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Llufriu S, Agüera E, Costa-Frossard L, Galán V, Landete L, Lourido D, Meca-Lallana JE, Moral E, Bravo-Rodríguez F, Koren L, Labiano A, León A, Martín P, Monedero MD, Requeni L, Zubizarreta I, Rovira À. Recommendations for the coordination of Neurology and Neuroradiology Departments in the management of patients with multiple sclerosis. Neurologia 2023; 38:453-462. [PMID: 37120107 DOI: 10.1016/j.nrleng.2021.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 01/01/2021] [Indexed: 05/01/2023] Open
Abstract
INTRODUCTION Magnetic resonance imaging (MRI) is widely used for the diagnosis and follow-up of patients with multiple sclerosis (MS). Coordination between neurology and neuroradiology departments is crucial for performing and interpreting radiological studies as efficiently and as accurately as possible. However, improvements can be made in the communication between these departments in many Spanish hospitals. METHODS A panel of 17 neurologists and neuroradiologists from 8 Spanish hospitals held in-person and online meetings to draft a series of good practice guidelines for the coordinated management of MS. The drafting process included 4 phases: 1) establishing the scope of the guidelines and the methodology of the study; 2) literature review on good practices or recommendations on the use of MRI in MS; 3) discussion and consensus between experts; and 4) validation of the contents. RESULTS The expert panel agreed a total of 9 recommendations for improving coordination between neurology and neuroradiology departments. The recommendations revolve around 4 main pillars: 1) standardising the process for requesting and scheduling MRI studies and reports; 2) designing common protocols for MRI studies; 3) establishing multidisciplinary committees and coordination meetings; and 4) creating formal communication channels between both departments. CONCLUSIONS These consensus recommendations are intended to optimise coordination between neurologists and neuroradiologists, with the ultimate goal of improving the diagnosis and follow-up of patients with MS.
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Affiliation(s)
- S Llufriu
- Servicio de Neurología, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
| | - E Agüera
- Servicio de Neurología, Hospital Universitario Reina Sofía, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
| | - L Costa-Frossard
- Servicio de Neurología, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - V Galán
- Servicio de Neurología, Hospital Virgen de la Salud, Toledo, Spain
| | - L Landete
- Servicio de Neurología, Hospital Universitario Dr. Peset, Valencia, Spain
| | - D Lourido
- Sección de Neurorradiología, Servicio de Radiología, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - J E Meca-Lallana
- CSUR Esclerosis Múltiple y Unidad de Neuroinmunología Clínica, Servicio de Neurología, Hospital Clínico Universitario Virgen de la Arrixaca, IMIB-Arrixaca, Murcia, Spain
| | - E Moral
- Servicio de Neurología, Hospital Moisès Broggi, Sant Joan Despí, Barcelona, Spain
| | - F Bravo-Rodríguez
- Sección de Neurorradiología, Servicio de Radiología, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - L Koren
- Sección de Neurorradiología, Servicio de Radiología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - A Labiano
- Servicio de Neurología, Hospital Virgen de la Salud, Toledo, Spain
| | - A León
- Sección de Neurorradiología, Servicio de Radiología, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - P Martín
- Sección de Neurorradiología, Servicio de Radiología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - M D Monedero
- Sección de Neurorradiología, Servicio de Radiodiagnóstico, Hospital Universitario Dr. Peset, Valencia, Spain
| | - L Requeni
- Sección de Neurorradiología, Servicio de Radiodiagnóstico, Hospital Universitario Dr. Peset, Valencia, Spain
| | - I Zubizarreta
- Servicio de Neurología, Hospital Moisès Broggi, Sant Joan Despí, Barcelona, Spain
| | - À Rovira
- Sección de Neurorradiología, Servicio de Radiología, Hospital Universitario Vall d'Hebron, Barcelona, Spain
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González R, Aymerich FX, Alberich M, Caronna E, Gallardo VJ, Pozo-Rosich P, Rovira À, Pareto D. Estimation of the density of veins from susceptibility-weighted imaging by using Mamdani fuzzy-type rule-based system. Investigating the neurovascular coupling in migraine. Neuroimage Clin 2023; 39:103489. [PMID: 37611372 PMCID: PMC10466899 DOI: 10.1016/j.nicl.2023.103489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 07/25/2023] [Accepted: 08/03/2023] [Indexed: 08/25/2023]
Abstract
BACKGROUND AND PURPOSE An impaired neurovascular coupling has been described as a possible player in neurodegeneration and cognitive decline. Migraine is a recurrent and incapacitating disorder that starts early in life and has shown neurovascular coupling abnormalities. Despite its high prevalence, the physiology and underlying mechanisms are poorly understood. In this context, new biomarkers from magnetic resonance imaging (MRI) are needed to bring new knowledge into the field. The aim of this study was to determine the vein density from Susceptibility-Weighted Imaging (SWI) MRI, in subjects with migraine and healthy controls; and to assess whether it relates to Resting-State functional MRI (RS-fMRI). MATERIALS AND METHODS The cohort included 30 healthy controls and 70 subjects with migraine (26 episodic, 44 chronic) who underwent a brain 3.0 T MRI. Clinical characteristics were also collected. Maps of density of veins were generated based on a Mamdani Fuzzy-Type Rule-Based System from the SWI MRI. Mean values of vein density were obtained in grey (GM) and white matter (WM) Freesurfer lobar parcellations. The Amplitude of Low-Frequency Fluctuations (ALFF) image was calculated for the RS-fMRI, and the mean values over the parcellated GM lobes were estimated. Differences between groups were assessed through and analysis of variance (age, sex, education and anxiety as covariates; p < 0.05), followed by post-hoc comparisons. Associations were run between clinical and MRI-derived variables. RESULTS When comparing the density of veins in GM, no differences between groups were found, neither associations with clinical variables. The density of veins was significantly higher in the WM of the occipital lobe for subjects with chronic migraine compared to controls (30%, p < 0.05). WM vein density in either frontal, temporal or cingulate regions was associated with clinical variables such as headache days, disability scores, and cognitive impairment (r between 0.25 and 0.41; p < 0.05). Mean values of ALFF did not differ significantly between controls and subjects with migraine. Strong significant associations between vein density and ALFF measures were obtained in most GM lobes for healthy subjects (r between 0.50 and 0.67; p < 0.05), instead, vein density in WM was significantly associated with ALFF for subjects with migraine (r between 0.32 and 0.58; p < 0.05). CONCLUSIONS Results point towards an increase in vein density in subjects with migraine, when compared to healthy controls. In addition, the association between GM vein density and ALFF found in healthy subjects was lost in migraine. Taken together, these results support the idea of abnormalities in the neurovascular coupling in migraine. Quantitative SWI MRI indicators in migraine might be an interesting target that may contribute to its comprehension.
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Affiliation(s)
- R González
- Neuroradiology Group, Vall Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - F X Aymerich
- Neuroradiology Group, Vall Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain; Radiology Department (IDI), Vall Hebron University Hospital, Barcelona, Spain; Automatic Control Department (ESAII), Univesitat Politècnica de Catalunya Barcelona Tech, Barcelona, Spain
| | - M Alberich
- Neuroradiology Group, Vall Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain; Radiology Department (IDI), Vall Hebron University Hospital, Barcelona, Spain
| | - E Caronna
- Headache and Craniofacial Pain Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain; Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - V J Gallardo
- Headache and Craniofacial Pain Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain; Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - P Pozo-Rosich
- Headache and Craniofacial Pain Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain; Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - À Rovira
- Neuroradiology Group, Vall Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain; Radiology Department (IDI), Vall Hebron University Hospital, Barcelona, Spain
| | - D Pareto
- Neuroradiology Group, Vall Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain; Radiology Department (IDI), Vall Hebron University Hospital, Barcelona, Spain.
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Mongay-Ochoa N, Pareto D, Alberich M, Tintore M, Montalban X, Rovira À, Sastre-Garriga J. Validation of a New Semiautomated Segmentation Pipeline Based on the Spinal Cord Toolbox DeepSeg Algorithm to Estimate the Cervical Canal Area. AJNR Am J Neuroradiol 2023:ajnr.A7899. [PMID: 37290816 PMCID: PMC10337626 DOI: 10.3174/ajnr.a7899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 05/11/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND AND PURPOSE As in the brain reserve concept, a larger cervical canal area may also protect against disability. In this context, a semiautomated pipeline has been developed to obtain quantitative estimations of the cervical canal area. The aim of the study was to validate the pipeline, to evaluate the consistency of the cervical canal area measurements during a 1-year period, and to compare cervical canal area estimations obtained from brain and cervical MRI acquisitions. MATERIALS AND METHODS Eight healthy controls and 18 patients with MS underwent baseline and follow-up 3T brain and cervical spine sagittal 3D MPRAGE. The cervical canal area was measured in all acquisitions, and estimations obtained with the proposed pipeline were compared with manual segmentations performed by 1 evaluator using the Dice similarity coefficient. The cervical canal area estimations obtained on baseline and follow-up T1WI were compared; brain and cervical cord acquisitions were also compared using the individual and average intraclass correlation coefficients. RESULTS The agreement between the manual cervical canal area masks and the masks provided by the proposed pipeline was excellent, with a mean Dice similarity coefficient mean of 0.90 (range, 0.73-0.97). The cervical canal area estimations obtained from baseline and follow-up scans showed a good level of concordance (intraclass correlation coefficient = 0.76; 95% CI, 0.44-0.88); estimations obtained from brain and cervical MRIs also had good agreement (intraclass correlation coefficient = 0.77; 95% CI, 0.45-0.90). CONCLUSIONS The proposed pipeline is a reliable tool to estimate the cervical canal area. The cervical canal area is a stable measure across time; moreover, when cervical sequences are not available, the cervical canal area could be estimated using brain T1WI.
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Affiliation(s)
- N Mongay-Ochoa
- From the Department of Neurology (N.M.-O., M.T., X.M., J.S.-G.), Multiple Sclerosis Centre of Catalonia
| | - D Pareto
- Section of Neuroradiology (D.P., M.A., À.R.), Department of Radiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - M Alberich
- Section of Neuroradiology (D.P., M.A., À.R.), Department of Radiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - M Tintore
- From the Department of Neurology (N.M.-O., M.T., X.M., J.S.-G.), Multiple Sclerosis Centre of Catalonia
| | - X Montalban
- From the Department of Neurology (N.M.-O., M.T., X.M., J.S.-G.), Multiple Sclerosis Centre of Catalonia
| | - À Rovira
- Section of Neuroradiology (D.P., M.A., À.R.), Department of Radiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - J Sastre-Garriga
- From the Department of Neurology (N.M.-O., M.T., X.M., J.S.-G.), Multiple Sclerosis Centre of Catalonia
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Pareto D, Corral JF, Garcia-Vidal A, Alberich M, Auger C, Rio J, Mongay N, Sastre-Garriga J, Rovira À. Assessing the Equivalence of Brain-Derived Measures from Two 3D T1-Weighted Acquisitions: One Covering the Brain and One Covering the Brain and Spinal Cord. AJNR Am J Neuroradiol 2023; 44:569-573. [PMID: 37080719 PMCID: PMC10171373 DOI: 10.3174/ajnr.a7843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 02/01/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND AND PURPOSE In MS, it is common to acquire brain and spinal cord MR imaging sequences separately to assess the extent of the disease. The goal of this study was to see how replacing the traditional brain T1-weighted images (brain-T1) with an acquisition that included both the brain and the cervical spinal cord (cns-T1) affected brain- and spinal cord-derived measures. MATERIALS AND METHODS Thirty-six healthy controls (HC) and 42 patients with MS were included. Of those, 18 HC and 35 patients with MS had baseline and follow-up at 1 year acquired on a 3T magnet. Two 3D T1-weighted images (brain-T1 and cns-T1) were acquired at each time point. Regional cortical thickness and volumes were determined with FastSurfer, and the percentage brain volume change per year was obtained with SIENA. The spinal cord area was estimated with the Spinal Cord Toolbox. Intraclass correlation coefficients (ICC) were calculated to check for consistency of measures obtained from brain-T1 and cns-T1. RESULTS Cortical thickness measures showed an ICC >0.75 in 94% of regions in healthy controls and 80% in patients with MS. Estimated regional volumes had an ICC >0.88, and the percentage brain volume change had an ICC >0.79 for both groups. The spinal cord area measures had an ICC of 0.68 in healthy controls and 0.92 in patients with MS. CONCLUSIONS Brain measurements obtained from 3D cns-T1 are highly equivalent to those obtained from a brain-T1, suggesting that it could be feasible to replace the brain-T1 with cns-T1.
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Affiliation(s)
- D Pareto
- From the Neuroradiology Group (D.P., J.F.C., A.G.-V., C.A., À.R.), Vall d'Hebron Research Institute, Barcelona, Spain
- Section of Neuroradiology (D.P., J.F.C., M.A., À.R.), Radiology Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - J F Corral
- From the Neuroradiology Group (D.P., J.F.C., A.G.-V., C.A., À.R.), Vall d'Hebron Research Institute, Barcelona, Spain
- Section of Neuroradiology (D.P., J.F.C., M.A., À.R.), Radiology Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - A Garcia-Vidal
- From the Neuroradiology Group (D.P., J.F.C., A.G.-V., C.A., À.R.), Vall d'Hebron Research Institute, Barcelona, Spain
| | - M Alberich
- Section of Neuroradiology (D.P., J.F.C., M.A., À.R.), Radiology Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - C Auger
- From the Neuroradiology Group (D.P., J.F.C., A.G.-V., C.A., À.R.), Vall d'Hebron Research Institute, Barcelona, Spain
| | - J Rio
- Department of Neurology and Neuroimmunology (J.R., N.M., J.S.-G.), Multiple Sclerosis Centre of Catalonia, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - N Mongay
- Department of Neurology and Neuroimmunology (J.R., N.M., J.S.-G.), Multiple Sclerosis Centre of Catalonia, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - J Sastre-Garriga
- Department of Neurology and Neuroimmunology (J.R., N.M., J.S.-G.), Multiple Sclerosis Centre of Catalonia, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - À Rovira
- From the Neuroradiology Group (D.P., J.F.C., A.G.-V., C.A., À.R.), Vall d'Hebron Research Institute, Barcelona, Spain
- Section of Neuroradiology (D.P., J.F.C., M.A., À.R.), Radiology Department, Vall d'Hebron University Hospital, Barcelona, Spain
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Martín-Aguilar L, Presas-Rodriguez S, Rovira À, Capellades J, Massuet-Vilamajó A, Ramió-Torrentà L, Tintoré M, Brieva-Ruiz L, Moral E, Cano-Orgaz A, Blanco Y, Batlle-Nadal J, Carmona O, Gea M, Hervás-García J, Ramo-Tello C. Gadolinium-enhanced brain lesions in multiple sclerosis relapse. Neurología (English Edition) 2022; 37:557-563. [DOI: 10.1016/j.nrleng.2021.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 10/28/2021] [Indexed: 10/14/2022] Open
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Rovira À, Llufriu S. Coordination between neuroradiology and neurology departments in the care of patients with multiple sclerosis: Recommendations for optimization. Radiología (English Edition) 2022; 64:379-382. [DOI: 10.1016/j.rxeng.2021.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 09/07/2021] [Indexed: 11/25/2022]
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Rovira À, Llufriu S. Coordinación de los servicios de neurorradiología y neurología en la atención a pacientes con esclerosis múltiple: recomendaciones para su optimización. Radiología 2022. [DOI: 10.1016/j.rx.2021.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Caruana G, Auger C, Pessini LM, Calderon W, de Barros A, Salerno A, Sastre-Garriga J, Montalban X, Rovira À. SWI as an Alternative to Contrast-Enhanced Imaging to Detect Acute MS Lesions. AJNR Am J Neuroradiol 2022; 43:534-539. [PMID: 35332015 PMCID: PMC8993188 DOI: 10.3174/ajnr.a7474] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 02/04/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Acute inflammatory activity of MS lesions is traditionally assessed through contrast-enhanced T1-weighted MR images. The aim of our study was to determine whether a qualitative evaluation of non-contrast-enhanced SWI of new T2-hyperintense lesions might help distinguish acute and chronic lesions and whether it could be considered a possible alternative to gadolinium-based contrast agents for this purpose. MATERIALS AND METHODS Serial MR imaging studies from 55 patients with MS were reviewed to identify 169 new T2-hyperintense lesions. Two blinded neuroradiologists determined their signal pattern on SWI, considering 5 categories (hypointense rings, marked hypointensity, mild hypointensity, iso-/hyperintensity, indeterminate). Two different blinded neuroradiologists evaluated the presence or absence of enhancement in postcontrast T1-weighted images of the lesions. The Fisher exact test was used to determine whether each category of signal intensity on SWI was associated with gadolinium enhancement. RESULTS The presence of hypointense rings or marked hypointensity showed a strong association with the absence of gadolinium enhancement (P < .001), with a sensitivity of 93.0% and a specificity of 82.9%. The presence of mild hypointensity or isohyperintensity showed a strong association with the presence of gadolinium enhancement (P < .001), with a sensitivity of 68.3% and a specificity of 99.2%. CONCLUSIONS A qualitative analysis of the signal pattern on SWI of new T2-hyperintense MS lesions allows determining the likelihood that the lesions will enhance after administration of a gadolinium contrast agent, with high specificity albeit with a moderate sensitivity. While it cannot substitute for the use of contrast agent, it can be useful in some clinical settings in which the contrast agent cannot be administered.
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Affiliation(s)
- G Caruana
- From the Neuroradiology Section (G.C., C.A., L.M.P., W.C., A.d.B., A.S., À.R.)
| | - C Auger
- From the Neuroradiology Section (G.C., C.A., L.M.P., W.C., A.d.B., A.S., À.R.)
| | - L M Pessini
- From the Neuroradiology Section (G.C., C.A., L.M.P., W.C., A.d.B., A.S., À.R.)
| | - W Calderon
- From the Neuroradiology Section (G.C., C.A., L.M.P., W.C., A.d.B., A.S., À.R.)
| | - A de Barros
- From the Neuroradiology Section (G.C., C.A., L.M.P., W.C., A.d.B., A.S., À.R.)
| | - A Salerno
- From the Neuroradiology Section (G.C., C.A., L.M.P., W.C., A.d.B., A.S., À.R.)
| | - J Sastre-Garriga
- Department of Radiology, and Servei de Neurologia-Neuroimmunologia (J.S.-G., X.M.). Centre d'Esclerosi Múltiple de Catalunya, Institut de Recerca Vall d'Hebron, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - X Montalban
- Department of Radiology, and Servei de Neurologia-Neuroimmunologia (J.S.-G., X.M.). Centre d'Esclerosi Múltiple de Catalunya, Institut de Recerca Vall d'Hebron, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - À Rovira
- From the Neuroradiology Section (G.C., C.A., L.M.P., W.C., A.d.B., A.S., À.R.)
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Rovira À. The SERAM’s publishing area: What have we done in these years? Radiología (English Edition) 2022. [DOI: 10.1016/j.rxeng.2022.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Schonstedt Geldres V, Stecher Guzmán X, Manterola Mordojovich C, Rovira À. Radiología en el estudio de la macrocefalia. ¿Por qué?, ¿cuándo?, ¿cómo? Radiología 2022. [DOI: 10.1016/j.rx.2021.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Friera A, Martí M, Torregrosa A, Valdés P, Fernández-Gil M, Martel J, Pueyo J, Gorospe L, Rovira À, Mesa J, Parlorio E, Munuera J. Ecografía: estado actual y postura de la SERAM. Radiología 2022. [DOI: 10.1016/j.rx.2021.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Plasencia-Martínez JM, Rovira À, Caro Domínguez P, Barber I, García-Garrigós E, Arenas-Jiménez JJ. Extrathoracic manifestations of COVID-19 in adults and presentation of the disease in children. Radiologia 2021; 63:370-383. [PMID: 35370317 PMCID: PMC8077575 DOI: 10.1016/j.rx.2021.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 03/17/2021] [Indexed: 01/08/2023]
Abstract
El síndrome de distrés respiratorio grave por el virus coronavirus 2, conocido como SARS-CoV-2, fue declarado pandemia mundial en marzo de 2020 por la Organización Mundial de la Salud y sigue activo actualmente en casi todos los países del mundo. Aunque los síntomas y manifestaciones en pruebas de imagen predominan en el aparato respiratorio, conocer las manifestaciones y posibles complicaciones en otros órganos será fundamental para ayudar al diagnóstico y orientar hacia el pronóstico de la enfermedad. Saber cuándo están indicadas las pruebas de imagen extratorácicas y cuáles son más rentables en cada circunstancia será crucial para mejorar el proceso diagnóstico sin aumentar innecesariamente el riesgo de contagio. En este trabajo hemos tratado de proporcionar estas respuestas, y hemos descrito iconográficamente las manifestaciones radiológicas de la enfermedad COVID-19 en regiones extratorácicas en adultos, así como en su conjunto en el paciente pediátrico.
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Affiliation(s)
- J M Plasencia-Martínez
- Sección de Radiología de Urgencias e Imagen Cardíaca, Servicio de Radiodiagnóstico, Hospital General Universitario José María Morales Meseguer, Murcia, España.
| | - À Rovira
- Sección de Neurorradiología, Servicio de Radiología, Hospital Universitari Vall d'Hebron, Barcelona, España
| | - P Caro Domínguez
- Unidad de Radiología Pediátrica, Servicio de Radiodiagnóstico, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - I Barber
- Unidad de Radiología Pediátrica, Servicio de Radiodiagnóstico, Hospital Sant Joan de Déu, Barcelona, España
| | - E García-Garrigós
- Servicio de Radiodiagnóstico, Hospital General Universitario de Alicante, Alicante, España; Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, España
| | - J J Arenas-Jiménez
- Servicio de Radiodiagnóstico, Hospital General Universitario de Alicante, Alicante, España; Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, España
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Llufriu S, Agüera E, Costa-Frossard L, Galán V, Landete L, Lourido D, Meca-Lallana JE, Moral E, Bravo-Rodríguez F, Koren L, Labiano A, León A, Martín P, Monedero MD, Requeni L, Zubizarreta I, Rovira À. Recommendations for the coordination of Neurology and Neuroradiology Departments in the management of patients with multiple sclerosis. Neurologia 2021; 38:S0213-4853(21)00029-3. [PMID: 33744061 DOI: 10.1016/j.nrl.2021.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 01/01/2021] [Indexed: 10/21/2022] Open
Abstract
INTRODUCTION Magnetic resonance imaging (MRI) is widely used for the diagnosis and follow-up of patients with multiple sclerosis (MS). Coordination between Neurology and Neuroradiology departments is crucial for performing and interpreting radiological studies as efficiently and as accurately as possible. However, improvements can be made in the communication between these departments in many Spanish hospitals. METHODS A panel of 17 neurologists and neuroradiologists from 8 Spanish hospitals held in-person and online meetings to draft a series of good practice guidelines for the coordinated management of MS. The drafting process included 4 phases: 1) establishing the scope of the guidelines and the methodology of the study; 2) literature review on good practices or recommendations on the use of MRI in MS; 3) discussion and consensus between experts; and 4) validation of the contents. RESULTS The expert panel agreed a total of 9 recommendations for improving coordination between neurology and neuroradiology departments. The recommendations revolve around 4 main pillars: 1) standardising the process for requesting and scheduling MRI studies and reports; 2) designing common protocols for MRI studies; 3) establishing multidisciplinary committees and coordination meetings; and 4) creating formal communication channels between both departments. CONCLUSIONS These consensus recommendations are intended to optimise coordination between neurologists and neuroradiologists, with the ultimate goal of improving the diagnosis and follow-up of patients with MS.
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Affiliation(s)
- S Llufriu
- Servicio de Neurología, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, España.
| | - E Agüera
- Servicio de Neurología, Hospital Universitario Reina Sofía, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, España
| | - L Costa-Frossard
- Servicio de Neurología, Hospital Universitario Ramón y Cajal, Madrid, España
| | - V Galán
- Servicio de Neurología, Hospital Virgen de la Salud, Toledo, España
| | - L Landete
- Servicio de Neurología, Hospital Universitario Dr. Peset, Valencia, España
| | - D Lourido
- Sección de Neurorradiología, Servicio de Radiología, Hospital Universitario Ramón y Cajal, Madrid, España
| | - J E Meca-Lallana
- CSUR Esclerosis Múltiple y Unidad de Neuroinmunología Clínica, Servicio de Neurología, Hospital Clínico Universitario Virgen de la Arrixaca, IMIB-Arrixaca, Murcia, España
| | - E Moral
- Servicio de Neurología, Hospital Moisès Broggi, Sant Joan Despí, Barcelona, España
| | - F Bravo-Rodríguez
- Sección de Neurorradiología, Servicio de Radiología, Hospital Universitario Reina Sofía, Córdoba, España
| | - L Koren
- Sección de Neurorradiología, Servicio de Radiología, Hospital Universitario 12 de Octubre, Madrid, España
| | - A Labiano
- Servicio de Neurología, Hospital Virgen de la Salud, Toledo, España
| | - A León
- Sección de Neurorradiología, Servicio de Radiología, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España
| | - P Martín
- Sección de Neurorradiología, Servicio de Radiología, Hospital Universitario 12 de Octubre, Madrid, España
| | - M D Monedero
- Sección de Neurorradiología, Servicio de Radiodiagnóstico, Hospital Universitario Dr. Peset, Valencia, España
| | - L Requeni
- Sección de Neurorradiología, Servicio de Radiodiagnóstico, Hospital Universitario Dr. Peset, Valencia, España
| | - I Zubizarreta
- Servicio de Neurología, Hospital Moisès Broggi, Sant Joan Despí, Barcelona, España
| | - À Rovira
- Sección de Neurorradiología, Servicio de Radiología, Hospital Universitario Vall d'Hebron, Barcelona, España
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Herrera Herrera I, Garrido Morro I, Guzmán de Villoria Lebiedziejewski J, Ordoñez González C, Rovira À. Enfoque clínico-radiológico de la mielopatía no traumática. Radiología 2020; 62:464-480. [DOI: 10.1016/j.rx.2020.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 06/28/2020] [Accepted: 07/02/2020] [Indexed: 11/16/2022]
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Herrera Herrera I, Garrido Morro I, Guzmán de Villoria Lebiedziejewski J, Ordoñez González C, Rovira À. Clinical-radiological approach to nontraumatic myelopathy. Radiología (English Edition) 2020. [DOI: 10.1016/j.rxeng.2020.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Auger C, Rovira À. New concepts about the role of magnetic resonance imaging in the diagnosis and follow-up of multiple sclerosis. Radiología (English Edition) 2020. [DOI: 10.1016/j.rxeng.2020.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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17
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Clarke MA, Pareto D, Pessini-Ferreira L, Arrambide G, Alberich M, Crescenzo F, Cappelle S, Tintoré M, Sastre-Garriga J, Auger C, Montalban X, Evangelou N, Rovira À. Value of 3T Susceptibility-Weighted Imaging in the Diagnosis of Multiple Sclerosis. AJNR Am J Neuroradiol 2020; 41:1001-1008. [PMID: 32439639 DOI: 10.3174/ajnr.a6547] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 03/19/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Previous studies have suggested that the central vein sign and iron rims are specific features of MS lesions. Using 3T SWI, we aimed to compare the frequency of lesions with central veins and iron rims in patients with clinically isolated syndrome and MS-mimicking disorders and test their diagnostic value in predicting conversion from clinically isolated syndrome to MS. MATERIALS AND METHODS For each patient, we calculated the number of brain lesions with central veins and iron rims. We then identified a simple rule involving an absolute number of lesions with central veins and iron rims to predict conversion from clinically isolated syndrome to MS. Additionally, we tested the diagnostic performance of central veins and iron rims when combined with evidence of dissemination in space. RESULTS We included 112 patients with clinically isolated syndrome and 35 patients with MS-mimicking conditions. At follow-up, 94 patients with clinically isolated syndrome developed MS according to the 2017 McDonald criteria. Patients with clinically isolated syndrome had a median of 2 central veins (range, 0-19), while the non-MS group had a median of 1 central vein (range, 0-6). Fifty-six percent of patients who developed MS had ≥1 iron rim, and none of the patients without MS had iron rims. The sensitivity and specificity of finding ≥3 central veins and/or ≥1 iron rim were 70% and 86%, respectively. In combination with evidence of dissemination in space, the 2 imaging markers had higher specificity than dissemination in space and positive findings of oligoclonal bands currently used to support the diagnosis of MS. CONCLUSIONS A single 3T SWI scan offers valuable diagnostic information, which has the potential to prevent MS misdiagnosis.
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Affiliation(s)
- M A Clarke
- From the Vall d'Hebron Research Institute (M.A.C., D.P., M.A., M.T., J.S.-G., C.A., X.M., A.R.), Barcelona, Spain
| | - D Pareto
- From the Vall d'Hebron Research Institute (M.A.C., D.P., M.A., M.T., J.S.-G., C.A., X.M., A.R.), Barcelona, Spain.,Section of Neuroradiology, Department of Radiology (D.P., L.P.-F., C.A., A.R.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - L Pessini-Ferreira
- Section of Neuroradiology, Department of Radiology (D.P., L.P.-F., C.A., A.R.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - G Arrambide
- Department of Neurology-Neuroimmunology (G.A., M.T., J.S.-G., X.M.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - M Alberich
- From the Vall d'Hebron Research Institute (M.A.C., D.P., M.A., M.T., J.S.-G., C.A., X.M., A.R.), Barcelona, Spain
| | - F Crescenzo
- Department of Neurosciences, Biomedicine and Movement Sciences (F.C.), University of Verona, Verona, Italy
| | - S Cappelle
- Division of Radiology (S.C.), University Hospital Leuven, Leuven, Belgium
| | - M Tintoré
- From the Vall d'Hebron Research Institute (M.A.C., D.P., M.A., M.T., J.S.-G., C.A., X.M., A.R.), Barcelona, Spain.,Department of Neurology-Neuroimmunology (G.A., M.T., J.S.-G., X.M.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - J Sastre-Garriga
- From the Vall d'Hebron Research Institute (M.A.C., D.P., M.A., M.T., J.S.-G., C.A., X.M., A.R.), Barcelona, Spain.,Department of Neurology-Neuroimmunology (G.A., M.T., J.S.-G., X.M.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - C Auger
- From the Vall d'Hebron Research Institute (M.A.C., D.P., M.A., M.T., J.S.-G., C.A., X.M., A.R.), Barcelona, Spain.,Section of Neuroradiology, Department of Radiology (D.P., L.P.-F., C.A., A.R.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - X Montalban
- From the Vall d'Hebron Research Institute (M.A.C., D.P., M.A., M.T., J.S.-G., C.A., X.M., A.R.), Barcelona, Spain.,Department of Neurology-Neuroimmunology (G.A., M.T., J.S.-G., X.M.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.,Division of Neurology (X.M.), St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - N Evangelou
- Division of Clinical Neuroscience (N.E.), University of Nottingham, Nottingham, UK
| | - À Rovira
- From the Vall d'Hebron Research Institute (M.A.C., D.P., M.A., M.T., J.S.-G., C.A., X.M., A.R.), Barcelona, Spain .,Section of Neuroradiology, Department of Radiology (D.P., L.P.-F., C.A., A.R.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
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Mallio CA, Quattrocchi CC, Rovira À, Parizel PM. Gadolinium Deposition Safety: Seeking the Patient's Perspective. AJNR Am J Neuroradiol 2020; 41:944-946. [PMID: 32381539 DOI: 10.3174/ajnr.a6586] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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19
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Pareto D, Garcia-Vidal A, Alberich M, Auger C, Montalban X, Tintoré M, Sastre-Garriga J, Rovira À. Ratio of T1-Weighted to T2-Weighted Signal Intensity as a Measure of Tissue Integrity: Comparison with Magnetization Transfer Ratio in Patients with Multiple Sclerosis. AJNR Am J Neuroradiol 2020; 41:461-463. [PMID: 32139431 DOI: 10.3174/ajnr.a6481] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 01/05/2020] [Indexed: 11/07/2022]
Abstract
The study aim was to compare the ratio of T1WI to T2WI signal intensity (T1/T2) with magnetization transfer ratio, a marker of myelin integrity, in patients with multiple sclerosis. A moderate correlation (r = 0.50, P = .034) was found between the magnetization transfer ratio and T1/T2 in normal-appearing gray matter, and a strong correlation for normal-appearing white matter (r = 0.63, P = .005) and lesions (r = 0.70, P = .001). Results suggest that besides myelin integrity, other factors may be playing a role in T1/T2 measures.
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Affiliation(s)
- D Pareto
- From the Neuroradiology Section (D.P., A.G.-V., M.A., C.A., A.R.)
| | - A Garcia-Vidal
- From the Neuroradiology Section (D.P., A.G.-V., M.A., C.A., A.R.)
| | - M Alberich
- From the Neuroradiology Section (D.P., A.G.-V., M.A., C.A., A.R.)
| | - C Auger
- From the Neuroradiology Section (D.P., A.G.-V., M.A., C.A., A.R.)
| | - X Montalban
- Department of Radiology and Department of Neuroimmunology-Cemcat (X.M., M.T., J.S.-G.), Vall d'Hebron University Hospital and Research Institute, Autonomous University, Barcelona, Spain.,Division of Neurology (X.M.), St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - M Tintoré
- Department of Radiology and Department of Neuroimmunology-Cemcat (X.M., M.T., J.S.-G.), Vall d'Hebron University Hospital and Research Institute, Autonomous University, Barcelona, Spain
| | - J Sastre-Garriga
- Department of Radiology and Department of Neuroimmunology-Cemcat (X.M., M.T., J.S.-G.), Vall d'Hebron University Hospital and Research Institute, Autonomous University, Barcelona, Spain
| | - À Rovira
- From the Neuroradiology Section (D.P., A.G.-V., M.A., C.A., A.R.)
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20
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Cabezas M, Corral JF, Oliver A, Díez Y, Tintoré M, Auger C, Montalban X, Lladó X, Pareto D, Rovira À. Improved Automatic Detection of New T2 Lesions in Multiple Sclerosis Using Deformation Fields. AJNR Am J Neuroradiol 2016; 37:1816-1823. [PMID: 27282863 DOI: 10.3174/ajnr.a4829] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 03/21/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Detection of disease activity, defined as new/enlarging T2 lesions on brain MR imaging, has been proposed as a biomarker in MS. However, detection of new/enlarging T2 lesions can be hindered by several factors that can be overcome with image subtraction. The purpose of this study was to improve automated detection of new T2 lesions and reduce user interaction to eliminate inter- and intraobserver variability. MATERIALS AND METHODS Multiparametric brain MR imaging was performed at 2 time points in 36 patients with new T2 lesions. Images were registered by using an affine transformation and the Demons algorithm to obtain a deformation field. After affine registration, images were subtracted and a threshold was applied to obtain a lesion mask, which was then refined by using the deformation field, intensity, and local information. This pipeline was compared with only applying a threshold, and with a state-of-the-art approach relying only on image intensities. To assess improvements, we compared the results of the different pipelines with the expert visual detection. RESULTS The multichannel pipeline based on the deformation field obtained a detection Dice similarity coefficient close to 0.70, with a false-positive detection of 17.8% and a true-positive detection of 70.9%. A statistically significant correlation (r = 0.81, P value = 2.2688e-09) was found between visual detection and automated detection by using our approach. CONCLUSIONS The deformation field-based approach proposed in this study for detecting new/enlarging T2 lesions resulted in significantly fewer false-positives while maintaining most true-positives and showed a good correlation with visual detection annotations. This approach could reduce user interaction and inter- and intraobserver variability.
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Affiliation(s)
- M Cabezas
- From the Section of Neuroradiology, Department of Radiology (M.C., J.F.C., C.A., D.P., À.R.) .,Visió per Computador i Robòtica group (M.C., A.O., Y.D., X.L.), University of Girona, Girona, Spain
| | - J F Corral
- From the Section of Neuroradiology, Department of Radiology (M.C., J.F.C., C.A., D.P., À.R.)
| | - A Oliver
- Visió per Computador i Robòtica group (M.C., A.O., Y.D., X.L.), University of Girona, Girona, Spain
| | - Y Díez
- Visió per Computador i Robòtica group (M.C., A.O., Y.D., X.L.), University of Girona, Girona, Spain
| | - M Tintoré
- Centre d'Esclerosi Múltiple de Catalunya, Department of Neurology/Neuroimmunology (M.T., X.M.), Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Autonomous University of Barcelona, Barcelona, Spain
| | - C Auger
- From the Section of Neuroradiology, Department of Radiology (M.C., J.F.C., C.A., D.P., À.R.)
| | - X Montalban
- Centre d'Esclerosi Múltiple de Catalunya, Department of Neurology/Neuroimmunology (M.T., X.M.), Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Autonomous University of Barcelona, Barcelona, Spain
| | - X Lladó
- Visió per Computador i Robòtica group (M.C., A.O., Y.D., X.L.), University of Girona, Girona, Spain
| | - D Pareto
- From the Section of Neuroradiology, Department of Radiology (M.C., J.F.C., C.A., D.P., À.R.)
| | - À Rovira
- From the Section of Neuroradiology, Department of Radiology (M.C., J.F.C., C.A., D.P., À.R.)
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Valverde S, Oliver A, Díez Y, Cabezas M, Vilanova JC, Ramió-Torrentà L, Rovira À, Lladó X. Evaluating the effects of white matter multiple sclerosis lesions on the volume estimation of 6 brain tissue segmentation methods. AJNR Am J Neuroradiol 2015; 36:1109-15. [PMID: 25678478 DOI: 10.3174/ajnr.a4262] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 12/20/2014] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The accuracy of automatic tissue segmentation methods can be affected by the presence of hypointense white matter lesions during the tissue segmentation process. Our aim was to evaluate the impact of MS white matter lesions on the brain tissue measurements of 6 well-known segmentation techniques. These include straightforward techniques such as Artificial Neural Network and fuzzy C-means as well as more advanced techniques such as the Fuzzy And Noise Tolerant Adaptive Segmentation Method, fMRI of the Brain Automated Segmentation Tool, SPM5, and SPM8. MATERIALS AND METHODS Thirty T1-weighted images from patients with MS from 3 different scanners were segmented twice, first including white matter lesions and then masking the lesions before segmentation and relabeling as WM afterward. The differences in total tissue volume and tissue volume outside the lesion regions were computed between the images by using the 2 methodologies. RESULTS Total gray matter volume was overestimated by all methods when lesion volume increased. The tissue volume outside the lesion regions was also affected by white matter lesions with differences up to 20 cm(3) on images with a high lesion load (≈50 cm(3)). SPM8 and Fuzzy And Noise Tolerant Adaptive Segmentation Method were the methods less influenced by white matter lesions, whereas the effect of white matter lesions was more prominent on fuzzy C-means and the fMRI of the Brain Automated Segmentation Tool. CONCLUSIONS Although lesions were removed after segmentation to avoid their impact on tissue segmentation, the methods still overestimated GM tissue in most cases. This finding is especially relevant because on images with high lesion load, this bias will most likely distort actual tissue atrophy measurements.
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Affiliation(s)
- S Valverde
- From the Computer Vision and Robotics Group (S.V., A.O., Y.D., X.L.), University of Girona, Campus Montilivi, Girona, Spain
| | - A Oliver
- From the Computer Vision and Robotics Group (S.V., A.O., Y.D., X.L.), University of Girona, Campus Montilivi, Girona, Spain
| | - Y Díez
- From the Computer Vision and Robotics Group (S.V., A.O., Y.D., X.L.), University of Girona, Campus Montilivi, Girona, Spain
| | - M Cabezas
- Magnetic Resonance Unit (M.C., A.R.), Department of Radiology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - J C Vilanova
- Girona Magnetic Resonance Center (J.C.V.), Girona, Spain
| | - L Ramió-Torrentà
- Multiple Sclerosis and Neuroimmunology Unit (L.R.-T.), Dr. Josep Trueta University Hospital, Institut d'Investigació Biomèdica de Girona, Girona, Spain
| | - À Rovira
- Magnetic Resonance Unit (M.C., A.R.), Department of Radiology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - X Lladó
- From the Computer Vision and Robotics Group (S.V., A.O., Y.D., X.L.), University of Girona, Campus Montilivi, Girona, Spain
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Affiliation(s)
- À Rovira
- Responsable de Publicaciones de la Sociedad Española de Radiología Médica (SERAM).
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24
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Montalban X, Sastre-Garriga J, Tintoré M, Brieva L, Aymerich FX, Río J, Porcel J, Borràs C, Nos C, Rovira À. A single-center, randomized, double-blind, placebo-controlled study of interferon beta-1b on primary progressive and transitional multiple sclerosis. Mult Scler 2009; 15:1195-205. [DOI: 10.1177/1352458509106937] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Inflammation and neurodegeneration may have differential impacts on disease evolution in the different forms of multiple sclerosis. However, a beneficial effect of immunomodulatory drugs should not be ruled out in primary progressive multiple sclerosis. Our aim is to investigate the safety and efficacy of interferon beta-1b in primary progressive multiple sclerosis. We conducted a double-blind, stratified, randomized, parallel group, phase II pilot study where patients with primary progressive multiple sclerosis or ‘transitional’ forms of multiple sclerosis received interferon beta-1b at doses of 8 MIU or placebo for 24 months. The main objective of the study was to investigate the safety and tolerability of interferon beta-1b. The primary efficacy variable was the time to neurological deterioration (Expanded Disability Status Scale) confirmed at 3 months. Seventy-three patients were included and three dropped out the study. More patients in the treatment arm had at least one related adverse event (94.4% versus 45.9%; p < 0.001); no other significant differences in safety endpoints were observed. Time to neurological deterioration was not different between trial arms (log-rank test, p = 0.3135). Statistically significant differences favoring treatment were observed for the Multiple Sclerosis Functional Composite score at several timepoints, T1 and T2 lesion volume changes at 12 and 24 months, mean number of active lesions and proportion of patients with active lesions at 24 months. We conclude that interferon beta-1b is safe and well tolerated in patients with primary progressive multiple sclerosis and transitional multiple sclerosis. Positive effects of interferon beta on secondary clinical and magnetic resonance imaging outcomes were observed, but a beneficial effect on Expanded Disability Status Scale progression was not demonstrated.
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Affiliation(s)
- X. Montalban
- Unitat de Neuroimmunologia Clínica, Multiple Sclerosis Centre of Catalonia (CEM-Cat), Barcelona, Spain,
| | - J. Sastre-Garriga
- Unitat de Neuroimmunologia Clínica, Multiple Sclerosis Centre of Catalonia (CEM-Cat), Barcelona, Spain
| | - M. Tintoré
- Unitat de Neuroimmunologia Clínica, Multiple Sclerosis Centre of Catalonia (CEM-Cat), Barcelona, Spain
| | - L. Brieva
- Unitat de Neuroimmunologia Clínica, Multiple Sclerosis Centre of Catalonia (CEM-Cat), Barcelona, Spain
| | - FX Aymerich
- Unitat de Ressonància Magnètica, Hospital Vall d'Hebron, Barcelona, Spain
| | - J. Río
- Unitat de Neuroimmunologia Clínica, Multiple Sclerosis Centre of Catalonia (CEM-Cat), Barcelona, Spain
| | - J. Porcel
- Unitat de Neuroimmunologia Clínica, Multiple Sclerosis Centre of Catalonia (CEM-Cat), Barcelona, Spain
| | - C. Borràs
- Unitat de Neuroimmunologia Clínica, Multiple Sclerosis Centre of Catalonia (CEM-Cat), Barcelona, Spain
| | - C. Nos
- Unitat de Neuroimmunologia Clínica, Multiple Sclerosis Centre of Catalonia (CEM-Cat), Barcelona, Spain
| | - À. Rovira
- Unitat de Ressonància Magnètica, Hospital Vall d'Hebron, Barcelona, Spain
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