The relationship between brain diffusion microstructural changes and disability in multiple sclerosis (MS) remains poorly understood. We aimed to explore the predictive value of microstructural ...properties in white (WM) and grey matter (GM), and identify areas associated with mid-term disability in MS patients. We studied 185 patients (71% female; 86% RRMS) with the Expanded Disability Status Scale (EDSS), timed 25-foot walk (T25FW), nine-hole peg test (9HPT), and Symbol Digit Modalities Test (SDMT) at two time-points. We used Lasso regression to analyse the predictive value of baseline WM fractional anisotropy and GM mean diffusivity, and to identify areas related to each outcome at 4.1 years follow-up. Motor performance was associated with WM (T25FW: RMSE = 0.524, R
= 0.304; 9HPT dominant hand: RMSE = 0.662, R
= 0.062; 9HPT non-dominant hand: RMSE = 0.649, R
= 0.139), and SDMT with GM diffusion metrics (RMSE = 0.772, R
= 0.186). Cingulum, longitudinal fasciculus, optic radiation, forceps minor and frontal aslant were the WM tracts most closely linked to motor dysfunction, and temporal and frontal cortex were relevant for cognition. Regional specificity related to clinical outcomes provide valuable information that can be used to develop more accurate predictive models that could improve therapeutic strategies.
We aimed to compare the ability of diffusion tensor imaging and multi‐compartment spherical mean technique to detect focal tissue damage and in distinguishing between different connectivity patterns ...associated with varying clinical outcomes in multiple sclerosis (MS). Seventy‐six people diagnosed with MS were scanned using a SIEMENS Prisma Fit 3T magnetic resonance imaging (MRI), employing both conventional (T1w and fluid‐attenuated inversion recovery) and advanced diffusion MRI sequences from which fractional anisotropy (FA) and microscopic FA (μFA) maps were generated. Using automated fiber quantification (AFQ), we assessed diffusion profiles across multiple white matter (WM) pathways to measure the sensitivity of anisotropy diffusion metrics in detecting localized tissue damage. In parallel, we analyzed structural brain connectivity in a specific patient cohort to fully grasp its relationships with cognitive and physical clinical outcomes. This evaluation comprehensively considered different patient categories, including cognitively preserved (CP), mild cognitive deficits (MCD), and cognitively impaired (CI) for cognitive assessment, as well as groups distinguished by physical impact: those with mild disability (Expanded Disability Status Scale EDSS <=3) and those with moderate–severe disability (EDSS >3). In our initial objective, we employed Ridge regression to forecast the presence of focal MS lesions, comparing the performance of μFA and FA. μFA exhibited a stronger association with tissue damage and a higher predictive precision for focal MS lesions across the tracts, achieving an R‐squared value of .57, significantly outperforming the R‐squared value of .24 for FA (p‐value <.001). In structural connectivity, μFA exhibited more pronounced differences than FA in response to alteration in both cognitive and physical clinical scores in terms of effect size and number of connections. Regarding cognitive groups, FA differences between CP and MCD groups were limited to 0.5% of connections, mainly around the thalamus, while μFA revealed changes in 2.5% of connections. In the CP and CI group comparison, which have noticeable cognitive differences, the disparity was 5.6% for FA values and 32.5% for μFA. Similarly, μFA outperformed FA in detecting WM changes between the MCD and CI groups, with 5% versus 0.3% of connections, respectively. When analyzing structural connectivity between physical disability groups, μFA still demonstrated superior performance over FA, disclosing a 2.1% difference in connectivity between regions closely associated with physical disability in MS. In contrast, FA spotted a few regions, comprising only 0.6% of total connections. In summary, μFA emerged as a more effective tool than FA in predicting MS lesions and identifying structural changes across patients with different degrees of cognitive and global disability, offering deeper insights into the complexities of MS‐related impairments.
This research reveals that microscopic fractional anisotropy outperforms standard fractional anisotropy in identifying tissue damage and discerning connectivity patterns in multiple sclerosis, thus improving lesion prediction and insight into the disease's cognitive and physical effects.
Plasma exchange (PE) is used to treat severe episodes of CNS demyelination unresponsive to corticosteroids. Predictors of long-term response are not well known.
We retrospectively reviewed the ...medical records of 41 patients consecutively treated by PE between January 1995 and July 2007. The primary outcome was improvement at 6 months after PE defined as decrease of >or=1 point in the Expanded Disability Status Scale (EDSS) score for patients with EDSS <or=7.5 or 1.5 points with EDSS >or=8.0 or improvement of more than 2 lines in the visual acuity chart for patients with optic neuritis (ON).
Twenty-five patients (61%) were women, and the median age was 33 years (range 14-57 years). Twenty-three (56%) had multiple sclerosis, 2 (5%) had clinically isolated syndrome, 2 (5%) had Marburg disease, 7 (17%) had acute disseminated encephalomyelitis, 4 (10%) had neuromyelitis optica, 2 (5%) had idiopathic ON, and 1 (2%) had idiopathic transverse myelitis. The median EDSS score before the attack was 1.0 (range 0-6.5). At PE onset, the median EDSS score was 7.0 (range 3.0-9.5). Sixteen patients (39%) improved at discharge, and 26 (63%) improved at 6 months. In the multivariate analysis, early initiation of PE (odds ratio OR 6.29, 95% confidence interval CI 1.18-52.96) and improvement at discharge (OR 7.32, 95% CI 1.21-44.38) were significantly associated with response at 6 months.
Plasma exchange (PE) was associated with clinical improvement in 63% of patients at 6 months. Early initiation of PE and improvement at discharge were predictors of this response. Twelve patients (48%) who did not improve early did so during follow-up.
Synthetic MRI in subarachnoid haemorrhage Montejo, C.; Laredo, C.; Llull, L. ...
Clinical radiology,
October 2021, 2021-10-00, 20211001, Letnik:
76, Številka:
10
Journal Article
Recenzirano
Odprti dostop
To evaluate the reliability of synthetic magnetic resonance imaging (SyMRI) for detecting complications associated with subarachnoid haemorrhage (SAH), such as ischaemic lesions, hydrocephalus, or ...bleeding complications.
Twenty patients with SAH, who underwent a conventional brain MRI and a SyMRI on a 3 T MRI machine. Comparable conventional and synthetic T2-weighted fluid attenuated inversion recovery (FLAIR) images were acquired. The presence of ischaemic lesions, hydrocephalus, extra-axial blood collections as well as the volumes of grey matter (GMv), white matter (WMv), and cerebrospinal (CSFv) were compared. The acquisition times of both sequences was also analysed.
The concordance between the two techniques was excellent for the detection of ischaemic lesions and extra-axial collections (kappa = 0.80 and 0.88 respectively) and good for the detection of hydrocephalus (kappa = 0.69). No significant differences were detected in the number of ischaemic lesions (p=0.31) or in the Evans index (p=0.11). The WMv and CSFv measures were also similar (p=0.18 and p=0.94, respectively), as well as the volume of ischaemic lesions (p=0.79). Compared to conventional MRI, the SyMRI acquisition time was shorter regardless of the number of sections (32% and 6% time reduction for 4 or 3 mm section thickness, respectively).
SyMRI allows the detection of potential complications of SAH in a similar way to conventional MRI with a shorter acquisition time.
•SyMRI detects intracranial complications of SAH similarly to conventional MRI.•SyMRI acquisitions have quality metrics comparable to conventional MRI.•SyMRI acquisition time is shorter compared to conventional MRI.
Background Sensorimotor integration can be assessed using simple reaction time tasks to somatosensory stimuli (ssRT). Tasks performed to stimuli applied to the contralateral hemibody would reveal ...interhemispheric transfer of information (IHT) across corpus callosum, while tasks performed when a startling-auditory stimulus (SAS) is presented together with the somatosensory cue would reveal the level of subcortical motor preparation. We studied both preparation and IHT in MS patients in whom callosal pathways and subcortical structures may be particularly involved. Methods In 13 controls and 20 mildly disabled relapsing-remitting MS patients, we studied ssRT for voluntary wrist-extension to ipsilateral and contralateral low intensity electrical stimuli, applied to the index finger. Percentage delay (PD) of contralateral vs ipsilateral responses was calculated as a measure of IHT. StartReact trials were performed applying randomly a SAS in ssRT trials (20%). Percentage shortening (SAS-Short) with respect to ssRT was calculated as a measure of the effectiveness of preparation. Motor conduction time (MCT) was assessed by recording the motor-evoked potentials to TMS. Results In controls, mean PD of contralateral responses was 105.7% longer than for ipsilateral responses. In StartReact trials, the mean SAS-Short was 29.7% for ipsilateral and 23.3% for contralateral responses. With respect to controls, patients had no differences in PD (105.4%) but showed significantly lower SAS-Short for ipsilateral (23.4%; p = 0.02) and contralateral trials (10.9%; p = 0.005). Contralateral SAS-Short was inversely correlated with MCT ( r = −0.294). Two patients had abnormally delayed orbiculari-oculi responses to SAS. Conclusions Patients with MS have defective subcortical motor preparation that is worse when IHT sensorimotor integration is required.
Multiple Sclerosis (MS) results in color vision impairment regardless of optic neuritis (ON). The exact location of injury remains undefined. The objective of this study is to identify the region ...leading to dyschromatopsia in MS patients’ NON-eyes. We evaluated Spearman correlations between color vision and measures of different regions in the afferent visual pathway in 106 MS patients. Regions with significant correlations were included in logistic regression models to assess their independent role in dyschromatopsia. We evaluated color vision with Hardy–Rand–Rittler plates and retinal damage using Optical Coherence Tomography. We ran SIENAX to measure Normalized Brain Parenchymal Volume (NBPV), FIRST for thalamus volume and Freesurfer for visual cortex areas. We found moderate, significant correlations between color vision and macular retinal nerve fiber layer (rho = 0.289,
p
= 0.003), ganglion cell complex (GCC = GCIP) (rho = 0.353,
p
< 0.001), thalamus (rho = 0.361,
p
< 0.001), and lesion volume within the optic radiations (rho = –0.230,
p
= 0.030). Only GCC thickness remained significant (
p
= 0.023) in the logistic regression model. In the final model including lesion load and NBPV as markers of diffuse neuroaxonal damage, GCC remained associated with dyschromatopsia OR = 0.88 95 % CI (0.80–0.97)
p
= 0.016. This association remained significant when we also added sex, age, and disease duration as covariates in the regression model. Dyschromatopsia in NON-eyes is due to damage of retinal ganglion cells (RGC) in MS. Color vision can serve as a marker of RGC damage in MS.
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.
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.
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.
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.
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.
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.
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.
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.
El uso de la resonancia magnética (RM) está ampliamente extendido en el diagnóstico y seguimiento de los pacientes con esclerosis múltiple (EM). La coordinación entre los Servicios de Neurología y Neurorradiología es clave para la realización e interpretación de estudios radiológicos de la manera más eficaz posible. Sin embargo, esta coordinación es susceptible de mejoras en una gran parte de los hospitales nacionales.
Un panel de 17 neurólogos y neurorradiólogos de 8 hospitales españoles, presencialmente y a través de comunicación online, consensuaron una Guía de Buenas Prácticas en la Coordinación en EM. La guía se estableció en cuatro fases: 1) definición del alcance de la guía y metodología del estudio; 2) revisión bibliográfica sobre buenas prácticas o recomendaciones en el uso de la RM en EM; 3) discusión y búsqueda de consenso entre los expertos; 4) formalización y validación de los contenidos para elaborar el documento de consenso.
Se consensuaron un total de 9 recomendaciones dirigidas a la mejora de la coordinación entre los Servicios de Neurología y Neurorradiología, que se pueden resumir en: I) estandarizar las solicitudes de RM, informes y planificación, II) crear protocolos compartidos para los estudios de RM, III) establecer comités multidisciplinares y sesiones de coordinación, y IV) generar canales de comunicación formales entre los profesionales de ambos departamentos.
Se espera que las recomendaciones consensuadas sirvan de guía para optimizar la coordinación entre neurólogos y neurorradiólogos y que repercutan en la mejora del diagnóstico y seguimiento de los pacientes con EM.
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