Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.094
Filtrar
1.
Medicina (B Aires) ; 79 Suppl 3: 66-70, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-31603847

RESUMO

The two main demyelinating diseases in children are reviewed. Acute disseminated encephalomyelitis (ADEM) and multiple sclerosis (MS). For its physiopathological characteristics, probable etiologies, clinical manifestations, diagnosis, treatment, prognosis, evolution, as well as atypical alterations that complicate its diagnosis, the smaller the child is, more study is needed before reaching the diagnosis. The International Study Group of Multiple Pediatric Sclerosis, published the operating definitions for demyelinating diseases acquired from the central nervous system in children: the ADEM is monophasic, polysymptomatic and with encephalopathy. Its duration is up to 3 months, with fluctuating symptoms and magnetic resonance findings. MS is an isolated monofocal or polyfocal syndrome, without encephalopathy. Currently, two different and distinguishable diseases are considered from the onset of symptoms.


Assuntos
Encefalomielite Aguda Disseminada/diagnóstico por imagem , Esclerose Múltipla/diagnóstico por imagem , Encéfalo/diagnóstico por imagem , Encéfalo/fisiopatologia , Criança , Quimioterapia Combinada , Encefalomielite Aguda Disseminada/tratamento farmacológico , Humanos , Imunoterapia , Imagem por Ressonância Magnética , Esclerose Múltipla/tratamento farmacológico , Esteroides/uso terapêutico , Síndrome
2.
Postgrad Med ; 131(7): 523-532, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31478421

RESUMO

Objectives: Many people affected by multiple sclerosis (MS) experience cognitive impairment, especially decreases in information processing speed (PS). Neural disconnection is thought to represent the neural marker of this symptom, although the role played by alterations of specific functional brain networks still remains unclear. The aim is to investigate and compare patterns of association between PS-demanding cognitive performance and functional connectivity across two MS phenotypes. Methods: Forty patients with relapsing-remitting MS (RRMS) and 25 with secondary progressive MS (SPMS) had neuropsychological and MRI assessments. Multiple regression models were used to investigate the relationship between performance on tests of visuomotor and verbal PS, and on the verbal fluency tests, and functional connectivity of four cognitive networks, i.e. left and right frontoparietal, salience and default-mode, and two control networks, i.e. visual and sensorimotor. Results: Patients with SPMS were older and had longer disease history than patients with RRMS and presented with worse overall clinical conditions: higher disease severity, total lesion volume, and cognitive impairment rates. However, in both patient samples, cognitive performance across tests was negatively correlated with functional connectivity of the salience and default-mode networks, and positively with connectivity of the left frontoparietal network. Only the visuomotor PS scores of the RRMS group were also associated with connectivity of the sensorimotor network. Conclusions: PS-demanding cognitive performance in patients with MS appears mainly associated with strength of functional connectivity of frontal networks involved in the evaluation and manipulation of information, as well as the default mode network. These results are in line with the hypothesis that multiple neural networks are needed to support normal cognitive performance across MS phenotypes. However, different PS measures showed partially different patterns of association with functional connectivity. Therefore, further investigations are needed to clarify the contribution of inter-network communication to specific cognitive deficits due to MS.


Assuntos
Encéfalo/diagnóstico por imagem , Esclerose Múltipla Crônica Progressiva/diagnóstico por imagem , Esclerose Múltipla Recidivante-Remitente/diagnóstico por imagem , Adulto , Idoso , Encéfalo/fisiopatologia , Cerebelo/diagnóstico por imagem , Cerebelo/fisiopatologia , Feminino , Lobo Frontal/diagnóstico por imagem , Lobo Frontal/fisiopatologia , Neuroimagem Funcional , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla/diagnóstico por imagem , Esclerose Múltipla/fisiopatologia , Esclerose Múltipla/psicologia , Esclerose Múltipla Crônica Progressiva/fisiopatologia , Esclerose Múltipla Crônica Progressiva/psicologia , Esclerose Múltipla Recidivante-Remitente/fisiopatologia , Esclerose Múltipla Recidivante-Remitente/psicologia , Vias Neurais/diagnóstico por imagem , Vias Neurais/fisiopatologia , Testes Neuropsicológicos , Lobo Parietal/diagnóstico por imagem , Lobo Parietal/fisiopatologia , Desempenho Psicomotor
3.
Sheng Wu Yi Xue Gong Cheng Xue Za Zhi ; 36(3): 453-459, 2019 Jun 25.
Artigo em Chinês | MEDLINE | ID: mdl-31232549

RESUMO

A multi-label based level set model for multiple sclerosis lesion segmentation is proposed based on the shape, position and other information of lesions from magnetic resonance image. First, fuzzy c-means model is applied to extract the initial lesion region. Second, an intensity prior information term and a label fusion term are constructed using intensity information of the initial lesion region, the above two terms are integrated into a region-based level set model. The final lesion segmentation is achieved by evolving the level set contour. The experimental results show that the proposed method can accurately and robustly extract brain lesions from magnetic resonance images. The proposed method helps to reduce the work of radiologists significantly, which is useful in clinical application.


Assuntos
Imagem por Ressonância Magnética , Esclerose Múltipla/diagnóstico por imagem , Algoritmos , Humanos
4.
Zh Nevrol Psikhiatr Im S S Korsakova ; 119(2. Vyp. 2): 36-41, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31156239

RESUMO

AIM: To analyze clinical, neuroimaging and laboratory characteristics of acute disseminated encephalomyelitis (ODEM) in adults with an analysis of the frequency of diagnostic errors at the initial examination stage. MATERIAL AND METHODS: The study included 23 patients hospitalized with a diagnosis of ODEM. The analysis of clinical characteristics, MRI results and cerebrospinal fluid (CSF) was performed. The diagnosis of the disease in each case was specified after a full examination and dynamic observation. RESULTS: The diagnosis of ODEM was confirmed only in 16 cases. In 6 cases, the final diagnosis of multiple sclerosis (MS) was made, and one case of Susak syndrome, primary CNS lymphoma and levamisole-associated multifocal inflammatory leukoencephalopathy was also detected. It has been shown that ODEM in adults is characterized by the acute development of multifocal brain lesions in combination with clinical manifestations of encephalopathy, which in half of cases is preceded by an infectious disease. There were no specific clinical, neuroimaging and laboratory features, which could allow differentiation of ODEM from onset of MS. CONCLUSION: To make a correct diagnosis in the first episode of acute multifocal brain lesion, a dynamic observation, including repeated MRI, is needed. The development of specific biomarkers may be of great importance for the early differential diagnosis of demyelinating diseases.


Assuntos
Encefalomielite Aguda Disseminada , Esclerose Múltipla , Adulto , Encéfalo/diagnóstico por imagem , Diagnóstico Diferencial , Encefalomielite Aguda Disseminada/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Esclerose Múltipla/diagnóstico por imagem
5.
J Clin Neurosci ; 66: 51-55, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31155343

RESUMO

The data for oligoclonal IgG bands (OCB) in cerebrospinal fluid and the association with clinical profiles of Chinese patients with multiple sclerosis (MS) is lacking. We aimed to investigate the positive OCB incidence, as well as the clinical and magnetic resonance imaging (MRI) features associated with positive OCB in MS patients in South China. Consecutive MS patients were recruited from two centers, located in Guangzhou city and Hong Kong in South China. MS was re-diagnosed by McDonald criteria 2017. OCB was tested using isoelectric focusing method. The difference in the clinical and MRI features between OCB-positive and OCB-negative MS patients was evaluated. Among 184 MS patients analyzed (102 from Guangzhou and 82 from Hong Kong), 110 (59.8%) patients were OCB-positive. Except for onset age (P = 0.019), there was no significant difference between MS patients with or without OCB in relation to the course of disease, symptoms of first attack, lesion distribution on MRI, relapse rates, or disability progression. Our results demonstrate no significant clinical differences between the OCB positive and negative MS patients in this MS cohort. Larger cohort in Chinese patients with MS is warranted.


Assuntos
Esclerose Múltipla/epidemiologia , Esclerose Múltipla/metabolismo , Bandas Oligoclonais/metabolismo , Adulto , Idade de Início , Biomarcadores/sangue , Biomarcadores/líquido cefalorraquidiano , China/epidemiologia , Estudos de Coortes , Progressão da Doença , Feminino , Seguimentos , Hong Kong/epidemiologia , Humanos , Imagem por Ressonância Magnética/tendências , Masculino , Esclerose Múltipla/diagnóstico por imagem , Recidiva , Adulto Jovem
6.
Br J Radiol ; 92(1101): 20180926, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30994035

RESUMO

Multiple sclerosis is a chronic inflammatory demyelinating and degenerative disease of the central nervous system. It is the most common non-traumatic cause of chronic disability in young adults. An early and accurate diagnosis, and effective disease modifying treatment are key elements of optimum care for people with MS (pwMS). MRI has become a critical tool to confirm the presence of dissemination in space and time of lesions characteristic of inflammatory demyelination, a cornerstone of MS diagnosis, over and above exclusion of numerous differential diagnoses. In the modern era of early and highly effective DMT, follow-up of pwMS also relies heavily on MRI, to both confirm efficacy and for pharmacovigilance. Since criteria for MS rely heavily on MRI, an agreed standardized acquisition and reporting protocol enabling efficient and equitable application across the UK is desirable. Following a recent meeting of MS experts in London (UK), we make recommendations for a standardized UK MRI protocol that captures the diagnostic phase as well as monitoring for safety and treatment efficacy once the diagnosis is established. Our views take into account issues arising from the (repeated) use of contrast agents as well as the advent of (semi-) automated tools to further optimize disease monitoring in pwMS.


Assuntos
Encéfalo/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Esclerose Múltipla/diagnóstico por imagem , Encéfalo/patologia , Diagnóstico Diferencial , Humanos , Esclerose Múltipla/patologia , Reino Unido
7.
Int J Immunopathol Pharmacol ; 33: 2058738419843690, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30968726

RESUMO

Alemtuzumab, an anti-CD52 monoclonal antibody, is effective in the treatment of relapsing-remitting multiple sclerosis (RRMS). Common adverse effects include the development of autoimmune diseases, and Graves' disease is one of the most frequent presentations. We report here a case of alemtuzumab-induced thyroid disease in a female patient who showed a phase of thyrotoxicosis with positive anti-thyroglobulin (anti-Tg) and anti-thyroid peroxidase (TPO) antibodies, but a negative TSH receptor antibody, spontaneously followed by hypothyroidism. The aim is to illustrate the clinical presentation, evaluation over time, and the possibility to consider a conservative management up to the spontaneous resolution of the thyrotoxicosis. All these are intended to emphasize the importance of pretreatment screening and follow-up in the management of treatment with alemtuzumab.


Assuntos
Alemtuzumab/efeitos adversos , Antineoplásicos Imunológicos/efeitos adversos , Doenças Autoimunes/induzido quimicamente , Hipotireoidismo/induzido quimicamente , Esclerose Múltipla/tratamento farmacológico , Adulto , Doenças Autoimunes/diagnóstico por imagem , Feminino , Humanos , Hipotireoidismo/diagnóstico por imagem , Esclerose Múltipla/diagnóstico por imagem
8.
Magn Reson Imaging ; 60: 44-51, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30954651

RESUMO

PURPOSE: To evaluate the quality of brain quantitative susceptibility mapping (QSM) that is fully automatically reconstructed in clinical MRI of various neurological diseases. METHODS: 393 consecutive patients in one month were recruited for this evaluation study. QSM was reconstructed using Morphology Enabled Dipole Inversion without zero reference regularization (MEDI) and using MEDI with cerebrospinal fluid automatic zero-reference regularization to generate susceptibility values (MEDI+0). Two neuroradiologists independently assessed the image quality of MEDI+0 and MEDI and image concordance between them. Lesion susceptibility values were measured in 20 cases of glioma, 21 cases of ischemic stroke and 43 multiple sclerosis (MS) cases on both MEDI+0 and MEDI images. RESULTS: The two neuroradiologists rated the MEDI+0 image qualities of the 393 cases as 351 (89.3%) and 362 (92.1%) excellent, 29 (7.4%) and 24 (6.1%) diagnostic, and 13 (3.3%) and 7 (1.8%) poor, and scored the concordances between MEDI+0 and MEDI as 364 (92.6%) and 351 (89.3%) excellent, 13 (3.3%) and 31 (7.9%) good, 14 (3.6%) and 9 (2.3%) intermediate, 2 (0.5%) and 2 (0.5%) poor, and 0 (0%) and 0 (0%) none. There was good correlation between MEDI+0 and MEDI in lesion susceptibility contrast of glioma, ischemic stroke, and MS cases (all p < 0.05). The MS lesion susceptibility time course from this patient cohort was found to be similar to the reported pattern: isointense initially for acute enhancing lesions, and hyperintense over the following years for active chronic lesions. CONCLUSION: Brain QSM images of various neurological diseases have reliable diagnostic quality in clinical MRI, with MEDI+0 providing susceptibility values automatically referenced to CSF in longitudinal and cross-center studies.


Assuntos
Isquemia Encefálica/diagnóstico por imagem , Encéfalo/diagnóstico por imagem , Glioma/diagnóstico por imagem , Processamento de Imagem Assistida por Computador/métodos , Esclerose Múltipla/diagnóstico por imagem , Doenças do Sistema Nervoso/diagnóstico por imagem , Acidente Vascular Cerebral/diagnóstico por imagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Encéfalo/patologia , Mapeamento Encefálico/métodos , Criança , Pré-Escolar , Estudos de Viabilidade , Feminino , Glioma/patologia , Humanos , Imagem Tridimensional , Lactente , Recém-Nascido , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla/patologia , Reconhecimento Automatizado de Padrão , Estudos Retrospectivos , Acidente Vascular Cerebral/patologia , Adulto Jovem
9.
Hell J Nucl Med ; 22 Suppl: 75-81, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30877725

RESUMO

Cognitive impairment is a common phenomenon in multiple sclerosis (MS), occurring at all stages of the disease, even at the earliest, and can be a major source of disability, social impairment, and impoverished quality of life. Cognitive dysfunction is mainly focused on working memory, conceptual reasoning, verbal fluency, speed of information processing, attention and executive function. Additional clinical factors, including disease course, fatigue and affective disturbance, can impact the degree of MS-related cognitive impairment. We present the results from the two-phases of our prospective study on cognitive decline in MS patients using the data collected from the A' Neurologic clinic at AHEPA hospital, Thessaloniki, Greece. Most of the patients of the present study revealed mild cognitive impairment with mild influence on the everyday function. We found weak correlation between cognitive deficit and the duration of MS, as well as the physical disability status and moderate correlation between cognitive impairment and the type of the disease as well as MRI findings (atrophy and lesion load). Our results also indicate that the currently available battery of neuropsychological tests: California Verbal Learning test (CVLT), Symbol Digit Modalities Test (SDMT), Brief Visuospatial Memory Test and Paced Auditory Serial Addition Test (PASAT) can be used as a reliable tool in the diagnosis of cognitive deficits of MS patients, as related to their degree of disability and to the type of their disease. Evaluation of cognitive functions should be incorporated in the regular assessment and monitoring of MS patients since they seem to be well correlated with the progression of the disease.


Assuntos
Cognição , Esclerose Múltipla/fisiopatologia , Humanos , Imagem por Ressonância Magnética , Esclerose Múltipla/diagnóstico por imagem , Testes Neuropsicológicos
10.
Mult Scler Relat Disord ; 30: 236-243, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30844611

RESUMO

BACKGROUND: Ocrelizumab is an infusible humanized monoclonal antibody that selectively depletes CD20+ B cells. Infusion-related reactions (IRRs) were summarized from the OPERA I, OPERA II, and ORATORIO trials for relapsing and primary progressive multiple sclerosis (MS). METHODS: OPERA I and OPERA II were identical, randomized, double-blind, active-controlled trials that enrolled patients with relapsing MS (RMS). Patients in the ocrelizumab group initially received two 300-mg intravenous (IV) infusions separated by 14 days (on Days 1 and 15); subsequent doses were administered as single 600-mg IV infusions. Ocrelizumab-treated patients also received subcutaneous (SC) placebo injections 3 times weekly. Patients in the active comparator group received SC injections of IFN ß-1a 3 times weekly, as well as placebo infusions on Days 1 and 15 and Weeks 24, 48, and 72. ORATORIO was a randomized, parallel-group, double-blind, placebo-controlled study that enrolled patients with primary progressive MS (PPMS). As in the OPERA studies, patients in the ocrelizumab group initially received two 300-mg infusions separated by 14 days; however, ORATORIO patients continued to receive this divided-dose regimen throughout the study. The ORATORIO control group received IV placebo. Prior to each infusion, all patients in the OPERA and ORATORIO studies were pretreated with 100 mg IV methylprednisolone; additional prophylactic treatment with analgesics, antipyretics, and/or an IV or oral antihistamine was optional. IRRs were defined as adverse events that occurred during or within 24 h of IV infusion of ocrelizumab or placebo. RESULTS: Safety analyses included 1651 patients with RMS from OPERA I and OPERA II (ocrelizumab, n = 825; IFN ß-1a, n = 826) and 725 patients with PPMS from ORATORIO (ocrelizumab, n = 486; placebo, n = 239). Across studies, IRRs were reported in 34.3% (vs 9.7% with IFN ß-1a) and 39.9% (vs 25.5% with placebo) of ocrelizumab-treated patients in the pooled OPERA and ORATORIO populations, respectively. The majority of IRRs were mild to moderate in the OPERA (ocrelizumab, 92.6%; IFN ß-1a, 98.8%) and ORATORIO (ocrelizumab, 96.9%; placebo, 93.4%) studies. IRRs most commonly occurred with the first infusion. Severe IRRs were reported in 2.4% of ocrelizumab-treated patients in the OPERA studies (vs 0.1% with IFN ß-1a) and 1.2% of ocrelizumab-treated patients in ORATORIO (vs 1.7% with placebo). Two serious IRRs occurred across the OPERA studies, both of which occurred with the initial infusion. The first event occurred in an IFN ß-1a-treated patient in association with the initial infusion of IV placebo and consisted of severe balance disorder, dizziness, flushing, and hypoesthesia. The second event was a life-threatening reaction (bronchospasm) that occurred in an ocrelizumab-treated patient 15 min after the infusion started. Frequently reported IRR symptoms included pruritus, rash, throat irritation, and flushing. Premedication use, particularly antihistamines, was associated with fewer IRRs. CONCLUSION: Findings from the OPERA I, OPERA II, and ORATORIO trials show that IRRs were the most frequently reported adverse events with ocrelizumab, were mostly mild to moderate in severity, were reduced with appropriate pretreatment, and decreased with subsequent dosing. IRRs that did occur were effectively managed through infusion rate adjustment and symptomatic treatment.


Assuntos
Anticorpos Monoclonais Humanizados/uso terapêutico , Fatores Imunológicos/uso terapêutico , Adulto , Anti-Inflamatórios/uso terapêutico , Relação Dose-Resposta a Droga , Método Duplo-Cego , Esquema de Medicação , Feminino , Seguimentos , Antagonistas dos Receptores Histamínicos/administração & dosagem , Humanos , Infusões Intravenosas/métodos , Reação no Local da Injeção/etiologia , Reação no Local da Injeção/prevenção & controle , Imagem por Ressonância Magnética , Masculino , Metilprednisolona/uso terapêutico , Pessoa de Meia-Idade , Esclerose Múltipla/diagnóstico por imagem , Esclerose Múltipla/tratamento farmacológico
11.
Mult Scler Relat Disord ; 30: 247-251, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30849681

RESUMO

BACKGROUND: Efficacy and safety profiles of alemtuzumab for relapsing-remitting multiple sclerosis (RRMS) mainly come from Western countries and have not been reported in Asian populations. The aim of this study was to report the efficacy and safety of alemtuzumab for RRMS patients in a Korean population. METHODS: We retrospectively reviewed RRMS patients treated with alemtuzumab. Study outcomes included annualized relapse rate (ARR), expanded disability status scale (EDSS) score, 6-month confirmed disability worsening (CDW), confirmed disability improvement (CDI), MRI lesion activity (new/enlarging T2 hyperintense and gadolinium-enhancing T1 lesions), no evidence of disease activity (NEDA), and adverse events. RESULTS: Nineteen patients were identified and mean follow-up was 1.5 years after alemtuzumab initiation. Mean ARR fell from 1.20 pre-treatment to 0.30 post-treatment (p < 0.001). Mean EDSS score remained stable, with a change from baseline of -0.08 at 1 year. After treatment, 16 patients (84.2%) had freedom from 6-month CDW, 3 (15.8%) had 6-month CDI, 11 (57.9%) had freedom from new/enlarging T2 hyperintense lesions, 13 (68.4%) had freedom from gadolinium-enhancing lesions, and 10 (52.6%) had NEDA. Four patients (21.1%) developed relapses after alemtuzumab therapy. CONCLUSION: Alemtuzumab efficacy and safety were similar to that reported previously in Western populations. Severe relapses can occur after alemtuzumab administration.


Assuntos
Alemtuzumab/uso terapêutico , Antineoplásicos Imunológicos/uso terapêutico , Esclerose Múltipla/tratamento farmacológico , Adulto , Encéfalo/diagnóstico por imagem , Avaliação da Deficiência , Feminino , Seguimentos , Humanos , Imagem por Ressonância Magnética , Masculino , Esclerose Múltipla/diagnóstico por imagem , República da Coreia , Estudos Retrospectivos , Medula Espinal/diagnóstico por imagem
12.
Adv Clin Exp Med ; 28(7): 989-999, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30729761

RESUMO

We review the current role of magnetic resonance (MR) volumetry as a meaningful indicator of neurodegeneration and clinical disease progression in multiple sclerosis (MS) patients. Based on a review of the current literature we summarize the mechanisms that contribute to brain atrophy. We present the newest magnetic resonance imaging (MRI)-based methods used in atrophy quantification. We also analyze important biological factors which can influence the accuracy of brain atrophy evaluation. Evidence shows that measures of brain volume (BV) have the potential to be an important determinant of disease progression to a greater extent than conventional lesion assessment. Finally, scientific reports concerning limitations of MRI-based volumetry that affect its implementation into routine clinical practice are also reviewed. The technical challenges that need to be overcome include creating a standardized protocol for image acquisition - a fully automated, accurate and reproducible method that allows comparison in either single-center or multicenter settings. In the near future, quantitative MR research will probably be the basic method used in neurology to monitor the rate of atrophic processes and clinical deterioration in MS patients, and to evaluate the results of treatment.


Assuntos
Atrofia/diagnóstico por imagem , Encéfalo/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Esclerose Múltipla/diagnóstico por imagem , Atrofia/patologia , Encéfalo/patologia , Humanos , Espectroscopia de Ressonância Magnética , Esclerose Múltipla/patologia , Tamanho do Órgão/fisiologia
13.
Mult Scler Relat Disord ; 30: 149-153, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30772673

RESUMO

BACKGOUND: A major aim in MS field has been the search for biomarkers that enable accurate detection of neuronal damage. Besides MRI, recent studies have shown that neuroaxonal damage can also be tracked by neurofilament detection. Nevertheless, before widespread implementation, a better understanding of the principal contributors for this biomarker is of paramount importance. Therefore, we analyzed neurofilament light chain (NfL) in relapsing (RMS) and progressive MS (PMS), addressing which MRI and clinical variables are better related to this biomarker. METHODS: Forty-seven MS patients underwent MRI (3T) and cerebrospinal fluid (CSF) sampling. We measured NfL concentrations using ELISA (UmanDiagnostics) and performed multivariable regression analysis to assess the contribution of clinical and MRI metrics to NfL. RESULTS: NfL correlated with previous clinical activity in RMS (p < 0.001). In RMS, NfL also correlated with Gad+ and cortical lesion volumes. However, after multivariable analysis, only cortical lesions and relapses in previous 12 months remained in the final model (R2 = 0.610; p = 0.009 and p = 0.00008, respectively). In PMS, T1-hypointense lesion volume was the only predictor after multivariate analysis (R2 = 0.564; p = 0.012). CONCLUSIONS: CSF NfL levels are increased in RMS and associated with relapses and cortical lesions. Although NfL levels were correlated with Gad+ lesion volume, this association did not persist in multivariable analysis after controlling for previous clinical activity. We encourage controlling for previous clinical activity when testing the association of NfL with MRI. In PMS, the major contributor to NfL was T1-hypointense lesion volume.


Assuntos
Córtex Cerebral/diagnóstico por imagem , Imagem por Ressonância Magnética , Esclerose Múltipla/líquido cefalorraquidiano , Esclerose Múltipla/diagnóstico por imagem , Proteínas de Neurofilamentos/líquido cefalorraquidiano , Adulto , Biomarcadores/líquido cefalorraquidiano , Avaliação da Deficiência , Feminino , Humanos , Processamento de Imagem Assistida por Computador , Masculino , Pessoa de Meia-Idade , Exame Neurológico , Estudos Prospectivos , Recidiva , Análise de Regressão
14.
Neuroscience ; 403: 27-34, 2019 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-30708049

RESUMO

In multiple sclerosis (MS), it would be of clinical value to be able to track the progression of axonal pathology, especially before the manifestation of clinical disability. However, non-invasive evaluation of short-term longitudinal progression of white matter integrity is challenging. This study aims at assessing longitudinal changes in the restricted (i.e. intracellular) diffusion signal fraction (FR) in early-stage MS by using ultra-high gradient strength multi-shell diffusion magnetic resonance imaging. In 11 early MS subjects (disease duration ≤5 years), FR was obtained at two timepoints (one year apart) through the Composite Hindered and Restricted Model of Diffusion, along with conventional Diffusion Tensor Imaging metrics. At follow-up, no statistically significant change was detected in clinical variables, while all imaging metrics showed statistically significant longitudinal changes (p < 0.01, corrected for multiple comparisons) in widespread regions in normal-appearing white matter (NAWM). The most extensive longitudinal changes were observed in FR, including areas known to include a large fraction of crossing fibers. Furthermore, FR was also the only metric showing significant longitudinal changes in lesions that were present at both time points (p = 0.007), with no significant differences found for conventional diffusion metrics. Finally, FR was the only diffusion metric (as compared to Diffusion Tensor Imaging) that revealed pre-lesional changes already present at baseline. Taken together, our data provide evidence for progressive microstructural damage in the NAWM of early MS cases detectable already at 1-year follow-up. Our study highlights the value of multi-shell diffusion imaging for sensitive tracking of disease evolution in MS before any clinical changes are observed. This article is part of a Special Issue entitled: SI: MRI and Neuroinflammation.


Assuntos
Imagem de Difusão por Ressonância Magnética , Esclerose Múltipla/diagnóstico por imagem , Adulto , Fatores Etários , Axônios , Encéfalo/diagnóstico por imagem , Imagem de Difusão por Ressonância Magnética/métodos , Progressão da Doença , Feminino , Seguimentos , Humanos , Interpretação de Imagem Assistida por Computador , Estudos Longitudinais , Masculino , Reprodutibilidade dos Testes , Substância Branca/diagnóstico por imagem
15.
Acta Neurol Scand ; 139(6): 497-504, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30802931

RESUMO

OBJECTIVES: People with multiple sclerosis (pwMS) often have magnetic resonance imaging (MRI) examinations. While MRI can help guide MS management, it may be a source of anxiety for pwMS. We aimed to develop and validate a questionnaire on the "EMotions and Attitudes towards MRI" (MRI-EMA). MATERIAL AND METHODS: The questionnaire was developed, tested in two samples of pwMS and validated in a sample of n = 457 pwMS using exploratory (EFA) and confirmatory factor analysis (CFA). RESULTS: EFA revealed four factors underlying the questionnaire: fear of MRI scan, fear of MRI results, feeling of control over the disease and feeling of competence in the patient-physician encounter. CFA confirmed the model fit. Receiving the MRI results, but not undergoing the procedure was associated with anxiety. Seeing MRI results gave participants a feeling of control over the disease. Only 50% felt competent to discuss MRI findings with their physician. Fear of MRI results was especially high and feeling of competence low in participants with a short disease duration and little MRI experience. CONCLUSION: PwMS do not feel competent when discussing the role, MRI plays in their care. Receiving MRI results caused anxiety and provides some pwMS with a-perhaps false-feeling of control over the disease. The MRI-EMA constitutes a new tool for the assessments of pwMS' feelings towards MRI, that can be applied in future research and clinical settings.


Assuntos
Emoções , Imagem por Ressonância Magnética/psicologia , Esclerose Múltipla/diagnóstico por imagem , Esclerose Múltipla/psicologia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários
16.
Magn Reson Imaging ; 58: 1-5, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30630068

RESUMO

OBJECTIVE: Over the last years several studies reported an increased signal intensity (SI) of the dentate nucleus (DN) on unenhanced T1-weighted images after repeated application of gadolinium-based contrast agents (GBCAs), suggesting gadolinium deposition. The aim of this study was to investigate with diffusion-weighted MRI possible tissue abnormalities of the DN in multiple sclerosis (MS) patients. MATERIAL AND METHODS: We retrospectively identified seventeen patients with at least six contrast-enhanced MRI examinations by using the linear GBCA gadopentate dimeglumine and twenty-three patients with the exclusive use of the macrocyclic contrast agent gadoterate meglumine followed by another 3 Tesla MRI scan including unenhanced T1-weighted and diffusion-weighted images. RESULTS: In the linear GBCA group, we found significant differences of the DN-to-pons SI ratio on unenhanced T1-weighted images (1.13 ±â€¯0.05) when compared to the macrocyclic GBCA group (0.97 ±â€¯0.03; p < 0.001). However, we found no significant differences between apparent diffusion coefficient (ADC) values of the DN in both groups (linear GBCA group: 0.82 ±â€¯0.04 × 10-3 mm/s2; marcocyclic GBCA group: 0.79 ±â€¯0.04 × 10-3 mm/s2; p = 0.15). CONCLUSIONS: Our results do not suggest that there is any difference in ADC values in the T1-hyperintense DN, which does not indicate a difference in tissue integrity between patients exposed to macrocyclic or linear GBCAs.


Assuntos
Núcleos Cerebelares/diagnóstico por imagem , Meios de Contraste/química , Imagem de Difusão por Ressonância Magnética , Gadolínio/química , Meglumina/química , Esclerose Múltipla/diagnóstico por imagem , Compostos Organometálicos/química , Adulto , Feminino , Gadolínio DTPA/química , Humanos , Processamento de Imagem Assistida por Computador/métodos , Masculino , Pessoa de Meia-Idade , Ponte/diagnóstico por imagem , Estudos Retrospectivos
17.
Mult Scler Relat Disord ; 29: 23-25, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30658260

RESUMO

BACKGROUND: McDonald criteria for multiple sclerosis (MS) diagnosis were revised in 2017. OBJECTIVE: Aim of our study was to evaluate and compare the sensitivity and specificity of 2017 and 2010 McDonald criteria in patients presenting with an initial demyelinating event (IDE). METHODS: We retrospectively identified patients with an IDE and collected clinical, MRI and CSF data in order to demonstrate fulfilment of 2010 and 2017 McDonald criteria. RESULTS: 2017 McDonald criteria showed 100% (86.8-100%) sensitivity and 13.8% (3.9-31.7%) specificity. CONCLUSION: 2017 McDonald criteria appear to have higher sensitivity but reduced specificity compared to 2010 McDonald criteria.


Assuntos
Diagnóstico Precoce , Esclerose Múltipla/diagnóstico , Guias de Prática Clínica como Assunto/normas , Adulto , Progressão da Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla/líquido cefalorraquidiano , Esclerose Múltipla/diagnóstico por imagem , Esclerose Múltipla/fisiopatologia , Estudos Retrospectivos , Sensibilidade e Especificidade
18.
Mult Scler Relat Disord ; 29: 15-22, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30658259

RESUMO

BACKGROUND: MOG antibody disease is an autoimmune disease of the central nervous system (CNS) characterized by the presence of a serological antibody against myelin oligodendrocyte glycoprotein (MOG). MRI is instrumental in distinguishing neuromyelitis optica spectrum disorder (NMOSD) from multiple sclerosis (MS), but MRI features of MOG disease appear to overlap with NMOSD and MS. OBJECTIVES: In this study we aim to characterize the radiological features of MOG antibody disease and compare the findings with those previously described. METHODS: This is a retrospective study of 26 MOG positive patients. We aim to describe their brain, spinal and orbital MRI features and compare our findings with those previously reported in the literature. RESULTS: The majority of the abnormal findings was located on orbital MRIs, with more involvement of the anterior structures and bilateral involvement of the optic nerves. Brain abnormalities were distinct from both NMOSD and MS lesions. Spinal cord was the least affected. CONCLUSIONS: This is a dedicated radiological study aiming to characterize the features of MOG antibody disease which might aid in the proper investigation of cases presenting with acquired demyelinating disorders.


Assuntos
Autoanticorpos/sangue , Encéfalo/diagnóstico por imagem , Doenças Autoimunes Desmielinizantes do Sistema Nervoso Central/diagnóstico por imagem , Doenças Autoimunes Desmielinizantes do Sistema Nervoso Central/imunologia , Glicoproteína Mielina-Oligodendrócito/imunologia , Nervo Óptico/diagnóstico por imagem , Trato Óptico/diagnóstico por imagem , Medula Espinal/diagnóstico por imagem , Adulto , Encéfalo/patologia , Doenças Autoimunes Desmielinizantes do Sistema Nervoso Central/sangue , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla/diagnóstico por imagem , Mielite Transversa/diagnóstico por imagem , Neuromielite Óptica/diagnóstico por imagem , Nervo Óptico/patologia , Trato Óptico/patologia , Estudos Retrospectivos , Medula Espinal/patologia
19.
Mult Scler Relat Disord ; 29: 48-54, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30669020

RESUMO

BACKGROUND: Several studies have reported the characteristics of acute multiple sclerosis (MS) lesions on diffusion-weighted magnetic resonance imaging (DWI MRI). Current publications reported a transient reduction of the apparent diffusion coefficient (ADC) delineating an early phase of lesion evolution, before increased diffusion occurs in parallel to blood-brain-barrier (BBB) breakdown. Sodium MRI might provide another perspective on lesion development, but clinical applications have been limited to high field MR systems. The objective in this study was to investigate the temporal evolution of acute MS lesions using conventional (T2-fluid-attenuated inversion recovery (T2-FLAIR) images, post-contrast T1-weighted images), diffusion and sodium MRI. METHODS: Initial and follow-up MRI (23Na and 1H MRI) were performed on a 3T scanner. Quantitative assessment of total sodium concentration (TSC) and ADC was performed. The study was designed for frequent follow-up MRI examinations during 4 weeks after the initial presentation. RESULTS: Thirty-one acute MS lesions (7 lesions with reduced diffusion) in eleven MS patients were included. On initial MRI, TSC in contrast-enhancing lesions was increased when compared to the normal-appearing white matter (NAWM), while lesions with an initial reduced diffusion showed a TSC comparable to the NAWM. On follow-up MRI, in lesions with reduced diffusion subsequent increase of ADC and TSC values occurred along with signs of the development of vasogenic edema and contrast-enhancement. After four weeks, TSC values decreased along with regression of vasogenic edema and contrast-enhancement. CONCLUSIONS: In lesions with a reduction of the ADC sodium levels are near normal and precede signs of BBB breakdown. These findings suggest a relatively preserved tissue structure in this early phase of lesion evolution.


Assuntos
Progressão da Doença , Imagem por Ressonância Magnética/métodos , Espectroscopia de Ressonância Magnética/métodos , Esclerose Múltipla/diagnóstico por imagem , Esclerose Múltipla/patologia , Sódio , Adulto , Imagem de Difusão por Ressonância Magnética/métodos , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Espectroscopia de Prótons por Ressonância Magnética/métodos , Adulto Jovem
20.
Mult Scler Relat Disord ; 28: 305-308, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30641355

RESUMO

BACKGROUND: Accidental falls and fall-related injuries are common among people with multiple sclerosis (MS). Fractures are the most common injury, pointing to the need to understand current practices related to bone health management in this population. We sought to identify factors associated with bone mineral density (BMD) screening, using dual-energy X-ray absorptiometry, among people with MS. METHODS: Using population-based databases from Manitoba, Canada, we identified all people with MS. Through linkage to the Manitoba Bone Mineral Density Database we subsequently determined which of these individuals underwent BMD screening following their MS diagnosis. We used Cox proportional hazards regression analysis to identify factors associated with time to BMD screening after MS diagnosis. RESULTS: Of the 5729 eligible persons with MS, most were females (n = 4032, 70.4%) and were living in an urban centre (n = 3601, 62.9%). Ten percent (n = 584) had suffered a recent fracture and nearly one-third used anticonvulsants. BMD screening occurred in 783 (13.7%). Factors associated with BMD screening were female sex (hazard ratio [HR] 5.34; 95%CI: 4.10-6.95), prolonged glucocorticoid therapy (HR 3.73; 95%CI: 2.64-5.25), breast cancer (HR 3.54; 95%CI: 2.37-5.30), recent fracture (HR 3.44; 95%CI: 2.39-4.90), continuity of care (HR 1.69; 95%CI: 1.17-2.44), greater disability (HR 1.49; 95%CI: 1.19-1.86), older age (HR/decade 1.34; 95%CI: 1.22-1.34), anticonvulsant use (HR 1.32; 95%CI: 1.06-1.63) and urban (versus rural) residence (HR 1.17; 95%CI: 1.00-1.36). CONCLUSION: Factors known to be associated with low BMD were associated with BMD screening in people with MS, but overall BMD screening rates are relatively low, suggesting that a clinically meaningful proportion of individuals with MS who have low bone mass may be missed.


Assuntos
Absorciometria de Fóton , Doenças Ósseas Metabólicas/diagnóstico , Doenças Ósseas Metabólicas/epidemiologia , Esclerose Múltipla/diagnóstico por imagem , Esclerose Múltipla/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Densidade Óssea , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla/terapia , Adulto Jovem
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA