Previous diagnostic guidelines for MS relied largely on clinical evidence and cerebrospinal fluid analysis. In 2001, guidelines were published that allowed partial substitution of the required ...clinical evidence by magnetic resonance imaging findings and defined primary progressive multiple sclerosis (PPMS). Recently, revised guidelines on MS diagnosis were published, mainly to improve definitions of dissemination in space (using spinal cord imaging) and in time (using T2 lesions), enabling a faster and more accurate MS diagnosis. Criteria for PPMS were also revised. Current research is concentrating on the definition of uniform clinical terms, to allow a more standardized diagnosis, and aims to simplify the criteria while improving diagnostic accuracy.
The McDonald International Panel accepted the Barkhof/Tintoré criteria for providing MRI evidence of dissemination in space to allow a diagnosis of multiple sclerosis in patients with clinically ...isolated syndromes (CIS). We applied these criteria in a large cohort of patients with CIS, representative of those seen in a general diagnostic setting, to assess their accuracy in predicting conversion to definite multiple sclerosis and to identify factors that affect this risk.
In a collaborative study of seven centres, baseline MRI and clinical follow-up data for 532 patients with CIS were studied, with the development of a second clinical event used as the main outcome. All scans were scored for lesion counts and spatial lesion distribution to assess the fulfilment—ie, at least three out of four—of the Barkhof/Tintoré criteria. We used survival analysis and 2×2 tables to assess the test characteristics of the criteria at baseline.
Overall conversion rate was 32·5% with a median survival time of 85·3 months. Fulfilment of the criteria at baseline showed, after a survival time of 2 years, a conversion rate of about 45% (95% CI 37–53) versus about 10% (6–16) in those with no asymptomatic lesions at baseline (p<0·0001). For patients with a follow-up of at least 2 years, the fulfilment of the MRI criteria showed an accuracy of 68% (sensitivity 49%, specificity 79%) for predicting conversion and an increase in risk of nearly four times for conversion compared with those not fulfilling the criteria (odds ratio 3·7, 95% CI 2·3–5·9; p<0·0001). Cox proportional hazards regression analysis accorded with this increased risk. No effects were recorded on the performance of the criteria by sex, presenting symptoms, or centre. Age at baseline did have a small but significant effect as predictor (hazard ratio 0·97, 0·95–0·99; p=0·002), but did not affect the prognostic value of the MRI criteria.
MRI abnormalities have important prognostic value. The cut-off, based on the Barkhof/Tintoré criteria, as incorporated in the McDonald diagnostic scheme yields acceptable specificity, but could have lower sensitivity than previously reported.
Introduction In patients with potentially resectable esophageal cancer (EC), the value of endoscopic ultrasonography (EUS) after fluorine-18 labeled fluorodeoxyglucose positron emission tomography ...with computed tomography (18F-FDG-PET/CT) is questionable. Retrospectively, we assessed the impact of EUS after PET/CT on the given treatment in EC patients. Methods During the period 2009-2015, 318 EC patients were staged as T1-4aN0-3M0 with hybrid 18F-FDG-PET/CT or 18F-FDG-PET with CT and EUS if applicable in a nonspecific order. We determined the impact of EUS on the given treatment in 279 patients who also were staged with EUS. EUS had clinical consequences if it changed curability, extent of radiation fields or lymph node resection (AJCC stations 2-5), and when the performed fine-needle aspiration (FNA) provided conclusive information of suspicious lymph node. Results EUS had an impact in 80 (28.7%) patients; it changed the radiation field in 63 (22.6%), curability in 5 (1.8%), lymphadenectomy in 48 (17.2%), and FNA was additional in 21 (7.5%). In patients treated with nCRT (n = 194), EUS influenced treatment in 53 (27.3%) patients; in 38 (19.6%) the radiation field changed, in 3 (1.5%) the curability, in 35 (18.0%) the lymphadenectomy, and in 17 (8.8%) FNA was additional. EUS influenced both the extent of radiation field and nodal resection in 31 (16.0%) nCRT patients. Conclusions EUS had an impact on the given treatment in approximately 29%. In most patients, the magnitude of EUS found expression in the extent of radiotherapy target volume delineation to upper/high mediastinal lymph nodes.
Although the mechanisms underlying the accumulation of disability in primary progressive (PP) multiple sclerosis (MS) are still unclear, a major role seems to be played by `occult' tissue damage. We ...investigated whether conventional and magnetization transfer (MT) MRI may provide complementary information for the assessment of PPMS severity. Conventional and MT MRI scans from 226 PPMS patients and 84 healthy controls were collected for centralized analysis. The expanded disability status scale (EDSS) score was rated at the time of MRI acquisition. T2 lesion volume, normalized brain volume (NBV) and cervical cord cross-sectional area (CSA) were measured. Magnetization transfer ratio (MTR) histograms from whole brain tissue, normal-appearing white matter and grey matter (NAGM) were also obtained. Mean NBV, CSA and MTR histogram-derived metrics showed significant inter-centre heterogeneity. After correcting for the acquisition centre, pooled average MTR and histogram peak height values were different between PPMS patients and controls for all tissue classes (P-values between 0.03 and 0.0001). More severe brain and cord atrophy and MT MRI-detectable NAGM damage were found in patients who required walking aids than in those who did not (P-values: 0.03, 0.001 and 0.016). A composite score of NBV, CSA, whole brain and NAGM MTR histogram peak height z-scores was correlated with patients' EDSS (r = 0.37, P 0.001). Magnetization transfer MRI might provide information complementary to that given by conventional MRI when assessing PPMS severity. Sequence-related variability of measurements makes the standardization of MT MRI acquisition essential for the design of multicentre studies. Multiple Sclerosis 2008; 14: 455—464. http://msj.sagepub.com
Retrospectively, we assessed the specificity of two proposed magnetic resonance imaging (MRI) criteria for multiple sclerosis (MS) in patients suspected to have MS but who ultimately receive another ...diagnosis. Brain MRIs of 28 patients mixed with 28 MRIs of MS patients from the same cohort of 377 consecutively referred patients were scored by a neuroradiologist masked to the final diagnosis. The criteria for dissemination in space incorporated in the McDonald International Panel showed good specificity (89%). However, the more sensitive criteria proposed by a Subcommittee of the American Academy of Neurology resulted in a lower specificity (29%), indicating an increased risk of a false‐positive diagnosis. Ann Neurol 2005;58:781–783
In patients with potentially resectable esophageal cancer (EC), the value of endoscopic ultrasonography (EUS) after fluorine-18 labeled fluorodeoxyglucose positron emission tomography with computed ...tomography (
F-FDG-PET/CT) is questionable. Retrospectively, we assessed the impact of EUS after PET/CT on the given treatment in EC patients.
During the period 2009-2015, 318 EC patients were staged as T1-4aN0-3M0 with hybrid
F-FDG-PET/CT or
F-FDG-PET with CT and EUS if applicable in a nonspecific order. We determined the impact of EUS on the given treatment in 279 patients who also were staged with EUS. EUS had clinical consequences if it changed curability, extent of radiation fields or lymph node resection (AJCC stations 2-5), and when the performed fine-needle aspiration (FNA) provided conclusive information of suspicious lymph node.
EUS had an impact in 80 (28.7%) patients; it changed the radiation field in 63 (22.6%), curability in 5 (1.8%), lymphadenectomy in 48 (17.2%), and FNA was additional in 21 (7.5%). In patients treated with nCRT (n = 194), EUS influenced treatment in 53 (27.3%) patients; in 38 (19.6%) the radiation field changed, in 3 (1.5%) the curability, in 35 (18.0%) the lymphadenectomy, and in 17 (8.8%) FNA was additional. EUS influenced both the extent of radiation field and nodal resection in 31 (16.0%) nCRT patients.
EUS had an impact on the given treatment in approximately 29%. In most patients, the magnitude of EUS found expression in the extent of radiotherapy target volume delineation to upper/high mediastinal lymph nodes.
Background: Magnetic resonance(MR)-derived measure of brain atrophy is increasingly accepted as a marker of disease progression in multiple sclerosis (MS). However, differences in atrophy rates ...between MS patients with different subtypes and disease stages are not known. Objective: To evaluate differences in brain atrophy progression in a large population with different forms of MS and free from disease modifying treatment during follow-up. Methods: We analysed existing data sets of MS patients who either were in the placebo arm of clinical trials or were not taking any disease modifying therapy. The total of 964 patients were classified into clinically isolated syndromes (CIS, 16%), relapsing-remitting (RR, 60%), secondary progressive (SP, 15%) and primary progressive (PP, 9%). Expanded Disability Status Scale (EDSS) score was assessed at baseline and end of study. The mean follow-up was 18 months (range: 12-68). Conventional T1-weighted MR images (two scans per patient) were used to quantify brain volume changes over time. The analysis was performed using the SIENA method. The results were correlated with clinical-demographic information. Results: Annualized percent brain volume change (PBVC/y) was -0.40 plus or minus 0.47 in CIS, -0.49 plus or minus 0.65 in RR, -0.64 plus or minus 0.67 in SP, -0.56 plus or minus 0.55 in PP. PBVC/y of CIS was significantly different from that of SP after correcting for age and gender (p <0.01). This difference disappeared when data were also corrected for the baseline brain volume. EDSS at baseline and annualized EDSS changes weakly correlated with PBVC/y in the total population (r= -0.15 and r= -0.10, respectively; p<0.005), but did not correlate in MS subtypes. Conclusions: In a large group of MS patients free from specific drug treatments, annualized brain volume changes had similar rates at early and late disease stages. This suggests that mechanisms leading to brain atrophy act steadily during disease evolution. In the short term, brain volume loss is weakly associated with disability progression.
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