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Pappolla A, Auger C, Sao-Aviles A, Tur C, Rodriguez-Barranco M, Cobo-Calvo Á, Mongay-Ochoa N, Rodríguez-Acevedo B, Zabalza A, Midaglia L, Carbonell-Mirabent P, Carvajal R, Castilló-Justribó J, Braga N, Bollo L, Vidal-Jordana A, Arrambide G, Nos C, Salerno A, Galán I, Comabella M, Sastre-Garriga J, Tintoré M, Rovira A, Montalban X, Río J. Prediction of disease activity and treatment failure in relapsing-remitting MS patients initiating daily oral DMTs. Mult Scler 2024; 30:820-832. [PMID: 38551315 DOI: 10.1177/13524585241240653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
BACKGROUND Limited data exist regarding treatment response prediction to oral disease-modifying therapies (DMTs) in multiple sclerosis (MS). OBJECTIVES We assessed the capacity of available scoring systems to anticipate disease activity parameters in naïve relapsing-remitting MS (RRMS) patients initiating daily oral DMTs, hypothesizing that they exhibit different predictive potentials. METHODS We conducted a retrospective study and applied the Rio Score (RS), modified Rio Score (mRS), and MAGNIMS Score 12 months after DMT initiation. At 36 months, we examined their ability to predict evidence of disease activity (EDA) components and treatment failure by logistic regression analysis. RESULTS Notably, 218 patients (62.4% females) initiating dimethyl fumarate, teriflunomide, and fingolimod were included. At 36 months, the RS high-risk group predicted evidence of clinical activity (odds ratio (OR) 10 [2.7-36.9]) and treatment failure (OR 10.6 [3.4-32.5]) but did not predict radiological activity (OR 1.9 [0.7-5]). The mRS non-responders group did not predict EDA and treatment failure. RS, mRS, and MAGNIMS 0 categories showed significantly lower EDA and treatment failure than the remainder. CONCLUSION Scoring systems present different predictive abilities for disease activity parameters at 36 months in MS patients initiating daily oral therapies, warranting further adjustments (i.e. introduction of fluid biomarkers) to depict disease activity status fully.
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Affiliation(s)
- Agustin Pappolla
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Cristina Auger
- Section of Neuroradiology, Department of Radiology, Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Augusto Sao-Aviles
- Statistics and Bioinformatics Unit, Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Barcelona, Spain
| | - Carmen Tur
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marta Rodriguez-Barranco
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Álvaro Cobo-Calvo
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Neus Mongay-Ochoa
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Breogán Rodríguez-Acevedo
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ana Zabalza
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Luciana Midaglia
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Pere Carbonell-Mirabent
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Rene Carvajal
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Joaquín Castilló-Justribó
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Nathane Braga
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Luca Bollo
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Angela Vidal-Jordana
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Georgina Arrambide
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Carlos Nos
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Annalaura Salerno
- Section of Neuroradiology, Department of Radiology, Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ingrid Galán
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Manuel Comabella
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jaume Sastre-Garriga
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Mar Tintoré
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alex Rovira
- Section of Neuroradiology, Department of Radiology, Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Xavier Montalban
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jordi Río
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Barcelona, Spain
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Nistri R, Ianniello A, Pozzilli V, Giannì C, Pozzilli C. Advanced MRI Techniques: Diagnosis and Follow-Up of Multiple Sclerosis. Diagnostics (Basel) 2024; 14:1120. [PMID: 38893646 PMCID: PMC11171945 DOI: 10.3390/diagnostics14111120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 05/08/2024] [Accepted: 05/13/2024] [Indexed: 06/21/2024] Open
Abstract
Brain and spinal cord imaging plays a pivotal role in aiding clinicians with the diagnosis and monitoring of multiple sclerosis. Nevertheless, the significance of magnetic resonance imaging in MS extends beyond its clinical utility. Advanced imaging modalities have facilitated the in vivo detection of various components of MS pathogenesis, and, in recent years, MRI biomarkers have been utilized to assess the response of patients with relapsing-remitting MS to the available treatments. Similarly, MRI indicators of neurodegeneration demonstrate potential as primary and secondary endpoints in clinical trials targeting progressive phenotypes. This review aims to provide an overview of the latest advancements in brain and spinal cord neuroimaging in MS.
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Affiliation(s)
- Riccardo Nistri
- Department of Human Neuroscience, Sapienza University, 00185 Rome, Italy; (A.I.); (C.G.); (C.P.)
| | - Antonio Ianniello
- Department of Human Neuroscience, Sapienza University, 00185 Rome, Italy; (A.I.); (C.G.); (C.P.)
| | - Valeria Pozzilli
- Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
- Unit of Neurology, Neurophysiology, Neurobiology and Psychiatry, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - Costanza Giannì
- Department of Human Neuroscience, Sapienza University, 00185 Rome, Italy; (A.I.); (C.G.); (C.P.)
- IRCCS Neuromed, 86077 Pozzilli, Italy
| | - Carlo Pozzilli
- Department of Human Neuroscience, Sapienza University, 00185 Rome, Italy; (A.I.); (C.G.); (C.P.)
- MS Center Sant’Andrea Hospital, 00189 Rome, Italy
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Tekin A, Rende B, Efendi H, Bunul SD, Çakır Ö, Çolak T, Balcı S. Volumetric and Asymmetric Index Analysis of Subcortical Structures in Multiple Sclerosis Patients: A Retrospective Study Using volBrain Software. Cureus 2024; 16:e55799. [PMID: 38590495 PMCID: PMC10999780 DOI: 10.7759/cureus.55799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2024] [Indexed: 04/10/2024] Open
Abstract
Introduction Multiple sclerosis (MS) is a chronic and autoimmune disease that has a significant influence on the central nervous system, such as the brain and spinal cord, affecting millions of individuals globally. Understanding the connection between subcortical brain regions and MS is crucial for effective diagnostic and therapeutic approaches for treating this disabling disease. This study explores the relationship between volume and contours of asymmetry index of subcortical brain regions in individuals with MS using volBrain software (https://www.volbrain.net; developed by José V. Manjón (Valencia Polytechnic University, Valencia, Spain) and Pierrick Coupé (University of Bordeaux, Bordeaux, France)). Methods In our retrospective investigation, we admitted 100 Turkish individuals, comprising 50 patients diagnosed with relapsing-remitting MS (RRMS) (24 (48%) males and 26 (52%) females) and 50 healthy controls (23 (46%) males and 27 (54%) females), registered between October 2017 and February 2022 for five years and underwent assessment in the radiology department at the Teaching and Research Hospital of Kocaeli University; 1,150 Turkish patients were excluded from our study based on our exclusion criteria. We used magnetic resonance imaging with a 3-Tesla (3T) scanner and volBrain software to assess volumes (cm3) and asymmetry indexes due to asymmetry for different levels of atrophy of total intracranial, total brain, gray matter, white matter, and subcortical regions, the most affected regions in MS patients for both patient and control cohorts. Results Statistical analysis revealed a significant difference between patient and control groups (p < 0.001), with patient group mean age at 38.32 years and control group mean age at 32.88 years. Patient group exhibited lower values for total intracranial, total brain, gray matter, white matter, and cerebrospinal fluid volume compared to control group (p < 0.05). The results indicated a statistically significant decrease (p < 0.05) in the values for total intracranial and total brain volume, whereas all other values remained unchanged. We compared volumes of subcortical structures on the right and left sides and found that the putamen, thalamus, and globus pallidus had statistically lower values in the patient group than in the control group (p < 0.001), apart from the lateral ventricle. Furthermore, our retrospective investigation demonstrated a statistically significant difference in the globus pallidus asymmetry index, indicating a preference for the patient group (p < 0.05). A lower asymmetry index value signifies a larger volume for the right side of the subcortical regions of the brain when compared to the left side. Conclusion Brain atrophy, although characterized by irreversible tissue damage, is targeted by therapeutic interventions to prevent progression. It is, therefore, imperative to develop a universally accepted measurement standard for subcortical structures that also considers the inherent variability present within each structure. Our findings serve as an important basis and indicator for the determination of subcortical atrophy and asymmetry in MS, the prognosis of the disease, and the etiology of clinical symptoms. Subsequent research may benefit by adopting the novel approach of considering brain atrophy as an outcome rather than a predictor, thereby facilitating the elucidation of the intricate biological mechanisms that give rise to volume loss.
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Affiliation(s)
- Ayla Tekin
- Anatomy, Kocaeli University, Kocaeli, TUR
| | - Buket Rende
- Anatomy, European Vocational School, Kocaeli Health and Technology University, Kocaeli, TUR
| | | | | | | | - Tuncay Çolak
- Anatomy, Faculty of Medicine, Kocaeli University, Kocaeli, TUR
| | - Sibel Balcı
- Biostatistics and Medical Informatics, Kocaeli University, Kocaeli, TUR
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Shekari F, Vard A, Adibi I, Danesh-Mobarhan S. Investigating the feasibility of differentiating MS active lesions from inactive ones using texture analysis and machine learning methods in DWI images. Mult Scler Relat Disord 2024; 82:105363. [PMID: 38118289 DOI: 10.1016/j.msard.2023.105363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 12/04/2023] [Accepted: 12/05/2023] [Indexed: 12/22/2023]
Abstract
BACKGROUND Magnetic resonance imaging (MRI) is commonly used in conjunction with a gadolinium-based contrast agent (GBCA) to distinguish active multiple sclerosis (MS) lesions. However, recent studies have raised concerns regarding the long-term effects of the accumulation of GBCA in the body. Thus, the purpose of this study is to investigate the possibility of using texture analysis in diffusion-weighted imaging (DWI) and machine learning algorithms to discriminate active from inactive MS lesions without the use of GBCA. METHODS To achieve this purpose, we introduce an image processing pipeline. In the proposed pipeline, following registration and alignment of slices, MS lesions from DWI images are segmented and quantized. Next, different texture analysis methods are employed to extract texture features from the lesions. Then, a two-stage feature reduction method is applied, in which the first stage involves a statistical t-test and the second stage relies on principal component analysis (PCA), sequential forward selection (SFS), sequential backward selection (SBS), and ReliefF algorithms. Finally, we use five classifiers logistic regression (LR), support vector machine (SVM), decision tree (DT), K nearest neighbor (KNN), and linear discriminant analysis (LDA) in a 5-fold cross-validation procedure to determine active and inactive MS lesions. RESULTS In this study, we collected and prepared 255 active/inactive MS lesions from MRI scans of 34 patients diagnosed with MS, with a mean age of 35.56±10.89. Among 89 texture features extracted, 63 features showed statistically significant differences between the means of active and inactive lesions (P<0.05). The SVM classifier with the PCA feature reduction algorithm demonstrated the best performance with an average accuracy of 0.960 (±0.024), specificity and precision of 1.0, sensitivity of 0.913 (±0.053), and AUC of 0.957 (±0.027). CONCLUSION Our study indicates that DWI changes detected using texture analysis-based machine learning models can precisely differentiate active from inactive MS lesions. This finding provides valuable clinical information for the early diagnosis and effective monitoring of MS disease.
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Affiliation(s)
- Farshad Shekari
- Department of Bioelectrics and Biomedical Engineering, School of Advanced Technologies in Medicine, Isfahan University of Medical Sciences, Isfahan 81746-73461, Iran; Student Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Alireza Vard
- Department of Bioelectrics and Biomedical Engineering, School of Advanced Technologies in Medicine, Isfahan University of Medical Sciences, Isfahan 81746-73461, Iran; Medical Image and Signal Processing Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Iman Adibi
- Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran,; Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Safieh Danesh-Mobarhan
- Department of Radiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Raj A, Gass A, Eisele P, Dabringhaus A, Kraemer M, Zöllner FG. A generalizable deep voxel-guided morphometry algorithm for the detection of subtle lesion dynamics in multiple sclerosis. Front Neurosci 2024; 18:1326108. [PMID: 38332857 PMCID: PMC10850259 DOI: 10.3389/fnins.2024.1326108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 01/10/2024] [Indexed: 02/10/2024] Open
Abstract
Introduction Multiple sclerosis (MS) is a chronic neurological disorder characterized by the progressive loss of myelin and axonal structures in the central nervous system. Accurate detection and monitoring of MS-related changes in brain structures are crucial for disease management and treatment evaluation. We propose a deep learning algorithm for creating Voxel-Guided Morphometry (VGM) maps from longitudinal MRI brain volumes for analyzing MS disease activity. Our approach focuses on developing a generalizable model that can effectively be applied to unseen datasets. Methods Longitudinal MS patient high-resolution 3D T1-weighted follow-up imaging from three different MRI systems were analyzed. We employed a 3D residual U-Net architecture with attention mechanisms. The U-Net serves as the backbone, enabling spatial feature extraction from MRI volumes. Attention mechanisms are integrated to enhance the model's ability to capture relevant information and highlight salient regions. Furthermore, we incorporate image normalization by histogram matching and resampling techniques to improve the networks' ability to generalize to unseen datasets from different MRI systems across imaging centers. This ensures robust performance across diverse data sources. Results Numerous experiments were conducted using a dataset of 71 longitudinal MRI brain volumes of MS patients. Our approach demonstrated a significant improvement of 4.3% in mean absolute error (MAE) against the state-of-the-art (SOTA) method. Furthermore, the algorithm's generalizability was evaluated on two unseen datasets (n = 116) with an average improvement of 4.2% in MAE over the SOTA approach. Discussion Results confirm that the proposed approach is fast and robust and has the potential for broader clinical applicability.
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Affiliation(s)
- Anish Raj
- Computer Assisted Clinical Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Baden Württemberg, Germany
- Mannheim Institute for Intelligent Systems in Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Baden Württemberg, Germany
| | - Achim Gass
- Department of Neurology, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Baden Württemberg, Germany
- Mannheim Center for Translational Neurosciences, Heidelberg University, Mannheim, Baden Württemberg, Germany
| | - Philipp Eisele
- Department of Neurology, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Baden Württemberg, Germany
- Mannheim Center for Translational Neurosciences, Heidelberg University, Mannheim, Baden Württemberg, Germany
| | | | - Matthias Kraemer
- VGMorph GmbH, Mülheim an der Ruhr, Nordrhein-Westfalen, Germany
- NeuroCentrum, Grevenbroich, Nordrhein-Westfalen, Germany
| | - Frank G. Zöllner
- Computer Assisted Clinical Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Baden Württemberg, Germany
- Mannheim Institute for Intelligent Systems in Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Baden Württemberg, Germany
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Nabizadeh F, Pirahesh K, Azami M, Moradkhani A, Sardaripour A, Ramezannezhad E. T1 and T2 weighted lesions and cognition in multiple Sclerosis: A systematic review and meta-analysis. J Clin Neurosci 2024; 119:1-7. [PMID: 37952373 DOI: 10.1016/j.jocn.2023.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 11/01/2023] [Accepted: 11/07/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND Considering the different results regarding the correlation between Magnetic Resonance Imaging (MRI) structural measures and cognitive dysfunction in patients with MS, we aimed to perform a systematic review and meta-analysis study to investigate the correlation between T1 and T2 weighted lesions and cognitive scores to find the most robust MRI markers for cognitive function in MS population. METHODS The literature of this paper was identified through a comprehensive search of electronic datasets including PubMed, Scopus, Web of Science, and Embase in February 2022. Studies that reported the correlation between cognitive status and T1 and T2 weighted lesions in MS patients were selected. RESULTS 21 studies with a total of 3771 MS patients with mean ages ranging from 30 to 57 years were entered into our study. Our analysis revealed that the volume of T1 lesions was significantly correlated with Symbol Digit Modality test (SDMT) (r: -0.30, 95 %CI: -0.59, -0.01) and Paced Auditory Serial-Addition Task (PASAT) scores (r: -0.23, 95 %CI: -0.36, -0.10). We investigated the correlation between T2 lesions and cognitive scores. The pooled estimates of z scores were significant for SDMT (r: -0.27, 95 %CI: -0.51, -0.03) and PASAT (r: -0.27, 95 %CI: -0.41, -0.13). CONCLUSION In conclusion, our systematic review and meta-analysis study provides strong evidence of the correlation between T1 and T2 lesions and cognitive function in MS patients. Further research is needed to explore the potential mechanisms underlying this relationship and to develop targeted interventions to improve cognitive outcomes in MS patients.
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Affiliation(s)
- Fardin Nabizadeh
- School of Medicine, Iran University of Medical Sciences, Tehran, Iran; School of Medicine, Tehran University of Medical Science, Tehran, Iran.
| | - Kasra Pirahesh
- Student Research Committee, School of Medicine, Kurdistan University of Medical Science, Sanandaj, Iran
| | - Mobin Azami
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Asra Moradkhani
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Science, Tehran, Iran
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Lechner-Scott J, Maltby V, Giovannoni G, Hawkes C, Levy M, Yeh A. Are we there yet? The holy grail: A biomarker for Multiple Sclerosis. Mult Scler Relat Disord 2023; 78:104998. [PMID: 37738709 DOI: 10.1016/j.msard.2023.104998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/24/2023]
Affiliation(s)
- Jeannette Lechner-Scott
- John Hunter Hsopital, Hunter New England Local Health District, Newcastle, Australia; Immune Health Program, Hunter Medical Research Institute, Newcastle, Australia.
| | - Vicki Maltby
- John Hunter Hsopital, Hunter New England Local Health District, Newcastle, Australia; Immune Health Program, Hunter Medical Research Institute, Newcastle, Australia
| | - Gavin Giovannoni
- Department of Neurology, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom
| | - Chris Hawkes
- Department of Neuroimmunology, Queen Mary University of London, United Kingdom
| | - Michael Levy
- Department of Neuroimmunology, Massachusetts General Hospital, Havard Medical School, Boston, USA
| | - Ann Yeh
- Department of Paediatrics (Neurology), The Hospital for SickKids, University of Toronto in Ontario, Canada
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Wu S, Shi D. Editorial for "A Multicenter Longitudinal MRI Study Assessing LeMan-PV Software Accuracy in the Detection of White Matter Lesions in Multiple Sclerosis Patients". J Magn Reson Imaging 2023; 58:877-878. [PMID: 36811223 DOI: 10.1002/jmri.28652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 12/19/2022] [Indexed: 02/24/2023] Open
Affiliation(s)
- Shuohua Wu
- Department of Radiology, The Second Affiliated Hospital, Shantou University Medical College, Shantou, China
| | - Dafa Shi
- Department of Radiology, Xiang'an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
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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] [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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Todea AR, Melie-Garcia L, Barakovic M, Cagol A, Rahmanzadeh R, Galbusera R, Lu PJ, Weigel M, Ruberte E, Radue EW, Schaedelin S, Benkert P, Oezguer Y, Sinnecker T, Müller S, Achtnichts L, Vehoff J, Disanto G, Findling O, Chan A, Salmen A, Pot C, Lalive P, Bridel C, Zecca C, Derfuss T, Remonda L, Wagner F, Vargas M, Du Pasquier R, Pravata E, Weber J, Gobbi C, Leppert D, Wuerfel J, Kober T, Marechal B, Corredor-Jerez R, Psychogios M, Lieb J, Kappos L, Cuadra MB, Kuhle J, Granziera C. A Multicenter Longitudinal MRI Study Assessing LeMan-PV Software Accuracy in the Detection of White Matter Lesions in Multiple Sclerosis Patients. J Magn Reson Imaging 2023; 58:864-876. [PMID: 36708267 DOI: 10.1002/jmri.28618] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 01/13/2023] [Accepted: 01/14/2023] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Detecting new and enlarged lesions in multiple sclerosis (MS) patients is needed to determine their disease activity. LeMan-PV is a software embedded in the scanner reconstruction system of one vendor, which automatically assesses new and enlarged white matter lesions (NELs) in the follow-up of MS patients; however, multicenter validation studies are lacking. PURPOSE To assess the accuracy of LeMan-PV for the longitudinal detection NEL white-matter MS lesions in a multicenter clinical setting. STUDY TYPE Retrospective, longitudinal. SUBJECTS A total of 206 patients with a definitive MS diagnosis and at least two follow-up MRI studies from five centers participating in the Swiss Multiple Sclerosis Cohort study. Mean age at first follow-up = 45.2 years (range: 36.9-52.8 years); 70 males. FIELD STRENGTH/SEQUENCE Fluid attenuated inversion recovery (FLAIR) and T1-weighted magnetization prepared rapid gradient echo (T1-MPRAGE) sequences at 1.5 T and 3 T. ASSESSMENT The study included 313 MRI pairs of datasets. Data were analyzed with LeMan-PV and compared with a manual "reference standard" provided by a neuroradiologist. A second rater (neurologist) performed the same analysis in a subset of MRI pairs to evaluate the rating-accuracy. The Sensitivity (Se), Specificity (Sp), Accuracy (Acc), F1-score, lesion-wise False-Positive-Rate (aFPR), and other measures were used to assess LeMan-PV performance for the detection of NEL at 1.5 T and 3 T. The performance was also evaluated in the subgroup of 123 MRI pairs at 3 T. STATISTICAL TESTS Intraclass correlation coefficient (ICC) and Cohen's kappa (CK) were used to evaluate the agreement between readers. RESULTS The interreader agreement was high for detecting new lesions (ICC = 0.97, Pvalue < 10-20 , CK = 0.82, P value = 0) and good (ICC = 0.75, P value < 10-12 , CK = 0.68, P value = 0) for detecting enlarged lesions. Across all centers, scanner field strengths (1.5 T, 3 T), and for NEL, LeMan-PV achieved: Acc = 61%, Se = 65%, Sp = 60%, F1-score = 0.44, aFPR = 1.31. When both follow-ups were acquired at 3 T, LeMan-PV accuracy was higher (Acc = 66%, Se = 66%, Sp = 66%, F1-score = 0.28, aFPR = 3.03). DATA CONCLUSION In this multicenter study using clinical data settings acquired at 1.5 T and 3 T, and variations in MRI protocols, LeMan-PV showed similar sensitivity in detecting NEL with respect to other recent 3 T multicentric studies based on neural networks. While LeMan-PV performance is not optimal, its main advantage is that it provides automated clinical decision support integrated into the radiological-routine flow. EVIDENCE LEVEL 4 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Alexandra Ramona Todea
- Department of Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital of Basel, Basel, Switzerland
- Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Lester Melie-Garcia
- Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Neurology, University Hospital Basel, Switzerland, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
| | - Muhamed Barakovic
- Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Neurology, University Hospital Basel, Switzerland, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
| | - Alessandro Cagol
- Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Neurology, University Hospital Basel, Switzerland, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
| | - Reza Rahmanzadeh
- Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Neurology, University Hospital Basel, Switzerland, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
| | - Riccardo Galbusera
- Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Neurology, University Hospital Basel, Switzerland, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
| | - Po-Jui Lu
- Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Neurology, University Hospital Basel, Switzerland, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
| | - Matthias Weigel
- Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Neurology, University Hospital Basel, Switzerland, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
- Division of Radiological Physics, Department of Radiology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Esther Ruberte
- Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Neurology, University Hospital Basel, Switzerland, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
| | - Ernst-Wilhelm Radue
- Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Sabine Schaedelin
- Clinical Trial Unit, Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Pascal Benkert
- Clinical Trial Unit, Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Yaldizli Oezguer
- Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Neurology, University Hospital Basel, Switzerland, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
| | - Tim Sinnecker
- Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Neurology, University Hospital Basel, Switzerland, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
- Medical Image Analysis Center (MIAC) and qbig, Department of Biomedical Engineering, University Basel, Basel, Switzerland
| | - Stefanie Müller
- Department of Neurology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Lutz Achtnichts
- Department of Neurology, Cantonal Hospital Aarau, Switzerland
| | - Jochen Vehoff
- Department of Neurology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Giulio Disanto
- Department of Neurology, Neurocenter of Southern Switzerland, EOC, Lugano, Switzerland
| | - Oliver Findling
- Department of Neurology, Cantonal Hospital Aarau, Switzerland
| | - Andrew Chan
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Anke Salmen
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Caroline Pot
- Service of Neurology, Department of Clinical Neurosciences, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Patrice Lalive
- Department of Clinical Neurosciences, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland
| | - Claire Bridel
- Department of Clinical Neurosciences, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland
| | - Chiara Zecca
- Department of Neurology, Neurocenter of Southern Switzerland, EOC, Lugano, Switzerland
- Faculty of Biomedical Sciences, University of Italian Switzerland, Lugano, Switzerland
| | - Tobias Derfuss
- Department of Neurology, University Hospital Basel, Switzerland, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
| | - Luca Remonda
- Department of Radiology, Cantonal Hospital Aarau, Switzerland
| | - Franca Wagner
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Maria Vargas
- Department of Radiology, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland
| | - Renaud Du Pasquier
- Service of Neurology, Department of Clinical Neurosciences, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Emanuele Pravata
- Faculty of Biomedical Sciences, University of Italian Switzerland, Lugano, Switzerland
- Department of Neuroradiology, Neurocenter of Southern Switzerland, Lugano, Switzerland
| | - Johannes Weber
- Department of Radiology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Claudio Gobbi
- Department of Neurology, Neurocenter of Southern Switzerland, EOC, Lugano, Switzerland
- Faculty of Biomedical Sciences, University of Italian Switzerland, Lugano, Switzerland
| | - David Leppert
- Department of Neurology, University Hospital Basel, Switzerland, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
| | - Jens Wuerfel
- Medical Image Analysis Center (MIAC) and qbig, Department of Biomedical Engineering, University Basel, Basel, Switzerland
| | - Tobias Kober
- Advanced Clinical Imaging Technology, Siemens Healthineers International, Lausanne, Switzerland
- Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- LTS5, École Polytechnique FÉdÉrale de Lausanne (EPFL), Lausanne, Switzerland
| | - Benedicte Marechal
- Advanced Clinical Imaging Technology, Siemens Healthineers International, Lausanne, Switzerland
- Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- LTS5, École Polytechnique FÉdÉrale de Lausanne (EPFL), Lausanne, Switzerland
| | - Ricardo Corredor-Jerez
- Advanced Clinical Imaging Technology, Siemens Healthineers International, Lausanne, Switzerland
- Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- LTS5, École Polytechnique FÉdÉrale de Lausanne (EPFL), Lausanne, Switzerland
| | - Marios Psychogios
- Department of Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital of Basel, Basel, Switzerland
| | - Johanna Lieb
- Department of Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital of Basel, Basel, Switzerland
| | - Ludwig Kappos
- Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Neurology, University Hospital Basel, Switzerland, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
| | - Meritxell Bach Cuadra
- CIBM Center for Biomedical Imaging, Radiology Department, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Jens Kuhle
- Department of Neurology, University Hospital Basel, Switzerland, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
| | - Cristina Granziera
- Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Neurology, University Hospital Basel, Switzerland, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
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11
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Chitnis T, Foley J, Ionete C, El Ayoubi NK, Saxena S, Gaitan-Walsh P, Lokhande H, Paul A, Saleh F, Weiner H, Qureshi F, Becich MJ, da Costa FR, Gehman VM, Zhang F, Keshavan A, Jalaleddini K, Ghoreyshi A, Khoury SJ. Clinical validation of a multi-protein, serum-based assay for disease activity assessments in multiple sclerosis. Clin Immunol 2023:109688. [PMID: 37414379 DOI: 10.1016/j.clim.2023.109688] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 06/30/2023] [Accepted: 07/01/2023] [Indexed: 07/08/2023]
Abstract
An 18-protein multiple sclerosis (MS) disease activity (DA) test was validated based on associations between algorithm scores and clinical/radiographic assessments (N = 614 serum samples; Train [n = 426; algorithm development] and Test [n = 188; evaluation] subsets). The multi-protein model was trained based on presence/absence of gadolinium-positive (Gd+) lesions and was also strongly associated with new/enlarging T2 lesions, and active versus stable disease (composite of radiographic and clinical evidence of DA) with improved performance (p < 0.05) compared to the neurofilament light single protein model. The odds of having ≥1 Gd + lesions with a moderate/high DA score were 4.49 times that of a low DA score, and the odds of having ≥2 Gd + lesions with a high DA score were 20.99 times that of a low/moderate DA score. The MSDA Test was clinically validated with improved performance compared to the top-performing single-protein model and can serve as a quantitative tool to enhance the care of MS patients.
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Affiliation(s)
- Tanuja Chitnis
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - John Foley
- Rocky Mountain Multiple Sclerosis Clinic, Salt Lake City, UT, USA
| | - Carolina Ionete
- University of Massachusetts Medical School, Worcester, MA, USA.
| | - Nabil K El Ayoubi
- Nehme and Thgerese Tohme Multiple Sclerosis Center, American University of Beirut, Beirut, Lebanon.
| | - Shrishti Saxena
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | | | | | - Anu Paul
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Fermisk Saleh
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Howard Weiner
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | | | | | | | | | - Fujun Zhang
- Octave Bioscience, Inc., Menlo Park, CA, USA
| | | | | | | | - Samia J Khoury
- Nehme and Thgerese Tohme Multiple Sclerosis Center, American University of Beirut, Beirut, Lebanon.
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12
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Ismail MA, Elsayed NM. Diffusion-Weighted Images and Contrast-Enhanced MRI in the Diagnosis of Different Stages of Multiple Sclerosis of the Central Nervous System. Cureus 2023; 15:e41650. [PMID: 37575819 PMCID: PMC10420334 DOI: 10.7759/cureus.41650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2023] [Indexed: 08/15/2023] Open
Abstract
Introduction Multiple sclerosis (MS) is one of the most prevalent disorders of the central nervous system (CNS), and it can be observed in the field of radiological cross-sectional magnetic resonance imaging (MRI). The prevalence of MS in Saudi Arabia has increased as compared to the past few years. MRI is the gold standard non-invasive modality of choice in MS diagnosis according to the National Multiple Sclerosis Society (NMSS), New York City. This study aimed to highlight the significance of using diffusion-weighted images (DWIs) and the use of contrast media in the MS protocol, as well as the importance of identifying the suitable time of imaging after contrast enhancement to detect active lesions. Methods A retrospective cross-sectional study was conducted of 100 MS patients with an age range of 17 to 56 years. The data set included 41 active cases and 59 inactive cases. All patients had an MRI standard protocol of both the brain and spine in addition to DWI sequence and contrast agent (CA) injection, with images taken in early and delayed time. Results Of the patients, 71% were female and 29% were male. Active MS disease was more significant at younger ages than at older ages. Active lesions were significantly enhanced in delayed contrast images and showed high signal intensity in both the DWI and apparent diffusion coefficient (ADC) map, while inactive lesions showed no enhancement after contrast injection and showed an iso-signal intensity in both the DWI and ADC map. Conclusion The use of CA has developed over the years in the diagnosis of MS patients. In this study, the relationship between active lesions, DWI, and delayed contrast enhancement is very strong. In future research, we recommend adding a DWI sequence for the suspected active MS spine lesions in addition to delayed enhancement time in active MS after contrast injection to increase MRI sensitivity toward active MS lesions of the brain and spinal cord as well.
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Affiliation(s)
- Mashael A Ismail
- Radiologic Sciences, Faculty of Applied Medical Sciences, King Abdullah Medical Complex, Ministry of Health, Jeddah, SAU
| | - Naglaa M Elsayed
- Radiologic Sciences, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, SAU
- Diagnostic Radiology, Faculty of Medicine, Cairo University, Cairo, EGY
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13
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Khan Z, Gupta GD, Mehan S. Cellular and Molecular Evidence of Multiple Sclerosis Diagnosis and Treatment Challenges. J Clin Med 2023; 12:4274. [PMID: 37445309 DOI: 10.3390/jcm12134274] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 06/19/2023] [Accepted: 06/21/2023] [Indexed: 07/15/2023] Open
Abstract
Multiple sclerosis (MS) is a chronic autoimmune disease that impacts the central nervous system and can result in disability. Although the prevalence of MS has increased in India, diagnosis and treatment continue to be difficult due to several factors. The present study examines the difficulties in detecting and treating multiple sclerosis in India. A lack of MS knowledge among healthcare professionals and the general public, which delays diagnosis and treatment, is one of the significant issues. Inadequate numbers of neurologists and professionals with knowledge of MS management also exacerbate the situation. In addition, MS medications are expensive and not covered by insurance, making them inaccessible to most patients. Due to the absence of established treatment protocols and standards for MS care, India's treatment techniques vary. In addition, India's population diversity poses unique challenges regarding genetic variations, cellular and molecular abnormalities, and the potential for differing treatment responses. MS is more difficult to accurately diagnose and monitor due to a lack of specialized medical supplies and diagnostic instruments. Improved awareness and education among healthcare professionals and the general public, as well as the development of standardized treatment regimens and increased investment in MS research and infrastructure, are required to address these issues. By addressing these issues, it is anticipated that MS diagnosis and treatment in India will improve, leading to better outcomes for those affected by this chronic condition.
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Affiliation(s)
- Zuber Khan
- Division of Neuroscience, Department of Pharmacology, ISF College of Pharmacy, IK Gujral Punjab Technical University, Jalandhar 144603, India
| | - Ghanshyam Das Gupta
- Department of Pharmaceutics, ISF College of Pharmacy, IK Gujral Punjab Technical University, Jalandhar 144603, India
| | - Sidharth Mehan
- Division of Neuroscience, Department of Pharmacology, ISF College of Pharmacy, IK Gujral Punjab Technical University, Jalandhar 144603, India
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14
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Hajeer S, Nasr F, Nabha S, Saab MB, Harati H, Desoutter A, Al Ahmar E, Estephan E. Association between vitamin D deficiency and multiple sclerosis- MRI significance: A scoping review. Heliyon 2023; 9:e15754. [PMID: 37180903 PMCID: PMC10172888 DOI: 10.1016/j.heliyon.2023.e15754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 04/04/2023] [Accepted: 04/20/2023] [Indexed: 05/16/2023] Open
Abstract
Background/Objective Multiple Sclerosis is a common demyelinating disease of the central nervous system. Several studies suggested a link between vitamin D deficiency and multiple sclerosis disease activity, which can be evaluated by magnetic resonance imaging. Thereby, the main objective of the following scoping review is to summarize the magnetic resonance imaging findings assessing the probable effects of vitamin D on MS disease activity. Methodology PRISMA checklist for systematic reviews and meta-analyses was employed to structure this review. Literature was searched for observational and clinical studies tackling the given matter using several search engines including PubMed, CORE, and Embase. Data was extracted in a systematic manner, and the articles meeting the inclusion criteria were quality-assessed by Jadad scale for randomized clinical trials (RCTs) and Newcastle-Ottawa scale for observational studies. Results A total of 35 articles were included. Twenty-one (60%) studies noted a statistically significant association between vitamin D and Multiple Sclerosis MRI-detected disease activity. MRI-detected features involved lower contrast-enhancing T1 lesions, lower hyperintense T2 lesions, and a decrease in lesions volume. On the other hand, 40% (14 articles) of the articles did not detect any significant effect of vitamin D on Multiple Sclerosis disease activity. Due to the heterogeneity of the studies involved, meta-analysis was not employed in the given review. Discussion/conclusion There was an abundance in the number of research studies investigating the relationship between vitamin D and Multiple Sclerosis while highlighting the significant role of MRI in assessing the activity of the disease. Numerous studies found that higher serum vitamin D levels are associated with decreased new active cortical and subcortical lesions and lower lesions volume. These findings highlight the importance of imaging modalities in the various aspects of neurological diseases and encourage further research to focus on the preventive effects of vitamin D on MS patients.
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Affiliation(s)
- Shorouk Hajeer
- Neuroscience Research Center, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Farah Nasr
- Neuroscience Research Center, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Sanaa Nabha
- Neuroscience Research Center, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Marie-belle Saab
- Faculty of Pedagogy, Lebanese University, Furn-El-Chebbak, Lebanon
| | - Hayat Harati
- Neuroscience Research Center, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | | | - Elie Al Ahmar
- Faculty of Arts and Sciences, Holy Spirit University of Kaslik, Jounieh, Lebanon
- School of Engineering, Holy Spirit University of Kaslik, Jounieh, Lebanon
- Corresponding author. Faculty of Arts and Sciences, Holy Spirit University of Kaslik, Jounieh, Lebanon
| | - Elias Estephan
- Neuroscience Research Center, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
- LBN, University Montpellier, Montpellier, France
- Faculty of Arts and Sciences, Holy Spirit University of Kaslik, Jounieh, Lebanon
- Corresponding author. LBN, University Montpellier, Montpellier, France.
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15
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Jammoul M, Abou-Kheir W, Lawand N. How Safe Is Gadobutrol? Examining the Effect of Gadolinium Deposition on the Nervous System. RADIATION 2023. [DOI: 10.3390/radiation3020007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
Abstract
This study aimed to evaluate the safety of gadobutrol, a gadolinium-based contrast agent used in medical imaging, by investigating its effect on the nervous system under physiological and inflammatory conditions. Male Sprague Dawley rats were divided randomly into four groups, including gadobutrol, saline, LPS + gadobutrol, and LPS + saline, and were given intraperitoneal injections of gadobutrol (2.5 mmol/kg) or saline for 20 days. Weekly sensorimotor and cognitive behavioral tests were performed over 4 weeks, and Gd concentration in nervous tissues was analyzed using inductively coupled plasma mass spectrometry (ICP-MS). Lactate dehydrogenase (LDH) activity was measured to evaluate cytotoxicity, and electromyography (EMG) recordings from the gastrocnemius muscle were also obtained to examine signal transmission in sciatic nerves. The results indicated that gadobutrol did not induce significant behavioral changes under normal conditions. However, when administered along with LPS, the combination led to behavioral dysfunction. ICP-MS analysis revealed a higher concentration of Gd in the cerebrum and spinal cord of gadobutrol + LPS-treated rats, while peripheral nerves showed lower concentrations. In addition, there was a significant increase in LDH activity in the hippocampus of the gadobutrol group. EMG responses to electrical stimulation of the sciatic nerve demonstrated a decreased threshold of nociceptive reflexes in the gadobutrol group. Overall, while gadobutrol may be considered safe under normal physiological conditions, the findings suggest that its safety may be compromised under inflammatory conditions.
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Affiliation(s)
- Maya Jammoul
- Department of Anatomy, Cell Biology and Physiological Sciences, Faculty of Medicine, American University of Beirut, Beirut 1107 2020, Lebanon
| | - Wassim Abou-Kheir
- Department of Anatomy, Cell Biology and Physiological Sciences, Faculty of Medicine, American University of Beirut, Beirut 1107 2020, Lebanon
| | - Nada Lawand
- Department of Anatomy, Cell Biology and Physiological Sciences, Faculty of Medicine, American University of Beirut, Beirut 1107 2020, Lebanon
- Department of Neurology, Faculty of Medicine, American University of Beirut, Beirut 1107 2020, Lebanon
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Sedaghat S, Jang H, Athertya JS, Groezinger M, Corey-Bloom J, Du J. The signal intensity variation of multiple sclerosis (MS) lesions on magnetic resonance imaging (MRI) as a potential biomarker for patients' disability: A feasibility study. Front Neurosci 2023; 17:1145251. [PMID: 36992852 PMCID: PMC10040653 DOI: 10.3389/fnins.2023.1145251] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 02/27/2023] [Indexed: 03/14/2023] Open
Abstract
Introduction Although many lesion-based MRI biomarkers in multiple sclerosis (MS) patients were investigated, none of the previous studies dealt with the signal intensity variations (SIVs) of MS lesions. In this study, the SIVs of MS lesions on direct myelin imaging and standard clinical sequences as possible MRI biomarkers for disability in MS patients were assessed. Methods Twenty seven MS patients were included in this prospective study. IR-UTE, FLAIR, and MPRAGE sequences were employed on a 3T scanner. Regions of interest (ROIs) were manually drawn within the MS lesions, and the cerebrospinal fluid (CSF) and signal intensity ratios (SIR) were calculated from the derived values. Variations coefficients were determined from the standard deviations (Coeff 1) and the absolute differences (Coeff 2) of the SIRs. Disability grade was assessed by the expanded disability status scale (EDSS). Cortical/gray matter, subcortical, infratentorial, and spinal lesions were excluded. Results The mean diameter of the lesions was 7.8 ± 1.97 mm, while the mean EDSS score was 4.5 ± 1.73. We found moderate correlations between the EDSS and Coeff 1 and 2 on IR-UTE and MPRAGE images. Accordingly, Pearson's correlations on IR-UTE were R = 0.51 (p = 0.007) and R = 0.49 (p = 0.01) for Coeff 1 and 2, respectively. For MPRAGE, Pearson's correlations were R = 0.5 (p = 0.008) and R = 0.48 (p = 0.012) for Coeff 1 and 2, respectively. For FLAIR, only poor correlations could be found. Conclusion The SIVs of MS lesions on IR-UTE and MPRAGE images, assessed by Coeff 1 and 2, could be used as novel potential MRI biomarkers for patients' disability.
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Affiliation(s)
- Sam Sedaghat
- Department of Radiology, University of California, San Diego, San Diego, CA, United States
- University Hospital Heidelberg, Heidelberg, Germany
| | - Hyungseok Jang
- Department of Radiology, University of California, San Diego, San Diego, CA, United States
| | - Jiyo S. Athertya
- Department of Radiology, University of California, San Diego, San Diego, CA, United States
| | | | - Jody Corey-Bloom
- Department of Neurosciences, University of California, San Diego, San Diego, CA, United States
| | - Jiang Du
- Department of Radiology, University of California, San Diego, San Diego, CA, United States
- Department of Bioengineering, University of California, San Diego, San Diego, CA, United States
- Radiology Service, Veterans Affairs San Diego Healthcare System, San Diego, CA, United States
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17
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Dufresne E, Fortun D, Kremer S, Noblet V. A unified framework for focal intensity change detection and deformable image registration. Application to the monitoring of multiple sclerosis lesions in longitudinal 3D brain MRI. FRONTIERS IN NEUROIMAGING 2022; 1:1008128. [PMID: 37555167 PMCID: PMC10406299 DOI: 10.3389/fnimg.2022.1008128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 12/06/2022] [Indexed: 08/10/2023]
Abstract
Registration is a crucial step in the design of automatic change detection methods dedicated to longitudinal brain MRI. Even small registration inaccuracies can significantly deteriorate the detection performance by introducing numerous spurious detections. Rigid or affine registration are usually considered to align baseline and follow-up scans, as a pre-processing step before applying a change detection method. In the context of multiple sclerosis, using deformable registration can be required to capture the complex deformations due to brain atrophy. However, non-rigid registration can alter the shape of appearing and evolving lesions while minimizing the dissimilarity between the two images. To overcome this issue, we consider registration and change detection as intertwined problems that should be solved jointly. To this end, we formulate these two separate tasks as a single optimization problem involving a unique energy that models their coupling. We focus on intensity-based change detection and registration, but the approach is versatile and could be extended to other modeling choices. We show experimentally on synthetic and real data that the proposed joint approach overcomes the limitations of the sequential scheme.
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Affiliation(s)
| | - Denis Fortun
- ICube UMR 7357, Université de Strasbourg, CNRS, Strasbourg, France
| | - Stéphane Kremer
- ICube UMR 7357, Université de Strasbourg, CNRS, Strasbourg, France
- Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Vincent Noblet
- ICube UMR 7357, Université de Strasbourg, CNRS, Strasbourg, France
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18
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Kee R, Naughton M, McDonnell GV, Howell OW, Fitzgerald DC. A Review of Compartmentalised Inflammation and Tertiary Lymphoid Structures in the Pathophysiology of Multiple Sclerosis. Biomedicines 2022; 10:biomedicines10102604. [PMID: 36289863 PMCID: PMC9599335 DOI: 10.3390/biomedicines10102604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 10/10/2022] [Indexed: 11/24/2022] Open
Abstract
Multiple sclerosis (MS) is a chronic, immune-mediated, demyelinating disease of the central nervous system (CNS). The most common form of MS is a relapsing–remitting disease characterised by acute episodes of demyelination associated with the breakdown of the blood–brain barrier (BBB). In the relapsing–remitting phase there is often relative recovery (remission) from relapses characterised clinically by complete or partial resolution of neurological symptoms. In the later and progressive stages of the disease process, accrual of neurological disability occurs in a pathological process independent of acute episodes of demyelination and is accompanied by a trapped or compartmentalised inflammatory response, most notable in the connective tissue spaces of the vasculature and leptomeninges occurring behind an intact BBB. This review focuses on compartmentalised inflammation in MS and in particular, what we know about meningeal tertiary lymphoid structures (TLS; also called B cell follicles) which are organised clusters of immune cells, associated with more severe and progressive forms of MS. Meningeal inflammation and TLS could represent an important fluid or imaging marker of disease activity, whose therapeutic abrogation might be necessary to stop the most severe outcomes of disease.
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Affiliation(s)
- Rachael Kee
- Wellcome-Wolfson Institute for Experimental Medicine, Queen’s University Belfast, Belfast BT9 7BL, UK
- Department of Neurology, Royal Victoria Hospital, Belfast BT12 6BA, UK
- Correspondence:
| | - Michelle Naughton
- Wellcome-Wolfson Institute for Experimental Medicine, Queen’s University Belfast, Belfast BT9 7BL, UK
| | | | - Owain W. Howell
- Institute of Life Sciences, Swansea University, Wales SA2 8QA, UK
| | - Denise C. Fitzgerald
- Wellcome-Wolfson Institute for Experimental Medicine, Queen’s University Belfast, Belfast BT9 7BL, UK
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19
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Serin M, Kara P. Biosensing strategies (approaches) for diagnosis and monitoring of multiple sclerosis. Talanta 2022; 252:123794. [DOI: 10.1016/j.talanta.2022.123794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 07/20/2022] [Accepted: 07/26/2022] [Indexed: 11/29/2022]
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20
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Pirozzi MA, Tranfa M, Tortora M, Lanzillo R, Brescia Morra V, Brunetti A, Alfano B, Quarantelli M. A polynomial regression-based approach to estimate relaxation rate maps suitable for multiparametric segmentation of clinical brain MRI studies in multiple sclerosis. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2022; 223:106957. [PMID: 35772230 DOI: 10.1016/j.cmpb.2022.106957] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 05/28/2022] [Accepted: 06/13/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND OBJECTIVE Relaxation parameter maps (RPMs) calculated from spin-echo data have provided a basis for the segmentation of normal brain tissues and white matter lesions in multiple sclerosis (MS) MRI studies. However, Conventional Spin-Echo (CSE) sequences, once the core of clinical MRI studies, have been largely replaced by faster ones, which do not allow the calculation a-posteriori of RPMs from clinical studies. Aim of the study was to develop and validate a method to estimate RPMs (pseudo-RPMs) from routine clinical MRI protocols (including 3D-Gradient Echo T1w, FLAIR and fast-T2w sequences), suitable for fully automatic multiparametric segmentation of normal-appearing and pathological brain tissues in MS. METHODS The proposed method processes spatially normalized clinical MRI studies through a multistep pipeline, to collect a set of data points of matched signal intensities (from MRI studies) and relaxation parameters (from a CSE-derived digital template and an MS lesion database), which are then fitted by a multiple and multivariate 4-th degree polynomial regression, providing pseudo-RPMs. The method was applied to a dataset of 59 clinical MRI studies providing pseudo-RPMs that were segmented through a method originally developed for the CSE-derived RPMs. Results of the segmentation in 12 studies were used to iteratively optimize method parameters. Accuracy of segmentation of normal-appearing brain tissues from the pseudo-RPMs was assessed by comparing their age-related changes, as measured in 47 clinical studies, against those measured acquired using CSE sequences in a comparable dataset of 47 patients. Lesion segmentation was validated against manual segmentation carried out by three neuroradiologists. RESULTS Age-related changes of normal-appearing brain tissue volumes measured using the pseudo-RPMs substantially overlapped those measured using the RPMs obtained from CSE sequences, and segmentation of MS lesions showed a moderate-high spatial overlap with manual segmentation, comparable to that achieved by the widely used Lesion Segmentation Tool on FLAIR images, with a greater volumetric agreement. CONCLUSIONS The proposed approach allows calculation from clinical studies of pseudo-RPMs, which are equivalent to those obtainable from CSE sequences, avoiding the need for the acquisition of additional, dedicated sequences for segmentation purposes.
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Affiliation(s)
- Maria Agnese Pirozzi
- Institute of Biostructures and Bioimaging, Italian National Research Council, Naples, Italy; Department of Electrical Engineering and Information Technologies, University of Naples "Federico II", Naples, Italy.
| | - Mario Tranfa
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Mario Tortora
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Roberta Lanzillo
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy
| | - Vincenzo Brescia Morra
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy
| | - Arturo Brunetti
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | | | - Mario Quarantelli
- Institute of Biostructures and Bioimaging, Italian National Research Council, Naples, Italy
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21
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Collongues N, Becker G, Jolivel V, Ayme-Dietrich E, de Seze J, Binamé F, Patte-Mensah C, Monassier L, Mensah-Nyagan AG. A Narrative Review on Axonal Neuroprotection in Multiple Sclerosis. Neurol Ther 2022; 11:981-1042. [PMID: 35610531 PMCID: PMC9338208 DOI: 10.1007/s40120-022-00363-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 05/03/2022] [Indexed: 01/08/2023] Open
Abstract
Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system (CNS) resulting in demyelination and neurodegeneration. The therapeutic strategy is now largely based on reducing inflammation with immunosuppressive drugs. Unfortunately, when disease progression is observed, no drug offers neuroprotection apart from its anti-inflammatory effect. In this review, we explore current knowledge on the assessment of neurodegeneration in MS and look at putative targets that might prove useful in protecting the axon from degeneration. Among them, Bruton's tyrosine kinase inhibitors, anti-apoptotic and antioxidant agents, sex hormones, statins, channel blockers, growth factors, and molecules preventing glutamate excitotoxicity have already been studied. Some of them have reached phase III clinical trials and carry a great message of hope for our patients with MS.
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Affiliation(s)
- Nicolas Collongues
- Department of Neurology, University Hospital of Strasbourg, Strasbourg, France. .,Center for Clinical Investigation, INSERM U1434, Strasbourg, France. .,Biopathology of Myelin, Neuroprotection and Therapeutic Strategy, INSERM U1119, Strasbourg, France. .,University Department of Pharmacology, Addictology, Toxicology and Therapeutic, Strasbourg University, Strasbourg, France.
| | - Guillaume Becker
- University Department of Pharmacology, Addictology, Toxicology and Therapeutic, Strasbourg University, Strasbourg, France.,NeuroCardiovascular Pharmacology and Toxicology Laboratory, UR7296, University Hospital of Strasbourg, Strasbourg, France
| | - Valérie Jolivel
- Biopathology of Myelin, Neuroprotection and Therapeutic Strategy, INSERM U1119, Strasbourg, France
| | - Estelle Ayme-Dietrich
- University Department of Pharmacology, Addictology, Toxicology and Therapeutic, Strasbourg University, Strasbourg, France.,NeuroCardiovascular Pharmacology and Toxicology Laboratory, UR7296, University Hospital of Strasbourg, Strasbourg, France
| | - Jérôme de Seze
- Department of Neurology, University Hospital of Strasbourg, Strasbourg, France.,Center for Clinical Investigation, INSERM U1434, Strasbourg, France.,Biopathology of Myelin, Neuroprotection and Therapeutic Strategy, INSERM U1119, Strasbourg, France
| | - Fabien Binamé
- Biopathology of Myelin, Neuroprotection and Therapeutic Strategy, INSERM U1119, Strasbourg, France
| | - Christine Patte-Mensah
- Biopathology of Myelin, Neuroprotection and Therapeutic Strategy, INSERM U1119, Strasbourg, France
| | - Laurent Monassier
- University Department of Pharmacology, Addictology, Toxicology and Therapeutic, Strasbourg University, Strasbourg, France.,NeuroCardiovascular Pharmacology and Toxicology Laboratory, UR7296, University Hospital of Strasbourg, Strasbourg, France
| | - Ayikoé Guy Mensah-Nyagan
- Biopathology of Myelin, Neuroprotection and Therapeutic Strategy, INSERM U1119, Strasbourg, France
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22
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Deoni SCL, Medeiros P, Deoni AT, Burton P, Beauchemin J, D'Sa V, Boskamp E, By S, McNulty C, Mileski W, Welch BE, Huentelman M. Development of a mobile low-field MRI scanner. Sci Rep 2022; 12:5690. [PMID: 35383255 PMCID: PMC8982311 DOI: 10.1038/s41598-022-09760-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 03/15/2022] [Indexed: 12/23/2022] Open
Abstract
Magnetic resonance imaging (MRI) allows important visualization of the brain and central nervous system anatomy and organization. However, unlike electroencephalography (EEG) or functional near infrared spectroscopy, which can be brought to a patient or study participant, MRI remains a hospital or center-based modality. Low magnetic field strength MRI systems, however, offer the potential to extend beyond these traditional hospital and imaging center boundaries. Here we describe the development of a modified cargo van that incorporates a removable low-field permanent magnet MRI system and demonstrate its proof-of-concept. Using phantom scans and in vivo T2-weighted neuroimaging data, we show no significant differences with respect to geometric distortion, signal-to-noise ratio, or tissue segmentation outcomes in data acquired in the mobile system compared to a similar static system in a laboratory setting. These encouraging results show, for the first time, MRI that can be performed at a participant’s home, community center, school, etc. Breaking traditional barriers of access, this mobile approach may enable imaging of patients and participants who have mobility challenges, live long distances from imaging centers, or are otherwise unable to travel to an imaging center or hospital.
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Affiliation(s)
- Sean C L Deoni
- Advanced Baby Imaging Lab, Rhode Island Hospital, Warren Alpert Medical School at Brown University, Providence, RI, USA. .,Department of Diagnostic Radiology, Warren Alpert Medical School at Brown University, Providence, RI, USA. .,Department of Pediatrics, Warren Alpert Medical School at Brown University, Providence, RI, USA.
| | | | - Alexandra T Deoni
- Advanced Baby Imaging Lab, Rhode Island Hospital, Warren Alpert Medical School at Brown University, Providence, RI, USA
| | - Phoebe Burton
- Advanced Baby Imaging Lab, Rhode Island Hospital, Warren Alpert Medical School at Brown University, Providence, RI, USA
| | - Jennifer Beauchemin
- Advanced Baby Imaging Lab, Rhode Island Hospital, Warren Alpert Medical School at Brown University, Providence, RI, USA
| | - Viren D'Sa
- Advanced Baby Imaging Lab, Rhode Island Hospital, Warren Alpert Medical School at Brown University, Providence, RI, USA.,Department of Diagnostic Radiology, Warren Alpert Medical School at Brown University, Providence, RI, USA
| | | | | | | | | | - Brian E Welch
- Hyperfine, Guilford, CT, USA.,Philips North America, Cambridge, MA, USA
| | - Matthew Huentelman
- Neurogenomics Division, Translational Genomics Research Institute, Phoenix, AZ, USA
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23
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Yolanda IR, Ritarwan K. Case Report Multiple Sclerosis. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.9241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Multiple sclerosis (MS) is an autoimmune disease in the form of chronic inflammation of the CNS. This disease is mediated by autoreactive lymphocytes that can cross the blood-brain barrier and thus enter the CNS and cause inflammation. Chronic demyelinating CNS lesions characterize multiple sclerosis, and immunity to myelin is involved. This disease predominantly attacks the brain, spinal cord, and optic nerve. The diagnosis of MS is made clinically, and there is no single definitive test for MS. The key to diagnosis is Dissemination in Space (DIS) and Dissemination in Time (DIT). Magnetic resonance imaging has become an essential part of the diagnosis of MS after clinical.
CASE REPORT: Here, we report a case of a 31 year-old woman with the main complaint of weakness of four extremities accompanied by a decreased vision and impaired urination and bowel movement. The patient was diagnosed with suspected MS.
CONCLUSION: The patient subsequently was treated with intravenous steroids and, on the routine follow-up found marked clinical improvement.
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24
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Weinstein DR, Owens GM, Gandhi A. Multiple Sclerosis: Systemic Challenges to Cost-Effective Care. AMERICAN HEALTH & DRUG BENEFITS 2022; 15:13-20. [PMID: 35586614 PMCID: PMC9038003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 11/22/2021] [Indexed: 06/15/2023]
Abstract
BACKGROUND Multiple sclerosis (MS) is a progressive autoimmune disorder of the central nervous system characterized by symptoms including reduced mobility, pain, fatigue, and spasticity. MS affects nearly 1 million people in the United States, with significant negative impact on a patient's quality of life, and an average lifetime cost of care in excess of $4 million. The cost-effective management of patients with MS faces several challenges. OBJECTIVE To review the challenges to the cost-effective management of patients with MS, and to offer healthcare stakeholders a roadmap to address them. DISCUSSION The cost-effective management of patients with MS, which is driven largely by how quickly a patient receives effective medication therapy, is challenged by a paucity of between-office-visit clinical data, variability of provider expertise with magnetic resonance imaging (MRI), MRI machine quality, lack of standards for MRI machines and reports, misaligned financial incentives, the limited number of available Current Procedural Terminology (CPT) codes for brain MRI, the complexity of disease-modifying therapy (DMT) selection, poor patient adherence to treatment plans, poor communication among providers, and a lack of objective measures of disease progression. CONCLUSION Insurers, neurologists, researchers, and patient advocacy groups must address the needs of patients with MS holistically. These efforts should include establishing standards for MRI machines and reports, matching patients with MS specialists, aligning financial incentives, including creating a new CPT code for complex brain MRI, streamlining prior authorization processes of DMTs, using technology to gather patient data and improve coordination of care, and developing better measurement tools of disease activity.
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Affiliation(s)
| | - Gary M Owens
- President, Gary Owens Associates, Ocean View, DE
| | - Ankit Gandhi
- Clinical Trials Results Analyst, National Institutes of Health, Bethesda, MD
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25
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Lesion Volume Quantification Using Two Convolutional Neural Networks in MRIs of Multiple Sclerosis Patients. Diagnostics (Basel) 2022; 12:diagnostics12020230. [PMID: 35204321 PMCID: PMC8870921 DOI: 10.3390/diagnostics12020230] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 12/23/2021] [Accepted: 01/14/2022] [Indexed: 01/18/2023] Open
Abstract
Background: Multiple sclerosis (MS) is a neurologic disease of the central nervous system which affects almost three million people worldwide. MS is characterized by a demyelination process that leads to brain lesions, allowing these affected areas to be visualized with magnetic resonance imaging (MRI). Deep learning techniques, especially computational algorithms based on convolutional neural networks (CNNs), have become a frequently used algorithm that performs feature self-learning and enables segmentation of structures in the image useful for quantitative analysis of MRIs, including quantitative analysis of MS. To obtain quantitative information about lesion volume, it is important to perform proper image preprocessing and accurate segmentation. Therefore, we propose a method for volumetric quantification of lesions on MRIs of MS patients using automatic segmentation of the brain and lesions by two CNNs. Methods: We used CNNs at two different moments: the first to perform brain extraction, and the second for lesion segmentation. This study includes four independent MRI datasets: one for training the brain segmentation models, two for training the lesion segmentation model, and one for testing. Results: The proposed brain detection architecture using binary cross-entropy as the loss function achieved a 0.9786 Dice coefficient, 0.9969 accuracy, 0.9851 precision, 0.9851 sensitivity, and 0.9985 specificity. In the second proposed framework for brain lesion segmentation, we obtained a 0.8893 Dice coefficient, 0.9996 accuracy, 0.9376 precision, 0.8609 sensitivity, and 0.9999 specificity. After quantifying the lesion volume of all patients from the test group using our proposed method, we obtained a mean value of 17,582 mm3. Conclusions: We concluded that the proposed algorithm achieved accurate lesion detection and segmentation with reproducibility corresponding to state-of-the-art software tools and manual segmentation. We believe that this quantification method can add value to treatment monitoring and routine clinical evaluation of MS patients.
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26
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Bergamaschi R, Mallucci G, Fusco S, Montomoli C. Disability and mortality in a cohort of MS patients: how the real-world scenario is changed. J Neurol 2022; 269:3355-3358. [PMID: 35029742 DOI: 10.1007/s00415-021-10940-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 12/13/2021] [Accepted: 12/14/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Roberto Bergamaschi
- Multiple Sclerosis Centre, IRCCS Mondino Foundation, Via Mondino 2, 27100, Pavia, Italy
| | - Giulia Mallucci
- Multiple Sclerosis Centre, IRCCS Mondino Foundation, Via Mondino 2, 27100, Pavia, Italy.
| | - Sara Fusco
- Multiple Sclerosis Centre, IRCCS Mondino Foundation, Via Mondino 2, 27100, Pavia, Italy
| | - Cristina Montomoli
- Department of Public Health, Experimental and Forensic Medicine, Unit of Biostatistics and Clinical Epidemiology, University of Pavia, Pavia, Italy
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27
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Edwards EM, Wu W, Fritz NE. Using Myelin Water Imaging to Link Underlying Pathology to Clinical Function in Multiple Sclerosis: A Scoping Review. Mult Scler Relat Disord 2022; 59:103646. [DOI: 10.1016/j.msard.2022.103646] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 12/14/2021] [Accepted: 01/29/2022] [Indexed: 12/28/2022]
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28
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Patti F, Chisari CG, Arena S, Toscano S, Finocchiaro C, Fermo SL, Judica ML, Maimone D. Factors driving delayed time to multiple sclerosis diagnosis: Results from a population-based study. Mult Scler Relat Disord 2022; 57:103361. [PMID: 35158432 DOI: 10.1016/j.msard.2021.103361] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 09/30/2021] [Accepted: 10/29/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) is a highly complex chronic inflammatory disease, in which a diagnostic delay could reduce the available therapeutic options. Our aim was to identify factors contributing to diagnostic delay in a MS population living in the municipality of Biancavilla. METHODS This retrospective population-based study consecutively selected patients with MS diagnosed from 1992 to 2018 and resident in the city of Biancavilla. Socio-demographic and clinical data were collected through the iMed database. Date of final MS diagnosis was obtained and diagnostic delay was calculated. RESULTS A total of 70 patients (66.7% women) were found affected by MS according to the 2011 McDonald criteria in the municipality of Biancavilla in the period between 2005 and 2010. The mean diagnostic delay in the MS cohort of Biancavilla was 33.8 ± 56 months [median 19.5, range 1-315]. The multivariate logistic regression confirmed that age ≥ 40 years, lower educational level (1-5 years) and motor symptoms at onset were associated to longer diagnostic delay. CONCLUSION In this population-based study a mean delay of about 30 months occurred between initial symptoms and the MS diagnosis. Older age at onset, lower education level and motor symptoms at onset were associated to longer MS diagnostic delay.
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Affiliation(s)
- Francesco Patti
- Department of Medical and Surgical Sciences, and Advanced Technologies, "G.F. Ingrassia", Multiple Sclerosis Center, University of Catania, Via Santa Sofia, 78, Catania 95123, Italy.
| | - Clara Grazia Chisari
- Department of Medical and Surgical Sciences, and Advanced Technologies, "G.F. Ingrassia", Multiple Sclerosis Center, University of Catania, Via Santa Sofia, 78, Catania 95123, Italy
| | - Sebastiano Arena
- Department of Medical and Surgical Sciences, and Advanced Technologies, "G.F. Ingrassia", Multiple Sclerosis Center, University of Catania, Via Santa Sofia, 78, Catania 95123, Italy
| | - Simona Toscano
- Department of Medical and Surgical Sciences, and Advanced Technologies, "G.F. Ingrassia", Multiple Sclerosis Center, University of Catania, Via Santa Sofia, 78, Catania 95123, Italy
| | - Chiara Finocchiaro
- Department of Medical and Surgical Sciences, and Advanced Technologies, "G.F. Ingrassia", Multiple Sclerosis Center, University of Catania, Via Santa Sofia, 78, Catania 95123, Italy
| | - Salvatore Lo Fermo
- Department of Medical and Surgical Sciences, and Advanced Technologies, "G.F. Ingrassia", Multiple Sclerosis Center, University of Catania, Via Santa Sofia, 78, Catania 95123, Italy
| | - Maria Luisa Judica
- Azienda Sanitaria Provinciale di Catania, distretto di Adrano, Catania, Italy
| | - Davide Maimone
- Multiple Sclerosis Center, Garibaldi-Nesima Hospital, Catania, Italy
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29
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Health Economic Impact of Software-Assisted Brain MRI on Therapeutic Decision-Making and Outcomes of Relapsing-Remitting Multiple Sclerosis Patients-A Microsimulation Study. Brain Sci 2021; 11:brainsci11121570. [PMID: 34942872 PMCID: PMC8699604 DOI: 10.3390/brainsci11121570] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 11/20/2021] [Accepted: 11/25/2021] [Indexed: 11/17/2022] Open
Abstract
Aim: To develop a microsimulation model to assess the potential health economic impact of software-assisted MRI in detecting disease activity or progression in relapsing-remitting multiple sclerosis (RRMS) patients. Methods: We develop a simulated decision analytical model based on a hypothetical cohort of RRMS patients to compare a baseline decision-making strategy in which only clinical evolution (relapses and disability progression) factors are used for therapy decisions in MS follow-up, with decision-making strategies involving MRI. In this context, we include comparisons with a visual radiologic assessment of lesion evolution, software-assisted lesion detection, and software-assisted brain volume loss estimation. The model simulates clinical (EDSS transitions, number of relapses) and subclinical (new lesions and brain volume loss) disease progression and activity, modulated by the efficacy profiles of different disease-modifying therapies (DMTs). The simulated decision-making process includes the possibility to escalate from a low efficacy DMT to a high efficacy DMT or to switch between high efficacy DMTs when disease activity is detected. We also consider potential error factors that may occur during decision making, such as incomplete detection of new lesions, or inexact computation of brain volume loss. Finally, differences between strategies in terms of the time spent on treatment while having undetected disease progression/activity, the impact on the patient’s quality of life, and costs associated with health status from a US perspective, are reported. Results: The average time with undetected disease progression while on low efficacy treatment is shortened significantly when using MRI, from around 3 years based on clinical criteria alone, to 2 when adding visual examination of MRI, and down to only 1 year with assistive software. Hence, faster escalation to a high efficacy DMT can be performed when MRI software is added to the radiological reading, which has positive effects in terms of health outcomes. The incremental utility shows average gains of 0.23 to 0.37 QALYs over 10 and 15 years, respectively, when using software-assisted MRI compared to clinical parameters only. Due to long-term health benefits, the average annual costs associated with health status are lower by $1500–$2200 per patient when employing MRI and assistive software. Conclusions: The health economic burden of MS is high. Using assistive MRI software to detect and quantify lesions and/or brain atrophy has a significant impact on the detection of disease activity, treatment decisions, health outcomes, utilities, and costs in patients with MS.
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Lees S, Dicker M, Ku JE, Chaganti V, Mew-Sum M, Wang N, Smith A, Oldmeadow C, Goon WL, Bevan M, Lang D, Hinwood M. Impact of disease-modifying therapies on MRI and neurocognitive outcomes in relapsing-remitting multiple sclerosis: a protocol for a systematic review and network meta-analysis. BMJ Open 2021; 11:e051509. [PMID: 34728450 PMCID: PMC8565566 DOI: 10.1136/bmjopen-2021-051509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Disease-modifying therapies (DMTs) are the mainstay of treatment for relapsing-remitting multiple sclerosis (RRMS). There is established evidence that DMTs are effective at reducing relapse rate and disease progression in RRMS, but there has been less consideration to the synthesis of MRI and neurocognitive outcomes, which play an increasingly important role in treatment decisions. The aim of this systematic review and network meta-analysis is to examine the relative efficacy, acceptability and tolerability of DMTs for RRMS, using MRI and neurocognitive outcomes. METHODS AND ANALYSIS We will search electronic databases, including MEDLINE, Embase and the Cochrane Central Register of Controlled Trials, with no date restrictions. We will also search the websites of international regulatory bodies for pharmaceuticals and international trial registries. We will include parallel group randomised controlled trials of DMTs including interferon beta-1a intramuscular, interferon beta-1a subcutaneous, interferon beta-1b, peginterferon beta-1a, glatiramer acetate, natalizumab, ocrelizumab, alemtuzumab, dimethyl fumarate, teriflunomide, fingolimod, cladribine, ozanimod, mitoxantrone and rituximab, either head-to-head or against placebo in adults with RRMS. Primary outcomes include efficacy (MRI outcomes including new T1/hypointense lesions and T2/hyperintense lesions) and acceptability (all-cause dropouts). Secondary outcomes include gadolinium-enhancing lesions, cerebral atrophy and tolerability (dropouts due to adverse events). Neurocognitive measures across three domains including processing speed, working memory and verbal learning will be included as exploratory outcomes. Data will be analysed using a random-effects pairwise meta-analysis and a Bayesian hierarchical random effects network meta-analysis to evaluate the efficacy, acceptability and tolerability of the included DMTs. Subgroup and sensitivity analyses will be conducted to assess the robustness of the findings. The review will be reported using the Preferred Reporting Items for Systematic Reviews incorporating Network Meta-Analyses statement. ETHICS AND DISSEMINATION This protocol does not require ethics approval. Results will be disseminated in a peer-reviewed academic journal. PROSPERO REGISTRATION NUMBER CRD42021239630.
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Affiliation(s)
- Samuel Lees
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Mathew Dicker
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Jie En Ku
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Varun Chaganti
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Matthew Mew-Sum
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Nick Wang
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Angela Smith
- HNEHealth Libraries, Hunter New England Local Health District, New Lambton, New South Wales, Australia
| | | | - Wooi Lynn Goon
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Marc Bevan
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Danielle Lang
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Madeleine Hinwood
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
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Demir CF, BALGETiR F, Ethemoğlu Ö, Aksoy D, Aktaş F, Koca SS, Yetkin MF, Taşci İ. Positive effects of ocrelizumab in patients with familial mediterranean fever and coexistent multiple sclerosis. Arch Rheumatol 2021; 36:219-226. [PMID: 34527926 PMCID: PMC8418767 DOI: 10.46497/archrheumatol.2021.8229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 08/11/2020] [Indexed: 11/17/2022] Open
Abstract
Objectives
This study aims to evaluate the effects of ocrelizumab (OCZ) on familial Mediterranean fever (FMF) attacks in multiple sclerosis (MS) patients with FMF (MS+FMF patients). Patients and methods
This retrospective observational study included 11 patients (2 males, 9 females; mean age 46.6±9.2; range, 22 to 55 years) with MS+FMF hospitalized between January 2016 and July 2019. Demographic, clinical, and laboratory parameters and patient reported outcomes were analyzed in patients treated with OCZ for 18 months. Results
Combining OCZ with colchicine in MS+FMF patients significantly reduced the frequency of FMF attacks (p=0.003) and the frequency of joint attacks (p=0.002). Consistent with the clinical improvement, the maximum serum C-reactive protein levels were significantly decreased after combination therapy compared to before combination therapy (p=0.003). MS+FMF patients reported that FMF disease activity improved after OCZ therapy (Visual Analog Scale [VAS] 74±9.6 vs. VAS 46.5±8.1 mm, p=0.003). Conclusion Ocrelizumab therapy led to a prominent decrease in the frequency of FMF attacks, alleviated functional impairment, and improved quality of life in MS+FMF patients.
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Affiliation(s)
- Caner Feyzi Demir
- Department of Neurology, Fırat University, Faculty of Medicine, Elazığ, Turkey
| | - Ferhat BALGETiR
- Department of Neurology, Fırat University, Faculty of Medicine, Elazığ, Turkey
| | - Özlem Ethemoğlu
- Department of Neurology, Harran University, Faculty of Medicine, Şanlıurfa, Turkey
| | - Dürdane Aksoy
- Department of Neurology, Gaziosmanpaşa University, Faculty of Medicine, Tokat, Turkey
| | - Filiz Aktaş
- Department of Neurology, Konya Training and Research Hospital, Konya, Turkey
| | - Süleyman Serdar Koca
- Department of Internal Medicine, Division of Rheumatology, Fırat University, Faculty of Medicine, Elazığ, Turkey
| | - Mehmet Fatih Yetkin
- Department of Neurology, Erciyes University, Faculty of Medicine, Kayseri, Turkey
| | - İrem Taşci
- Department of Neurology, Malatya Training and Research Hospital, Malatya, Turkey
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Lavrova E, Lommers E, Woodruff HC, Chatterjee A, Maquet P, Salmon E, Lambin P, Phillips C. Exploratory Radiomic Analysis of Conventional vs. Quantitative Brain MRI: Toward Automatic Diagnosis of Early Multiple Sclerosis. Front Neurosci 2021; 15:679941. [PMID: 34421515 PMCID: PMC8374240 DOI: 10.3389/fnins.2021.679941] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 06/14/2021] [Indexed: 12/23/2022] Open
Abstract
Conventional magnetic resonance imaging (cMRI) is poorly sensitive to pathological changes related to multiple sclerosis (MS) in normal-appearing white matter (NAWM) and gray matter (GM), with the added difficulty of not being very reproducible. Quantitative MRI (qMRI), on the other hand, attempts to represent the physical properties of tissues, making it an ideal candidate for quantitative medical image analysis or radiomics. We therefore hypothesized that qMRI-based radiomic features have added diagnostic value in MS compared to cMRI. This study investigated the ability of cMRI (T1w) and qMRI features extracted from white matter (WM), NAWM, and GM to distinguish between MS patients (MSP) and healthy control subjects (HCS). We developed exploratory radiomic classification models on a dataset comprising 36 MSP and 36 HCS recruited in CHU Liege, Belgium, acquired with cMRI and qMRI. For each image type and region of interest, qMRI radiomic models for MS diagnosis were developed on a training subset and validated on a testing subset. Radiomic models based on cMRI were developed on the entire training dataset and externally validated on open-source datasets with 167 HCS and 10 MSP. Ranked by region of interest, the best diagnostic performance was achieved in the whole WM. Here the model based on magnetization transfer imaging (a type of qMRI) features yielded a median area under the receiver operating characteristic curve (AUC) of 1.00 in the testing sub-cohort. Ranked by image type, the best performance was achieved by the magnetization transfer models, with median AUCs of 0.79 (0.69–0.90, 90% CI) in NAWM and 0.81 (0.71–0.90) in GM. The external validation of the T1w models yielded an AUC of 0.78 (0.47–1.00) in the whole WM, demonstrating a large 95% CI and a low sensitivity of 0.30 (0.10–0.70). This exploratory study indicates that qMRI radiomics could provide efficient diagnostic information using NAWM and GM analysis in MSP. T1w radiomics could be useful for a fast and automated check of conventional MRI for WM abnormalities once acquisition and reconstruction heterogeneities have been overcome. Further prospective validation is needed, involving more data for better interpretation and generalization of the results.
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Affiliation(s)
- Elizaveta Lavrova
- The D-Lab, Department of Precision Medicine, GROW-School for Oncology, Maastricht University, Maastricht, Netherlands.,GIGA Cyclotron Research Centre In Vivo Imaging, University of Liège, Liège, Belgium
| | - Emilie Lommers
- GIGA Cyclotron Research Centre In Vivo Imaging, University of Liège, Liège, Belgium.,Clinical Neuroimmunology Unit, Neurology Department, CHU Liège, Liège, Belgium
| | - Henry C Woodruff
- The D-Lab, Department of Precision Medicine, GROW-School for Oncology, Maastricht University, Maastricht, Netherlands.,Department of Radiology and Nuclear Imaging, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Avishek Chatterjee
- The D-Lab, Department of Precision Medicine, GROW-School for Oncology, Maastricht University, Maastricht, Netherlands
| | - Pierre Maquet
- GIGA Cyclotron Research Centre In Vivo Imaging, University of Liège, Liège, Belgium.,Clinical Neuroimmunology Unit, Neurology Department, CHU Liège, Liège, Belgium
| | - Eric Salmon
- GIGA Cyclotron Research Centre In Vivo Imaging, University of Liège, Liège, Belgium
| | - Philippe Lambin
- The D-Lab, Department of Precision Medicine, GROW-School for Oncology, Maastricht University, Maastricht, Netherlands.,Department of Radiology and Nuclear Imaging, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Christophe Phillips
- GIGA Cyclotron Research Centre In Vivo Imaging, University of Liège, Liège, Belgium.,GIGA In Silico Medicine, University of Liège, Liège, Belgium
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Pardo G, Coates S, Okuda DT. Outcome measures assisting treatment optimization in multiple sclerosis. J Neurol 2021; 269:1282-1297. [PMID: 34338857 PMCID: PMC8857110 DOI: 10.1007/s00415-021-10674-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 06/14/2021] [Accepted: 06/16/2021] [Indexed: 11/30/2022]
Abstract
Objective To review instruments used to assess disease stability or progression in persons with multiple sclerosis (pwMS) that can guide clinicians in optimizing therapy. Methods A non-systematic review of scientific literature was undertaken to explore modalities of monitoring symptoms and the disease evolution of MS. Results Multiple outcome measures, or tools, have been developed for use in MS research as well as for the clinical management of pwMS. Beginning with the Expanded Disability Status Scale, introduced in 1983, clinicians and researchers have developed monitoring modalities to assess all aspects of MS and the neurological impairment it causes. Conclusions Much progress has been made in recent decades for the management of MS and for the evaluation of disease progression. New technology, such as wearable sensors, will provide new opportunities to better understand changes in function, dexterity, and cognition. Essential work over the decades since EDSS was introduced continues to improve our ability to treat this debilitating disease.
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Affiliation(s)
- Gabriel Pardo
- OMRF Multiple Sclerosis Center of Excellence, Oklahoma Medical Research Foundation, 820 NE 15th Street, Oklahoma City, OK, 73104, USA.
| | | | - Darin T Okuda
- Department of Neurology, University of Texas Southwestern, Dallas, TX, USA
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Demir CF, BALGETiR F, Ethemoğlu Ö, Aksoy D, Aktaş F, Koca SS, Yetkin MF, Taşci İ. Positive effects of ocrelizumab in patients with familial mediterranean fever and coexistent multiple sclerosis. Arch Rheumatol 2021. [PMID: 34527926 DOI: 10.4649/archrheumatol.2021.8229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
OBJECTIVES This study aims to evaluate the effects of ocrelizumab (OCZ) on familial Mediterranean fever (FMF) attacks in multiple sclerosis (MS) patients with FMF (MS+FMF patients). PATIENTS AND METHODS This retrospective observational study included 11 patients (2 males, 9 females; mean age 46.6±9.2; range, 22 to 55 years) with MS+FMF hospitalized between January 2016 and July 2019. Demographic, clinical, and laboratory parameters and patient reported outcomes were analyzed in patients treated with OCZ for 18 months. RESULTS Combining OCZ with colchicine in MS+FMF patients significantly reduced the frequency of FMF attacks (p=0.003) and the frequency of joint attacks (p=0.002). Consistent with the clinical improvement, the maximum serum C-reactive protein levels were significantly decreased after combination therapy compared to before combination therapy (p=0.003). MS+FMF patients reported that FMF disease activity improved after OCZ therapy (Visual Analog Scale [VAS] 74±9.6 vs. VAS 46.5±8.1 mm, p=0.003). CONCLUSION Ocrelizumab therapy led to a prominent decrease in the frequency of FMF attacks, alleviated functional impairment, and improved quality of life in MS+FMF patients.
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Affiliation(s)
- Caner Feyzi Demir
- Department of Neurology, Fırat University, Faculty of Medicine, Elazığ, Turkey
| | - Ferhat BALGETiR
- Department of Neurology, Fırat University, Faculty of Medicine, Elazığ, Turkey
| | - Özlem Ethemoğlu
- Department of Neurology, Harran University, Faculty of Medicine, Şanlıurfa, Turkey
| | - Dürdane Aksoy
- Department of Neurology, Gaziosmanpaşa University, Faculty of Medicine, Tokat, Turkey
| | - Filiz Aktaş
- Department of Neurology, Konya Training and Research Hospital, Konya, Turkey
| | - Süleyman Serdar Koca
- Department of Internal Medicine, Division of Rheumatology, Fırat University, Faculty of Medicine, Elazığ, Turkey
| | - Mehmet Fatih Yetkin
- Department of Neurology, Erciyes University, Faculty of Medicine, Kayseri, Turkey
| | - İrem Taşci
- Department of Neurology, Malatya Training and Research Hospital, Malatya, Turkey
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Gisleskog PO, Valenzuela B, Scherz T, Burcklen M, Pérez-Ruixo JJ, Poggesi I. An Exposure-Response Analysis of the Clinical Efficacy of Ponesimod in a Randomized Phase II Study in Patients with Multiple Sclerosis. Clin Pharmacokinet 2021; 60:1227-1237. [PMID: 33914286 DOI: 10.1007/s40262-021-01020-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND OBJECTIVE Ponesimod is a sphingosphine-1-phosphate receptor modulator being developed for the treatment of multiple sclerosis. The effects of disease-modifying treatments on magnetic resonance imaging (MRI) lesions in relapsing multiple sclerosis accurately predict effects on clinical relapses, therefore MRI lesion counts are generally accepted efficacy endpoints in phase II clinical studies of multiple sclerosis disease-modifying treatments. Here, we characterize the effect of ponesimod systemic exposure on the cumulative number of T1 gadolinium-enhancing (Gd+) lesions and the annualized relapse rate in a phase IIb study. METHODS This study assessed the cumulative number of new Gd+ lesions on T1-weighted MRI scans (primary endpoint) at weeks 12, 16, 20, and 24 and the annualized relapse rate (secondary endpoint). The effect of the demographic and prognostic covariates of sex, age, weight, T1 Gd+ lesions at baseline, and Expanded Disability Status Scale score at baseline were explored. Analyses were performed using NONMEM, Version 7.3.0 (ICON plc). RESULTS An increase in ponesimod exposure led to a statistically significant decrease in the cumulative T1 Gd+ lesions on MRI from week 12 to 24 of treatment. Increasing the ponesimod daily dose beyond 20 mg did not provide significant additional benefits. Sex, age, T1 Gd+ lesions at baseline, and Expanded Disability Status Scale score at baseline were associated with a higher number of new cumulative T1 Gd+ from week 12 to 24 of treatment. CONCLUSIONS This analysis shows a relationship between ponesimod exposure and the cumulative number of new T1 Gd+ lesions. Sex, age, T1 Gd+ lesions at baseline, and Expanded Disability Status Score at baseline were not found to be importantly associated with the magnitude of ponesimod effect, and consequently, there is no indication from these analyses that dosage adjustments based on the explored covariates are warranted. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01006265, registration date 1 November, 2009.
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Affiliation(s)
| | - Belén Valenzuela
- Janssen-Cilag Spain, part of Janssen Pharmaceutical Companies, Madrid, Spain
| | - Tatiana Scherz
- Actelion Pharmaceuticals Ltd, part of Janssen Pharmaceutical Companies, Allschwil, Switzerland
| | - Michel Burcklen
- Actelion Pharmaceuticals Ltd, part of Janssen Pharmaceutical Companies, Allschwil, Switzerland
| | | | - Italo Poggesi
- Janssen-Cilag Italy, part of Janssen Pharmaceutical Companies, Milan, Italy.
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Meca-Lallana V, Berenguer-Ruiz L, Carreres-Polo J, Eichau-Madueño S, Ferrer-Lozano J, Forero L, Higueras Y, Téllez Lara N, Vidal-Jordana A, Pérez-Miralles FC. Deciphering Multiple Sclerosis Progression. Front Neurol 2021; 12:608491. [PMID: 33897583 PMCID: PMC8058428 DOI: 10.3389/fneur.2021.608491] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 03/11/2021] [Indexed: 12/12/2022] Open
Abstract
Multiple sclerosis (MS) is primarily an inflammatory and degenerative disease of the central nervous system, triggered by unknown environmental factors in patients with predisposing genetic risk profiles. The prevention of neurological disability is one of the essential goals to be achieved in a patient with MS. However, the pathogenic mechanisms driving the progressive phase of the disease remain unknown. It was described that the pathophysiological mechanisms associated with disease progression are present from disease onset. In daily practice, there is a lack of clinical, radiological, or biological markers that favor an early detection of the disease's progression. Different definitions of disability progression were used in clinical trials. According to the most descriptive, progression was defined as a minimum increase in the Expanded Disability Status Scale (EDSS) of 1.5, 1.0, or 0.5 from a baseline level of 0, 1.0–5.0, and 5.5, respectively. Nevertheless, the EDSS is not the most sensitive scale to assess progression, and there is no consensus regarding any specific diagnostic criteria for disability progression. This review document discusses the current pathophysiological concepts associated with MS progression, the different measurement strategies, the biomarkers associated with disability progression, and the available pharmacologic therapeutic approaches.
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Affiliation(s)
- Virginia Meca-Lallana
- Multiple Sclerosis Unit, Neurology Department, Fundación de Investigación Biomédica, Hospital Universitario de la Princesa, Madrid, Spain
| | | | - Joan Carreres-Polo
- Neuroradiology Section, Radiology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Sara Eichau-Madueño
- Multiple Sclerosis CSUR Unit, Neurology Department, Hospital Universitario Virgen Macarena, Seville, Spain
| | - Jaime Ferrer-Lozano
- Department of Pathology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Lucía Forero
- Neurology Department, Hospital Puerta del Mar, Cádiz, Spain
| | - Yolanda Higueras
- Neurology Department, Instituto de Investigación Sanitaria Gregorio Marañón (IISGM), Hospital Universitario Gregorio Marañón, Madrid, Spain.,Department of Experimental Psychology, Cognitive Processes and Speech Therapy, Universidad Complutense, Madrid, Spain
| | - Nieves Téllez Lara
- Neurology Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Angela Vidal-Jordana
- Neurology/Neuroimmunology Department, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Francisco Carlos Pérez-Miralles
- Neuroimmunology Unit, Neurology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain.,Department of Medicine, University of València, Valencia, Spain
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Systematic Literature Review and Meta-Analysis of Sacral Neuromodulation (SNM) in Patients with Neurogenic Lower Urinary Tract Dysfunction (nLUTD): Over 20 Years' Experience and Future Directions. Adv Ther 2021; 38:1987-2006. [PMID: 33713279 PMCID: PMC8004509 DOI: 10.1007/s12325-021-01650-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 02/03/2021] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Sacral neuromodulation (SNM) has been used in carefully selected patients with neurogenic lower urinary tract dysfunctions (nLUTD) for over two decades. METHODS The aim of the current work was to perform a systematic literature review and meta-analysis of studies reporting the safety and effectiveness of SNM in patients with nLUTD (neurogenic detrusor overactivity, non-obstructive urinary retention, or a combination of both). For this purpose a systematic literature research was conducted using Embase (OvidSP), MEDLINE (OvidSP), MEDLINE In-Process Citations & Daily Update (OvidSP), MEDLINE (OvidSP) e-Pub ahead of print, Cochrane Central Register of Controlled Trials (CENTRAL), NIH Clinicaltrials.gov, and WHO International Clinical Trials Registry Platform (ICTRP) between 1998 and March 2020, supplemented by a hand search. RESULTS Forty-seven studies were included in the systematic literature review. Twenty-one studies comprising a total of 887 patients were included in the meta-analysis of test SNM. The pooled success rate of SNM test stimulation was 66.2% (95% CI 56.9-74.4). Depending on neurogenic conditions test success rates varied greatly. Twenty-four studies with a total of 428 patients were included in the meta-analysis of permanent SNM. The success rate of pooled permanent SNM was 84.2% (95% CI 77.8-89.0). Among the identified studies, the most common adverse events (AEs) were loss of effectiveness, infection, pain at implant site, and lead migration with AE rates of 4.7%, 3.6%, 3.2%, and 3.2%, respectively. Limitations entail lower level of evidence (Oxford classification 3-4) of included studies, significant risk of bias, small sample sizes in some studies, the inclusion of retrospective case series, substantial between-study heterogeneity, heterogeneous patient populations, insufficient disease classification, and variations in terms of outcome parameters as well as techniques. Furthermore, long-term data are limited. CONCLUSION This meta-analysis supports not only the benefits of permanent SNM for various nLUTDs but also high overall success rates, similar to idiopathic patients. Current data of the analyzed studies showed that SNM is safe for these patients. However, more vigorous studies and/or registries are needed before definitive conclusions can be drawn.
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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] [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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Sánchez RC, de la Fe AD, Suarez AP, Grass D, Vega TM, Canal AS, Siniscalco D, de Los Angeles Robinson Agramonte M. Interferon beta 1a (Rebif®) in relapsing remitting multiple sclerosis. Drug Dev Res 2021; 82:707-715. [PMID: 33586209 DOI: 10.1002/ddr.21798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 01/15/2021] [Accepted: 01/21/2021] [Indexed: 11/10/2022]
Abstract
Multiple sclerosis (MS) is an autoimmune neurodegenerative disease that affects the central nervous system. It is the second cause of neurological disability in young adults. The exact cause of the disease remains unknown and there is no curative treatment. It is imperative to evaluate the efficacy of newest, biotechnological products modifying the disease. This study was designed to evaluate the use of interferon beta 1a (Rebif®) in patients with relapsing remitting MS treated at International Center for Neurological Restoration. Thirty-one patients with relapsing remitting MS, between 10 and 65 years of age, four males and 27 females, were treated with Rebif® three times per week during 1 year. The safety of the treatment was evaluated based on the adverse events and the efficacy based on the disability scale score, the number of attacks and the number of lesions at magnetic resonance imaging (MRI). The public clinical trial is registered in Cuba (Number B-10-030-L03). Adverse effects occurred in 75% of the cases, but they were mild. A significant reduction in the number of attacks, the disability scale score and the number of lesions at MRI were observed in patients with relapsing remitting MS treated with Rebif®. The use of interferon beta 1a showed safety and efficacy in the treatment of patients with relapsing remitting MS.
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Affiliation(s)
| | - Amado Díaz de la Fe
- Neuromuscular Diseases Clinic, International Center for Neurological Restoration, Habana, Cuba
| | - Alejandro Peláez Suarez
- Neuromuscular Diseases Clinic, International Center for Neurological Restoration, Habana, Cuba
| | - Dayme Grass
- Neuromuscular Diseases Clinic, International Center for Neurological Restoration, Habana, Cuba
| | - Teresa Morgado Vega
- Neuromuscular Diseases Clinic, International Center for Neurological Restoration, Habana, Cuba
| | - Armando Sánchez Canal
- Division of Neuromuscular Diseases Clinic, Abel Santamaria Cuadrado University Hospital, Pinar del Río, Cuba
| | - Dario Siniscalco
- Department of Experimental Medicine, Division of Biotechnology, Molecular Biology and Histology, University of Campania L. Vanvitelli, Naples, Italy
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Boyko A, Therapontos C, Horakova D, Szilasiová J, Kalniņa J, Kolontareva J, Gross-Paju K, Selmaj K, Sereike I, Milo R, Gabelić T, Rot U. Approaches and challenges in the diagnosis and management of secondary progressive multiple sclerosis: A Central Eastern European perspective from healthcare professionals. Mult Scler Relat Disord 2021; 50:102778. [PMID: 33592384 DOI: 10.1016/j.msard.2021.102778] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 01/15/2021] [Accepted: 01/16/2021] [Indexed: 10/22/2022]
Abstract
Secondary progressive multiple sclerosis (SPMS) is a debilitating condition characterized by gradual worsening after an initial relapsing disease course. Despite the recent advances in our understanding of the disease, the diagnosis and treatment of SPMS continue to be challenging in routine clinical practice. The aim of this review article is to present the views of leading MS experts on the challenges in the diagnosis and management of SPMS and clinicians' perspectives in Central and Eastern Europe. This article also provides recommendations of MS experts to improve the situation with diagnosis and management of SPMS. Many countries within Central and Eastern Europe have high prevalence of MS (>100 per 100,000 population). Consistent with the global trend, in the absence of reliable tests or biomarkers, SPMS at early stage remains undiagnosed. Due to diagnostic uncertainty and lack of a universally accepted disease definition, clinicians rely more on retrospective analysis of the clinical symptoms to confirm the diagnosis. With the lack of awareness and poor understanding of the timing of the onset of SPMS, clinicians may tend to direct attention to relapses than the symptoms of progression, which leads to underestimation of SPMS. Although several predictors of progression to SPMS have been identified, their predictive value is highly variable. Therefore, defining the transitioning period as a separate stage of MS is essential. According to experts' opinion, frequent follow-up of patients and periodic assessment of progression are recommended for the timely identification of patients transitioning from RRMS to SPMS. MSProDiscuss Tool is an example of a quick assessment tool for identifying patients progressing from RRMS to SPMS. MS progression is usually assessed by changes in Expanded Disability Status Scale (EDSS) scores. As EDSS scores tend to fluctuate when measured in the short term (3-6 months), a longer period (≥12 months) may be needed to confirm the progression. Assessment of cognitive function is also important for evaluating secondary progression. Compartmentalization of inflammation within the central nervous system is an important reason behind the limited success of disease-modifying therapies (DMTs) for treating SPMS. Most of the DMTs fail to cross the blood-brain barrier; only 38% of the tested DMTs achieved their primary endpoint in SPMS. In Europe, siponimod is the first oral treatment for adults with active SPMS. Particularly, in Central and Eastern Europe, patients with SPMS are still being prescribed less efficacious DMTs and interferons. The absence of alternative treatments in SPMS supports the use of new products (siponimod and others); however the decision to initiate siponimod therapy in more severe patients (EDSS score of 7 or higher) should be individualized in consultation with the payers. The focus should be on early treatment initiation to delay disease progression.
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Affiliation(s)
- Alexey Boyko
- Department of Neurology, Neurosurgery and Medical Genetics, Pirogov's Russian National Research Medical University, Moscow, Russian Federation; Department of Neuropharmacology, Federal Center of Brain and Neurotechnology, Moscow, Russian Federation.
| | | | - Dana Horakova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine Charles University and General University Hospital in Prague, Czech Republic
| | - Jarmila Szilasiová
- Department of Neurology, Faculty of Medicine, P. J. Safarik University, Kosice, Slovakia
| | - Jolanta Kalniņa
- Centre of Multiple Sclerosis, Latvian Maritime Medicine Centre, Rīga, Latvija
| | | | - Katrin Gross-Paju
- West-Tallinn Central Hospital Centre for Neurological Diseases, Tallinn, Estonia; TalTech, Tallinn, Estonia
| | - Krzysztof Selmaj
- Center for Neurology, Lodz, Poland; Collegium Medicum, Department of Neurology, University of Warmia and Mazury, Olsztyn, Poland
| | - Ieva Sereike
- Centre of Neurology, Vilnius University, Vilnius, Lithuania
| | - Ron Milo
- Department of Neurology, Barzilai Medical Center, Ashkelon, Faculty of Health Sciences, Ben-Gurion University of the Negev, Israel
| | - Tereza Gabelić
- Department of Neurology, Referral Center for Autonomic Nervous System Disorders, University Hospital Center Zagreb, Zagreb, Croatia; School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Uroš Rot
- Department of Neurology University Medical Center Ljubljana, Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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Brune S, Høgestøl EA, Cengija V, Berg-Hansen P, Sowa P, Nygaard GO, Harbo HF, Beyer MK. LesionQuant for Assessment of MRI in Multiple Sclerosis-A Promising Supplement to the Visual Scan Inspection. Front Neurol 2020; 11:546744. [PMID: 33362682 PMCID: PMC7759639 DOI: 10.3389/fneur.2020.546744] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 11/23/2020] [Indexed: 11/17/2022] Open
Abstract
Background and Goals: Multiple sclerosis (MS) is a central nervous system inflammatory disease where magnetic resonance imaging (MRI) is an important tool for diagnosis and disease monitoring. Quantitative measurements of lesion volume, lesion count, distribution of lesions, and brain atrophy have a potentially significant value for evaluating disease progression. We hypothesize that utilizing software designed for evaluating MRI data in MS will provide more accurate and detailed analyses compared to the visual neuro-radiological evaluation. Methods: A group of 56 MS patients (mean age 35 years, 70% females and 96% relapsing-remitting MS) was examined with brain MRI one and 5 years after diagnosis. The T1 and FLAIR brain MRI sequences for all patients were analyzed using the LesionQuant (LQ) software. These data were compared with data from structured visual evaluations of the MRI scans performed by neuro-radiologists, including assessments of atrophy, and lesion count. The data from LQ were also compared with data from other validated research methods for brain segmentation, including assessments of whole brain volume and lesion volume. Correlations with clinical tests like the timed 25-foot walk test (T25FT) were performed to explore additional value of LQ analyses. Results: Lesion count assessments by LQ and by the neuro-radiologist were significantly correlated one year (cor = 0.92, p = 2.2 × 10−16) and 5 years (cor = 0.84, p = 2.7 × 10−16) after diagnosis. Analyzes of the intra- and interrater variability also correlated significantly (cor = 0.96, p < 0.001, cor = 0.97, p < 0.001). Significant positive correlation was found between lesion volume measured by LQ and by the software Cascade (cor = 0.7, p < 0.001. LQ detected a reduction in whole brain percentile >10 in 10 patients across the time-points, whereas the neuro-radiologist assessment identified six of these. The neuro-radiologist additionally identified five patients with increased atrophy in the follow-up period, all of them displayed decreasing low whole brain percentiles (median 11, range 8–28) in the LQ analysis. Significant positive correlation was identified between lesion volume measured by LQ and test performance on the T25FT both at 1 and 5 years after diagnosis. Conclusion: For the number of MS lesions at both time-points, we demonstrated strong correlations between the assessments done by LQ and the neuro-radiologist. Lesion volume evaluated with LQ correlated with T25FT performance. LQ-analyses classified more patients to have brain atrophy than the visual neuro-radiological evaluation. In conclusion, LQ seems like a promising supplement to the evaluation performed by neuro-radiologists, providing an automated tool for evaluating lesions in MS patients and also detecting early signs of atrophy in both a longitudinal and cross-sectional setting.
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Affiliation(s)
- Synne Brune
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - Einar A Høgestøl
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - Vanja Cengija
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Pål Berg-Hansen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - Piotr Sowa
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Gro O Nygaard
- Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - Hanne F Harbo
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - Mona K Beyer
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
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Schiffmann I, Freund M, Vettorazzi E, Stellmann JP, Heyer-Borchelt S, D'Hooghe M, Häußler V, Rahn AC, Heesen C. Assessing the effect of an evidence-based patient online educational tool for people with multiple sclerosis called UMIMS-understanding magnetic resonance imaging in multiple sclerosis: study protocol for a double-blind, randomized controlled trial. Trials 2020; 21:1008. [PMID: 33298133 PMCID: PMC7724874 DOI: 10.1186/s13063-020-04855-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Accepted: 11/01/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND While magnetic resonance imaging (MRI) plays a major role in the lives of people with multiple sclerosis (pwMS), studies have shown that MRI-specific knowledge in pwMS is limited. Moreover, poor knowledge was associated with negative feelings towards MRI (e.g. anxiety concerning MRI scan). Because information sources about MRI in MS for pwMS are not available, we designed and evaluated an evidence-based online educational platform about MRI in MS called "Understanding MRI in MS" (UMIMS). Based on a pilot study in n= 79 subjects, an educational intervention was found to be feasible and effective. We hypothesize that MRI-specific knowledge can be increased by using UMIMS and that, subsequently, negative feelings towards MRI will be reduced and shared decision-making competences increased. METHODS This randomized, controlled, double-blinded trial (RCT) will recruit n = 120 pwMS. The intervention group will receive access to UMIMS. The control group will get access to a specifically developed control website, which visually imitates UMIMS and contains the standard information available by several MS self-help organizations. The change in MRI-specific knowledge assessed via the MRI-risk knowledge questionnaire (MRI-RIKNO) after the intervention is the primary endpoint at 2 weeks. Several secondary endpoints will be assessed at different timepoints throughout the study, e.g. emotions towards MRI, autonomy preferences, threat by MS and shared decision-making competences. The study includes a process evaluation. DISCUSSION The aim of this RCT is to prove that access to an education tool on MRI in MS will increase pwMS' MRI-specific knowledge and enhance shared decision-making when discussing decisions involving MRI results during patient-physician encounters. TRIAL REGISTRATION Clinicaltrials.gov NCT03872583 . Registered on 13 March 2019.
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Affiliation(s)
- Insa Schiffmann
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Centre Hamburg-Eppendorf (UKE), Hamburg, Germany.
- Department of Neurology, University Medical Centre Hamburg-Eppendorf (UKE), Hamburg, Germany.
| | - Magalie Freund
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Centre Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Eik Vettorazzi
- Department of Medical Biometry and Epidemiology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Jan-Patrick Stellmann
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Centre Hamburg-Eppendorf (UKE), Hamburg, Germany
- Department of Neurology, University Medical Centre Hamburg-Eppendorf (UKE), Hamburg, Germany
- APHM, Hopital de la Timone, CEMEREM, Marseille, France
- Aix Marseille Université, CNRS, CRMBM, UMR 7339, Marseille, France
| | - Susanne Heyer-Borchelt
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Centre Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Marie D'Hooghe
- Centre for Neurosciences, Vrije Universiteit Brussel, Brussels, Belgium
- National MS Centre Melsbroek, Melsbroek, Belgium
| | - Vivien Häußler
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Centre Hamburg-Eppendorf (UKE), Hamburg, Germany
- Department of Neurology, University Medical Centre Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Anne Christin Rahn
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Centre Hamburg-Eppendorf (UKE), Hamburg, Germany
- Department of Health Services Research, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Christoph Heesen
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Centre Hamburg-Eppendorf (UKE), Hamburg, Germany
- Department of Neurology, University Medical Centre Hamburg-Eppendorf (UKE), Hamburg, Germany
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Houtchens M, Bove R, Healy B, Houtchens S, Kaplan TB, Mahlanza T, Chitnis T, Bakshi R. MRI activity in MS and completed pregnancy: Data from a tertiary academic center. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2020; 7:7/6/e890. [PMID: 32917773 PMCID: PMC7643615 DOI: 10.1212/nxi.0000000000000890] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 08/19/2020] [Indexed: 12/12/2022]
Abstract
Objective To evaluate postpartum MRI activity in patients with MS and a completed
pregnancy and to compare these results to an age-matched untreated
nonpregnant MS cohort. Methods Patient with MS from a tertiary care MS center between 2006 and 2015, with
prepartum and postpartum neurologic follow-ups and MRI scans were analyzed.
Clinical activity and inflammatory brain MRI activity (new T2-hyperintense
or gadolinium-enhancing [Gd+] lesions) were assessed peripartum. The
results were compared with untreated reproductive-age patients with MS from
the placebo arm of the clinical trials. Results A total of 123 pregnancies in 123 women (median Expanded Disability Status
Scale 1.0) were analyzed. Approximately 7.2% relapsed during pregnancy and
48.7% relapsed postpartum. Of pregnancies with prepartum and postpartum
gadolinium (Gd)-enhanced MRI (n = 112), 8% had Gd+ lesions
prepartum and 33% had new Gd+ lesions postpartum. Overall, 54.4% had
either new T2 or Gd+ lesions postpartum. Seventy-nine percent of
subjects with postpartum relapse had new MRI activity compared with 37.1%
without relapse (p < 0.001). Twenty-five percent had
both clinical and radiographic activity and only 24.9% maintained no
evidence of disease activity status postpartum. There was no association
between postpartum MRI activity and disease-modifying treatments (DMTs)
(p > 0.5). MRI and clinical outcomes were also
assessed for 126 nonpregnant untreated female patients with MS. Comparing
pregnancy and no pregnancy groups, there was no difference in MRI activity
at follow-up. Conclusions There was a high level of inflammatory radiographic disease activity which
was related to relapses in postpartum patients with MS. Further studies are
needed to determine whether hormonal fluctuations vs extended time off DMTs
may be the underlying cause of our observations.
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Affiliation(s)
- Maria Houtchens
- From the Department of Neurology (M.H., B.H., T.B.K., T.M., T.C., R. Bakshi), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Neurology (R. Bove), School of Medicine, University of California, San Francisco; and National Forensic Cybersecurity Alliance (S.H.), Pittsburgh, PA.
| | - Riley Bove
- From the Department of Neurology (M.H., B.H., T.B.K., T.M., T.C., R. Bakshi), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Neurology (R. Bove), School of Medicine, University of California, San Francisco; and National Forensic Cybersecurity Alliance (S.H.), Pittsburgh, PA
| | - Brian Healy
- From the Department of Neurology (M.H., B.H., T.B.K., T.M., T.C., R. Bakshi), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Neurology (R. Bove), School of Medicine, University of California, San Francisco; and National Forensic Cybersecurity Alliance (S.H.), Pittsburgh, PA
| | - Stepan Houtchens
- From the Department of Neurology (M.H., B.H., T.B.K., T.M., T.C., R. Bakshi), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Neurology (R. Bove), School of Medicine, University of California, San Francisco; and National Forensic Cybersecurity Alliance (S.H.), Pittsburgh, PA
| | - Tamara Bockow Kaplan
- From the Department of Neurology (M.H., B.H., T.B.K., T.M., T.C., R. Bakshi), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Neurology (R. Bove), School of Medicine, University of California, San Francisco; and National Forensic Cybersecurity Alliance (S.H.), Pittsburgh, PA
| | - Tatenda Mahlanza
- From the Department of Neurology (M.H., B.H., T.B.K., T.M., T.C., R. Bakshi), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Neurology (R. Bove), School of Medicine, University of California, San Francisco; and National Forensic Cybersecurity Alliance (S.H.), Pittsburgh, PA
| | - Tanuja Chitnis
- From the Department of Neurology (M.H., B.H., T.B.K., T.M., T.C., R. Bakshi), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Neurology (R. Bove), School of Medicine, University of California, San Francisco; and National Forensic Cybersecurity Alliance (S.H.), Pittsburgh, PA
| | - Rohit Bakshi
- From the Department of Neurology (M.H., B.H., T.B.K., T.M., T.C., R. Bakshi), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Neurology (R. Bove), School of Medicine, University of California, San Francisco; and National Forensic Cybersecurity Alliance (S.H.), Pittsburgh, PA
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Plavina T, Singh CM, Sangurdekar D, de Moor C, Engle B, Gafson A, Goyal J, Fisher E, Szak S, Kinkel RP, Sandrock AW, Su R, Kieseier BC, Rudick RA. Association of Serum Neurofilament Light Levels With Long-term Brain Atrophy in Patients With a First Multiple Sclerosis Episode. JAMA Netw Open 2020; 3:e2016278. [PMID: 33151313 PMCID: PMC7645699 DOI: 10.1001/jamanetworkopen.2020.16278] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
IMPORTANCE Data are needed on the potential long-term prognostic association of serum neurofilament light in multiple sclerosis (MS). OBJECTIVE To evaluate serum neurofilament light as a biomarker associated with long-term disease outcomes in clinically isolated syndrome. DESIGN, SETTING, AND PARTICIPANTS This post hoc cohort study used data from the Controlled High-Risk Avonex Multiple Sclerosis Prevention Study, a 36-month, multicenter, placebo-controlled interferon β-1a randomized clinical trial conducted from April 1996 to March 2000, and its long-term (5- and 10-year) extension study from February 2001 to March 2009. Participants included individuals with a symptomatic initial demyelinating event and brain magnetic resonance imaging (MRI) lesions suggestive of MS. Data were analyzed from April 2017 through 2019. EXPOSURE The variable of interest was naturally occurring serum neurofilament light concentration. MAIN OUTCOMES AND MEASURES Gadolinium-enhancing (Gd+) lesion number, T2 lesion volume, and brain parenchymal fraction, a measure of brain atrophy were measured at baseline and 5 and 10 years. Multivariate regression models evaluated whether age, sex, and baseline covariates, including serum neurofilament light, brain parenchymal fraction, Expanded Disability Status Scale, Gd+ lesion count, and T2 lesion volume, were associated with brain parenchymal fraction changes over 5 and 10 years. RESULTS Among 308 included participants (mean [SD] age, 33.2 [7.6] years; 234 [76.0%] women), baseline serum neurofilament light concentrations were associated with Gd+ lesions (Spearman r = 0.41; P < .001) and T2 lesion volume (Spearman r = 0.42; P < .001). Among covariates for brain parenchymal fraction change, serum neurofilament light concentration had the greatest correlation with change in brain parenchymal fraction at 5 years (Spearman r = -0.38; P < .001) and was the only variable associated with brain parenchymal fraction at 10 years (Spearman r = -0.45; P < .001). Participants in the highest vs lowest baseline serum neurofilament light tertiles showed brain parenchymal fraction reduction at 5 years (-1.83% [95% CI, -1.49% to -2.18%] vs -0.95% [95% CI, -0.78% to -1.12%]; P < .001) and 10 years (-3.54% [95% CI, -2.90% to -4.17%] vs -1.90% [95% CI, -1.43% to -2.37%]; P < .001). At 5 years, 6 of 45 participants (13.3%) in the highest neurofilament tertile and 2 of 52 participants (3.8%) in the lowest neurofilament tertile achieved an Expanded Disability Status Scale score of 3.5 or greater. CONCLUSIONS AND RELEVANCE This cohort study found that higher baseline serum neurofilament light levels were associated with increased brain atrophy over 5 and 10 years. These findings suggest that serum neurofilament light could be a biomarker associated with disease severity stratification in early MS and may help to guide intervention.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Revere P. Kinkel
- Department of Neurosciences, University of California, San Diego
| | | | - Ray Su
- Biogen, Cambridge, Massachusetts
| | - Bernd C. Kieseier
- Biogen, Cambridge, Massachusetts
- Department of Neurology, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
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Twose J, Licitra G, McConchie H, Lam KH, Killestein J. Early-warning signals for disease activity in patients diagnosed with multiple sclerosis based on keystroke dynamics. CHAOS (WOODBURY, N.Y.) 2020; 30:113133. [PMID: 33261343 DOI: 10.1063/5.0022031] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 10/21/2020] [Indexed: 06/12/2023]
Abstract
Within data gathered through passive monitoring of patients with Multiple Sclerosis (MS), there is a clear necessity for improved methodological approaches to match the emergence of continuous, objective, measuring technologies. As most gold standards measure infrequently and require clinician presence, fluctuations in the daily progression are not accounted for. Due to the underlying conditions of homogeneity and stationarity (the main tenets of ergodicity) not being met for the majority of the statistical methods employed in the clinical setting, alternative approaches should be investigated. A solution is to use a non-linear time series analysis approach. Here, Early-Warning Signals (EWS) in the form of critical fluctuations in Keystroke Dynamics (KD), collected using participant's smartphones, are investigated as indicators for a clinical change in three groups. These are patients with MS and changes in Magnetic Resonance Imaging (MRI), patients with MS but without changes in MRI, and healthy controls (HCs). Here, we report examples of EWS and changes in KD coinciding with clinically relevant changes in outcome measures in both patients with and without differences in the amount of MRI enhancing lesions. We also report no clinically relevant changes in EWS in the HC population. This study is a first promising step toward using EWS to identify periods of instability as measured by a continuous objective measure as a proxy for outcome measures in the field of MS.
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Affiliation(s)
- J Twose
- Neurocast B.V., Amsterdam 1097DN, The Netherlands
| | - G Licitra
- Neurocast B.V., Amsterdam 1097DN, The Netherlands
| | - H McConchie
- Neurocast B.V., Amsterdam 1097DN, The Netherlands
| | - K H Lam
- Department of Neurology, Amsterdam University Medical Centers, Amsterdam 1105AZ, The Netherlands
| | - J Killestein
- Department of Neurology, Amsterdam University Medical Centers, Amsterdam 1105AZ, The Netherlands
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Korupalli C, Kalluru P, Nuthalapati K, Kuthala N, Thangudu S, Vankayala R. Recent Advances of Polyaniline-Based Biomaterials for Phototherapeutic Treatments of Tumors and Bacterial Infections. Bioengineering (Basel) 2020; 7:E94. [PMID: 32823566 PMCID: PMC7552745 DOI: 10.3390/bioengineering7030094] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 08/05/2020] [Accepted: 08/11/2020] [Indexed: 01/01/2023] Open
Abstract
Conventional treatments fail to completely eradicate tumor or bacterial infections due to their inherent shortcomings. In recent years, photothermal therapy (PTT) has emerged as an attractive treatment modality that relies on the absorption of photothermal agents (PTAs) at a specific wavelength, thereby transforming the excitation light energy into heat. The advantages of PTT are its high efficacy, specificity, and minimal damage to normal tissues. To this end, various inorganic nanomaterials such as gold nanostructures, carbon nanostructures, and transition metal dichalcogenides have been extensively explored for PTT applications. Subsequently, the focus has shifted to the development of polymeric PTAs, owing to their unique properties such as biodegradability, biocompatibility, non-immunogenicity, and low toxicity when compared to inorganic PTAs. Among various organic PTAs, polyaniline (PANI) is one of the best-known and earliest-reported organic PTAs. Hence, in this review, we cover the recent advances and progress of PANI-based biomaterials for PTT application in tumors and bacterial infections. The future prospects in this exciting area are also addressed.
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Affiliation(s)
- Chiranjeevi Korupalli
- Department of Chemical Engineering, National Tsing Hua University, Hsinchu 30013, Taiwan;
| | - Poliraju Kalluru
- Department of Chemistry, University of Calgary, Calgary, AB T2N1N4, Canada;
| | - Karthik Nuthalapati
- Department of Chemistry, National Tsing Hua University, Hsinchu 30013, Taiwan; (K.N.); (N.K.); (S.T.)
| | - Naresh Kuthala
- Department of Chemistry, National Tsing Hua University, Hsinchu 30013, Taiwan; (K.N.); (N.K.); (S.T.)
| | - Suresh Thangudu
- Department of Chemistry, National Tsing Hua University, Hsinchu 30013, Taiwan; (K.N.); (N.K.); (S.T.)
| | - Raviraj Vankayala
- Department of Bioscience and Bioengineering, Indian Institute of Technology Jodhpur, Jodhpur, Rajasthan 342037, India
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Barraza G, Deiva K, Husson B, Adamsbaum C. Imaging in Pediatric Multiple Sclerosis : An Iconographic Review. Clin Neuroradiol 2020; 31:61-71. [PMID: 32676699 DOI: 10.1007/s00062-020-00929-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 06/20/2020] [Indexed: 11/29/2022]
Abstract
Pediatric-onset multiple sclerosis (POMS) is defined by a first multiple sclerosis (MS) attack occurring before 18 years old and is diagnosed by demonstration of dissemination in time (DIT) and space (DIS). Although guidelines evolved over the years, they always recognized the importance of magnetic resonance imaging (MRI) for diagnosis. The 2017 McDonald criteria are increasingly used and have been validated in several cohorts. The use of MRI is the most important tool for the early diagnosis, monitoring, and assessment of treatment response of MS and standard protocols include precontrast and postcontrast T1, T2, fluid attenuation inversion recovery (FLAIR) and diffusion sequences. A distinctive MS lesion compromises white matter and it is well-demarcated and confluent, showing demyelination, inflammation, gliosis, and relative axonal preservation. Considering the growing recognition of pediatric MS as a differential diagnosis for children presenting with a clinical central nervous system event, we present a POMS lesions guide (periventricular, juxtacortical, infratentorial, spinal cord, cortical, tumefactive, black hole, contrast-enhanced). Owing to its rareness, POMS is a diagnosis by exclusion and MRI plays a fundamental role in distinguishing POMS from other demyelinating and non-demyelinating conditions. Three main groups of disorders can mimic POMS: inflammatory, metabolic and tumoral; however, imaging patterns earlier described lower the possibilities of alternative diagnoses and strongly suggest POMS when likely.
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Affiliation(s)
- Gonzalo Barraza
- Pediatric Radiology Department, Hôpitaux Universitaires Paris-Sud, Bicêtre AP-HP, 94270, Le Kremlin-Bicêtre, France.
| | - Kumaran Deiva
- Pediatric Neurology Department, Hôpitaux Universitaires Paris-Sud, Bicêtre AP-HP, 94270, Le Kremlin-Bicêtre, France.,Inserm UMR1184 "Immunology of viral infections and autoimmune diseases", CEA, IDMIT, Faculty of Medicine, Paris-Sud University, 94270, Le Kremlin-Bicêtre, France
| | - Béatrice Husson
- Pediatric Radiology Department, Hôpitaux Universitaires Paris-Sud, Bicêtre AP-HP, 94270, Le Kremlin-Bicêtre, France.,Pediatric stroke National Reference Center, Hôpitaux Universitaires Paris-Sud, Bicêtre AP-HP, 94270, Le Kremlin-Bicêtre, France
| | - Catherine Adamsbaum
- Pediatric Radiology Department, Hôpitaux Universitaires Paris-Sud, Bicêtre AP-HP, 94270, Le Kremlin-Bicêtre, France.,Faculty of Medicine, Paris-Sud University, 94270, Le Kremlin-Bicêtre, France
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48
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Abstract
Multiple sclerosis (MS) is an aggravating autoimmune disease that cripples young patients slowly with physical, sensory and cognitive deficits. The break of self-tolerance to neuronal antigens is the key to the pathogenesis of MS, with autoreactive T cells causing demyelination that subsequently leads to inflammation-mediated neurodegenerative events in the central nervous system. The exact etiology of MS remains elusive; however, the interplay of genetic and environmental factors contributes to disease development and progression. Given that genetic variation only accounts for a fraction of risk for MS, extrinsic risk factors including smoking, infection and lack of vitamin D or sunshine, which cause changes in gene expression, contribute to disease development through epigenetic regulation. To date, there is a growing body of scientific evidence to support the important roles of epigenetic processes in MS. In this chapter, the three main layers of epigenetic regulatory mechanisms, namely DNA methylation, histone modification and microRNA-mediated gene regulation, will be discussed, with a particular focus on the role of epigenetics on dysregulated immune responses and neurodegenerative events in MS. Also, the potential for epigenetic modifiers as biomarkers and therapeutics for MS will be reviewed.
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Affiliation(s)
- Vera Sau-Fong Chan
- Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.
- Queen Mary Hospital, Hong Kong SAR, China.
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49
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Senousy MA, Shaker OG, Sayed NH, Fathy N, Kortam MA. LncRNA GAS5 and miR-137 Polymorphisms and Expression are Associated with Multiple Sclerosis Risk: Mechanistic Insights and Potential Clinical Impact. ACS Chem Neurosci 2020; 11:1651-1660. [PMID: 32348112 DOI: 10.1021/acschemneuro.0c00150] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The pathogenesis of multiple sclerosis (MS) is influenced by the interaction of genetic and epigenetic mechanisms. The long noncoding RNA GAS5 acts as a competing endogenous RNA for microRNA-137 and is involved in demyelination. We investigated the association of GAS5 and miR-137 expression and their polymorphisms with MS susceptibility. One hundred and eight MS patients and 104 healthy controls were included. Expression analysis and genotyping of GAS5-rs2067079 and miR-137-rs1625579 single nucleotide polymorphisms were performed by qPCR. Serum GAS5 was upregulated, while serum miR-137 was downregulated in MS compared with the controls. Serum miR-137 was an excellent discriminator of MS patients from the controls (AUC = 0.97) and a negative independent predictor of MS in multivariate logistic analysis. Serum GAS5 expression was positively correlated with the expanded disability status scale scores in the relapsing-remitting MS patients. The rs2067079TT minor homozygote genotype was associated with an increased MS risk, while the rs1625579G minor allele was protective. rs1625579 showed an age-specific effect, while the rs2067079 affected the MS risk in gender- and age-specific manners. In MS patients, rs2067079TT was associated with a higher serum GAS5 than other genotypes, while serum miR-137 did not differ between rs1625579 genotypes. Our results suggest serum GAS5 and miR-137 as MS biomarkers, with miR-137 as a negative predictor of MS risk and GAS5 as a marker of MS severity. We propose rs2067079 and rs1625579 as novel genetic markers of MS susceptibility, and at least, rs2067079 possibly impacts the crosstalk between GAS5 and miR-137.
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Affiliation(s)
- Mahmoud A. Senousy
- Biochemistry Department, Faculty of Pharmacy, Cairo University, Cairo 11562, Egypt
| | - Olfat G. Shaker
- Medical Biochemistry and Molecular Biology Department, Faculty of Medicine, Cairo University, Cairo 11562, Egypt
| | - Noha H. Sayed
- Biochemistry Department, Faculty of Pharmacy, Cairo University, Cairo 11562, Egypt
| | - Nevine Fathy
- Biochemistry Department, Faculty of Pharmacy, Cairo University, Cairo 11562, Egypt
| | - Mona A. Kortam
- Biochemistry Department, Faculty of Pharmacy, Cairo University, Cairo 11562, Egypt
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50
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Fooladi M, Riyahi Alam N, Sharini H, Firouznia K, Shakiba M, Harirchian M. Multiparametric qMTI Assessment and Monitoring of Normal Appearing White Matter and Classified T1 Hypointense Lesions in Relapsing-Remitting Multiple Sclerosis. Ing Rech Biomed 2020. [DOI: 10.1016/j.irbm.2020.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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