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  • 1
    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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  • 2
    Electronic Resource
    Electronic Resource
    Sensitivity and reproducibility of volume change measurements of different brain portions on magnetic resonance imaging in patients with multiple sclerosis (2000)
    Springer
    Journal of neurology 247 (2000), S. 960-965 
    Details
    ISSN: 1432-1459
    Keywords: Key words Multiple sclerosis ; Brain volume ; Magnetic resonance ; Disease course ; Clinical trials
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The course of multiple sclerosis (MS) can be monitored by measuring changes in brain volume, but consensus is still lacking on the best strategy to be adoped. We compared the reproducibility and sensitivity of volume measurements from different brain portions for detecting changes on magnetic resonance imaging (MRI) in patients with MS. T1-weighted MRI of the brain was performed in 50 patients with relapsing-remitting MS at study entry and after an average follow-up of 18.4 months. Using a semiautomated technique for brain parenchyma segmentation, the volumes of the following brain portions were measured: (a) the whole brain (whole brain volume, WBV), (b) the seven slices rostral to the velum interpositum (seven-slice volume, SSV), (c) the central slice of the image set (central-slice volume, CSV) and (d) the infratentorial regions (infratentorial-brain volume, IBV). All these measurements were carried out by a single observer and were repeated twice on ten randomly selected scans to test the intra-observer reproducibility using the four strategies. At follow-up there was a significant decrease in all the measures of brain volume (P ranged from 0.002 to 〈 0.001). The univariate correlations between changes in WBV, SSV, CSV and IBV were all statistically significant, with the exception of that between changes in CSV and IBV; r values ranged from 0.34 (for the WBV/IBV correlation) to 0.80 (for the WBV/SSV correlation). The mean intra-observer coefficient of variations were 1.9% for WBV, 1.5% for SSV, 2.9% for CSV and 2.2% for IBV measurements. The measurement of volume on a portion of brain selectively including the regions in which MS pathology is more diffuse is as reliable and sensitive to disease-related changes as that on the whole brain, with significant time saving for processing.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004150070054
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  • 3
    Electronic Resource
    Electronic Resource
    MRI and motor evoked potential findings in nondisabled multiple sclerosis patients with and without symptoms of fatique (2000)
    Springer
    Journal of neurology 247 (2000), S. 506-509 
    Details
    ISSN: 1432-1459
    Keywords: Key words Multiple sclerosis ; Fatigue ; Magnetic resonance imaging ; Motor evoked potentials
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Fatique is a common symptom of multiple sclerosis (MS) even in the early phases of the disease, when neurological disability is usually still not present. To investigate the pathophysiology of fatigue we compared neurophysiological (motor evoked potentials of the four limbs, MEPs) and brain magnetic resonance imaging (MRI) findings in two groups of nondisabled MS patients, those with (n=15) and those without (n=15) fatigue. Fatigue was assessed by an interview and scored by the Fatigue Severity Scale. The two groups were matched for sex, age, disease duration, Expanded Disability Status Scale score, pyramidal Functional System (FS) score, and depression score. MEPs were abnormal in five patients with fatigue and in one patient without fatigue. A significant association was found between the patient scores on the Fatigue Severity Scale, and the burden of MRI lesions (r=0.5; P〈0.005). Significantly higher parietal lobe (P〈0.05), internal capsule (P〈0.05), and periventricular trigone (P〈0.05) lesion loads were found in patients with fatigue than in those without. Our results agree with a central nervous system origin of fatigue in MS patients. This symptom might be a consequence either of a functional deafferentation of the cortex due to cortico-subcortical interconnection damage or of a demyelination in critical sites of the CNS, such as the cortico-spinal tract.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004150070148
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  • 4
    Electronic Resource
    Electronic Resource
    Cardiac autonomic function during sleep and wakefulness in multiple sclerosis (1995)
    Springer
    Journal of neurology 242 (1995), S. 639-643 
    Details
    ISSN: 1432-1459
    Keywords: Multiple sclerosis ; Sleep ; Autonomic nervous system
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Some studies in multiple sclerosis (MS) patients have shown evidence of autonomic dysfunction involving the cardiovascular system. However, the findings in these studies have not been completely consistent. The discrepancy may be related to the limits of the traditional autonomic tests during wakefulness. In our study, after the investigation of the cardiovascular reflexes during wakefulness, heart rate (HR) variations were considered during sleep in order to avoid the limits of cooperation and the emotional state of the patient. We evaluated tonic (vagal activity) HR modifications in relation to the deepening of sleep, as well as phasic (sympathetic activity) HR modifications in relation to spontaneous body movements during sleep, in 25 MS patients and 25 age-matched controls. No difference was found between the two groups in autonomic function during wakefulness. A reduced parasympathetic activity was observed in MS subjects during both rapid eye movement (REM) and non-REM sleep, while no difference was found in sympathetic function between patients and controls. No significant correlation was found between cardiac autonomic data during sleep and MRI lesion load in the infratentorial areas and, in particular, of the brain stem. The findings of our study suggest that autonomic nervous system evaluation during sleep could show impairment earlier than the traditional autonomic tests during wakefulness.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00866913
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  • 5
    Electronic Resource
    Electronic Resource
    Patterns of disease activity in multiple sclerosis patients: A study with quantitative gadolinium-enhanced brain MRI and cytokine measurement in different clinical subgroups (1996)
    Springer
    Journal of neurology 243 (1996), S. 536-542 
    Details
    ISSN: 1432-1459
    Keywords: Multiple sclerosis ; Magnetic resonance imaging ; Gadolinium ; Cytokines
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract In this study we assessed the subclinical disease activity in 45 patients with primary progressive, secondary progressive or relapsing-remitting multiple sclerosis (MS). The patients had gadolinium-enhanced brain MRI scans, which were analysed using a semiquantitative method both for lesion load and for degree of enhancement. At the same time cerebrospinal fluid (CSF) and serum samples were collected and, from these, cytokine levels were measured in most cases by enzyme-linked immunoassay using commercially available kits. Enhancing lesions on MRI were found in 73% of the patients. The sensitivity of this test was greatly increased by our method of analysis as far as the primary progressive patients are concerned (70% vs 40% for conventional evaluation). CSF interleukin-1 β (IL-1 β) levels were above the normal range in 22% and IL-6 levels in 13% of patients, while tumour necrosis factor alpha (TNF-α) was undetectable or below the upper normal limits in all the samples tested. Serum IL-1 β was above the normal limits in 40%, IL-6 in 42% and TNF-α in 7% of patients. No significant differences in cytokine profiles were found between the clinical subgroups. This study confirms the high sensitivity of gadolinium-enhanced MRI in detecting MS activity, which was further increased by our method of analysis. Longitudinal studies performed with more sensitive immunological techniques are needed to define better the relationship between cytokine, clinical and MRI data in MS patients.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00886876
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  • 6
    Electronic Resource
    Electronic Resource
    Intra-observer reproducibility in measuring new putative MR markers of demyelination and axonal loss in multiple sclerosis: a comparison with conventional T2-weighted images (1997)
    Springer
    Journal of neurology 244 (1997), S. 266-270 
    Details
    ISSN: 1432-1459
    Keywords: Key words Multiple sclerosis ; Magnetic resonance imaging ; Magnetisation tranfer imaging ; Spinal cord ; Measurement ; reproducibility
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract New magnetic resonance (MR) measures considered to be putative markers of demyelination and axonal loss were found to be more closely related to clinical disability than T2-weighted MR imaging (MRI) findings in patients with multiple sclerosis (MS). In this study, we evaluated the reproducibility of such measurements in order to assess their reliability for longitudinal studies in MS. The intra-observer coefficients of variation for repeated measurements did not significantly differ among the MR techniques studied [2.6% for T2-weighted MRI, 4.38% for unenhanced T1-weighted MRI, 3.65% for magnetisation transfer imaging (MTI) and 2.28% for spinal cord cross-sectional area at C5]. Our findings suggest that non-conventional MR techniques may be reliable outcome measures for clinical trials in MS.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004150050083
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    Paper (German National Licenses)
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  • 7
    Electronic Resource
    Electronic Resource
    The effect of repositioning on brain MRI lesion load assessment in multiple sclerosis: reliability of subjective quality criteria (1998)
    Springer
    Journal of neurology 245 (1998), S. 273-275 
    Details
    ISSN: 1432-1459
    Keywords: Key words Multiple sclerosis ; Brain magnetic resonance imaging ; Repositioning ; Clinical trials
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The aim of this study was to assess the variability of lesion load measurements for repeated brain magnetic resonance imaging (MRI) scans judged to have either poor or good repositioning quality on the basis of subjective criteria used for clinical trials in multiple sclerosis (MS). Scan-rescan variability was also compared with the intra-observer variability assessed from three repeated volume measurements of the same scan. Nine patients with MS were studied; each of them underwent the scan-rescan procedure on the same day. Five scans were considered to have poor and four scans to have good repositioning. Between these two groups there were no differences in either the mean lesion loads or the measurement variance. For the whole group of patients, the intra-observer variability of repeated measurements gave a significantly lower coefficient of variation (COV=4.9%) than the variability owing to repositioning (COV=8.9%, P〈0.01, F test). Our results confirm that the effect of repositioning on brain MRI lesion load assessment is stronger than that owing to the intra-observer variability for repeated measurements and indicate that the simple visual judgment about the scan repositioning quality seems unable to predict the scan-rescan reproducibility.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004150050217
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