Lesion Volume Quantification Using Two Convolutional Neural Networks in MRIs of Multiple Sclerosis Patients.

BACKGROUND: Multiple sclerosis (MS) is a neurologic disease of the central nervous system which affects almost three million people worldwide. MS is characterized by a demyelination process that leads to brain lesions, allowing these affected areas to be visualized with magnetic resonance imaging (MRI). Deep learning techniques, especially computational algorithms based on convolutional neural networks (CNNs), have become a frequently used algorithm that performs feature self-learning and enables segmentation of structures in the image useful for quantitative analysis of MRIs, including quantitative analysis of MS. To obtain quantitative information about lesion volume, it is important to perform proper image preprocessing and accurate segmentation. Therefore, we propose a method for volumetric quantification of lesions on MRIs of MS patients using automatic segmentation of the brain and lesions by two CNNs. METHODS: We used CNNs at two different moments: the first to perform brain extraction, and the second for lesion segmentation. This study includes four independent MRI datasets: one for training the brain segmentation models, two for training the lesion segmentation model, and one for testing. RESULTS: The proposed brain detection architecture using binary cross-entropy as the loss function achieved a 0.9786 Dice coefficient, 0.9969 accuracy, 0.9851 precision, 0.9851 sensitivity, and 0.9985 specificity. In the second proposed framework for brain lesion segmentation, we obtained a 0.8893 Dice coefficient, 0.9996 accuracy, 0.9376 precision, 0.8609 sensitivity, and 0.9999 specificity. After quantifying the lesion volume of all patients from the test group using our proposed method, we obtained a mean value of 17,582 mm3. CONCLUSIONS: We concluded that the proposed algorithm achieved accurate lesion detection and segmentation with reproducibility corresponding to state-of-the-art software tools and manual segmentation. We believe that this quantification method can add value to treatment monitoring and routine clinical evaluation of MS patients.

A preliminary study of the concentration of metallic elements in the blood of patients with multiple sclerosis as measured by ICP-MS.

It is estimated that multiple sclerosis (MS) affects 35,000 Brazilians and 2.5 million individuals worldwide. Many studies have suggested a possible role of metallic elements in the etiology of MS, but their concentration in the blood of MS patients is nonetheless little investigated in Brazil. In this work, these elements were studied through Inductively Coupled Plasma Mass Spectrometry (ICP-MS), whose analysis provides a tool to quantify the concentrations of metal elements in the blood samples of individuals with neurodegenerative disorders. This study aimed to compare the concentration of metallic elements in blood samples from patients with MS and healthy individuals. Blood was collected from 30 patients with multiple sclerosis and compared with the control group. Blood samples were digested in closed vessels using a microwave and ICP-MS was used to determine the concentrations of 12 metallic elements (Ba, Be, Ca, Co, Cr, Cu, Fe, Mg, Mo, Ni, Pb and Zn). In MS patients, we observed a reduction in the concentrations of beryllium, copper, chromium, cobalt, nickel, magnesium and iron. The mean concentration of lead in blood was significantly elevated in the MS group. However, no difference was observed in the concentrations of Mo, Ba, Ca and Zn in blood samples from MS patients and the control group. According to our data, there is a possible role for the concentrations of 8 of the 12 evaluated metallic elements in multiple sclerosis. Abnormalities in transition metals levels in biological matrices have been reported in several neurological diseases.

[Health-related quality of life in multiple sclerosis]. / Qualidade de vida em portadores de esclerose múltipla.

Multiple sclerosis (MS) is a chronic disease which may exert significant effects on the life of patients. Traditional outcome measures in MS lack in consider the effects of the disease on health-related quality of life (HRQoL). The goal of this study is to measure HRQoL in MS patients in the city of Uberlândia, State of Minas Gerais, Brazil. The Brazilian version of the SF-36 was applied in 23 MS patients and in 69 subjects of general population (blood donors) in Uberlândia. MS patients scored lower in all SF-36 scales than do the general population, principally in physical function domains. Patients with EDSS scores < or =3.5 had higher mean scores in four domains than do the patients with EDSS scores > or =4.0, and lower in all domains than control group. Depressive symptoms and heat intolerance showed correlation with SF-36 domains and components. In conclusion, MS patients have a significant negative impact on all HRQoL domains measured by SF-36, compared with general population, even in the stages with lower disability.

Correlation of clinical findings and brain volume data in multiple sclerosis.

Brain volume measurements are becoming an important tool for assessing success in controlling multiple sclerosis (MS) activity. MSmetrix (icometrix) is an easy-to-use platform, specific for MS magnetic resonance imaging (MRI) of the brain. It provides data on total brain volume, grey matter volume and lesion load volume. The objective of the present study was to assess whether disability and the number of relapses during the previous year correlated with brain volume measurements from MSmetrix. Data on 185 icometrix reports from patients with MS were used to evaluate the potential correlation between brain volume measurements and clinical parameters. There was a significant correlation between higher disability and decreased brain volume (total and grey matter). Increased lesion load in the brain and higher number of relapses in the previous year were also independently correlated with decreased brain tissue volume and with increased disability. This is the first study with real-world data to show that icometrix is a relevant tool for the study of brain volume loss in MS.

[The BCTRIMS expanded consensus on treatment of multiple sclerosis: II. The evidences for the use of glucocorticoids and immunomodulatory treatments]. / Consenso expandido do BCTRIMS para o tratamento da esclerose múltipla: II. As evidências para o uso de glicocorticóides e imunomoduladores.

Multiple sclerosis is an inflammatory disease in which immunological mechanisms play an important role in causing demyelinating lesions in the central nervous system. A number of drugs acting in different stages of these mechanisms have been tested for its treatment. This paper analyses the most important clinical trials with glucocorticoids and immunomodulatory treatments, including human immunoglobulin, using the classes of evidences and types of recommendations as have been defined and widely accepted by the international scientific community. It aims to provide sufficient information to support the BCTRIMS Expanded Consensus on Treatment of MS.

[The BCTRIMS Expanded Consensus on treatment of multiple sclerosis: I. The evidences for the use of immunosuppressive agents, plasma exchange and autologous hematopoietic stem cell transplantation]. / Consenso expandido do BCTRIMS para o tratamento da esclerose múltipla: I. As evidências para o uso de imunossupressores, plasmaférese e transplante autólogo de células tronco.

Since the sixties immunosuppressive agents have been used in the treatment of multiple sclerosis as there was cumulating evidence of the inflammatory nature of the disease. Cyclophosphamide, azathioprine and methotrexate have been the most frequently employed drugs whereas other agents such as cyclosporine and cladribine have been recently tested for RRMS. Mithoxantrone, on the other hand, was approved by the FDA for treatment of aggressive forms of the disease. Other immunointerventions such as plasma exchange and autologous hematopoietic stem cell transplantation have recently been employed in some special circumstances. This paper analyses the most important published data on the use of the immunosuppressive agents, plasma exchange and autologous hematopoietic stem cell transplantation according to the classes of evidences and types of recommendations of these drugs and immunointerventions. It provides sufficient information to support the guidelines expressed in the BCTRIMS Expanded Consensus on Treatment of MS.

[The BCTRIMS Expanded Consensus on treatment of multiple sclerosis: III. Evidence and recommendation-based guidelines]. / Consenso expandido do BCTRIMS para o tratamento da esclerose múltipla: III. Diretrizes baseadas em evidências e recomendações.

There has been unprecedented advances in knowledge of multiple sclerosis (MS) in the last few years. A new set of criteria for its diagnosis and a bunch of recent clinical trials with disease-modifying agents (DMA) have been published. All of that has made it necessary to update and expand the previous consensus for MS treatment as formulated by the Brazilian Committee for Treatment and Research in Multiple Sclerosis (BCTRIMS) two years ago. The BCTRIMS Expanded Consensus emphasizes the need to (1) consider MS treatment on an individual basis; (2) educate patients about the potential benefits and risks of treatment; (3) monitor drugs side effects; (4) have a signed Informed Consent Form; (5) consider the relative cost of the drug. The various clinical possibilities and the indications of the DMA and other immunointerventions are considered according to classes of evidences and types of recommendations. The BCTRIMS Expanded Consensus on Treatment of MS may turn out to be a model to other developing countries.

Qualidade de vida em portadores de esclerose múltipla / Health-related quality of life in multiple sclerosis

A esclerose múltipla (EM) é doença crônica que pode causar repercussões importantes na vida dos pacientes. Medidas tradicionais de evolução na EM não consideram os efeitos da doença na qualidade de vida relacionada à saúde (QVRS). O objetivo deste estudo é avaliar o impacto da EM na QVRS de portadores residentes em Uberlândia - MG. O SF-36 foi aplicado em 23 portadores de EM e em 69 doadores de sangue. Os portadores de EM apresentaram escores mais baixos que a população geral, principalmente nos domínios de função física. Pacientes com EDSS <3,5 apresentam escores maiores em quatro domínios do SF-36 que aqueles com EDSS >4,0, e menores em todos os domínios em relação ao grupo controle. Sintomas depressivos e intolerância ao calor mostram correlação com domínios e componentes do SF-36. Concluindo, a EM provoca impacto negativo significante em todos os domínios do SF-36, comparados à população geral, mesmo nas fases de menor incapacidade.

Multiple sclerosis (MS) is a chronic disease which may exert significant effects on the life of patients. Traditional outcome measures in MS lack in consider the effects of the disease on health-related quality of life (HRQoL). The goal of this study is to measure HRQoL in MS patients in the city of Uberlândia, State of Minas Gerais, Brazil. The Brazilian version of the SF-36 was applied in 23 MS patients and in 69 subjects of general population (blood donors) in Uberlândia. MS patients scored lower in all SF-36 scales than do the general population, principally in physical function domains. Patients with EDSS scores <3.5 had higher mean scores in four domains than do the patients with EDSS scores >4.0, and lower in all domains than control group. Depressive symptoms and heat intolerance showed correlation with SF-36 domains and components. In conclusion, MS patients have a significant negative impact on all HRQoL domains measured by SF-36, compared with general population, even in the stages with lower disability.

Curso de reumatologia: aula 7: manifestações neurológicas nas colagenoses / Course of rheumatology: class 7: neurologic manifestations in collagenosis

O propósito deste artigo é focar as principais manifestações neurológicas das doenças difusas do tecido conjuntivo, com ênfase nas suas manifestações clínicas. Os autores discutem as várias complicações do sistema nervoso central e periférico na doença muscular inflamatória (polimiosite e dermatomiosite), policondrite recidivante, esclerose sistêmica, artrite reumatoide, síndrome de Sjõgren, doença mista do tecido conjuntivo (doença de Sharp), lúpus eritematoso sistêmico e síndrome do anticorpo antifosfolipide.

The purpose of this article is to focus on the major nervous system manifestations in connective tissue diseases, with emphasis on their clinica findings. Authors discuss several complications in inflammatory muscle disease (polymyositis an dermatomyositis), relapsing polychondritis, systemic sclarosis, rheumatoid arthritis, Sjõgren syndorme, mixed connective tissue (Sharp disease), systemic lupus erythematosus and antiphospholipid syndrome.

Consenso expandido do BCTRIMS para o tratamento da esclerose múltipla: II. As evidências para o uso de glicocorticóides e imunomoduladores / The BCTRIMS expanded consensus on treatment of multiple sclerosis: II The evidences for the use of glucocorticoids and immunomodulatory treatments

A esclerose múltipla (EM) é doença inflamatória em que mecanismos imunológicos desempenham importante papel na patogênese das lesöes do sistema nervoso central. Drogas que agem em diferentes etapas destes mecanismos têm sido usadas em seu tratamento. O presente artigo analisa com base nas classes de evidências científicas e tipos de recomendaçöes propostos pela comunidade científica, os mais importantes ensaios clínico-terapêuticos com os glicocorticóides e os imunomoduladores, incluindo a imunoglobulina humana endovenosa, no tratamento da esclerose múltipla. Ele tem por objetivo fornecer subsídios para a formulaçäo do Consenso Expandido para o Tratamento da Esclerose Múltipla

Consenso expandido do BCTRIMS para o tratamento da esclerose múltipla: I. As evidências para o uso de imunossupressores, plasmaférese e transplante autólogo de células tronco / The BCTRIMS Expanded Consensus on treatment of multiple sclerosis: I. The evidences for the use of immunossupressive agents, plasma exchange and autologous hematopoietic stem cell transplantation

O tratamento da esclerose múltipla (EM) com imunossupressores teve início na década de 60. As observaçöes laboratoriais e clínicas de que a doença tinha um caráter inflamatório induziu os clínicos a utilizarem medicamentos citostáticos e imunossupressores. Foram assim incorporados ao arsenal terapêutico da EM as drogas utilizadas em outras doenças inflamatórias sistêmicas como a artrite reumatóide e o lupus eritematoso sistêmico. As drogas imunossupressoras mais utilizadas säo a ciclofosfamida, azatioprina e o metotrexate. A ciclosporina e a cladribina foram utilizadas mais recentemente para o controle da EM na forma recorrente-remitente (RR). O mitoxantrone foi aprovado pelo FDA em 2000 para as formas mais agressivas, tanto RR, como secundariamente progressiva (SP) ou primariamente progressiva (PP). Outras formas de tratamento como plasmaférese e transplante autólogo de células tronco (TACT), foram inseridas neste arsenal terapêutico com suas características específicas e para casos especiais

Consenso expandido do BCTRIMS para o tratamento da esclerose múltipla: III. Diretrizes baseadas em evidências e recomendaçöes / The BCTRIMS Expanded Consensus on treatment of multiple sclerosis: III. Evidence and recommendation-based guidelines

Em razäo dos avanços no conhecimento da esclerose múltipla (EM), dos novos critérios diagnósticos e ensaios terapêuticos publicados, a atualizaçäo e expansäo das diretrizes para orientaçäo do neurologista brasileiro em relaçäo ao tratamento da EM se tornam necessárias. O Consenso Expandido do BCTRIMS enfatiza a individualizaçäo do tratamento a critério do neurologista, e a necessidade de informaçäo do paciente quanto aos potenciais benefícios e riscos das drogas, assim como do Consentimento Informado e compromisso de realizaçäo de controles periódicos. Na ausência de evidências científicas favorecendo uma determinada droga o médico deve considerar o custo diferencial dos imunomoduladores ao fazer sua opçäo terapêutica. As várias situaçöes clínicas e os diferentes agentes modificadores da doença, assim como as outras intervençöes terapêuticas de eficácia no tratamento säo consideradas à luz das classes de evidências científicas e dos tipos de recomendaçäo, aceitos pela comunidade científica internacional. O Consenso Expandido do BCTRIMS pode servir de modelo para outros países em desenvolvimento