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Ineichen BV, Moridi T, Ewing E, Ouellette R, Manouchehrinia A, Stawiarz L, Ferreira D, Muehlboeck SJ, Kuhle J, Westman E, Leppert D, Hillert J, Olsson T, Kockum I, Piehl F, Granberg T. Neurofilament light chain as a marker for cortical atrophy in multiple sclerosis without radiological signs of disease activity. J Intern Med 2021; 290:473-476. [PMID: 33871105 DOI: 10.1111/joim.13286] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/11/2021] [Accepted: 03/12/2021] [Indexed: 11/27/2022]
Affiliation(s)
- B V Ineichen
- From the, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - T Moridi
- From the, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Center of Neurology, Academic Specialist Center, Stockholm Health Services, Stockholm, Sweden
| | - E Ewing
- From the, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - R Ouellette
- From the, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - A Manouchehrinia
- From the, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - L Stawiarz
- From the, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - D Ferreira
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - S J Muehlboeck
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - J Kuhle
- Neurologic Clinic and Policlinic, Departments of Medicine, University Hospital Basel and University of Basel, Basel, Switzerland
| | - E Westman
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Department of Neuroimaging, Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - D Leppert
- Neurologic Clinic and Policlinic, Departments of Medicine, University Hospital Basel and University of Basel, Basel, Switzerland
| | - J Hillert
- From the, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - T Olsson
- From the, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - I Kockum
- From the, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - F Piehl
- From the, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Center of Neurology, Academic Specialist Center, Stockholm Health Services, Stockholm, Sweden
| | - T Granberg
- From the, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
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2
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Paucar M, Lundin J, Alshammari T, Bergendal Å, Lindefeldt M, Alshammari M, Solders G, Di Re J, Savitcheva I, Granberg T, Laezza F, Iwarsson E, Svenningsson P. Broader phenotypic traits and widespread brain hypometabolism in spinocerebellar ataxia 27. J Intern Med 2020; 288:103-115. [PMID: 32112487 PMCID: PMC10123866 DOI: 10.1111/joim.13052] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE The goal of this study was to characterize a Swedish family with members affected by spinocerebellar ataxia 27 (SCA27), a rare autosomal dominant disease caused by mutations in fibroblast growth factor 14 (FGF14). Despite normal structural neuroimaging, psychiatric manifestations and intellectual disability are part of the SCA27 phenotype raising the need for functional neuroimaging. Here, we used clinical assessments, structural and functional neuroimaging to characterize these new SCA27 patients. Since one patient presents with a psychotic disorder, an exploratory study of markers of schizophrenia associated with GABAergic neurotransmission was performed in fgf14-/- mice, a preclinical model that replicates motor and learning deficits of SCA27. METHODS A comprehensive characterization that included clinical assessments, cognitive tests, structural neuroimaging studies, brain metabolism with 18 F-fluorodeoxyglucose PET ([18F] FDG PET) and genetic analyses was performed. Brains of fgf14-/- mice were studied with immunohistochemistry. RESULTS Nine patients had ataxia, and all affected patients harboured an interstitial deletion of chromosome 13q33.1 encompassing the entire FGF14 and integrin subunit beta like 1 (ITGBL1) genes. New features for SCA27 were identified: congenital onset, psychosis, attention deficit hyperactivity disorder and widespread hypometabolism that affected the medial prefrontal cortex (mPFC) in all patients. Hypometabolism in the PFC was far more pronounced in a SCA27 patient with psychosis. Reduced expression of VGAT was found in the mPFC of fgf14-/- mice. CONCLUSIONS This is the second largest SCA27 family identified to date. We provide new clinical and preclinical evidence for a significant psychiatric component in SCA27, strengthening the hypothesis of FGF14 as an important modulator of psychiatric disease.
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Affiliation(s)
- M Paucar
- From the, Departments of, Department of, Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of, Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - J Lundin
- Department of, Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - T Alshammari
- Department of Pharmacology and Toxicology, The University of Texas Medical Branch, Galveston, TX, USA
- Department of, Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Å Bergendal
- From the, Departments of, Department of, Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - M Lindefeldt
- Department of, Pediatric Neurology, Astrid Lindgren's Hospital, Stockholm, Sweden
| | - M Alshammari
- Department of Pharmacology and Toxicology, The University of Texas Medical Branch, Galveston, TX, USA
- Department of, Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - G Solders
- From the, Departments of, Department of, Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of, Neurophysiology, Karolinska University Hospital, Stockholm, Sweden
| | - J Di Re
- Department of Pharmacology and Toxicology, The University of Texas Medical Branch, Galveston, TX, USA
- Neuroscience Graduate Program, The University of Texas Medical Branch, Galveston, TX, USA
| | - I Savitcheva
- Departments of, Department of, Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - T Granberg
- From the, Departments of, Department of, Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of, Radiology, Karolinska University Hospital, Stockholm, Sweden
| | - F Laezza
- Department of Pharmacology and Toxicology, The University of Texas Medical Branch, Galveston, TX, USA
| | - E Iwarsson
- Department of, Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - P Svenningsson
- From the, Departments of, Department of, Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of, Neurology, Karolinska University Hospital, Stockholm, Sweden
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3
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Forslin Y, Martola J, Bergendal Å, Fredrikson S, Wiberg MK, Granberg T. Gadolinium Retention in the Brain: An MRI Relaxometry Study of Linear and Macrocyclic Gadolinium-Based Contrast Agents in Multiple Sclerosis. AJNR Am J Neuroradiol 2019; 40:1265-1273. [PMID: 31248867 DOI: 10.3174/ajnr.a6112] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 05/20/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND PURPOSE Brain gadolinium retention is consistently reported for linear gadolinium-based contrast agents, while the results for macrocyclics are contradictory and potential clinical manifestations remain controversial. Furthermore, most previous studies are based on conventional T1-weighted MR imaging. We therefore aimed to quantitatively investigate longitudinal and transversal relaxation in the brain in relation to previous gadolinium-based contrast agent administration and explore associations with disability in multiple sclerosis. MATERIALS AND METHODS Eighty-five patients with MS and 21 healthy controls underwent longitudinal and transverse relaxation rate (R1 and R2) relaxometry. Patients were divided into linear, mixed, and macrocyclic groups based on previous gadolinium-based contrast agent administration. Neuropsychological testing was performed in 53 patients. The dentate nucleus, globus pallidus, caudate nucleus, and thalamus were manually segmented. Repeatability measures were also performed. RESULTS The relaxometry was robust (2.0% scan-rescan difference) and detected higher R1 (dentate nucleus, globus pallidus, caudate nucleus, thalamus) and R2 (globus pallidus, caudate nucleus) in patients receiving linear gadolinium-based contrast agents compared with controls. The number of linear gadolinium-based contrast agent administrations was associated with higher R1 and R2 in all regions (except R2 in the thalamus). No similar differences and associations were found for the macrocyclic group. Higher relaxation was associated with lower information-processing speed (dentate nucleus, thalamus) and verbal fluency (caudate nucleus, thalamus). No associations were found with physical disability or fatigue. CONCLUSIONS Previous linear, but not macrocyclic, gadolinium-based contrast agent administration is associated with higher relaxation rates in a dose-dependent manner. Higher relaxation in some regions is associated with cognitive impairment but not physical disability or fatigue in MS. The findings should be interpreted with care but encourage studies into gadolinium retention and cognition.
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Affiliation(s)
- Y Forslin
- From the Department of Clinical Neuroscience (Y.F., J.M., Å.B., S.F., M.K.W., T.G.), Karolinska Institutet, Stockholm, Sweden .,Departments of Radiology (Y.F., J.M., M.K.W., T.G.)
| | - J Martola
- From the Department of Clinical Neuroscience (Y.F., J.M., Å.B., S.F., M.K.W., T.G.), Karolinska Institutet, Stockholm, Sweden.,Departments of Radiology (Y.F., J.M., M.K.W., T.G.)
| | - Å Bergendal
- From the Department of Clinical Neuroscience (Y.F., J.M., Å.B., S.F., M.K.W., T.G.), Karolinska Institutet, Stockholm, Sweden
| | - S Fredrikson
- From the Department of Clinical Neuroscience (Y.F., J.M., Å.B., S.F., M.K.W., T.G.), Karolinska Institutet, Stockholm, Sweden.,Neurology (S.F.), Karolinska University Hospital, Stockholm, Sweden
| | - M K Wiberg
- From the Department of Clinical Neuroscience (Y.F., J.M., Å.B., S.F., M.K.W., T.G.), Karolinska Institutet, Stockholm, Sweden.,Departments of Radiology (Y.F., J.M., M.K.W., T.G.).,Department of Medical and Health Sciences (M.K.W.), Division of Radiological Sciences, Linköping University, Linköping, Sweden
| | - T Granberg
- From the Department of Clinical Neuroscience (Y.F., J.M., Å.B., S.F., M.K.W., T.G.), Karolinska Institutet, Stockholm, Sweden.,Departments of Radiology (Y.F., J.M., M.K.W., T.G.)
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4
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Forslin Y, Bergendal Å, Hashim F, Martola J, Shams S, Wiberg MK, Fredrikson S, Granberg T. Detection of Leukocortical Lesions in Multiple Sclerosis and Their Association with Physical and Cognitive Impairment: A Comparison of Conventional and Synthetic Phase-Sensitive Inversion Recovery MRI. AJNR Am J Neuroradiol 2018; 39:1995-2000. [PMID: 30262646 DOI: 10.3174/ajnr.a5815] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 08/02/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND PURPOSE Cortical lesions are common in multiple sclerosis and are included in the latest diagnostic criteria. The limited sensitivity of cortical MS lesions on conventional MR imaging can be improved by phase-sensitive inversion recovery. Synthetic MR imaging could provide phase-sensitive inversion recovery without additional scanning, but the use of synthetic phase-sensitive inversion recovery remains to be validated. We aimed to compare the ability and clinical value of detecting leukocortical lesions with conventional and synthetic phase-sensitive inversion recovery in MS. MATERIALS AND METHODS Twenty-one patients with MS prospectively underwent conventional and synthetic phase-sensitive inversion recovery, 3D T1-weighted, and T2 FLAIR imaging. Two neuroradiologists independently performed blinded phase-sensitive inversion recovery lesion assessments; a consensus rating with all sequences was considered the criterion standard. Lesion volumes were segmented. All participants underwent standardized cognitive and physical examinations and Fatigue Severity Scale assessment. Results were analyzed with multiple linear regressions. RESULTS Interrater and criterion standard agreement for leukocortical lesions was excellent for both conventional and synthetic phase-sensitive inversion recovery (intraclass correlation coefficient = 0.79-0.97). Leukocortical lesion volumes for both sequences were associated with lower information-processing speed (P ≤ .01) and verbal fluency (P ≤ .02). Both phase-sensitive inversion recovery sequences showed a positive effect on the association when combining volumes of leukocortical lesions and white matter lesions with information-processing speed (P ≤ .005) and verbal fluency (P ≤ .03). No associations were found between leukocortical lesion volumes and physical disability or fatigue. CONCLUSIONS Synthetic and conventional phase-sensitive inversion recovery have a sensitivity similar to that of leukocortical MS lesions. The detected leukocortical lesions are associated with cognitive dysfunction and thus provide clinically relevant information, which encourages assessment of cortical MS involvement at conventional field strengths.
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Affiliation(s)
- Y Forslin
- From the Departments of Clinical Science, Intervention and Technology (Y.F., Å.B., F.H., J.M., S.S., M.K.W., T.G.) .,Clinical Neuroscience (S.F.), Karolinska Institutet, Stockholm, Sweden
| | - Å Bergendal
- From the Departments of Clinical Science, Intervention and Technology (Y.F., Å.B., F.H., J.M., S.S., M.K.W., T.G.)
| | - F Hashim
- From the Departments of Clinical Science, Intervention and Technology (Y.F., Å.B., F.H., J.M., S.S., M.K.W., T.G.).,Clinical Neuroscience (S.F.), Karolinska Institutet, Stockholm, Sweden
| | - J Martola
- From the Departments of Clinical Science, Intervention and Technology (Y.F., Å.B., F.H., J.M., S.S., M.K.W., T.G.).,Clinical Neuroscience (S.F.), Karolinska Institutet, Stockholm, Sweden
| | - S Shams
- From the Departments of Clinical Science, Intervention and Technology (Y.F., Å.B., F.H., J.M., S.S., M.K.W., T.G.).,Clinical Neuroscience (S.F.), Karolinska Institutet, Stockholm, Sweden
| | - M K Wiberg
- From the Departments of Clinical Science, Intervention and Technology (Y.F., Å.B., F.H., J.M., S.S., M.K.W., T.G.).,Clinical Neuroscience (S.F.), Karolinska Institutet, Stockholm, Sweden
| | - S Fredrikson
- Clinical Neuroscience (S.F.), Karolinska Institutet, Stockholm, Sweden.,Neurology (S.F.), Karolinska University Hospital, Stockholm, Sweden
| | - T Granberg
- From the Departments of Clinical Science, Intervention and Technology (Y.F., Å.B., F.H., J.M., S.S., M.K.W., T.G.).,Clinical Neuroscience (S.F.), Karolinska Institutet, Stockholm, Sweden
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5
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Forslin Y, Shams S, Hashim F, Aspelin P, Bergendal G, Martola J, Fredrikson S, Kristoffersen-Wiberg M, Granberg T. Retention of Gadolinium-Based Contrast Agents in Multiple Sclerosis: Retrospective Analysis of an 18-Year Longitudinal Study. AJNR Am J Neuroradiol 2017; 38:1311-1316. [PMID: 28495943 DOI: 10.3174/ajnr.a5211] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Accepted: 03/03/2017] [Indexed: 01/06/2023]
Abstract
BACKGROUND AND PURPOSE Gadolinium-based contrast agents have been associated with lasting high T1-weighted signal intensity in the dentate nucleus and globus pallidus, with histopathologically confirmed gadolinium retention. We aimed to longitudinally investigate the relationship of multiple gadolinium-based contrast agent administrations to the Signal Intensity Index in the dentate nucleus and globus pallidus and any associations with cognitive function in multiple sclerosis. MATERIALS AND METHODS The Signal Intensity Index in the dentate nucleus and globus pallidus was retrospectively evaluated on T1-weighted MR imaging in an 18-year longitudinal cohort study of 23 patients with MS receiving multiple gadolinium-based contrast agent administrations and 23 healthy age- and sex-matched controls. Participants also underwent comprehensive neuropsychological testing. RESULTS Patients with MS had a higher Signal Intensity Index in the dentate nucleus (P < .001), but not in the globus pallidus (P = .19), compared with non-gadolinium-based contrast agent-exposed healthy controls by an unpaired t test. Increasing numbers of gadolinium-based contrast agent administrations were associated with an increased Signal Intensity Index in the dentate nucleus (β = 0.45, P < .001) and globus pallidus (β = 0.60, P < .001). This association remained stable with corrections for the age, disease duration, and physical disability for both the dentate nucleus (β = 0.43, P = .001) and globus pallidus (β = 0.58, P < .001). An increased Signal Intensity Index in the dentate nucleus among patients with MS was associated with lower verbal fluency scores, which remained significant after correction for several aspects of disease severity (β = -0.40 P = .013). CONCLUSIONS Our data corroborate previous reports of lasting gadolinium retention in brain tissues. An increased Signal Intensity Index in the dentate nucleus and globus pallidus was associated with lower verbal fluency, which does not prove causality but encourages further studies on cognition and gadolinium-based contrast agent administration.
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Affiliation(s)
- Y Forslin
- From the Departments of Clinical Science Intervention and Technology (Y.F., S.S., F.H., P.A., G.B., J.M., M.K.-W., T.G.) .,Radiology (Y.F., S.S., F.H., P.A., G.B., J.M., M.K.-W., T.G.)
| | - S Shams
- From the Departments of Clinical Science Intervention and Technology (Y.F., S.S., F.H., P.A., G.B., J.M., M.K.-W., T.G.).,Radiology (Y.F., S.S., F.H., P.A., G.B., J.M., M.K.-W., T.G.)
| | - F Hashim
- From the Departments of Clinical Science Intervention and Technology (Y.F., S.S., F.H., P.A., G.B., J.M., M.K.-W., T.G.).,Radiology (Y.F., S.S., F.H., P.A., G.B., J.M., M.K.-W., T.G.)
| | - P Aspelin
- From the Departments of Clinical Science Intervention and Technology (Y.F., S.S., F.H., P.A., G.B., J.M., M.K.-W., T.G.).,Radiology (Y.F., S.S., F.H., P.A., G.B., J.M., M.K.-W., T.G.)
| | - G Bergendal
- From the Departments of Clinical Science Intervention and Technology (Y.F., S.S., F.H., P.A., G.B., J.M., M.K.-W., T.G.).,Radiology (Y.F., S.S., F.H., P.A., G.B., J.M., M.K.-W., T.G.).,Neurology (G.B., S.F.)
| | - J Martola
- From the Departments of Clinical Science Intervention and Technology (Y.F., S.S., F.H., P.A., G.B., J.M., M.K.-W., T.G.).,Radiology (Y.F., S.S., F.H., P.A., G.B., J.M., M.K.-W., T.G.)
| | - S Fredrikson
- Neurology (G.B., S.F.).,Clinical Neuroscience (S.F.), Karolinska Institutet, Stockholm, Sweden
| | - M Kristoffersen-Wiberg
- From the Departments of Clinical Science Intervention and Technology (Y.F., S.S., F.H., P.A., G.B., J.M., M.K.-W., T.G.).,Radiology (Y.F., S.S., F.H., P.A., G.B., J.M., M.K.-W., T.G.)
| | - T Granberg
- From the Departments of Clinical Science Intervention and Technology (Y.F., S.S., F.H., P.A., G.B., J.M., M.K.-W., T.G.).,Radiology (Y.F., S.S., F.H., P.A., G.B., J.M., M.K.-W., T.G.)
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6
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Vågberg M, Axelsson M, Birgander R, Burman J, Cananau C, Forslin Y, Granberg T, Gunnarsson M, von Heijne A, Jönsson L, Karrenbauer VD, Larsson EM, Lindqvist T, Lycke J, Lönn L, Mentesidou E, Müller S, Nilsson P, Piehl F, Svenningsson A, Vrethem M, Wikström J. Guidelines for the use of magnetic resonance imaging in diagnosing and monitoring the treatment of multiple sclerosis: recommendations of the Swedish Multiple Sclerosis Association and the Swedish Neuroradiological Society. Acta Neurol Scand 2017; 135:17-24. [PMID: 27558404 PMCID: PMC5157754 DOI: 10.1111/ane.12667] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [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] [Accepted: 08/05/2016] [Indexed: 01/28/2023]
Abstract
Multiple sclerosis (MS) is associated with inflammatory lesions in the brain and spinal cord. The detection of such inflammatory lesions using magnetic resonance imaging (MRI) is important in the consideration of the diagnosis and differential diagnoses of MS, as well as in the monitoring of disease activity and predicting treatment efficacy. Although there is strong evidence supporting the use of MRI for both the diagnosis and monitoring of disease activity, there is a lack of evidence regarding which MRI protocols to use, the frequency of examinations, and in what clinical situations to consider MRI examination. A national workshop to discuss these issues was held in Stockholm, Sweden, in August 2015, which resulted in a Swedish consensus statement regarding the use of MRI in the care of individuals with MS. The aim of this consensus statement is to provide practical advice for the use of MRI in this setting. The recommendations are based on a review of relevant literature and the clinical experience of workshop attendees. It is our hope that these recommendations will benefit individuals with MS and guide healthcare professionals responsible for their care.
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Affiliation(s)
- M. Vågberg
- Department of Pharmacology and Clinical Neuroscience, Section of Neuroscience; Umeå University; Umeå Sweden
| | - M. Axelsson
- Department of Clinical Neuroscience; Institute of Neuroscience and Physiology at Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - R. Birgander
- Department of Radiation Sciences; Umeå University; Umeå Sweden
| | - J. Burman
- Department of Neuroscience; Uppsala University; Uppsala Sweden
| | - C. Cananau
- Department of Clinical Science, Intervention and Technology; Department of Radiology; Karolinska Institutet; Karolinska University Hospital; Stockholm Sweden
| | - Y. Forslin
- Department of Clinical Science, Intervention and Technology; Department of Radiology; Karolinska Institutet; Karolinska University Hospital; Stockholm Sweden
| | - T. Granberg
- Department of Clinical Science, Intervention and Technology; Department of Radiology; Karolinska Institutet; Karolinska University Hospital; Stockholm Sweden
| | - M. Gunnarsson
- Department of Neurology; School of Medical Sciences; Örebro University; Örebro Sweden
| | - A. von Heijne
- Department of Clinical Sciences; Karolinska Institutet; Danderyd Hospital; Stockholm Sweden
| | - L. Jönsson
- Department of Neuroradiology; Sahlgrenska University Hospital; Gothenburg Sweden
| | - V. D. Karrenbauer
- Department of Clinical Neuroscience; Department of Neurology; Karolinska Institutet; Karolinska University Hospital; Stockholm Sweden
| | - E.-M. Larsson
- Department of Surgical Sciences, Radiology; Uppsala University; Uppsala Sweden
| | - T. Lindqvist
- Department of Radiation Sciences; Umeå University; Umeå Sweden
| | - J. Lycke
- Department of Clinical Neuroscience; Institute of Neuroscience and Physiology at Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - L. Lönn
- Department of Clinical Science, Intervention and Technology; Department of Radiology; Karolinska Institutet; Karolinska University Hospital; Stockholm Sweden
| | - E. Mentesidou
- Department of Clinical Neuroscience; Department of Neurology; Karolinska Institutet; Karolinska University Hospital; Stockholm Sweden
| | - S. Müller
- Department of Clinical Science, Intervention and Technology; Department of Radiology; Karolinska Institutet; Karolinska University Hospital; Stockholm Sweden
| | - P. Nilsson
- Department of Clinical Sciences Lund, Neurology; Faculty of Medicine; Lund University; Lund Sweden
| | - F. Piehl
- Department of Clinical Neuroscience; Department of Neurology; Karolinska Institutet; Karolinska University Hospital; Stockholm Sweden
| | - A. Svenningsson
- Department of Clinical Sciences; Karolinska Institutet; Danderyd Hospital; Stockholm Sweden
| | - M. Vrethem
- Department of Neurology and Department of Clinical and Experimental Medicine; Linköping University; Linköping Sweden
| | - J. Wikström
- Department of Surgical Sciences, Radiology; Uppsala University; Uppsala Sweden
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7
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Affiliation(s)
- T Granberg
- Department of Clinical Science, Intervention, and Technology Karolinska Institutet Stockholm, Sweden.,Department of Radiology Karolinska University Hospital Stockholm, Sweden
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8
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Forslin Y, Granberg T, Jumah AA, Shams S, Aspelin P, Kristoffersen-Wiberg M, Martola J, Fredrikson S. Incidence of Radiologically Isolated Syndrome: A Population-Based Study. AJNR Am J Neuroradiol 2016; 37:1017-22. [PMID: 26846927 DOI: 10.3174/ajnr.a4660] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [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: 10/14/2015] [Accepted: 11/20/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Incidental MR imaging findings resembling MS in asymptomatic individuals, fulfilling the Okuda criteria, are termed "radiologically isolated syndrome." Those with radiologically isolated syndrome are at high risk of their condition converting to MS. The epidemiology of radiologically isolated syndrome remains largely unknown, and there are no population-based studies, to our knowledge. Our aim was to study the population-based incidence of radiologically isolated syndrome in a high-incidence region for MS and to evaluate the effect on radiologically isolated syndrome incidence when revising the original radiologically isolated syndrome criteria by using the latest radiologic classification for dissemination in space. MATERIALS AND METHODS All 2272 brain MR imaging scans in 1907 persons obtained during 2013 in the Swedish county of Västmanland, with a population of 259,000 inhabitants, were blindly evaluated by a senior radiologist and a senior neuroradiologist. The Okuda criteria for radiologically isolated syndrome were applied by using both the Barkhof and Swanton classifications for dissemination in space. Assessments of clinical data were performed by a radiology resident and a senior neurologist. RESULTS The cumulative incidence of radiologically isolated syndrome was 2 patients (0.1%), equaling an incidence rate of 0.8 cases per 100,000 person-years, in a region with an incidence rate of MS of 10.2 cases per 100,000 person-years. There was no difference in the radiologically isolated syndrome incidence rate when applying a modified version of the Okuda criteria by using the newer Swanton classification for dissemination in space. CONCLUSIONS Radiologically isolated syndrome is uncommon in a high-incidence region for MS. Adapting the Okuda criteria to use the dissemination in space-Swanton classification may be feasible. Future studies on radiologically isolated syndrome may benefit from a collaborative approach to ensure adequate numbers of participants.
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Affiliation(s)
- Y Forslin
- From the Departments of Clinical Science, Intervention and Technology (Y.F., T.G., S.S., P.A., M.K.-W., J.M.) Radiology (Y.F., T.G., S.S., P.A., M.K.-W., J.M.) Department of Radiology (Y.F., T.G., A.A.J.), Västmanland Hospital, Västerås, Sweden.
| | - T Granberg
- From the Departments of Clinical Science, Intervention and Technology (Y.F., T.G., S.S., P.A., M.K.-W., J.M.) Radiology (Y.F., T.G., S.S., P.A., M.K.-W., J.M.) Department of Radiology (Y.F., T.G., A.A.J.), Västmanland Hospital, Västerås, Sweden
| | - A Antwan Jumah
- Department of Radiology (Y.F., T.G., A.A.J.), Västmanland Hospital, Västerås, Sweden
| | - S Shams
- From the Departments of Clinical Science, Intervention and Technology (Y.F., T.G., S.S., P.A., M.K.-W., J.M.) Radiology (Y.F., T.G., S.S., P.A., M.K.-W., J.M.)
| | - P Aspelin
- From the Departments of Clinical Science, Intervention and Technology (Y.F., T.G., S.S., P.A., M.K.-W., J.M.) Radiology (Y.F., T.G., S.S., P.A., M.K.-W., J.M.)
| | - M Kristoffersen-Wiberg
- From the Departments of Clinical Science, Intervention and Technology (Y.F., T.G., S.S., P.A., M.K.-W., J.M.) Radiology (Y.F., T.G., S.S., P.A., M.K.-W., J.M.)
| | - J Martola
- From the Departments of Clinical Science, Intervention and Technology (Y.F., T.G., S.S., P.A., M.K.-W., J.M.) Radiology (Y.F., T.G., S.S., P.A., M.K.-W., J.M.)
| | - S Fredrikson
- Clinical Neuroscience (S.F.) Neurology (S.F.), Karolinska University Hospital, Stockholm, Sweden
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Granberg T, Uppman M, Hashim F, Cananau C, Nordin LE, Shams S, Berglund J, Forslin Y, Aspelin P, Fredrikson S, Kristoffersen-Wiberg M. Clinical Feasibility of Synthetic MRI in Multiple Sclerosis: A Diagnostic and Volumetric Validation Study. AJNR Am J Neuroradiol 2016; 37:1023-9. [PMID: 26797137 DOI: 10.3174/ajnr.a4665] [Citation(s) in RCA: 100] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 11/24/2015] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND PURPOSE Quantitative MR imaging techniques are gaining interest as methods of reducing acquisition times while additionally providing robust measurements. This study aimed to implement a synthetic MR imaging method on a new scanner type and to compare its diagnostic accuracy and volumetry with conventional MR imaging in patients with MS and controls. MATERIALS AND METHODS Twenty patients with MS and 20 healthy controls were enrolled after ethics approval and written informed consent. Synthetic MR imaging was implemented on a Siemens 3T scanner. Comparable conventional and synthetic proton-density-, T1-, and T2-weighted, and FLAIR images were acquired. Diagnostic accuracy, lesion detection, and artifacts were assessed by blinded neuroradiologic evaluation, and contrast-to-noise ratios, by manual tracing. Volumetry was performed with synthetic MR imaging, FreeSurfer, FMRIB Software Library, and Statistical Parametric Mapping. Repeatability was quantified by using the coefficient of variance. RESULTS Synthetic proton-density-, T1-, and T2-weighted images were of sufficient or good quality and were acquired in 7% less time than with conventional MR imaging. Synthetic FLAIR images were degraded by artifacts. Lesion counts and volumes were higher in synthetic MR imaging due to differences in the contrast of dirty-appearing WM but did not affect the radiologic diagnostic classification or lesion topography (P = .50-.77). Synthetic MR imaging provided segmentations with the shortest processing time (16 seconds) and the lowest repeatability error for brain volume (0.14%), intracranial volume (0.12%), brain parenchymal fraction (0.14%), and GM fraction (0.56%). CONCLUSIONS Synthetic MR imaging can be an alternative to conventional MR imaging for generating diagnostic proton-density-, T1-, and T2-weighted images in patients with MS and controls while additionally delivering fast and robust volumetric measurements suitable for MS studies.
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Affiliation(s)
- T Granberg
- From the Departments of Clinical Science, Intervention and Technology (T.G., M.U., F.H., L.E.N., S.S., J.B., Y.F., P.A., M.K.-W.) Departments of Radiology (T.G., F.H., C.C., S.S., Y.F., P.A., M.K.-W)
| | - M Uppman
- From the Departments of Clinical Science, Intervention and Technology (T.G., M.U., F.H., L.E.N., S.S., J.B., Y.F., P.A., M.K.-W.) Diagnostic Medical Physics (M.U., L.E.N., J.B.)
| | - F Hashim
- From the Departments of Clinical Science, Intervention and Technology (T.G., M.U., F.H., L.E.N., S.S., J.B., Y.F., P.A., M.K.-W.) Departments of Radiology (T.G., F.H., C.C., S.S., Y.F., P.A., M.K.-W)
| | - C Cananau
- Departments of Radiology (T.G., F.H., C.C., S.S., Y.F., P.A., M.K.-W)
| | - L E Nordin
- From the Departments of Clinical Science, Intervention and Technology (T.G., M.U., F.H., L.E.N., S.S., J.B., Y.F., P.A., M.K.-W.) Diagnostic Medical Physics (M.U., L.E.N., J.B.)
| | - S Shams
- From the Departments of Clinical Science, Intervention and Technology (T.G., M.U., F.H., L.E.N., S.S., J.B., Y.F., P.A., M.K.-W.) Departments of Radiology (T.G., F.H., C.C., S.S., Y.F., P.A., M.K.-W)
| | - J Berglund
- From the Departments of Clinical Science, Intervention and Technology (T.G., M.U., F.H., L.E.N., S.S., J.B., Y.F., P.A., M.K.-W.) Diagnostic Medical Physics (M.U., L.E.N., J.B.)
| | - Y Forslin
- From the Departments of Clinical Science, Intervention and Technology (T.G., M.U., F.H., L.E.N., S.S., J.B., Y.F., P.A., M.K.-W.) Departments of Radiology (T.G., F.H., C.C., S.S., Y.F., P.A., M.K.-W)
| | - P Aspelin
- From the Departments of Clinical Science, Intervention and Technology (T.G., M.U., F.H., L.E.N., S.S., J.B., Y.F., P.A., M.K.-W.) Departments of Radiology (T.G., F.H., C.C., S.S., Y.F., P.A., M.K.-W)
| | - S Fredrikson
- Clinical Neuroscience (S.F.), Karolinska Institutet, Stockholm, Sweden Neurology (S.F.), Karolinska University Hospital, Stockholm, Sweden
| | - M Kristoffersen-Wiberg
- From the Departments of Clinical Science, Intervention and Technology (T.G., M.U., F.H., L.E.N., S.S., J.B., Y.F., P.A., M.K.-W.) Departments of Radiology (T.G., F.H., C.C., S.S., Y.F., P.A., M.K.-W)
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Granberg T, Hashim F, Andersen O, Sundal C, Karrenbauer VD. Hereditary diffuse leukoencephalopathy with spheroids - a volumetric and radiological comparison with multiple sclerosis patients and healthy controls. Eur J Neurol 2016; 23:817-22. [DOI: 10.1111/ene.12948] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Accepted: 11/13/2015] [Indexed: 02/02/2023]
Affiliation(s)
- T. Granberg
- Division of Medical Imaging and Technology; Department of Clinical Science; Intervention and Technology; Karolinska Institutet; Stockholm Sweden
- Department of Radiology; Karolinska University Hospital; Stockholm Sweden
| | - F. Hashim
- Division of Medical Imaging and Technology; Department of Clinical Science; Intervention and Technology; Karolinska Institutet; Stockholm Sweden
- Department of Radiology; Karolinska University Hospital; Stockholm Sweden
| | - O. Andersen
- The Sahlgrenska Academy; Department of Neuroscience and Physiology; Section of Clinical Neuroscience and Rehabilitation; University of Gothenburg; Gothenburg Sweden
| | - C. Sundal
- The Sahlgrenska Academy; Department of Neuroscience and Physiology; Section of Clinical Neuroscience and Rehabilitation; University of Gothenburg; Gothenburg Sweden
- Department of Neurology; Haukeland University Hospital; Bergen Norway
| | - V. D. Karrenbauer
- Department of Clinical Neuroscience; Karolinska Institutet; Stockholm Sweden
- Department of Neurology; Karolinska University Hospital; Stockholm Sweden
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Shams S, Martola J, Cavallin L, Granberg T, Shams M, Aspelin P, Wahlund LO, Kristoffersen-Wiberg M. SWI or T2*: which MRI sequence to use in the detection of cerebral microbleeds? The Karolinska Imaging Dementia Study. AJNR Am J Neuroradiol 2015; 36:1089-95. [PMID: 25698623 DOI: 10.3174/ajnr.a4248] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 12/16/2014] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND PURPOSE Cerebral microbleeds are thought to have potentially important clinical implications in dementia and stroke. However, the use of both T2* and SWI MR imaging sequences for microbleed detection has complicated the cross-comparison of study results. We aimed to determine the impact of microbleed sequences on microbleed detection and associated clinical parameters. MATERIALS AND METHODS Patients from our memory clinic (n = 246; 53% female; mean age, 62) prospectively underwent 3T MR imaging, with conventional thick-section T2*, thick-section SWI, and conventional thin-section SWI. Microbleeds were assessed separately on thick-section SWI, thin-section SWI, and T2* by 3 raters, with varying neuroradiologic experience. Clinical and radiologic parameters from the dementia investigation were analyzed in association with the number of microbleeds in negative binomial regression analyses. RESULTS Prevalence and number of microbleeds were higher on thick-/thin-section SWI (20/21%) compared with T2*(17%). There was no difference in microbleed prevalence/number between thick- and thin-section SWI. Interrater agreement was excellent for all raters and sequences. Univariate comparisons of clinical parameters between patients with and without microbleeds yielded no difference across sequences. In the regression analysis, only minor differences in clinical associations with the number of microbleeds were noted across sequences. CONCLUSIONS Due to the increased detection of microbleeds, we recommend SWI as the sequence of choice in microbleed detection. Microbleeds and their association with clinical parameters are robust to the effects of varying MR imaging sequences, suggesting that comparison of results across studies is possible, despite differing microbleed sequences.
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Affiliation(s)
- S Shams
- From the Department of Clinical Science, Intervention, and Technology, Division of Medical Imaging and Technology (S.S., J.M., L.C., T.G., M.S., P.A., M.K.-W.) Department of Radiology (S.S., J.M., L.C., T.G., M.S., P.A., M.K.-W.)
| | - J Martola
- From the Department of Clinical Science, Intervention, and Technology, Division of Medical Imaging and Technology (S.S., J.M., L.C., T.G., M.S., P.A., M.K.-W.) Department of Radiology (S.S., J.M., L.C., T.G., M.S., P.A., M.K.-W.)
| | - L Cavallin
- From the Department of Clinical Science, Intervention, and Technology, Division of Medical Imaging and Technology (S.S., J.M., L.C., T.G., M.S., P.A., M.K.-W.) Department of Radiology (S.S., J.M., L.C., T.G., M.S., P.A., M.K.-W.)
| | - T Granberg
- From the Department of Clinical Science, Intervention, and Technology, Division of Medical Imaging and Technology (S.S., J.M., L.C., T.G., M.S., P.A., M.K.-W.) Department of Radiology (S.S., J.M., L.C., T.G., M.S., P.A., M.K.-W.)
| | - M Shams
- From the Department of Clinical Science, Intervention, and Technology, Division of Medical Imaging and Technology (S.S., J.M., L.C., T.G., M.S., P.A., M.K.-W.) Department of Radiology (S.S., J.M., L.C., T.G., M.S., P.A., M.K.-W.)
| | - P Aspelin
- From the Department of Clinical Science, Intervention, and Technology, Division of Medical Imaging and Technology (S.S., J.M., L.C., T.G., M.S., P.A., M.K.-W.) Department of Radiology (S.S., J.M., L.C., T.G., M.S., P.A., M.K.-W.)
| | - L O Wahlund
- Department of Neurobiology, Care Sciences, and Society (L.O.W.), Karolinska Institutet, Stockholm, Sweden Division of Clinical Geriatrics (L.O.W.), Karolinska University Hospital, Stockholm, Sweden
| | - M Kristoffersen-Wiberg
- From the Department of Clinical Science, Intervention, and Technology, Division of Medical Imaging and Technology (S.S., J.M., L.C., T.G., M.S., P.A., M.K.-W.) Department of Radiology (S.S., J.M., L.C., T.G., M.S., P.A., M.K.-W.)
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Shams S, Martola J, Granberg T, Li X, Shams M, Fereshtehnejad SM, Cavallin L, Aspelin P, Kristoffersen-Wiberg M, Wahlund LO. Cerebral microbleeds: different prevalence, topography, and risk factors depending on dementia diagnosis—the Karolinska Imaging Dementia Study. AJNR Am J Neuroradiol 2014; 36:661-6. [PMID: 25523590 DOI: 10.3174/ajnr.a4176] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Accepted: 09/16/2014] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND PURPOSE Cerebral microbleeds are thought to represent cerebral amyloid angiopathy when in lobar regions of the brain and hypertensive arteriopathy when in deep and infratentorial locations. By studying cerebral microbleeds, their topography, and risk factors, we aimed to gain an insight into the vascular and amyloid pathology of dementia diagnoses and increase the understanding of cerebral microbleeds in dementia. MATERIALS AND METHODS We analyzed 1504 patients (53% women; mean age, 63 ± 10 years; 10 different dementia diagnoses) in this study. All patients underwent MR imaging as part of the dementia investigation, and all their clinical parameters were recorded. RESULTS Among the 1504 patients with dementia, 22% had cerebral microbleeds. Cerebral microbleed topography was predominantly lobar (P = .01) and occipital (P = .007) in Alzheimer disease. Patients with cerebral microbleeds were significantly older (P < .001), were more frequently male (P < .001), had lower cognitive scores (P = .006), and more often had hypertension (P < .001). Risk factors for cerebral microbleeds varied depending on the dementia diagnosis. Odds ratios for having cerebral microbleeds increased with the number of risk factors (hypertension, hyperlipidemia, diabetes, male sex, and age 65 and older) in the whole patient group and increased differently in the separate dementia diagnoses. CONCLUSIONS Prevalence, topography, and risk factors of cerebral microbleeds vary depending on the dementia diagnosis and reflect the inherent pathology of different dementia diagnoses. Because cerebral microbleeds are seen as possible predictors of intracerebral hemorrhage, their increasing prevalence with an increasing number of risk factors, as shown in our study, may require taking the number of risk factors into account when deciding on anticoagulant therapy in dementia.
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Affiliation(s)
- S Shams
- Clinical Science, Intervention, and Technology (S.S., J.M., T.G., M.S., L.C., P.A., M.K.-W.), Division of Medical Imaging and Technology, Karolinska Institute, Stockholm, Sweden Department of Radiology (S.S., J.M., T.G., M.S., L.C., P.A., M.K.-W.)
| | - J Martola
- Clinical Science, Intervention, and Technology (S.S., J.M., T.G., M.S., L.C., P.A., M.K.-W.), Division of Medical Imaging and Technology, Karolinska Institute, Stockholm, Sweden Department of Radiology (S.S., J.M., T.G., M.S., L.C., P.A., M.K.-W.)
| | - T Granberg
- Clinical Science, Intervention, and Technology (S.S., J.M., T.G., M.S., L.C., P.A., M.K.-W.), Division of Medical Imaging and Technology, Karolinska Institute, Stockholm, Sweden Department of Radiology (S.S., J.M., T.G., M.S., L.C., P.A., M.K.-W.)
| | - X Li
- From the Departments of Neurobiology, Care Sciences, and Society (X.L., S.M.F., L.O.W.) Division of Clinical Geriatrics (X.L., S.M.F., L.O.W.), Karolinska University Hospital, Stockholm, Sweden
| | - M Shams
- Clinical Science, Intervention, and Technology (S.S., J.M., T.G., M.S., L.C., P.A., M.K.-W.), Division of Medical Imaging and Technology, Karolinska Institute, Stockholm, Sweden Department of Radiology (S.S., J.M., T.G., M.S., L.C., P.A., M.K.-W.)
| | - S M Fereshtehnejad
- From the Departments of Neurobiology, Care Sciences, and Society (X.L., S.M.F., L.O.W.) Division of Clinical Geriatrics (X.L., S.M.F., L.O.W.), Karolinska University Hospital, Stockholm, Sweden
| | - L Cavallin
- Clinical Science, Intervention, and Technology (S.S., J.M., T.G., M.S., L.C., P.A., M.K.-W.), Division of Medical Imaging and Technology, Karolinska Institute, Stockholm, Sweden Department of Radiology (S.S., J.M., T.G., M.S., L.C., P.A., M.K.-W.)
| | - P Aspelin
- Clinical Science, Intervention, and Technology (S.S., J.M., T.G., M.S., L.C., P.A., M.K.-W.), Division of Medical Imaging and Technology, Karolinska Institute, Stockholm, Sweden Department of Radiology (S.S., J.M., T.G., M.S., L.C., P.A., M.K.-W.)
| | - M Kristoffersen-Wiberg
- Clinical Science, Intervention, and Technology (S.S., J.M., T.G., M.S., L.C., P.A., M.K.-W.), Division of Medical Imaging and Technology, Karolinska Institute, Stockholm, Sweden Department of Radiology (S.S., J.M., T.G., M.S., L.C., P.A., M.K.-W.)
| | - L O Wahlund
- From the Departments of Neurobiology, Care Sciences, and Society (X.L., S.M.F., L.O.W.) Division of Clinical Geriatrics (X.L., S.M.F., L.O.W.), Karolinska University Hospital, Stockholm, Sweden
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