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Ganelin‐Cohen E, Buxbaum C, Bosak N, Sobol S, Vaknin‐Dembinsky A, Hellmann MA, Wilf‐Yarkoni A, Regev K, Pustovoyt E, Shifrin A, Wexler Y, Rozenberg A. The effect of COVID-19 vaccination on multiple sclerosis activity as reflected by MRI. Brain Behav 2024; 14:e3587. [PMID: 38940313 PMCID: PMC11212002 DOI: 10.1002/brb3.3587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 12/23/2023] [Accepted: 05/04/2024] [Indexed: 06/29/2024] Open
Abstract
INTRODUCTION Examining the safety of theBNT162b2 mRNA vaccine in multiple sclerosis (MS) patients remains inconclusive, particularly regarding the potential for disease exacerbations. This study aims to assess the effects of BNT162b2 COVID-19 vaccination on disease activity in MS patients through sequential MRI imaging. METHODS A retrospective study of 84 MS patients from five Israeli hospitals was conducted. MS lesion load was determined from three brain MRI scans, one postvaccination and two prevaccination scans. A post hoc analysis compared subgroups featuring vaccinated and unvaccinated patients respectively, with early onset MS. RESULTS The cohort included 70 women with early onset (mean age 16.4 ± 0.8 years) and adult onset (mean age 34.9 ± 1.1 years) MS. Among the early onset group, vaccinated patients showed an increased risk of new lesions (p = .00026), while there was no increased risk among adult-onset patients. Additionally, a comparison between early onset vaccinated and nonvaccinated groups revealed a higher risk of increased lesions in the vaccinated group (p = .024). DISCUSSION Overall, the study suggests that the BNT162b2 vaccine is generally safe in MS patients, with no association found between vaccination and new lesions in most patients. However, close MRI follow-up is recommended for early-onset MS cases to monitor lesion development.
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Affiliation(s)
- Esther Ganelin‐Cohen
- Neuroimmunological ClinicInstitute of Pediatric Neurology, Schneider Children's Medical Center of IsraelPetah TikvaIsrael
- Sackler School of MedicineTel Aviv UniversityTel AvivIsrael
| | - Chen Buxbaum
- Department of NeurologyRambam Health Care CampusHaifaIsrael
| | - Noam Bosak
- Department of NeurologyRambam Health Care CampusHaifaIsrael
| | - Shani Sobol
- Department of NeurologyRambam Health Care CampusHaifaIsrael
| | - Adi Vaknin‐Dembinsky
- Unit for Neuro‐Immunology, Multiple Sclerosis & Cell Therapy, Department of NeurologyHadassah Medical CenterJerusalemIsrael
| | - Mark A Hellmann
- Sackler School of MedicineTel Aviv UniversityTel AvivIsrael
- Department of Neurology, Rabin Medical CenterBeilinson HospitalPetah TikvaIsrael
| | - Adi Wilf‐Yarkoni
- Sackler School of MedicineTel Aviv UniversityTel AvivIsrael
- Department of Neurology, Rabin Medical CenterBeilinson HospitalPetah TikvaIsrael
| | - Keren Regev
- The Neuroimmunology and Multiple Sclerosis Unit, Neurology InstituteTel Aviv Sourasky Medical CenterTel AvivIsrael
| | - Elizaveta Pustovoyt
- The Neuroimmunology and Multiple Sclerosis Unit, Neurology InstituteTel Aviv Sourasky Medical CenterTel AvivIsrael
| | - Alla Shifrin
- Department of NeurologyRambam Health Care CampusHaifaIsrael
| | - Yair Wexler
- School of Neurobiology, Biochemistry and Biophysics, The George S. Wise Faculty of Life SciencesTel‐Aviv UniversityTel AvivIsrael
| | - Ayal Rozenberg
- Department of NeurologyRambam Health Care CampusHaifaIsrael
- Neuroimmunology Laboratory, Department of Neurology, Rambam Health Care Campus and Ruth and Bruce Rapaport Faculty of Medicine, TechnionIsrael Institute of TechnologyHaifaIsrael
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Al-Tameemi HN, Hassoun HK, Mohammed IQ, Allebban Z. MRI assessment of cervical spinal cord cross-sectional area in patients with multiple sclerosis. J Neurosci Rural Pract 2023; 14:660-666. [PMID: 38059247 PMCID: PMC10696324 DOI: 10.25259/jnrp_87_2023] [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: 02/23/2023] [Accepted: 06/30/2023] [Indexed: 12/08/2023] Open
Abstract
Objectives Spinal cord abnormalities including cervical cord atrophy are common in multiple sclerosis (MS). This study aimed to assess the cervical spinal cord cross-sectional area (CSA) using magnetic resonance imaging (MRI) in MS patients. Materials and Methods Sixty participants were enrolled in this study (16 male and 44 female), 30 patients with MS, diagnosed according to the revised McDonald criteria, and 30 apparently healthy individuals as the control group. CSA of the spinal cord was measured on axial T2-weighted images of the cervical MRI studies from C2 to C7 vertebral levels. Results There was a significant difference between MS patients and the control group in mean CSA at a different level. The mean CSA at C2, in MS cases, was significantly lower than controls (67.7 ± 9.4 mm2 vs. 81.3 ± 4.6 mm2). Similarly, the mean CSA at C7 (64.4 ± 9.9 mm2) and average C2-7 (68 ± 9.1 mm2) of MS cases were significantly lower than the control. There was a strong inverse correlation between mean cervical cord CSA and duration of the disease and disability score. The reduction in cervical cord CSA was more prominent in patients with secondary progressive MS. There was no significant difference regarding age, gender, type of treatment, or the number of cervical cord lesions. Conclusion The mean CSA was significantly lower in patients with MS than in the control group and was lesser in progressive types. Patients with a longer duration of MS and a high disability score tend to have smaller CSA.
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Affiliation(s)
- Haider N. Al-Tameemi
- Middle Euphrates Neurosciences Center, Faculty of Medicine, Kufa University, Al-Najaf, Iraq
| | - Hayder K. Hassoun
- Middle Euphrates Neurosciences Center, Faculty of Medicine, Kufa University, Al-Najaf, Iraq
| | | | - Zuhair Allebban
- Middle Euphrates Unit of Cancer Research, Kufa University College of Medicine, Al-Najaf, Iraq
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Riederer I, Mühlau M, Wiestler B, Bender B, Hempel JM, Kowarik M, Huber T, Zimmer C, Andrisan T, Patzig M, Zimmermann H, Havla J, Berlis A, Behrens L, Beer M, Dietrich J, Sollmann N, Kirschke JS. Structured Reporting in Multiple Sclerosis - Consensus-Based Reporting Templates for Magnetic Resonance Imaging of the Brain and Spinal Cord. ROFO-FORTSCHR RONTG 2023; 195:135-138. [PMID: 35913055 DOI: 10.1055/a-1867-3942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
As a result of technical developments and greater availability of imaging equipment, the number of neuroradiological examinations is steadily increasing [1]. Due to improved image quality and sensitivity, more details can be detected making reporting more complex and time-intensive. At the same time, reliable algorithms increasingly allow quantitative image analysis that should be integrated in reports in a standardized manner. Moreover, increasing digitalization is resulting in a decrease in the personal exchange between neuroradiologists and referring disciplines, thereby making communication more difficult. The introduction of structured reporting tailored to the specific disease and medical issue [2, 3] and corresponding to at least the second reporting level as defined by the German Radiological Society (https://www.befundung.drg.de/de-DE/2908/strukturierte-befundung/) is therefore desirable to ensure that the quality standards of neuroradiological reports continue to be met.The advantages of structured reporting include a reduced workload for neuroradiologists and an information gain for referring physicians. A complete and standardized list with relevant details for image reporting is provided to neuroradiologists in accordance with the current state of knowledge, thereby ensuring that important points are not forgotten [4]. A time savings and increase in efficiency during reporting were also seen [5]. Further advantages include report clarity and consistency and better comparability in follow-up examinations regardless of the neuroradiologist's particular reporting style. This results in better communication with the referring disciplines and makes clinical decision significantly easier [6, 7]. Although the advantages are significant, any potential disadvantages like the reduction of autonomy in reporting and inadequate coverage of all relevant details and any incidental findings not associated with the main pathology in complex cases or in rare diseases should be taken into consideration [4]. Therefore, studies examining the advantages of structured reporting, promoting the introduction of this system in the clinical routine, and increasing the acceptance among neuroradiologists are still needed.Numerous specific templates for structured reporting, e. g., regarding diseases in cardiology and oncology, are already available on the website www.befundung.drg.de . Multiple sclerosis (MS) is an idiopathic chronic inflammatory and neurodegenerative disease of the central nervous system and is the most common non-trauma-based inflammatory neurological disease in young adults. Therefore, it has significant individual and socioeconomic relevance [8]. Magnetic resonance imaging (MRI) plays an important role in the diagnosis, prognosis evaluation, and follow-up of this disease. MRI is established as the central diagnostic method in the diagnostic criteria. Therefore, specific changes are seen on MRI in almost all patients with a verified MS diagnosis [9]. Reporting of MRI datasets regarding the brain and spinal cord of patients with MS includes examination of the images with respect to the relevant medical issue in order to determine whether the McDonald criteria, which were revised in 2017 [10] and define dissemination in time and space clinically as well as with respect to MRI based on the recommendations of the MAGNIMS groups [11, 12], are fulfilled. A more precise definition of lesion types and locations according to the recommendations of an international expert group [13] is discussed in the supplementary material. Spinal cord signal abnormalities are seen in up to 92 % of MS patients [14-16] and are primarily located in the cervical spine [15]. The recommendations of the MAGNIMS-CMSC-NAIMS working group published in 2021 [11] explicitly recommend the use of structured reporting for MS patients.Therefore, a reporting template for evaluating MRI examinations of the brain and spinal cord of patients with MS was created as part of the BMBF-funded DIFUTURE consortium in consensus with neuroradiological and neurological experts in concordance with the recommendations mentioned above [11] and was made available for broad use (https://github.com/DRGagit/ak_befundung). The goal is to facilitate efficient and comprehensive evaluation of patients with MS in the primary diagnostic workup and follow-up imaging. These reporting templates are consensus-based recommendations and do not make any claim to general validity or completeness. The information technology working group (@GIT) of the German Radiological Society and the German Society for Neuroradiology strive to keep the reporting templates presented here up-to-date with respect to new research data and recommendations of the MAGNIMS-CMSC-NAIMS group [11]. KEY POINTS:: · consensus-based reporting templates. · template for the structured reporting of MRI examinations of patients with multiple sclerosis. · structured reporting might facilitate communication between neuroradiologists and referring disciplines. CITATION FORMAT: · Riederer I, Mühlau M, Wiestler B et al. Structured Reporting in Multiple Sclerosis - Consensus-Based Reporting Templates for Magnetic Resonance Imaging of the Brain and Spinal Cord. Fortschr Röntgenstr 2023; 195: 135 - 138.
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Affiliation(s)
- Isabelle Riederer
- Klinikum rechts der Isar, Technische Universität München, Abteilung für Diagnostische und Interventionelle Neuroradiologie, München, Deutschland
| | - Mark Mühlau
- Klinikum rechts der Isar, Technische Universität München, Neurologische Klinik und Poliklinik, München, Deutschland
| | - Benedikt Wiestler
- Klinikum rechts der Isar, Technische Universität München, Abteilung für Diagnostische und Interventionelle Neuroradiologie, München, Deutschland
| | - Benjamin Bender
- Radiologische Universitätsklinik Tübingen, Abteilung Diagnostische und Interventionelle Neuroradiologie, Tübingen, Deutschland
| | - Johann-Martin Hempel
- Radiologische Universitätsklinik Tübingen, Abteilung Diagnostische und Interventionelle Neuroradiologie, Tübingen, Deutschland
| | - Markus Kowarik
- Radiologische Universitätsklinik Tübingen, Abteilung Diagnostische und Interventionelle Neuroradiologie, Tübingen, Deutschland
| | - Thomas Huber
- Universitätsmedizin Mannheim, Klinik für Radiologie und Nuklearmedizin, Mannheim, Deutschland
| | - Claus Zimmer
- Klinikum rechts der Isar, Technische Universität München, Abteilung für Diagnostische und Interventionelle Neuroradiologie, München, Deutschland
| | - Tiberiu Andrisan
- Klinikum rechts der Isar, Technische Universität München, Abteilung für Diagnostische und Interventionelle Neuroradiologie, München, Deutschland
| | - Maximilian Patzig
- Klinikum der Universität München, LMU, Institut für diagnostische und interventionelle Neuroradiologie, München, Deutschland
| | - Hanna Zimmermann
- Klinikum der Universität München, LMU, Institut für diagnostische und interventionelle Neuroradiologie, München, Deutschland
| | - Joachim Havla
- LMU Klinikum, Institut für Klinische Neuroimmunologie, Ludwig-Maximilians-Universität, München, Deutschland
| | - Ansgar Berlis
- Universitätsklinikum Augsburg, Klinik für Diagnostische und Interventionelle Neuroradiologie, Augsburg, Deutschland
| | - Lars Behrens
- Universitätsklinikum Augsburg, Klinik für Diagnostische und Interventionelle Neuroradiologie, Augsburg, Deutschland
| | - Meinrad Beer
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Ulm, Ulm, Deutschland
| | - Jennifer Dietrich
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Ulm, Ulm, Deutschland
| | - Nico Sollmann
- Klinikum rechts der Isar, Technische Universität München, Abteilung für Diagnostische und Interventionelle Neuroradiologie, München, Deutschland.,Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Ulm, Ulm, Deutschland
| | - Jan Stefan Kirschke
- Klinikum rechts der Isar, Technische Universität München, Abteilung für Diagnostische und Interventionelle Neuroradiologie, München, Deutschland
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Brain and Spinal Cord MRI Findings in Thai Multiple Sclerosis Patients. J Imaging 2023; 9:jimaging9020027. [PMID: 36826946 PMCID: PMC9958745 DOI: 10.3390/jimaging9020027] [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: 12/09/2022] [Revised: 01/20/2023] [Accepted: 01/21/2023] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Previous studies have demonstrated different MRI characteristics in Asian and Western patients with multiple sclerosis (MS). However, the number of studies performed on Thai patients is still limited. Furthermore, these studies were conducted before the revision of the McDonald criteria in 2017. METHODS A retrospective descriptive study was performed on Thai patients diagnosed with MS, according to the McDonald criteria (2017), in a tertiary care hospital in Thailand. RESULTS Thirty-two patients were included (twenty-seven female and five male patients). The mean age was 37.8 years. Most (28 patients) had relapsing remitting MS. Brain MRIs were available for all 32 patients, all of which showed abnormalities. The most common locations were the periventricular regions (78.1%), juxtacortical regions (75%) and deep white matter (62.5%). Dawson's fingers were identified in 20 patients (62.5%). Tumefactive MS was noted in two patients. Gadolinium-enhancing brain lesions were noted in nine patients (28.1%). Optic nerve lesions were found in seven patients. Six of the seven patients showed short segmental lesions with predominant posterior-half involvement. Spinal MRIs were available for 26 patients, with abnormalities detected in 23. Most (11 patients) had lesions both in the cervical and in the thoracic spinal cord. In total, 22 patients (95.7%) showed lesions at the periphery, most commonly at the lateral column. Fifteen patients showed lesions shorter than three vertebral segments (65.2%). Enhancing spinal lesions were noted in 14 patients. Dissemination in space was fulfilled in 31 patients (96.9%). CONCLUSION Some of the MRI findings in our study were similar to those of previous studies in Thailand and Asia, emphasizing the difference between Asian and Western MS.
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Kanazawa Y, Harada M, Taniguchi Y, Hayashi H, Abe T, Otomo M, Matsumoto Y, Ono M, Ito K, Bito Y, Haga A. Myelin-weighted imaging derived from quantitative parameter mapping. Eur J Radiol 2022; 156:110525. [PMID: 36166986 DOI: 10.1016/j.ejrad.2022.110525] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 09/10/2022] [Indexed: 11/15/2022]
Abstract
PURPOSE We developed a novel method which is applicable to visualize contrast according to myelin components in the human brain using relaxation time derived from quantitative parameter mapping magnetic resonance imaging (QPM-MRI). MATERIALS AND METHODS Using healthy volunteer data (n = 10), we verified that our method demonstrated that the myelin-weighted contrast increased proportionally by products R1 and R2*, i.e., QPM-myelin-weighted image, in which modified T1-weighted/T2-weighted (T1w/T2w) ratio mapping method was applied. We compared measurement values in white matter (WM) and gray matter (GM) regions of the T1w/T2w ratio and R1·R2* product maps of healthy volunteers. Linear regression analysis between each value. Mann Whitney U test between WM and GM signals in each myelin map. In addition, Additionally, QPM-myelin-weighted image was applied to a 32-year-old female MS patient. RESULTS Linear regression analysis showed a highly significant correlation between conventional T1w/T2w ratios and R1·R2* products derived from QPM (R = 0.73, P < 0.0001). Moreover, there is a significant difference between WM and GM structures in each myelin images (both, P < 0.0001). Additionally, in a clinical case, MS lesions enabled observation of not only MS plaques but also heterogeneous myelin signal loss associated with demyelination more clearly than T2w image and conventional T1w/T2w ratio image. CONCLUSION Our myelin-weighted imaging technique using QPM may be useful for myelin visualization and is expected to become independent of measurement conditions due to having quantitative characteristics of QPM itself.
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Affiliation(s)
- Yuki Kanazawa
- Graduate School of Biomedical Sciences, Tokushima University, Tokushima 770-8503, Japan.
| | - Masafumi Harada
- Graduate School of Biomedical Sciences, Tokushima University, Tokushima 770-8503, Japan.
| | - Yo Taniguchi
- FUJIFILM Healthcare Corporation, Tokyo 107-0052, Japan.
| | - Hiroaki Hayashi
- College of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Ishikawa 920-0942, Japan.
| | - Takashi Abe
- Department of Radiology, Nagoya University Hospital, Aichi 466-8550, Japan.
| | - Maki Otomo
- Graduate School of Biomedical Sciences, Tokushima University, Tokushima 770-8503, Japan.
| | - Yuki Matsumoto
- Graduate School of Biomedical Sciences, Tokushima University, Tokushima 770-8503, Japan.
| | - Masaharu Ono
- FUJIFILM Healthcare Corporation, Tokyo 107-0052, Japan.
| | - Kosuke Ito
- FUJIFILM Healthcare Corporation, Tokyo 107-0052, Japan.
| | | | - Akihiro Haga
- Graduate School of Biomedical Sciences, Tokushima University, Tokushima 770-8503, Japan.
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Abstract
ABSTRACT A 39-year-old woman with no significant medical history underwent a brain MRI because of headaches and dysarthria having lasted 3 weeks. A tumor lesion was suspected. PET imaging was decided. She underwent FDG and FDOPA PET, leading to the diagnosis of low-grade glioma. Three months later, a new imaging assessment was organized. It showed a decrease in the hypermetabolism of the lesion and the appearance of a second lesion questioning the diagnosis. Further assessment led to the conclusion of a multiple sclerosis. This case illustrates that FDOPA PET uptake should be interpreted with caution in patients with suspected primary brain tumors.
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Yolanda IR, Ritarwan K. Case Report Multiple Sclerosis. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.9241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Multiple sclerosis (MS) is an autoimmune disease in the form of chronic inflammation of the CNS. This disease is mediated by autoreactive lymphocytes that can cross the blood-brain barrier and thus enter the CNS and cause inflammation. Chronic demyelinating CNS lesions characterize multiple sclerosis, and immunity to myelin is involved. This disease predominantly attacks the brain, spinal cord, and optic nerve. The diagnosis of MS is made clinically, and there is no single definitive test for MS. The key to diagnosis is Dissemination in Space (DIS) and Dissemination in Time (DIT). Magnetic resonance imaging has become an essential part of the diagnosis of MS after clinical.
CASE REPORT: Here, we report a case of a 31 year-old woman with the main complaint of weakness of four extremities accompanied by a decreased vision and impaired urination and bowel movement. The patient was diagnosed with suspected MS.
CONCLUSION: The patient subsequently was treated with intravenous steroids and, on the routine follow-up found marked clinical improvement.
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Pajouhan-Far H, Qaemian N, Hajian-Tilaki K, Nabahati M, Saadat P, Mehraein R. Delayed phases of contrast MRI, can it be valuable in multiple sclerosis active phase diagnosis? CASPIAN JOURNAL OF INTERNAL MEDICINE 2021; 11:432-436. [PMID: 33680386 PMCID: PMC7911766 DOI: 10.22088/cjim.11.4.432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Observing the enhancing plaques in magnetic resonance imaging (MRI) is one of the most valuable diagnostic modalities in confirming the diagnosis of multiple sclerosis (MS), its recurrence and for better detection of active disease. Since active lesions discovery can improve designating diffusion in time diagnosis of MS and controlling disease activity, and there is not any definite time for delay image acquisition, therefore, the aim of the current study was to evaluate the enhancement of MS plaques in different delayed phases. Methods: In this interventional study, after receiving written consent, 40 MS patients with at least one enhancing plaque in a previous MRI were evaluated in Babol Ayatollah Rouhani Hospital. Gadolinium was injected to all patients at the dose of 0.1 mg/kg, and MRI was taken at 5 and 15 minutes. The results were analyzed using SPSS 23. A p<0.05 was considered as significant level. Results: The mean of plaque signal intensity was 1190.20 and 1349.60 at 5 and 15 min, respectively, and this difference was significant (p<0.001). Moreover, the mean of plaque total size was 5.16 cm and 7.04 cm at 5 and 15 min with significant difference, respectively (p<0.001). The mean of plaque number was 1.92 and 2.58 at 5 and 15 min, respectively, which was significantly different (P<0.001). Conclusion: The results indicated improvement in detection of MS plaques in images taken in the delayed phase compared to those in the early phase. The plaque intensity, size and number were significantly higher in the delayed phase (15 min), than early phase (5 min).
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Affiliation(s)
| | - Naser Qaemian
- Department of Radiology, Babol University of Medical Sciences, Babol, Iran
| | - Karimollah Hajian-Tilaki
- Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Mehrdad Nabahati
- Department of Radiology, Babol University of Medical Sciences, Babol, Iran
| | - Payam Saadat
- Mobility Impairment Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Raheleh Mehraein
- Department of Radiology, Babol University of Medical Sciences, Babol, Iran
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Sun M, Liu N, Xie Q, Li X, Sun J, Wang H, Wang M. A candidate biomarker of glial fibrillary acidic protein in CSF and blood in differentiating multiple sclerosis and its subtypes: A systematic review and meta-analysis. Mult Scler Relat Disord 2021; 51:102870. [PMID: 33819724 DOI: 10.1016/j.msard.2021.102870] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 01/20/2021] [Accepted: 02/23/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Multiple sclerosis (MS) is an inflammatory demyelinating autoimmune disease of the central nervous system. Glial fibrillary acidic protein (GFAP) is a monomeric intermediate filament protein. A systematic review and meta-analysis was performed regarding a candidate biomarker for astrocytic damage of cerebrospinal fluid (CSF) and blood GFAP levels in differentiating multiple sclerosis and its subtypes. METHODS Relevant studies published prior to October 2020 were retrieved from the PubMed, Web of Science, Cochrane Library and clinicaltrials.gov databases using the following keywords: 'Multiple sclerosis' or 'MS' and 'Glial Fibrillary Acidic Protein' or 'GFAP'. Two authors independently selected the articles and extracted the data. Of the 31 full articles screened, 11 were included in the qualitative analysis and meta-analysis. Differences in the mean CSF and blood GFAP levels were used as the main efficacy measures, and the meta-analysis was performed using Review Manager version 5.3 software. RESULTS Eleven clinical trials comprising 960 patients were selected. CSF GFAP levels were higher in 503 MS patients than in 252 (healthy and disease) controls, with a moderate effect size of 0.72 (p < 0.00001). Mean CSF GFAP levels were significantly higher in 325 MS patients with relapsing disease than in 140 MS patients with progressive disease (SMD=-0.47; 95% CI=-0.80 to -0.15; P = 0.005). CSF GFAP levels in 161 MS patients in relapse (irrespective of MS subtype) were significantly higher than those in 180 MS patients in remission (MD=103.83; 95% CI=68.09 to139.57; P<0.001). The performances of GFAP in blood for differentiating patients with MS from controls were also significant. Blood GFAP was higher in 245 MS patients than in 53 (healthy and disease) controls, with a moderate effect size of 37.25 (p < 0.00001). CONCLUSION The level of CSF-GFAP is correlated with MS and its different subtypes, reflecting the different degrees of damage to astrocytes in different subtypes of MS. In addition, progressive MS is more closely related to the increase in cerebrospinal fluid GFAP level than relapsing-remitting MS, and GFAP may be a useful marker of disease progression. Moreover, the GFAP level in the blood of MS patients is higher than that in the control group, and the sample size needs to be further expanded for verification in the future..
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Affiliation(s)
- MengJiao Sun
- Department of Neurology, Lanzhou University Second Hospital, Cuiyingmen 82, Chengguan District, Lanzhou 730030, Gansu, China.
| | - Ning Liu
- Department of Neurology, Lanzhou University Second Hospital, Cuiyingmen 82, Chengguan District, Lanzhou 730030, Gansu, China
| | - QinFang Xie
- Department of Neurology, Lanzhou University Second Hospital, Cuiyingmen 82, Chengguan District, Lanzhou 730030, Gansu, China
| | - Xiaoling Li
- Department of Neurology, Lanzhou University Second Hospital, Cuiyingmen 82, Chengguan District, Lanzhou 730030, Gansu, China
| | - Jing Sun
- Department of Neurology, Lanzhou University Second Hospital, Cuiyingmen 82, Chengguan District, Lanzhou 730030, Gansu, China
| | - Hongxia Wang
- Department of Neurology, Lanzhou University Second Hospital, Cuiyingmen 82, Chengguan District, Lanzhou 730030, Gansu, China
| | - ManXia Wang
- Department of Neurology, Lanzhou University Second Hospital, Cuiyingmen 82, Chengguan District, Lanzhou 730030, Gansu, China.
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Horáková D, Boster A, Bertolotto A, Freedman MS, Firmino I, Cavalier SJ, Jacobs AK, Thangavelu K, Daizadeh N, Poole EM, Baker DP, Margolin DH, Ziemssen T. Proportion of alemtuzumab-treated patients converting from relapsing-remitting multiple sclerosis to secondary progressive multiple sclerosis over 6 years. Mult Scler J Exp Transl Clin 2021; 6:2055217320972137. [PMID: 33414927 PMCID: PMC7750777 DOI: 10.1177/2055217320972137] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 10/19/2020] [Indexed: 11/17/2022] Open
Abstract
Background Few data exist concerning conversion to secondary progressive MS in patients treated with disease-modifying therapies. Objective Determine the proportion of alemtuzumab-treated patients converting from relapsing-remitting to secondary progressive MS during the CARE-MS core and extension studies. Methods Patients (N = 811) were analyzed post hoc for secondary progressive MS conversion. Optimal conversion definition: Expanded Disability Status Scale (EDSS) score ≥4, pyramidal functional system score ≥2, and confirmed progression over ≥3 months including confirmation within the functional system leading to progression, independent of relapse. Results Over 6.2 years median follow-up, 20 alemtuzumab-treated patients converted (Kaplan-Meier estimate, 2.7%; 95% confidence interval, 1.8%-4.2%). Sensitivity analysis accounting for dropouts showed similar results (3%), as did analyses using alternative definitions with different EDSS thresholds and/or confirmation periods, and analysis of core study subcutaneous interferon beta-1a-treated patients who received alemtuzumab in the extension. Patients converting to secondary progressive MS were older, and had higher EDSS scores and greater brain lesion volumes at baseline, but did not need additional alemtuzumab or other therapies. Conclusions The 6-year conversion rate to secondary progressive MS was low for alemtuzumab-treated patients, supporting further study of the role alemtuzumab may play in reducing risk of secondary progression.ClinicalTrials.gov identifiers: NCT00530348, NCT00548405, NCT00930553.
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Affiliation(s)
- Dana Horáková
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Aaron Boster
- The Boster Center for Multiple Sclerosis, Columbus, USA
| | | | - Mark S Freedman
- University of Ottawa and the Ottawa Hospital Research Institute, Ottawa, Canada
| | | | | | | | | | | | | | | | | | - Tjalf Ziemssen
- Center of Clinical Neuroscience, Carl Gustav Carus University Hospital, Dresden, Germany Employees of Sanofi during study conduct and analysis
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11
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Fischer T, Stern C, Freund P, Schubert M, Sutter R. Wallerian degeneration in cervical spinal cord tracts is commonly seen in routine T2-weighted MRI after traumatic spinal cord injury and is associated with impairment in a retrospective study. Eur Radiol 2020; 31:2923-2932. [PMID: 33125565 PMCID: PMC8043949 DOI: 10.1007/s00330-020-07388-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 08/09/2020] [Accepted: 10/07/2020] [Indexed: 11/17/2022]
Abstract
Objectives Wallerian degeneration (WD) is a well-known process after nerve injury. In this study, occurrence of remote intramedullary signal changes, consistent with WD, and its correlation with clinical and neurophysiological impairment were assessed after traumatic spinal cord injury (tSCI). Methods In 35 patients with tSCI, WD was evaluated by two radiologists on T2-weighted images of serial routine MRI examinations of the cervical spine. Dorsal column (DC), lateral corticospinal tract (CS), and lateral spinothalamic tract (ST) were the analyzed anatomical regions. Impairment scoring according to the American Spinal Injury Association Impairment Scale (AIS, A–D) as well as a scoring system (0–4 points) for motor evoked potential (MEP) and sensory evoked potential (SEP) was included. Mann-Whitney U test was used to test for differences. Results WD in the DC occurred in 71.4% (n = 25), in the CS in 57.1% (n = 20), and in 37.1% (n = 13) in the ST. With WD present, AIS grades were worse for all tracts. DC: median AIS B vs D, p < 0.001; CS: B vs D, p = 0.016; and ST: B vs D, p = 0.015. More pathological MEP scores correlated with WD in the DC (median score 0 vs 3, p < 0.001) and in the CS (0 vs 2, p = 0.032). SEP scores were lower with WD in the DC only (1 vs 2, p = 0.031). Conclusions WD can be detected on T2-weighted scans in the majority of cervical spinal cord injury patients and should be considered as a direct effect of the trauma. When observed, it is associated with higher degree of impairment. Key Points • Wallerian degeneration is commonly seen in routine MRI after traumatic spinal cord injury. • Wallerian degeneration is visible in the anatomical regions of the dorsal column, the lateral corticospinal tract, and the lateral spinothalamic tract. • Presence of Wallerian degeneration is associated with higher degree of impairment.
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Affiliation(s)
- Tim Fischer
- Department of Radiology, University Hospital Balgrist, Forchstrasse 340, 8008, Zurich, Switzerland.
| | - Christoph Stern
- Department of Radiology, University Hospital Balgrist, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Patrick Freund
- Spinal Cord Injury Center, University Hospital Balgrist, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Martin Schubert
- Spinal Cord Injury Center, University Hospital Balgrist, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Reto Sutter
- Department of Radiology, University Hospital Balgrist, Forchstrasse 340, 8008, Zurich, Switzerland
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12
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A contrast-adaptive method for simultaneous whole-brain and lesion segmentation in multiple sclerosis. Neuroimage 2020; 225:117471. [PMID: 33099007 PMCID: PMC7856304 DOI: 10.1016/j.neuroimage.2020.117471] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 10/12/2020] [Accepted: 10/16/2020] [Indexed: 12/24/2022] Open
Abstract
Here we present a method for the simultaneous segmentation of white matter lesions and normal-appearing neuroanatomical structures from multi-contrast brain MRI scans of multiple sclerosis patients. The method integrates a novel model for white matter lesions into a previously validated generative model for whole-brain segmentation. By using separate models for the shape of anatomical structures and their appearance in MRI, the algorithm can adapt to data acquired with different scanners and imaging protocols without retraining. We validate the method using four disparate datasets, showing robust performance in white matter lesion segmentation while simultaneously segmenting dozens of other brain structures. We further demonstrate that the contrast-adaptive method can also be safely applied to MRI scans of healthy controls, and replicate previously documented atrophy patterns in deep gray matter structures in MS. The algorithm is publicly available as part of the open-source neuroimaging package FreeSurfer.
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13
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Domínguez-Mozo MI, Nieto-Guerrero A, Pérez-Pérez S, García-Martínez MÁ, Arroyo R, Álvarez-Lafuente R. MicroRNAs of Human Herpesvirus 6A and 6B in Serum and Cerebrospinal Fluid of Multiple Sclerosis Patients. Front Immunol 2020; 11:2142. [PMID: 33072077 PMCID: PMC7531184 DOI: 10.3389/fimmu.2020.02142] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 08/06/2020] [Indexed: 12/19/2022] Open
Abstract
Human herpesvirus-6A (HHV-6A) and −6B (HHV-6B) might be involved in the etiopathogenesis of multiple sclerosis (MS), especially the HHV-6A. We aim at assessing, for the first time in the scientific literature, the HHV-6A/B microRNAs in MS patients. We analyzed the miRNAs of HHV-6A: miR-U86, and −6B: hhv6b-miR-Ro6-1, −2, −3-3p, −3-5p, and −4 in paired samples of serum and CSF of 42 untreated MS patients and 23 patients with other neurological diseases (OND), using Taqman MicroRNA Assays. Intrathecal HHV-6A/B antibody production and anti-HHV-6A/B IgG/IgM levels in serum were measured. MS clinical data were available. We detected the following miRNAs: hhv6b-miR-Ro6-2 (serum: MS:97.7%, OND:95.7%; CSF: MS:81%, OND:86.4%), 3-3p (serum: MS:4.8%, OND:0%; CSF: MS:2.4%, OND:4.5%), −3-5p (serum: MS:95.2%, OND:91.3%; CSF: MS:50%, OND:54.5%), and miR-U86 (serum: MS:54.8%, OND:47.8%; CSF: MS:11.9%, OND:9.1%). In the serum of the whole population (MS and OND patients) we found a significant correlation between the levels of hhv6b-miR-Ro6-2 and −3-5p (Spearman r = 0.839, pcorr = 3E-13), −2 and miR-U86 (Spearman r = 0.578, pcorr = 0.001) and −3-5p and miR-U86 (Spearman r = 0.698, pcorr = 1.34E-5); also in the CSF, between hhv6b-miR-Ro6-2 and −3-5p (Spearman r = 0.626, pcorr = 8.52E-4). These correlations remained statistically significant when both populations were considered separately. The anti-HHV-6A/B IgG levels in CSF and the intrathecal antibody production in positive MS patients for hhv6b-miR-Ro6-3-5p were statistically significant higher than in the negative ones (pcorr = 0.006 and pcorr = 0.036). The prevalence of miR-U86 (30.8%) in the CSF of individuals without gadolinium-enhancing lesions was higher (p = 0.035) than in the ones with these lesions (0%); however, the difference did not withstand Bonferroni correction (pcorr = 0.105). We propose a role of HHV-6A/B miRNAs in the maintenance of the viral latency state. Further investigations are warranted to validate these results and clarify the function of these viral miRNAs.
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Affiliation(s)
- María I Domínguez-Mozo
- Environmental Factors in Degenerative Diseases Research Group, Instituto Investigación Sanitaria San Carlos (IdISSC), Hospital Clínico San Carlos, Madrid, Spain
| | - Alejandro Nieto-Guerrero
- Environmental Factors in Degenerative Diseases Research Group, Instituto Investigación Sanitaria San Carlos (IdISSC), Hospital Clínico San Carlos, Madrid, Spain
| | - Silvia Pérez-Pérez
- Environmental Factors in Degenerative Diseases Research Group, Instituto Investigación Sanitaria San Carlos (IdISSC), Hospital Clínico San Carlos, Madrid, Spain
| | - María Á García-Martínez
- Environmental Factors in Degenerative Diseases Research Group, Instituto Investigación Sanitaria San Carlos (IdISSC), Hospital Clínico San Carlos, Madrid, Spain
| | - Rafael Arroyo
- Neurology Department, Hospital Universitario Quirónsalud Madrid, Madrid, Spain
| | - Roberto Álvarez-Lafuente
- Environmental Factors in Degenerative Diseases Research Group, Instituto Investigación Sanitaria San Carlos (IdISSC), Hospital Clínico San Carlos, Madrid, Spain
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14
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Santana LM, Valadares EDJA, Rosa-Júnior M. Differential diagnosis of temporal lobe lesions with hyperintense signal on T2-weighted and FLAIR sequences: pictorial essay. Radiol Bras 2020; 53:129-136. [PMID: 32336830 PMCID: PMC7170575 DOI: 10.1590/0100-3984.2018.0117] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Various neuropathologies produce hyperintense signals on T2-weighted or fluid-attenuated inversion recovery sequences of the temporal lobes. Recognition of the distribution pattern and associated findings may narrow the spectrum of differential diagnoses or suggest a specific disease. This pictorial essay aims to illustrate the relatively common diseases that affect the temporal lobe, such as herpes simplex encephalitis, neurosyphilis, limbic encephalitis, postictal edema, neoplasia, and multiple sclerosis, as well as those that are less common, such as myotonic dystrophy type 1, CADASIL, and CARASIL, together with the particularities of each entity.
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Affiliation(s)
- Larissa Marques Santana
- Hospital Universitário Cassiano Antônio de Moraes da Universidade Federal do Espírito Santo (HUCAM/UFES), Vitória, ES, Brazil
| | | | - Marcos Rosa-Júnior
- Hospital Universitário Cassiano Antônio de Moraes da Universidade Federal do Espírito Santo (HUCAM/UFES), Vitória, ES, Brazil
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15
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Costelloe CM, Amini B, Madewell JE. Risks and Benefits of Gadolinium-Based Contrast-Enhanced MRI. Semin Ultrasound CT MR 2020; 41:170-182. [DOI: 10.1053/j.sult.2019.12.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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16
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Costelloe CM, Amini B, Madewell JE. WITHDRAWN: Risks and Benefits of Gadolinium-Based Contrast Enhanced MRI. Semin Ultrasound CT MR 2020; 41:260-274. [PMID: 32446435 DOI: 10.1053/j.sult.2020.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The Publisher regrets that this article is an accidental duplication of an article that has already been published in [Seminars in Ultrasound, CT, and MRI, 41/2 (2020) 170–182], https://dx.doi.org/10.1053/j.sult.2019.12.005. The duplicate article has therefore been withdrawn. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal
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Affiliation(s)
- Colleen M Costelloe
- Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX.
| | - Behrang Amini
- Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX
| | - John E Madewell
- Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX
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17
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Bendfeldt K, Taschler B, Gaetano L, Madoerin P, Kuster P, Mueller-Lenke N, Amann M, Vrenken H, Wottschel V, Barkhof F, Borgwardt S, Klöppel S, Wicklein EM, Kappos L, Edan G, Freedman MS, Montalbán X, Hartung HP, Pohl C, Sandbrink R, Sprenger T, Radue EW, Wuerfel J, Nichols TE. MRI-based prediction of conversion from clinically isolated syndrome to clinically definite multiple sclerosis using SVM and lesion geometry. Brain Imaging Behav 2020; 13:1361-1374. [PMID: 30155789 DOI: 10.1007/s11682-018-9942-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Neuroanatomical pattern classification using support vector machines (SVMs) has shown promising results in classifying Multiple Sclerosis (MS) patients based on individual structural magnetic resonance images (MRI). To determine whether pattern classification using SVMs facilitates predicting conversion to clinically definite multiple sclerosis (CDMS) from clinically isolated syndrome (CIS). We used baseline MRI data from 364 patients with CIS, randomised to interferon beta-1b or placebo. Non-linear SVMs and 10-fold cross-validation were applied to predict converters/non-converters (175/189) at two years follow-up based on clinical and demographic data, lesion-specific quantitative geometric features and grey-matter-to-whole-brain volume ratios. We applied linear SVM analysis and leave-one-out cross-validation to subgroups of converters (n = 25) and non-converters (n = 44) based on cortical grey matter segmentations. Highest prediction accuracies of 70.4% (p = 8e-5) were reached with a combination of lesion-specific geometric (image-based) and demographic/clinical features. Cortical grey matter was informative for the placebo group (acc.: 64.6%, p = 0.002) but not for the interferon group. Classification based on demographic/clinical covariates only resulted in an accuracy of 56% (p = 0.05). Overall, lesion geometry was more informative in the interferon group, EDSS and sex were more important for the placebo cohort. Alongside standard demographic and clinical measures, both lesion geometry and grey matter based information can aid prediction of conversion to CDMS.
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Affiliation(s)
- Kerstin Bendfeldt
- Medical Image Analysis Center (MIAC AG), Mittlere Str. 83, CH-4031, Basel, Switzerland.
| | - Bernd Taschler
- German Center for Neurodegenerative Diseases, Bonn, Germany.,Department of Statistics, University of Warwick, Coventry, UK
| | - Laura Gaetano
- Medical Image Analysis Center (MIAC AG), Mittlere Str. 83, CH-4031, Basel, Switzerland.,Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Philip Madoerin
- Medical Image Analysis Center (MIAC AG), Mittlere Str. 83, CH-4031, Basel, Switzerland
| | - Pascal Kuster
- Medical Image Analysis Center (MIAC AG), Mittlere Str. 83, CH-4031, Basel, Switzerland
| | - Nicole Mueller-Lenke
- Medical Image Analysis Center (MIAC AG), Mittlere Str. 83, CH-4031, Basel, Switzerland
| | - Michael Amann
- Medical Image Analysis Center (MIAC AG), Mittlere Str. 83, CH-4031, Basel, Switzerland.,Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Hugo Vrenken
- VU University Medical Center, Amsterdam, The Netherlands
| | | | - Frederik Barkhof
- VU University Medical Center, Amsterdam, The Netherlands.,Institutes of Neurology and Healthcare Engineering, UCL, London, UK
| | - Stefan Borgwardt
- Medical Image Analysis Center (MIAC AG), Mittlere Str. 83, CH-4031, Basel, Switzerland.,Department of Psychiatry (1), University of Basel, Basel, Switzerland.,King's College London, Department of Psychosis Studies, Institute of Psychiatry, London, UK
| | - Stefan Klöppel
- Department of Psychiatry and Psychotherapy, Freiburg Brain Imaging, University Medical Center Freiburg, Freiburg, Germany
| | | | - Ludwig Kappos
- Department of Neurology, University Hospital Basel, Basel, Switzerland
| | | | - Mark S Freedman
- University of Ottawa and Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | | | - Hans-Peter Hartung
- Department of Neurology, Heinrich-Heine Universität, Düsseldorf, Germany
| | - Christoph Pohl
- Bayer Pharma AG, Berlin, Germany.,Charité University Medicine Berlin, Berlin, Germany
| | - Rupert Sandbrink
- Bayer Pharma AG, Berlin, Germany.,Department of Neurology, Heinrich-Heine Universität, Düsseldorf, Germany
| | - Till Sprenger
- Medical Image Analysis Center (MIAC AG), Mittlere Str. 83, CH-4031, Basel, Switzerland.,Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Ernst-Wilhelm Radue
- Medical Image Analysis Center (MIAC AG), Mittlere Str. 83, CH-4031, Basel, Switzerland
| | - Jens Wuerfel
- Medical Image Analysis Center (MIAC AG), Mittlere Str. 83, CH-4031, Basel, Switzerland.,Charité University Medicine Berlin, Berlin, Germany
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18
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Arm J, Ribbons K, Lechner-Scott J, Ramadan S. Evaluation of MS related central fatigue using MR neuroimaging methods: Scoping review. J Neurol Sci 2019; 400:52-71. [PMID: 30903860 DOI: 10.1016/j.jns.2019.03.007] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 02/17/2019] [Accepted: 03/11/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Fatigue is a common and debilitating symptom in multiple sclerosis (MS). Over the past decade, a growing body of research has focussed on the pathophysiological mechanisms underlying central (cognitive and physical) fatigue in MS. The precise mechanisms causing fatigue in MS patients are complex and poorly understood, and may differ between patients. Advanced quantitative magnetic resonance imaging (MRI) techniques allow for objective assessment of disease pathology and have been used to characterise the pathophysiology of central fatigue in MS. OBJECTIVE To systematically review the existing literature of MRI-based studies assessing the pathophysiological mechanisms of MS-related central fatigue. METHODS A systematic literature search of four major databases (PubMed, Medline, Embase, Scopus and Google Scholar) was conducted to identify MRI-based studies of MS-related fatigue published in the past 20 years. Studies using the following MRI-based methods were included: structural (lesion load/atrophy), T1 relaxation time/magnetisation transfer ratio (MTR), diffusion tensor imaging (DTI), functional MRI (fMRI) and magnetic resonance spectroscopy (MRS). RESULTS A total of 92 studies were identified as meeting the search criteria and included for review. Structurally, regional gray/white matter atrophy, cortical thinning, decreased T1 relaxation times and reduced fractional anisotropy were associated with central fatigue in MS. Functionally, hyperactivity and reduced functional connectivity in several regional areas of frontal, parietal, occipital, temporal and cerebellum were suggested as causes of central fatigue. Biochemically, a reduction in N-acetyl aspartate/creatine and increased (glutamine+glutamate)/creatine ratios were correlated with fatigue severity in MS. CONCLUSION Several advanced quantitative MRI methods have been employed in the study of central fatigue in MS. Central fatigue in MS is associated with macro/microstructural and functional changes within specific brain regions (frontal, parietal, temporal and deep gray matter) and specific pathways/networks (cortico-cortical and cortico-subcortical). Alternations in the cortico-striatal-thalamocortical (CSTC) loop are correlated with the development of fatigue in MS patients.
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Affiliation(s)
- Jameen Arm
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Karen Ribbons
- Department of Neurology, John Hunter Hospital, Lookout Road, New Lambton Heights, NSW 2305, Australia
| | - Jeannette Lechner-Scott
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW 2308, Australia; Department of Neurology, John Hunter Hospital, Lookout Road, New Lambton Heights, NSW 2305, Australia; Hunter Medical Research Institute, Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia
| | - Saadallah Ramadan
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW 2308, Australia; Hunter Medical Research Institute, Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia.
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Daltrozzo T, Hapfelmeier A, Donnachie E, Schneider A, Hemmer B. A Systematic Assessment of Prevalence, Incidence and Regional Distribution of Multiple Sclerosis in Bavaria From 2006 to 2015. Front Neurol 2018; 9:871. [PMID: 30425676 PMCID: PMC6218432 DOI: 10.3389/fneur.2018.00871] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Accepted: 09/26/2018] [Indexed: 11/13/2022] Open
Abstract
Introduction: Worldwide, incidence and prevalence of multiple sclerosis (MS) have increased over the last decades. We present a systematic epidemiological study with recent prevalence and incidence rates of MS in Bavaria. Methods: Incidence and prevalence of MS stratified by gender, age groups and region were analyzed by data records from 2006 to 2015 of more than 10 million people insured by the Bavarian Association of Statutory Health Insurance Physicians. Official statistics of the German Federal Ministry of Health provided the size of the general population. Future prevalence was estimated with a predictive model. Results: From 2006 to 2015 prevalence of MS in Bavaria increased from 171 per 100,000 to 277 per 100,000, while incidence rates remained relatively stable (range 16-18 per 100,000 inhabitants with a female to male ratio between 2.4:1 and 2:1). Incidence and prevalence were higher in urban than urbanized and rural areas. The prevalence is expected to increase to 374 per 100,000 in 2040 with the highest prevalence rates between 50 and 65 years. Conclusion: The prevalence of MS in Bavaria is among the highest worldwide and will further rise over the next two decades. This demonstrates a need to strengthen healthcare provision systems due to the increasing numbers of particularly older patients with MS in the future.
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Affiliation(s)
- Tanja Daltrozzo
- Department of Neurology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Alexander Hapfelmeier
- School of Medicine, Institute of Medical Informatics, Statistics and Epidemiology, Technical University of Munich, Munich, Germany
| | - Ewan Donnachie
- National Association of Statutory Health Insurance Physicians of Bavaria, Munich, Germany
| | - Antonius Schneider
- Institute of General Practice School of Medicine, Technical University of Munich, Munich, Germany
| | - Bernhard Hemmer
- Department of Neurology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
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Uddin MN, Figley TD, Figley CR. Effect of echo time and T2-weighting on GRASE-based T1w/T2w ratio measurements at 3T. Magn Reson Imaging 2018; 51:35-43. [DOI: 10.1016/j.mri.2018.04.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 04/17/2018] [Accepted: 04/18/2018] [Indexed: 12/24/2022]
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Multiple Sclerosis: Improved Detection of Active Cerebral Lesions With 3-Dimensional T1 Black-Blood Magnetic Resonance Imaging Compared With Conventional 3-Dimensional T1 GRE Imaging. Invest Radiol 2018; 53:13-19. [PMID: 28858894 DOI: 10.1097/rli.0000000000000410] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aim of this study was to assess the diagnostic accuracy of a modified high-resolution whole-brain three-dimensional T1-weighted black-blood sequence (T1-weighted modified volumetric isotropic turbo spin echo acquisition [T1-mVISTA]) in comparison to a standard three-dimensional T1-weighted magnetization-prepared rapid gradient echo (MP-RAGE) sequence for detection of contrast-enhancing cerebral lesions in patients with relapsing-remitting multiple sclerosis (MS). MATERIALS AND METHODS After institutional review board approval and informed consent, 22 patients (8 men; aged 31.0 ± 9.2 years) with relapsing-remitting MS were included in this monocentric prospective cohort study.Contrast-enhanced T1-mVISTA and MP-RAGE, both with 0.8 mm resolution, were performed in all patients. In a substudy of 12 patients, T1-mVISTA was compared with a T1-mVISTA with 1.0 mm resolution (T1-mVISTA_1.0). Reference lesions were defined by an experienced neuroradiologist using all available sequences and served as the criterion standard. T1-mVISTA, T1-mVISTA_1.0, and MP-RAGE sequences were read in random order 4 weeks apart. Image quality, visual contrast enhancement, contrast-to-noise-ratio (CNR), diagnostic confidence, and lesion size were assessed and compared by Wilcoxon and Mann-Whitney U tests. RESULTS Eleven of 22 patients displayed contrast-enhancing lesions. Visual contrast enhancement, CNR, and diagnostic confidence of contrast-enhancing MS lesions were significantly increased in T1-mVISTA compared with MP-RAGE (P < 0.001). Significantly more contrast-enhancing lesions were detected with T1-mVISTA than with MP-RAGE (71 vs 39, respectively; P < 0.001). With MP-RAGE, 25.6% of lesions were missed in the initial reading, whereas only 4.2% of lesions were missed with T1-mVISTA. Increase of the voxel volume from 0.8 mm to 1.0 mm isotropic in T1-mVISTA_1.0 did not affect the detectability of lesions, whereas scan time was decreased from 4:43 to 1:55 minutes. CONCLUSIONS Three-dimensional T1-mVISTA improves the detection rates of contrast-enhancing cerebral MS lesions compared with conventional 3D MP-RAGE sequences by increasing CNR of lesions and might, therefore, be useful in patient management.
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Mohajeri Moghaddam S, Bhatt AA. Location, length, and enhancement: systematic approach to differentiating intramedullary spinal cord lesions. Insights Imaging 2018; 9:511-526. [PMID: 29949034 PMCID: PMC6108975 DOI: 10.1007/s13244-018-0608-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 01/24/2018] [Accepted: 02/08/2018] [Indexed: 11/04/2022] Open
Abstract
Purpose Intramedullary spinal cord abnormalities are often challenging to diagnose. Spinal cord biopsy is a high-risk procedure with the potential to cause permanent neurological injury. Magnetic resonance imaging is the modality of choice for diagnosis and preoperative assessment of patients with spinal cord abnormalities. The radiologist’s ability to narrow the differential diagnosis of spinal cord abnormalities has the potential to save patients from invasive approaches for diagnosis and also guide appropriate management. Approach/methods This article will provide a systematic approach to the evaluation of intramedullary spinal cord lesions—with emphasis on location, length and segment distribution, and enhancement pattern—to help narrow the differential diagnosis. In doing so, we will review various spinal cord pathologies, including demyelinating and metabolic conditions, neoplasms, and vascular lesions. Summary/conclusion Although intramedullary spinal cord abnormalities can be a challenge for the radiologist, a systematic approach to the differential diagnosis with a focus on lesion location, cord length and segment involvement, as well as enhancement pattern, can greatly help narrow the differential diagnosis, if not synch the diagnosis. This strategy will potentially obviate the need for an invasive approach to diagnosis and help guide treatment. Teaching points • Imaging diagnosis of intramedullary spinal cord lesions could obviate cord biopsy. • Evaluation of cord lesions should focus on location, length, and enhancement pattern. • In demyelination, the degree of cross-sectional involvement is a distinguishing feature.
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Affiliation(s)
- Sarah Mohajeri Moghaddam
- Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Avenue, P.O. Box 648, Rochester, NY, 14642, USA.
| | - Alok A Bhatt
- Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Avenue, P.O. Box 648, Rochester, NY, 14642, USA
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Hannoun S, Heidelberg D, Hourani R, Nguyen TTT, Brisset JC, Grand S, Kremer S, Bonneville F, Guttmann CR, Dousset V, Cotton F. Diagnostic value of 3DFLAIR in clinical practice for the detection of infratentorial lesions in multiple sclerosis in regard to dual echo T2 sequences. Eur J Radiol 2018; 102:146-151. [DOI: 10.1016/j.ejrad.2018.03.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Revised: 02/19/2018] [Accepted: 03/13/2018] [Indexed: 11/16/2022]
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Krauss W, Gunnarsson M, Nilsson M, Thunberg P. Conventional and synthetic MRI in multiple sclerosis: a comparative study. Eur Radiol 2017; 28:1692-1700. [PMID: 29134354 PMCID: PMC5834550 DOI: 10.1007/s00330-017-5100-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 09/09/2017] [Accepted: 09/27/2017] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To compare the assessment of patients with multiple sclerosis (MS) using synthetic and conventional MRI. MATERIALS AND METHODS Synthetic and conventional axial images were prospectively acquired for 52 patients with diagnosed MS. Quantitative MRI (qMRI) was used for measuring proton density and relaxation times (T1, T2) and then, based on these parameters, synthetic T1W, T2W and FLAIR images were calculated. Image stacks were reviewed blindly, independently and in random order by two radiologists. The number and location for all lesions were documented and categorised. A combined report of lesion load and presence of contrast-enhancing lesions was compiled for each patient. Agreement was evaluated using kappa statistic. RESULTS There was no significant difference in lesion detection using synthetic and conventional MRI in any anatomical region or for any of the three image types. Inter- and intra-observer agreements were mainly higher (p < 0.05) using conventional images but there was no significant difference in any specific region or for any image type. There was no significant difference in the outcome of the combined reports. CONCLUSION Synthetic MR images show potential to be used in the assessment of MS dissemination in space (DIS) despite a slightly lower inter- and intra-observer agreement compared to conventional MRI. KEY POINTS • Synthetic MR images may potentially be useful in the assessment of MS. • Examination times may be shortened. • Inter- and intra-observer agreement is generally higher using conventional MRI.
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Affiliation(s)
- Wolfgang Krauss
- Department of Radiology, Faculty of Medicine and Health, Örebro University, SE-701 85, Örebro, Sweden. .,School of Medical Science, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
| | - Martin Gunnarsson
- Department of Neurology and Neurophysiology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.,Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Margareta Nilsson
- Centre for Medical Imaging and Physiology, Skåne University Hospital, Lund, Sweden
| | - Per Thunberg
- Faculty of Medicine and Health, Örebro University, Örebro, Sweden.,Department of Medical Physics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Kotari V, Salha R, Wang D, Wood E, Salvetti M, Ristori G, Tang L, Bagnato F, Ikonomidou VN. Validating Nonlinear Registration to Improve Subtraction Images for Lesion Detection and Quantification in Multiple Sclerosis. J Neuroimaging 2017; 28:70-78. [PMID: 29064129 DOI: 10.1111/jon.12479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 09/21/2017] [Accepted: 09/26/2017] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND AND PURPOSE To propose and validate nonlinear registration techniques for generating subtraction images because of their ability to reduce artifacts and improve lesion detection and lesion volume quantification. METHODS Postcontrast T1 -weighted spin echo and T2 -weighted dual echo images were acquired for 20 patients with relapsing-remitting multiple sclerosis (RRMS) on a monthly basis for a year (14 women, average age 33.6 ± 6.9). The T2 -weighted images from the first scan were used as a baseline for each patient. The images from the last scan were registered to the baseline image. Four different registration algorithms used for evaluation included; linear, halfway linear, nonlinear, and nonlinear halfway. Subtraction images were generated after brain extraction, intensity normalization, and Gaussian blurring. Lesion activity changes along with identified artifacts were scored on all four techniques by two independent observers. Additionally, quantitative analysis of the algorithms was performed by estimating the volume changes of simulated lesions and real lesions. For real lesion volume change analysis, five subjects were selected randomly. Subtraction images were generated between all the 11 time points and the baseline image using linear and nonlinear registration for the five subjects. RESULTS Lesion activity detection resulted in similar performance among the four registration techniques. Lesion volume measurements on subtraction images using nonlinear registration were closer to lesion volume on T2 -weighted images. A statistically significant difference was observed among the four registration techniques while evaluating yin-yang artifacts. Pairwise comparisons showed that nonlinear registration results in the least amount of yin-yang artifacts, which are significantly different. CONCLUSIONS Nonlinear registration for generation of subtraction images has been demonstrated to be a promising new technique as it shows improvement in lesion activity change detection. This approach decreases the number of artifacts in subtraction images. With improved lesion volume estimates and reduced artifacts, nonlinear registration may lead to discarding less subject data and an improvement in the statistical power of subtraction imaging studies.
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Affiliation(s)
- Vikas Kotari
- Electrical Engineering Department, George Mason University, Fairfax, VA
| | - Racha Salha
- Bioengineering Department, George Mason University, Fairfax, VA
| | - Dana Wang
- Bioengineering Department, George Mason University, Fairfax, VA
| | - Emily Wood
- Electrical Engineering Department, George Mason University, Fairfax, VA
| | - Marco Salvetti
- Centre for Experimental Neurological Therapies (CENTERS), Department of Neurosciences, Mental Health and Sensory Organs, Sapienza University - S. Andrea Hospital, Rome, Italy
| | - Giovanni Ristori
- Centre for Experimental Neurological Therapies (CENTERS), Department of Neurosciences, Mental Health and Sensory Organs, Sapienza University - S. Andrea Hospital, Rome, Italy
| | - Larry Tang
- IRCCS Istituto Neurologico Mediterraneo (INM) Neuromed, 86077, Pozzilli, IS, Italy, (MS).,Department of Statistics, George Mason University, Fairfax, VA
| | - Francesca Bagnato
- Vanderbilt University, Department of Neurology, Multiple Sclerosis Center, Nashville, TN
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Kaunzner UW, Gauthier SA. MRI in the assessment and monitoring of multiple sclerosis: an update on best practice. Ther Adv Neurol Disord 2017; 10:247-261. [PMID: 28607577 DOI: 10.1177/1756285617708911] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 03/09/2017] [Indexed: 01/14/2023] Open
Abstract
Magnetic resonance imaging (MRI) has developed into the most important tool for the diagnosis and monitoring of multiple sclerosis (MS). Its high sensitivity for the evaluation of inflammatory and neurodegenerative processes in the brain and spinal cord has made it the most commonly used technique for the evaluation of patients with MS. Moreover, MRI has become a powerful tool for treatment monitoring, safety assessment as well as for the prognostication of disease progression. Clinically, the use of MRI has increased in the past couple decades as a result of improved technology and increased availability that now extends well beyond academic centers. Consequently, there are numerous studies supporting the role of MRI in the management of patients with MS. The aim of this review is to summarize the latest insights into the utility of MRI in MS.
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Affiliation(s)
- Ulrike W Kaunzner
- Judith Jaffe Multiple Sclerosis Center, Weill Cornell Medicine, New York, NY, USA
| | - Susan A Gauthier
- Judith Jaffe Multiple Sclerosis Center, Weill Cornell Medicine, 1305 York Avenue, New York, NY 10021, USA
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McNamara C, Sugrue G, Murray B, MacMahon PJ. Current and Emerging Therapies in Multiple Sclerosis: Implications for the Radiologist, Part 1-Mechanisms, Efficacy, and Safety. AJNR Am J Neuroradiol 2017; 38:1664-1671. [PMID: 28408630 DOI: 10.3174/ajnr.a5147] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Imaging for the diagnosis and follow-up of patients with suspected or confirmed multiple sclerosis is a common scenario for many general radiologists and subspecialty neuroradiologists. The field of MS therapeutics has rapidly evolved with multiple new agents now being used in routine clinical practice. To provide an informed opinion in discussions concerning newer MS agents, radiologists must have a working understanding of the strengths and limitations of the various novel therapies. The role of imaging in MS has advanced beyond monitoring and surveillance of disease activity to include treatment complications. An understanding of the new generation of MS drugs in conjunction with the key role that MR imaging plays in the detection of disease progression, opportunistic infections, and drug-related adverse events is of vital importance to the radiologist and clinical physician alike. Radiologists are in a unique position to detect many of the described complications well in advance of clinical symptoms. Part 1 of this review outlines recent developments in the treatment of MS and discusses the published clinical data on the efficacy and safety of the currently approved and emerging therapies in this condition as they apply to the radiologist. Part 2 will cover pharmacovigilance and the role the neuroradiologist plays in monitoring patients for signs of opportunistic infection and/or disease progression.
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Affiliation(s)
- C McNamara
- From the Departments of Radiology (C.M., G.S., P.J.M.)
| | - G Sugrue
- From the Departments of Radiology (C.M., G.S., P.J.M.)
| | - B Murray
- Neurology (B.M.), Mater Misericordiae University Hospital, Dublin, Ireland
| | - P J MacMahon
- From the Departments of Radiology (C.M., G.S., P.J.M.)
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The Italian Neuroimaging Network Initiative (INNI): enabling the use of advanced MRI techniques in patients with MS. Neurol Sci 2017; 38:1029-1038. [PMID: 28293740 DOI: 10.1007/s10072-017-2903-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 03/07/2017] [Indexed: 10/20/2022]
Abstract
Magnetic resonance imaging (MRI) is an important paraclinical tool to diagnose and monitor multiple sclerosis (MS). Conventional MRI measures lack of pathological specificity and are weakly correlated with MS clinical manifestations. Advanced MRI techniques are improving the understanding of the mechanisms underlying tissue injury, repair, and functional adaptation in MS; however, they require careful standardization. The definition of standardized methods for the collection and analysis of advanced MRI techniques is central not only to improve the understanding of disease pathophysiology and evolution, but also to generate research hypotheses, monitor treatment, increase cost-effectiveness and power of clinical trials. We promoted the Italian Neuroimaging Network Initiative (INNI), involving centers and investigators with an International recognized expertise, with the major goal to determine and validate novel MRI biomarkers to be utilized as predictors and/or outcomes in future MS studies. The INNI initiative supported the creation of a centralized repository, where advanced structural and functional MRI scans available at the participating sites, with the related clinical and neuropsychological data, are collected. These data will be used to perform research studies to identify clinical, neuropsychological and imaging biomarkers characteristics of the entire spectrum of MS. INNI will be instrumental to help to define standardized MRI and clinical protocols towards an increasing uptake of personalized interventions for people with MS at a national and international level. Upon approval of the INNI Steering Committee, the data collected in the online database will be shared with any research center detailing specific research proposals on disease pathophysiology or treatment effects.
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Poutiainen P, Jaronen M, Quintana FJ, Brownell AL. Precision Medicine in Multiple Sclerosis: Future of PET Imaging of Inflammation and Reactive Astrocytes. Front Mol Neurosci 2016; 9:85. [PMID: 27695400 PMCID: PMC5023680 DOI: 10.3389/fnmol.2016.00085] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Accepted: 08/30/2016] [Indexed: 12/29/2022] Open
Abstract
Non-invasive molecular imaging techniques can enhance diagnosis to achieve successful treatment, as well as reveal underlying pathogenic mechanisms in disorders such as multiple sclerosis (MS). The cooperation of advanced multimodal imaging techniques and increased knowledge of the MS disease mechanism allows both monitoring of neuronal network and therapeutic outcome as well as the tools to discover novel therapeutic targets. Diverse imaging modalities provide reliable diagnostic and prognostic platforms to better achieve precision medicine. Traditionally, magnetic resonance imaging (MRI) has been considered the golden standard in MS research and diagnosis. However, positron emission tomography (PET) imaging can provide functional information of molecular biology in detail even prior to anatomic changes, allowing close follow up of disease progression and treatment response. The recent findings support three major neuroinflammation components in MS: astrogliosis, cytokine elevation, and significant changes in specific proteins, which offer a great variety of specific targets for imaging purposes. Regardless of the fact that imaging of astrocyte function is still a young field and in need for development of suitable imaging ligands, recent studies have shown that inflammation and astrocyte activation are related to progression of MS. MS is a complex disease, which requires understanding of disease mechanisms for successful treatment. PET is a precise non-invasive imaging method for biochemical functions and has potential to enhance early and accurate diagnosis for precision therapy of MS. In this review we focus on modulation of different receptor systems and inflammatory aspect of MS, especially on activation of glial cells, and summarize the recent findings of PET imaging in MS and present the most potent targets for new biomarkers with the main focus on experimental MS research.
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Affiliation(s)
- Pekka Poutiainen
- Athinoula A Martinos Biomedical Imaging Center, Department of Radiology, Massachusetts General Hospital, Harvard Medical SchoolCharlestown, MA, USA
| | - Merja Jaronen
- Ann Romney Center for Neurologic Diseases, Brigham and Women's Hospital, Harvard Medical SchoolBoston, MA, USA
| | - Francisco J. Quintana
- Ann Romney Center for Neurologic Diseases, Brigham and Women's Hospital, Harvard Medical SchoolBoston, MA, USA
| | - Anna-Liisa Brownell
- Athinoula A Martinos Biomedical Imaging Center, Department of Radiology, Massachusetts General Hospital, Harvard Medical SchoolCharlestown, MA, USA
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Comparison between gadolinium-enhanced 2D T1-weighted gradient-echo and spin-echo sequences in the detection of active multiple sclerosis lesions on 3.0T MRI. Eur Radiol 2016; 27:1361-1368. [DOI: 10.1007/s00330-016-4503-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 06/17/2016] [Accepted: 06/30/2016] [Indexed: 10/21/2022]
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Wu L, Zhang Y, Zhou F, Gao L, He L, Zeng X, Gong H. Altered intra- and interregional synchronization in relapsing-remitting multiple sclerosis: a resting-state fMRI study. Neuropsychiatr Dis Treat 2016; 12:853-62. [PMID: 27143886 PMCID: PMC4841392 DOI: 10.2147/ndt.s98962] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND AND PURPOSE Neuroimaging studies of relapsing-remitting multiple sclerosis (RRMS) have found structural disconnection and large-scale neural network dysfunction. However, few studies have explored the local brain activity of RRMS patients in the resting state. PATIENTS AND METHODS In this study, regional homogeneity (ReHo) and resting-state functional connectivity (FC) were used to investigate intra- and interregional synchronized activity in 22 patients with RRMS and 22 matched healthy controls (HCs). RESULTS Compared with HCs, patients with RRMS showed significantly decreased ReHo in the left insula and right caudate. Through further seed-based FC analysis, we found decreased FC between the left insula and left precentral gyrus in patients with RRMS compared with HCs, as well as increased FC between the right caudate and right dorsolateral prefrontal cortex. Pearson's correlation analysis showed that a decreased ReHo value in the left insula was associated with an increased total white matter lesion loads (TWMLL) score (r=-0.594, P=0.004) or a worsened paced auditory serial addition test score (r=0.536, P=0.010). No other significant correlations were observed between the FC value (left insula - left precentral gyrus) and clinical scores (P=0.246-0.982). The ReHo value of the right caudate was negatively correlated with disease duration (r=-0.526, P=0.012) and with the TWMLL score (r=-0.596, P=0.003). Moreover, a positive correlation was observed between the FC value (right caudate - right dorsolateral prefrontal cortex) and the TWMLL score (r=0.523, P=0.012) or the modified fatigue impact scale-5 score (r=0.608, P=0.003). CONCLUSION Together, these findings suggest that the insula with regional dysfunction involves disconnection with sensorimotor regions, and demyelinating lesion-related intra- and interregional dysfunction in the caudate is associated with the impact of fatigue on cognitive control functions. Abnormal synchronization of intra- and interregional activity in the insula and caudate may play important roles in the pathology of RRMS.
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Affiliation(s)
- Lin Wu
- Department of Radiology, The First Affiliated Hospital, Nanchang University, Nanchang, Jiangxi Province, People's Republic of China; Jiangxi Province Medical Imaging Research Institute, The Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, Jiangxi Province, People's Republic of China
| | - Yue Zhang
- Department of Radiology, The Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, Jiangxi Province, People's Republic of China
| | - Fuqing Zhou
- Department of Radiology, The First Affiliated Hospital, Nanchang University, Nanchang, Jiangxi Province, People's Republic of China; Jiangxi Province Medical Imaging Research Institute, The Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, Jiangxi Province, People's Republic of China
| | - Lei Gao
- Jiangxi Province Medical Imaging Research Institute, The Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, Jiangxi Province, People's Republic of China
| | - Laichang He
- Department of Radiology, The First Affiliated Hospital, Nanchang University, Nanchang, Jiangxi Province, People's Republic of China; Jiangxi Province Medical Imaging Research Institute, The Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, Jiangxi Province, People's Republic of China
| | - Xianjun Zeng
- Department of Radiology, The First Affiliated Hospital, Nanchang University, Nanchang, Jiangxi Province, People's Republic of China; Jiangxi Province Medical Imaging Research Institute, The Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, Jiangxi Province, People's Republic of China
| | - Honghan Gong
- Department of Radiology, The First Affiliated Hospital, Nanchang University, Nanchang, Jiangxi Province, People's Republic of China; Jiangxi Province Medical Imaging Research Institute, The Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, Jiangxi Province, People's Republic of China
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Design and development of an ethnically-diverse imaging informatics-based eFolder system for multiple sclerosis patients. Comput Med Imaging Graph 2015; 46 Pt 2:257-68. [PMID: 26564667 DOI: 10.1016/j.compmedimag.2015.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Revised: 09/06/2015] [Accepted: 09/29/2015] [Indexed: 11/24/2022]
Abstract
PURPOSE MRI has been used to identify multiple sclerosis (MS) lesions in brain and spinal cord visually. Integrating patient information into an electronic patient record system has become key for modern patient care in medicine in recent years. Clinically, it is also necessary to track patients' progress in longitudinal studies, in order to provide comprehensive understanding of disease progression and response to treatment. As the amount of required data increases, there exists a need for an efficient systematic solution to store and analyze MS patient data, disease profiles, and disease tracking for both clinical and research purposes. METHOD An imaging informatics based system, called MS eFolder, has been developed as an integrated patient record system for data storage and analysis of MS patients. The eFolder system, with a DICOM-based database, includes a module for lesion contouring by radiologists, a MS lesion quantification tool to quantify MS lesion volume in 3D, brain parenchyma fraction analysis, and provide quantitative analysis and tracking of volume changes in longitudinal studies. Patient data, including MR images, have been collected retrospectively at University of Southern California Medical Center (USC) and Los Angeles County Hospital (LAC). The MS eFolder utilizes web-based components, such as browser-based graphical user interface (GUI) and web-based database. The eFolder database stores patient clinical data (demographics, MS disease history, family history, etc.), MR imaging-related data found in DICOM headers, and lesion quantification results. Lesion quantification results are derived from radiologists' contours on brain MRI studies and quantified into 3-dimensional volumes and locations. Quantified results of white matter lesions are integrated into a structured report based on DICOM-SR protocol and templates. The user interface displays patient clinical information, original MR images, and viewing structured reports of quantified results. The GUI also includes a data mining tool to handle unique search queries for MS. System workflow and dataflow steps has been designed based on the IHE post-processing workflow profile, including workflow process tracking, MS lesion contouring and quantification of MR images at a post-processing workstation, and storage of quantitative results as DICOM-SR in DICOM-based storage system. The web-based GUI is designed to display zero-footprint DICOM web-accessible data objects (WADO) and the SR objects. SUMMARY The MS eFolder system has been designed and developed as an integrated data storage and mining solution in both clinical and research environments, while providing unique features, such as quantitative lesion analysis and disease tracking over a longitudinal study. A comprehensive image and clinical data integrated database provided by MS eFolder provides a platform for treatment assessment, outcomes analysis and decision-support. The proposed system serves as a platform for future quantitative analysis derived automatically from CAD algorithms that can also be integrated within the system for individual disease tracking and future MS-related research. Ultimately the eFolder provides a decision-support infrastructure that can eventually be used as add-on value to the overall electronic medical record.
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MRI/MRS in neuroinflammation: methodology and applications. Clin Transl Imaging 2015; 3:475-489. [PMID: 26705534 PMCID: PMC4679099 DOI: 10.1007/s40336-015-0142-y] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 08/30/2015] [Indexed: 12/11/2022]
Abstract
Neuroinflammation encompasses a wide range of humoral and cellular responses, not only enabling the CNS to fight various noxious events, including infections and trauma, but also playing a critical role in autoimmune as well as in neurodegenerative diseases. The complex interactions of immune, endothelial, and neuronal cells that take place during inflammation require an equivalent complexity of imaging approaches to be appropriately explored in vivo. Magnetic Resonance provides several complementary techniques that allow to study most mechanisms underlying the brain/immune interaction. In this review, we discuss the MR approaches to the study of endothelial activation, blood-brain barrier permeability alterations, intercellular compartment modifications, immune cell trafficking, and of metabolic alterations linked to immune cell activity. The main advantages and limitations of these techniques are assessed, in view of their exploitation in the clinical arena, where the complementarity of the information that can be obtained has the potential to change our way of studying neuroinflammation, with implications for the management of several CNS diseases.
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Rovira À, Wattjes MP, Tintoré M, Tur C, Yousry TA, Sormani MP, De Stefano N, Filippi M, Auger C, Rocca MA, Barkhof F, Fazekas F, Kappos L, Polman C, Miller D, Montalban X. Evidence-based guidelines: MAGNIMS consensus guidelines on the use of MRI in multiple sclerosis-clinical implementation in the diagnostic process. Nat Rev Neurol 2015; 11:471-82. [PMID: 26149978 DOI: 10.1038/nrneurol.2015.106] [Citation(s) in RCA: 305] [Impact Index Per Article: 33.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The clinical use of MRI in patients with multiple sclerosis (MS) has advanced markedly over the past few years. Technical improvements and continuously emerging data from clinical trials and observational studies have contributed to the enhanced performance of this tool for achieving a prompt diagnosis in patients with MS. The aim of this article is to provide guidelines for the implementation of MRI of the brain and spinal cord in the diagnosis of patients who are suspected of having MS. These guidelines are based on an extensive review of the recent literature, as well as on the personal experience of the members of the MAGNIMS (Magnetic Resonance Imaging in MS) network. We address the indications, timing, coverage, reporting and interpretation of MRI studies in patients with suspected MS. Our recommendations are intended to help radiologists and neurologists standardize and optimize the use of MRI in clinical practice for the diagnosis of MS.
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Affiliation(s)
- Àlex Rovira
- Magnetic Resonance Unit, Cemcat, Hospital Vall d'Hebron, Autonomous University of Barcelona, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Mike P Wattjes
- MS Centre Amsterdam, VU University Medical Centre, Netherlands
| | - Mar Tintoré
- Neurology/Neuroimmunology Unit, Cemcat, Hospital Vall d'Hebron, Autonomous University of Barcelona, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Carmen Tur
- Neurology/Neuroimmunology Unit, Cemcat, Hospital Vall d'Hebron, Autonomous University of Barcelona, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Tarek A Yousry
- Lysholm Department of Neuroradiology, UCLH National Hospital for Neurology and Neurosurgery, University College London Institute of Neurology, UK
| | - Maria P Sormani
- Biostatistics Unit, Department of Health Sciences, University of Genoa, Italy
| | - Nicola De Stefano
- Department of Neurological and Behavioural Sciences, University of Siena, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Italy
| | - Cristina Auger
- Magnetic Resonance Unit, Cemcat, Hospital Vall d'Hebron, Autonomous University of Barcelona, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Maria A Rocca
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Italy
| | | | - Franz Fazekas
- Department of Neurology, Medical University of Graz, Austria
| | - Ludwig Kappos
- Department of Neurology, University of Basel, Switzerland
| | - Chris Polman
- MS Centre Amsterdam, VU University Medical Centre, Netherlands
| | - David Miller
- NMR Research Unit, Queen Square MS Centre, University College London Institute of Neurology, UK
| | - Xavier Montalban
- Magnetic Resonance Unit, Cemcat, Hospital Vall d'Hebron, Autonomous University of Barcelona, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
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Saake M, Langner S, Schwenke C, Weibart M, Jansen O, Hosten N, Doerfler A. MRI in multiple sclerosis: an intra-individual, randomized and multicentric comparison of gadobutrol with gadoterate meglumine at 3 T. Eur Radiol 2015; 26:820-8. [PMID: 26123410 DOI: 10.1007/s00330-015-3889-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 05/28/2015] [Accepted: 06/10/2015] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To compare contrast effects of gadobutrol with gadoterate meglumine for brain MRI in multiple sclerosis (MS) in a multicentre, randomized, prospective, intraindividual study at 3 T. METHODS Institutional review board approval was obtained. Patients with known or suspected active MS lesions were included. Two identical MRIs were performed using randomized contrast agent order. Four post-contrast T1 sequences were acquired (start time points 0, 3, 6 and 9 min). If no enhancing lesion was present in first MRI, second MRI was cancelled. Quantitative (number and signal intensity of enhancing lesions) and qualitative parameters (time points of first and all lesions enhancing; subjective preference regarding contrast enhancement and lesion delineation; global preference) were evaluated blinded. RESULTS Seventy-four patients (male, 26; mean age, 35 years) were enrolled in three centres. In 45 patients enhancing lesions were found. Number of enhancing lesions increased over time for both contrast agents without significant difference (median 2 for both). Lesions signal intensity was significantly higher for gadobutrol (p < 0.05 at time points 3, 6 and 9 min). Subjective preference rating showed non-significant tendency in favour of gadobutrol. CONCLUSION Both gadobutrol and gadoterate meglumine can be used for imaging of acute inflammatory MS lesions. However, gadobutrol generates higher lesion SI. KEY POINTS Contrast-enhanced MRI plays a key role in the management of multiple sclerosis. Different gadolinium-based contrast agents are available. Number of visibly enhancing lesions increases over time after contrast injection. Gadobutrol and gadoterate meglumine do not differ in number of visible lesions. Gadobutrol generates higher signal intensity than gadoterate meglumine.
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Affiliation(s)
- Marc Saake
- Department of Neuroradiology, University of Erlangen-Nuremberg, Schwabachanlage 6, 91054, Erlangen, Germany.
| | - Soenke Langner
- Institute for Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany
| | | | - Marina Weibart
- Department of Neuroradiology, University of Erlangen-Nuremberg, Schwabachanlage 6, 91054, Erlangen, Germany
| | - Olav Jansen
- Department of Radiology and Neuroradiology, University of Kiel, Kiel, Germany
| | - Norbert Hosten
- Institute for Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany
| | - Arnd Doerfler
- Department of Neuroradiology, University of Erlangen-Nuremberg, Schwabachanlage 6, 91054, Erlangen, Germany
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Arnold DL, Li D, Hohol M, Chakraborty S, Chankowsky J, Alikhani K, Duquette P, Bhan V, Montanera W, Rabinovitch H, Morrish W, Vandorpe R, Guilbert F, Traboulsee A, Kremenchutzky M. Evolving role of MRI in optimizing the treatment of multiple sclerosis: Canadian Consensus recommendations. Mult Scler J Exp Transl Clin 2015; 1:2055217315589775. [PMID: 28607695 PMCID: PMC5433339 DOI: 10.1177/2055217315589775] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2015] [Accepted: 05/03/2015] [Indexed: 01/10/2023] Open
Abstract
Background Magnetic resonance imaging (MRI) is increasingly important for the early detection of suboptimal responders to disease-modifying therapy for relapsing–remitting multiple sclerosis. Treatment response criteria are becoming more stringent with the use of composite measures, such as no evidence of disease activity (NEDA), which combines clinical and radiological measures, and NEDA-4, which includes the evaluation of brain atrophy. Methods The Canadian MRI Working Group of neurologists and radiologists convened to discuss the use of brain and spinal cord imaging in the assessment of relapsing–remitting multiple sclerosis patients during the treatment course. Results Nine key recommendations were developed based on published sources and expert opinion. Recommendations addressed image acquisition, use of gadolinium, MRI requisitioning by clinicians, and reporting of lesions and brain atrophy by radiologists. Routine MRI follow-ups are recommended beginning at three to six months after treatment initiation, at six to 12 months after the reference scan, and annually thereafter. The interval between scans may be altered according to clinical circumstances. Conclusions The Canadian recommendations update the 2006 Consortium of MS Centers Consensus revised guidelines to assist physicians in their management of MS patients and to aid in treatment decision making.
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Affiliation(s)
| | - David Li
- University of British Columbia, Canada
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Cotton F, Kremer S, Hannoun S, Vukusic S, Dousset V. OFSEP, a nationwide cohort of people with multiple sclerosis: Consensus minimal MRI protocol. J Neuroradiol 2015; 42:133-40. [DOI: 10.1016/j.neurad.2014.12.001] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 12/04/2014] [Indexed: 11/25/2022]
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Abstract
BACKGROUND A definitive diagnosis of multiple sclerosis (MS), as distinct from a clinically isolated syndrome, requires one of two conditions: a second clinical attack or particular magnetic resonance imaging (MRI) findings as defined by the McDonald criteria. MRI is also important after a diagnosis is made as a means of monitoring subclinical disease activity. While a standardized protocol for diagnostic and follow-up MRI has been developed by the Consortium of Multiple Sclerosis Centres, acceptance and implementation in Canada have been suboptimal. METHODS To improve diagnosis, monitoring, and management of a clinically isolated syndrome and MS, a Canadian expert panel created consensus recommendations about the appropriate application of the 2010 McDonald criteria in routine practice, strategies to improve adherence to the standardized Consortium of Multiple Sclerosis Centres MRI protocol, and methods for ensuring effective communication among health care practitioners, in particular referring physicians, neurologists, and radiologists. RESULTS This article presents eight consensus statements developed by the expert panel, along with the rationale underlying the recommendations and commentaries on how to prioritize resource use within the Canadian healthcare system. CONCLUSIONS The expert panel calls on neurologists and radiologists in Canada to incorporate the McDonald criteria, the Consortium of Multiple Sclerosis Centres MRI protocol, and other guidance given in this consensus presentation into their practices. By improving communication and general awareness of best practices for MRI use in MS diagnosis and monitoring, we can improve patient care across Canada by providing timely diagnosis, informed management decisions, and better continuity of care.
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Milo R. Effectiveness of multiple sclerosis treatment with current immunomodulatory drugs. Expert Opin Pharmacother 2015; 16:659-73. [DOI: 10.1517/14656566.2015.1002769] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Crombé A, Saranathan M, Ruet A, Durieux M, de Roquefeuil E, Ouallet JC, Brochet B, Dousset V, Tourdias T. MS lesions are better detected with 3D T1 gradient-echo than with 2D T1 spin-echo gadolinium-enhanced imaging at 3T. AJNR Am J Neuroradiol 2014; 36:501-7. [PMID: 25376810 DOI: 10.3174/ajnr.a4152] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE In multiple sclerosis, gadolinium enhancement is used to classify lesions as active. Regarding the need for a standardized and accurate method for detection of multiple sclerosis activity, we compared 2D-spin-echo with 3D-gradient-echo T1WI for the detection of gadolinium-enhancing MS lesions. MATERIALS AND METHODS Fifty-eight patients with MS were prospectively imaged at 3T by using both 2D-spin-echo and 3D-gradient recalled-echo T1WI in random order after the injection of gadolinium. Blinded and independent evaluation was performed by a junior and a senior reader to count gadolinium-enhancing lesions and to characterize their location, size, pattern of enhancement, and the relative contrast between enhancing lesions and the adjacent white matter. Finally, the SNR and relative contrast of gadolinium-enhancing lesions were computed for both sequences by using simulations. RESULTS Significantly more gadolinium-enhancing lesions were reported on 3D-gradient recalled-echo than on 2D-spin-echo (n = 59 versus n = 30 for the junior reader, P = .021; n = 77 versus n = 61 for the senior reader, P = .017). The difference between the 2 readers was significant on 2D-spin-echo (P = .044), for which images were less reproducible (κ = 0.51) than for 3D-gradient recalled-echo (κ = 0.65). Further comparisons showed that there were statistically more small lesions (<5 mm) on 3D-gradient recalled-echo than on 2D-spin-echo (P = .04), while other features were similar. Theoretic results from simulations predicted SNR and lesion contrast for 3D-gradient recalled-echo to be better than for 2D-spin-echo for visualization of small enhancing lesions and were, therefore, consistent with clinical observations. CONCLUSIONS At 3T, 3D-gradient recalled-echo provides a higher detection rate of gadolinium-enhancing lesions, especially those with smaller size, with a better reproducibility; this finding suggests using 3D-gradient recalled-echo to detect MS activity, with potential impact in initiation, monitoring, and optimization of therapy.
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Affiliation(s)
- A Crombé
- From the Service de NeuroImagerie Diagnostique et Thérapeutique (A.C., M.D., E.d.R., V.D., T.T.)
| | - M Saranathan
- Department of Radiology (M.S.), Stanford University, Stanford, California
| | - A Ruet
- Pôle de Neurosciences Cliniques (A.R., J.C.O., B.B.), Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France INSERM U862 (A.R., B.B., V.D., T.T.), Neurocentre Magendie, Université de Bordeaux, Bordeaux, France
| | - M Durieux
- From the Service de NeuroImagerie Diagnostique et Thérapeutique (A.C., M.D., E.d.R., V.D., T.T.)
| | - E de Roquefeuil
- From the Service de NeuroImagerie Diagnostique et Thérapeutique (A.C., M.D., E.d.R., V.D., T.T.)
| | - J C Ouallet
- Pôle de Neurosciences Cliniques (A.R., J.C.O., B.B.), Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - B Brochet
- Pôle de Neurosciences Cliniques (A.R., J.C.O., B.B.), Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France INSERM U862 (A.R., B.B., V.D., T.T.), Neurocentre Magendie, Université de Bordeaux, Bordeaux, France
| | - V Dousset
- From the Service de NeuroImagerie Diagnostique et Thérapeutique (A.C., M.D., E.d.R., V.D., T.T.) INSERM U862 (A.R., B.B., V.D., T.T.), Neurocentre Magendie, Université de Bordeaux, Bordeaux, France
| | - T Tourdias
- From the Service de NeuroImagerie Diagnostique et Thérapeutique (A.C., M.D., E.d.R., V.D., T.T.) INSERM U862 (A.R., B.B., V.D., T.T.), Neurocentre Magendie, Université de Bordeaux, Bordeaux, France.
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Loizou CP, Petroudi S, Seimenis I, Pantziaris M, Pattichis CS. Quantitative texture analysis of brain white matter lesions derived from T2-weighted MR images in MS patients with clinically isolated syndrome. J Neuroradiol 2014; 42:99-114. [PMID: 24970463 DOI: 10.1016/j.neurad.2014.05.006] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2014] [Revised: 04/18/2014] [Accepted: 05/04/2014] [Indexed: 01/21/2023]
Abstract
INTRODUCTION This study investigates the application of texture analysis methods on brain T2-white matter lesions detected with magnetic resonance imaging (MRI) for the prognosis of future disability in subjects diagnosed with clinical isolated syndrome (CIS) of multiple sclerosis (MS). METHODS Brain lesions and normal appearing white matter (NAWM) from 38 symptomatic untreated subjects diagnosed with CIS as well as normal white matter (NWM) from 20 healthy volunteers, were manually segmented, by an experienced MS neurologist, on transverse T2-weighted images obtained from serial brain MR imaging scans (0 and 6-12 months). Additional clinical information in the form of the Expanded Disability Status Scale (EDSS), a scale from 0 to 10, which provides a way of quantifying disability in MS and monitoring the changes over time in the level of disability, were also provided. Shape and most importantly different texture features including GLCM and laws were then extracted for all above regions, after image intensity normalization. RESULTS The findings showed that: (i) there were significant differences for the texture futures extracted between the NAWM and lesions at 0 month and between NAWM and lesions at 6-12 months. However, no significant differences were found for all texture features extracted when comparing lesions temporally at 0 and 6-12 months with the exception of contrast (gray level difference statistics-GLDS) and difference entropy (spatial gray level dependence matrix-SGLDM); (ii) significant differences were found between NWM and NAWM for most of the texture features investigated in this study; (iii) there were significant differences found for the lesion texture features at 0 month for those with EDSS≤2 versus those with EDSS>2 (mean, median, inverse difference moment and sum average) and for the lesion texture features at 6-12 months with EDSS>2 and EDSS≤2 for the texture features (mean, median, entropy and sum average). It should be noted that whilst there were no differences in entropy at time 0 between the two groups, significant change was observed at 6-12 months, relating the corresponding features to the follow-up and disability (EDSS) progression. For the NAWM, significant differences were found between 0 month and 6-12 months with EDSS≤2 (contrast, inverse difference moment), for 6-12 months for EDSS>2 and 0 month with EDSS>2 (difference entropy) and for 6-12 months for EDSS>2 and EDSS≤2 (sum average); (iv) there was no significant difference for NAWM and the lesion texture features (for both 0 and 6-12 months) for subjects with no change in EDSS score versus subjects with increased EDSS score from 2 to 5 years. CONCLUSIONS The findings of this study provide evidence that texture features of T2 MRI brain white matter lesions may have an additional potential role in the clinical evaluation of MRI images in MS and perhaps may provide some prognostic evidence in relation to future disability of patients. However, a larger scale study is needed to establish the application in clinical practice and for computing shape and texture features that may provide information for better and earlier differentiation between normal brain tissue and MS lesions.
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Affiliation(s)
- C P Loizou
- Department of Computer Science, School of Sciences, Intercollege, 92, Ayias Phylaxeos Street, PO Box 51604, 3507 Limassol, Cyprus.
| | - S Petroudi
- Department of Computer Science, University of Cyprus, Nicosia, Cyprus.
| | - I Seimenis
- Medical Physics Laboratory, Medical School, Democritus University, Alexandroupolis, Greece.
| | - M Pantziaris
- Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus.
| | - C S Pattichis
- Department of Computer Science, University of Cyprus, Nicosia, Cyprus.
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Taschler B, Ge T, Bendfeldt K, Müller-Lenke N, Johnson TD, Nichols TE. Spatial modeling of multiple sclerosis for disease subtype prediction. MEDICAL IMAGE COMPUTING AND COMPUTER-ASSISTED INTERVENTION : MICCAI ... INTERNATIONAL CONFERENCE ON MEDICAL IMAGE COMPUTING AND COMPUTER-ASSISTED INTERVENTION 2014; 17:797-804. [PMID: 25485453 DOI: 10.1007/978-3-319-10470-6_99] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Magnetic resonance imaging (MRI) has become an essential tool in the diagnosis and managing of Multiple Sclerosis (MS). Currently, the assessment of MS is based on a combination of clinical scores and subjective rating of lesion images by clinicians. In this work we present an objective 5-way classification of MS disease subtype as well as a comparison between three different approaches. First we propose two spatially informed models, a Bayesian Spatial Generalized Linear Mixed Model (BSGLMM) and a Log Gaussian Cox Process (LGCP). The BSGLMM accounts for the binary nature of lesion maps and the spatial dependence between neighboring voxels, and the LGCP accounts for the random spatial variation in lesion location. Both improve upon mass univariate analyses that ignore spatial dependence and rely on some level of arbitrarily defined smoothing of the data. As a comparison, we consider a machine learning approach based on multi-class support vector machine (SVM). For the SVM classification scheme, unlike previous work, we use a large number of quantitative features derived from three MRI sequences in addition to traditional demographic and clinical measures. We show that the spatial models outperform standard approaches with average prediction accuracies of up to 85%.
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Curley M, Josey L, Lucas R, Dear K, Taylor BV, Coulthard A, Chapman C, Coulthard A, Dear K, Dwyer T, Kilpatrick T, Lucas R, McMichael T, Pender MP, Ponsonby AL, Taylor B, Valery P, van der Mei I, Williams D. Adherence to MRI protocol consensus guidelines in multiple sclerosis: an Australian multi-centre study. J Med Imaging Radiat Oncol 2013; 56:594-8. [PMID: 23210577 DOI: 10.1111/1754-9485.12000] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Accepted: 09/28/2012] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Multiple sclerosis (MS) is a debilitating disease that causes significant morbidity within a young demographic. Diagnostic guidelines for MS have evolved, and imaging has played an increasingly important role in diagnosis over the last two decades. For imaging to contribute to diagnosis in a meaningful way, it must be reproducible. Consensus guidelines for MRI in MS exist to define correct sequence type and imaging technique, but it is not clear to what extent they are followed. This study reviewed MRI studies performed on Australian individuals presenting with a first clinical diagnosis of central nervous system demyelination (FCD) for adherence to published guidelines and discussed practical implementation of MS guidelines in light of recent updates. METHODS The Ausimmune study was a prospective case control study of Australian participants presenting with FCD from 2003 to 2006. Baseline cranial and spinal cord MRI studies of 226 case participants from four separate Australian regions were reviewed. MRI sequences were classified according to anatomical location, slice plane, tissue weighting and use of gadolinium-containing contrast media. Results were compared with the 2003 Consortium of Multiple Sclerosis Centres MRI protocol for the diagnosis of MS. RESULTS The composition of core cranial MRI sequences performed varied across the 226 scans. Of the studies, 91% included sagittal fluid attenuated inversion recovery (FLAIR) sequences. Cranial axial T2-weighted, axial FLAIR and axial proton density-weighted sequences were performed in 88%, 60% and 16% (respectively) of scans. Only 25% of the studies included a T1-weighted contrast-enhanced sequence. Concordance with the guidelines in all sequences was very low (2). CONCLUSION Only a small number of MRI investigations performed included all of the sequences stipulated by consensus guidelines. This is likely due to poor awareness in the imaging community of the guidelines and the rationale behind certain sequences. Radiologists with a sub-speciality interest in neuroradiology should take ownership of this issue and ensure that recommended imaging guidelines are followed.
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Affiliation(s)
- Michael Curley
- Department of Medical Imaging, Royal Brisbane and Women's Hospital, Australia
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Hodel J, Outteryck O, Ryo E, Bocher AL, Lambert O, Chéchin D, Zéphir H, Lacour A, Pruvo JP, Vermersch P, Leclerc X. Accuracy of postcontrast 3D turbo spin-echo MR sequence for the detection of enhanced inflammatory lesions in patients with multiple sclerosis. AJNR Am J Neuroradiol 2013; 35:519-23. [PMID: 24200899 DOI: 10.3174/ajnr.a3795] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Therapeutic strategies for patients with MS partly rely on contrast-enhanced MR imaging. Our aim was to assess the diagnostic performance of 3D turbo spin-echo MR imaging with variable refocusing flip angles at 3T for the detection of enhanced inflammatory lesions in patients with multiple sclerosis. MATERIALS AND METHODS Fifty-six patients with MS were prospectively investigated by using postcontrast T1-weighted axial 2D spin-echo and 3D TSE MR images. The order in which both sequences were performed was randomized. Axial reformats from 3D T1 TSE were generated to match the 2D spin-echo images. The reference standard was defined by using clinical data and all MR images available. Three separate sets of MR images (2D spin-echo images, axial reformats, and multiplanar images from 3D TSE sequences) were examined in a blinded fashion by 2 neuroradiologists separately for the detection of enhanced MS lesions. Image artifacts and contrast were evaluated. RESULTS No artifacts related to vascular pulsation were observed on 3D TSE images, whereas image artifacts were demonstrated on 2D spin-echo images in 41 patients. One hundred twelve enhanced MS lesions were identified in 19 patients. Sixty-four lesions were correctly diagnosed by using 2D spin-echo images; 90, by using 3D TSE axial reformatted views; and 106, by using multiplanar analysis of the 3D TSE sequence. Multiplanar analysis was 94.7% sensitive and 100% specific for the diagnosis of patients with at least 1 enhanced lesion. Contrast of enhanced MS lesions was significantly improved by using the 3D TSE sequence (P < .011). CONCLUSIONS The 3D TSE sequence with multiplanar analysis is a useful tool for the detection of enhanced MS lesions.
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Affiliation(s)
- J Hodel
- From the Departments of Neuroradiology (J.H., E.R., A.-L.B., J.-P.P., X.L.)
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Quantifying the local tissue volume and composition in individual brains with magnetic resonance imaging. Nat Med 2013; 19:1667-72. [PMID: 24185694 PMCID: PMC3855886 DOI: 10.1038/nm.3390] [Citation(s) in RCA: 196] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Accepted: 02/05/2013] [Indexed: 12/25/2022]
Abstract
We describe a quantitative neuroimaging method to estimate the macromolecular tissue volume (MTV), a fundamental measure of brain anatomy. By making measurements over a range of field strengths and scan parameters, we tested the key assumptions and the robustness of the method. The measurements confirm that a consistent, quantitative estimate of macromolecular volume can be obtained across a range of scanners. MTV estimates are sufficiently precise to enable a comparison between data obtained from an individual subject with control population data. We describe two applications. First, we show that MTV estimates can be combined with T1 and diffusion measurements to augment our understanding of the tissue properties. Second we show that MTV provides a sensitive measure of disease status in individual patients with multiple sclerosis. The MTV maps are obtained using short clinically appropriate scans that can reveal how tissue changes influence behavior and cognition.
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Scott LJ. Gadobutrol: a review of its use for contrast-enhanced magnetic resonance imaging in adults and children. Clin Drug Investig 2013; 33:303-14. [PMID: 23435930 DOI: 10.1007/s40261-013-0066-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Since the introduction of the first gadolinium-based contrast agent (GBCA) approximately 25 years ago, magnetic resonance imaging (MRI) using GBCAs has revolutionized diagnostic and follow-up imaging of pathological lesions, with clinical applications expanded to encompass almost all fields of medicine. Intravenous gadobutrol (Gadovist™ [EU]; Gadavist(®) [USA]) is a second-generation extracellular non-ionic macrocyclic GBCA that is used in patients undergoing diagnostic contrast-enhanced MRI for visualization of pathological lesions in the CNS and all other body regions or for contrast-enhanced magnetic resonance angiography (MRA) to evaluate perfusion and flow-related abnormalities. Its unique physicochemical profile, along with the high thermostability of macrocyclic GBCAs, means gadobutrol is formulated at twice the gadolinium ion concentration of other currently licensed GBCAs. This reduces the injection volume and provides a narrower bolus, thereby improving image enhancement. Based on extensive clinical experience in a broad range of patients, including paediatric and adult patients (younger and elderly adults), and those with moderate to severe hepatic or renal impairment or cardiovascular disorders, gadobutrol is an effective and generally well tolerated extracellular GBCA for patients undergoing diagnostic contrast-enhanced MRI and contrast-enhanced MRA. As with all macrocyclic GBCAs, the potential for gadobutrol to cause nephrogenic systemic fibrosis appears to be lower than with linear GBCAs.
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Affiliation(s)
- Lesley J Scott
- Adis, 41 Centorian Drive, Private Bag 65901, Mairangi Bay, North Shore, 0754, Auckland, New Zealand.
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Koelblinger C, Fruehwald-Pallamar J, Kubin K, Wallner-Blazek M, van den Hauwe L, Macedo L, Puchner SB, Thurnher MM. Atypical idiopathic inflammatory demyelinating lesions (IIDL): conventional and diffusion-weighted MR imaging (DWI) findings in 42 cases. Eur J Radiol 2013; 82:1996-2004. [PMID: 23993757 DOI: 10.1016/j.ejrad.2013.07.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Accepted: 07/31/2013] [Indexed: 02/08/2023]
Abstract
INTRODUCTION The purpose of this study was to evaluate MR imaging characteristics with conventional and advanced MR imaging techniques in patients with IIDL. METHODS MR images of the brain in 42 patients (20 male, 22 female) with suspected or known multiple sclerosis (MS) from four institutions were retrospectively analyzed. Lesions were classified into five different subtypes: (1) ring-like lesions; (2) Balo-like lesions; (3) diffuse infiltrating lesions; (4) megacystic lesions; and (5) unclassified lesions. The location, size, margins, and signal intensities on T1WI, T2WI, and diffusion-weighted images (DWI), and the ADC values/ratios for all lesions, as well as the contrast enhancement pattern, and the presence of edema, were recorded. RESULTS There were 30 ring-like, 10 Balo-like, 3 megacystic-like and 16 diffuse infiltrating-like lesions were detected. Three lesions were categorized as unclassified lesions. Of the 30 ring-like lesions, 23 were hypointense centrally with a hyperintense rim. The mean ADC, measured centrally, was 1.50 ± 0.41 × 10(-3) mm(2)/s. The mean ADC in the non-enhancing layers of the Balo-like lesions was 2.29 ± 0.17 × 10(-3) mm(2)/s, and the mean ADC in enhancing layers was 1.03 ± 0.30 × 10(-3) mm(2)/s. Megacystic lesions had a mean ADC of 2.14 ± 0.26 × 10(-3)mm(2)/s. Peripheral strong enhancement with high signal on DWI was present in all diffuse infiltrating lesions. Unclassified lesions showed a mean ADC of 1.43 ± 0.13 mm(2)/s. CONCLUSION Restriction of diffusion will be seen in the outer layers of active inflammation/demyelination in Balo-like lesions, in the enhancing part of ring-like lesions, and at the periphery of infiltrative-type lesions.
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Affiliation(s)
- Claus Koelblinger
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University Vienna, Vienna, Austria
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Abstract
OBJECTIVE This and its companion article address the 10 most frequently asked questions that radiologists face when planning, performing, processing, and interpreting different MR perfusion studies in CNS imaging. CONCLUSION Perfusion MRI is a promising tool in assessing stroke, brain tumors, and patients with neurodegenerative diseases. Most of the impediments that have limited the use of perfusion MRI can be overcome to allow integration of these methods into modern neuroimaging protocols.
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