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AlTokhis AI, AlAmrani A, Alotaibi A, Podlasek A, Constantinescu CS. Magnetic Resonance Imaging as a Prognostic Disability Marker in Clinically Isolated Syndrome and Multiple Sclerosis: A Systematic Review and Meta-Analysis. Diagnostics (Basel) 2022; 12:270. [PMID: 35204361 PMCID: PMC8871297 DOI: 10.3390/diagnostics12020270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/17/2022] [Accepted: 01/18/2022] [Indexed: 01/27/2023] Open
Abstract
To date, there are no definite imaging predictors for long-term disability in multiple sclerosis (MS). Magnetic resonance imaging (MRI) is the key prognostic tool for MS, primarily at the early stage of the disease. Recent findings showed that white matter lesion (WML) counts and volumes could predict long-term disability for MS. However, the prognostic value of MRI in the early stage of the disease and its link to long-term physical disability have not been assessed systematically and quantitatively. A meta-analysis was conducted using studies from four databases to assess whether MS lesion counts and volumes at baseline MRI scans could predict long-term disability, assessed by the expanded disability status scale (EDSS). Fifteen studies were eligible for the qualitative analysis and three studies for meta-analysis. T2 brain lesion counts and volumes after the disease onset were associated with disability progression after 10 years. Four or more lesions at baseline showed a highly significant association with EDSS 3 and EDSS 6, with a pooled OR of 4.10 and 4.3, respectively. The risk increased when more than 10 lesions were present. This review and meta-analysis confirmed that lesion counts and volumes could be associated with disability and might offer additional valid guidance in treatment decision making. Future work is essential to determine whether these prognostic markers have high predictive potential.
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Affiliation(s)
- Amjad I. AlTokhis
- Mental and Clinical Neuroscience Academic Unit, School of Medicine, Nottingham University Hospitals NHS Trust, University of Nottingham, Nottingham NG7 2UH, UK; (A.A.); (A.P.)
- Division of Health and Rehabilitation Sciences, Princess Nourah Bint Abdulrahman University, Riyadh 11564, Saudi Arabia
| | - Abrar AlAmrani
- Faculty of Health, York University, Toronto, ON M3J 1P3, Canada;
| | - Abdulmajeed Alotaibi
- Mental and Clinical Neuroscience Academic Unit, School of Medicine, Nottingham University Hospitals NHS Trust, University of Nottingham, Nottingham NG7 2UH, UK; (A.A.); (A.P.)
- Department of Radiological Sciences, School of Applied Medical Sciences, King Saud bin Abdul-Aziz University for Health Sciences, Riyadh 14611, Saudi Arabia
| | - Anna Podlasek
- Mental and Clinical Neuroscience Academic Unit, School of Medicine, Nottingham University Hospitals NHS Trust, University of Nottingham, Nottingham NG7 2UH, UK; (A.A.); (A.P.)
- Tayside Innovation MedTech Ecosystem, Division of Imaging Science and Technology, School of Medicine, University of Dundee, Dundee DD1 4HN, UK
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2
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El Fayomy NM, Mohamed HH, Kamal MM, Alsayyad AH, Alsayyad EH, Shamloul RM. Signs of neuroinflammation outweigh neurodegeneration as predictors for early conversion to MS. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2021. [DOI: 10.1186/s41983-021-00356-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The pathophysiological mechanisms underlying multiple sclerosis include both inflammatory and degenerative processes. We aimed to study and compare markers of neuroinflammation and neurodegeneration in patients with first presentation of demyelinating disorder and to prospectively identify which of the studied markers serve as predictors for early conversion to multiple sclerosis. Thus, 42 patients with first clinical manifestations suggestive of demyelinating disease were included in a prospective study. Subjects underwent thorough history taking and clinical evaluation. Laboratory studies involved analysis of cerebrospinal fluid (CSF) and serum chitinase 3-like 1 levels. Brain imaging included MRI and ultrasonographic assessment.
Results
T1 black holes, elevated oligoclonal bands (OCB), high baseline T2 lesion load, and enhanced MRI lesions were significantly higher in patients with 1st attack multiple sclerosis. Significantly higher CSF-OCB and serum chitinase 3-like 1 protein was detected in patients with multiple sclerosis (MS) compared to clinically isolated syndrome, and higher levels in MS convertors than non-convertors. Cognitive dysfunction evaluated by MoCA test and brain atrophy assessed using transcranial sonography did not show significant difference among the studied groups. Logistic regression analysis showed that heavy T2 lesion load served as the only predictor of conversion to MS.
Conclusion
Early conversion to MS after first attack of demyelination is related to detection of signs of neuroinflammation rather than neurodegeneration.
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3
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Simonsen CS, Flemmen HØ, Broch L, Brunborg C, Berg-Hansen P, Moen SM, Celius EG. Early High Efficacy Treatment in Multiple Sclerosis Is the Best Predictor of Future Disease Activity Over 1 and 2 Years in a Norwegian Population-Based Registry. Front Neurol 2021; 12:693017. [PMID: 34220694 PMCID: PMC8248666 DOI: 10.3389/fneur.2021.693017] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 05/25/2021] [Indexed: 11/14/2022] Open
Abstract
Background: Moderate and high efficacy disease modifying therapies (DMTs) have a profound effect on disease activity. The current treatment guidelines only recommend high efficacy DMTs for patients with highly active MS. The objective was to examine the impact of initial treatment choice in achieving no evidence of disease activity (NEDA) at year 1 and 2. Methods: Using a real-world population-based registry with limited selection bias from the southeast of Norway, we determined how many patients achieved NEDA on moderate and high efficacy DMTs. Results: 68.0% of patients who started a high efficacy DMT as the first drug achieved NEDA at year 1 and 52.4% at year 2 as compared to 36.0 and 19.4% of patients who started a moderate efficacy DMT as a first drug. The odds ratio (OR) of achieving NEDA on high efficacy drugs compared to moderate efficacy drugs as a first drug at year 1 was 3.9 (95% CI 2.4–6.1, p < 0.001). The OR for high efficacy DMT as the second drug was 2.5 (95% CI 1.7–3.9, p < 0.001), and was not significant for the third drug. Patients with a medium or high risk of disease activity were significantly more likely to achieve NEDA on a high efficacy therapy as a first drug compared to moderate efficacy therapy as a first drug. Conclusions: Achieving NEDA at year 1 and 2 is significantly more likely in patients on high-efficacy disease modifying therapies than on moderate efficacy therapies, and the first choice of treatment is the most important. The immunomodulatory treatment guidelines should be updated to ensure early, high efficacy therapy for the majority of patients diagnosed with MS.
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Affiliation(s)
- Cecilia Smith Simonsen
- Department of Neurology, Vestre Viken Hospital Trust, Drammen, Norway.,Department of Neurology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Heidi Øyen Flemmen
- Department of Neurology, Telemark Hospital Trust, Skien, Norway.,Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Line Broch
- Department of Neurology, Vestre Viken Hospital Trust, Drammen, Norway.,Department of Neurology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Cathrine Brunborg
- Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway
| | - Pål Berg-Hansen
- Department of Neurology, Oslo University Hospital, Oslo, Norway
| | | | - Elisabeth Gulowsen Celius
- Department of Neurology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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4
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De Lury A, Bisulca J, Coyle PK, Peyster R, Bangiyev L, Duong TQ. MRI features associated with rapid disease activity in clinically isolated syndrome patients at high risk for multiple sclerosis. Mult Scler Relat Disord 2020; 41:101985. [PMID: 32087591 DOI: 10.1016/j.msard.2020.101985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 01/31/2020] [Accepted: 02/03/2020] [Indexed: 11/27/2022]
Abstract
Clinically isolated syndrome (CIS) is a central nervous system inflammatory and demyelinating event that lasts at least 24 h and can represent the first episode of relapsing-remitting multiple sclerosis. MRI is an important imaging tool in the diagnosis and longitudinal monitoring of CIS progression. Accurate differential diagnosis of high-risk versus low-risk CIS is important because high-risk CIS patients could be treated early. Although a few studies have previously characterized CIS and explored possible imaging predictors of CIS conversion to MS, it remains unclear which amongst the commonly measured MRI features, if any, are good predictors of rapid disease progression in CIS patients. The goal of this review paper is to identify MRI features in high-risk CIS patients that are associated with rapid disease activity within 5 years as measured by clinical disability.
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Affiliation(s)
- Amy De Lury
- Departments of Radiology, Stony Brook Medicine, 101 Nicolls Rd, Stony Brook, New York, 11794, USA
| | - Joseph Bisulca
- Departments of Radiology, Stony Brook Medicine, 101 Nicolls Rd, Stony Brook, New York, 11794, USA
| | - Patricia K Coyle
- Departments of Neurology, Stony Brook Medicine, 101 Nicolls Rd, Stony Brook, New York, 11794, USA
| | - Robert Peyster
- Departments of Radiology, Stony Brook Medicine, 101 Nicolls Rd, Stony Brook, New York, 11794, USA
| | - Lev Bangiyev
- Departments of Radiology, Stony Brook Medicine, 101 Nicolls Rd, Stony Brook, New York, 11794, USA
| | - Tim Q Duong
- Departments of Radiology, Stony Brook Medicine, 101 Nicolls Rd, Stony Brook, New York, 11794, USA; Departments of Neurology, Stony Brook Medicine, 101 Nicolls Rd, Stony Brook, New York, 11794, USA.
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5
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Rahn AC, Köpke S, Stellmann JP, Schiffmann I, Lukas C, Chard D, Heesen C. Magnetic resonance imaging as a prognostic disability marker in clinically isolated syndrome: A systematic review. Acta Neurol Scand 2019; 139:18-32. [PMID: 30091223 DOI: 10.1111/ane.13010] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 07/30/2018] [Indexed: 11/30/2022]
Abstract
Magnetic resonance imaging (MRI) is the key prognostic tool in people with a clinically isolated syndrome (CIS). There is increasing interest in treating people following a CIS in the hope that conversion to multiple sclerosis (MS) will be prevented and future disability reduced. So far, the prognostic value of MRI for disability following a CIS has not been evaluated systematically. We systematically searched MEDLINE and EMBASE. Cohort studies were selected if they reported associations of MRI and disability following a CIS, included at least 50 people with a CIS at baseline, had at least 5 years of follow-up and obtained at least one structural MRI measurement (T1 lesions, T2 lesions, T1 contrast-enhancing lesions or brain atrophy). We assessed the studies for quality and rated the completeness of MRI reporting. In total, 13 studies were identified reporting on the following: T2 lesion number and volume, T2 infratentorial lesion number and volume, T1 contrast-enhancing lesions and grey matter fraction. T2 brain lesion number determined soon after the occurrence of a CIS was associated with disability progression after 5-7 years, with an increased risk when 10 or more lesions were present. Infratentorial lesions were also associated with a higher risk of subsequent disability. The number and distribution of MRI-visible lesions soon after a CIS are associated with disability later on, and may offer additional useful information when making treatment decisions in people with early MS. Further work is required to determine whether other measures have a higher predictive potential.
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Affiliation(s)
- Anne C. Rahn
- Institute of Neuroimmunology and Multiple Sclerosis; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - Sascha Köpke
- Nursing Research Unit; University of Lübeck; Lübeck Germany
| | - Jan-Patrick Stellmann
- Institute of Neuroimmunology and Multiple Sclerosis; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - Insa Schiffmann
- Institute of Neuroimmunology and Multiple Sclerosis; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - Carsten Lukas
- Department of Radiology; St. Josef Hospital Bochum; Ruhr University; Bochum Germany
| | - Declan Chard
- NMR Research Unit; Queen Square Multiple Sclerosis Centre; University College London (UCL); Institute of Neurology; London UK
- National Institute for Health Research (NIHR); University College London Hospitals (UCLH); Biomedical Research Centre; London UK
| | - Christoph Heesen
- Institute of Neuroimmunology and Multiple Sclerosis; University Medical Center Hamburg-Eppendorf; Hamburg Germany
- Department of Neurology; University Medical Center Hamburg-Eppendorf; Hamburg Germany
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6
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Forslin Y, Bergendal Å, Hashim F, Martola J, Shams S, Wiberg MK, Fredrikson S, Granberg T. Detection of Leukocortical Lesions in Multiple Sclerosis and Their Association with Physical and Cognitive Impairment: A Comparison of Conventional and Synthetic Phase-Sensitive Inversion Recovery MRI. AJNR Am J Neuroradiol 2018; 39:1995-2000. [PMID: 30262646 DOI: 10.3174/ajnr.a5815] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 08/02/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND PURPOSE Cortical lesions are common in multiple sclerosis and are included in the latest diagnostic criteria. The limited sensitivity of cortical MS lesions on conventional MR imaging can be improved by phase-sensitive inversion recovery. Synthetic MR imaging could provide phase-sensitive inversion recovery without additional scanning, but the use of synthetic phase-sensitive inversion recovery remains to be validated. We aimed to compare the ability and clinical value of detecting leukocortical lesions with conventional and synthetic phase-sensitive inversion recovery in MS. MATERIALS AND METHODS Twenty-one patients with MS prospectively underwent conventional and synthetic phase-sensitive inversion recovery, 3D T1-weighted, and T2 FLAIR imaging. Two neuroradiologists independently performed blinded phase-sensitive inversion recovery lesion assessments; a consensus rating with all sequences was considered the criterion standard. Lesion volumes were segmented. All participants underwent standardized cognitive and physical examinations and Fatigue Severity Scale assessment. Results were analyzed with multiple linear regressions. RESULTS Interrater and criterion standard agreement for leukocortical lesions was excellent for both conventional and synthetic phase-sensitive inversion recovery (intraclass correlation coefficient = 0.79-0.97). Leukocortical lesion volumes for both sequences were associated with lower information-processing speed (P ≤ .01) and verbal fluency (P ≤ .02). Both phase-sensitive inversion recovery sequences showed a positive effect on the association when combining volumes of leukocortical lesions and white matter lesions with information-processing speed (P ≤ .005) and verbal fluency (P ≤ .03). No associations were found between leukocortical lesion volumes and physical disability or fatigue. CONCLUSIONS Synthetic and conventional phase-sensitive inversion recovery have a sensitivity similar to that of leukocortical MS lesions. The detected leukocortical lesions are associated with cognitive dysfunction and thus provide clinically relevant information, which encourages assessment of cortical MS involvement at conventional field strengths.
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Affiliation(s)
- Y Forslin
- From the Departments of Clinical Science, Intervention and Technology (Y.F., Å.B., F.H., J.M., S.S., M.K.W., T.G.) .,Clinical Neuroscience (S.F.), Karolinska Institutet, Stockholm, Sweden
| | - Å Bergendal
- From the Departments of Clinical Science, Intervention and Technology (Y.F., Å.B., F.H., J.M., S.S., M.K.W., T.G.)
| | - F Hashim
- From the Departments of Clinical Science, Intervention and Technology (Y.F., Å.B., F.H., J.M., S.S., M.K.W., T.G.).,Clinical Neuroscience (S.F.), Karolinska Institutet, Stockholm, Sweden
| | - J Martola
- From the Departments of Clinical Science, Intervention and Technology (Y.F., Å.B., F.H., J.M., S.S., M.K.W., T.G.).,Clinical Neuroscience (S.F.), Karolinska Institutet, Stockholm, Sweden
| | - S Shams
- From the Departments of Clinical Science, Intervention and Technology (Y.F., Å.B., F.H., J.M., S.S., M.K.W., T.G.).,Clinical Neuroscience (S.F.), Karolinska Institutet, Stockholm, Sweden
| | - M K Wiberg
- From the Departments of Clinical Science, Intervention and Technology (Y.F., Å.B., F.H., J.M., S.S., M.K.W., T.G.).,Clinical Neuroscience (S.F.), Karolinska Institutet, Stockholm, Sweden
| | - S Fredrikson
- Clinical Neuroscience (S.F.), Karolinska Institutet, Stockholm, Sweden.,Neurology (S.F.), Karolinska University Hospital, Stockholm, Sweden
| | - T Granberg
- From the Departments of Clinical Science, Intervention and Technology (Y.F., Å.B., F.H., J.M., S.S., M.K.W., T.G.).,Clinical Neuroscience (S.F.), Karolinska Institutet, Stockholm, Sweden
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7
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8
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Yoo Y, Tang LYW, Li DKB, Metz L, Kolind S, Traboulsee AL, Tam RC. Deep learning of brain lesion patterns and user-defined clinical and MRI features for predicting conversion to multiple sclerosis from clinically isolated syndrome. COMPUTER METHODS IN BIOMECHANICS AND BIOMEDICAL ENGINEERING: IMAGING & VISUALIZATION 2017. [DOI: 10.1080/21681163.2017.1356750] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Youngjin Yoo
- Department of Electrical and Computer Engineering, University of British Columbia , Vancouver, Canada
- Biomedical Engineering Program, University of British Columbia , Vancouver, Canada
- MS/MRI Research Group, University of British Columbia , Vancouver, Canada
| | - Lisa Y. W. Tang
- Department of Radiology, University of British Columbia , Vancouver, Canada
- MS/MRI Research Group, University of British Columbia , Vancouver, Canada
| | - David K. B. Li
- Department of Radiology, University of British Columbia , Vancouver, Canada
- MS/MRI Research Group, University of British Columbia , Vancouver, Canada
| | - Luanne Metz
- Division of Neurology, University of Calgary , Calgary, Canada
| | - Shannon Kolind
- Division of Neurology, University of British Columbia , Vancouver, Canada
| | - Anthony L. Traboulsee
- Division of Neurology, University of British Columbia , Vancouver, Canada
- MS/MRI Research Group, University of British Columbia , Vancouver, Canada
| | - Roger C. Tam
- Biomedical Engineering Program, University of British Columbia , Vancouver, Canada
- Department of Radiology, University of British Columbia , Vancouver, Canada
- MS/MRI Research Group, University of British Columbia , Vancouver, Canada
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9
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Varma G, Girard OM, Prevost VH, Grant AK, Duhamel G, Alsop DC. In vivo measurement of a new source of contrast, the dipolar relaxation time, T 1D , using a modified inhomogeneous magnetization transfer (ihMT) sequence. Magn Reson Med 2016; 78:1362-1372. [PMID: 27859618 DOI: 10.1002/mrm.26523] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 09/27/2016] [Accepted: 10/01/2016] [Indexed: 02/04/2023]
Abstract
PURPOSE This paper describes a technique that can be used in vivo to measure the dipolar relaxation time, T1D , of macromolecular protons contributing to magnetization transfer (MT) in tissues and to produce quantitative T1D maps. THEORY AND METHODS The technique builds upon the inhomogeneous MT (ihMT) technique that is particularly sensitive to tissue components with long T1D . A standard ihMT experiment was altered to introduce a variable time for switching between positive and negative offset frequencies for RF saturation. A model for the dependence of ihMT was developed and used to fit data acquired in vivo. RESULTS Application of the method to images from brains of healthy volunteers produced values of T1D = (5.9 ± 1.2) ms in gray matter and T1D = (6.2 ± 0.4) ms in white matter regions and provided maps of the T1D parameter. CONCLUSION The model and experiments described provide access to a new relaxation characteristic of tissue with potentially unique diagnostic information. Magn Reson Med 78:1362-1372, 2017. © 2016 International Society for Magnetic Resonance in Medicine.
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Affiliation(s)
- Gopal Varma
- Department of Radiology, Division of MR Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Olivier M Girard
- Aix Marseille Université, CNRS, CRMBM-CEMEREM, UMR 7339, Marseille, France
| | - Valentin H Prevost
- Aix Marseille Université, CNRS, CRMBM-CEMEREM, UMR 7339, Marseille, France
| | - Aaron K Grant
- Department of Radiology, Division of MR Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Guillaume Duhamel
- Aix Marseille Université, CNRS, CRMBM-CEMEREM, UMR 7339, Marseille, France
| | - David C Alsop
- Department of Radiology, Division of MR Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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10
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von Gumberz J, Mahmoudi M, Young K, Schippling S, Martin R, Heesen C, Siemonsen S, Stellmann JP. Short-term MRI measurements as predictors of EDSS progression in relapsing-remitting multiple sclerosis: grey matter atrophy but not lesions are predictive in a real-life setting. PeerJ 2016; 4:e2442. [PMID: 27688965 PMCID: PMC5036070 DOI: 10.7717/peerj.2442] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 08/13/2016] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Magnetic resonance imaging (MRI) is the best biomarker of inflammatory disease activity in relapsing remitting Multiple Sclerosis (RRMS) so far but the association with disability is weak. Appearance of new MRI-lesions is used to evaluate response to immunotherapies in individual patients as well as being the most common primary outcome in phase-2 trials. Measurements of brain atrophy show promising outcomes in natural cohort studies and some phase-2 trials. From a theoretical perspective they might represent irreversible neurodegeneration and be more closely associated with disability. However, these atrophy measurements are not yet established as prognostic factors in real-life clinical routine. High field MRI has improved image quality and resolution and new methods to measure atrophy dynamics have become available. OBJECTIVE To investigate the predictive value of MRI classification criteria in to high/low atrophy and inflammation groups, and to explore predictive capacity of two consecutive routine MRI scans for disability progression in RRMS in a real-life prospective cohort. METHODS 82 RRMS-patients (40 untreated, 42 treated with immunotherapies, mean age 40 years, median Expanded Disability Status Scale (EDSS) of 2, underwent two clinically indicated MRI scans (3 Tesla) within 5-14 months, and EDSS assessment after a mean of 3.0 (1.5-4.2) years. We investigated the predictive value of predefined classifications in low/high inflammatory and atrophy groups for EDSS progression (≥1.5 if baseline EDSS = 0, ≥1.0 if baseline EDSS <5, ≥0.5 for other) by chi-square tests and by analysis of variance (ANOVA). The classifications were based on current scientific or clinical recommendation (e.g., treatment response criteria). Brain atrophy was assessed with three different methods (SIENA, SIENAX, and FreeSurfer). Post-hoc analyses aimed to explore clinical data and dynamics of MRI outcomes as predictors in multivariate linear and logit models. RESULTS Progression was observed in 24% of patients and was independent from treatment status. None of the predefined classifications were predictive for progression. Explorative post-hoc analyses found lower baseline EDSS and higher grey matter atrophy (FreeSurfer) as best predictors (R (2) = 0.29) for EDSS progression and the accuracy was overall good (Area under the curve = 0.81). CONCLUSION Beside EDSS at baseline, short-term grey matter atrophy is predictive for EDSS progression in treated and untreated RRMS. The development of atrophy measurements for individual risk counselling and evaluation of treatment response seems possible, but needs further validation in larger cohorts. MRI-atrophy estimates from the FreeSurfer toolbox seem to be more reliable than older methods.
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Affiliation(s)
- Johanna von Gumberz
- Institute of Neuroimmunology and MS (INIMS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Mina Mahmoudi
- Institute of Neuroimmunology and MS (INIMS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Kim Young
- Institute of Neuroimmunology and MS (INIMS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sven Schippling
- Neuroimmunology and Multiple Sclerosis Research Section, Department of Neurology, University Hospital Zürich, Zürich, Switzerland
| | - Roland Martin
- Neuroimmunology and Multiple Sclerosis Research Section, Department of Neurology, University Hospital Zürich, Zürich, Switzerland
| | - Christoph Heesen
- Institute of Neuroimmunology and MS (INIMS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Susanne Siemonsen
- Institute of Neuroimmunology and MS (INIMS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jan-Patrick Stellmann
- Institute of Neuroimmunology and MS (INIMS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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11
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Pokryszko-Dragan A, Dziadkowiak E, Zagrajek M, Slotwinski K, Gruszka E, Bilinska M, Podemski R. Cognitive performance, fatigue and event-related potentials in patients with clinically isolated syndrome. Clin Neurol Neurosurg 2016; 149:68-74. [PMID: 27484631 DOI: 10.1016/j.clineuro.2016.07.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 07/12/2016] [Accepted: 07/13/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Cognitive impairment and fatigue are regarded as important aspects of multiple sclerosis. The aim of this study was to evaluate cognitive performance, the level of fatigue and parameters of event-related potentials (ERP) in patients diagnosed with clinically isolated syndrome (CIS). PATIENTS AND METHODS The study comprised 44 patients with CIS and 45 healthy controls. Cognitive performance was assessed using the Brief Repeatable Battery of Neuropsychological Tests (BRBNT), fatigue - using the Fatigue Severity Scale (FSS) and Modified Fatigue Impact Scale (MFIS). Auditory ERP were performed and the parameters of N200 and P300 components were analyzed. Neuropsychological and electrophysiological measures were referred to clinical and radiological features of the disease activity. RESULTS Forty five% of patients failed in at least one test from BRBNT, mainly within the domains of memory and attention. In 18% of patients FSS corresponded with moderate or severe fatigue. The mean latency of N200 and P300 was significantly longer and amplitude of P300 was lower in those patients with CIS than in the controls. Significant correlations were found between the results of MFIS and tests evaluating verbal memory and attention, as well as between N200 latency and results of tests for verbal memory. CONCLUSIONS Cognitive performance and fatigue deserve attention from the earliest clinical stage of MS. Abnormalities of event-related potentials in CIS suggest early impact of the disease on functional neural networks.
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Affiliation(s)
| | | | | | | | - Ewa Gruszka
- Department of Neurology, Medical University of Wroclaw, Poland
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12
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Deep Learning of Brain Lesion Patterns for Predicting Future Disease Activity in Patients with Early Symptoms of Multiple Sclerosis. DEEP LEARNING AND DATA LABELING FOR MEDICAL APPLICATIONS 2016. [DOI: 10.1007/978-3-319-46976-8_10] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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13
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11C-acetate PET imaging in patients with multiple sclerosis. PLoS One 2014; 9:e111598. [PMID: 25369426 PMCID: PMC4219725 DOI: 10.1371/journal.pone.0111598] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 09/25/2014] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Activation of glial cells is a cardinal feature in multiple sclerosis (MS) pathology, and acetate has been reported to be selectively uptaken by astrocytes in the CNS. The aim of this study was to investigate the efficacy of PET with (11)C-acetate for MS diagnosis. MATERIALS AND METHODS Six patients with relapsing-remitting MS and 6 healthy volunteers (HV) were enrolled. The (11)C-acetate brain uptake on PET was measured in patients with MS and HV. Volume-of-interest analysis of cerebral gray and white matter based on the segmentation technique for co-registered MRI and voxel-based statistical parametric analysis were performed. Correlation between 11C-acetate uptake and the lesion number in T1- and T2- weighted MR images were also assessed. RESULTS The standardized uptake value (SUV) of 11C-acetate was increased in both white and gray matter in MS patients compared to HV. Voxel-based statistical analysis revealed a significantly increased SUV relative to that in the bilateral thalami (SUVt) in a broad area of white matter, particularly in the subcortical white matter of MS patients. The numbers of T2 lesions and T1 black holes were significantly correlated with SUV of (11)C-acetate in white and gray matter. CONCLUSIONS The 11C-acetate uptake significantly increased in MS patients and correlated to the number of MRI lesions. These preliminary data suggest that (11)C-acetate PET can be a useful clinical examination for MS patients.
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