Magnetic Resonance Imaging in Multiple Sclerosis: The Role of Conventional Imaging
Multiple Sclerosis Program, Cedars-Sinai Medical Center, David Geffen School of Medicine at UCLA, 8730 Alden Drive, Thalians E216, Los Angeles, CA 90048, USA. Neurologic Clinics
(Impact Factor: 1.4).
05/2011; 29(2):343-56. DOI: 10.1016/j.ncl.2011.01.005
Magnetic resonance imaging (MRI) of the brain and spinal cord plays a central role in establishing the diagnosis of multiple sclerosis (MS), in monitoring disease activity, and as a key outcome measure in clinical trials of new MS therapies. Conventional MRI continues to evolve, reflecting advances in imaging hardware and software. These advances have led to important new insights into MS disease pathophysiology and can be used to improve patient management. Despite these improvements, standard MRI continues to capture only a small portion of the underlying changes that occur during the course of the disease.
Available from: Chrisostomos Katsenos
- "The MRI can detect changes in inflammatory activity but for quantification of intact myelin and remyelination, magnetization transfer imaging has been proposed. Diffusion tensor imaging can be used to monitor tract-specific changes that may be more closely linked to clinical measures and may be particularly powerful when combined with functional measures, such as functional MRI [10,11]. "
[Show abstract] [Hide abstract]
Demyelinating diseases cause destruction of the myelin sheath, while axons are relatively spared. Pathologically, demyelination can be the result of an inflammatory process, viral infection, acquired metabolic derangement and ischemic insult. Three diseases that can cause inflammatory demyelination of the CNS are: Multiple sclerosis (MS), Acute disseminated encephalomyelitis (ADEM) and Acute hemorrhagic leucoencephalitis. Differentiation is not always easy and there is considerable overlaping. Data about adults with acute demyelination requiring ICU admission is limited.
A 17 year old Greek female was hospitalised in the ICU because of acute respiratory failure requiring mechanical ventilation. She had a history of febrile disease one month before, acute onset of paraplegia, diplopia, progressive arm weakness and dyspnea. Her consciousness was not impaired. A demyelinating central nervous system (CNS) disease, possibly post infectious encephalomyelitis (ADEM) was the underlying condition. The MRI of the brain disclosed diffused expanded cerebral lesions involving the optic nerve, basal ganglia cerebellum, pons and medulla oblongata. There was also extended involvement of the cervical and thoracic part of the spinal cord. CSF leukocyte count was elevated with lymphocyte predominance. The patient required mechanical ventilation for two months. Then she was transferred to a rehabilitation centre. Three years later she remains paraplegic. Since then she has not suffered any other demyelination attack.
Demyelinating diseases can cause acute respiratory failure when the spinal cord is affected. Severe forms of these diseases, making necessary ICU admission, is less frequently reported. Intensivists should be aware of the features of these rare diseases.
BMC Research Notes 01/2013; 6(1):22. DOI:10.1186/1756-0500-6-22
[Show abstract] [Hide abstract]
ABSTRACT: To assess the reliability of new magnetic resonance imaging (MRI) lesion counts by clinicians in a multiple sclerosis specialty clinic.
An observational study.
A multiple sclerosis specialty clinic.
Eighty-five patients with multiple sclerosis participating in a National Institutes of Health–supported longitudinal study were included.
Each patient had a brain MRI scan at entry and 6 months later using a standardized protocol.
The number of new T2 lesions, newly enlarging T2 lesions, and gadolinium-enhancing lesions were measured on the 6-month MRI using a computer-based image analysis program for the original study. For this study, images were reanalyzed by an expert neuroradiologist and 3 clinician raters. The neuroradiologist evaluated the original image pairs; the clinicians evaluated image pairs that were modified to simulate clinical practice. New lesion counts were compared across raters, as was classification of patients as MRI active or inactive.
Agreement on lesion counts was highest for gadolinium-enhancing lesions, intermediate for new T2 lesions, and poor for enlarging T2 lesions. In 18% to 25% of the cases, MRI activity was classified differently by the clinician raters compared with the neuroradiologist or computer program. Variability among the clinical raters for estimates of new T2 lesions was affected most strongly by the image modifications that simulated low image quality and different head position.
Between-rater variability in new T2 lesion counts may be reduced by improved standardization of image acquisitions, but this approach may not be practical in most clinical environments. Ultimately, more reliable, robust, and accessible image analysis methods are needed for accurate multiple sclerosis disease-modifying drug monitoring and decision making in the routine clinic setting.
03/2013; 70(3):338-44. DOI:10.1001/2013.jamaneurol.211
[Show abstract] [Hide abstract]
ABSTRACT: Multiple sclerosis (MS) is a progressive inflammatory disease of the central nervous system that results in neurological dysfunction and disability. The initiation of disease-modifying therapy (DMT) early in the course of MS may improve the prognosis for patients with MS and reduce the occurrence of neurological damage. In patients with relapsing-remitting MS (RRMS), DMT reduces the rate of relapses, reduces the appearance of magnetic resonance imaging markers of disease activity, and slows the course of disability progression. DMT has been shown to be more effective when initiated early in the course of MS. In patients who have not yet developed clinically definite MS (CDMS), but have had 1 attack of neurological symptoms consistent with MS (ie, clinically isolated syndrome [CIS]), the initiation of DMT (specifically, interferon beta, glatiramer acetate, and teriflunomide) following this attack has been shown to delay the conversion to CDMS. Current guidelines have recognized the benefits of early treatment of MS with DMTs. However, there are a number of barriers to implementing early MS treatment. Early diagnosis and treatment of MS can be hindered because patients may delay consulting a physician about their neurological symptoms or may be reluctant to start DMT. Further, even after initiating DMT, continued adherence to treatment is often poor. These delays in treatment and a lack of adherence to treatment are associated with poor patient outcomes. The objectives of this review are to highlight the importance of early diagnosis and treatment of CIS or RRMS and discuss the favorable outcomes associated with early initiation of DMT.
The American journal of managed care 11/2013; 19(17 Suppl):s321-31. · 2.26 Impact Factor
Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual current impact factor. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.