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Secker S, Holmes H, Warren D, Avula S, Bhattacharya D, Choi S, Likeman M, Liu A, Mitra D, Oates A, Pearce K, Wheeler M, Mankad K, Batty R. Review of standard paediatric neuroradiology MRI protocols from 12 UK tertiary paediatric hospitals: is there much variation between centres? Clin Radiol 2023; 78:e941-e949. [PMID: 37788968 DOI: 10.1016/j.crad.2023.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 08/12/2023] [Accepted: 08/21/2023] [Indexed: 10/05/2023]
Abstract
AIM To investigate how magnetic resonance imaging (MRI) examinations are protocolled in tertiary paediatric neuroradiology centres around the UK for some of the more common presentations encountered in paediatric neuroradiology, and to identify any variations of note. MATERIALS AND METHODS All 19 UK tertiary paediatric neuroradiology centres registered with the British Society of Neuroradiologists-Paediatric Group were contacted and asked if they could provide a copy of their standard MRI protocols. Twelve responded (63%) and 10 of the more common presentations were selected and the standard acquired sequences obtained at each participating centre were compared. Where available the collated protocols were also compared against current published guidance. RESULTS The basic sequences carried out by centres around the UK are similar; however, there are lots of variations overall. The only standardised protocol currently being implemented nationally in paediatric imaging is that for brain tumours. Otherwise, chosen protocols are generally dependent on the preferences and technical capabilities of individual centres. Suggested published protocols also exist for non-accidental injury (NAI), multiple sclerosis, epilepsy, and head and neck imaging. CONCLUSIONS The differences in MRI protocolling depend in part on technical capabilities and in part on the experience and preferences of the paediatric neuroradiologists at each centre. For most presentations, there is no consensus as to what constitutes the perfect protocol. The present results will be useful for specialist centres who may wish to review their current protocols, and for more generalist centres to use as a reference to guide their MRI protocolling.
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Affiliation(s)
- S Secker
- Neuroradiology, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Broomhall, Sheffield, UK.
| | - H Holmes
- Neuroradiology, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Broomhall, Sheffield, UK
| | - D Warren
- Neuroradiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - S Avula
- Radiology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - D Bhattacharya
- Neuroradiology, The Royal Belfast Hospital for Sick Children, Belfast, UK
| | - S Choi
- Radiology, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - M Likeman
- Neuroradiology, Bristol Children's Hospital, Bristol, UK
| | - A Liu
- University Hospital of Wales, Cardiff, UK
| | - D Mitra
- Neuroradiology, Great North Children's Hospital, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP, UK
| | - A Oates
- Radiology, Birmingham Children's Hospital, Birmingham Women's and Children's NHS Trust, Birmingham, UK
| | - K Pearce
- Neuroradiology, University Hospitals Plymouth NHS Trust, Plymouth, Devon, UK
| | - M Wheeler
- University Hospital of Wales, Cardiff, UK
| | - K Mankad
- Neuroradiology, Great Ormond Street Hospital, London, UK
| | - R Batty
- Neuroradiology, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Broomhall, Sheffield, UK
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Adoum A, Mazzolo L, Lecler A, Sadik JC, Savatovsky J, Duron L. Co-registration with subtraction and color-coding or fusion improves the detection of new and growing lesions on follow-up MRI examination of patients with multiple sclerosis. Diagn Interv Imaging 2023:S2211-5684(23)00117-1. [PMID: 37290977 DOI: 10.1016/j.diii.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/15/2023] [Accepted: 05/23/2023] [Indexed: 06/10/2023]
Abstract
PURPOSE The purpose of this study was to compare the performance of three magnetic resonance imaging (MRI) reading methods in the follow-up of patients with multiple sclerosis (MS). MATERIALS AND METHODS This retrospective study included patients with MS who underwent two brain follow-up MRI examinations with three-dimensional fluid-attenuated inversion recovery (FLAIR) sequences between September 2016 and December 2019. Two neuroradiology residents independently reviewed FLAIR images using three post-processing methods including conventional reading (CR), co-registration fusion (CF), and co-registration subtraction with color-coding (CS), while being blinded to all data but FLAIR images. The presence and number of new, growing, or shrinking lesions were compared between reading methods. The reading time, reading confidence, and inter- and intra-observer agreements were also assessed. An expert neuroradiologist established the standard of reference. Statistical analyses were corrected for multiple testing. RESULTS A total of 198 patients with MS were included. There were 130 women and 68 men, with a mean age of 41 ± 12 (standard deviation) years (age range: 21-79 years). Using CS and CF, more patients were detected with new lesions compared to CR (93/198 [47%] and 79/198 [40%] vs. 54/198 [27%], respectively; P < 0.01). The median number of new hyperintense FLAIR lesions detected was significantly greater using CS and CF compared to CR (2 [Q1, Q3: 0, 6] and 1 [Q1, Q3: 0, 3] vs. 0 [Q1, Q3: 0, 1], respectively; P < 0.001). The mean reading time was significantly shorter using CS and CF compared to CR (P < 0.001), with higher confidence in readings and higher inter- and intra-observer agreements. CONCLUSION Post-processing tools such as CS and CF substantially improve the accuracy of follow-up MRI examinations in patients with MS while reducing reading time and increasing readers' confidence and reproducibility.
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Affiliation(s)
- Akim Adoum
- Department of Neuroradiology, Hôpital Fondation Adolphe de Rothschild, 25 rue Manin, 75019 Paris, France
| | - Leila Mazzolo
- Department of Neuroradiology, Hôpital Fondation Adolphe de Rothschild, 25 rue Manin, 75019 Paris, France
| | - Augustin Lecler
- Department of Neuroradiology, Hôpital Fondation Adolphe de Rothschild, 25 rue Manin, 75019 Paris, France; Université Paris Cité, 75006 Paris, France
| | - Jean-Claude Sadik
- Department of Neuroradiology, Hôpital Fondation Adolphe de Rothschild, 25 rue Manin, 75019 Paris, France
| | - Julien Savatovsky
- Department of Neuroradiology, Hôpital Fondation Adolphe de Rothschild, 25 rue Manin, 75019 Paris, France
| | - Loïc Duron
- Department of Neuroradiology, Hôpital Fondation Adolphe de Rothschild, 25 rue Manin, 75019 Paris, France.
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Lecler A. Revolutionizing MS Monitoring: The Impact of Postprocessing Techniques on Lesion Detection. AJNR Am J Neuroradiol 2023; 44:656-657. [PMID: 37169539 PMCID: PMC10249689 DOI: 10.3174/ajnr.a7868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Affiliation(s)
- A Lecler
- Department of NeuroradiologyAdolphe de Rothschild Foundation HospitalParis, FranceUniversity of ParisParis, France
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4
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de Panafieu A, Lecler A, Goujon A, Krystal S, Gueguen A, Sadik JC, Savatovsky J, Duron L. Contrast-Enhanced 3D Spin Echo T1-Weighted Sequence Outperforms 3D Gradient Echo T1-Weighted Sequence for the Detection of Multiple Sclerosis Lesions on 3.0 T Brain MRI. Invest Radiol 2023; 58:314-319. [PMID: 36729811 DOI: 10.1097/rli.0000000000000937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Using reliable contrast-enhanced T1 sequences is crucial to detect enhancing brain lesions for multiple sclerosis (MS) at the time of diagnosis and over follow-up. Contrast-enhanced 3D gradient-recalled echo (GRE) T1-weighted imaging (WI) and 3D turbo spin echo (TSE) T1-WI are both available for clinical practice and have never been compared within the context of this diagnosis. PURPOSE The aim of this study was to compare contrast-enhanced 3D GRE T1-WI and 3D TSE T1-WI for the detection of enhancing lesions in the brains of MS patients. METHODS This single-center prospective study enrolled patients with MS who underwent a 3.0 T brain MRI from August 2017 to April 2021 for follow-up. Contrast-enhanced 3D GRE T1-WI and 3D TSE T1-WI were acquired in randomized order. Two independent radiologists blinded to all data reported all contrast-enhanced lesions in each sequence. Their readings were compared with a reference standard established by a third expert neuroradiologist. Interobserver agreement, contrast ratio, and contrast-to-noise ratio were calculated for both sequences. RESULTS A total of 158 MS patients were included (mean age, 40 ± 11 years; 95 women). Significantly more patients had at least 1 contrast-enhanced lesion on 3D TSE T1-WI than on 3D GRE T1-WI for both readers (61/158 [38.6%] vs 48/158 [30.4%] and 60/158 [38.6%] vs 47/158 [29.7%], P < 0.001). Significantly more contrast-enhanced lesions per patient were detected on 3D TSE T1-WI (mean 2.47 vs 1.56 and 2.56 vs 1.39, respectively, P < 0.001). Interobserver agreement was excellent for both sequences, κ = 0.96 (confidence interval [CI], 0.91-1.00) for 3D TSE T1-WI and 0.92 (CI, 0.86-0.99) for 3D GRE T1-WI. Contrast ratio and contrast-to-noise ratio were significantly higher on 3D TSE T1-WI (0.84 vs 0.53, P < 0.001, and 87.9 vs 57.8, P = 0.03, respectively). CONCLUSIONS At 3.0 T, contrast-enhanced 3D TSE-T1-WI supports the detection of significantly more enhancing lesions than 3D GRE T1-WI and should therefore be used for MS patients requiring contrast-enhanced examination.
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Affiliation(s)
| | - Augustin Lecler
- From the Department of Neuroradiology, Hôpital Fondation Adolphe de Rothschild
| | - Adrien Goujon
- From the Department of Neuroradiology, Hôpital Fondation Adolphe de Rothschild
| | - Sidney Krystal
- From the Department of Neuroradiology, Hôpital Fondation Adolphe de Rothschild
| | - Antoine Gueguen
- From the Department of Neuroradiology, Hôpital Fondation Adolphe de Rothschild
| | - Jean-Claude Sadik
- From the Department of Neuroradiology, Hôpital Fondation Adolphe de Rothschild
| | - Julien Savatovsky
- From the Department of Neuroradiology, Hôpital Fondation Adolphe de Rothschild
| | - Loïc Duron
- From the Department of Neuroradiology, Hôpital Fondation Adolphe de Rothschild
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5
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Garjani A, Liu BJY, Allen CM, Gunzler DD, Gerry SW, Planchon SM, das Nair R, Chataway J, Tallantyre EC, Ontaneda D, Evangelou N. Decentralised clinical trials in multiple sclerosis research. Mult Scler 2023; 29:317-325. [PMID: 35735014 PMCID: PMC9972228 DOI: 10.1177/13524585221100401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Randomised controlled trials (RCTs) play an important role in multiple sclerosis (MS) research, ensuring that new interventions are safe and efficacious before their introduction into clinical practice. Trials have been evolving to improve the robustness of their designs and the efficiency of their conduct. Advances in digital and mobile technologies in recent years have facilitated this process and the first RCTs with decentralised elements became possible. Decentralised clinical trials (DCTs) are conducted remotely, enabling participation of a more heterogeneous population who can participate in research activities from different locations and at their convenience. DCTs also rely on digital and mobile technologies which allows for more flexible and frequent assessments. While hospitals quickly adapted to e-health and telehealth assessments during the COVID-19 pandemic, the conduct of conventional RCTs was profoundly disrupted. In this paper, we review the existing evidence and gaps in knowledge in the design and conduct of DCTs in MS.
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Affiliation(s)
- Afagh Garjani
- Mental Health and Clinical Neurosciences
Academic Unit, School of Medicine, University of Nottingham, Nottingham,
UK/Academic Neurology, Nottingham University Hospitals NHS Trust,
Nottingham, UK
| | | | - Christopher Martin Allen
- Mental Health and Clinical Neurosciences
Academic Unit, School of Medicine, University of Nottingham, Nottingham,
UK/Academic Neurology, Nottingham University Hospitals NHS Trust,
Nottingham, UK
| | | | - Stephen William Gerry
- Centre for Statistics in Medicine, Nuffield
Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences,
University of Oxford, Oxford, UK
| | | | - Roshan das Nair
- Mental Health and Clinical Neurosciences
Academic Unit, School of Medicine, University of Nottingham, Nottingham,
UK/Institute of Mental Health, Nottinghamshire Healthcare NHS Foundation
Trust, Nottingham, UK
| | - Jeremy Chataway
- Queen Square Multiple Sclerosis Centre,
Department of Neuroinflammation, UCL Queen Square Institute of Neurology,
Faculty of Brain Sciences, University College London, London, UK/National
Institute for Health Research, University College London Hospitals
Biomedical Research Centre, London, UK/MRC CTU at UCL, Institute of Clinical
Trials and Methodology, University College London, London, UK
| | - Emma C Tallantyre
- Helen Durham Neuro-Inflammatory Unit,
University Hospital of Wales, Cardiff, UK/Division of Psychological Medicine
and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - Daniel Ontaneda
- Mellen Center for Multiple Sclerosis,
Cleveland Clinic, Cleveland, OH, USA
| | - Nikos Evangelou
- N Evangelou Academic Neurology, Nottingham
University Hospitals NHS Trust, C Floor, South Block, Queen’s Medical Centre,
Nottingham NG7 2UH, UK. ;
@nikosevangelou3
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6
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Fominykh V, Averchenkov D, Volik A, Popova E, Bryukhov V, Nazarov V, Moshnikova A, Arzumanian N, Tatarenko A, Nechaev V, Manuylova O, Lapin S, Brylev L, Guekht A. Levamisole-associated multifocal inflammatory encephalopathy: clinical and MRI characteristics, and diagnostic algorithm. Mult Scler Relat Disord 2023; 69:104418. [PMID: 36450175 DOI: 10.1016/j.msard.2022.104418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 11/12/2022] [Accepted: 11/15/2022] [Indexed: 11/18/2022]
Abstract
Levamisole-associated multifocal inflammatory encephalopathy (LAMIE) is a devastating adverse effect of levamisole (LEV) treatment. In Russia, people often use LEV without a doctor's prescription for anthelmintic prophylaxis. LAMIE often misdiagnosed as the first episode of MS or acute disseminated encephalomyelitis (ADEM). The aim of our study was to describe clinical, laboratory and morphological characteristics of LAMIE, magnetic resonance imaging (MRI) patterns and create an algorithm for the differential diagnosis. This study was a prospective observational study with retrospective analysis of cases. It was performed at two hospitals with ambulatory service for MS. We included 43 patients with LAMIE with follow-up was from 1 year to 5 years. Age was 19-68 y.o. with female predominance. The most typical manifestations of LAMIE were cerebellar, pyramidal and cognitive symptoms, and majority of patients had biphasic course of the disease. Three main types of MRI patterns were described: ADEM-like, MS-like, atypical demyelination. About 40% of patients had CSF specific oligoclonal bands synthesis, but only 20 % of them converted to MS during the period from 1 month until 2 years. The CSF albumin levels and immunoglobulin G index were elevated in LAMIE patients compared to reference values. We described results of brain biopsy in two cases. Therefore LAMIE should be considered in patients with demyelinating or inflammatory conditions with biphasic onset of the disease and variable MRI presentation.
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Affiliation(s)
- V Fominykh
- Institute of Higher Nervous Activity and Neurophysiology, Butlerova street 5a, Moscow 117485, Russia.
| | - D Averchenkov
- Bujanov Moscow City Clinical Hospital, Moscow, Russia
| | - A Volik
- Institute of Higher Nervous Activity and Neurophysiology, Butlerova street 5a, Moscow 117485, Russia; Federal State Budget Educational Institution of Higher Education M.V.Lomonosov Moscow State University, Moscow, Russia
| | - E Popova
- City Clinical Hospital № 24, Moscow, Russia
| | - V Bryukhov
- Research Center of Neurology, Moscow, Russia
| | - V Nazarov
- Research Center of Neurology, Moscow, Russia; Pavlov First Saint Petersburg Medical University, Saint Petersburg, Russia
| | - A Moshnikova
- Pavlov First Saint Petersburg Medical University, Saint Petersburg, Russia
| | - N Arzumanian
- Bujanov Moscow City Clinical Hospital, Moscow, Russia
| | - A Tatarenko
- Bujanov Moscow City Clinical Hospital, Moscow, Russia
| | - V Nechaev
- Bujanov Moscow City Clinical Hospital, Moscow, Russia
| | - O Manuylova
- Bujanov Moscow City Clinical Hospital, Moscow, Russia
| | - S Lapin
- Pavlov First Saint Petersburg Medical University, Saint Petersburg, Russia
| | - L Brylev
- Institute of Higher Nervous Activity and Neurophysiology, Butlerova street 5a, Moscow 117485, Russia; Bujanov Moscow City Clinical Hospital, Moscow, Russia; Moscow Research and Clinical Center for Neuropsychiatry, Moscow Healthcare Department, Russia
| | - A Guekht
- Moscow Research and Clinical Center for Neuropsychiatry, Moscow Healthcare Department, Russia; Pirogov Russian National Research Medical University, Moscow, Russia
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7
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Mattay RR, Davtyan K, Rudie JD, Mattay GS, Jacobs DA, Schindler M, Loevner LA, Schnall MD, Bilello M, Mamourian AC, Cook TS. Economic impact of selective use of contrast for routine follow-up MRI of patients with multiple sclerosis. J Neuroimaging 2022; 32:656-666. [PMID: 35294074 DOI: 10.1111/jon.12984] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 02/19/2022] [Accepted: 02/22/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND AND PURPOSE Imaging and autopsy studies show intracranial gadolinium deposition in patients who have undergone serial contrast-enhanced MRIs. This observation has raised concerns when using contrast administration in patients who receive frequent MRIs. To address this, we implemented a contrast-conditional protocol wherein gadolinium is administered only for multiple sclerosis (MS) patients with imaging evidence of new disease activity on precontrast imaging. In this study, we explore the economic impact of our new MRI protocol. METHODS We compared scanner time and Medicare reimbursement using our contrast-conditional methodology versus that of prior protocols where all patients received gadolinium. RESULTS For 422 patients over 4 months, the contrast-conditional protocol amounted to 60% decrease in contrast injection and savings of approximately 20% of MRI scanner time. If the extra scanner time was used for performing MS follow-up MRIs in additional patients, the contrast-conditional protocol would amount to net revenue loss of $21,707 (∼3.7%). CONCLUSIONS Implementation of a new protocol to limit contrast in MS follow-up MRIs led to a minimal decrease in revenue when controlled for scanner time utilized and is outweighed by other benefits, including substantial decreased gadolinium administration, increased patient comfort, and increased availability of scanner time, which depending on type of studies performed could result in additional financial benefit.
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Affiliation(s)
- Raghav R Mattay
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Karapet Davtyan
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jeffrey D Rudie
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
| | - Govind S Mattay
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Dina A Jacobs
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Matthew Schindler
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Laurie A Loevner
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mitchell D Schnall
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Michel Bilello
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Alexander C Mamourian
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Radiology, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Tessa S Cook
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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8
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Karimian-Jazi K, Neuberger U, Schregel K, Brugnara G, Bendszus M, Breckwoldt MO, Schwarz D, Jäger LB, Wick W. Diagnostic value of gadolinium contrast administration for spinal cord magnetic resonance imaging in multiple sclerosis patients and correlative markers of lesion enhancement. Mult Scler J Exp Transl Clin 2021; 7:20552173211047978. [PMID: 34868625 PMCID: PMC8637714 DOI: 10.1177/20552173211047978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 09/02/2021] [Indexed: 11/17/2022] Open
Abstract
Background Magnetic resonance imaging is essential for monitoring people with multiple
sclerosis, but the diagnostic value of gadolinium contrast administration in
spine magnetic resonance imaging is unclear. Objective To assess the diagnostic value of gadolinium contrast administration in spine
magnetic resonance imaging follow-up examinations and identify imaging
markers correlating with lesion enhancement. Methods A total of 65 multiple sclerosis patients with at least 2 spinal magnetic
resonance imaging follow-up examinations were included. Spine magnetic
resonance imaging was performed at 3 Tesla with a standardized protocol
(sagittal and axial T2-weighted turbo spin echo and T1-weighted
post-contrast sequences). T2 lesion load and enhancing lesions were assessed
by two independent neuroradiologists for lesion size, localization, and T2
signal ratio (T2 signallesion/T2 signalnormal appearing
spinal cord). Results A total of 68 new spinal T2 lesions and 20 new contrast-enhancing lesions
developed during follow-up. All enhancing lesions had a discernable
correlate as a new T2 lesion. Lesion enhancement correlated with a higher T2
signal ratio compared to non-enhancing lesions (T2 signal ratio: 2.0 ± 0.4
vs. 1.4 ± 0.2, ****p < 0.001). Receiver operating
characteristics analysis showed an optimal cutoff value of signal ratio 1.78
to predict lesion enhancement (82% sensitivity and 97% specificity). Conclusion Gadolinium contrast administration is dispensable in follow-up spine magnetic
resonance imaging if no new T2 lesions are present. Probability of
enhancement correlates with the T2 signal ratio.
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Affiliation(s)
- Kianush Karimian-Jazi
- Clinical Cooperation Unit Neurooncology, German Cancer Consortium, German Cancer Research Center, Heidelberg, Germany
| | - Ulf Neuberger
- Clinical Cooperation Unit Neurooncology, German Cancer Consortium, German Cancer Research Center, Heidelberg, Germany
| | - Katharina Schregel
- Clinical Cooperation Unit Neurooncology, German Cancer Consortium, German Cancer Research Center, Heidelberg, Germany
| | - Gianluca Brugnara
- Clinical Cooperation Unit Neurooncology, German Cancer Consortium, German Cancer Research Center, Heidelberg, Germany
| | - Martin Bendszus
- Clinical Cooperation Unit Neurooncology, German Cancer Consortium, German Cancer Research Center, Heidelberg, Germany
| | - Michael O Breckwoldt
- Clinical Cooperation Unit Neurooncology, German Cancer Consortium, German Cancer Research Center, Heidelberg, Germany
| | - Daniel Schwarz
- Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Wolfgang Wick
- Clinical Cooperation Unit Neurooncology, German Cancer Consortium (DKTK) within the German Cancer Research Center (DKFZ), Heidelberg, Germany Neurology Clinic and National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany
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9
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Fernandes L, Allen CM, Williams T, Tallantyre E, Evangelou N, Chataway J, Ford HL. The contemporary role of MRI in the monitoring and management of people with multiple sclerosis in the UK. Mult Scler Relat Disord 2021; 55:103190. [PMID: 34365316 DOI: 10.1016/j.msard.2021.103190] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 07/28/2021] [Accepted: 08/01/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Compare the contemporary use of magnetic resonance imaging (MRI) in the monitoring and management of people with MS in the UK to current consensus guidelines. METHODS This retrospective multicentre audit of clinical practice gathered data on 2567 patients with MS from 25 MS centres across the UK. RESULTS Routine monitoring (44.7%), and recent clinical relapse (20.3%) were the most common scan indications. In routine monitoring, the addition of spinal imaging to brain showed no significant difference in disease modifying treatment (DMT) decision at subsequent clinical review. Approximately 1 in 5 gadolinium administered scans showed enhancement, and in 1 in 20 patients, gadolinium enhancement was the only evidence of radiological disease activity. Mean inter-scan intervals in relapsing-remitting MS for routine monitoring was 19.2 months (SD 20.7) with wide variation between centres. Only 53.8% of patients under progressive multifocal leukoencephalopathy (PML) surveillance met the recommended scanning frequency. MRI protocols demonstrated heterogeneity in the sequences used for diagnostic, monitoring and PML surveillance scans. CONCLUSIONS MS centres across the UK demonstrate varied practice and protocols when using MRI to monitor people with MS. In this cohort, gadolinium use and spinal imaging demonstrates limited impact on subsequent DMT decisions.
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Affiliation(s)
| | | | - Thomas Williams
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
| | | | | | - Jeremy Chataway
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
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10
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Herrmann CJJ, Els A, Boehmert L, Periquito J, Eigentler TW, Millward JM, Waiczies S, Kuchling J, Paul F, Niendorf T. Simultaneous T 2 and T 2 ∗ mapping of multiple sclerosis lesions with radial RARE-EPI. Magn Reson Med 2021; 86:1383-1402. [PMID: 33951214 DOI: 10.1002/mrm.28811] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 03/26/2021] [Accepted: 03/26/2021] [Indexed: 12/26/2022]
Abstract
PURPOSE The characteristic MRI features of multiple sclerosis (MS) lesions make it conceptually appealing to pursue parametric mapping techniques that support simultaneous generation of quantitative maps of 2 or more MR contrast mechanisms. We present a modular rapid acquisition with relaxation enhancement (RARE)-EPI hybrid that facilitates simultaneous T2 and T 2 ∗ mapping (2in1-RARE-EPI). METHODS In 2in1-RARE-EPI the first echoes in the echo train are acquired with a RARE module, later echoes are acquired with an EPI module. To define the fraction of echoes covered by the RARE and EPI module, an error analysis of T2 and T 2 ∗ was conducted with Monte Carlo simulations. Radial k-space (under)sampling was implemented for acceleration (R = 2). The feasibility of 2in1-RARE-EPI for simultaneous T2 and T 2 ∗ mapping was examined in a phantom study mimicking T2 and T 2 ∗ relaxation times of the brain. For validation, 2in1-RARE-EPI was benchmarked versus multi spin-echo (MSE) and multi gradient-echo (MGRE) techniques. The clinical applicability of 2in1-RARE-EPI was demonstrated in healthy subjects and MS patients. RESULTS There was a good agreement between T2 / T 2 ∗ values derived from 2in1-RARE-EPI and T2 / T 2 ∗ reference values obtained from MSE and MGRE in both phantoms and healthy subjects. In patients, MS lesions in T2 and T 2 ∗ maps deduced from 2in1-RARE-EPI could be just as clearly delineated as in reference maps calculated from MSE/MGRE. CONCLUSION This work demonstrates the feasibility of radially (under)sampled 2in1-RARE-EPI for simultaneous T2 and T 2 ∗ mapping in MS patients.
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Affiliation(s)
- Carl J J Herrmann
- Berlin Ultrahigh Field Facility (B.U.F.F.), Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany.,Department of Physics, Humboldt University of Berlin, Berlin, Germany
| | - Antje Els
- Berlin Ultrahigh Field Facility (B.U.F.F.), Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
| | - Laura Boehmert
- Berlin Ultrahigh Field Facility (B.U.F.F.), Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
| | - Joao Periquito
- Berlin Ultrahigh Field Facility (B.U.F.F.), Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
| | - Thomas Wilhelm Eigentler
- Berlin Ultrahigh Field Facility (B.U.F.F.), Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany.,Chair of Medical Engineering, Technical University of Berlin, Berlin, Germany
| | - Jason M Millward
- Berlin Ultrahigh Field Facility (B.U.F.F.), Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
| | - Sonia Waiczies
- Berlin Ultrahigh Field Facility (B.U.F.F.), Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
| | - Joseph Kuchling
- Experimental and Clinical Research Center, a joint cooperation between the Charité Medical Faculty and the Max Delbrück Center for Molecular Medicine, Berlin, Germany.,NeuroCure Clinical Research Center, Charité-Universitätsmedizin, Berlin, Germany.,Department of Neurology, Charité-Universitätsmedizin, Berlin, Germany
| | - Friedemann Paul
- Experimental and Clinical Research Center, a joint cooperation between the Charité Medical Faculty and the Max Delbrück Center for Molecular Medicine, Berlin, Germany.,NeuroCure Clinical Research Center, Charité-Universitätsmedizin, Berlin, Germany.,Department of Neurology, Charité-Universitätsmedizin, Berlin, Germany
| | - Thoralf Niendorf
- Berlin Ultrahigh Field Facility (B.U.F.F.), Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany.,Experimental and Clinical Research Center, a joint cooperation between the Charité Medical Faculty and the Max Delbrück Center for Molecular Medicine, Berlin, Germany
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Abstract
An individualized innovative disease management is of great importance for people with multiple sclerosis (pwMS) to cope with the complexity of this chronic, multidimensional disease. However, an individual state of the art strategy, with precise adjustment to the patient's characteristics, is still far from being part of the everyday care of pwMS. The development of digital twins could decisively advance the necessary implementation of an individualized innovative management of MS. Through artificial intelligence-based analysis of several disease parameters - including clinical and para-clinical outcomes, multi-omics, biomarkers, patient-related data, information about the patient's life circumstances and plans, and medical procedures - a digital twin paired to the patient's characteristic can be created, enabling healthcare professionals to handle large amounts of patient data. This can contribute to a more personalized and effective care by integrating data from multiple sources in a standardized manner, implementing individualized clinical pathways, supporting physician-patient communication and facilitating a shared decision-making. With a clear display of pre-analyzed patient data on a dashboard, patient participation and individualized clinical decisions as well as the prediction of disease progression and treatment simulation could become possible. In this review, we focus on the advantages, challenges and practical aspects of digital twins in the management of MS. We discuss the use of digital twins for MS as a revolutionary tool to improve diagnosis, monitoring and therapy refining patients' well-being, saving economic costs, and enabling prevention of disease progression. Digital twins will help make precision medicine and patient-centered care a reality in everyday life.
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Affiliation(s)
| | | | | | | | | | - Tjalf Ziemssen
- Center of Clinical Neuroscience, Department of Neurology, University Hospital Carl Gustav Carus, Technical University of Dresden, Dresden, Germany
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12
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Goodkin O, Prados F, Vos SB, Pemberton H, Collorone S, Hagens MHJ, Cardoso MJ, Yousry TA, Thornton JS, Sudre CH, Barkhof F. FLAIR-only joint volumetric analysis of brain lesions and atrophy in clinically isolated syndrome (CIS) suggestive of multiple sclerosis. Neuroimage Clin 2020; 29:102542. [PMID: 33418171 PMCID: PMC7804983 DOI: 10.1016/j.nicl.2020.102542] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 12/20/2020] [Indexed: 11/18/2022]
Abstract
Background MRI assessment in multiple sclerosis (MS) focuses on the presence of typical white matter (WM) lesions. Neurodegeneration characterised by brain atrophy is recognised in the research field as an important prognostic factor. It is not routinely reported clinically, in part due to difficulty in achieving reproducible measurements. Automated MRI quantification of WM lesions and brain volume could provide important clinical monitoring data. In general, lesion quantification relies on both T1 and FLAIR input images, while tissue volumetry relies on T1. However, T1-weighted scans are not routinely included in the clinical MS protocol, limiting the utility of automated quantification. Objectives We address an aspect of this important translational challenge by assessing the performance of FLAIR-only lesion and brain segmentation, against a conventional approach requiring multi-contrast acquisition. We explore whether FLAIR-only grey matter (GM) segmentation yields more variability in performance compared with two-channel segmentation; whether this is related to field strength; and whether the results meet a level of clinical acceptability demonstrated by the ability to reproduce established biological associations. Methods We used a multicentre dataset of subjects with a CIS suggestive of MS scanned at 1.5T and 3T in the same week. WM lesions were manually segmented by two raters, ‘manual 1′ guided by consensus reading of CIS-specific lesions and ‘manual 2′ by any WM hyperintensity. An existing brain segmentation method was adapted for FLAIR-only input. Automated segmentation of WM hyperintensity and brain volumes were performed with conventional (T1/T1 + FLAIR) and FLAIR-only methods. Results WM lesion volumes were comparable at 1.5T between ‘manual 2′ and FLAIR-only methods and at 3T between ‘manual 2′, T1 + FLAIR and FLAIR-only methods. For cortical GM volume, linear regression measures between conventional and FLAIR-only segmentation were high (1.5T: α = 1.029, R2 = 0.997, standard error (SE) = 0.007; 3T: α = 1.019, R2 = 0.998, SE = 0.006). Age-associated change in cortical GM volume was a significant covariate in both T1 (p = 0.001) and FLAIR-only (p = 0.005) methods, confirming the expected relationship between age and GM volume for FLAIR-only segmentations. Conclusions FLAIR-only automated segmentation of WM lesions and brain volumes were consistent with results obtained through conventional methods and had the ability to demonstrate biological effects in our study population. Imaging protocol harmonisation and validation with other MS phenotypes could facilitate the integration of automated WM lesion volume and brain atrophy analysis as clinical tools in radiological MS reporting.
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Affiliation(s)
- O Goodkin
- Centre for Medical Image Computing (CMIC), University College London, London, United Kingdom; Neuroradiological Academic Unit, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom.
| | - F Prados
- Centre for Medical Image Computing (CMIC), University College London, London, United Kingdom; Neuroradiological Academic Unit, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom; eHealth Centre, Universitat Oberta de Catalunya, Barcelona, Spain
| | - S B Vos
- Centre for Medical Image Computing (CMIC), University College London, London, United Kingdom; Neuroradiological Academic Unit, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom; Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, UCLH NHS Foundation Trust, London, United Kingdom
| | - H Pemberton
- Centre for Medical Image Computing (CMIC), University College London, London, United Kingdom; Neuroradiological Academic Unit, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - S Collorone
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Institute of Neurology, Faculty of Brain Sciences, University College London (UCL), London, United Kingdom
| | - M H J Hagens
- MS Center Amsterdam, Department of Neurology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - M J Cardoso
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - T A Yousry
- Neuroradiological Academic Unit, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom; Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, UCLH NHS Foundation Trust, London, United Kingdom
| | - J S Thornton
- Neuroradiological Academic Unit, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom; Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, UCLH NHS Foundation Trust, London, United Kingdom
| | - C H Sudre
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom; Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - F Barkhof
- Centre for Medical Image Computing (CMIC), University College London, London, United Kingdom; Neuroradiological Academic Unit, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom; Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, UCLH NHS Foundation Trust, London, United Kingdom; Radiology & Nuclear Medicine, VU University Medical Center, Amsterdam, Netherlands
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