internal Medicine and Infectious Diseases (H.Y., L.P.), Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Section of Infections of the Nervous System (B.S.); Viral Immunology Section (S.J.), National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD; Neurology Service (R.A.D.P., P.M.), Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Switzerland; Department of Neurology (V.V.P., P.M.), Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Neuroimaging Research Unit (M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Translational Neuroradiology Section (D.S.R.), National Institute of Neurological Disorders and Stroke (NINDS), National In-stitutes of Health (NIH); and Department of Neurology (M.A.), Johns Hopkins University School of Medicine, Baltimore, MD
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Prillard D, Charbonneau F, Clavel P, Vignal-Clermont C, Deschamps R, de la Motte MB, Guillaume J, Savatovsky J, Lecler A. Comparison of a Whole-Brain Contrast-Enhanced 3D TSE T1WI versus Orbits Contrast-Enhanced 2D Coronal T1WI at 3T MRI for the Detection of Optic Nerve Enhancement in Patients with Acute Loss of Visual Acuity. AJNR Am J Neuroradiol 2024:ajnr.A8233. [PMID: 38902008 DOI: 10.3174/ajnr.a8233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 02/07/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND AND PURPOSE MR imaging is the technique of choice for patients presenting with acute loss of visual acuity with no obvious ophthalmologic cause. The goal of our study was to compare orbits contrast-enhanced 2D coronal T1WI with a whole-brain contrast-enhanced 3D (WBCE-3D) TSE T1WI at 3T for the detection of optic nerve enhancement. MATERIALS AND METHODS This institutional review board-approved retrospective single-center study included patients presenting with acute loss of vision who underwent 3T MR imaging from November 2014 to February 2020. Two radiologists, blinded to all data, individually assessed the presence of enhancement of the optic nerve on orbits contrast-enhanced 2D T1WI and WBCE-3D T1WI separately and in random order. A McNemar test and a Cohen κ method were used for comparing the 2 MR imaging sequences. RESULTS One thousand twenty-three patients (638 women and 385 men; mean age, 42 [SD, 18.3] years) were included. There was a strong concordance between WBCE-3D T1WI and orbits contrast-enhanced 2D T1WI when detecting enhancement of the optic nerve: κ = 0.87 (95% CI, 0.84-0.90). WBCE-3D T1WI was significantly more likely to detect canalicular enhancement compared with orbits contrast-enhanced 2D T1WI: 178/1023 (17.4%) versus 138/1023 (13.5%) (P < .001) and 108/1023 (10.6%) versus 90/1023 (8.8%) (P = .04), respectively. The WBCE-3D T1WI sequence detected 27/1023 (3%) instances of optic disc enhancement versus 0/1023 (0%) on orbits contrast-enhanced 2D T1WI. There were significantly fewer severe artifacts on WBCE-3D T1WI compared with orbits contrast-enhanced 2D T1WI: 68/1023 (6.6%) versus 101/1023 (9.8%) (P < .001). The median reader-reported confidence was significantly higher with coronal T1WI compared with 3D TSE T1WI: 5 (95% CI, 4-5) versus 3 (95% CI, 1-4; P < .001). CONCLUSIONS Our study showed that there was a strong concordance between WBCE-3D T1WI and orbits contrast-enhanced 2D T1WI when detecting enhancement of the optic nerve in patients with acute loss of visual acuity with no obvious ophthalmologic cause. WBCE-3D T1WI demonstrated higher sensitivity and specificity in diagnosing optic neuritis, particularly in cases involving the canalicular segments.
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Affiliation(s)
- David Prillard
- From the Department of Neuroradiology (D.P., F.C., P.C., J.S., A.L.), A. Rothschild Foundation Hospital, Paris, France
| | - Frédérique Charbonneau
- From the Department of Neuroradiology (D.P., F.C., P.C., J.S., A.L.), A. Rothschild Foundation Hospital, Paris, France
| | - Pierre Clavel
- From the Department of Neuroradiology (D.P., F.C., P.C., J.S., A.L.), A. Rothschild Foundation Hospital, Paris, France
| | | | - Romain Deschamps
- Department of Neurology (R.D., M.B.d.l.M.), A. Rothschild Foundation Hospital, Paris, France
| | | | - Jessica Guillaume
- Department of Clinical Research (J.G.), A. Rothschild Foundation Hospital, Paris, France
| | - Julien Savatovsky
- From the Department of Neuroradiology (D.P., F.C., P.C., J.S., A.L.), A. Rothschild Foundation Hospital, Paris, France
| | - Augustin Lecler
- From the Department of Neuroradiology (D.P., F.C., P.C., J.S., A.L.), A. Rothschild Foundation Hospital, Paris, France
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Fiscone C, Sighinolfi G, Manners DN, Motta L, Venturi G, Panzera I, Zaccagna F, Rundo L, Lugaresi A, Lodi R, Tonon C, Castelli M. Multiparametric MRI dataset for susceptibility-based radiomic feature extraction and analysis. Sci Data 2024; 11:575. [PMID: 38834674 DOI: 10.1038/s41597-024-03418-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 05/24/2024] [Indexed: 06/06/2024] Open
Abstract
Multiple sclerosis (MS) is a progressive demyelinating disease impacting the central nervous system. Conventional Magnetic Resonance Imaging (MRI) techniques (e.g., T2w images) help diagnose MS, although they sometimes reveal non-specific lesions. Quantitative MRI techniques are capable of quantifying imaging biomarkers in vivo, offering the potential to identify specific signs related to pre-clinical inflammation. Among those techniques, Quantitative Susceptibility Mapping (QSM) is particularly useful for studying processes that influence the magnetic properties of brain tissue, such as alterations in myelin concentration. Because of its intrinsic quantitative nature, it is particularly well-suited to be analyzed through radiomics, including techniques that extract a high number of complex and multi-dimensional features from radiological images. The dataset presented in this work provides information about normal-appearing white matter (NAWM) in a cohort of MS patients and healthy controls. It includes QSM-based radiomic features from NAWM and its tracts, and MR sequences necessary to implement the pipeline: T1w, T2w, QSM, DWI. The workflow is outlined in this article, along with an application showing feature reliability assessment.
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Affiliation(s)
- Cristiana Fiscone
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Giovanni Sighinolfi
- Functional and Molecular Neuroimaging Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - David Neil Manners
- Functional and Molecular Neuroimaging Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.
- Department for Life Quality Sciences, University of Bologna, Bologna, Italy.
| | - Lorenzo Motta
- Functional and Molecular Neuroimaging Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Greta Venturi
- Functional and Molecular Neuroimaging Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Ivan Panzera
- UOSI Riabilitazione Sclerosi Multipla, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Fulvio Zaccagna
- Department of Imaging, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, United Kingdom
- Department of Radiology, University of Cambridge, Cambridge, United Kingdom
- Investigative Medicine Division, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Leonardo Rundo
- Department of Information and Electrical Engineering and Applied Mathematics, University of Salerno, Fisciano, Italy
| | - Alessandra Lugaresi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
- UOSI Riabilitazione Sclerosi Multipla, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Raffaele Lodi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
- Functional and Molecular Neuroimaging Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Caterina Tonon
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
- Functional and Molecular Neuroimaging Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Mauro Castelli
- NOVA Information Management School (NOVA IMS), Universidade NOVA de Lisboa, Campus de Campolide, 1070-312, Lisbon, Portugal
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5
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Maheshwari M, Ho ML, Bosemani T, Dahmoush H, Fredrick D, Guimaraes CV, Gulko E, Jaimes C, Joseph MM, Kaplan SL, Miyamoto RC, Nadel HR, Partap S, Pfeifer CM, Pruthi S. ACR Appropriateness Criteria® Orbital Imaging and Vision Loss-Child. J Am Coll Radiol 2024; 21:S219-S236. [PMID: 38823946 DOI: 10.1016/j.jacr.2024.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 02/28/2024] [Indexed: 06/03/2024]
Abstract
Orbital disorders in children consist of varied pathologies affecting the orbits, orbital contents, visual pathway, and innervation of the extraocular or intraocular muscles. The underlying etiology of these disorders may be traumatic or nontraumatic. Presumed location of the lesion along with the additional findings, such as eye pain, swelling, exophthalmos/enophthalmos, erythema, conjunctival vascular dilatation, intraocular pressure, etc, help in determining if imaging is needed, modality of choice, and extent of coverage (orbits and/or head). Occasionally, clinical signs and symptoms may be nonspecific, and, in these cases, diagnostic imaging studies play a key role in depicting the nature and extent of the injury or disease. In this document, various clinical scenarios are discussed by which a child may present with an orbital or vision abnormality. Imaging studies that might be most appropriate (based on the best available evidence or expert consensus) in these clinical scenarios are also discussed. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
| | - Mai-Lan Ho
- Panel Vice Chair, Nationwide Children's Hospital, Columbus, Ohio
| | | | - Hisham Dahmoush
- Lucile Packard Children's Hospital at Stanford, Stanford, California
| | - Douglas Fredrick
- Oregon Health & Science University-Casey Eye Institute, Portland, Oregon; American Academy of Pediatrics
| | | | - Edwin Gulko
- Westchester Medical Center, Valhalla, New York
| | - Camilo Jaimes
- Massachusetts General Hospital, Boston, Massachusetts
| | - Madeline M Joseph
- University of Florida College of Medicine Jacksonville, Jacksonville, Florida; American College of Emergency Physicians
| | - Summer L Kaplan
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Committee on Emergency Radiology-GSER
| | - R Christopher Miyamoto
- Peyton Manning Children's Hospital at Ascension St. Vincent, Indianapolis, Indiana; American Academy of Otolaryngology-Head and Neck Surgery
| | - Helen R Nadel
- Lucile Packard Children's Hospital at Stanford, Stanford, California; Commission on Nuclear Medicine and Molecular Imaging
| | - Sonia Partap
- Stanford University, Stanford, California; American Academy of Pediatrics
| | | | - Sumit Pruthi
- Specialty Chair, Vanderbilt Children's Hospital, Nashville, Tennessee
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6
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Peters S, Neves FB, Huhndorf M, Gärtner F, Stürner K, Jansen O, Salehi Ravesh M. Detection of Spinal Cord Multiple Sclerosis Lesions Using a 3D-PSIR Sequence at 1.5 T. Clin Neuroradiol 2024; 34:403-410. [PMID: 38289376 PMCID: PMC11130041 DOI: 10.1007/s00062-023-01376-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 12/20/2023] [Indexed: 03/07/2024]
Abstract
PURPOSE Multiple sclerosis (MS) is a prevalent autoimmune inflammatory disease. Besides cerebral manifestations, an affection of the spinal cord is typical; however, imaging of the spinal cord is difficult due to its anatomy. The aim of this study was to assess the diagnostic value of a 3D PSIR pulse sequencing at a 1.5 T magnetic field strength for both the cervical and thoracic spinal cord. METHODS Phase sensitive inversion recovery (PSIR), short tau inversion recovery (STIR) and T2-weighted (T2-w) images of the spinal cord of 50 patients were separately evaluated by three radiologists concerning the number and location of MS lesions. Furthermore, lesion to cord contrast ratios were determined for the cervical and thoracic spinal cord. RESULTS Of the lesions 54.81% were located in the cervical spinal cord, 42.26% in the thoracic spinal cord and 2.93% in the conus medullaris. The PSIR images showed a higher sensitivity for lesion detection in the cervical and thoracic spinal cord (77.10% and 72.61%, respectively) compared to the STIR images (58.63% and 59.10%, respectively) and the T2-w images (59.95% and 59.52%, respectively). The average lesion to cord contrast ratio was significantly higher in the PSIR images compared to the STIR images (p < 0.001) and the T2-w images (p < 0.001). CONCLUSION Evaluation of the spinal cord with a 3D PSIR sequence at a magnetic field strength of 1.5 T is feasible with a high sensitivity for the detection of spinal MS lesions for the cervical as well as the thoracic segments. In combination with other pulse sequences it might become a valuable addition in an advanced imaging protocol.
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Affiliation(s)
- Sönke Peters
- Department of Radiology and Neuroradiology, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Germany.
| | - Fernando Bueno Neves
- Department of Radiology and Neuroradiology, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Germany
| | - Monika Huhndorf
- Department of Radiology and Neuroradiology, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Germany
| | - Friederike Gärtner
- Department of Radiology and Neuroradiology, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Germany
| | - Klarissa Stürner
- Department of Neurology, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Olav Jansen
- Department of Radiology and Neuroradiology, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Germany
| | - Mona Salehi Ravesh
- Department of Radiology and Neuroradiology, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Germany
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7
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Biddle G, Beck RT, Raslan O, Ebinu J, Jenner Z, Hamer J, Hacein-Bey L, Apperson M, Ivanovic V. Autoimmune diseases of the spine and spinal cord. Neuroradiol J 2024; 37:285-303. [PMID: 37394950 PMCID: PMC11138326 DOI: 10.1177/19714009231187340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2023] Open
Abstract
Magnetic resonance imaging (MRI) and clinicopathological tools have led to the identification of a wide spectrum of autoimmune entities that involve the spine. A clearer understanding of the unique imaging features of these disorders, along with their clinical presentations, will prove invaluable to clinicians and potentially limit the need for more invasive procedures such as tissue biopsies. Here, we review various autoimmune diseases affecting the spine and highlight salient imaging features that distinguish them radiologically from other disease entities.
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Affiliation(s)
- Garrick Biddle
- Radiology Department, University of California Davis School of Medicine, Sacramento, CA, USA
| | - Ryan T Beck
- Neuroradiology, Radiology Department, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Osama Raslan
- Radiology Department, University of California Davis School of Medicine, Sacramento, CA, USA
| | - Julius Ebinu
- Neurosurgery Department, University of California Davis School of Medicine, Sacramento, CA, USA
| | - Zach Jenner
- Radiology Department, University of California Davis School of Medicine, Sacramento, CA, USA
| | - John Hamer
- Neuroradiology, Radiology Department, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Lotfi Hacein-Bey
- Radiology Department, University of California Davis School of Medicine, Sacramento, CA, USA
| | - Michelle Apperson
- Neurology Department, University of California Davis School of Medicine, Sacramento, CA, USA
| | - Vladimir Ivanovic
- Neuroradiology, Radiology Department, Medical College of Wisconsin, Milwaukee, WI, USA
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8
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Nistri R, Ianniello A, Pozzilli V, Giannì C, Pozzilli C. Advanced MRI Techniques: Diagnosis and Follow-Up of Multiple Sclerosis. Diagnostics (Basel) 2024; 14:1120. [PMID: 38893646 PMCID: PMC11171945 DOI: 10.3390/diagnostics14111120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 05/08/2024] [Accepted: 05/13/2024] [Indexed: 06/21/2024] Open
Abstract
Brain and spinal cord imaging plays a pivotal role in aiding clinicians with the diagnosis and monitoring of multiple sclerosis. Nevertheless, the significance of magnetic resonance imaging in MS extends beyond its clinical utility. Advanced imaging modalities have facilitated the in vivo detection of various components of MS pathogenesis, and, in recent years, MRI biomarkers have been utilized to assess the response of patients with relapsing-remitting MS to the available treatments. Similarly, MRI indicators of neurodegeneration demonstrate potential as primary and secondary endpoints in clinical trials targeting progressive phenotypes. This review aims to provide an overview of the latest advancements in brain and spinal cord neuroimaging in MS.
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Affiliation(s)
- Riccardo Nistri
- Department of Human Neuroscience, Sapienza University, 00185 Rome, Italy; (A.I.); (C.G.); (C.P.)
| | - Antonio Ianniello
- Department of Human Neuroscience, Sapienza University, 00185 Rome, Italy; (A.I.); (C.G.); (C.P.)
| | - Valeria Pozzilli
- Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
- Unit of Neurology, Neurophysiology, Neurobiology and Psychiatry, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - Costanza Giannì
- Department of Human Neuroscience, Sapienza University, 00185 Rome, Italy; (A.I.); (C.G.); (C.P.)
- IRCCS Neuromed, 86077 Pozzilli, Italy
| | - Carlo Pozzilli
- Department of Human Neuroscience, Sapienza University, 00185 Rome, Italy; (A.I.); (C.G.); (C.P.)
- MS Center Sant’Andrea Hospital, 00189 Rome, Italy
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9
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Huang L, Shao Y, Yang H, Guo C, Wang Y, Zhao Z, Gong Y. A joint model for lesion segmentation and classification of MS and NMOSD. Front Neurosci 2024; 18:1351387. [PMID: 38863883 PMCID: PMC11166028 DOI: 10.3389/fnins.2024.1351387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 05/01/2024] [Indexed: 06/13/2024] Open
Abstract
Introduction Multiple sclerosis (MS) and neuromyelitis optic spectrum disorder (NMOSD) are mimic autoimmune diseases of the central nervous system with a very high disability rate. Their clinical symptoms and imaging findings are similar, making it difficult to diagnose and differentiate. Existing research typically employs the T2-weighted fluid-attenuated inversion recovery (T2-FLAIR) MRI imaging technique to focus on a single task in MS and NMOSD lesion segmentation or disease classification, while ignoring the collaboration between the tasks. Methods To make full use of the correlation between lesion segmentation and disease classification tasks of MS and NMOSD, so as to improve the accuracy and speed of the recognition and diagnosis of MS and NMOSD, a joint model is proposed in this study. The joint model primarily comprises three components: an information-sharing subnetwork, a lesion segmentation subnetwork, and a disease classification subnetwork. Among them, the information-sharing subnetwork adopts a dualbranch structure composed of a convolution module and a Swin Transformer module to extract local and global features, respectively. These features are then input into the lesion segmentation subnetwork and disease classification subnetwork to obtain results for both tasks simultaneously. In addition, to further enhance the mutual guidance between the tasks, this study proposes two information interaction methods: a lesion guidance module and a crosstask loss function. Furthermore, the lesion location maps provide interpretability for the diagnosis process of the deep learning model. Results The joint model achieved a Dice similarity coefficient (DSC) of 74.87% on the lesion segmentation task and accuracy (ACC) of 92.36% on the disease classification task, demonstrating its superior performance. By setting up ablation experiments, the effectiveness of information sharing and interaction between tasks is verified. Discussion The results show that the joint model can effectively improve the performance of the two tasks.
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Affiliation(s)
- Lan Huang
- College of Computer Science and Technology, Jilin University, Changchun, China
| | - Yangguang Shao
- College of Computer Science and Technology, Jilin University, Changchun, China
| | - Hui Yang
- Public Computer Education and Research Center, Jilin University, Changchun, China
| | - Chunjie Guo
- Department of Radiology, The First Hospital of Jilin University, Changchun, China
| | - Yan Wang
- College of Computer Science and Technology, Jilin University, Changchun, China
| | - Ziqi Zhao
- College of Computer Science and Technology, Jilin University, Changchun, China
| | - Yingchun Gong
- College of Computer Science and Technology, Jilin University, Changchun, China
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10
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Nguyen P, Rempe T, Forghani R. Multiple Sclerosis: Clinical Update and Clinically-Oriented Radiologic Reporting. Magn Reson Imaging Clin N Am 2024; 32:363-374. [PMID: 38555146 DOI: 10.1016/j.mric.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
Multiple sclerosis (MS) is a chronic inflammatory disease of the nervous system. MR imaging findings play an integral part in establishing diagnostic hallmarks of the disease during initial diagnosis and evaluating disease status. Multiple iterations of diagnostic criteria and consensus guidelines are put forth by various expert groups incorporating imaging of the brain and spine, and efforts have been made to standardize imaging protocols for MS. Emerging ancillary imaging findings have also attracted increasing interests and should be sought for on radiologic examination. In this paper, the authors review the clinical guidelines and approach to imaging of MS and related disorders, focusing on clinically impactful image interpretation and MR imaging reporting.
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Affiliation(s)
- Phuong Nguyen
- Department of Radiology, University of Florida College of Medicine, 1600 SW Archer Road, Gainesville, FL 32610-0374, USA
| | - Torge Rempe
- Department of Neurology, University of Florida College of Medicine, Norman Fixel Institute for Neurological Diseases, 3009 SW Williston Road, Gainesville, FL 32608, USA
| | - Reza Forghani
- Department of Radiology, University of Florida College of Medicine, 1600 SW Archer Road, Gainesville, FL 32610-0374, USA; Division of Movement Disorders, Department of Neurology, University of Florida College of Medicine, Norman Fixel Institute for Neurological Diseases, 3009 SW Williston Road, Gainesville, FL 32608, USA; Division of Medical Physics, University of Florida College of Medicine, 1600 SW Archer Road, Gainesville, FL 32610-0374, USA; Radiomics and Augmented Intelligence Laboratory (RAIL), Department of Radiology and the Norman Fixel Institute for Neurological Diseases, University of Florida College of Medicine, Room 221.1, 3011 SW Williston Road, Gainesville, FL 32608, USA.
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11
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Bruzaite A, Gedvilaite G, Balnyte R, Kriauciuniene L, Liutkeviciene R. Influence of STAT4 Genetic Variants and Serum Levels on Multiple Sclerosis Occurrence in the Lithuanian Population. J Clin Med 2024; 13:2385. [PMID: 38673659 PMCID: PMC11050845 DOI: 10.3390/jcm13082385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 04/10/2024] [Accepted: 04/13/2024] [Indexed: 04/28/2024] Open
Abstract
Background: Multiple sclerosis (MS) is an autoimmune disease involving demyelination, inflammation, gliosis, and the loss of neurons. MS is a growing global health problem most likely caused by genetic, immunological, and environmental factors. However, the exact etiology of the disease is still unknown. Since MS is related to a dysregulation of the immune system, it could be linked to signal transducer and activator of transcription 4 (STAT4). To fully comprehend the significance of the STAT4 gene and STAT4 serum levels in MS, further research is required. Methods: A total of 200 MS patients and 200 healthy controls participated in the study. Deoxyribonucleic acid (DNA) was extracted using silica-based membrane technology. Polymerase chain reaction was used in real time for genotyping. Using the ELISA technique, serum levels were measured. Results:STAT4 rs7601754 AA genotype and the A allele were statistically significantly less frequent in MS patients (p = 0.003). Also, rs7601754 was associated with 1.9-fold increased odds of MS occurrence (p = 0.004). The rs7601754 AG genotype was more common in males with MS (p = 0.011) and was associated with 2.5-fold increased odds of MS occurrence in males (p = 0.012). STAT4 serum levels were statistically significantly lower in MS patients compared to the control group (p = 0.007). Conclusions:STAT4 rs7601754 increases the odds of MS occurrence. STAT4 serum levels were statistically significantly lower in MS patients compared to the control group.
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Affiliation(s)
- Akvile Bruzaite
- Ophthalmology Laboratory, Neuroscience Institute, Medical Academy, Lithuanian University of Health Sciences, Eiveniu Street 2, LT-50161 Kaunas, Lithuania; (G.G.); (L.K.); (R.L.)
| | - Greta Gedvilaite
- Ophthalmology Laboratory, Neuroscience Institute, Medical Academy, Lithuanian University of Health Sciences, Eiveniu Street 2, LT-50161 Kaunas, Lithuania; (G.G.); (L.K.); (R.L.)
| | - Renata Balnyte
- Department of Neurology, Medical Academy, Lithuanian University of Health Sciences, Eiveniu Street 2, LT-50161 Kaunas, Lithuania;
| | - Loresa Kriauciuniene
- Ophthalmology Laboratory, Neuroscience Institute, Medical Academy, Lithuanian University of Health Sciences, Eiveniu Street 2, LT-50161 Kaunas, Lithuania; (G.G.); (L.K.); (R.L.)
| | - Rasa Liutkeviciene
- Ophthalmology Laboratory, Neuroscience Institute, Medical Academy, Lithuanian University of Health Sciences, Eiveniu Street 2, LT-50161 Kaunas, Lithuania; (G.G.); (L.K.); (R.L.)
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12
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Lin Q, Li C, Wang Y, Zhu Y, Gu Y. Discovery of Near-Infrared Heptamethine Cyanine Probes for Imaging-Guided Surgery in Solid Tumors. J Med Chem 2024; 67:5800-5812. [PMID: 38560986 DOI: 10.1021/acs.jmedchem.4c00010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Near-infrared (NIR) fluorescence imaging has attracted much attention in image-guided interventions with unique advantages. However, the clinical translation rate of fluorescence probes is extremely low, primarily due to weak lesion signal contrast and poor specificity. To address this dilemma, a series of small-molecule near-infrared fluorescence probes have been designed for tumor imaging. Among them, YQ-04-03 showed notable optical stability and remarkable sensitivity toward tumor targeting. Moreover, within a specific concentration and time range against oxidizing reducing agents and laser, it demonstrated better stability than ICG. The retention time of YQ-04-03 in tumors was significantly longer compared to other nonspecific uptake sites in the subjects, and its tumor-to-normal tissue ratio (TNR) outperformed ICG. Successful resection of in situ hepatocarcinoma and peritoneal carcinoma was achieved using probe imaging guidance, with the smallest visual lesion resected measuring approximately 1 mm3. Ultimately, this probe holds great potential for advancing tumor tracer.
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Affiliation(s)
- Qiao Lin
- State Key Laboratory of Natural Medicines, Department of Biomedical Engineering, School of Engineering, China Pharmaceutical University, Nanjing 211198, China
| | - Changsheng Li
- State Key Laboratory of Natural Medicines, Department of Biomedical Engineering, School of Engineering, China Pharmaceutical University, Nanjing 211198, China
- Nanjing Nuoyuan Medical Devices Co., Ltd, NO.18 Ziyun Avenue, Qinhuai District, Nanjing 210000, China
| | - Yuhua Wang
- State Key Laboratory of Natural Medicines, Department of Biomedical Engineering, School of Engineering, China Pharmaceutical University, Nanjing 211198, China
| | - Yanqing Zhu
- State Key Laboratory of Natural Medicines, Department of Biomedical Engineering, School of Engineering, China Pharmaceutical University, Nanjing 211198, China
| | - Yueqing Gu
- State Key Laboratory of Natural Medicines, Department of Biomedical Engineering, School of Engineering, China Pharmaceutical University, Nanjing 211198, China
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13
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Mortazavi M, Ann Gerdes L, Hizarci Ö, Kümpfel T, Anslinger K, Padberg F, Stöcklein S, Keeser D, Ertl-Wagner B. Impact of adult-onset multiple sclerosis on MRI-based intracranial volume: A study in clinically discordant monozygotic twins. Neuroimage Clin 2024; 42:103597. [PMID: 38522363 PMCID: PMC10981084 DOI: 10.1016/j.nicl.2024.103597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 02/23/2024] [Accepted: 03/20/2024] [Indexed: 03/26/2024]
Abstract
OBJECTIVE Intracranial volume (ICV) represents the maximal brain volume for an individual, attained prior to late adolescence and remaining constant throughout life after. Thus, ICV serves as a surrogate marker for brain growth integrity. To assess the potential impact of adult-onset multiple sclerosis (MS) and its preceding prodromal subclinical changes on ICV in a large cohort of monozygotic twins clinically discordant for MS. METHODS FSL software was used to derive ICV estimates from 3D-T1-weighted-3 T-MRI images by using an atlas scaling factor method. ICV were compared between clinically affected and healthy co-twins. All twins were compared to a large healthy reference cohort using standardized ICV z-scores. Mixed models assessed the impact of age at MS diagnosis on ICV. RESULTS 54 twin-pairs (108 individuals/80female/42.45 ± 11.98 years), 731 individuals (375 non-twins, 109/69 monozygotic/dizygotic twin-pairs; 398female/29.18 ± 0.13 years) and 35 healthy local individuals (20male/31.34 ± 1.53 years). In 45/54 (83 %) twin-pairs, both clinically affected and healthy co-twins showed negative ICV z-scores, i.e., ICVs lower than the average of the healthy reference cohort (M = -1.53 ± 0.11, P<10-5). Younger age at MS diagnosis was strongly associated with lower ICVs (t = 3.76, P = 0.0003). Stratification of twin-pairs by age at MS diagnosis of the affected co-twin (≤30 versus > 30 years) yielded lower ICVs in those twin pairs with younger age at diagnosis (P = 0.01). Comparison within individual twin-pairs identified lower ICVs in the MS-affected co-twins with younger age at diagnosis compared to their corresponding healthy co-twins (P = 0.003). CONCLUSION We offer for the first-time evidence for strong associations between adult-onset MS and lower ICV, which is more pronounced with younger age at diagnosis. This suggests pre-clinical alterations in early neurodevelopment associated with susceptibility to MS both in individuals with and without clinical manifestation of the disease.
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Affiliation(s)
- Matin Mortazavi
- Department of Psychiatry, Psychotherapy and Psychosomatics of the University Augsburg, Bezirkskrankenhaus Augsburg, Medical Faculty, University of Augsburg, Augsburg, Germany; Department of Psychiatry and Psychotherapy, University Hospital LMU, Munich, Germany; NeuroImaging Core Unit Munich (NICUM) - University Hospital LMU, Munich, Germany.
| | - Lisa Ann Gerdes
- Institute of Clinical Neuroimmunology, University Hospital LMU, Munich, Germany; Munich Cluster of Systems Neurology (SyNergy), Munich, Germany
| | - Öznur Hizarci
- Department of Psychiatry and Psychotherapy, University Hospital LMU, Munich, Germany; Department of Radiology, University Hospital LMU, Munich, Germany; NeuroImaging Core Unit Munich (NICUM) - University Hospital LMU, Munich, Germany
| | - Tania Kümpfel
- Institute of Clinical Neuroimmunology, University Hospital LMU, Munich, Germany; Munich Cluster of Systems Neurology (SyNergy), Munich, Germany
| | - Katja Anslinger
- Department of Forensic Genetics, Institute of Legal Medicine, University Hospital LMU, Munich, Germany
| | - Frank Padberg
- Department of Psychiatry and Psychotherapy, University Hospital LMU, Munich, Germany
| | - Sophia Stöcklein
- Department of Radiology, University Hospital LMU, Munich, Germany; NeuroImaging Core Unit Munich (NICUM) - University Hospital LMU, Munich, Germany
| | - Daniel Keeser
- Department of Psychiatry and Psychotherapy, University Hospital LMU, Munich, Germany; Department of Radiology, University Hospital LMU, Munich, Germany; NeuroImaging Core Unit Munich (NICUM) - University Hospital LMU, Munich, Germany
| | - Birgit Ertl-Wagner
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada; Division of Neuroradiology, The Hospital for Sick Children, Toronto
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14
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Yang J, Imlay-Gillespie L, Dierkes JG, Khoo TK. Erdheim-Chester disease: misdiagnosed as multiple sclerosis. Pract Neurol 2024; 24:144-147. [PMID: 37932040 DOI: 10.1136/pn-2023-003865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2023] [Indexed: 11/08/2023]
Abstract
Erdheim-Chester disease is a rare histiocytic neoplasm with a wide range of clinical manifestations. Due to its rarity and protean characteristics, this condition often presents a diagnostic challenge. A Caucasian woman in her late 60s presented with unsteadiness, dysphagia and dysarthria. She was initially diagnosed with secondary progressive multiple sclerosis but deteriorated over 2 years with a potential lack of therapeutic response. Subsequent investigations resulted in the diagnosis of Erdheim-Chester disease. She received targeted therapy with BRAF and MAPK-pathway inhibitors. Her initial response to treatment has been positive with functional gains and reduced disease burden on MR brain imaging, and with no significant adverse effects.
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Affiliation(s)
- Jason Yang
- Medicine, The University of Queensland - Saint Lucia Campus, Saint Lucia, Queensland, Australia
| | | | | | - Tien Kheng Khoo
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
- Graduate School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia
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Chaves H, Serra MM, Shalom DE, Ananía P, Rueda F, Osa Sanz E, Stefanoff NI, Rodríguez Murúa S, Costa ME, Kitamura FC, Yañez P, Cejas C, Correale J, Ferrante E, Fernández Slezak D, Farez MF. Assessing robustness and generalization of a deep neural network for brain MS lesion segmentation on real-world data. Eur Radiol 2024; 34:2024-2035. [PMID: 37650967 DOI: 10.1007/s00330-023-10093-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 07/01/2023] [Accepted: 07/12/2023] [Indexed: 09/01/2023]
Abstract
OBJECTIVES Evaluate the performance of a deep learning (DL)-based model for multiple sclerosis (MS) lesion segmentation and compare it to other DL and non-DL algorithms. METHODS This ambispective, multicenter study assessed the performance of a DL-based model for MS lesion segmentation and compared it to alternative DL- and non-DL-based methods. Models were tested on internal (n = 20) and external (n = 18) datasets from Latin America, and on an external dataset from Europe (n = 49). We also examined robustness by rescanning six patients (n = 6) from our MS clinical cohort. Moreover, we studied inter-human annotator agreement and discussed our findings in light of these results. Performance and robustness were assessed using intraclass correlation coefficient (ICC), Dice coefficient (DC), and coefficient of variation (CV). RESULTS Inter-human ICC ranged from 0.89 to 0.95, while spatial agreement among annotators showed a median DC of 0.63. Using expert manual segmentations as ground truth, our DL model achieved a median DC of 0.73 on the internal, 0.66 on the external, and 0.70 on the challenge datasets. The performance of our DL model exceeded that of the alternative algorithms on all datasets. In the robustness experiment, our DL model also achieved higher DC (ranging from 0.82 to 0.90) and lower CV (ranging from 0.7 to 7.9%) when compared to the alternative methods. CONCLUSION Our DL-based model outperformed alternative methods for brain MS lesion segmentation. The model also proved to generalize well on unseen data and has a robust performance and low processing times both on real-world and challenge-based data. CLINICAL RELEVANCE STATEMENT Our DL-based model demonstrated superior performance in accurately segmenting brain MS lesions compared to alternative methods, indicating its potential for clinical application with improved accuracy, robustness, and efficiency. KEY POINTS • Automated lesion load quantification in MS patients is valuable; however, more accurate methods are still necessary. • A novel deep learning model outperformed alternative MS lesion segmentation methods on multisite datasets. • Deep learning models are particularly suitable for MS lesion segmentation in clinical scenarios.
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Affiliation(s)
- Hernán Chaves
- Diagnostic Imaging Department, Fleni, Montañeses, 2325 (C1428AQK), Ciudad de Buenos Aires, Argentina.
| | - María M Serra
- Diagnostic Imaging Department, Fleni, Montañeses, 2325 (C1428AQK), Ciudad de Buenos Aires, Argentina
| | - Diego E Shalom
- Department of Physics, University of Buenos Aires (UBA), Buenos Aires, Argentina
- Physics Institute of Buenos Aires (IFIBA) CONICET, Buenos Aires, Argentina
- Laboratorio de Neurociencia, Universidad Torcuato Di Tella, Buenos Aires, Argentina
| | | | - Fernanda Rueda
- Radiology Department, Diagnósticos da América SA (Dasa), Rio de Janeiro, Brazil
| | - Emilia Osa Sanz
- Diagnostic Imaging Department, Fleni, Montañeses, 2325 (C1428AQK), Ciudad de Buenos Aires, Argentina
| | - Nadia I Stefanoff
- Diagnostic Imaging Department, Fleni, Montañeses, 2325 (C1428AQK), Ciudad de Buenos Aires, Argentina
| | - Sofía Rodríguez Murúa
- Center for Research On Neuroimmunological Diseases (CIEN), Fleni, Buenos Aires, Argentina
| | | | - Felipe C Kitamura
- DasaInova, Diagnósticos da América SA (Dasa), São Paulo, São Paulo, Brazil
| | - Paulina Yañez
- Diagnostic Imaging Department, Fleni, Montañeses, 2325 (C1428AQK), Ciudad de Buenos Aires, Argentina
| | - Claudia Cejas
- Diagnostic Imaging Department, Fleni, Montañeses, 2325 (C1428AQK), Ciudad de Buenos Aires, Argentina
| | | | - Enzo Ferrante
- Instituto de Investigación en Señales, Sistemas e Inteligencia Computacional, sinc(i) CONICET-UNL, Santa Fe, Argentina
| | - Diego Fernández Slezak
- Center for Research On Neuroimmunological Diseases (CIEN), Fleni, Buenos Aires, Argentina
- Departamento de Computación, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires (UBA), Buenos Aires, Argentina
- Instituto de Investigación en Ciencias de la Computación (ICC), CONICET-UBA, Buenos Aires, Argentina
| | - Mauricio F Farez
- Radiology Department, Diagnósticos da América SA (Dasa), Rio de Janeiro, Brazil
- Center for Research On Neuroimmunological Diseases (CIEN), Fleni, Buenos Aires, Argentina
- Center for Biostatistics, Epidemiology and Public Health (CEBES), Fleni, Buenos Aires, Argentina
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Labella Álvarez F, Mosleh R, Bouthour W, Saindane AM, Bruce BB, Dattilo M, Newman NJ, Biousse V. Optic Nerve MRI T2-Hyperintensity: A Nonspecific Marker of Optic Nerve Damage. J Neuroophthalmol 2024; 44:22-29. [PMID: 38251954 DOI: 10.1097/wno.0000000000002017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
BACKGROUND MRI abnormalities are common in optic neuropathies, especially on dedicated orbital imaging. In acute optic neuritis, optic nerve T2-hyperintensity associated with optic nerve contrast enhancement is the typical imaging finding. In chronic optic neuropathies, optic nerve T2-hyperintensity and atrophy are regularly seen. Isolated optic nerve T2-hyperintensity is often erroneously presumed to reflect optic neuritis, frequently prompting unnecessary investigations and neuro-ophthalmology consultations. Our goal was to determine the significance of optic nerve/chiasm T2-hyperintensity and/or atrophy on MRI. METHODS Retrospective study of consecutive patients who underwent brain/orbital MRI with/without contrast at our institution between July 1, 2019, and June 6, 2022. Patients with optic nerve/chiasm T2-hyperintensity and/or atrophy were included. Medical records were reviewed to determine the etiology of the T2-hyperintensity and/or atrophy. RESULTS Four hundred seventy-seven patients (698 eyes) were included [mean age 52 years (SD ±18 years); 57% women]. Of the 364 of 698 eyes with optic nerve/chiasm T2-hyperintensity without atrophy, the causes were compressive (104), inflammatory (103), multifactorial (49), glaucoma (21), normal (19), and other (68); of the 219 of 698 eyes with optic nerve/chiasm T2-hyperintensity and atrophy, the causes were compressive (57), multifactorial (40), inflammatory (38), glaucoma (33), normal (7), and other (44); of the 115 of 698 eyes with optic nerve/chiasm atrophy without T2-hyperintensity, the causes were glaucoma (34), multifactorial (21), inflammatory (13), compressive (11), normal (10), and other (26). Thirty-six eyes with optic nerve/chiasm T2-hyperintensity or atrophy did not have evidence of optic neuropathy or retinopathy on ophthalmologic examination, and 17 eyes had clinical evidence of severe retinopathy without primary optic neuropathy. CONCLUSIONS Optic nerve T2-hyperintensity or atrophy can be found with any cause of optic neuropathy and with severe chronic retinopathy. These MRI findings should not automatically prompt optic neuritis diagnosis, workup, and treatment, and caution is advised regarding their use in the diagnostic criteria for multiple sclerosis. Cases of incidentally found MRI optic nerve T2-hyperintensity and/or atrophy without a known underlying optic neuropathy or severe retinopathy are rare. Such patients should receive an ophthalmologic examination before further investigations.
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Affiliation(s)
- Fernando Labella Álvarez
- Departments of Ophthalmology (FLÁ, RM, WB, BBB, MD, NJN, VB), Radiology and Imaging Sciences (AMS), Neurological Surgery (AMS, NJN), and Neurology (BBB, NJN, VB), Emory University School of Medicine, Atlanta, Georgia; Sheba Medical Center (RM), Goldschleger Eye Institute, Tel Hashomer, Israel; and Department of Epidemiology (BBB), Rollins School of Public Health, Emory University, Atlanta, Georgia
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17
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Meca-Lallana JE, Martínez Yélamos S, Eichau S, Llaneza MÁ, Martín Martínez J, Peña Martínez J, Meca Lallana V, Alonso Torres AM, Moral Torres E, Río J, Calles C, Ares Luque A, Ramió-Torrentà L, Marzo Sola ME, Prieto JM, Martínez Ginés ML, Arroyo R, Otano Martínez MÁ, Brieva Ruiz L, Gómez Gutiérrez M, Rodríguez-Antigüedad Zarranz A, Sánchez-Seco VG, Costa-Frossard L, Hernández Pérez MÁ, Landete Pascual L, González Platas M, Oreja-Guevara C. Consensus statement of the Spanish Society of Neurology on the treatment of multiple sclerosis and holistic patient management in 2023. Neurologia 2024; 39:196-208. [PMID: 38237804 DOI: 10.1016/j.nrleng.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 06/14/2023] [Indexed: 01/25/2024] Open
Abstract
The last consensus statement of the Spanish Society of Neurology's Demyelinating Diseases Study Group on the treatment of multiple sclerosis (MS) was issued in 2016. Although many of the positions taken remain valid, there have been significant changes in the management and treatment of MS, both due to the approval of new drugs with different action mechanisms and due to the evolution of previously fixed concepts. This has enabled new approaches to specific situations such as pregnancy and vaccination, and the inclusion of new variables in clinical decision-making, such as the early use of high-efficacy disease-modifying therapies (DMT), consideration of the patient's perspective, and the use of such novel technologies as remote monitoring. In the light of these changes, this updated consensus statement, developed according to the Delphi method, seeks to reflect the new paradigm in the management of patients with MS, based on the available scientific evidence and the clinical expertise of the participants. The most significant recommendations are that immunomodulatory DMT be started in patients with radiologically isolated syndrome with persistent radiological activity, that patient perspectives be considered, and that the term "lines of therapy" no longer be used in the classification of DMTs (> 90% consensus). Following diagnosis of MS, the first DMT should be selected according to the presence/absence of factors of poor prognosis (whether epidemiological, clinical, radiological, or biomarkers) for the occurrence of new relapses or progression of disability; high-efficacy DMTs may be considered from disease onset.
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Affiliation(s)
- J E Meca-Lallana
- Unidad de Neuroinmunología Clínica y CSUR Esclerosis Múltiple, Servicio de Neurología, Hospital Clínico Universitario Virgen de la Arrixaca (IMIB-Arrixaca)/Cátedra de Neuroinmunología Clínica y Esclerosis Múltiple, Universidad Católica San Antonio (UCAM), Murcia, Spain.
| | - S Martínez Yélamos
- Unidad de Esclerosis Múltiple «EMxarxa», Servicio de Neurología. H.U. de Bellvitge, IDIBELL, Departament de Ciències Clíniques, Universitat de Barcelona, Barcelona, Spain
| | - S Eichau
- Servicio de Neurología, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - M Á Llaneza
- Servicio de Neurología, Complejo Hospitalario Universitario de Ferrol, Ferrol, Spain
| | - J Martín Martínez
- Servicio de Neurología, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | | | - V Meca Lallana
- Servicio de Neurología, Hospital Universitario La Princesa, Madrid, Spain
| | - A M Alonso Torres
- Unidad de Esclerosis Múltiple, Servicio de Neurología, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - E Moral Torres
- Servicio de Neurología, Complejo Hospitalario y Universitario Moisès Broggi, Barcelona, Spain
| | - J Río
- Servicio de Neurología, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitario Vall d'Hebrón, Barcelona, Spain
| | - C Calles
- Servicio de Neurología, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - A Ares Luque
- Servicio de Neurología, Complejo Asistencial Universitario de León, León, Spain
| | - L Ramió-Torrentà
- Unitat de Neuroimmunologia i Esclerosi Múltiple Territorial de Girona (UNIEMTG), Hospital Universitari Dr. Josep Trueta y Hospital Santa Caterina. Grupo Neurodegeneració i Neuroinflamació, IDIBGI. Departamento de Ciencias Médicas, Universidad de Girona, Girona, Spain
| | - M E Marzo Sola
- Servicio de Neurología, Hospital San Pedro, Logroño, Spain
| | - J M Prieto
- Servicio de Neurología, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | - M L Martínez Ginés
- Servicio de Neurología, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - R Arroyo
- Servicio de Neurología, Hospital Universitario Quirón Salud Madrid, Madrid, Spain
| | - M Á Otano Martínez
- Servicio de Neurología, Hospital Universitario de Navarra, Navarra, Spain
| | - L Brieva Ruiz
- Hospital Universitari Arnau de Vilanova, Universitat de Lleida, Lleida, Spain
| | - M Gómez Gutiérrez
- Servicio de Neurología, Hospital San Pedro de Alcántara, Cáceres, Spain
| | | | - V G Sánchez-Seco
- Servicio de Neurología, Hospital Universitario de Toledo, Toledo, Spain
| | - L Costa-Frossard
- CSUR de Esclerosis Múltiple, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - M Á Hernández Pérez
- Unidad de Esclerosis Múltiple, Servicio de Neurología, Hospital Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - L Landete Pascual
- Servicio de Neurología, Hospital Universitario Dr. Peset, Valencia, Spain
| | - M González Platas
- Servicio de Neurología, Hospital Universitario de Canarias, La Laguna, Spain
| | - C Oreja-Guevara
- Departamento de Neurología, Hospital Clínico San Carlos, IdISSC, Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid (UCM), Madrid, Spain
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Carass A, Greenman D, Dewey BE, Calabresi PA, Prince JL, Pham DL. Image harmonization improves consistency of intra-rater delineations of MS lesions in heterogeneous MRI. NEUROIMAGE. REPORTS 2024; 4:100195. [PMID: 38370461 PMCID: PMC10871705 DOI: 10.1016/j.ynirp.2024.100195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
Clinical magnetic resonance images (MRIs) lack a standard intensity scale due to differences in scanner hardware and the pulse sequences used to acquire the images. When MRIs are used for quantification, as in the evaluation of white matter lesions (WMLs) in multiple sclerosis, this lack of intensity standardization becomes a critical problem affecting both the staging and tracking of the disease and its treatment. This paper presents a study of harmonization on WML segmentation consistency, which is evaluated using an object detection classification scheme that incorporates manual delineations from both the original and harmonized MRIs. A cohort of ten people scanned on two different imaging platforms was studied. An expert rater, blinded to the image source, manually delineated WMLs on images from both scanners before and after harmonization. It was found that there is closer agreement in both global and per-lesion WML volume and spatial distribution after harmonization, demonstrating the importance of image harmonization prior to the creation of manual delineations. These results could lead to better truth models in both the development and evaluation of automated lesion segmentation algorithms.
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Affiliation(s)
- Aaron Carass
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Danielle Greenman
- Center for Neuroscience and Regenerative Medicine, The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD 20817, USA
| | - Blake E. Dewey
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA
| | - Peter A. Calabresi
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA
| | - Jerry L. Prince
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Dzung L. Pham
- Department of Radiology, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
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Li M, Liu S, Zhou J, Xiao L, Man R, Yin J. An AQP-4-IgG-Positive Patient with Neuroimaging Findings Suggestive of Multiple Sclerosis. AMERICAN JOURNAL OF CASE REPORTS 2024; 25:e942475. [PMID: 38303503 PMCID: PMC10846751 DOI: 10.12659/ajcr.942475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 12/23/2023] [Accepted: 12/06/2023] [Indexed: 02/03/2024]
Abstract
BACKGROUND Multiple sclerosis (MS) and neuromyelitis optica spectrum disorders (NMOSDs) are 2 similar but distinct diseases. These diseases were difficult to distinguish from each other until aquaporin-4-IgG (AQP-4-IgG) was discovered. The accurate identification of these 2 diseases is crucial for appropriate drug treatment in clinical practice. Herein, we report a case of AQP-4-IgG seroconversion with magnetic resonance imaging (MRI) findings suggestive of MS. CASE REPORT A 54-year-old woman developed weakness in her right lower extremity that gradually returned to normal 4 years ago. Recently, she was admitted to the hospital for numbness and weakness of both lower limbs and the right upper limb for more than 10 days. The clinical and MRI features of the patient suggested a high susceptibility for misdiagnosis of MS. However, careful observation of the MRI revealed the presence of atypical MS lesions ("red flag" signs), indicating the possibility of other diagnoses in this patient. After further examination, serum AQP-4-IgG was detected, suggesting the potential presence of another disorder, NMOSD, in the patient. CONCLUSIONS Attention should be given to the identification of MS MRI "red flag" signs. Even for patients with a high suspicion of MS, it is necessary to conduct antibody tests for AQP-4-IgG, MOG-IgG and other relevant markers to screen for associated diseases because MS disease-modifying therapy approaches may lead to a deterioration in the state of NMOSD patients. Analyzing this case can help us to further distinguish the differences between these 2 types of diseases, which has important practical clinical value.
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Affiliation(s)
- Mingxia Li
- Department of Neurology, Hunan University of Medicine General Hospital, Huaihua, Hunan, PR China
| | - Shuangxi Liu
- Department of Neurology, Hunan University of Medicine General Hospital, Huaihua, Hunan, PR China
| | - Jun Zhou
- Department of Neurology, Hunan University of Medicine General Hospital, Huaihua, Hunan, PR China
| | - Liqian Xiao
- Department of Health Management Center, Hunan University of Medicine General Hospital, Huaihua, Hunan, PR China
| | - Rongyong Man
- Department of Neurology, Hunan University of Medicine General Hospital, Huaihua, Hunan, PR China
| | - Junjie Yin
- Department of Neurology, Hunan University of Medicine General Hospital, Huaihua, Hunan, PR China
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Ananthavarathan P, Sahi N, Chard DT. An update on the role of magnetic resonance imaging in predicting and monitoring multiple sclerosis progression. Expert Rev Neurother 2024; 24:201-216. [PMID: 38235594 DOI: 10.1080/14737175.2024.2304116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 01/08/2024] [Indexed: 01/19/2024]
Abstract
INTRODUCTION While magnetic resonance imaging (MRI) is established in diagnosing and monitoring disease activity in multiple sclerosis (MS), its utility in predicting and monitoring disease progression is less clear. AREAS COVERED The authors consider changing concepts in the phenotypic classification of MS, including progression independent of relapses; pathological processes underpinning progression; advances in MRI measures to assess them; how well MRI features explain and predict clinical outcomes, including models that assess disease effects on neural networks, and the potential role for machine learning. EXPERT OPINION Relapsing-remitting and progressive MS have evolved from being viewed as mutually exclusive to having considerable overlap. Progression is likely the consequence of several pathological elements, each important in building more holistic prognostic models beyond conventional phenotypes. MRI is well placed to assess pathogenic processes underpinning progression, but we need to bridge the gap between MRI measures and clinical outcomes. Mapping pathological effects on specific neural networks may help and machine learning methods may be able to optimize predictive markers while identifying new, or previously overlooked, clinically relevant features. The ever-increasing ability to measure features on MRI raises the dilemma of what to measure and when, and the challenge of translating research methods into clinically useable tools.
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Affiliation(s)
- Piriyankan Ananthavarathan
- Department of Neuroinflammation, University College London Queen Square Multiple Sclerosis Centre, London, UK
| | - Nitin Sahi
- Department of Neuroinflammation, University College London Queen Square Multiple Sclerosis Centre, London, UK
| | - Declan T Chard
- Clinical Research Associate & Consultant Neurologist, Institute of Neurology - Queen Square Multiple Sclerosis Centre, London, UK
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Pervin I, Ramanathan S, Cappelen-Smith C, Vucic S, Reddel SW, Hardy TA. Clinical and radiological characteristics and outcomes of patients with recurrent or relapsing tumefactive demyelination. Mult Scler Relat Disord 2024; 82:105408. [PMID: 38219394 DOI: 10.1016/j.msard.2023.105408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 11/27/2023] [Accepted: 12/22/2023] [Indexed: 01/16/2024]
Abstract
BACKGROUND Relapsing or recurrent tumefactive demyelination is rare and has not been studied beyond individual case reports. OBJECTIVE We examined the clinical course, neuroimaging, cerebrospinal fluid (CSF), treatment and outcomes of patients with recurrent tumefactive demyelinating lesions (TDLs). METHODS We used PubMed to identify reports of recurrent TDLs and included the details of an additional, unpublished patient. RESULTS We identified 18 cases (11F, 7 M). The median age at onset of the index TDL was 37 years (range 12-72) and most were solitary lesions 72 % (13/18). CSF-restricted oligoclonal bands (OCBs) were detected in 25 % (4/16). Only one of those tested (n = 13) was positive for AQP4-IgG. A moderate-to-marked treatment response (high dose corticosteroid with or without additional plasmapheresis, IVIg or disease modifying therapies) was evident in 89 % of treated patients. Median EDSS at the median follow-up of 36 months (range 6-144) was 2 (range 1-10). Most remained ambulatory (EDSS < 4 in 13/18), but 1 patient died. CONCLUSION The median age of patients with relapsing TDLs is similar to that of typical MS, but differences include a lower female:male sex ratio, larger lesions, and a comparative lack of CSF-restricted OCBs. Outcomes vary among this group of patients ranging from minimal disability through to death.
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Affiliation(s)
- Irin Pervin
- Multiple sclerosis and Neuroimmunology Clinics, Concord Hospital, University of Sydney, NSW, Australia
| | - Sudarshini Ramanathan
- Multiple sclerosis and Neuroimmunology Clinics, Concord Hospital, University of Sydney, NSW, Australia; Translational Neuroimmunology Group, Faculty of medicine and health, University of Sydney, NSW, Australia; Brain & Mind Centre, University of Sydney, NSW, Australia
| | | | - Steve Vucic
- Multiple sclerosis and Neuroimmunology Clinics, Concord Hospital, University of Sydney, NSW, Australia
| | - Stephen W Reddel
- Multiple sclerosis and Neuroimmunology Clinics, Concord Hospital, University of Sydney, NSW, Australia; Brain & Mind Centre, University of Sydney, NSW, Australia
| | - Todd A Hardy
- Multiple sclerosis and Neuroimmunology Clinics, Concord Hospital, University of Sydney, NSW, Australia; Brain & Mind Centre, University of Sydney, NSW, Australia.
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Yagdiran B, Cakir BT, Cetin H. Diagnostic Contribution of Additional Sequences to the Evaluation of Cord Lesions in Patients with Cervical Spinal Multiple Sclerosis in Turkey: A Retrospective Study. Niger J Clin Pract 2024; 27:272-279. [PMID: 38409158 DOI: 10.4103/njcp.njcp_333_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 01/15/2024] [Indexed: 02/28/2024]
Abstract
BACKGROUND Multiple Sclerosis (MS) is the most common cause of non-traumatic disability in young adults. Spinal cord involvement is observed in 55-75% of patients with MS. AIM To identify the strengths and shortcomings of sagittal phase-sensitive inversion recovery (PSIR), sagittal proton density/T2-weighted (PD/T2W), and axial turbo inversion recovery magnitude (TIRM) sequences in the detection of cervical MS plaques by comparing with routine sequences (axial and sagittal T2W, sagittal T1W, sagittal TIRM, fat-suppressed contrast T1W) and therefore determine their diagnostic contributions. MATERIALS AND METHODS A total of 48 patients in whom additional magnetic resonance imaging (MRI) sequences were obtained for the diagnosis of cervical MS were retrospectively identified and included in the study. A total of 111 MS plaques were analyzed in terms of visibility, number, size, border sharpness, and intensity ratio based on the routine and additional MRI sequences. The evaluation of the images was independently undertaken by two radiologists. RESULTS The highest visibility was provided by sagittal PSIR, sagittal TIRM, and axial TIRM sequences (P < 0.05 for all additional sequences). Seven lesions in PD/T2W and four lesions in axial T2W sequences were unable to be detected. Lesions seen in sagittal and axial TIRM sequences were larger than the others. The sharpest borders were determined in the axial TIRM sequence, and the most diffuse borders in the PD/T2W sequence. In intensity ratio, the sagittal PSIR sequence revealed the most significant contrast difference. CONCLUSION The sagittal PSIR sequence may improve the detection of cervical MS plaques due to the improved visibility and intensity ratios. The axial TIRM sequence may be more useful than routine axial T2W in the evaluation of visibility, border sharpness, and size measurement of MS plaques.
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Affiliation(s)
- B Yagdiran
- Department of Radiology, Başkent University, Faculty of Medicine, Fevzi Çakmak Cd. 10. Sk. No: 45 Bahçelievler/ANKARA, Turkey
| | - B T Cakir
- Department of Radiology, Gülhane Training and Research Hospital, General Dr. Tevfik Sağlam Cd. No: 1 Etlik/Ankara, Turkey
| | - H Cetin
- Department of Radiology, Yildirim Beyazit University, Üniversiteler Mahallesi Bilkent Caddesi No: 1, Çankaya, Ankara, Turkey
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Raj A, Gass A, Eisele P, Dabringhaus A, Kraemer M, Zöllner FG. A generalizable deep voxel-guided morphometry algorithm for the detection of subtle lesion dynamics in multiple sclerosis. Front Neurosci 2024; 18:1326108. [PMID: 38332857 PMCID: PMC10850259 DOI: 10.3389/fnins.2024.1326108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 01/10/2024] [Indexed: 02/10/2024] Open
Abstract
Introduction Multiple sclerosis (MS) is a chronic neurological disorder characterized by the progressive loss of myelin and axonal structures in the central nervous system. Accurate detection and monitoring of MS-related changes in brain structures are crucial for disease management and treatment evaluation. We propose a deep learning algorithm for creating Voxel-Guided Morphometry (VGM) maps from longitudinal MRI brain volumes for analyzing MS disease activity. Our approach focuses on developing a generalizable model that can effectively be applied to unseen datasets. Methods Longitudinal MS patient high-resolution 3D T1-weighted follow-up imaging from three different MRI systems were analyzed. We employed a 3D residual U-Net architecture with attention mechanisms. The U-Net serves as the backbone, enabling spatial feature extraction from MRI volumes. Attention mechanisms are integrated to enhance the model's ability to capture relevant information and highlight salient regions. Furthermore, we incorporate image normalization by histogram matching and resampling techniques to improve the networks' ability to generalize to unseen datasets from different MRI systems across imaging centers. This ensures robust performance across diverse data sources. Results Numerous experiments were conducted using a dataset of 71 longitudinal MRI brain volumes of MS patients. Our approach demonstrated a significant improvement of 4.3% in mean absolute error (MAE) against the state-of-the-art (SOTA) method. Furthermore, the algorithm's generalizability was evaluated on two unseen datasets (n = 116) with an average improvement of 4.2% in MAE over the SOTA approach. Discussion Results confirm that the proposed approach is fast and robust and has the potential for broader clinical applicability.
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Affiliation(s)
- Anish Raj
- Computer Assisted Clinical Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Baden Württemberg, Germany
- Mannheim Institute for Intelligent Systems in Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Baden Württemberg, Germany
| | - Achim Gass
- Department of Neurology, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Baden Württemberg, Germany
- Mannheim Center for Translational Neurosciences, Heidelberg University, Mannheim, Baden Württemberg, Germany
| | - Philipp Eisele
- Department of Neurology, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Baden Württemberg, Germany
- Mannheim Center for Translational Neurosciences, Heidelberg University, Mannheim, Baden Württemberg, Germany
| | | | - Matthias Kraemer
- VGMorph GmbH, Mülheim an der Ruhr, Nordrhein-Westfalen, Germany
- NeuroCentrum, Grevenbroich, Nordrhein-Westfalen, Germany
| | - Frank G. Zöllner
- Computer Assisted Clinical Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Baden Württemberg, Germany
- Mannheim Institute for Intelligent Systems in Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Baden Württemberg, Germany
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24
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Lemonaris M, Kleopa KA. Highly Active Relapsing-Remitting Multiple Sclerosis with Neurofibromatosis Type 1: Radiological Aspects and Therapeutic Challenges - Case Report. Case Rep Neurol 2024; 16:48-54. [PMID: 38405018 PMCID: PMC10890804 DOI: 10.1159/000536463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 01/22/2024] [Indexed: 02/27/2024] Open
Abstract
Introduction Multiple sclerosis (MS) is an autoimmune neurodegenerative disease which can rarely co-exist with neurofibromatosis 1 (NF1), a neurocutaneous inherited disorder that predisposes to oncogenesis. Patients who suffer from both conditions can be challenging cases for clinicians, as clinical symptoms and radiological findings may overlap, while MS immune-modifying treatments could further increase the risk of oncogenesis. Case Presentation In this study, we describe the case of a 27-year-old woman who presented with signs and symptoms of optic neuritis and was then diagnosed with both MS and NF1. As the patient continued to experience MS relapses despite initial interferon-beta treatment, she was subsequently switched to natalizumab and responded well. Conclusion This case illustrates how MRI lesion differentiation with the co-existence of MS and NF1 can be difficult due to overlaps in lesion characteristics, while treatment decisions can be challenging mainly due to scarce data on the oncogenic risk of MS immunomodulary therapies. Therefore, clinicians need to balance out the risk of malignancy development with the risk of progressive neurological disability when treating such patients.
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Affiliation(s)
- Marios Lemonaris
- Acute and General Medicine Department, Royal Infirmary of Edinburgh, NHS Scotland, Edinburgh, UK
| | - Kleopas A. Kleopa
- Department of Neuroscience, Nicosia, Cyprus
- Center for Multiple Sclerosis and Related Disorders, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
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25
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Gadhave DG, Sugandhi VV, Kokare CR. Potential biomaterials and experimental animal models for inventing new drug delivery approaches in the neurodegenerative disorder: Multiple sclerosis. Brain Res 2024; 1822:148674. [PMID: 37952871 DOI: 10.1016/j.brainres.2023.148674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 09/14/2023] [Accepted: 11/07/2023] [Indexed: 11/14/2023]
Abstract
The tight junction of endothelial cells in the central nervous system (CNS) has an ideal characteristic, acting as a biological barrier that can securely regulate the movement of molecules in the brain. Tightly closed astrocyte cell junctions on blood capillaries are the blood-brain barrier (BBB). This biological barrier prohibits the entry of polar drugs, cells, and ions, which protect the brain from harmful toxins. However, delivering any therapeutic agent to the brain in neurodegenerative disorders (i.e., schizophrenia, multiple sclerosis, etc.) is extremely difficult. Active immune responses such as microglia, astrocytes, and lymphocytes cross the BBB and attack the nerve cells, which causes the demyelination of neurons. Therefore, there is a hindrance in transmitting electrical signals properly, resulting in blindness, paralysis, and neuropsychiatric problems. The main objective of this article is to shed light on the performance of biomaterials, which will help researchers to create nanocarriers that can cross the blood-brain barrier and achieve a therapeutic concentration of drugs in the CNS of patients with multiple sclerosis (MS). The present review focuses on the importance of biomaterials with diagnostic and therapeutic efficacy that can help enhance multiple sclerosis therapeutic potential. Currently, the development of MS in animal models is limited by immune responses, which prevent MS induction in healthy animals. Therefore, this article also showcases animal models currently used for treating MS. A future advance in developing a novel effective strategy for treating MS is now a potential area of research.
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Affiliation(s)
- Dnyandev G Gadhave
- Department of Pharmaceutics, Sinhgad Technical Education Society's, Sinhgad Institute of Pharmacy (Affiliated to Savitribai Phule Pune University), Narhe, Pune 411041, Maharashtra, India; Department of Pharmaceutical Sciences, College of Pharmacy and Health Sciences, St. John's University, 8000 Utopia Parkway, Queens, NY 11439, USA; Department of Pharmaceutics, Dattakala Shikshan Sanstha's, Dattakala College of Pharmacy (Affiliated to Savitribai Phule Pune University), Swami Chincholi, Daund, Pune 413130, Maharashtra, India.
| | - Vrashabh V Sugandhi
- Department of Pharmaceutical Sciences, College of Pharmacy and Health Sciences, St. John's University, 8000 Utopia Parkway, Queens, NY 11439, USA
| | - Chandrakant R Kokare
- Department of Pharmaceutics, Sinhgad Technical Education Society's, Sinhgad Institute of Pharmacy (Affiliated to Savitribai Phule Pune University), Narhe, Pune 411041, Maharashtra, India
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26
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Daboul L, O’Donnell CM, Amin M, Rodrigues P, Derbyshire J, Azevedo C, Bar-Or A, Caverzasi E, Calabresi PA, Cree BA, Freeman L, Henry RG, Longbrake EE, Oh J, Papinutto N, Pelletier D, Prchkovska V, Raza P, Ramos M, Samudralwar RD, Schindler MK, Sotirchos ES, Sicotte NL, Solomon AJ, Shinohara RT, Reich DS, Sati P, Ontaneda D. A multicenter pilot study evaluating simplified central vein assessment for the diagnosis of multiple sclerosis. Mult Scler 2024; 30:25-34. [PMID: 38088067 PMCID: PMC11037932 DOI: 10.1177/13524585231214360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
BACKGROUND The central vein sign (CVS) is a proposed magnetic resonance imaging (MRI) biomarker for multiple sclerosis (MS); the optimal method for abbreviated CVS scoring is not yet established. OBJECTIVE The aim of this study was to evaluate the performance of a simplified approach to CVS assessment in a multicenter study of patients being evaluated for suspected MS. METHODS Adults referred for possible MS to 10 sites were recruited. A post-Gd 3D T2*-weighted MRI sequence (FLAIR*) was obtained in each subject. Trained raters at each site identified up to six CVS-positive lesions per FLAIR* scan. Diagnostic performance of CVS was evaluated for a diagnosis of MS which had been confirmed using the 2017 McDonald criteria at thresholds including three positive lesions (Select-3*) and six positive lesions (Select-6*). Inter-rater reliability assessments were performed. RESULTS Overall, 78 participants were analyzed; 37 (47%) were diagnosed with MS, and 41 (53%) were not. The mean age of participants was 45 (range: 19-64) years, and most were female (n = 55, 71%). The area under the receiver operating characteristic curve (AUROC) for the simplified counting method was 0.83 (95% CI: 0.73-0.93). Select-3* and Select-6* had sensitivity of 81% and 65% and specificity of 68% and 98%, respectively. Inter-rater agreement was 78% for Select-3* and 83% for Select-6*. CONCLUSION A simplified method for CVS assessment in patients referred for suspected MS demonstrated good diagnostic performance and inter-rater agreement.
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Affiliation(s)
- Lynn Daboul
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD
- Cleveland Clinic Lerner College of Medicine, Cleveland, OH
| | - Carly M. O’Donnell
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Moein Amin
- Neurological Institute, Cleveland Clinic, Cleveland, OH
| | | | - John Derbyshire
- Functional MRI Facility, NIMH, National Institutes of Health, Bethesda, MD
| | - Christina Azevedo
- Department of Neurology, University of Southern California, Los Angeles, CA
| | - Amit Bar-Or
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Eduardo Caverzasi
- Department of Neurology, University of California at San Francisco, San Francisco, CA
| | | | - Bruce A.C. Cree
- Department of Neurology, University of California at San Francisco, San Francisco, CA
| | - Leorah Freeman
- Department of Neurology, Dell Medical School, The University of Texas, Austin, TX
| | - Roland G. Henry
- Department of Neurology, University of California at San Francisco, San Francisco, CA
| | | | - Jiwon Oh
- Division of Neurology, St. Michael’s Hospital, University of Toronto, Toronto, ON, CANADA
| | - Nico Papinutto
- Department of Neurology, University of California at San Francisco, San Francisco, CA
| | - Daniel Pelletier
- Department of Neurology, University of Southern California, Los Angeles, CA
| | | | - Praneeta Raza
- Cleveland Clinic Lerner College of Medicine, Cleveland, OH
| | - Marc Ramos
- QMENTA Cloud Platform, QMENTA Inc., Boston, MA, USA
| | | | - Matthew K. Schindler
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | | | - Nancy L. Sicotte
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Andrew J. Solomon
- Department of Neurological Sciences, Larner College of Medicine, The University of Vermont, Burlington, VT
| | - Russell T. Shinohara
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Daniel S. Reich
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD
| | - Pascal Sati
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Daniel Ontaneda
- Mellen Center for Multiple Sclerosis, Cleveland Clinic, Cleveland, OH
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27
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Yuzkan S, Balsak S, Cinkir U, Kocak B. Multiple sclerosis versus cerebral small vessel disease in MRI: a practical approach using qualitative and quantitative signal intensity differences in white matter lesions. Acta Radiol 2024; 65:106-114. [PMID: 36862588 DOI: 10.1177/02841851231155608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
BACKGROUND Multiple sclerosis (MS) and cerebral small vessel disease (CSVD) are relatively common radiological entities that occasionally necessitate differential diagnosis. PURPOSE To investigate the differences in magnetic resonance imaging (MRI) signal intensity (SI) between MS and CSVD related white matter lesions. MATERIAL AND METHODS On 1.5-T and 3-T MRI scanners, 50 patients with MS (380 lesions) and 50 patients with CSVD (395 lesions) were retrospectively evaluated. Visual inspection was used to conduct qualitative analysis on diffusion-weighted imaging (DWI)_b1000 to determine relative signal intensity. The thalamus served as the reference for quantitative analysis based on SI ratio (SIR). The statistical analysis utilized univariable and multivariable methods. There were analyses of patient and lesion datasets. On a dataset restricted by age (30-50 years), additional evaluations, including unsupervised fuzzy c-means clustering, were performed. RESULTS Using both quantitative and qualitative features, the optimal model achieved a 100% accuracy, sensitivity, and specificity with an area under the curve (AUC) of 1 in patient-wise analysis. With an AUC of 0.984, the best model achieved a 94% accuracy, sensitivity, and specificity when using only quantitative features. The model's accuracy, sensitivity, and specificity were 91.9%, 84.6%, and 95.8%, respectively, when using the age-restricted dataset. Independent predictors were T2_SIR_max (optimal cutoff=2.1) and DWI_b1000_SIR_mean (optimal cutoff=1.1). Clustering also performed well with an accuracy, sensitivity, and specificity of 86.5%, 70.6%, and 100%, respectively, in the age-restricted dataset. CONCLUSION SI characteristics derived from DWI_b1000 and T2-weighted-based MRI demonstrate excellent performance in differentiating white matter lesions caused by MS and CSVD.
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Affiliation(s)
- Sabahattin Yuzkan
- Department of Radiology, University of Health Sciences, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Serdar Balsak
- Department of Radiology, Bezmialem Vakif University Hospital, Istanbul, Turkey
| | - Ufuk Cinkir
- Department of Neurology, University of Health Sciences, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Burak Kocak
- Department of Radiology, University of Health Sciences, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
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28
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Stavropoulou De Lorenzo S, Bakirtzis C, Konstantinidou N, Kesidou E, Parissis D, Evangelopoulos ME, Elsayed D, Hamdy E, Said S, Grigoriadis N. How Early Is Early Multiple Sclerosis? J Clin Med 2023; 13:214. [PMID: 38202221 PMCID: PMC10780129 DOI: 10.3390/jcm13010214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 12/22/2023] [Accepted: 12/27/2023] [Indexed: 01/12/2024] Open
Abstract
The development and further optimization of the diagnostic criteria for multiple sclerosis (MS) emphasize the establishment of an early and accurate diagnosis. So far, numerous studies have revealed the significance of early treatment administration for MS and its association with slower disease progression and better late outcomes of the disease with regards to disability accumulation. However, according to current research results, both neuroinflammatory and neurodegenerative processes may exist prior to symptom initiation. Despite the fact that a significant proportion of individuals with radiologically isolated syndrome (RIS) progress to MS, currently, there is no available treatment approved for RIS. Therefore, our idea of "early treatment administration" might be already late in some cases. In order to detect the individuals who will progress to MS, we need accurate biomarkers. In this review, we present notable research results regarding the underlying pathology of MS, as well as several potentially useful laboratory and neuroimaging biomarkers for the identification of high-risk individuals with RIS for developing MS. This review aims to raise clinicians' awareness regarding "subclinical" MS, enrich their understanding of MS pathology, and familiarize them with several potential biomarkers that are currently under investigation and might be used in clinical practice in the future for the identification of individuals with RIS at high risk for conversion to definite MS.
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Affiliation(s)
- Sotiria Stavropoulou De Lorenzo
- Multiple Sclerosis Center, Second Department of Neurology, School of Medicine, Aristotle University of Thessaloniki, 54621 Thessaloniki, Greece; (S.S.D.L.); (N.K.); (E.K.); (D.P.); (N.G.)
| | - Christos Bakirtzis
- Multiple Sclerosis Center, Second Department of Neurology, School of Medicine, Aristotle University of Thessaloniki, 54621 Thessaloniki, Greece; (S.S.D.L.); (N.K.); (E.K.); (D.P.); (N.G.)
| | - Natalia Konstantinidou
- Multiple Sclerosis Center, Second Department of Neurology, School of Medicine, Aristotle University of Thessaloniki, 54621 Thessaloniki, Greece; (S.S.D.L.); (N.K.); (E.K.); (D.P.); (N.G.)
| | - Evangelia Kesidou
- Multiple Sclerosis Center, Second Department of Neurology, School of Medicine, Aristotle University of Thessaloniki, 54621 Thessaloniki, Greece; (S.S.D.L.); (N.K.); (E.K.); (D.P.); (N.G.)
| | - Dimitrios Parissis
- Multiple Sclerosis Center, Second Department of Neurology, School of Medicine, Aristotle University of Thessaloniki, 54621 Thessaloniki, Greece; (S.S.D.L.); (N.K.); (E.K.); (D.P.); (N.G.)
| | | | - Dina Elsayed
- Department of Neuropsychiatry, Faculty of Medicine, Alexandria University, Alexandria 21311, Egypt; (D.E.); (E.H.); (S.S.)
| | - Eman Hamdy
- Department of Neuropsychiatry, Faculty of Medicine, Alexandria University, Alexandria 21311, Egypt; (D.E.); (E.H.); (S.S.)
| | - Sameh Said
- Department of Neuropsychiatry, Faculty of Medicine, Alexandria University, Alexandria 21311, Egypt; (D.E.); (E.H.); (S.S.)
| | - Nikolaos Grigoriadis
- Multiple Sclerosis Center, Second Department of Neurology, School of Medicine, Aristotle University of Thessaloniki, 54621 Thessaloniki, Greece; (S.S.D.L.); (N.K.); (E.K.); (D.P.); (N.G.)
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29
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Jankowska A, Chwojnicki K, Szurowska E. The diagnosis of multiple sclerosis: what has changed in diagnostic criteria? Pol J Radiol 2023; 88:e574-e581. [PMID: 38362016 PMCID: PMC10867947 DOI: 10.5114/pjr.2023.133677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 11/14/2023] [Indexed: 02/17/2024] Open
Abstract
Multiple sclerosis (MS) is a chronic, demyelinating disease affecting the central nervous system. Diagnosis of MS is based on the proof of disease dissemination in time (DIT) and dissemination in space (DIS) and excluding other disorders that can mimic multiple sclerosis in laboratory tests and clinical manifestation. Over the years the diagnostic criteria have evolved; the introduction of magnetic resonance in the McDonald's 2001 criteria was revolutionary. Since then, the criteria have been modified up to the currently used McDonald 2017. The aim of this review is to analyse the 2017 McDonald criteria, assess what has changed from the 2010 criteria, and present the impact of revised criteria on rapid and accurate diagnosis of MS. The main differences are as follows: inclusion of oligoclonal bands in cerebrospinal fluid as a DIT criterion, and symptomatic and cortical lesions in magnetic resonance imaging are counted in the determination of DIS and DIT. We present also the newest recommendations of the Polish Medical Society of Radiology and the Polish Society of Neurology and international group of North American Imaging in Multiple Sclerosis and Consortium of Multiple Sclerosis Centers, as well as future directions for further investigations. A proper diagnosis is crucial for the patient's quality of life, to give the possibility of early treatment, and to help avoid misdiagnosis and unnecessary therapy.
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Affiliation(s)
- Anna Jankowska
- 2 Department of Radiology, Medical University of Gdańsk, Poland
| | - Kamil Chwojnicki
- Department of Anaesthesiology and Intensive Care, Medical University of Gdańsk, Poland
| | - Edyta Szurowska
- 2 Department of Radiology, Medical University of Gdańsk, Poland
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30
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Chen D, Lin Y, Fan Y, Li L, Tan C, Wang J, Lin H, Gao J. Glycan Metabolic Fluorine Labeling for In Vivo Visualization of Tumor Cells and In Situ Assessment of Glycosylation Variations. Angew Chem Int Ed Engl 2023; 62:e202313753. [PMID: 37899303 DOI: 10.1002/anie.202313753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 10/24/2023] [Accepted: 10/29/2023] [Indexed: 10/31/2023]
Abstract
The abnormality in the glycosylation of surface proteins is critical for the growth and metastasis of tumors and their capacity for immunosuppression and drug resistance. This anomaly offers an entry point for real-time analysis on glycosylation fluctuations. In this study, we report a strategy, glycan metabolic fluorine labeling (MEFLA), for selectively tagging glycans of tumor cells. As a proof of concept, we synthesized two fluorinated unnatural monosaccharides with distinctive 19 F chemical shifts (Ac4 ManNTfe and Ac4 GalNTfa). These two probes could undergo selective uptake by tumor cells and subsequent incorporation into surface glycans. This approach enables efficient and specific 19 F labeling of tumor cells, which permits in vivo tracking of tumor cells and in situ assessment of glycosylation changes by 19 F MRI. The efficiency and specificity of our probes for labeling tumor cells were verified in vitro with A549 cells. The feasibility of our method was further validated with in vivo experiments on A549 tumor-bearing mice. Moreover, the capacity of our approach for assessing glycosylation changes of tumor cells was illustrated both in vitro and in vivo. Our studies provide a promising means for visualizing tumor cells in vivo and assessing their glycosylation variations in situ through targeted multiplexed 19 F MRI.
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Affiliation(s)
- Dongxia Chen
- Fujian Provincial Key Laboratory of Chemical Biology, The MOE Key Laboratory of Spectrochemical Analysis & Instrumentation, and Department of Chemical Biology, College of Chemistry and Chemical Engineering, Xiamen University, Xiamen, 361005, China
| | - Yaying Lin
- Fujian Provincial Key Laboratory of Chemical Biology, The MOE Key Laboratory of Spectrochemical Analysis & Instrumentation, and Department of Chemical Biology, College of Chemistry and Chemical Engineering, Xiamen University, Xiamen, 361005, China
| | - Yifan Fan
- Fujian Provincial Key Laboratory of Chemical Biology, The MOE Key Laboratory of Spectrochemical Analysis & Instrumentation, and Department of Chemical Biology, College of Chemistry and Chemical Engineering, Xiamen University, Xiamen, 361005, China
| | - Lingxuan Li
- Fujian Provincial Key Laboratory of Chemical Biology, The MOE Key Laboratory of Spectrochemical Analysis & Instrumentation, and Department of Chemical Biology, College of Chemistry and Chemical Engineering, Xiamen University, Xiamen, 361005, China
| | - Chenlei Tan
- Fujian Provincial Key Laboratory of Chemical Biology, The MOE Key Laboratory of Spectrochemical Analysis & Instrumentation, and Department of Chemical Biology, College of Chemistry and Chemical Engineering, Xiamen University, Xiamen, 361005, China
| | - Junjie Wang
- Fujian Provincial Key Laboratory of Chemical Biology, The MOE Key Laboratory of Spectrochemical Analysis & Instrumentation, and Department of Chemical Biology, College of Chemistry and Chemical Engineering, Xiamen University, Xiamen, 361005, China
| | - Hongyu Lin
- Fujian Provincial Key Laboratory of Chemical Biology, The MOE Key Laboratory of Spectrochemical Analysis & Instrumentation, and Department of Chemical Biology, College of Chemistry and Chemical Engineering, Xiamen University, Xiamen, 361005, China
- Shenzhen Research Institute of Xiamen University, Shenzhen, 518000, China
| | - Jinhao Gao
- Fujian Provincial Key Laboratory of Chemical Biology, The MOE Key Laboratory of Spectrochemical Analysis & Instrumentation, and Department of Chemical Biology, College of Chemistry and Chemical Engineering, Xiamen University, Xiamen, 361005, China
- Shenzhen Research Institute of Xiamen University, Shenzhen, 518000, China
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31
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Landes-Chateau C, Levraut M, Cohen M, Sicard M, Papeix C, Cotton F, Balcerac A, Themelin A, Mondot L, Lebrun-Frenay C. Identification of demyelinating lesions and application of McDonald criteria when confronted with white matter lesions on brain MRI. Rev Neurol (Paris) 2023; 179:1103-1110. [PMID: 37730469 DOI: 10.1016/j.neurol.2023.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 03/14/2023] [Accepted: 04/18/2023] [Indexed: 09/22/2023]
Abstract
INTRODUCTION White matter lesions (WML) on magnetic resonance imaging (MRI) are common in clinical practice. When analyzing WML, radiologists sometimes propose a pathophysiological mechanism to explain the observed MRI abnormalities, which can be a source of anxiety for patients. In some cases, discordance may appear between the patient's clinical symptoms and the identification of the MRI-appearing WML, leading to extensive diagnostic work-up. To avoid misdiagnosis, the analysis of WML should be standardized, and a consensual MRI reading approach is needed. OBJECTIVE To analyze the MRI WML identification process, associated diagnosis approach, and misinterpretations in physicians involved in WML routine practice. METHODS Through a survey distributed online to practitioners involved in WML diagnostic work-up, we described the leading causes of MRI expertise misdiagnosis and associated factors: clinical experience, physicians' subspecialty and location of practice, and type of device used to complete the survey. The survey consisted of sixteen T2-weighted images MRI analysis, from which ten were guided (binary response to lesion location identification), four were not shown (multiple possible answers), and two were associated with dissemination in space (DIS) McDonald criteria application. Two independent, experienced practitioners determined the correct answers before the participants' completion. RESULTS In total, 364 participants from the French Neuro Radiological (SFNR), French Neurological (SFN), and French Multiple Sclerosis (SFSEP) societies completed the survey entirely. According to lesion identification, 34.3% and 16.9% of the participants correctly identified juxtacortical and periventricular lesions, respectively, whereas 56.3% correctly identified non-guided lesions. Application of the 2017 McDonald's DIS criteria was correct for 35.3% of the participants. According to the global survey scoring, factors independently associated with correct answers in multivariate analysis were MS-expert subspecialty (P<0.001), young clinical practitioners (P=0.02), and the use of a computer instead of a smartphone to perform WML analysis (P=0.03). CONCLUSION Our results highlight the difficulties regarding WML analysis in clinical practice and suggest that radiologists and neurologists should rely on each other to ensure the diagnosis of multiple sclerosis and related disorders and limit misdiagnoses.
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Affiliation(s)
- C Landes-Chateau
- UR2CA-URRIS, CRCSEP neurologie, CHU de Nice, université Côte d'Azur, Nice, France.
| | - M Levraut
- UR2CA-URRIS, CRCSEP neurologie, CHU de Nice, université Côte d'Azur, Nice, France
| | - M Cohen
- UR2CA-URRIS, CRCSEP neurologie, CHU de Nice, université Côte d'Azur, Nice, France
| | - M Sicard
- UR2CA-URRIS, CRCSEP neurologie, CHU de Nice, université Côte d'Azur, Nice, France
| | - C Papeix
- Service de neurologie générale, hôpital Fondation Adolphe-de-Rothschild, Paris, France
| | - F Cotton
- U1044 Inserm, CREATIS, UMR 5220 CNRS, service de radiologie, centre hospitalier Lyon-Sud, hospices civils de Lyon, université Claude-Bernard Lyon, Lyon, France
| | - A Balcerac
- Département de neurologie, université la Sorbonne, Pitié-Salpêtrière Hospital, AP-HP, Paris, France
| | - A Themelin
- Service de radiologie, CHU de Nice, université Côte d'Azur, Nice, France
| | - L Mondot
- UR2CA-URRIS, CRCSEP neurologie, CHU de Nice, université Côte d'Azur, Nice, France
| | - C Lebrun-Frenay
- UR2CA-URRIS, CRCSEP neurologie, CHU de Nice, université Côte d'Azur, Nice, France
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32
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Faigle W, Piccirelli M, Hortobágyi T, Frontzek K, Cannon AE, Zürrer WE, Granberg T, Kulcsar Z, Ludersdorfer T, Frauenknecht KBM, Reimann R, Ineichen BV. The Brainbox -a tool to facilitate correlation of brain magnetic resonance imaging features to histopathology. Brain Commun 2023; 5:fcad307. [PMID: 38025281 PMCID: PMC10664401 DOI: 10.1093/braincomms/fcad307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 07/20/2023] [Accepted: 11/07/2023] [Indexed: 12/01/2023] Open
Abstract
Magnetic resonance imaging (MRI) has limitations in identifying underlying tissue pathology, which is relevant for neurological diseases such as multiple sclerosis, stroke or brain tumours. However, there are no standardized methods for correlating MRI features with histopathology. Thus, here we aimed to develop and validate a tool that can facilitate the correlation of brain MRI features to corresponding histopathology. For this, we designed the Brainbox, a waterproof and MRI-compatible 3D printed container with an integrated 3D coordinate system. We used the Brainbox to acquire post-mortem ex vivo MRI of eight human brains, fresh and formalin-fixed, and correlated focal imaging features to histopathology using the built-in 3D coordinate system. With its built-in 3D coordinate system, the Brainbox allowed correlation of MRI features to corresponding tissue substrates. The Brainbox was used to correlate different MR image features of interest to the respective tissue substrate, including normal anatomical structures such as the hippocampus or perivascular spaces, as well as a lacunar stroke. Brain volume decreased upon fixation by 7% (P = 0.01). The Brainbox enabled degassing of specimens before scanning, reducing susceptibility artefacts and minimizing bulk motion during scanning. In conclusion, our proof-of-principle experiments demonstrate the usability of the Brainbox, which can contribute to improving the specificity of MRI and the standardization of the correlation between post-mortem ex vivo human brain MRI and histopathology. Brainboxes are available upon request from our institution.
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Affiliation(s)
- Wolfgang Faigle
- Neuroimmunology and MS Research Section, Neurology Clinic, University Zurich, University Hospital Zurich, CH-8091 Zurich, Switzerland
| | - Marco Piccirelli
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, CH-8091 Zurich, Switzerland
| | - Tibor Hortobágyi
- Institute of Neuropathology, University of Zurich, CH-8091 Zurich, Switzerland
| | - Karl Frontzek
- Institute of Neuropathology, University of Zurich, CH-8091 Zurich, Switzerland
- Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, WC1N 1PJ London, United Kingdom
| | - Amelia Elaine Cannon
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, CH-8091 Zurich, Switzerland
| | - Wolfgang Emanuel Zürrer
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, CH-8091 Zurich, Switzerland
| | - Tobias Granberg
- Department of Neuroradiology, Karolinska University Hospital, S-141 86 Stockholm, Sweden
| | - Zsolt Kulcsar
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, CH-8091 Zurich, Switzerland
| | - Thomas Ludersdorfer
- Neuroimmunology and MS Research Section, Neurology Clinic, University Zurich, University Hospital Zurich, CH-8091 Zurich, Switzerland
| | - Katrin B M Frauenknecht
- Institute of Neuropathology, University of Zurich, CH-8091 Zurich, Switzerland
- Luxembourg Center of Neuropathology (LCNP), Laboratoire National de Santé, 3555 Dudelange, Luxembourg
- National Center of Pathology (NCP), Laboratoire National de Santé, 3555 Dudelange, Luxembourg
| | - Regina Reimann
- Institute of Neuropathology, University of Zurich, CH-8091 Zurich, Switzerland
| | - Benjamin Victor Ineichen
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, CH-8091 Zurich, Switzerland
- Center for Reproducible Science, University of Zurich, CH-8001 Zurich, Switzerland
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De Stefano N, Rovira À. Do we need new MRI criteria for the diagnosis of radiologically isolated syndrome? Brain 2023; 146:e102-e103. [PMID: 37258492 DOI: 10.1093/brain/awad185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 05/28/2023] [Indexed: 06/02/2023] Open
Affiliation(s)
- Nicola De Stefano
- Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy
| | - Àlex Rovira
- Department of Radiology, Section of Neuroradiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain
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López-Gómez J, Sacristán Enciso B, Caro Miró MA, Querol Pascual MR. Clinically isolated syndrome: Diagnosis and risk of developing clinically definite multiple sclerosis. Neurologia 2023; 38:663-670. [PMID: 37858891 DOI: 10.1016/j.nrleng.2021.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 01/01/2021] [Indexed: 10/21/2023] Open
Abstract
INTRODUCTION In most cases, multiple sclerosis (MS) initially presents as clinically isolated syndrome (CIS). Differentiating CIS from other acute or subacute neurological diseases and estimating the risk of progression to clinically definite MS is essential since presenting a second episode in a short time is associated with poorer long-term prognosis. DEVELOPMENT We conducted a literature review to evaluate the usefulness of different variables in improving diagnostic accuracy and predicting progression from CIS to MS, including magnetic resonance imaging (MRI) and such biofluid markers as oligoclonal IgG and IgM bands, lipid-specific oligoclonal IgM bands in the CSF, CSF kappa free light-chain (KFLC) index, neurofilament light chain (NfL) in the CSF and serum, and chitinase 3-like protein 1 (CHI3L1) in the CSF and serum. CONCLUSIONS Codetection of oligoclonal IgG bands and MRI lesions reduces diagnostic delays and suggests a high risk of CIS progression to MS. A KFLC index > 10.6 and CSF NfL concentrations > 1150 ng/L indicate that CIS is more likely to progress to MS within one year (40%-50%); 90% of patients with CIS and serum CHI3L1 levels > 33 ng/mL and 100% of those with lipid-specific oligoclonal IgM bands present MS within one year of CIS onset.
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Affiliation(s)
- J López-Gómez
- Unidad de Proteínas, Servicio de Análisis Clínicos, Hospital Universitario de Badajoz, Badajoz, Spain.
| | - B Sacristán Enciso
- Sección de Proteínas y Autoinmunidad, Servicio de Análisis Clínicos, Hospital de Mérida, Badajoz, Spain
| | - M A Caro Miró
- Servicio de Análisis Clínicos, Hospital Universitario de Badajoz, Badajoz, Spain
| | - M R Querol Pascual
- Servicio de Neurología, Hospital Universitario de Badajoz, Badajoz, Spain
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Adoum A, Mazzolo L, Lecler A, Sadik JC, Savatovsky J, Duron L. Co-registration with subtraction and color-coding or fusion improves the detection of new and growing lesions on follow-up MRI examination of patients with multiple sclerosis. Diagn Interv Imaging 2023; 104:529-537. [PMID: 37290977 DOI: 10.1016/j.diii.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/15/2023] [Accepted: 05/23/2023] [Indexed: 06/10/2023]
Abstract
PURPOSE The purpose of this study was to compare the performance of three magnetic resonance imaging (MRI) reading methods in the follow-up of patients with multiple sclerosis (MS). MATERIALS AND METHODS This retrospective study included patients with MS who underwent two brain follow-up MRI examinations with three-dimensional fluid-attenuated inversion recovery (FLAIR) sequences between September 2016 and December 2019. Two neuroradiology residents independently reviewed FLAIR images using three post-processing methods including conventional reading (CR), co-registration fusion (CF), and co-registration subtraction with color-coding (CS), while being blinded to all data but FLAIR images. The presence and number of new, growing, or shrinking lesions were compared between reading methods. The reading time, reading confidence, and inter- and intra-observer agreements were also assessed. An expert neuroradiologist established the standard of reference. Statistical analyses were corrected for multiple testing. RESULTS A total of 198 patients with MS were included. There were 130 women and 68 men, with a mean age of 41 ± 12 (standard deviation) years (age range: 21-79 years). Using CS and CF, more patients were detected with new lesions compared to CR (93/198 [47%] and 79/198 [40%] vs. 54/198 [27%], respectively; P < 0.01). The median number of new hyperintense FLAIR lesions detected was significantly greater using CS and CF compared to CR (2 [Q1, Q3: 0, 6] and 1 [Q1, Q3: 0, 3] vs. 0 [Q1, Q3: 0, 1], respectively; P < 0.001). The mean reading time was significantly shorter using CS and CF compared to CR (P < 0.001), with higher confidence in readings and higher inter- and intra-observer agreements. CONCLUSION Post-processing tools such as CS and CF substantially improve the accuracy of follow-up MRI examinations in patients with MS while reducing reading time and increasing readers' confidence and reproducibility.
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Affiliation(s)
- Akim Adoum
- Department of Neuroradiology, Hôpital Fondation Adolphe de Rothschild, 25 rue Manin, 75019 Paris, France
| | - Leila Mazzolo
- Department of Neuroradiology, Hôpital Fondation Adolphe de Rothschild, 25 rue Manin, 75019 Paris, France
| | - Augustin Lecler
- Department of Neuroradiology, Hôpital Fondation Adolphe de Rothschild, 25 rue Manin, 75019 Paris, France; Université Paris Cité, 75006 Paris, France
| | - Jean-Claude Sadik
- Department of Neuroradiology, Hôpital Fondation Adolphe de Rothschild, 25 rue Manin, 75019 Paris, France
| | - Julien Savatovsky
- Department of Neuroradiology, Hôpital Fondation Adolphe de Rothschild, 25 rue Manin, 75019 Paris, France
| | - Loïc Duron
- Department of Neuroradiology, Hôpital Fondation Adolphe de Rothschild, 25 rue Manin, 75019 Paris, France.
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Lebrun-Frenay C, Kantarci O, Siva A, Azevedo CJ, Makhani N, Pelletier D, Okuda DT. Radiologically isolated syndrome. Lancet Neurol 2023; 22:1075-1086. [PMID: 37839432 DOI: 10.1016/s1474-4422(23)00281-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 05/29/2023] [Accepted: 07/17/2023] [Indexed: 10/17/2023]
Abstract
Individuals can be deemed to have radiologically isolated syndrome (RIS) if they have incidental demyelinating-appearing lesions in their brain or spinal cord that are highly suggestive of multiple sclerosis but their clinical history does not include symptoms consistent with multiple sclerosis. Data from international longitudinal cohorts indicate that around half of people with RIS will develop relapsing or progressive symptoms of multiple sclerosis within 10 years, suggesting that in some individuals, RIS is a presymptomatic stage of multiple sclerosis. Risk factors for progression from RIS to clinical multiple sclerosis include younger age (ie, <35 years), male sex, CSF-restricted oligoclonal bands, spinal cord or infratentorial lesions, and gadolinium-enhancing lesions. Other imaging, biological, genetic, and digital biomarkers that might be of value in identifying individuals who are at the highest risk of developing multiple sclerosis need further investigation. Two 2-year randomised clinical trials showed the efficacy of approved multiple sclerosis immunomodulatory medications in preventing the clinical conversion to multiple sclerosis in some individuals with RIS. If substantiated in longer-term studies, these data have the potential to transform our approach to care for the people with RIS who are at the greatest risk of diagnosis with multiple sclerosis.
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Affiliation(s)
- Christine Lebrun-Frenay
- CRC-SEP Nice, Neurologie CHU Nice, Hôpital Pasteur 2, UMR2CA-URRIS, Université Côte d'Azur, Nice, France.
| | | | - Aksel Siva
- Department of Neurology, Cerrahpasa School of Medicine, Istanbul University, Turkiye
| | - Christina J Azevedo
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Naila Makhani
- Departments of Pediatrics and Neurology, Yale School of Medicine, New Haven, CT, USA
| | - Daniel Pelletier
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Darin T Okuda
- Department of Neurology, The University of Texas Southwestern Medical Center, Dallas, TX, USA
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Nasiri E, Sarkesh A, Daei Sorkhabi A, Naseri A, Daneshvar S, Naser Moghadasi A, Talebi M. Radiological features of late-onset multiple sclerosis: A systematic review and meta-analysis. J Neuroradiol 2023; 50:571-580. [PMID: 37558179 DOI: 10.1016/j.neurad.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 08/05/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND Late-onset multiple sclerosis (LOMS) is most commonly defined as the onset of the disease's presentations at age 50 or older. There is still much to discover about the radiological features of LOMS. The current study aims to assess the imaging features of LOMS, as well as the correlation between these findings and the clinical characteristics of these patients. METHOD This study was conducted following the PRISMA statement. A systematic search was conducted through PubMed, Scopus, and EMBASE databases to identify the studies that have applied magnetic-resonance imaging (MRI) or other imaging methods to investigate the radiological findings, as well as the relationship between them and clinical findings of LOMS patients. The risk of bias was assessed using the Joanna Briggs Institute (JBI) checklists. Meta-analysis was conducted using the third version of the compressive meta-analysis software (CMA3). RESULTS Our search identified 753 unique titles. Among them, 15 studies, including seven case-control, five case-series, and three cross-sectional studies, met the eligibility criteria. According to the quantitative synthesis, brain lesions were detected among 72.2% of LOMS patients (4 studies; 95% CI: 67.0% - 93.1%). In the context of spinal lesions, overall spinal cord involvement was 64.0% (8 studies; 95% CI: 42.5% - 81.1%). Based on the available evidence, supratentorial involvement was found in 82.7% of cases (3 studies; 95% CI: 17.4% - 99.1%), juxtacortical involvement in 34.1% (3 studies; 95% CI: 26.4% - 42.7%), infratentorial involvement in 51.3% (4 studies; 95% CI: 32.1% - 70.1%), and cerebellar involvement in 18.5% (3 studies; 95% CI: 13.9% - 24.1%). CONCLUSION Based on the neuroimaging findings, we found that, given the heterogeneity of MS, LOMS patients have a high rate of spinal cord lesions and supratentorial involvement. The limited available evidence suggests that Barkhof criteria are the best compromise for the diagnosis of LOMS. There is still a need for future studies.
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Affiliation(s)
- Ehsan Nasiri
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Aila Sarkesh
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran; Neurosciences Research Center (NSRC), Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Amin Daei Sorkhabi
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran; Neurosciences Research Center (NSRC), Tabriz University of Medical Sciences, Tabriz, Iran
| | - Amirreza Naseri
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran; Research Center for Evidence-Based Medicine, Iranian EBM Center: A Joanna Briggs Institute Center of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sara Daneshvar
- Research Center for Evidence-Based Medicine, Iranian EBM Center: A Joanna Briggs Institute Center of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Abdorreza Naser Moghadasi
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahnaz Talebi
- Neurosciences Research Center (NSRC), Tabriz University of Medical Sciences, Tabriz, Iran.
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Kaikaryte K, Gedvilaite G, Balnyte R, Uloziene I, Liutkeviciene R. Role of SIRT1 Gene Polymorphisms and Serum Levels in Patients with Multiple Sclerosis. Diagnostics (Basel) 2023; 13:3287. [PMID: 37892107 PMCID: PMC10606525 DOI: 10.3390/diagnostics13203287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/16/2023] [Accepted: 10/20/2023] [Indexed: 10/29/2023] Open
Abstract
AIM The purpose of this work was to investigate the prevalence of SIRT1 rs3818292, rs3758391, and rs7895833 single nucleotide polymorphisms and SIRT1 serum levels associated with multiple sclerosis (MS) in the Lithuanian population. METHODS A total of 250 MS patients and 250 healthy controls were included in the study. Genotyping was performed using the RT-PCR method. Statistical analysis was performed using "IBM SPSS version 29.0". The serum SIRT1 level was determined by the ELISA method. RESULTS We found that rs3818292 was associated with increased odds of developing MS under the dominant (p = 0.007) and allelic genetic (p = 0.004) models. rs3758391 was associated with increased odds of developing under the co-dominant (p < 0.001), overdominant (p < 0.001), dominant (p < 0.001), and allelic (p = 0.002) genetic models. rs7895833 was associated with increased odds of developing MS under co-dominant (p < 0.001), overdominant (p < 0.001), dominant (p < 0.001), and allelic (p < 0.001) genetic models. Additional sex-differentiated analysis within females revealed that the rs3758391 was associated with an increased odds ratio for the occurrence of MS among the co-dominant (p = 0.006), dominant (p = 0.002), and allelic (p = 0.001). rs7895833 was associated with an increased odds ratio for the development of MS under the co-dominant (p < 0.001), overdominant (p < 0.001), dominant (p < 0.001), and allelic (p < 0.001) genetic models. Age-differentiated analysis showed that rs3758391 was associated with an increased odds ratio for the development of MS in younger patients under the codominant (p = 0.002), overdominant (p = 0.003), and dominant (p = 0.004) genetic models. rs7895833 was associated with an increased odds ratio for the occurrence of MS under the overdominant genetic model (p = 0.013). In elderly patients, rs3818292 was associated with an increased odds ratio for the occurrence of MS under the dominant (p = 0.008) and allelic (p = 0.009) genetic models. rs7895833 was associated with an increased odds ratio for the occurrence of MS under the codominant (p = 0.011 and p = 0.012), dominant (p = 0.001), and allelic (p < 0.001) genetic models. We also found that serum SIRT1 levels were statistically significantly different between MS patients and control group subjects (p < 0.001). In addition, comparison of SIRT1 levels between study groups and genotypes showed that rs3818292 AA (p = 0.001), rs3758391 CT (p < 0.001), and rs7895833 AA (p = 0.002) and AG (p = 0.004) had higher SIRT1 levels in the control group than in the MS group. All results were provided after strict Bonferroni correction. CONCLUSIONS Genetic variations in SIRT1 rs3818292, rs3758391, and rs7895833 are associated with multiple sclerosis, with possible differences in gender and age, as well as lower serum SIRT1 levels.
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Affiliation(s)
- Kriste Kaikaryte
- Laboratory of Ophthalmology, Neuroscience Institute, Medical Academy, Lithuanian University of Health Sciences, Eiveniu 2, 50161 Kaunas, Lithuania; (G.G.); (R.L.)
| | - Greta Gedvilaite
- Laboratory of Ophthalmology, Neuroscience Institute, Medical Academy, Lithuanian University of Health Sciences, Eiveniu 2, 50161 Kaunas, Lithuania; (G.G.); (R.L.)
| | - Renata Balnyte
- Department of Neurology, Medical Academy, Lithuanian University of Health Sciences, Eiveniu 2, 50161 Kaunas, Lithuania;
| | - Ingrida Uloziene
- Department of Otorhinolaryngology, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania;
| | - Rasa Liutkeviciene
- Laboratory of Ophthalmology, Neuroscience Institute, Medical Academy, Lithuanian University of Health Sciences, Eiveniu 2, 50161 Kaunas, Lithuania; (G.G.); (R.L.)
- Department of Ophthalmology, Medical Academy, Lithuanian University of Health Sciences, Eiveniu 2 Str., 50161 Kaunas, Lithuania
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Nagtegaal MA, Hermann I, Weingärtner S, Martinez-Heras E, Solana E, Llufriu S, Gass A, Poot DHJ, van Osch MJP, Vos FM, de Bresser J. White matter changes measured by multi-component MR Fingerprinting in multiple sclerosis. Neuroimage Clin 2023; 40:103528. [PMID: 37837891 PMCID: PMC10589890 DOI: 10.1016/j.nicl.2023.103528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 09/11/2023] [Accepted: 10/09/2023] [Indexed: 10/16/2023]
Abstract
T2-hyperintense lesions are the key imaging marker of multiple sclerosis (MS). Previous studies have shown that the white matter surrounding such lesions is often also affected by MS. Our aim was to develop a new method to visualize and quantify the extent of white matter tissue changes in MS based on relaxometry properties. We applied a fast, multi-parametric quantitative MRI approach and used a multi-component MR Fingerprinting (MC-MRF) analysis. We assessed the differences in the MRF component representing prolongedrelaxation time between patients with MS and controls and studied the relation between this component's volume and structural white matter damage identified on FLAIR MRI scans in patients with MS. A total of 48 MS patients at two different sites and 12 healthy controls were scanned with FLAIR and MRF-EPI MRI scans. MRF scans were analyzed with a joint-sparsity multi-component analysis to obtain magnetization fraction maps of different components, representing tissues such as myelin water, white matter, gray matter and cerebrospinal fluid. In the MS patients, an additional component was identified with increased transverse relaxation times compared to the white matter, likely representing changes in free water content. Patients with MS had a higher volume of the long- component in the white matter of the brain compared to healthy controls (B (95%-CI) = 0.004 (0.0006-0.008), p = 0.02). Furthermore, this MRF component had a moderate correlation (correlation coefficient R 0.47) with visible structural white matter changes on the FLAIR scans. Also, the component was found to be more extensive compared to structural white matter changes in 73% of MS patients. In conclusion, our MRF acquisition and analysis captured white matter tissue changes in MS patients compared to controls. In patients these tissue changes were more extensive compared to visually detectable white matter changes on FLAIR scans. Our method provides a novel way to quantify the extent of white matter changes in MS patients, which is underestimated using only conventional clinical MRI scans.
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Affiliation(s)
- Martijn A Nagtegaal
- Department of Imaging Physics, Delft University of Technology, Delft, the Netherlands; C.J. Gorter MRI Center, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands.
| | - Ingo Hermann
- Department of Imaging Physics, Delft University of Technology, Delft, the Netherlands; Computer Assisted Clinical Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Sebastian Weingärtner
- Department of Imaging Physics, Delft University of Technology, Delft, the Netherlands
| | - Eloy Martinez-Heras
- Neuroimmunology and Multiple Sclerosis Unit and Laboratory of Advanced Imaging in Neuroimmunological Diseases (ImaginEM). Hospital Clinic Barcelona, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS) and Universitat de Barcelona, Barcelona, Spain
| | - Elisabeth Solana
- Neuroimmunology and Multiple Sclerosis Unit and Laboratory of Advanced Imaging in Neuroimmunological Diseases (ImaginEM). Hospital Clinic Barcelona, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS) and Universitat de Barcelona, Barcelona, Spain
| | - Sara Llufriu
- Neuroimmunology and Multiple Sclerosis Unit and Laboratory of Advanced Imaging in Neuroimmunological Diseases (ImaginEM). Hospital Clinic Barcelona, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS) and Universitat de Barcelona, Barcelona, Spain
| | - Achim Gass
- Department of Neurology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Dirk H J Poot
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, the Netherlands
| | - Matthias J P van Osch
- C.J. Gorter MRI Center, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Frans M Vos
- Department of Imaging Physics, Delft University of Technology, Delft, the Netherlands; Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, the Netherlands
| | - Jeroen de Bresser
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
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40
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Damer A, Chaudry E, Eftekhari D, Benseler SM, Safi F, Aviv RI, Tyrrell PN. Neuroimaging Scoring Tools to Differentiate Inflammatory Central Nervous System Small-Vessel Vasculitis: A Need for Artificial Intelligence/Machine Learning?-A Scoping Review. Tomography 2023; 9:1811-1828. [PMID: 37888736 PMCID: PMC10610796 DOI: 10.3390/tomography9050144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 09/26/2023] [Accepted: 09/29/2023] [Indexed: 10/28/2023] Open
Abstract
Neuroimaging has a key role in identifying small-vessel vasculitis from common diseases it mimics, such as multiple sclerosis. Oftentimes, a multitude of these conditions present similarly, and thus diagnosis is difficult. To date, there is no standardized method to differentiate between these diseases. This review identifies and presents existing scoring tools that could serve as a starting point for integrating artificial intelligence/machine learning (AI/ML) into the clinical decision-making process for these rare diseases. A scoping literature review of EMBASE and MEDLINE included 114 articles to evaluate what criteria exist to diagnose small-vessel vasculitis and common mimics. This paper presents the existing criteria of small-vessel vasculitis conditions and mimics them to guide the future integration of AI/ML algorithms to aid in diagnosing these conditions, which present similarly and non-specifically.
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Affiliation(s)
- Alameen Damer
- Department of Medical Imaging, University of Toronto, Toronto, ON M5T 1W7, Canada
- Department of Radiology, Radiation Oncology and Medical Physics, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - Emaan Chaudry
- Department of Medical Imaging, University of Toronto, Toronto, ON M5T 1W7, Canada
| | - Daniel Eftekhari
- Department of Medical Imaging, University of Toronto, Toronto, ON M5T 1W7, Canada
| | - Susanne M. Benseler
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Frozan Safi
- Department of Medical Imaging, University of Toronto, Toronto, ON M5T 1W7, Canada
| | - Richard I. Aviv
- Department of Radiology, Radiation Oncology and Medical Physics, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - Pascal N. Tyrrell
- Department of Medical Imaging, University of Toronto, Toronto, ON M5T 1W7, Canada
- Institute of Medical Science, Department of Statistical Sciences, University of Toronto, Toronto, ON M5G 1X6, Canada
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Fiscone C, Rundo L, Lugaresi A, Manners DN, Allinson K, Baldin E, Vornetti G, Lodi R, Tonon C, Testa C, Castelli M, Zaccagna F. Assessing robustness of quantitative susceptibility-based MRI radiomic features in patients with multiple sclerosis. Sci Rep 2023; 13:16239. [PMID: 37758804 PMCID: PMC10533494 DOI: 10.1038/s41598-023-42914-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 09/16/2023] [Indexed: 09/29/2023] Open
Abstract
Multiple Sclerosis (MS) is an autoimmune demyelinating disease characterised by changes in iron and myelin content. These biomarkers are detectable by Quantitative Susceptibility Mapping (QSM), an advanced Magnetic Resonance Imaging technique detecting magnetic properties. When analysed with radiomic techniques that exploit its intrinsic quantitative nature, QSM may furnish biomarkers to facilitate early diagnosis of MS and timely assessment of progression. In this work, we explore the robustness of QSM radiomic features by varying the number of grey levels (GLs) and echo times (TEs), in a sample of healthy controls and patients with MS. We analysed the white matter in total and within six clinically relevant tracts, including the cortico-spinal tract and the optic radiation. After optimising the number of GLs (n = 64), at least 65% of features were robust for each Volume of Interest (VOI), with no difference (p > .05) between left and right hemispheres. Different outcomes in feature robustness among the VOIs depend on their characteristics, such as volume and variance of susceptibility values. This study validated the processing pipeline for robustness analysis and established the reliability of QSM-based radiomics features against GLs and TEs. Our results provide important insights for future radiomics studies using QSM in clinical applications.
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Affiliation(s)
- Cristiana Fiscone
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Leonardo Rundo
- Department of Information and Electrical Engineering and Applied Mathematics, University of Salerno, Fisciano, Italy
| | - Alessandra Lugaresi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
- UOSI Riabilitazione Sclerosi Multipla, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - David Neil Manners
- Department for Life Quality Sciences, University of Bologna, Bologna, Italy
- Functional and Molecular Neuroimaging Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Kieren Allinson
- Department of Histopathology, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | - Elisa Baldin
- Epidemiology and Statistics Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Gianfranco Vornetti
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
- Functional and Molecular Neuroimaging Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Raffaele Lodi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
- Functional and Molecular Neuroimaging Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Caterina Tonon
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
- Functional and Molecular Neuroimaging Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Claudia Testa
- Department of Physics and Astronomy, University of Bologna, Bologna, Italy.
| | - Mauro Castelli
- NOVA Information Management School (NOVA IMS), Universidade NOVA de Lisboa, Campus de Campolide, 1070-312, Lisbon, Portugal
| | - Fulvio Zaccagna
- Department of Imaging, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, United Kingdom
- Department of Radiology, University of Cambridge, Cambridge, United Kingdom
- Investigative Medicine Division, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
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Rogić Vidaković M, Ćurković Katić A, Pavelin S, Bralić A, Mikac U, Šoda J, Jerković A, Mastelić A, Dolić K, Markotić A, Đogaš Z, Režić Mužinić N. Transcranial Magnetic Stimulation Measures, Pyramidal Score on Expanded Disability Status Scale and Magnetic Resonance Imaging of Corticospinal Tract in Multiple Sclerosis. Bioengineering (Basel) 2023; 10:1118. [PMID: 37892848 PMCID: PMC10604490 DOI: 10.3390/bioengineering10101118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 09/20/2023] [Accepted: 09/22/2023] [Indexed: 10/29/2023] Open
Abstract
Probing the cortic ospinal tract integrity by transcranial magnetic stimulation (TMS) could help to understand the neurophysiological correlations of multiple sclerosis (MS) symptoms. Therefore, the study objective was, first, to investigate TMS measures (resting motor threshold-RMT, motor evoked potential (MEP) latency, and amplitude) of corticospinal tract integrity in people with relapsing-remitting MS (pwMS). Then, the study examined the conformity of TMS measures with clinical disease-related (Expanded Disability Status Scale-EDSS) and magnetic resonance imaging (MRI) results (lesion count) in pwMS. The e-field navigated TMS, MRI, and EDSS data were collected in 23 pwMS and compared to non-clinical samples. The results show that pwMS differed from non-clinical samples in MEP latency for upper and lower extremity muscles. Also, pwMS with altered MEP latency (prolonged or absent MEP response) had higher EDSS, general and pyramidal, functional scores than pwMS with normal MEP latency finding. Furthermore, the RMT intensity for lower extremity muscles was predictive of EDSS functional pyramidal scores. TMS/MEP latency findings classified pwMS as the same as EDSS functional pyramidal scores in 70-83% of cases and were similar to the MRI results, corresponding to EDSS functional pyramidal scores in 57-65% of cases. PwMS with altered MEP latency differed from pwMS with normal MEP latency in the total number of lesions in the brain corticospinal and cervical corticospinal tract. The study provides preliminary results on the correspondence of MRI and TMS corticospinal tract evaluation results with EDSS functional pyramidal score results in MS.
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Affiliation(s)
- Maja Rogić Vidaković
- Laboratory for Human and Experimental Neurophysiology, Department of Neuroscience, School of Medicine, University of Split, 21000 Split, Croatia; (A.J.); (Z.Đ.)
| | - Ana Ćurković Katić
- Department of Neurology, University Hospital of Split, 21000 Split, Croatia;
| | - Sanda Pavelin
- Department of Neurology, University Hospital of Split, 21000 Split, Croatia;
| | - Antonia Bralić
- Department of Interventional and Diagnostic Radiology, University Hospital of Split, 21000 Split, Croatia; (A.B.); (K.D.)
| | - Una Mikac
- Department of Psychology, Faculty of Humanities and Social Sciences University of Zagreb, 10000 Zagreb, Croatia;
| | - Joško Šoda
- Signal Processing, Analysis, Advanced Diagnostics Research and Education Laboratory (SPAADREL), Faculty of Maritime Studies, Department for Marine Electrical Engineering and Information Technologies, University of Split, 21000 Split, Croatia;
| | - Ana Jerković
- Laboratory for Human and Experimental Neurophysiology, Department of Neuroscience, School of Medicine, University of Split, 21000 Split, Croatia; (A.J.); (Z.Đ.)
| | - Angela Mastelić
- Department of Medical Chemistry and Biochemistry, School of Medicine, University of Split, 21000 Split, Croatia; (A.M.); (A.M.); (N.R.M.)
| | - Krešimir Dolić
- Department of Interventional and Diagnostic Radiology, University Hospital of Split, 21000 Split, Croatia; (A.B.); (K.D.)
- Department of Radiology, School of Medicine, University of Split, 21000 Split, Croatia
| | - Anita Markotić
- Department of Medical Chemistry and Biochemistry, School of Medicine, University of Split, 21000 Split, Croatia; (A.M.); (A.M.); (N.R.M.)
| | - Zoran Đogaš
- Laboratory for Human and Experimental Neurophysiology, Department of Neuroscience, School of Medicine, University of Split, 21000 Split, Croatia; (A.J.); (Z.Đ.)
| | - Nikolina Režić Mužinić
- Department of Medical Chemistry and Biochemistry, School of Medicine, University of Split, 21000 Split, Croatia; (A.M.); (A.M.); (N.R.M.)
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43
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Ekmekyapar T, Taşcı B. Exemplar MobileNetV2-Based Artificial Intelligence for Robust and Accurate Diagnosis of Multiple Sclerosis. Diagnostics (Basel) 2023; 13:3030. [PMID: 37835771 PMCID: PMC10572467 DOI: 10.3390/diagnostics13193030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 09/21/2023] [Accepted: 09/21/2023] [Indexed: 10/15/2023] Open
Abstract
Multiple sclerosis (MS) is a chronic autoimmune disease of the central nervous system that prominently affects young adults due to its debilitating nature. The pathogenesis of the disease is focused on the inflammation and neurodegeneration processes. Inflammation is associated with relapses, while neurodegeneration emerges in the progressive stages of the disease. Magnetic resonance imaging (MRI) is commonly used for the diagnosis of MS, and guidelines such as the McDonald criteria are available. MRI is an essential tool to demonstrate the spatial distribution and changes over time in the disease. This study discusses the use of image processing techniques for the diagnosis of MS and specifically combines the MobileNetV2 network with exemplar-based learning, IMrMr feature selection, and K-Nearest Neighbors (KNN) classification methods. Experiments conducted on two different datasets (Dataset 1 and Dataset 2) demonstrate that these methods provide high accuracy in diagnosing MS. Dataset 1 comprises 128 patients with 706 MRI images, 131 MS patients with 667 MRI images, and 150 healthy control subjects with 1373 MRI images. Dataset 2 includes an MS group with 650 MRI images and a healthy control group with 676 MRI images. The results of the study include 10-fold cross-validation results performed on different image sections (Axial, Sagittal, and Hybrid) for Dataset 1. Accuracy rates of 99.76% for Axial, 99.48% for Sagittal, and 98.02% for Hybrid sections were achieved. Furthermore, 100% accuracy was achieved on Dataset 2. In conclusion, this study demonstrates the effective use of powerful image processing methods such as the MobileNetV2 network and exemplar-based learning for the diagnosis of MS. These findings suggest that these methods can be further developed in future research and offer significant potential for clinical applications in the diagnosis and monitoring of MS.
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Affiliation(s)
- Tuba Ekmekyapar
- Department of Neurology, Elazığ Fethi Sekin City Hospital, Elazig 23280, Turkiye
| | - Burak Taşcı
- Vocational School of Technical Sciences, Firat University, Elazig 23119, Turkiye
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44
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Stratton C, Vassilopoulos A, Brenton JN, Potter K, Vargas W, Rumm H, Bartels A, Bailey M, Odonkor C, Stoll S, Zempsky EWT, Yeh EA, Makhani N. Interim guidelines for the assessment and treatment of pain in children with multiple sclerosis. Front Neurosci 2023; 17:1235945. [PMID: 37781253 PMCID: PMC10536169 DOI: 10.3389/fnins.2023.1235945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 08/23/2023] [Indexed: 10/03/2023] Open
Abstract
Introduction Pain in multiple sclerosis (MS) is common, but literature on pain in children with MS remains scarce. Pain has physical, psychological, and social implications in MS, and both comprehensive assessment and interdisciplinary management approaches are needed. We sought to develop an interdisciplinary interim guideline for the assessment and management of pain in children with MS. Methods and materials We convened a modified Delphi panel composed of 13 experts in pediatric and adult MS neurology, physiotherapy, pain, patient lived-experience, advanced practice nursing, psychology, physiatry, and MS research. A survey was sent to panelists for anonymous completion. The panel discussed survey themes extracted by the panel chair. The process was repeated twice. Results Thirteen assessment and treatment recommendations were produced regarding pain in children with MS. Discussion Future studies will assess implementation of these pain assessment and treatment guidelines in the clinical setting.
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Affiliation(s)
- Catherine Stratton
- Department of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Areti Vassilopoulos
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, United States
- Child Study Center, Yale School of Medicine, New Haven, CT, United States
| | - J. Nicholas Brenton
- Division of Pediatric Neurology, Department of Neurology, University of Virginia Medical Center, Charlottesville, VA, United States
| | - Kirsten Potter
- Department of Physical Therapy, Tufts University, Medford, MA, United States
| | - Wendy Vargas
- Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States
- Department of Neurology, New York-Presbyterian NYP/Columbia University Irving Medical Center, New York, NY, United States
| | - Heather Rumm
- Connecticut Chapter, National Multiple Sclerosis Society, Hartford, CT, United States
| | - Andrea Bartels
- Department of Neurology, Yale School of Medicine, New Haven, CT, United States
| | - Mary Bailey
- Trinity Health of New England, Hartford, CT, United States
| | - Charles Odonkor
- Department of Orthopedics and Rehabilitation, Yale School of Medicine, New Haven, CT, United States
- Yale New Haven Health Old Saybrook Medical Center, Old Saybrook Medical Center, New Haven, CT, United States
| | - Sharon Stoll
- Department of Neurology, Yale School of Medicine, New Haven, CT, United States
- Yale MS Center, North Haven, CT, United States
| | - E. William T. Zempsky
- Division of Pain & Palliative Medicine, Connecticut Children’s Medical Center, Hartford, CT, United States
- Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT, United States
| | - E. Ann Yeh
- Department of Paediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Neuroscience and Mental Health, Department of Paediatrics (Neurology), Hospital for Sick Children, SickKids Research Institute, Toronto, ON, Canada
| | - Naila Makhani
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, United States
- Department of Neurology, Yale School of Medicine, New Haven, CT, United States
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45
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Rumšaitė G, Gedvilaitė G, Balnytė R, Kriaučiūnienė L, Liutkevičienė R. The Influence of TEP1 and TERC Genetic Variants on the Susceptibility to Multiple Sclerosis. J Clin Med 2023; 12:5863. [PMID: 37762804 PMCID: PMC10531829 DOI: 10.3390/jcm12185863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 09/04/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023] Open
Abstract
Multiple sclerosis (MS) is a chronic inflammatory autoimmune disease of the central nervous system. According to recent studies, cellular senescence caused by telomere shortening may contribute to the development of MS. AIM OF THE STUDY Our aim was to determine the associations of TEP1 rs1760904, rs1713418, TERC rs12696304, rs35073794 gene polymorphisms with the occurrence of MS. METHODS The study included 200 patients with MS and 230 healthy controls. Genotyping of TEP1 rs1760904, rs1713418 and TERC rs12696304, rs35073794 was performed using RT-PCR. The obtained data were analysed using the program "IBM SPSS Statistics 29.0". Haplotype analysis was performed using the online program "SNPStats". RESULTS The TERC rs12696304 G allele of this SNP is associated with 1.4-fold lower odds of developing MS (p = 0.035). TERC rs35073794 is associated with approximately 2.4-fold reduced odds of MS occurrence in the codominant, dominant, overdominant, and additive models (p < 0.001; p < 0.001; p < 0.001; p < 0.001, respectively). Haplotype analysis shows that the rs1760904-G-rs1713418-A haplotype is statistically significantly associated with 1.75-fold increased odds of developing MS (p = 0.006). The rs12696304-C-rs35073794-A haplotype is statistically significantly associated with twofold decreased odds of developing MS (p = 0.008). In addition, the rs12696304-G-rs35073794-A haplotype was found to be statistically significantly associated with 5.3-fold decreased odds of developing MS (p < 0.001). CONCLUSION The current evidence may suggest a protective role of TERC SNP in the occurrence of MS, while TEP1 has the opposite effect.
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Affiliation(s)
- Gintarė Rumšaitė
- Medical Faculty, Lithuanian University of Health Sciences, LT-50161 Kaunas, Lithuania;
| | - Greta Gedvilaitė
- Medical Faculty, Lithuanian University of Health Sciences, LT-50161 Kaunas, Lithuania;
- Neurosciences Institute, Medical Academy, Lithuanian University of Health Sciences, LT-50161 Kaunas, Lithuania; (L.K.); (R.L.)
| | - Renata Balnytė
- Department of Neurology, Medical Academy, Lithuanian University of Health Sciences, LT-50161 Kaunas, Lithuania;
| | - Loresa Kriaučiūnienė
- Neurosciences Institute, Medical Academy, Lithuanian University of Health Sciences, LT-50161 Kaunas, Lithuania; (L.K.); (R.L.)
| | - Rasa Liutkevičienė
- Neurosciences Institute, Medical Academy, Lithuanian University of Health Sciences, LT-50161 Kaunas, Lithuania; (L.K.); (R.L.)
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46
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Wu S, Shi D. Editorial for "A Multicenter Longitudinal MRI Study Assessing LeMan-PV Software Accuracy in the Detection of White Matter Lesions in Multiple Sclerosis Patients". J Magn Reson Imaging 2023; 58:877-878. [PMID: 36811223 DOI: 10.1002/jmri.28652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 12/19/2022] [Indexed: 02/24/2023] Open
Affiliation(s)
- Shuohua Wu
- Department of Radiology, The Second Affiliated Hospital, Shantou University Medical College, Shantou, China
| | - Dafa Shi
- Department of Radiology, Xiang'an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
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47
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Ammitzbøll C, Dyrby TB, Börnsen L, Schreiber K, Ratzer R, Romme Christensen J, Iversen P, Magyari M, Lundell H, Jensen PEH, Sørensen PS, Siebner HR, Sellebjerg F. NfL and GFAP in serum are associated with microstructural brain damage in progressive multiple sclerosis. Mult Scler Relat Disord 2023; 77:104854. [PMID: 37418931 DOI: 10.1016/j.msard.2023.104854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 06/04/2023] [Accepted: 06/22/2023] [Indexed: 07/09/2023]
Abstract
BACKGROUND The potential of neurofilament light chain (NfL) and glial fibrillary acidic protein (GFAP) as biomarkers of disease activity and severity in progressive forms of multiple sclerosis (MS) is unclear. OBJECTIVE To investigate the relationship between serum concentrations of NfL, GFAP, and magnetic resonance imaging (MRI) in progressive MS. METHODS Serum concentrations of NfL and GFAP were measured in 32 healthy controls and 32 patients with progressive MS from whom clinical and MRI data including diffusion tensor imaging (DTI) were obtained during three years of follow-up. RESULTS Serum concentrations of NfL and GFAP at follow-up were higher in progressive MS patients than in healthy controls and serum NfL correlated with the EDSS score. Decreasing fractional anisotropy (FA) in normal-appearing white matter (NAWM) correlated with worsening EDSS scores and higher serum NfL. Higher serum NfL and increasing T2 lesion volume correlated with worsening paced autitory serial addition test scores. In multivariable regression analyses with serum GFAP and NfL as independent factors and DTI measures of NAWM as dependent factors, we showed that high serum NfL at follow-up was independently associated with decreasing FA and increasing MD in NAWM. Moreover, we found that high serum GFAP was independently associated with decreasing MD in NAWM and with decreasing MD and increasing FA in cortical gray matter. CONCLUSION Serum concentrations of NfL and GFAP are increased in progressive MS and are associated with distinct microstructural changes in NAWM and CGM.
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Affiliation(s)
- C Ammitzbøll
- Danish Multiple Sclerosis Center, Copenhagen University Hospital - Rigshospitalet, Valdemar Hansens Vej 17, Glostrup 2600, Denmark.
| | - T B Dyrby
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark; Department of Applied Mathematics and Computer Science, Technical University of Denmark, Lyngby, Denmark
| | - L Börnsen
- Danish Multiple Sclerosis Center, Copenhagen University Hospital - Rigshospitalet, Valdemar Hansens Vej 17, Glostrup 2600, Denmark
| | - K Schreiber
- Danish Multiple Sclerosis Center, Copenhagen University Hospital - Rigshospitalet, Valdemar Hansens Vej 17, Glostrup 2600, Denmark
| | - R Ratzer
- Danish Multiple Sclerosis Center, Copenhagen University Hospital - Rigshospitalet, Valdemar Hansens Vej 17, Glostrup 2600, Denmark
| | - J Romme Christensen
- Danish Multiple Sclerosis Center, Copenhagen University Hospital - Rigshospitalet, Valdemar Hansens Vej 17, Glostrup 2600, Denmark
| | - P Iversen
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
| | - M Magyari
- Danish Multiple Sclerosis Center, Copenhagen University Hospital - Rigshospitalet, Valdemar Hansens Vej 17, Glostrup 2600, Denmark
| | - H Lundell
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
| | - P E H Jensen
- Danish Multiple Sclerosis Center, Copenhagen University Hospital - Rigshospitalet, Valdemar Hansens Vej 17, Glostrup 2600, Denmark
| | - P S Sørensen
- Danish Multiple Sclerosis Center, Copenhagen University Hospital - Rigshospitalet, Valdemar Hansens Vej 17, Glostrup 2600, Denmark
| | - H R Siebner
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark; Department of Neurology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - F Sellebjerg
- Danish Multiple Sclerosis Center, Copenhagen University Hospital - Rigshospitalet, Valdemar Hansens Vej 17, Glostrup 2600, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Abou Mrad T, Naja K, Khoury SJ, Hannoun S. Central vein sign and paramagnetic rim sign: From radiologically isolated syndrome to multiple sclerosis. Eur J Neurol 2023; 30:2912-2918. [PMID: 37350369 DOI: 10.1111/ene.15922] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 06/02/2023] [Accepted: 06/07/2023] [Indexed: 06/24/2023]
Abstract
The widespread use of magnetic resonance imaging (MRI) has led to an increase in incidental findings in the central nervous system. Radiologically isolated syndrome (RIS) is a condition where imaging reveals lesions suggestive of demyelinating disease without any clinical episodes consistent with multiple sclerosis (MS). The prognosis for RIS patients is uncertain, with some remaining asymptomatic while others progress to MS. Several risk factors for disease progression have been identified, including male sex, younger age at diagnosis, and spinal cord lesions. This article reviews two promising biomarkers, the central vein sign (CVS) and the paramagnetic rim sign (PRS), and their potential role in the diagnosis and prognosis of MS and RIS. Both CVS and PRS have been shown to be accurate diagnostic markers in MS, with high sensitivity and specificity, and have been useful in distinguishing MS from other disorders. Further research is needed to validate these findings and determine the clinical utility of these biomarkers in routine practice.
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Affiliation(s)
- Tatiana Abou Mrad
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Kim Naja
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Samia J Khoury
- Nehme and Therese Tohme Multiple Sclerosis Center, Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Salem Hannoun
- Medical Imaging Sciences Program, Division of Health Professions, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
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Testud B, Fabiani N, Demortière S, Mchinda S, Medina NL, Pelletier J, Guye M, Audoin B, Stellmann JP, Callot V. Contribution of the MP2RAGE 7T Sequence in MS Lesions of the Cervical Spinal Cord. AJNR Am J Neuroradiol 2023; 44:1101-1107. [PMID: 37562829 PMCID: PMC10494945 DOI: 10.3174/ajnr.a7964] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 07/06/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND AND PURPOSE The detection of spinal cord lesions in patients with MS is challenging. Recently, the 3D MP2RAGE sequence demonstrated its usefulness at 3T. Benefiting from the high spatial resolution provided by ultra-high-field MR imaging systems, we aimed to evaluate the contribution of the 3D MP2RAGE sequence acquired at 7T for the detection of MS lesions in the cervical spine. MATERIALS AND METHODS Seventeen patients with MS participated in this study. They were examined at both 3T and 7T. The MR imaging examination included a Magnetic Imaging in MS (MAGNIMS) protocol with an axial T2*-WI gradient recalled-echo sequence ("optimized MAGNIMS protocol") and a 0.9-mm isotropic 3D MP2RAGE sequence at 3T, as well as a 0.7-mm isotropic and 0.3-mm in-plane-resolution anisotropic 3D MP2RAGE sequences at 7T. Each data set was read by a consensus of radiologists, neurologists, and neuroscientists. The number of lesions and their topography, as well as the visibility of the lesions from one set to another, were carefully analyzed. RESULTS A total of 55 lesions were detected. The absolute number of visible lesions differed among the 4 sequences (linear mixed effect ANOVA, P = .020). The highest detection was observed for the two 7T sequences with 51 lesions each (92.7% of the total). The optimized 3T MAGNIMS protocol and the 3T MP2RAGE isotropic sequence detected 41 (74.5%) and 35 lesions (63.6%), respectively. CONCLUSIONS The 7T MP2RAGE sequences detected more lesions than the 3T sets. Isotropic and anisotropic acquisitions performed comparably. Ultra-high-resolution sequences obtained at 7T improve the identification and delineation of lesions of the cervical spinal cord in MS.
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Affiliation(s)
- B Testud
- From the Center for Magnetic Resonance in Biology and Medicine (B.T., N.F., S.D., S.M., N.L.M., J.P., M.G., B.A., J.P.S., V.C.), Aix-Marseille University, Centre national de la recherche scientifique, Marseille, France
- Assistance Publique-Hopitaux de Marseille (B.T., N.F., S.D., S.M., N.L.M., J,P., M.G., B.A., J.P.S., V.C.), Hôpital Universitaire Timone, CEMEREM, Marseille, France
| | - N Fabiani
- From the Center for Magnetic Resonance in Biology and Medicine (B.T., N.F., S.D., S.M., N.L.M., J.P., M.G., B.A., J.P.S., V.C.), Aix-Marseille University, Centre national de la recherche scientifique, Marseille, France
- Assistance Publique-Hopitaux de Marseille (B.T., N.F., S.D., S.M., N.L.M., J,P., M.G., B.A., J.P.S., V.C.), Hôpital Universitaire Timone, CEMEREM, Marseille, France
| | - S Demortière
- From the Center for Magnetic Resonance in Biology and Medicine (B.T., N.F., S.D., S.M., N.L.M., J.P., M.G., B.A., J.P.S., V.C.), Aix-Marseille University, Centre national de la recherche scientifique, Marseille, France
- Assistance Publique-Hopitaux de Marseille (B.T., N.F., S.D., S.M., N.L.M., J,P., M.G., B.A., J.P.S., V.C.), Hôpital Universitaire Timone, CEMEREM, Marseille, France
- Department of Neurology (S.D., J.P., B.A.), Assistance Publique-Hopitaux de Marseille, Hôpital Universitaire Timone, Marseille, France
| | - S Mchinda
- From the Center for Magnetic Resonance in Biology and Medicine (B.T., N.F., S.D., S.M., N.L.M., J.P., M.G., B.A., J.P.S., V.C.), Aix-Marseille University, Centre national de la recherche scientifique, Marseille, France
- Assistance Publique-Hopitaux de Marseille (B.T., N.F., S.D., S.M., N.L.M., J,P., M.G., B.A., J.P.S., V.C.), Hôpital Universitaire Timone, CEMEREM, Marseille, France
| | - N L Medina
- From the Center for Magnetic Resonance in Biology and Medicine (B.T., N.F., S.D., S.M., N.L.M., J.P., M.G., B.A., J.P.S., V.C.), Aix-Marseille University, Centre national de la recherche scientifique, Marseille, France
- Assistance Publique-Hopitaux de Marseille (B.T., N.F., S.D., S.M., N.L.M., J,P., M.G., B.A., J.P.S., V.C.), Hôpital Universitaire Timone, CEMEREM, Marseille, France
| | - J Pelletier
- From the Center for Magnetic Resonance in Biology and Medicine (B.T., N.F., S.D., S.M., N.L.M., J.P., M.G., B.A., J.P.S., V.C.), Aix-Marseille University, Centre national de la recherche scientifique, Marseille, France
- Assistance Publique-Hopitaux de Marseille (B.T., N.F., S.D., S.M., N.L.M., J,P., M.G., B.A., J.P.S., V.C.), Hôpital Universitaire Timone, CEMEREM, Marseille, France
- Department of Neurology (S.D., J.P., B.A.), Assistance Publique-Hopitaux de Marseille, Hôpital Universitaire Timone, Marseille, France
| | - M Guye
- From the Center for Magnetic Resonance in Biology and Medicine (B.T., N.F., S.D., S.M., N.L.M., J.P., M.G., B.A., J.P.S., V.C.), Aix-Marseille University, Centre national de la recherche scientifique, Marseille, France
- Assistance Publique-Hopitaux de Marseille (B.T., N.F., S.D., S.M., N.L.M., J,P., M.G., B.A., J.P.S., V.C.), Hôpital Universitaire Timone, CEMEREM, Marseille, France
| | - B Audoin
- From the Center for Magnetic Resonance in Biology and Medicine (B.T., N.F., S.D., S.M., N.L.M., J.P., M.G., B.A., J.P.S., V.C.), Aix-Marseille University, Centre national de la recherche scientifique, Marseille, France
- Assistance Publique-Hopitaux de Marseille (B.T., N.F., S.D., S.M., N.L.M., J,P., M.G., B.A., J.P.S., V.C.), Hôpital Universitaire Timone, CEMEREM, Marseille, France
- Department of Neurology (S.D., J.P., B.A.), Assistance Publique-Hopitaux de Marseille, Hôpital Universitaire Timone, Marseille, France
| | - J P Stellmann
- From the Center for Magnetic Resonance in Biology and Medicine (B.T., N.F., S.D., S.M., N.L.M., J.P., M.G., B.A., J.P.S., V.C.), Aix-Marseille University, Centre national de la recherche scientifique, Marseille, France
- Assistance Publique-Hopitaux de Marseille (B.T., N.F., S.D., S.M., N.L.M., J,P., M.G., B.A., J.P.S., V.C.), Hôpital Universitaire Timone, CEMEREM, Marseille, France
| | - V Callot
- From the Center for Magnetic Resonance in Biology and Medicine (B.T., N.F., S.D., S.M., N.L.M., J.P., M.G., B.A., J.P.S., V.C.), Aix-Marseille University, Centre national de la recherche scientifique, Marseille, France
- Assistance Publique-Hopitaux de Marseille (B.T., N.F., S.D., S.M., N.L.M., J,P., M.G., B.A., J.P.S., V.C.), Hôpital Universitaire Timone, CEMEREM, Marseille, France
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Agrawal A, Srivastava MVP, Bhatia R, Goyal V, Singh MB, Vishnu VY, Prabhakar A. A Real-World Experience of Azathioprine Versus First-Line Disease-Modifying Therapy in Relapsing-Remitting Multiple Sclerosis-A Prospective Cohort Study. Brain Sci 2023; 13:1249. [PMID: 37759850 PMCID: PMC10526455 DOI: 10.3390/brainsci13091249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 08/18/2023] [Accepted: 08/19/2023] [Indexed: 09/29/2023] Open
Abstract
Azathioprine (AZA) has demonstrated efficacy in multiple randomized control trials (RCTs) for Relapsing-Remitting Multiple Sclerosis (RRMS). However, we still need comparative real-world data with other first-line disease-modifying therapies (DMTs). We aimed to assess AZA's effectiveness regarding relapses, disability progression, time to the first relapse, magnetic resonance imaging (MRI) activity, and safety compared with other approved first-line DMTs in an Indian population in a real-world setting. We conducted a single-center prospective study of treatment-naive RRMS patients between 2017 and 2019. We evaluated the effects of AZA and other approved DMTs on clinical and radiological measures. Among 192 eligible patients (F:M ratio 2.84:1), 68 patients (35.4%) were on AZA, 68 patients (35.4%) were on dimethyl fumarate (DMF), 32 patients (16.7%) on interferon (IFN beta-1a), and 16 patients (8.3%) on teriflunomide (TFL). Four treatment groups were comparable: AZA v/s DMF v/s TFL v/s IFN beta-1a. In primary outcomes, there was no significant difference between the groups in terms of change in the Expanded Disability Status Scale (EDSS) score at three months (p-value = 0.169), six months (p-value = 0.303), 12 months (p-value = 0.082), and 24 months (p-value = 0.639), the number of relapses (p-value = 0.229), and time to the first relapse (p-value > 0.05 in all groups). In the secondary outcome, there was no significant difference between the treatment groups on serial MRI parameters used according to "Magnetic Resonance Imaging in Multiple Sclerosis" (MAGNIMS) 2016 criteria (p-value > 0.05). In safety outcomes, leukopenia was significantly more common in the AZA group (p-value = 0.025), flu-like symptoms (p-value = 0.0001), and injection site reactions (p-value = 0.035) were significantly more common in the IFN beta-1a group. Our study suggests AZA is as effective as other approved DMTs and a good alternative as a first-line treatment for multiple sclerosis's clinical and radiological activity in real-world settings on short follow-up. Based on these results, more randomized controlled trials of AZA v/s DMF or other DMTs are needed for more robust outcomes.
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Affiliation(s)
- Arpit Agrawal
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India; (A.A.); (R.B.); (V.G.); (M.B.S.); (V.Y.V.)
| | - M. V. Padma Srivastava
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India; (A.A.); (R.B.); (V.G.); (M.B.S.); (V.Y.V.)
| | - Rohit Bhatia
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India; (A.A.); (R.B.); (V.G.); (M.B.S.); (V.Y.V.)
| | - Vinay Goyal
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India; (A.A.); (R.B.); (V.G.); (M.B.S.); (V.Y.V.)
| | - Mamta Bhushan Singh
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India; (A.A.); (R.B.); (V.G.); (M.B.S.); (V.Y.V.)
| | - Venugopalan Y. Vishnu
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India; (A.A.); (R.B.); (V.G.); (M.B.S.); (V.Y.V.)
| | - Anuj Prabhakar
- Department of Neuroradiology, All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India;
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