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del Río‐Sancho S, Alvarez Martinez D, Pünchera J, Guerrier S, Laubach HJ. Dermobile: A cost-effective portable device for erythema evaluation. Skin Res Technol 2024; 30:e13668. [PMID: 38606726 PMCID: PMC11010262 DOI: 10.1111/srt.13668] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 03/11/2024] [Indexed: 04/13/2024]
Affiliation(s)
- Sergio del Río‐Sancho
- Laser Dermatology Consultation, Division of Dermatology and VenereologyGeneva University HospitalsGenevaSwitzerland
- Pediatric Dermatology Unit, Departments of Dermatology & VenereologyUniversity Hospital LausanneUniversity of LausanneLausanneSwitzerland
| | - David Alvarez Martinez
- Laser Dermatology Consultation, Division of Dermatology and VenereologyGeneva University HospitalsGenevaSwitzerland
| | - Jöri Pünchera
- Laser Dermatology Consultation, Division of Dermatology and VenereologyGeneva University HospitalsGenevaSwitzerland
| | | | - Hans Joachim Laubach
- Laser Dermatology Consultation, Division of Dermatology and VenereologyGeneva University HospitalsGenevaSwitzerland
- Pediatric Dermatology Unit, Departments of Dermatology & VenereologyUniversity Hospital LausanneUniversity of LausanneLausanneSwitzerland
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2
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Langbroek GB, Wolkerstorfer A, Horbach SER, Spuls PI, Kelly KM, Robertson SJ, van Raath MI, Al-Niaimi F, Kono T, Boixeda P, Laubach HJ, Badawi AM, Troilius Rubin A, Haedersdal M, Manuskiatti W, van der Horst CMAM, Ubbink DT. Development of a core outcome domain set for clinical research on capillary malformations (the COSCAM project). J Eur Acad Dermatol Venereol 2021; 35:1888-1895. [PMID: 34014582 PMCID: PMC8453952 DOI: 10.1111/jdv.17376] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 04/21/2021] [Indexed: 01/19/2023]
Abstract
Background Due to a large variety in treatment outcomes reported in therapeutic trials and lacking patient‐relevant outcomes, it is hard to adequately compare and improve current therapies for patients with capillary malformations (CMs). The Core Outcome Set for Capillary Malformations (COSCAM) project aims to develop a core outcome set (COS) for use in future CM trials, in which we will first develop a core outcome (sub)domain set (CDS). Here, we describe the methods for the development of a CDS and present the results of the first development stage. Methods The COSCAM project is carried out according to the recommendations of the Cochrane Skin Core OUtcomes Set INitiative (CS‐COUSIN) and the Core Outcome Measures in Effectiveness Trials (COMET) initiative. During the first stage, we identified all potentially relevant outcome subdomains based on a systematic review, two focus group sessions and input from patient representatives of Dutch patient organizations and the COSCAM‐founding group. In stage two, we will present the subdomains in a three‐round e‐Delphi study and online consensus meeting, in which CM patients, parents/caregivers and CM experts worldwide rate the importance of the proposed subdomains, hereby finalizing the core outcome (sub)domains of the CDS. Results A total of 67 potential outcome subdomains were included; sixteen were previously used in the literature, 20 were proposed by Dutch patients and their parents/caregivers (n = 13) in focus group sessions and 38 were suggested by the experts of the COSCAM‐founding group. Seven were excluded because of overlap. Conclusion The final CDS may serve as a minimum standard in future CM trials, thereby facilitating adequate comparison of treatment outcomes. After this CDS development, we will select appropriate outcome measurement instruments to measure the core outcome subdomains.
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Affiliation(s)
- G B Langbroek
- Department of Surgery, Amsterdam University Medical Center (UMC) Location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - A Wolkerstorfer
- Department of Dermatology, Amsterdam University Medical Center UMC, Amsterdam Public Health, Immunity and Infections, University of Amsterdam, Amsterdam, The Netherlands
| | - S E R Horbach
- Department of Plastic-, Reconstructive- and Hand Surgery, Amsterdam University Medical Center (UMC), University of Amsterdam, Amsterdam, The Netherlands
| | - P I Spuls
- Department of Dermatology, Amsterdam University Medical Center UMC, Amsterdam Public Health, Immunity and Infections, University of Amsterdam, Amsterdam, The Netherlands
| | - K M Kelly
- Department of Dermatology, University of California Irvine, Irvine, CA, USA
| | - S J Robertson
- Department of Dermatology and Murdoch Children's Research Institute, The Royal Children's Hospital, Melbourne, VIC, Australia
| | - M I van Raath
- Department of Plastic, Reconstructive, and Hand Surgery, Maastricht University Medical Center, Maastricht University, Maastricht, The Netherlands
| | - F Al-Niaimi
- Private Dermatological Practice, London, UK.,Department of Dermatology, University of Aalborg, Aalborg, Denmark
| | - T Kono
- Department of Plastic Surgery, Tokai University School of Medicine, Shimokasuya Isehara Kanagawa, Kanagawa, Japan
| | - P Boixeda
- Department of Dermatology, Hospital Ramon y Cajal, Madrid, Spain
| | - H J Laubach
- Department of Dermatology, Geneva University Hospitals (HUG), Geneva, Switzerland
| | - A M Badawi
- Department of Dermatology, Szeged University, Szeged, Hungary.,Department of Medical Laser Applications, National Institute of Laser Enhanced Sciences, Cairo University, Giza, Egypt
| | - A Troilius Rubin
- Department of Dermatology, Skåne University Hospital, Malmö, Sweden
| | - M Haedersdal
- Department of Dermatology, University of Copenhagen, Bispebjerg Hospital, Copenhagen NV, Denmark
| | - W Manuskiatti
- Department of Dermatology, Siriraj Skin Laser Center Department of Dermatology, Faculty of Medicine Siriraj Hospital, Bangkok, Thailand
| | - C M A M van der Horst
- Department of Plastic-, Reconstructive- and Hand Surgery, Amsterdam University Medical Center (UMC), University of Amsterdam, Amsterdam, The Netherlands
| | - D T Ubbink
- Department of Surgery, Amsterdam University Medical Center (UMC) Location AMC, University of Amsterdam, Amsterdam, The Netherlands
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3
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Fransen F, Spuls P, Alam M, Badawi A, Boixeda P, Haedersdal M, Hamzavi I, Hedelund L, Kelly KM, Kono T, Laubach HJ, Manuskiatti W, Marini L, Nouri K, Paasch U, Passeron T, Prinsen CACS, Verner I, Wolkerstorfer A. Generic outcome set for the international registry on Laser trEAtments in Dermatology (LEAD): a protocol for a Delphi study to achieve consensus on what to measure. BMJ Open 2020; 10:e038145. [PMID: 32595165 PMCID: PMC7322331 DOI: 10.1136/bmjopen-2020-038145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION While laser technology has expanded the armamentarium of treatment for various skin diseases during the past years, heterogeneity in study outcomes hampers comparability and appropriate evidence synthesis. Part of these issues can be addressed by developing a generic outcome set. Using the Delphi method, this study aims to seek consensus between key stakeholders on relevant generic outcomes (what to measure) for implementation in the international registry on Laser trEAtments in Dermatology (LEAD). The registry is focused on collecting research data on various laser treatments for skin disorders. METHODS AND ANALYSIS By reviewing the literature and involvement of key stakeholder groups and adult patients in need or after laser surgery and health professionals, a preliminary list of outcomes will be generated and categorised into domains. Using these outcomes, an international three-round Delphi study will be performed to rate the importance of outcomes in the selection of a generic outcome set. Participants are allowed to provide new outcomes to the preliminary list for revisions during the first Delphi round. Finally, results will be discussed during a consensus meeting to agree on generic outcomes to be used in the LEAD registry. ETHICS AND DISSEMINATION An ethics approval was not applicable (W19_290 # 18.336). The study is registered with the Cochrane Skin Core OUtcome Set INitiative) and the Core Outcome Measures in Effectiveness Trials initiative. Procedures will be conducted according to the Declaration of Helsinki. The findings will be disseminated through peer-reviewed publications and conference presentations.
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Affiliation(s)
- Frederike Fransen
- Dermatology, Amsterdam UMC, Amsterdam, Noord-Holland, The Netherlands
| | - Phyllis Spuls
- Dermatology, Amsterdam UMC, Amsterdam, Noord-Holland, The Netherlands
- Department of Dermatology, Amsterdam Public Health, Infection and Immunity, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Murad Alam
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois (IL), United States
- Department of Dermatology, Northwestern Memorial Hospital, Arkes Family Pavilion, Chicago, Illinois (IL), United States
| | - Ashraf Badawi
- Dermatology Unit, Department of Medical Applications of Lasers, National Institute of Laser Enhanced Sciences, Cairo University, Giza, Egypt
| | - Pablo Boixeda
- Dermatology Department, Ramón y Cajal Hospital, Madrid, Spain
| | - Merete Haedersdal
- Dermatology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
- Massachusetts General Hospital, Harvard Medical School Boston, Boston, United States
| | - Iltefat Hamzavi
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan, USA
| | - Lene Hedelund
- Dermatology, Aarhus Universitetshospital, Aarhus, Denmark
| | - Kristen M Kelly
- Beckman Laser Institute, University of California, Irvine, California, USA
| | - Tara Kono
- Department of Plastic and Reconstructive Surgery, Tokai University School of Medicine, Isehera, Japan
| | - Hans Joachim Laubach
- Dermatology and Venereology, Hopitaux Universitaires de Geneve, Geneva, Switzerland
| | - Woraphong Manuskiatti
- Faculty of Medicine Siriraj Hospital, Department of Dermatology, Mahidol University, Bangkok, Thailand
| | | | - Keyvan Nouri
- Dermatology and Cutaneous Surgery, University of Miami School of Medicine, Miami, Florida, USA
| | | | - Thierry Passeron
- Dermatology, Centre Hospitalier Universitaire de Nice, Nice, Provence-Alpes-Côte d'Azu, France
| | - Cecilia A C Sanna Prinsen
- Department of Epidemiology and Biostatistics, Amsterdam Public Health research institute, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
| | - Ines Verner
- Dermatology, Verner clinic, Tel Aviv, Israel
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4
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Fransen F, Tio DCKS, Prinsen CAC, Haedersdal M, Hedelund L, Laubach HJ, Marini L, Paasch U, Passeron T, Wolkerstorfer A. A systematic review of outcome reporting in laser treatments for dermatological diseases. J Eur Acad Dermatol Venereol 2019; 34:47-53. [PMID: 31469447 DOI: 10.1111/jdv.15928] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 08/14/2019] [Indexed: 11/30/2022]
Abstract
The standardization of outcome reporting is crucial for interpretation and comparison of studies related to laser treatment of skin disorders. In collaboration with the Cochrane Skin-Core Outcome Set Initiative (CS-COUSIN), a procedure has been proposed to find consensus on the most important generic outcome domains (what to measure) for implementation in the international Laser TrEAtment in Dermatology (LEAD) registry. As the first step in the development of a generic outcome set for the LEAD registry, we undertook a systematic review to identify outcomes, outcome measurement instruments, methods and definitions reported in recently published literature of laser treatments for skin disorders. A systematic search was conducted and generated a total of 707 papers. We assessed 150 studies including all types of studies involving laser treatments for the skin. Two researchers independently extracted the type, definition and frequency of all outcomes and used outcome measurement instruments. We identified 105 verbatim outcomes that were categorized into eight domains recommended by the COMET framework: appearance, long-term effects, physician and patient-reported physical signs, satisfaction, health-related quality of life, psychological functioning and adverse events. Heterogeneity in outcome reporting (e.g. categories and outcome measurement instruments) was high, and definitions were insufficiently reported. There was a clear under representation of life impact domains, including satisfaction (23%) quality of life (3%) and psychological functioning (1%). Outcome reporting concerning laser treatments for the skin is heterogeneous. Standardized outcomes are needed for improving evidence synthesis. Results of this review will be used in the next step to reach consensus between stakeholders on the outcome domains to be implemented in the LEAD registry.
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Affiliation(s)
- F Fransen
- Department of Dermatology, Amsterdam UMC, Amsterdam, The Netherlands
| | - D C K S Tio
- Department of Dermatology, Amsterdam UMC, Amsterdam, The Netherlands
| | - C A C Prinsen
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - M Haedersdal
- Massachusetts General Hospital, Harvard Medical School Boston, Boston, MA, USA.,Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - L Hedelund
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
| | - H J Laubach
- Department of Dermatology and Venereology, Geneva University Hospitals (HUG), Geneva, Switzerland
| | - L Marini
- SDC - The Skin Doctors' Center, Trieste, Italy
| | - U Paasch
- Department of Dermatology, Venereology and Allergy, University of Leipzig, Leipzig, Germany
| | - T Passeron
- Department of Dermatology, University of Côte d'Azur, University Hospital Nice, Nice, France.,Centre Méditéranéen de Médecine Moléculaire (C3M), INSERM U1065, team 12, University of Côte d'Azur, Nice, France
| | - A Wolkerstorfer
- Department of Dermatology, Amsterdam UMC, Amsterdam, The Netherlands
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Peukert N, Bayer J, Becke D, Zurakowski D, Luger T, Manstein D, Laubach HJ. Fraktionierte Photothermolyse zur Behandlung von Gesichtsfalten - die Suche nach optimalen Behandlungsparametern in einer randomisierten Studie im Halbseitendesign. J Dtsch Dermatol Ges 2012. [DOI: 10.1111/j.1610-0387.2012.07986_suppl.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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6
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Peukert N, Bayer J, Becke D, Zurakowski D, Luger T, Manstein D, Laubach HJ. Fractional photothermolysis for the treatment of facial wrinkles - searching for optimal treatment parameters in a randomized study in the split-face design. J Dtsch Dermatol Ges 2012; 10:898-904. [PMID: 22776535 DOI: 10.1111/j.1610-0387.2012.07986.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Fractionated photothermolysis (FP) is used for the treatment of facial wrinkles. OBJECTIVES Investigation of effects of different FP treatment parameters in the treatment of facial wrinkles. PATIENTS AND METHODS In a randomized split-face controlled study 11 patients received 3 FP sessions in 4-week intervals. Keeping the total energy input for each facial side constant, one side was treated with 6 mJ/MTZ with relatively high MTZ density (up to 2,625 MTZ/cm(2) ) and the contralateral side with 70 mJ/MTZ with lower MTZ density (up to 230 MTZ/cm(2) ). Follow-up (FU) visits were performed 1, 3, and 6 months after the last treatment. The cosmetic evaluation was done by the patient self-assessments and by assessment of standardized photographs by 3 independent, blinded investigators. Post-treatment side effects were documented daily in a patient diary up to 7 days after the procedure. RESULTS After 6 months, the patient self-assessments indicated significant improvements (p < 0.005) in wrinkle severity from 5.2 ± 1.5 to 3.8 ± 1.3 and 3.7 ± 1.3 for 6 and 70 mJ/MTZ, respectively, but without significant difference between the energy levels. In contrast, the photographic evaluation by the blinded investigators showed that wrinkle severity was rated significantly better at the sites treated with 70 mJ/MTZ than at the sites treated with 6 mJ/MTZ (p < 0.01). Treatment with 70 mJ/MTZ was significantly more painful than treatment with 6 mJ/MTZ. The typical local reactions to FP, erythema and edema, were also significantly more intense after 70 mJ/MTZ and lasted longer. CONCLUSIONS FP with higher energy per MTZ at constant total energy input is more effective in the treatment of facial wrinkles than lower energy. The gain in effectiveness is, nonetheless, accompanied by an increase in adverse reactions. The treating physician may use this information to adjust treatment to the preferences of the individual patient.
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Affiliation(s)
- Nadine Peukert
- Center for Modern Aesthetics & Laser Medicine am Aasee, aestheso, Münster, Germany.
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7
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Bunselmeyer B, Laubach HJ, Schiller M, Stanke M, Luger TA, Brehler R. Incremental build-up food challenge--a new diagnostic approach to evaluate pseudoallergic reactions in chronic urticaria: a pilot study: stepwise food challenge in chronic urticaria. Clin Exp Allergy 2009; 39:116-26. [PMID: 19137651 DOI: 10.1111/j.1365-2222.2008.03110.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The remission rate of patients with chronic urticaria (CU) due to elimination diets varies between 31% and 71%. However, the diagnostic value of subsequent traditional oral provocation tests with food additives in capsules remains unsatisfactory. OBJECTIVES A newly incremental build-up food challenge (IBUF) for patients with CU was designed and implemented in an open pilot study. Primary endpoint was the percentage of patients developing urticaria during at least one step of IBUF after an initial complete remission due to a pseudoallergen-free elimination diet. METHODS In total, 153 patients with CU were submitted for 5 weeks to a pseudoallergen-free diet. All patients with remission were included to the 6-week IBUF protocol, containing pseudoallergen-rich foods in a systematic and additive manner. The recurrence and severity of CU was evaluated by urticaria score. Subjective disturbance and quality of life were evaluated by patients' diary, visual analogue scale and quality of life questionnaire (CU-Q2oL). Subsequently, patients were followed up for 3-24 months after IBUF by a telephone interview. RESULTS A total of 104 patients completed the pseudoallergen-free diet, whereby 51% reported partial, 17% complete and 32% no remission due to the diet. All diet responders showed a decrease in subjective impairment, urticaria and quality of life score (P<0.001 each). Eighty-six percent (12/14) of the patients reaching complete remission, showed a recurrence of urticaria symptoms during the IBUF protocol. Fifty-eight percent (7/12) of these patients still remained free of symptoms due to avoidance of IBUF-identified foods at telephone follow-up. In patients with partial remission to pseudoallergen-free diet, however, IBUF did not provide information about the cause of urticaria symptoms. CONCLUSIONS The newly developed IBUF protocol seemed to be a promising method for identifying individually incompatible foods in some CU patients. IBUF should be verified by randomized controlled trials to gain additional evidence for its diagnostic value.
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Affiliation(s)
- B Bunselmeyer
- Department of Dermatology, University Hospital Münster, Münster, Germany.
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8
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Laubach HJ, Jakob PM, Loevblad KO, Baird AE, Bovo MP, Edelman RR, Warach S. A phantom for diffusion-weighted imaging of acute stroke. J Magn Reson Imaging 1998; 8:1349-54. [PMID: 9848751 DOI: 10.1002/jmri.1880080627] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.2] [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: 12/13/2022] Open
Abstract
A tissue phantom for diffusion-weighted imaging was developed, basing its contrast between two compartments on different apparent diffusion coefficients, without contrast due to T2 relaxation and proton density. These contrast properties of the phantom simulate the situation found in normal gray matter and areas of acute ischemia. A possible application of the phantom was demonstrated for the investigation of the accuracy of volume measurements based on diffusion-weighted images.
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Affiliation(s)
- H J Laubach
- Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02215, USA
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9
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Jakob PM, Lövblad KO, Weber J, Laubach HJ, Remonda L, Gönner F, Heid O, Mattle HP, Schroth G, Edelman RR, Warach S. [Diffusion-weighted imaging in acute stroke]. Nervenarzt 1998; 69:683-93. [PMID: 9757420 DOI: 10.1007/s001150050329] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Magnetic resonance imaging represents today the most important tool in neuroradiology for both clinical practice and research. MRI allows imaging of the human body in 2 or 3 dimensions with variable tissue contrast. The natural diffusion of tissue protons can now be used as a supplementary contrast mechanism. Different MRI techniques can be used to obtain clinically useful diffusion-weighted images. These techniques all require the use of strong gradient pulses in order to obtain the diffusion contrast. In the current article, the most important physical principles of diffusion measurement are presented. After a short introduction into the basic physical principles, we will present the prerequisites and limitations of clinically relevant applications today. Finally a few select examples of clinical use of these techniques in the acute diagnosis of stroke will be presented.
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Affiliation(s)
- P M Jakob
- Radiology Department, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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10
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Lövblad KO, Laubach HJ, Baird AE, Curtin F, Schlaug G, Edelman RR, Warach S. Clinical experience with diffusion-weighted MR in patients with acute stroke. AJNR Am J Neuroradiol 1998; 19:1061-6. [PMID: 9672012 PMCID: PMC8338657] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE Our purpose was to evaluate the clinical efficacy, sensitivity, and specificity of echo-planar diffusion-weighted MR imaging in patients with acute infarction. METHODS We retrospectively analyzed 194 cases of acute ischemic stroke diagnosed clinically within 24 hours of onset and studied with echo-planar diffusion-weighted MR imaging. Examinations were considered to be positive for infarction when an increase in signal was noted on images acquired at a high b value but absent on images with a low b value. A final clinical diagnosis of acute stroke was used as the standard of reference. A subset of 48 patients scanned within 6 hours was also analyzed. RESULTS Diffusion-weighted MR imaging studies were positive in 133 of 151 cases of infarction (88% sensitivity) and negative in 41 of 43 cases with no infarction (95% specificity). Two cases identified as positive on diffusion-weighted images had nonischemic diagnoses (1.5% false-positive rate). Diffusion-weighted imaging had a positive predictive value of 98.5% and a negative predictive value of 69.5%. Use of T2-weighted sequences as well as diffusion-weighted imaging produced no false-positive findings. Of the negative scans, 69.5% corresponded to transient ischemic attacks or infarcts (mostly small brain stem infarcts). When only cases scanned within 6 hours of onset were considered, the sensitivity rose to 94% and the specificity to 100%. CONCLUSION Despite bias due to dependence between diffusion-weighted imaging and the final diagnosis, this analysis suggests high sensitivity and specificity for echo-planar diffusion-weighted imaging in the diagnosis of acute cerebral infarction, although negative scans did not rule out an ischemic pathogenesis.
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Affiliation(s)
- K O Lövblad
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass, USA
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