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Rovira À, Doniselli FM, Auger C, Haider L, Hodel J, Severino M, Wattjes MP, van der Molen AJ, Jasperse B, Mallio CA, Yousry T, Quattrocchi CC. Use of gadolinium-based contrast agents in multiple sclerosis: a review by the ESMRMB-GREC and ESNR Multiple Sclerosis Working Group. Eur Radiol 2024; 34:1726-1735. [PMID: 37658891 DOI: 10.1007/s00330-023-10151-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 07/06/2023] [Accepted: 07/12/2023] [Indexed: 09/05/2023]
Abstract
Magnetic resonance imaging (MRI) is the most sensitive technique for detecting inflammatory demyelinating lesions in multiple sclerosis (MS) and plays a crucial role in diagnosis and monitoring treatment effectiveness, and for predicting the disease course. In clinical practice, detection of MS lesions is mainly based on T2-weighted and contrast-enhanced T1-weighted sequences. Contrast-enhancing lesions (CEL) on T1-weighted sequences are related to (sub)acute inflammation, while new or enlarging T2 lesions reflect the permanent footprint from a previous acute inflammatory demyelinating event. These two types of MRI features provide redundant information, at least in regular monitoring of the disease. Due to the concern of gadolinium deposition after repetitive injections of gadolinium-based contrast agents (GBCAs), scientific organizations and regulatory agencies in Europe and North America have proposed that these contrast agents should be administered only if clinically necessary. In this article, we provide data on the mode of action of GBCAs in MS, the indications of the use of these agents in clinical practice, their value in MS for diagnostic, prognostic, and monitoring purposes, and their use in specific populations (children, pregnant women, and breast-feeders). We discuss imaging strategies that achieve the highest sensitivity for detecting CELs in compliance with the safety regulations established by different regulatory agencies. Finally, we will briefly discuss some alternatives to the use of GBCA for detecting blood-brain barrier disruption in MS lesions. CLINICAL RELEVANCE STATEMENT: Although use of GBCA at diagnostic workup of suspected MS is highly valuable for diagnostic and prognostic purposes, their use in routine monitoring is not mandatory and must be reduced, as detection of disease activity can be based on the identification of new or enlarging lesions on T2-weighted images. KEY POINTS: • Both the EMA and the FDA state that the use of GBCA in medicine should be restricted to clinical scenarios in which the additional information offered by the contrast agent is required. • The use of GBCA is generally recommended in the diagnostic workup in subjects with suspected MS and is generally not necessary for routine monitoring in clinical practice. • Alternative MRI-based approaches for detecting acute focal inflammatory MS lesions are not yet ready to be used in clinical practice.
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Affiliation(s)
- Àlex Rovira
- Section of Neuroradiology, Department of Radiology, University Hospital Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain.
| | - Fabio M Doniselli
- Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Cristina Auger
- Section of Neuroradiology, Department of Radiology, University Hospital Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain
| | - Lukas Haider
- Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Vienna, Austria
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Jerome Hodel
- Department of Radiology, Groupe Hospitalier Paris-Saint Joseph, Paris, France
| | | | - Mike P Wattjes
- Department of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany
| | | | - Bas Jasperse
- Department of Radiology and Nuclear Medicine, MS Center Amsterdam, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Carlo A Mallio
- Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
- Research Unit of Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico Di Roma, Rome, Italy
| | - Tarek Yousry
- Lysholm Department of Neuroradiology, UCLH National Hospital for Neurology and Neurosurgery, Neuroradiological Academic Unit, UCL Institute of Neurology, London, UK
| | - Carlo C Quattrocchi
- Centre for Medical Sciences CISMed, University of Trento, Trento, Italy
- Radiology, Multizonal Unit of Rovereto and Arco, APSS Provincia Autonoma Di Trento, Trento, Italy
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Cruz A, Pereira D, Batista S. [Use of Gadolinium in Follow-Up MRI of Multiple Sclerosis Patients: Current Recommendations]. ACTA MEDICA PORT 2024; 37:53-63. [PMID: 38183232 DOI: 10.20344/amp.20467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 10/30/2023] [Indexed: 01/07/2024]
Abstract
Multiple sclerosis is the most frequent demyelinating disease of the central nervous system and is characterized by early onset and progressive disability. Magnetic resonance imaging, due to its high sensitivity and specificity in the detection of demyelinating lesions, is the most useful diagnostic test for this disease, with the administration of gadolinium-based contrast agents being an important contribution to imaging interpretation. Although contrast is essential for diagnostic purposes, its routine use in monitoring disease activity, response to treatment, and related complications is controversial. This article aims to collate current recommendations regarding the use of gadolinium in the imaging follow-up of multiple sclerosis and establish effective and safe guidelines for clinical practice. The literature review was conducted in PubMed, using the terms 'multiple sclerosis', 'magnetic resonance imaging' and 'gadolinium', or 'contrast media'. Articles published between January 2013 and January 2023 concerning the safety of gadolinium and the use of these contrast agents in follow-up scans of adult patients diagnosed with multiple sclerosis were selected. Although no biological or clinical consequences have been unequivocally attributed to the retention of gadolinium in the brain, which were mostly reported with linear agents, health authorities have been recommending the restriction of contrast to essential clinical circumstances. In multiple sclerosis, the detection of subclinical contrast-enhancing lesions with no corresponding new/ enlarging T2-WI lesions is rare and has a questionable impact on therapeutic decisions. On the other hand, gadolinium has a higher sensitivity in the differential diagnosis of relapses, in the detection of recent disease activity, before and after treatment initiation, and in patients with a large lesion burden or diffuse/confluent T2-WI lesions. Contrary to progressive multifocal leukoencephalopathy screening, monitoring of immune restitution inflammatory syndrome also benefits from the administration of gadolinium. It is feasible and safe to exclude gadolinium-based contrast agents from routine follow-up scans of multiple sclerosis, despite their additional contribution in specific clinical circumstances that should be acknowledged by the neurologist and neuroradiologist.
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Affiliation(s)
- Andreia Cruz
- Faculdade de Medicina. Universidade de Coimbra. Coimbra. Portugal
| | - Daniela Pereira
- Área Funcional de Neurorradiologia. Serviço de Imagem Médica. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal
| | - Sónia Batista
- Faculdade de Medicina. Universidade de Coimbra. Coimbra; Serviço de Neurologia. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal
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Fernandes L, Allen CM, Williams T, Tallantyre E, Evangelou N, Chataway J, Ford HL. The contemporary role of MRI in the monitoring and management of people with multiple sclerosis in the UK. Mult Scler Relat Disord 2021; 55:103190. [PMID: 34365316 DOI: 10.1016/j.msard.2021.103190] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 07/28/2021] [Accepted: 08/01/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Compare the contemporary use of magnetic resonance imaging (MRI) in the monitoring and management of people with MS in the UK to current consensus guidelines. METHODS This retrospective multicentre audit of clinical practice gathered data on 2567 patients with MS from 25 MS centres across the UK. RESULTS Routine monitoring (44.7%), and recent clinical relapse (20.3%) were the most common scan indications. In routine monitoring, the addition of spinal imaging to brain showed no significant difference in disease modifying treatment (DMT) decision at subsequent clinical review. Approximately 1 in 5 gadolinium administered scans showed enhancement, and in 1 in 20 patients, gadolinium enhancement was the only evidence of radiological disease activity. Mean inter-scan intervals in relapsing-remitting MS for routine monitoring was 19.2 months (SD 20.7) with wide variation between centres. Only 53.8% of patients under progressive multifocal leukoencephalopathy (PML) surveillance met the recommended scanning frequency. MRI protocols demonstrated heterogeneity in the sequences used for diagnostic, monitoring and PML surveillance scans. CONCLUSIONS MS centres across the UK demonstrate varied practice and protocols when using MRI to monitor people with MS. In this cohort, gadolinium use and spinal imaging demonstrates limited impact on subsequent DMT decisions.
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Affiliation(s)
| | | | - Thomas Williams
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
| | | | | | - Jeremy Chataway
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
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Zarei F, Ghaedian M, Ghaedian T. The role of contrast-enhanced and non-contrast-enhanced MRI in the follow-up of multiple sclerosis. Acta Radiol 2021; 62:916-921. [PMID: 32762243 DOI: 10.1177/0284185120946714] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Magnetic resonance imaging (MRI) is widely used in patients with multiple sclerosis (MS) for different indications. However, frequent administration of gadolinium in these patients can have some potential complications. So, a more limited approach reducing the use of gadolinium should be considered. PURPOSE To evaluate the additional benefits of contrast-enhanced MRI over non-contrast-enhanced MRI in routine follow-up of patients with MS. MATERIAL AND METHODS This is a retrospective cohort study including patients with MS who underwent both contrast-enhanced and non-contrast-enhanced MRI for two time-points with an interval of at least six months. Non-contrast-enhanced images were compared for each patient and interpreted as non-progressive or progressive disease. Then, rate and type of enhancing lesions were analyzed and compared between the groups. All images were reviewed and compared visually by two radiologists. RESULTS A total of 462 patients (392 women; mean age = 36 years) were included. Of these patients, 352 were in the non-progressive group and 112 were in progressive group. Comparison of baseline and follow-up contrast-enhanced MRIs revealed that 13 (3.7%) patients in the non-progressive group and 58 (51.8%) patients in progressive group developed enhancing lesions (P < 0.001). All 58 patients in the progressive group developed new enhancing lesions, whereas all those in the non-progressive group revealed persistent or reactivated enhancing lesions without evidence of new lesions. CONCLUSION According to the very low incidence rate of new enhancing lesions in patients with non-progressive disease on follow-up non-contrast-enhanced MRI, routine administration of contrast in follow-up studies is not suggested.
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Affiliation(s)
- Fariba Zarei
- Department of Radiology, Medical Imaging Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehrnaz Ghaedian
- Department of Radiology, Namazi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Tahereh Ghaedian
- Nuclear Medicine and Molecular Imaging Research Center, Namazi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
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Herrmann CJJ, Els A, Boehmert L, Periquito J, Eigentler TW, Millward JM, Waiczies S, Kuchling J, Paul F, Niendorf T. Simultaneous T 2 and T 2 ∗ mapping of multiple sclerosis lesions with radial RARE-EPI. Magn Reson Med 2021; 86:1383-1402. [PMID: 33951214 DOI: 10.1002/mrm.28811] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 03/26/2021] [Accepted: 03/26/2021] [Indexed: 12/26/2022]
Abstract
PURPOSE The characteristic MRI features of multiple sclerosis (MS) lesions make it conceptually appealing to pursue parametric mapping techniques that support simultaneous generation of quantitative maps of 2 or more MR contrast mechanisms. We present a modular rapid acquisition with relaxation enhancement (RARE)-EPI hybrid that facilitates simultaneous T2 and T 2 ∗ mapping (2in1-RARE-EPI). METHODS In 2in1-RARE-EPI the first echoes in the echo train are acquired with a RARE module, later echoes are acquired with an EPI module. To define the fraction of echoes covered by the RARE and EPI module, an error analysis of T2 and T 2 ∗ was conducted with Monte Carlo simulations. Radial k-space (under)sampling was implemented for acceleration (R = 2). The feasibility of 2in1-RARE-EPI for simultaneous T2 and T 2 ∗ mapping was examined in a phantom study mimicking T2 and T 2 ∗ relaxation times of the brain. For validation, 2in1-RARE-EPI was benchmarked versus multi spin-echo (MSE) and multi gradient-echo (MGRE) techniques. The clinical applicability of 2in1-RARE-EPI was demonstrated in healthy subjects and MS patients. RESULTS There was a good agreement between T2 / T 2 ∗ values derived from 2in1-RARE-EPI and T2 / T 2 ∗ reference values obtained from MSE and MGRE in both phantoms and healthy subjects. In patients, MS lesions in T2 and T 2 ∗ maps deduced from 2in1-RARE-EPI could be just as clearly delineated as in reference maps calculated from MSE/MGRE. CONCLUSION This work demonstrates the feasibility of radially (under)sampled 2in1-RARE-EPI for simultaneous T2 and T 2 ∗ mapping in MS patients.
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Affiliation(s)
- Carl J J Herrmann
- Berlin Ultrahigh Field Facility (B.U.F.F.), Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany.,Department of Physics, Humboldt University of Berlin, Berlin, Germany
| | - Antje Els
- Berlin Ultrahigh Field Facility (B.U.F.F.), Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
| | - Laura Boehmert
- Berlin Ultrahigh Field Facility (B.U.F.F.), Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
| | - Joao Periquito
- Berlin Ultrahigh Field Facility (B.U.F.F.), Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
| | - Thomas Wilhelm Eigentler
- Berlin Ultrahigh Field Facility (B.U.F.F.), Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany.,Chair of Medical Engineering, Technical University of Berlin, Berlin, Germany
| | - Jason M Millward
- Berlin Ultrahigh Field Facility (B.U.F.F.), Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
| | - Sonia Waiczies
- Berlin Ultrahigh Field Facility (B.U.F.F.), Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
| | - Joseph Kuchling
- Experimental and Clinical Research Center, a joint cooperation between the Charité Medical Faculty and the Max Delbrück Center for Molecular Medicine, Berlin, Germany.,NeuroCure Clinical Research Center, Charité-Universitätsmedizin, Berlin, Germany.,Department of Neurology, Charité-Universitätsmedizin, Berlin, Germany
| | - Friedemann Paul
- Experimental and Clinical Research Center, a joint cooperation between the Charité Medical Faculty and the Max Delbrück Center for Molecular Medicine, Berlin, Germany.,NeuroCure Clinical Research Center, Charité-Universitätsmedizin, Berlin, Germany.,Department of Neurology, Charité-Universitätsmedizin, Berlin, Germany
| | - Thoralf Niendorf
- Berlin Ultrahigh Field Facility (B.U.F.F.), Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany.,Experimental and Clinical Research Center, a joint cooperation between the Charité Medical Faculty and the Max Delbrück Center for Molecular Medicine, Berlin, Germany
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6
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Thaler C, Kyselyova AA, Faizy TD, Nawka MT, Jespersen S, Hansen B, Stellmann JP, Heesen C, Stürner KH, Stark M, Fiehler J, Bester M, Gellißen S. Heterogeneity of multiple sclerosis lesions in fast diffusional kurtosis imaging. PLoS One 2021; 16:e0245844. [PMID: 33539364 PMCID: PMC7861404 DOI: 10.1371/journal.pone.0245844] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 01/09/2021] [Indexed: 12/14/2022] Open
Abstract
Background Mean kurtosis (MK), one of the parameters derived from diffusion kurtosis imaging (DKI), has shown increased sensitivity to tissue microstructure damage in several neurological disorders. Methods Thirty-seven patients with relapsing-remitting MS and eleven healthy controls (HC) received brain imaging on a 3T MR scanner, including a fast DKI sequence. MK and mean diffusivity (MD) were measured in the white matter of HC, normal-appearing white matter (NAWM) of MS patients, contrast-enhancing lesions (CE-L), FLAIR lesions (FLAIR-L) and black holes (BH). Results Overall 1529 lesions were analyzed, including 30 CE-L, 832 FLAIR-L and 667 BH. Highest MK values were obtained in the white matter of HC (0.814 ± 0.129), followed by NAWM (0.724 ± 0.137), CE-L (0.619 ± 0.096), FLAIR-L (0.565 ± 0.123) and BH (0.549 ± 0.12). Lowest MD values were obtained in the white matter of HC (0.747 ± 0.068 10−3mm2/sec), followed by NAWM (0.808 ± 0.163 10−3mm2/sec), CE-L (0.853 ± 0.211 10−3mm2/sec), BH (0.957 ± 0.304 10−3mm2/sec) and FLAIR-L (0.976 ± 0.35 10−3mm2/sec). While MK differed significantly between CE-L and non-enhancing lesions, MD did not. Conclusion MK adds predictive value to differentiate between MS lesions and might provide further information about diffuse white matter injury and lesion microstructure.
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Affiliation(s)
- Christian Thaler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- * E-mail:
| | - Anna A. Kyselyova
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tobias D. Faizy
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marie T. Nawka
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sune Jespersen
- Department of Clinical Medicine - Center of Functionally Integrative Neuroscience, Aarhus University, Aarhus, Denmark
| | - Brian Hansen
- Department of Clinical Medicine - Center of Functionally Integrative Neuroscience, Aarhus University, Aarhus, Denmark
| | - Jan-Patrick Stellmann
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Institute for Neuroimmunology and Clinical MS Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- APHM, Hospital de la Timone, CEMEREM, Marseille, France
- Aix Marseille University, CNRS, CRMBM, UMR 7339, Marseille, France
| | - Christoph Heesen
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Institute for Neuroimmunology and Clinical MS Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Klarissa H. Stürner
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Institute for Neuroimmunology and Clinical MS Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Maria Stark
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Maxim Bester
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Susanne Gellißen
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Vinayagamani S, Sabarish S, Nair SS, Tandon V, Kesavadas C, Thomas B. Quantitative susceptibility-weighted imaging in predicting disease activity in multiple sclerosis. Neuroradiology 2021; 63:1061-1069. [PMID: 33403447 DOI: 10.1007/s00234-020-02605-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 11/10/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE Repeated use of Gadolinium (Gd) contrast for multiple sclerosis (MS) imaging leads to Gd deposition in brain. We aimed to study the utility of phase values by susceptibility weighted imaging (SWI) to assess the iron content in MS lesions to differentiate active and inactive lesions. METHODS MS persons who underwent MRI were grouped into group 1 with active lesions and group 2 with inactive lesions based on the presence or absence of contrast enhancing lesions. Phase values of lesions (PL) and contralateral normal white matter (PN) were calculated using the SPIN software by drawing ROI. Subtracted phase values (PS = PL - PN) and iron content (PS/3) of the lesions were calculated in both groups. RESULTS We analyzed 69 enhancing lesions from 22 patients (group 1) and 84 non-enhancing lesions from 29 patients (group 2). Mean-subtracted phase values and iron content corrected for voxels in ROI were significantly lower in enhancing lesions compared to non-enhancing lesions (p < 0.001). A cut-off value 2.8 μg/g for iron content showed area under the curve of 0.909 with good sensitivity. CONCLUSION Quantification of iron content using SWI phase values holds promise as a biomarker to differentiate active from inactive lesions of MS.
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Affiliation(s)
- Selvadasan Vinayagamani
- Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, 695011, India
| | - Sekar Sabarish
- Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, 695011, India
| | - Sruthi S Nair
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, 695011, India
| | - Vaibhav Tandon
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, 695011, India
| | - Chandrasekharan Kesavadas
- Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, 695011, India
| | - Bejoy Thomas
- Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, 695011, India.
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Lu PJ, Yoo Y, Rahmanzadeh R, Galbusera R, Weigel M, Ceccaldi P, Nguyen TD, Spincemaille P, Wang Y, Daducci A, La Rosa F, Bach Cuadra M, Sandkühler R, Nael K, Doshi A, Fayad ZA, Kuhle J, Kappos L, Odry B, Cattin P, Gibson E, Granziera C. GAMER MRI: Gated-attention mechanism ranking of multi-contrast MRI in brain pathology. NEUROIMAGE-CLINICAL 2020; 29:102522. [PMID: 33360973 PMCID: PMC7773673 DOI: 10.1016/j.nicl.2020.102522] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 11/11/2020] [Accepted: 11/30/2020] [Indexed: 12/24/2022]
Abstract
INTRODUCTION During the last decade, a multitude of novel quantitative and semiquantitative MRI techniques have provided new information about the pathophysiology of neurological diseases. Yet, selection of the most relevant contrasts for a given pathology remains challenging. In this work, we developed and validated a method, Gated-Attention MEchanism Ranking of multi-contrast MRI in brain pathology (GAMER MRI), to rank the relative importance of MR measures in the classification of well understood ischemic stroke lesions. Subsequently, we applied this method to the classification of multiple sclerosis (MS) lesions, where the relative importance of MR measures is less understood. METHODS GAMER MRI was developed based on the gated attention mechanism, which computes attention weights (AWs) as proxies of importance of hidden features in the classification. In the first two experiments, we used Trace-weighted (Trace), apparent diffusion coefficient (ADC), Fluid-Attenuated Inversion Recovery (FLAIR), and T1-weighted (T1w) images acquired in 904 acute/subacute ischemic stroke patients and in 6,230 healthy controls and patients with other brain pathologies to assess if GAMER MRI could produce clinically meaningful importance orders in two different classification scenarios. In the first experiment, GAMER MRI with a pretrained convolutional neural network (CNN) was used in conjunction with Trace, ADC, and FLAIR to distinguish patients with ischemic stroke from those with other pathologies and healthy controls. In the second experiment, GAMER MRI with a patch-based CNN used Trace, ADC and T1w to differentiate acute ischemic stroke lesions from healthy tissue. The last experiment explored the performance of patch-based CNN with GAMER MRI in ranking the importance of quantitative MRI measures to distinguish two groups of lesions with different pathological characteristics and unknown quantitative MR features. Specifically, GAMER MRI was applied to assess the relative importance of the myelin water fraction (MWF), quantitative susceptibility mapping (QSM), T1 relaxometry map (qT1), and neurite density index (NDI) in distinguishing 750 juxtacortical lesions from 242 periventricular lesions in 47 MS patients. Pair-wise permutation t-tests were used to evaluate the differences between the AWs obtained for each quantitative measure. RESULTS In the first experiment, we achieved a mean test AUC of 0.881 and the obtained AWs of FLAIR and the sum of AWs of Trace and ADC were 0.11 and 0.89, respectively, as expected based on previous knowledge. In the second experiment, we achieved a mean test F1 score of 0.895 and a mean AW of Trace = 0.49, of ADC = 0.28, and of T1w = 0.23, thereby confirming the findings of the first experiment. In the third experiment, MS lesion classification achieved test balanced accuracy = 0.777, sensitivity = 0.739, and specificity = 0.814. The mean AWs of T1map, MWF, NDI, and QSM were 0.29, 0.26, 0.24, and 0.22 (p < 0.001), respectively. CONCLUSIONS This work demonstrates that the proposed GAMER MRI might be a useful method to assess the relative importance of MRI measures in neurological diseases with focal pathology. Moreover, the obtained AWs may in fact help to choose the best combination of MR contrasts for a specific classification problem.
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Affiliation(s)
- Po-Jui Lu
- Translational Imaging in Neurology (ThINk) Basel, Department of Medicine and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland; Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland; Research Center for Clinical Neuroimmunology and Neuroscience Basel, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Youngjin Yoo
- Digital Technology and Innovation, Siemens Healthineers, Princeton, NJ, USA
| | - Reza Rahmanzadeh
- Translational Imaging in Neurology (ThINk) Basel, Department of Medicine and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland; Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland; Research Center for Clinical Neuroimmunology and Neuroscience Basel, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Riccardo Galbusera
- Translational Imaging in Neurology (ThINk) Basel, Department of Medicine and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland; Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland; Research Center for Clinical Neuroimmunology and Neuroscience Basel, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Matthias Weigel
- Translational Imaging in Neurology (ThINk) Basel, Department of Medicine and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland; Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland; Research Center for Clinical Neuroimmunology and Neuroscience Basel, University Hospital Basel and University of Basel, Basel, Switzerland; Division of Radiological Physics, Department of Radiology, University Hospital Basel, Basel, Switzerland
| | - Pascal Ceccaldi
- Digital Technology and Innovation, Siemens Healthineers, Princeton, NJ, USA
| | - Thanh D Nguyen
- Department of Radiology, Weill Cornell Medical College, New York, NY, USA
| | | | - Yi Wang
- Department of Radiology, Weill Cornell Medical College, New York, NY, USA
| | | | - Francesco La Rosa
- Signal Processing Laboratory (LTS5), Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland; Medical Image Analysis Laboratory, Center for Biomedical Imaging (CIBM), University of Lausanne, Lausanne, Switzerland; Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Meritxell Bach Cuadra
- Signal Processing Laboratory (LTS5), Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland; Medical Image Analysis Laboratory, Center for Biomedical Imaging (CIBM), University of Lausanne, Lausanne, Switzerland; Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Robin Sandkühler
- Center for Medical Image Analysis & Navigation, Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland
| | - Kambiz Nael
- Department of Radiological Sciences, David Geffen School of Medicine at University of California, Los Angeles, CA, USA; Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Amish Doshi
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Zahi A Fayad
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; BioMedical Engineering and Imaging Institute, Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jens Kuhle
- Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland; Research Center for Clinical Neuroimmunology and Neuroscience Basel, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Ludwig Kappos
- Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland; Research Center for Clinical Neuroimmunology and Neuroscience Basel, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Benjamin Odry
- AI for Clinical Analytics, Covera Health, New York, NY, USA
| | - Philippe Cattin
- Center for Medical Image Analysis & Navigation, Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland
| | - Eli Gibson
- Digital Technology and Innovation, Siemens Healthineers, Princeton, NJ, USA
| | - Cristina Granziera
- Translational Imaging in Neurology (ThINk) Basel, Department of Medicine and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland; Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland; Research Center for Clinical Neuroimmunology and Neuroscience Basel, University Hospital Basel and University of Basel, Basel, Switzerland
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9
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Di Stadio A, Ralli M, Altieri M, Greco A, Messineo D, Bernitsas E. Audiovestibular symptoms in patients with multiple sclerosis: A correlation between self-reported symptomatology and MRI findings to monitor disease progression. Mult Scler Relat Disord 2020; 45:102431. [DOI: 10.1016/j.msard.2020.102431] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 07/18/2020] [Accepted: 07/29/2020] [Indexed: 10/23/2022]
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10
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McCreary CR, Salluzzi M, Andersen LB, Gobbi D, Lauzon L, Saad F, Smith EE, Frayne R. Calgary Normative Study: design of a prospective longitudinal study to characterise potential quantitative MR biomarkers of neurodegeneration over the adult lifespan. BMJ Open 2020; 10:e038120. [PMID: 32792445 PMCID: PMC7430487 DOI: 10.1136/bmjopen-2020-038120] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION A number of MRI methods have been proposed to be useful, quantitative biomarkers of neurodegeneration in ageing. The Calgary Normative Study (CNS) is an ongoing single-centre, prospective, longitudinal study that seeks to develop, test and assess quantitative magnetic resonance (MR) methods as potential biomarkers of neurodegeneration. The CNS has three objectives: first and foremost, to evaluate and characterise the dependence of the selected quantitative neuroimaging biomarkers on age over the adult lifespan; second, to evaluate the precision, variability and repeatability of quantitative neuroimaging biomarkers as part of biomarker validation providing proof-of-concept and proof-of-principle; and third, provide a shared repository of normative data for comparison to various disease cohorts. METHODS AND ANALYSIS Quantitative MR mapping of the brain including longitudinal relaxation time (T1), transverse relaxation time (T2), T2*, magnetic susceptibility (QSM), diffusion and perfusion measurements, as well as morphological assessments are performed. The Montreal Cognitive Assessment (MoCA) and a brief, self-report medical history will be collected. Mixed regression models will be used to characterise changes in quantitative MR biomarker measures over the adult lifespan. In this report, we describe the study design, strategies to recruit and perform changes to the acquisition protocol from inception to 31 December 2018, planned statistical approach and data sharing procedures for the study. ETHICS AND DISSEMINATION Participants provide signed informed consent. Changes in quantitative MR biomarkers measured over the adult lifespan as well as estimates of measurement variance and repeatability will be disseminated through peer-reviewed scientific publication.
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Affiliation(s)
- Cheryl R McCreary
- Departments of Clinical Neurosciences and Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Seaman Family MR Research Centre, University of Calgary, Calgary, Alberta, Canada
| | - Marina Salluzzi
- Departments of Clinical Neurosciences and Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Calgary Image Analysis and Processing Centre, University of Calgary, Calgary, Alberta, Canada
| | - Linda B Andersen
- Departments of Clinical Neurosciences and Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - David Gobbi
- Departments of Clinical Neurosciences and Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Calgary Image Analysis and Processing Centre, University of Calgary, Calgary, Alberta, Canada
| | - Louis Lauzon
- Departments of Clinical Neurosciences and Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Seaman Family MR Research Centre, University of Calgary, Calgary, Alberta, Canada
| | - Feryal Saad
- Departments of Clinical Neurosciences and Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Eric E Smith
- Departments of Clinical Neurosciences and Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Seaman Family MR Research Centre, University of Calgary, Calgary, Alberta, Canada
| | - Richard Frayne
- Departments of Clinical Neurosciences and Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Seaman Family MR Research Centre, University of Calgary, Calgary, Alberta, Canada
- Calgary Image Analysis and Processing Centre, University of Calgary, Calgary, Alberta, Canada
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11
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Eichinger P, Zimmer C, Wiestler B. AI in Radiology: Where are we today in Multiple Sclerosis Imaging? ROFO-FORTSCHR RONTG 2020; 192:847-853. [DOI: 10.1055/a-1167-8402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background MR imaging is an essential component in managing patients with Multiple sclerosis (MS). This holds true for the initial diagnosis as well as for assessing the clinical course of MS. In recent years, a growing number of computer tools were developed to analyze imaging data in MS. This review gives an overview of the most important applications with special emphasis on artificial intelligence (AI).
Methods Relevant studies were identified through a literature search in recognized databases, and through parsing the references in studies found this way. Literature published as of November 2019 was included with a special focus on recent studies from 2018 and 2019.
Results There are a number of studies which focus on optimizing lesion visualization and lesion segmentation. Some of these studies accomplished these tasks with high accuracy, enabling a reproducible quantitative analysis of lesion loads. Some studies took a radiomics approach and aimed at predicting clinical endpoints such as the conversion from a clinically isolated syndrome to definite MS. Moreover, recent studies investigated synthetic imaging, i. e. imaging data that is not measured during an MR scan but generated by a computer algorithm to optimize the contrast between MS lesions and brain parenchyma.
Conclusion Computer-based image analysis and AI are hot topics in imaging MS. Some applications are ready for use in clinical routine. A major challenge for the future is to improve prediction of expected disease courses and thereby helping to find optimal treatment decisions on an individual level. With technical improvements, more questions arise about the integration of new tools into the radiological workflow.
Key Points:
Citation Format
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Affiliation(s)
- Paul Eichinger
- Department of Radiology, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - Claus Zimmer
- Department of Neuroradiology, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - Benedikt Wiestler
- Department of Neuroradiology, Klinikum rechts der Isar der Technischen Universität München, München, Germany
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12
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Affiliation(s)
- Cristina Granziera
- Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland/Translational Imaging in Neurology (ThINk) Basel, Department of Medicine and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Daniel S Reich
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD, USA
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13
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Prosperini L, Mancinelli C, Haggiag S, Cordioli C, De Giglio L, De Rossi N, Galgani S, Rasia S, Ruggieri S, Tortorella C, Pozzilli C, Gasperini C. Minimal evidence of disease activity (MEDA) in relapsing-remitting multiple sclerosis. J Neurol Neurosurg Psychiatry 2020; 91:271-277. [PMID: 31974130 DOI: 10.1136/jnnp-2019-322348] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 12/17/2019] [Accepted: 12/22/2019] [Indexed: 11/04/2022]
Abstract
OBJECTIVE This study aimed to define the minimal evidence of disease activity (MEDA) during treatment that can be tolerated without exposing patients with relapsing-remitting multiple sclerosis at risk of long-term disability. METHODS We retrospectively collected data of patients followed up to 10 years after starting interferon beta or glatiramer acetate. Survival analyses explored the association between the long-term risk of reaching an Expanded Disability Status Scale≥6.0 and early clinical and MRI activity assessed after the first and second year of treatment. Early disease activity was classified by the so-called 'MAGNIMS score' (low: no relapses and <3 new T2 lesions; medium: no relapses and ≥3 new T2 lesions or 1 relapse and 0-2 new T2 lesions; high: 1 relapse and ≥3 new T2 lesions or ≥2 relapses) and the absence or presence of contrast-enhancing lesions (CELs). RESULTS At follow-up, 148/1036 (14.3%) patients reached the outcome: 61/685 (8.9%) with low score (reference category), 57/241 (23.7%) with medium score (HR=1.94, p=0.002) and 30/110 (27.3%) with high score (HR=2.47, p<0.001) after the first year of treatment. In the low score subgroup, the risk was further reduced in the absence (49/607, 8.1%) than in the presence of CELs (12/78, 15.4%; HR=2.11, p=0.01). No evident disease activity and low score in the absence of CELs shared the same risk (p=0.54). Similar findings were obtained even after the second year of treatment. CONCLUSIONS Early marginal MRI activity of one to two new T2 lesions, in the absence of both relapses and CELs, is associated with a minor risk of future disability, thus representing a simple and valuable definition for MEDA.
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Affiliation(s)
- Luca Prosperini
- Multiple Sclerosis Center, San Camillo-Forlanini Hospital, Roma, Italy
| | - Chiara Mancinelli
- Multiple Sclerosis Center, Spedali Civili di Brescia, Presidio di Montichiari, Brescia, Italy
| | - Shalom Haggiag
- Multiple Sclerosis Center, San Camillo-Forlanini Hospital, Roma, Italy
| | - Cinzia Cordioli
- Multiple Sclerosis Center, Spedali Civili di Brescia, Presidio di Montichiari, Brescia, Italy
| | - Laura De Giglio
- Dept. of Human Neuroscience, Sapienza University, Rome, Italy.,Neurology Unit, San Filippo Neri Hospital, Rome, Italy
| | - Nicola De Rossi
- Multiple Sclerosis Center, Spedali Civili di Brescia, Presidio di Montichiari, Brescia, Italy
| | - Simonetta Galgani
- Multiple Sclerosis Center, San Camillo-Forlanini Hospital, Roma, Italy
| | - Sarah Rasia
- Multiple Sclerosis Center, Spedali Civili di Brescia, Presidio di Montichiari, Brescia, Italy
| | - Serena Ruggieri
- Multiple Sclerosis Center, San Camillo-Forlanini Hospital, Roma, Italy.,Dept. of Human Neuroscience, Sapienza University, Rome, Italy
| | - Carla Tortorella
- Multiple Sclerosis Center, San Camillo-Forlanini Hospital, Roma, Italy
| | - Carlo Pozzilli
- Dept. of Human Neuroscience, Sapienza University, Rome, Italy.,Multiple Sclerosis Center, Sant'Andrea Hospital, Rome, Italy
| | - Claudio Gasperini
- Multiple Sclerosis Center, San Camillo-Forlanini Hospital, Roma, Italy
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14
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Unal S, Peker E, Erdogan S, Erden MI. Is It Possible to Discriminate Active MS Lesions with Diffusion Weighted Imaging? Eurasian J Med 2019; 51:219-223. [PMID: 31692763 DOI: 10.5152/eurasianjmed.2019.18473] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective Patients with multiple sclerosis (MS) are at a risk of gadolinium deposition because of multiple control imaging. Therefore, it is important to determine biomarkers that can differentiate active and chronic lesions without using contrast agent. This study aimed to assess mean apparent diffusion coefficient (ADC) values and signal intensities (SI) on diffusion weighted imaging (DWI) values of active and nonactive lesions. Materials and Methods We included 25 patients in this study. We measured mean ADC values and SI on DWI of the randomly selected active and nonactive lesions and normal appearing white matter (NAWM) for all patients with MS. SI on DWI and ADC values were normalized to the SI of the CSF. We compared all of the measurements between active and nonactive lesions, active lesions and NAWM, and nonactive lesions and NAWM. SI on DWI and mean ADC values of normal healthy white matter (NHWM) of control group were measured. A comparison was made between NHWM and NAWM. Results For patients with active lesions, the mean nADC value was 0.35±0.06 for active lesions and 0.30±0.07 for nonactive lesions (p>0.050). The mean nDWI-SI value was 3.69±0.68 for active lesions was 3.39±0.68 for nonactive lesions (p<0.050). When patients with and without active lesions were compared, both nDWI values and nADC values for active and nonactive lesions were statistically insignificant (p>0.050). Discussion In MS lesions, diffusion alternations can be quantitatively evaluated with ADC mapping. Lesions seen in patients with MS have higher mean ADC values than NAWM and NHWM.
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Affiliation(s)
- Sena Unal
- Department of Radiology, Ankara University School of Medicine, Ankara, Turkey
| | - Elif Peker
- Department of Radiology, Ankara University School of Medicine, Ankara, Turkey
| | - Seyda Erdogan
- Department of Neurology, Ankara University School of Medicine, Ankara, Turkey
| | - Memet Ilhan Erden
- Department of Radiology, Ankara University School of Medicine, Ankara, Turkey
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15
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Wang KY, Carlton J, Guffey D, Hutton GJ, Moron FE. Histogram analysis of apparent diffusion coefficient and fluid-attenuated inversion recovery in discriminating between enhancing and nonenhancing lesions in multiple sclerosis. Clin Imaging 2019; 59:13-20. [PMID: 31715512 DOI: 10.1016/j.clinimag.2019.08.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 08/12/2019] [Accepted: 08/19/2019] [Indexed: 01/08/2023]
Abstract
PURPOSE This study evaluates the diagnostic performance of apparent diffusion coefficient (ADC) and T2 fluid-attenuation inversion recovery (T2 FLAIR) in discriminating between new white matter (WM) enhancing lesions (ELs) and non-enhancing lesions (NELs) in multiple sclerosis (MS) patients. METHODS Thirty MS patients with a new solitary WM lesion on brain MRI were analyzed. A region-of-interest was drawn on all lesions and the contralateral normal-appearing WM (NAWM) on T2 FLAIR and ADC maps. Normalized ratios of T2 FLAIR and ADC were calculated by dividing lesion value by the contralateral NAWM. Histogram analysis was performed on the T2 FLAIR, ADC values, and their normalized ratios. Mann-Whitney U test was used to compare histogram parameters and receiver operating characteristic (ROC) analysis determined the area under the curve (AUC). RESULTS T2 FLAIR histogram parameters were not significantly different between ELs and NELs. Several EL ADC histogram parameters, including maximum and mean, were significantly higher than NELs (p = 0.006 to p = 0.031). There was a trend toward significantly higher maximum ADC in ELs after adjusting for multiple comparisons (p = 0.054). The standard deviation of T2 FLAIR (AUC 0.70), maximum ADC (AUC 0.79), and normalized maximum ADC ratio (AUC 0.75) were among histogram parameters with the highest diagnostic performance. A maximum ADC cutoff of 1274 × 10-6 mm2/s provided a 0.86 sensitivity and 0.75 specificity. CONCLUSION In patients with contraindications to gadolinium or concerns with gadolinium brain deposition, consideration may be given to ADC and T2 FLAIR as potential noncontrast methods for the evaluation of active MS lesions.
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Affiliation(s)
- Kevin Yuqi Wang
- Department of Radiology, Baylor College of Medicine, Houston, TX, USA.
| | - Joshua Carlton
- Department of Radiology, Baylor College of Medicine, Houston, TX, USA
| | - Danielle Guffey
- Dan L Duncan Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, TX, USA
| | - George J Hutton
- Department of Neurology, Baylor College of Medicine, Houston, TX, USA
| | - Fanny E Moron
- Department of Radiology, Baylor College of Medicine, Houston, TX, USA
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16
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Falk Delgado A, Van Westen D, Nilsson M, Knutsson L, Sundgren PC, Larsson EM, Falk Delgado A. Diagnostic value of alternative techniques to gadolinium-based contrast agents in MR neuroimaging-a comprehensive overview. Insights Imaging 2019; 10:84. [PMID: 31444580 PMCID: PMC6708018 DOI: 10.1186/s13244-019-0771-1] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 07/12/2019] [Indexed: 12/16/2022] Open
Abstract
Gadolinium-based contrast agents (GBCAs) increase lesion detection and improve disease characterization for many cerebral pathologies investigated with MRI. These agents, introduced in the late 1980s, are in wide use today. However, some non-ionic linear GBCAs have been associated with the development of nephrogenic systemic fibrosis in patients with kidney failure. Gadolinium deposition has also been found in deep brain structures, although it is of unclear clinical relevance. Hence, new guidelines from the International Society for Magnetic Resonance in Medicine advocate cautious use of GBCA in clinical and research practice. Some linear GBCAs were restricted from use by the European Medicines Agency (EMA) in 2017. This review focuses on non-contrast-enhanced MRI techniques that can serve as alternatives for the use of GBCAs. Clinical studies on the diagnostic performance of non-contrast-enhanced as well as contrast-enhanced MRI methods, both well established and newly proposed, were included. Advantages and disadvantages together with the diagnostic performance of each method are detailed. Non-contrast-enhanced MRIs discussed in this review are arterial spin labeling (ASL), time of flight (TOF), phase contrast (PC), diffusion-weighted imaging (DWI), magnetic resonance spectroscopy (MRS), susceptibility weighted imaging (SWI), and amide proton transfer (APT) imaging. Ten common diseases were identified for which studies reported comparisons of non-contrast-enhanced and contrast-enhanced MRI. These specific diseases include primary brain tumors, metastases, abscess, multiple sclerosis, and vascular conditions such as aneurysm, arteriovenous malformation, arteriovenous fistula, intracranial carotid artery occlusive disease, hemorrhagic, and ischemic stroke. In general, non-contrast-enhanced techniques showed comparable diagnostic performance to contrast-enhanced MRI for specific diagnostic questions. However, some diagnoses still require contrast-enhanced imaging for a complete examination.
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Affiliation(s)
- Anna Falk Delgado
- Clinical neurosciences, Karolinska Institutet, Stockholm, Sweden. .,Department of Neuroradiology, Karolinska University Hospital, Eugeniavägen 3, Solna, Stockholm, Sweden.
| | - Danielle Van Westen
- Department of Clinical Sciences/Radiology, Faculty of Medicine, Lund University, Lund, Sweden
| | - Markus Nilsson
- Department of Clinical Sciences/Radiology, Faculty of Medicine, Lund University, Lund, Sweden
| | - Linda Knutsson
- Department of Medical Radiation Physics, Lund University, Lund, Sweden.,Russell H. Morgan Department of Radiology and Radiological Science, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Pia C Sundgren
- Department of Clinical Sciences/Radiology, Faculty of Medicine, Lund University, Lund, Sweden.,Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | - Elna-Marie Larsson
- Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden
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17
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Spincemaille P, Liu Z, Zhang S, Kovanlikaya I, Ippoliti M, Makowski M, Watts R, de Rochefort L, Venkatraman V, Desmond P, Santin MD, Lehéricy S, Kopell BH, Péran P, Wang Y. Clinical Integration of Automated Processing for Brain Quantitative Susceptibility Mapping: Multi-Site Reproducibility and Single-Site Robustness. J Neuroimaging 2019; 29:689-698. [PMID: 31379055 DOI: 10.1111/jon.12658] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 07/11/2019] [Accepted: 07/21/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND AND PURPOSE Quantitative susceptibility mapping (QSM) of the brain has become highly reproducible and has applications in an expanding array of diseases. To translate QSM from bench to bedside, it is important to automate its reconstruction immediately after data acquisition. In this work, a server system that automatically reconstructs QSM and exchange images with the scanner using the DICOM standard is demonstrated using a multi-site, multi-vendor reproducibility study and a large, single-site, multi-scanner image quality review study in a clinical environment. METHODS A single healthy subject was scanned with a 3D multi-echo gradient echo sequence at nine sites around the world using scanners from three manufacturers. A high-resolution (HiRes, .5 × .5 × 1 mm3 reconstructed) and standard-resolution (StdRes, .5 × .5 × 3 mm3 ) protocol was performed. ROI analysis of various white matter and gray matter regions was performed to investigate reproducibility across sites. At one institution, a retrospective multi-scanner image quality review was carried out of all clinical QSM images acquired consecutively in 1 month. RESULTS Reconstruction times using a GPU were 29 ± 22 seconds (StdRes) and 55 ± 39 seconds (HiRes). ROI standard deviation across sites was below 24 ppb (StdRes) and 17 ppb (HiRes). Correlations between ROI averages across sites were on average .92 (StdRes) and .96 (HiRes). Image quality review of 873 consecutive patients revealed diagnostic or excellent image quality in 96% of patients. CONCLUSION Online QSM reconstruction for a variety of sites and scanner platforms with low cross-site ROI standard deviation is demonstrated. Image quality review revealed diagnostic or excellent image quality in 96% of 873 patients.
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Affiliation(s)
- Pascal Spincemaille
- Department of Radiology, Weill Medical College of Cornell University, New York, NY
| | - Zhe Liu
- Department of Radiology, Weill Medical College of Cornell University, New York, NY.,Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY
| | - Shun Zhang
- Department of Radiology, Weill Medical College of Cornell University, New York, NY.,Department of Radiology, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Ilhami Kovanlikaya
- Department of Radiology, Weill Medical College of Cornell University, New York, NY
| | - Matteo Ippoliti
- Department of Radiology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Marcus Makowski
- Department of Radiology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Richard Watts
- Department of Psychology, Yale University, New Haven, CT
| | | | - Vijay Venkatraman
- Department of Medicine and Radiology, University of Melbourne, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Patricia Desmond
- Department of Medicine and Radiology, University of Melbourne, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Mathieu D Santin
- Inserm U 1127, CNRS UMR 7225, Centre for NeuroImaging Research, ICM (Brain & Spine Institute), Sorbonne University, Paris, France
| | - Stéphane Lehéricy
- Inserm U 1127, CNRS UMR 7225, Centre for NeuroImaging Research, ICM (Brain & Spine Institute), Sorbonne University, Paris, France.,Neuroradiology, Hôpital Pitié-Salpêtrière, Paris, France
| | - Brian H Kopell
- Division of Movement Disorders, Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY.,Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY.,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY.,Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Patrice Péran
- Toulouse NeuroImaging Center, Université de Toulouse Inserm, Toulouse, France
| | - Yi Wang
- Department of Radiology, Weill Medical College of Cornell University, New York, NY.,Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY
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18
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do Amaral LLF, Fragoso DC, Nunes RH, Littig IA, da Rocha AJ. Gadolinium-Enhanced Susceptibility-Weighted Imaging in Multiple Sclerosis: Optimizing the Recognition of Active Plaques for Different MR Imaging Sequences. AJNR Am J Neuroradiol 2019; 40:614-619. [PMID: 30846435 DOI: 10.3174/ajnr.a5997] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 01/24/2019] [Indexed: 01/14/2023]
Abstract
BACKGROUND AND PURPOSE Gadolinium SWI is MR imaging that has recently been reported to be effective in the evaluation of several neurologic disorders, including demyelinating diseases. Our aim was to analyze the accuracy of gadolinium SWI for detecting the imaging evidence of active inflammation on MS plaques when a BBB dysfunction is demonstrated by a focal gadolinium-enhanced lesion and to compare this technique with gadolinium-enhanced T1 spin-echo and T1 spin-echo with magnetization transfer contrast. MATERIALS AND METHODS MR imaging studies of 103 patients (170 examinations) were performed using a 1.5T scanner. Two neuroradiologists scrutinized signal abnormalities of the demyelinating plaques on gadolinium SWI and compared them with gadolinium T1 before and after an additional magnetization transfer pulse. Interrater agreement was evaluated among gadolinium T1 magnetization transfer contrast, gadolinium SWI, and gadolinium T1 spin-echo using the κ coefficient. The T1 magnetization transfer contrast sequence was adopted as the criterion standard in this cohort. Thus, the sensitivity, specificity, positive predictive value, and negative predictive value were calculated for gadolinium T1 spin-echo and gadolinium SWI sequences. RESULTS Differences in BBB dysfunction were evident among gadolinium SWI, gadolinium T1 spin-echo, and gadolinium T1 magnetization transfer contrast. Gadolinium T1 magnetization transfer contrast demonstrated the highest number of active demyelinating plaques. Gadolinium SWI was highly correlated with gadolinium T1 magnetization transfer contrast in depicting acute demyelinating plaques (κ coefficient = 0.860; sensitivity = 0.837), and these techniques provided better performance compared with gadolinium T1 spin-echo (κ coefficient = 0.78; sensitivity = 0.645). CONCLUSIONS Gadolinium SWI was able to better detect BBB dysfunction in MS plaques and had a better performance than gadolinium T1 spin-echo. Increasing SWI sequence applications in clinical practice can improve our knowledge of MS, likely allowing the addition of BBB dysfunction analysis to the striking findings of the previously reported central vein sign.
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Affiliation(s)
- L L F do Amaral
- From the Division of Neuroradiology (L.L.F.A, D.C.F., R.H.N., I.A.L., A.J.R.), Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil .,Neuroradiology Department (L.L.F.A.), BP Medicina Diagnóstica, Hospital BP e BP Mirante da Beneficěncia Portuguesa de São Paulo, São Paulo, Brazil
| | - D C Fragoso
- From the Division of Neuroradiology (L.L.F.A, D.C.F., R.H.N., I.A.L., A.J.R.), Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil.,Division of Neuroradiology (D.C.F., R.H.N., A.J.R.), Diagnósticos da América S.A. - DASA, São Paulo, Brazil.,Division of Neuroradiology (D.C.F.), Fleury S.A., São Paulo, Brazil
| | - R H Nunes
- From the Division of Neuroradiology (L.L.F.A, D.C.F., R.H.N., I.A.L., A.J.R.), Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil.,Division of Neuroradiology (D.C.F., R.H.N., A.J.R.), Diagnósticos da América S.A. - DASA, São Paulo, Brazil
| | - I A Littig
- From the Division of Neuroradiology (L.L.F.A, D.C.F., R.H.N., I.A.L., A.J.R.), Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil
| | - A J da Rocha
- From the Division of Neuroradiology (L.L.F.A, D.C.F., R.H.N., I.A.L., A.J.R.), Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil.,Division of Neuroradiology (D.C.F., R.H.N., A.J.R.), Diagnósticos da América S.A. - DASA, São Paulo, Brazil
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19
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Lin F, Prince MR, Spincemaille P, Wang Y. Patents on Quantitative Susceptibility Mapping (QSM) of Tissue Magnetism. Recent Pat Biotechnol 2018; 13:90-113. [PMID: 30556508 DOI: 10.2174/1872208313666181217112745] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 12/04/2018] [Accepted: 12/11/2018] [Indexed: 01/06/2023]
Abstract
BACKGROUND Quantitative susceptibility mapping (QSM) depicts biodistributions of tissue magnetic susceptibility sources, including endogenous iron and calcifications, as well as exogenous paramagnetic contrast agents and probes. When comparing QSM with simple susceptibility weighted MRI, QSM eliminates blooming artifacts and shows reproducible tissue susceptibility maps independent of field strength and scanner manufacturer over a broad range of image acquisition parameters. For patient care, QSM promises to inform diagnosis, guide surgery, gauge medication, and monitor drug delivery. The Bayesian framework using MRI phase data and structural prior knowledge has made QSM sufficiently robust and accurate for routine clinical practice. OBJECTIVE To address the lack of a summary of US patents that is valuable for QSM product development and dissemination into the MRI community. METHOD We searched the USPTO Full-Text and Image Database for patents relevant to QSM technology innovation. We analyzed the claims of each patent to characterize the main invented method and we investigated data on clinical utility. RESULTS We identified 17 QSM patents; 13 were implemented clinically, covering various aspects of QSM technology, including the Bayesian framework, background field removal, numerical optimization solver, zero filling, and zero-TE phase. CONCLUSION Our patent search identified patents that enable QSM technology for imaging the brain and other tissues. QSM can be applied to study a wide range of diseases including neurological diseases, liver iron disorders, tissue ischemia, and osteoporosis. MRI manufacturers can develop QSM products for more seamless integration into existing MRI scanners to improve medical care.
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Affiliation(s)
- Feng Lin
- School of Law, City University of Hong Kong, Hong Kong, China
| | - Martin R Prince
- Department of Radiology, Weill Medical College of Cornell University, New York, NY, United States
| | - Pascal Spincemaille
- Department of Radiology, Weill Medical College of Cornell University, New York, NY, United States
| | - Yi Wang
- Department of Radiology, Weill Medical College of Cornell University, New York, NY, United States.,Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY, United States
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20
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Mattay RR, Davtyan K, Bilello M, Mamourian AC. Do All Patients with Multiple Sclerosis Benefit from the Use of Contrast on Serial Follow-Up MR Imaging? A Retrospective Analysis. AJNR Am J Neuroradiol 2018; 39:2001-2006. [PMID: 30287455 DOI: 10.3174/ajnr.a5828] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 07/26/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Patients with multiple sclerosis routinely have MR imaging with contrast every 6-12 months to assess response to medication. Multiple recent studies provide evidence of tissue deposition of MR imaging contrast agents, questioning the long-term safety of these agents. The goal of this retrospective image-analysis study was to determine whether contrast could be reserved for only those patients who show new MS lesions on follow-up examinations. MATERIALS AND METHODS We retrospectively reviewed brain MRIs of 138 patients. To increase our sensitivity, we used a previously described computerized image-comparison software to evaluate the stability or progression of multiple sclerosis white matter lesions in noncontrast FLAIR sequences. We correlated these findings with evidence of contrast-enhancing lesions on the enhanced T1 sequence from the same scan. RESULTS Thirty-three scans showed an increase in white matter lesion burden. Among those 33 patients, 14 examinations also demonstrated enhancing new lesions. While we found a single example of enhancement of a pre-existing white matter lesion that appeared unchanged in size, that same examination showed an overall increase in lesion burden with enhancement of other, new lesions. Thus, we found that all patients with enhancing lesions had evidence of progression on their noncontrast imaging. CONCLUSIONS Because all enhancing lesions were associated with new lesions on unenhanced imaging and progression was only evident in 24% of patients, in patients with relapsing-remitting MS, it is reasonable to consider reserving contrast for only those patients with evidence of progression on noncontrast MR images.
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Affiliation(s)
- R R Mattay
- From the Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
| | - K Davtyan
- From the Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - M Bilello
- From the Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - A C Mamourian
- From the Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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21
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Maloney E, Stanescu AL, Perez FA, Iyer RS, Otto RK, Leary S, Steuten L, Phipps AI, Shaw DWW. Surveillance magnetic resonance imaging for isolated optic pathway gliomas: is gadolinium necessary? Pediatr Radiol 2018; 48:1472-1484. [PMID: 29789890 DOI: 10.1007/s00247-018-4154-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 02/21/2018] [Accepted: 04/30/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND Pediatric optic pathway gliomas are typically indolent but have a variable clinical course. Treatment is dictated by symptoms and changes on contrast-enhanced MRI examinations. Gadolinium retention in children has motivated parsimonious use of gadolinium-based contrast agents. OBJECTIVES To determine surveillance MR factors that motivate changes in tumor-directed therapies and extrapolate cost-efficacy of a non-contrast follow-up protocol. MATERIALS AND METHODS Using an imaging database search we identified children with isolated optic pathway gliomas and ≥3 follow-up contrast-enhanced MRIs. We reviewed medical records and imaging for: (1) coincident changes on contrast-enhanced MRI and tumor-directed therapy, (2) demographics and duration of follow-up, (3) motivations for intervention, (4) assessment of gadolinium-based contrast agents' utility and (5) health care utilization data. We assessed cost impact in terms of relative value unit (RVU) burden. RESULTS We included 17 neurofibromatosis type 1 (NF1) and 21 non-NF1 patients who underwent a median 16.9 and 24.3 cumulative contrast-enhanced MR exams over 7.7 years and 8.1 years of follow-up, respectively. Eight children (one with NF1) had intervention based on contrast-enhanced MR findings alone. For these eight, increased tumor size was the only common feature, and it was apparent on non-contrast T2 sequences. For the median patient, a non-contrast follow-up protocol could result in 15.9 (NF1) and 23.3 (non-NF1) fewer gadolinium-based contrast agent administrations, and a 39% lower yearly RVU burden. CONCLUSION Pediatric patients with isolated optic pathway gliomas undergo a large number of routine contrast-enhanced MR follow-up exams. Gadolinium might not be needed for these exams to inform management decisions. Secondary benefits of a non-contrast follow-up protocol include decreased cost and risk to the patient.
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Affiliation(s)
- Ezekiel Maloney
- Department of Radiology,, University of Washington,, Seattle, WA, USA.,Department of Radiology,, Seattle Children's Hospital,, 4800 Sand Point Way NE,, Seattle, WA, 98105, USA
| | - A Luana Stanescu
- Department of Radiology,, University of Washington,, Seattle, WA, USA.,Department of Radiology,, Seattle Children's Hospital,, 4800 Sand Point Way NE,, Seattle, WA, 98105, USA
| | - Francisco A Perez
- Department of Radiology,, University of Washington,, Seattle, WA, USA.,Department of Radiology,, Seattle Children's Hospital,, 4800 Sand Point Way NE,, Seattle, WA, 98105, USA
| | - Ramesh S Iyer
- Department of Radiology,, University of Washington,, Seattle, WA, USA.,Department of Radiology,, Seattle Children's Hospital,, 4800 Sand Point Way NE,, Seattle, WA, 98105, USA
| | - Randolph K Otto
- Department of Radiology,, University of Washington,, Seattle, WA, USA.,Department of Radiology,, Seattle Children's Hospital,, 4800 Sand Point Way NE,, Seattle, WA, 98105, USA
| | - Sarah Leary
- Cancer and Blood Disorders,, University of Washington, Seattle Children's Hospital,, Seattle, WA, USA
| | - Lotte Steuten
- Department of Pharmacy,, University of Washington, Fred Hutchinson Cancer Research Center,, Seattle, WA, USA
| | - Amanda I Phipps
- Department of Epidemiology,, University of Washington School of Public Health,, Seattle, WA, USA
| | - Dennis W W Shaw
- Department of Radiology,, University of Washington,, Seattle, WA, USA. .,Department of Radiology,, Seattle Children's Hospital,, 4800 Sand Point Way NE,, Seattle, WA, 98105, USA.
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22
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Lee H, Nam Y, Lee HJ, Hsu JJ, Henry RG, Kim DH. Improved three-dimensional multi-echo gradient echo based myelin water fraction mapping with phase related artifact correction. Neuroimage 2018; 169:1-10. [DOI: 10.1016/j.neuroimage.2017.11.058] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 11/21/2017] [Accepted: 11/25/2017] [Indexed: 12/17/2022] Open
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23
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Zhang S, Nguyen TD, Zhao Y, Gauthier SA, Wang Y, Gupta A. Diagnostic accuracy of semiautomatic lesion detection plus quantitative susceptibility mapping in the identification of new and enhancing multiple sclerosis lesions. NEUROIMAGE-CLINICAL 2018; 18:143-148. [PMID: 29387531 PMCID: PMC5790036 DOI: 10.1016/j.nicl.2018.01.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 01/10/2018] [Accepted: 01/15/2018] [Indexed: 11/25/2022]
Abstract
Purpose To evaluate the diagnostic accuracy of a novel non-contrast brain MRI method based on semiautomatic lesion detection using T2w FLAIR subtraction image, the statistical detection of change (SDC) algorithm (T2w + SDC), and quantitative susceptibility mapping (QSM). This method identifies new lesions and discriminates between enhancing and nonenhancing lesions in multiple sclerosis (MS). Methods Thirty three MS patients who had MRIs at two different time points with at least one new Gd-enhancing lesion on the 2nd MRI were included in the study. For a reference standard, new lesions were identified by two neuroradiologists on T2w and post-Gd T1w images with the help of T2w + SDC. The diagnostic accuracy of the proposed method based on QSM and T2w + SDC lesion detection (T2w + SDC + QSM) for assessing lesion enhancement status was determined. Receiver operating characteristic (ROC) analysis was performed to compute the optimal lesion susceptibility cutoff value. Results A total of 165 new lesions (54 enhancing, 111 nonenhancing) were identified. The sensitivity and specificity of T2w + SDC + QSM in predicting lesion enhancement status were 90.7% and 85.6%, respectively. For lesions ≥50 mm3, ROC analysis showed an optimal QSM cutoff value of 13.5 ppb with a sensitivity of 88.4% and specificity of 88.6% (0.93, 95% CI, 0.87–0.99). For lesions ≥15 mm3, the optimal QSM cutoff was 15.4 ppb with a sensitivity of 77.9% and specificity of 94.0% (0.93, 95% CI, 0.89–0.97). Conclusion The proposed T2w + SDC + QSM method is highly accurate for identifying and predicting the enhancement status of new MS lesions without the use of Gd injection. T2w + SDC has high sensitivity and accuracy in detecting new MS lesions. T2w + SDC + QSM is highly accurate in discriminating between new enhancing and new nonenhancing lesions. T2w + SDC + QSM can form the basis of an imaging protocol without Gadolinium injection for routine surveillance of MS patients.
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Affiliation(s)
- Shun Zhang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Department of Radiology, Weill Cornell Medicine, New York, NY, USA
| | - Thanh D Nguyen
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA
| | - Yize Zhao
- Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, NY, USA
| | - Susan A Gauthier
- Department of Neurology, Weill Cornell Medicine, New York, NY, USA; Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, USA
| | - Yi Wang
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA; Department of Biomedical Engineering, Cornell University, Ithaca, NY, USA
| | - Ajay Gupta
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA; Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, USA.
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Thaler C, Faizy TD, Sedlacik J, Bester M, Stellmann JP, Heesen C, Fiehler J, Siemonsen S. The use of multiparametric quantitative magnetic resonance imaging for evaluating visually assigned lesion groups in patients with multiple sclerosis. J Neurol 2017; 265:127-133. [PMID: 29159467 DOI: 10.1007/s00415-017-8683-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 11/13/2017] [Accepted: 11/14/2017] [Indexed: 12/19/2022]
Abstract
In multiple sclerosis (MS), inflammatory lesions present a broad spectrum of histopathologic processes. For a better discrimination, lesions are visually defined into different lesion groups according to their appearance on conventional magnetic resonance imaging (MRI). The aim of this study was to investigate the properties of different MS lesion groups using multiparametric quantitative MRI. 35 patients diagnosed with relapsing-remitting MS received 3 Tesla MRI including magnetization-prepared 2 rapid acquisition gradient echo, diffusion tensor imaging and magnetization transfer imaging. Lesion segmentation was performed for T2 lesions, black holes and contrast-enhancing lesions. A subtraction mask was created including only T2 lesions that did not correspond to a black hole or contrast-enhancing lesion. T1 relaxation time (T1-RT), magnetization transfer ratio (MTR), mean diffusivity (MD) and fractional anisotropy (FA) were determined for every lesion and in normal-appearing white matter. Only MD differed significantly between all lesion groups and NAWM (p < 0.05), while FA differed between all lesion groups but not NAWM. T1-RT and MTR were not useful imaging biomarkers to distinguish between lesion groups. A lack of sensitivity and specificity and unproportional alterations of quantitative MRI measures, due to heterogenous histopathologic processes within lesions, may be a possible explanation for missing discrimination. Thus, not only interpretation of visually defined MS lesion but also interpretation of quantitative MRI measures remains challenging and should be conducted carefully.
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Affiliation(s)
- Christian Thaler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
| | - Tobias D Faizy
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Jan Sedlacik
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Maxim Bester
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Jan-Patrick Stellmann
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Institute for Neuroimmunology and Clinical MS Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christoph Heesen
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Institute for Neuroimmunology and Clinical MS Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Susanne Siemonsen
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
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