ABSTRACT: This study demonstrates that 3T SV-MRS data can be used with the currently available automatic brain tumour diagnostic classifiers which were trained on databases of 1.5T spectra. This will allow the existing large databases of 1.5T MRS data to be used for diagnostic classification of 3T spectra, and perhaps also the combination of 1.5T and 3T databases.
Brain tumour classifiers trained with 154 1.5T spectra to discriminate among high grade malignant tumours and common grade II glial tumours were evaluated with a subsequently-acquired set of 155 1.5T and 37 3T spectra. A similarity study between spectra and main brain tumour metabolite ratios for both field strengths (1.5T and 3T) was also performed.
Our results showed that classifiers trained with 1.5T samples had similar accuracy for both test datasets (0.87 ± 0.03 for 1.5T and 0.88 ± 0.03 for 3.0T). Moreover, non-significant differences were observed with most metabolite ratios and spectral patterns.
These results encourage the use of existing classifiers based on 1.5T datasets for diagnosis with 3T (1)H SV-MRS. The large 1.5T databases compiled throughout many years and the prediction models based on 1.5T acquisitions can therefore continue to be used with data from the new 3T instruments.
MAGMA Magnetic Resonance Materials in Physics Biology and Medicine 02/2011; 24(1):35-42. · 1.88 Impact Factor
ABSTRACT: To analyze the clinical and laboratory characteristics and outcomes of patients with transverse myelitis affecting more than 4 spinal segments secondary to systemic lupus erythematosus (SLE).
A computer-assisted (PubMed) search of the literature was performed to identify all cases of transverse myelitis affecting more than 4 spinal segments secondary to SLE from 1966 to April 2008. In addition, we present 2 previously unreported cases of SLE patients with transverse myelitis affecting more than 4 spinal segments.
Twenty-two SLE patients with transverse myelitis affecting more than 4 spinal segments were finally reviewed. There were 17 (77%) females and the mean age at the diagnosis of myelitis was 29.3 +/- 9.4 years (range, 12-53 years). It was the first manifestation of SLE in 5 (23%) patients. The most frequent clinical manifestations were sensory deficit in 20 (91%) patients, variable motor deficit in 19 (86%), and urinary sphincter dysfunction in 15 (83%) patients. On magnetic resonance imaging, all patients showed increased T2 signal intensity of the spinal cord, most frequently in the cervical to mid-lower thoracic spinal segments. Most patients received a combination of therapies; corticosteroids and cyclophosphamide was the most common (45%). Three patients (14%) had complete resolution of symptoms and 14 (59%) had partial recovery.
Transverse myelitis affecting more than 4 spinal segments is a rare complication in patients with SLE but may be the first clinical manifestation of the disease in some patients. A high proportion of affected patients have variable degrees of disability after treatment.
Seminars in arthritis and rheumatism 12/2008; 39(4):246-56. · 4.72 Impact Factor
ABSTRACT: Magnetic resonance imaging (MRI) is the gold standard non-invasive technique to detect malignant disease in the bone marrow. Proton magnetic resonance spectroscopy (MRS) can be performed as a quick adjunct to routine spinal MRI. We performed proton MRS to patients with multiple myeloma (MM) at diagnosis and after treatment to investigate the possible correlation of MRS data with response to therapy.
Twenty-one patients with newly diagnosed MM underwent combined MRI/MRS explorations of a transverse center section in the fifth lumbar vertebral body. MRS was acquired with STEAM and 40 ms TE. Areas of unsuppressed water and lipid resonances were used to calculate the lipid-to-water ratio (LWR).
No association was detected between initial LWRs and the clinical characteristics of patients. Post treatment MRS was available in 16 patients of whom 11 (69%) presented an LWR increase, this included all complete responders (8/8, 100%, P = 0.012). A post-treatment LWR value equal to or larger than one is proposed as a non-invasive marker of complete response to treatment.
Only patients responding to treatment presented a significant increase in bone marrow LWR after therapy. MRS may provide an adequate quantification of response to chemotherapy in patients with MM.
MAGMA Magnetic Resonance Materials in Physics Biology and Medicine 05/2007; 20(2):93-101. · 1.88 Impact Factor
ABSTRACT: This phase II study evaluates the activity of temozolomide and cisplatin administered before radiation therapy in newly diagnosed glioblastoma multiforme patients, in terms of response, time to progression and survival.
Forty patients with measurable disease after surgery, a Karnofsky status > 60, and Barthel Index > 10 were included. They were treated with three cycles of temozolomide 200 mg/m2/day for 5 days and cisplatin 100 mg/m2 on day 1. Conventional focal radiation therapy to 60 Gy was administered after response evaluation.
Three patients were not evaluable for central reviewed response but all 40 were evaluable for toxicity, time to progression and survival. Objective responses by Macdonald criteria on an intent to treat basis were 45% including complete response in three patients (7.5%), and partial response in 15 patients (37.5%). Responses were seen in biopsy-only patients (33.4%) as well as in partial surgery patients (52%). Median survival for all patients was 12.5 months. Biopsy-only patients had a median survival of 12.8 months. Grade 3 to 4 neutropenia was the most important toxicity, and occurred in 37.5% of patients. A delay in 18.2% and a dose reduction in 9.6% of cycles were necessary due to myelosuppression on day 28. Two patients had neutropenic fever resulting in one treatment-related death. Eighty-two percent of patients received radiotherapy.
This regimen has significant activity, as it induces objective responses even in biopsy-only patients, appearing to improve their median survival. A better combination schedule is needed to improve the toxicity profile.
Journal of Neuro-Oncology 01/2005; 70(3):359-69. · 3.21 Impact Factor