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  • 1
    Electronic Resource
    Electronic Resource
    Antenatal diagnosis of vein of Galen aneurysmal malformation: MR study of fetal brain and postnatal follow-up (1995)
    Springer
    Neuroradiology 38 (1995), S. 87-90 
    Details
    ISSN: 1432-1920
    Keywords: Key words Vein of Galen aneurysmal malformation ; Prenatal diagnosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract About 20 cases of prenatal diagnosis of vein of Galen aneurysmal Malformation (VGAM) have been described. We present a case diagnosed prenatally by Doppler ultrasonography. Prenatal MRI and postnatal radiological studies including post-treatment MRI and MRA, were carried out.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00593231
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  • 2
    Electronic Resource
    Electronic Resource
    Interobserver agreement for diagnostic MRI criteria in suspected multiple sclerosis (1999)
    Springer
    Neuroradiology 41 (1999), S. 347-350 
    Details
    ISSN: 1432-1920
    Keywords: Key words Multiple sclerosis ; Magnetic resonance imaging ; Interobserver variation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract MRI is the paraclinical test most widely used to support the diagnosis of multiple sclerosis (MS). We evaluated interobserver agreement in applying diagnostic criteria to MRI obtained at first presentation. Five experienced observers scored 25 sets of images consisting of unenhanced T2- and gadolinium-enhanced T1-weighted images (approximately half the sets were normal). We scored frontal, parietal, temporal, occipital, infratentorial and basal ganglia lesions and the total number of lesions on T2-weighted images; periventricular, callosal, juxtacortical and ovoid lesions and those 〉 5 mm in maximum diameter; contrast-enhancing and hypointense lesions. Based on a combination of imaging findings patients were classified as compatible or not compatible with MS according to composite criteria. Observer concordance was characterised by weighted kappa values (ϰ) and mean average difference to the median (MADM) scores. Using the raw scores, there was poor agreement for the total number of lesions on T2-weighted images, and for occipital, oval, juxtacortical and hypointense lesions. Moderate agreement was found for frontal, callosal, basal ganglia and large lesions on T2 weighting. Good agreement was attained for parietal, temporal, infratentorial and periventricular lesions. After dichotomisation according to accepted cut-off values, most criteria performed better, especially the number of lesions on T2-weighted images (P 〈 0.05). Good agreement was found for the criteria of Paty and Fazekas and moderate agreement for those of Barkhof. While experienced observers may not agree on the total number of lesions, they show quite good agreement for commonly used cut-off points and elements in the composite criteria. This validates the use of MRI in the diagnosis of MS, and the use of dichotomised and composite criteria.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002340050762
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  • 3
    Electronic Resource
    Electronic Resource
    Visual analysis of serial T2-weighted MRI in multiple sclerosis: intra- and interobserver reproducibility (1999)
    Springer
    Neuroradiology 41 (1999), S. 882-888 
    Details
    ISSN: 1432-1920
    Keywords: Key words Multiple sclerosis ; Magnetic resonance imaging
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract We evaluated the effect of consensus formation and training on the agreement between observers in scoring the number of new and enlarging multiple sclerosis (MS) lesions on serial T2-weighted MRI studies. The baseline and month 9 MRI studies of 16 patients with a range of MRI activity were used (dual-echo conventional spin-echo sequence, TR 2000, TE 34 and 90 ms, 5 mm contiguous slices, in-plane resolution 1 mm). First, the serial studies were visually analysed for the presence of new and enlarging lesions, on two occasions, by five experienced observers, without adopting any consensus strategy and in isolation. Next, the observers met to identify the common sources of inconsistencies in reporting between observers and formulate consensus rules. Finally, a further independent reading session was performed on the same MRI dataset, this time applying the consensus rules. Agreement between observers was assessed using kappa scores. Without the consensus rules, interobserver kappa scores for the first and second reading sessions for new lesions were only 0.51 and 0.39 respectively; agreement for enlarging lesions was even worse. The mean intraobserver kappa score for new lesions was higher at 0.72, reflecting the fact that the observers were consistently applying their individual assessment strategies. Application of the consensus rules did not lead to a significant improvement in inter observer kappas; the kappa scores adopting the guidelines were 0.46 and 0.21 for new and enlarging lesions respectively. Consensus guidelines thus did not improve the reproducibility of visual analysis of serial T2-weighted MRI, and the level of agreement between observers remained only moderate. Suboptimal repositioning is likely to be a major source of residual variability and this suggests a future role for image registration strategies; until then, a single observer, or pair of observers working in consensus, should be used in MS studies.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002340050860
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  • 4
    Electronic Resource
    Electronic Resource
    Diffusion-weighted imaging in multiple sclerosis (1999)
    Springer
    Italian journal of neurological sciences 20 (1999), S. S246 
    Details
    ISSN: 1126-5442
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Diffusion-weighted imaging (DWI) provides a unique form of magnetic resonance (MR) contrast that enables the diffusional motion of water molecules to be quantitatively measured. As a consequence, DWI provides information about the orientation, size and geometry of brain structures. Cellular structures in the central nervous system restrict water molecular motion, and the apparent diffusion coefficient (ADC) is reduced compared to diffusion in bulk water. Pathological processes that modify tissue integrity, thus removing some of the “restricting” barriers, can result in increased ADC. Preliminary studies in multiple sclerosis (MS) using DWI showed that the ADC is higher in macroscopic lesions than in the normal appearing white matter (NAWM). The ADC is also dependent on the direction in which diffusion is measured, thus making comparison of ADC values meaningless without taking into account the measurement direction. One measurement of diffusion that is independent of the orientation of structures is provided by measuring the ADC in three orthogonal directions, and then averaging the results to form the mean diffusivity, ${\overline D}$ . We obtained DW scans from 35 patients with relapsing-remitting MS and 24 healthy volunteers. ${\overline D}$ was measured inside T2-visible lesions and regions located in different areas of the NAWM. ${\overline D}$ histograms from a large portion of the brain were created. MS lesions had a significantly higher ${\overline D}$ than NAWM. T1-hypointense lesions had the highest diffusion values, consistent with more severe tissue disruption. ${\overline D}$ was higher in the NAWM from patients than in the white matter from healthy controls. We also found significant differences between ${\overline D}$ histogram-derived measures from patients and controls, confirming the presence of diffuse damage in the brain of patients with MS.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s100729970005
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  • 5
    Electronic Resource
    Electronic Resource
    Introduction (1999)
    Springer
    Italian journal of neurological sciences 20 (1999), S. S227 
    Details
    ISSN: 1126-5442
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s100729970001
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  • 6
    Electronic Resource
    Electronic Resource
    Magnetization transfer imaging to monitor the evolution of multiple sclerosis (1999)
    Springer
    Italian journal of neurological sciences 20 (1999), S. S232 
    Details
    ISSN: 1126-5442
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Magnetization transfer imaging (MTI) is a magnetic resonance imaging (MRI) technique that is now used in multiple sclerosis (MS) studies, and is thought to have a higher pathological specificity than conventional T2-weighted imaging. This review outlines the major contributions given by MTI for the understanding of MS evolution. MTI studies of individual MS lesions confirm the pathological heterogeneity of T2-weighted MRI abnormalities and the potential role of unenhanced T1-weighted hypointensities as specific markers of localized severe white matter disruption. Correlative cross-sectional and longitudinal studies using MIT and gadolinium (Gd)-enhanced MRI reveal that MTI findings may vary in lesions with different patterns of enhancement, and that MTI abnormalities are closely related to the onset and recovery of blood-brain barrier disruption in new MS plaques. MTI lesion load (LL) is highly correlated with T2-weighted MRI lesion load, but it has a limited reliability as a measure of MS lesion burden. On the other hand, measures obtained from MT scans using whole-brain histogram analysis are highly correlated with the extent of MS abnormalities on conventional MRI scans, and predict patients' clinical disability well, since they are sensitive to both macro- and microscopic MS lesion burden in the whole brain and in specific regions. These data suggest that (a) MTI is sensitive to different stages of lesion pathology and pathological evolution in MS patients; and (b) MT histogram analysis can provide a more global assessment of MS lesion burden, since it encompasses both macro- and microscopic MS pathology.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s100729970003
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  • 7
    Electronic Resource
    Electronic Resource
    Multiple sclerosis: interobserver agreement in reporting active lesions on serial brain MRI using conventional spin echo, fast spin echo, fast fluid-attenuated inversion recovery and post-contrast T1-weighted images (1999)
    Springer
    Journal of neurology 246 (1999), S. 920-925 
    Details
    ISSN: 1432-1459
    Keywords: Key words Multiple sclerosis ; Magnetic resonance imaging ; Disease activity ; Fast spin echo ; Fast fluid-attenuated inversion ; recovery ; Reproducibility
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Previous studies have addressed the question of the precision in assessing multiple sclerosis (MS) activity by counting enhancing lesions on gadolinium enhanced brain magnetic resonance imaging (MRI). However, counting the active lesions on serial unenhanced MRI obtained by various pulse sequences has not been yet considered. We compared the interobserver levels of agreement in reporting active MS lesions on serial enhanced and unenhanced MRI to assess whether the use of various unenhanced techniques may change the degree of interobserver measurement reproducibility. Dual-echo conventional spin echo (CSE), dual-echo fast spin echo (FSE), fast fluid-attenuated inversion recovery (FLAIR) and Gd-enhanced T1-weighted brain MRI were obtained from five MS patients at baseline and monthly for 2 months. Six experienced observers independently identified and counted active MS lesions on the two follow-up MRI scans. Active lesions were considered to be all the enhancing lesions and any new or enlarging lesion on enhanced and unenhanced scans. Interobserver levels of agreement were calculated by weighted κ values. Very good agreement was reached only for counting total and new Gd-enhancing lesions. Good agreement was achieved for counting new lesions on the three unenhanced techniques, whereas the agreement for counting enlarging lesions was poor with all the MRI techniques. The level of agreement was significantly heterogeneous for various MRI techniques but not for various lesion sites. These results confirm that counting enhancing lesions is the most reliable method for assessing MS activity, but the use of any of the available unenhanced MRI techniques did not result in different levels of interobserver agreement when reporting new and enlarging MS lesions on serial scans.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004150050483
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  • 8
    Electronic Resource
    Electronic Resource
    A comparison of the sensitivity of monthly unenhanced and enhanced MRI techniques in detecting new multiple sclerosis lesions (1999)
    Springer
    Journal of neurology 246 (1999), S. 97-106 
    Details
    ISSN: 1432-1459
    Keywords: Key words Multiple sclerosis ; Conventional spin-echo ; Fast ; fluid-attenuated inversion recovery ; Post-contrast T1-weighted scans
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract In this longitudinal study, the sensitivities of three magnetic resonance imaging techniques for detecting the appearance of new lesions in multiple sclerosis (MS) were evaluated and compared. Dual-echo conventional spin-echo (CSE), fast fluid-attenuated inversion recovery (fast-FLAIR) and post-contrast T1-weighted scans were obtained on four occasions, each separated by 28 days, from 18 patients with relapsing-remitting MS using a 1.5-T machine. New lesions seen using each sequence during the follow-up were counted by agreement by four observers in two stages (stage 1: random review of complete sets of scans from each technique; stage 2: side-by-side review with a ‘retrospective’ count of new lesions). At stage 1, 1.44 new lesions per patient per month were detected on CSE scans, 1.88 on fast-FLAIR (31% more than CSE) and 2.07 on post-contrast T1-weighted scans (44% more than CSE) (P = 0.03). Differences were, however, reduced after stage 2: fast-FLAIR detected 29% and post-contrast T1-weighted scans detected 31% more new lesions than CSE (P = 0.08). The combination of fast-FLAIR and post-contrast scans detected 144 new lesions, whilst the usual combination of CSE and post-contrast scans detected 133 new lesions. This study indicates that enhanced MRI remains the most sensitive method for detecting ‘active’ lesions in MS and that fast-FLAIR may be used when monitoring short-term disease activity in MS, either natural or modified by treatment.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004150050315
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  • 9
    Electronic Resource
    Electronic Resource
    Acute myelopathy of unknown aetiology: a clinical, neurophysiological and MRI study of short-and long-term prognostic factors (1995)
    Springer
    Journal of neurology 242 (1995), S. 497-503 
    Details
    ISSN: 1432-1459
    Keywords: Acute myelopathy ; Magnetic resonance imaging ; Evoked potentials ; Multiple sclerosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Brain and spinal cord magnetic resonance imaging (MRI), multimodal evoked potentials (EPs) and cerebrospinal fluid (CSF) analysis were performed in 27 patients with acute myelopathy of unknown aetiology (AMUA), to detect the diagnostic and prognostic values of paraclinical tests at presentation. Spinal cord MRI was abnormal in 56% and brain MRI in 33% of the patients. Visual EPs were abnormal in 7%, median somatosensory EPs in 17%, tibial somatosensory EPs in 56% and motor EPs in 35% of the cases examined. Brain-stem acoustic EPs were normal in all the patients. CSF oligoclonal bands (OBs) were detected in 30% of cases. The patients were divided into subgroups according to the short-term clinical outcome (complete, partial or absent recovery). There were no significant differences among the three groups as regards MRI findings. Patients with complete recovery showed a significantly lower frequency of tibial somatosensory EP and motor EP abnormalities. According to the paraclinical findings at onset and on the basis of a long-term clinical follow-up (mean duration 24 months), 6 patients were diagnosed as having clinically definite multiple sclerosis, while 21 did not develop further neurological disturbances. Only the presence of CSF OBs was significantly more frequent in patients with definite multiple sclerosis. Our study indicates that EPs exploring spinal cord function are more powerful than spinal MRI for predicting the short-term outcome of AMUA, while the combined use of brain MRI and CSF OBs has the highest negative predictive value for the subsequent development of clinically definite multiple sclerosis.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00867419
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  • 10
    Electronic Resource
    Electronic Resource
    Fatigue and magnetic resonance imaging activity in multiple sclerosis (1999)
    Springer
    Journal of neurology 246 (1999), S. 454-458 
    Details
    ISSN: 1432-1459
    Keywords: Key words Multiple sclerosis ; Fatigue ; Magnetic resonance ; imaging
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Fatigue is a frequent and often severe symptom in multiple sclerosis. Pathogenic mechanisms proposed for fatigue include the release of proinflammatory cytokines, which is thought to have an important effect on changes in the blood-brain barrier (BBB). To investigate whether fatigue is related to BBB disruption we studied 11 relapsing-remitting MS patients participating in a multicenter longitudinal study comparing the sensitivity of monthly enhanced magnetic resonance imaging (MRI) after standard-dose and triple-dose injection of gadolinium-diethylene triaminopentoacetic acid (Gd-DTPA). Serial Gd-enhanced MRI studies were performed in two separate sessions every 4 weeks for 3 months. An expanded version of the Fatigue Severity Scale, including 29 items, was administered 24 h before each MRI examination. No relationship was found between the number and volume of Gd-enhancing lesions and fatigue scores at any monthly examination over the study period. Furthermore changes in MRI activity were not significantly related to changes in fatigue scores. These results were obtained on triple-dose delayed scanning, which is more sensitive than standard-dose scanning in detecting areas of BBB disruption. Our preliminary results thus do not support the hypothesis of a relationship between BBB alterations and fatigue severity in multiple sclerosis.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004150050382
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