A CAD system for assessment of MRI findings to track the progression of multiple sclerosis

Magnetic resonance imaging (MRI) is increasingly being used as a monitoring tool for disease activity in therapeutic trials in multiple sclerosis. There is, however, only a limited relationship between MRI findings and clinical outcome measurements. It has been suggested that hypointense lesion load on T1 weighted imaging has a better correlation with disability than the more conventional T2 hyper intense lesion load. This study was undertaken to (i) evaluate different measurement techniques used to quantify T1 hypointense lesion load, and (ii) to compare lesion load as measured using different parameters and disability. Twenty-five patients with secondary progressive multiple sclerosis, mean age of 40 years (23-57), mean EDSS 5.7 (4-7) were analysed. T2 lesion load on FSE correlated well with both the hypointense lesion load on T1 pre-gadolinium (r=0.8, P50.0001) and T1 post-gadolinium (r=0.8, P50.0001) but less so with the enhancing lesion load (r=0.4, P50.05). There was a very strong correlation with T1 hypo-intense lesion volume pre and post gadolinium (r=0.96, P50.001). However, the EDSS was not correlated with the T2 lesion load (r=70.27, P=0.2), T1 pre-gadolinium load (r=70.3, P=0.1), T1 post gadolinium load (r=70.4, P=0.7) and enhancing lesion load (r=70.28, P=0.2), or with the degree of hypointensity of T1 weighted images determined using the threshold technique. There is a strong correlation between T1 hypointense lesion volume both pre and post gadolinium and also between T1 and T2 lesion volumes.

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Infectious and Noninfectious Granulomatosis in Patient with Multiple Sclerosis: Diagnostic Dilemmas and Followup

Case Reports in Immunology ◽

10.1155/2014/876525 ◽

2014 ◽

Vol 2014 ◽

pp. 1-6

Author(s):

Jelena Paovic ◽

Predrag Paovic ◽

Vojislav Sredovic

Keyword(s):

Multiple Sclerosis ◽

Immune System ◽

Pulmonary Tuberculosis ◽

Cataract Surgery ◽

Systemic Infection ◽

Neurological Manifestations ◽

Initial Attack ◽

Mri Findings ◽

Retrobulbar Neuritis ◽

Preoperative Procedures

Patient was followed up over the course of 30 years. In 1978, after severe systemic infection followed by fever, pulmonary edema, and numerous neurological manifestations, patient was differentially diagnosed with apoplectic form of multiple sclerosis (MS), which was confirmed a year later via neurological and MRI findings. Approximately 20 years following the initial attack, sarcoidosis was diagnosed during the regular preoperative procedures required for cataract surgery. As consequence of lower immune system, infectious granulomatosis in form of pulmonary tuberculosis developed. Ophthalmological findings revealed bilateral retrobulbar neuritis (RBN) approximately six years after initial attack. This developed into total uveitis with retinal periphlebitis and anterior granulomatous uveitis—all of which are clinically similar in both MS and sarcoidosis.

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Cyclophosphamide Versus Rituximab in Progressive Forms of Multiple Sclerosis

ACTA MEDICA IRANICA ◽

10.18502/acta.v57i8.2413 ◽

2020 ◽

Author(s):

Masoud Etemadifar ◽

Shadi Ghourchian ◽

Nazanin Mahinparvar ◽

Mehri Salari ◽

Fatemeh Etemadifar ◽

...

Keyword(s):

Multiple Sclerosis ◽

Progressive Multiple Sclerosis ◽

The Other ◽

Medical Sciences ◽

Mri Findings ◽

Disability Score ◽

Radiologic Findings ◽

Spss Software ◽

And Gender

This study aimed to compare the efficacy of rituximab versus Cyclophosphamide on active secondary progressive multiple sclerosis (SPMS). The randomized clinical trial was performed from 2015 to 2017 in multiple sclerosis (MS) clinics affiliated to Isfahan MS society (IMSS). Patients were randomized to two groups, and one of them received Rituximab that was repeated every six months in case of medical indication. The other one received a monthly pulse of methylprednisolone plus cyclophosphamide (Endoxan, Baxter, UK) until two years. Expanded disabilities status scale (EDSS), clinical, and MRI findings were assessed every six months. Statistical analysis was performed using SPSS software. 39 patients in the Rituximab group and 30 in the Cyclophosphamide group with similar age and gender distribution were entered for analysis. At baseline, the mean number of attacks in the Rituximab group was significantly more than the Cyclophosphamide group (P=0.0001). After 6, 12, and 18 months of treatment, the rate of attacks was similar between groups although it increased significantly in the Rituximab group (P=0.030) after 24 months of treatment. EDSS was increased in the Rituximab group more than the other group at the end of the study. Both drugs were well-tolerated by patients. The EDSS was increased in the Rituximab group but the disability score did not worsen in the Cyclophosphamide group. Both therapies were associated with a reduction in disease attacks and improvement in radiologic findings in a two-year period of follow-up. © 2019 Tehran University of Medical Sciences. All rights reserved. Acta Med Iran 2019;57(8):484-491.

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Correlation of MRI findings and neuropsychological results in patients with multiple sclerosis

Psychiatry Research ◽

10.1016/0165-1781(89)90068-1 ◽

1989 ◽

Vol 29 (3) ◽

pp. 293-294 ◽

Cited By ~ 2

Author(s):

U. Mann ◽

D. Staedt ◽

L. Kappos ◽

A.V.D. Wense ◽

I. Haubitz

Keyword(s):

Multiple Sclerosis ◽

Mri Findings

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Discrepancies in the interpretation of clinical symptoms and signs in the diagnosis of multiple sclerosis. A proposal for standardization

Multiple Sclerosis Journal ◽

10.1191/1352458505ms1149oa ◽

2005 ◽

Vol 11 (2) ◽

pp. 227-231 ◽

Cited By ~ 23

Author(s):

Bernard MJ Uitdehaag ◽

Ludwig Kappos ◽

Lars Bauer ◽

Mark S Freedman ◽

David Miller ◽

...

Keyword(s):

Multiple Sclerosis ◽

Demyelinating Disease ◽

Clinical Symptoms ◽

Clinical Findings ◽

Large Trial ◽

Mri Findings ◽

Mcdonald Criteria ◽

Magnetic Resonance Imaging Mri ◽

Eligibility Assessment

The new McDonald diagnostic criteria for multiple sclerosis (MS) incorporate detailed criteria for the interpretation and classification of magnetic resonance imaging (MRI) findings, but, in contrast, provide no instructions for the interpretation of clinical findings. Because MS according to the McDonald criteria is one of the primary endpoints in a large trial enrolling patients after the first manifestation suggestive for a demyelinating disease (BENEFIT study), it was decided to organize a centralized eligibility assessment for this trial. During this eligibility assessment it was observed that there were marked inconsistencies in the decisions of participating neurologists with respect to the classification of clinical symptoms as being caused by one or more lesions provoking discussions in about one in every five patients. This paper describes these inconsistencies and their sources, and recommends a systematic approach that attempts to reduce the variability in interpreting clinical findings.

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Familial multiple sclerosis: MRI findings in clinically affected and unaffected siblings.

Journal of Neurology Neurosurgery & Psychiatry ◽

10.1136/jnnp.55.10.883 ◽

1992 ◽

Vol 55 (10) ◽

pp. 883-886 ◽

Cited By ~ 47

Author(s):

P J Tienari ◽

O Salonen ◽

J Wikstrom ◽

L Valanne ◽

J Palo

Keyword(s):

Multiple Sclerosis ◽

Mri Findings

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Multiple Sclerosis in a Multi-Ethnic Population in Houston, Texas: A Retrospective Analysis

Biomedicines ◽

10.3390/biomedicines8120534 ◽

2020 ◽

Vol 8 (12) ◽

pp. 534

Author(s):

Vicki Mercado ◽

Deepa Dongarwar ◽

Kristen Fisher ◽

Hamisu M. Salihu ◽

George J. Hutton ◽

...

Keyword(s):

Multiple Sclerosis ◽

Brain Atrophy ◽

Clinical Encounter ◽

Mri Findings ◽

Disease Epidemiology ◽

Treatment Regimens ◽

Hispanic Patients ◽

History Of ◽

Different Populations ◽

Disability Severity

Multiple Sclerosis (MS) is a progressive neurodegenerative disease that affects more than 2 million people worldwide. Increasing knowledge about MS in different populations has advanced our understanding of disease epidemiology and variation in the natural history of MS among White and minority populations. In addition to differences in incidence, African American (AA) and Hispanic patients have greater disease burden and disability in earlier stages of disease compared to White patients. To further characterize MS in AA and Hispanic populations, we conducted a retrospective chart analysis of 112 patients treated at an MS center in Houston, Texas. Here, we describe similarities and differences in clinical presentation, MRI findings, treatment regimens, disability progression, and relapse rate. While we found several similarities between the groups regarding mean age, disability severity, and degree of brain atrophy at diagnosis, we also describe a few divergences. Interestingly, we found that patients who were evaluated by a neurologist at symptom onset had significantly decreased odds of greater disability [defined as Expanded Disability Status Scale (EDSS) > 4.5] at last presentation compared to patients who were not evaluated by a neurologist (OR: 0.04, 95% CI: 0.16–0.9). We also found that active smokers had significantly increased odds of greater disability both at diagnosis and at last clinical encounter compared to nonsmokers (OR: 2.44, 95% CI: 1.10–7.10, OR= 2.44, 95% CI: 1.35–6.12, p = 0.01, respectively). Additionally, we observed significant differences in treatment adherence between groups. Assessment of the degree of brain atrophy and progression over time, along with an enumeration of T1, T2, and gadolinium-enhancing brain lesions, did not reveal differences across groups.

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Bedside Tested Ocular Motor Disorders in Multiple Sclerosis Patients

Multiple Sclerosis International ◽

10.1155/2014/732329 ◽

2014 ◽

Vol 2014 ◽

pp. 1-4 ◽

Cited By ~ 5

Author(s):

G. Servillo ◽

D. Renard ◽

G. Taieb ◽

P. Labauge ◽

S. Bastide ◽

...

Keyword(s):

Multiple Sclerosis ◽

Disease Duration ◽

Clinically Isolated Syndrome ◽

Motor Disorders ◽

Ocular Motor ◽

Mri Findings ◽

Substantial Impact ◽

Ocular Motor Disorders ◽

Definition Of ◽

Multiple Sclerosis Patients

Background/Aims. Ocular motor disorders (OMDs) are a common feature of multiple sclerosis (MS). In clinical practice, if not reported by patients, OMDs are often underdiagnosed and their prevalence is underestimated.Methods. We studied 163 patients (125 women, 76.7%, 38 men, 23.3%; median age 45.0 years; median disease duration 10 years; median EDSS 3.5) with definite MS (n=150, 92%) or clinically isolated syndrome (n=13, 8%) who underwent a thorough clinical examination of eye movements. Data on localization of previous relapses, MS subtype, and MRI findings were collected and analyzed.Results. Overall, 111/163 (68.1%) patients showed at least one abnormality of eye movement. Most frequent OMDs were impaired smooth pursuit (42.3%), saccadic dysmetria (41.7%), unilateral internuclear ophthalmoplegia (14.7%), slowing of saccades (14.7%), skew deviation (13.5%), and gaze evoked nystagmus (13.5%). Patients with OMDs had more severe disability(P=0.0005)and showed more frequently infratentorial MRI lesions(P=0.004). Localization of previous relapses was not associated with presence of OMDs.Conclusion. OMDs are frequent in patients with stable (no relapses) MS. A precise bedside examination of eye motility can disclose abnormalities that imply the presence of subclinical MS lesions and may have a substantial impact on definition of the diagnosis and on management of MS patients.

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Alemtuzumab—A New Efficacy Benchmark in Relapsing–Remitting Multiple Sclerosis?

US Neurology ◽

10.17925/usn.2010.06.02.82 ◽

2010 ◽

Vol 06 (02) ◽

pp. 82

Author(s):

Omar A Khan ◽

Keyword(s):

Multiple Sclerosis ◽

Phase Iii ◽

Mri Findings ◽

Disability Score ◽

Disease Modifying Drugs ◽

Relapsing Remitting ◽

Phase Iii Trials ◽

Magnetic Resonance Imaging Mri ◽

Relapsing Remitting Multiple Sclerosis ◽

Ongoing Phase

The disease-modifying drugs (DMDs) available for the treatment of multiple sclerosis (MS) have been used effectively for nearly two decades. These treatments delay the neurorodegenerative process, but do not restore lost neurological function. New oral DMDs are becoming available that offer improved convenience over existing injectable DMDs. Recently, several monoclonal antibody treatments have been developed for MS; the furthest developed is alemtuzumab (Campath-1H). In a landmark phase II clinical trial (CAMMS223) on patients with relapsing–remitting MS (RRMS), short cycles of alemtuzumab given at baseline, at 12 months, and optionally at 24 months, demonstrated superior and sustained efficacy in terms of relapse rates and magnetic resonance imaging (MRI) findings over the comparator compound, interferon beta-1a (IFNβ-1a), which was given subcutaneously and continuously. Most notably, the mean disability score for patients receiving alemtuzumab showed an unprecedented improvement, whereas for IFNβ-1a it deteriorated. Alemtuzumab in treating RRMS is the subject of two ongoing phase III trials, the results of which have the potential to change future treatments and prognoses for many patients.

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