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Background and Purpose— Early neurological deterioration (END) occurs in approximately one third of all ischemic stroke patients and is associated with a poor outcome. Our study sought to assess the value of ultra-early MRI in the... more
Background and Purpose— Early neurological deterioration (END) occurs in approximately one third of all ischemic stroke patients and is associated with a poor outcome. Our study sought to assess the value of ultra-early MRI in the prediction of END in stroke patients. Methods— Between August 1999 and November 2001, 38 stroke patients with a proven middle cerebral artery (MCA) or intracranial internal carotid artery (ICA) occlusion on MR angiography underwent perfusion-weighted imaging (PWI) and diffusion-weighted imaging (DWI) within 6 hours after onset, and 30 fulfilled all inclusion criteria. Control DWI and MR angiography were performed between days 3 and 5. Cranial CT was performed to rule out hemorrhagic transformation. Vascular risk factors, temperature, blood pressure, glycemia, and blood count were assessed on admission. National Institutes of Health Stroke Scale (NIHSS) scores were obtained at baseline and at 6, 12, 24, and 48 hours. At the same time points, transcranial Do...
Research Interests: Cardiology, Magnetic Resonance Imaging, Humans, Diffusion, Female, and 15 moreBrain Ischemia, Ischemic Stroke, Clinical Sciences, Angiography, Aged, Adult, Disease Progression, Logistic Models, Brain Edema, Internal Carotid Artery, Magnetic resonance angiography, Magnetic resonance image, Acute Disease, Cardiovascular medicine and haematology, and Carotid artery diseases
Background and Purpose— Multiparametric imaging is meant to identify nonreversible lesions and predict on admission the minimum final infarct volume, a strong predictor of outcome. We aimed to confirm this hypothesis and define the... more
Background and Purpose— Multiparametric imaging is meant to identify nonreversible lesions and predict on admission the minimum final infarct volume, a strong predictor of outcome. We aimed to confirm this hypothesis and define the maximal admission lesion volume compatible with favorable outcome (MALCOM). Methods— We studied patients with internal carotid artery/middle cerebral artery occlusion selected with multiparametric computed tomography/magnetic resonance imaging, who underwent endovascular procedures. Admission infarct core was measured on initial cerebral blood volume–computed tomography perfusion or diffusion weighted imaging–magnetic resonance imaging. We defined percentage of lesion growth (final lesion admission core/admission core) and MALCOM: cutoff admission core volume above which probability of modified Rankin Scale 0 to 2 is <10%. Results— Fifty-seven patients were studied (29 magnetic resonance imaging and 28 computed tomography perfusion). Mean core volume w...
Research Interests: Magnetic Resonance Imaging, Medicine, Brain, Humans, Female, and 15 moreMale, Clinical Sciences, Aged, Middle Aged, Lesion, Age Factors, Neurosciences, Logistic Models, Middle Cerebral Artery, Cohort Studies, Endovascular Procedures, Diffusion magnetic resonance imaging, modified Rankin Scale, Cardiovascular medicine and haematology, and Mechanical thrombolysis
We describe two cases of atypical acute Schmörl's nodes, one benign, the other on a tumoral vertebra. In both cases, MR imaging showed a decreased vertebral T1 signal and a slightly increased T2 signal. These signal intensities are... more
We describe two cases of atypical acute Schmörl's nodes, one benign, the other on a tumoral vertebra. In both cases, MR imaging showed a decreased vertebral T1 signal and a slightly increased T2 signal. These signal intensities are indistinguishable from tumoral disease or inflammatory lesions. The identification of endplate defects or intranuclear cleft bending of the disk by either CT or MR may be helpful for the correct diagnosis of acute Schmörl's nodes.
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Radiologic assessment of acute transient ischemic attacks (TIAs) has been handicapped by the low sensitivity of CT and conventional MR imaging for acute small-vessel infarction and the difficulty in differentiating between acute and... more
Radiologic assessment of acute transient ischemic attacks (TIAs) has been handicapped by the low sensitivity of CT and conventional MR imaging for acute small-vessel infarction and the difficulty in differentiating between acute and chronic lesions by use of these methods. Our purpose was to evaluate the incidence of TIA-related infarction by using diffusion-weighted MR imaging to determine whether the presence of a diffusion imaging abnormality correlates with the duration of symptoms or cause of TIA. We prospectively studied 58 consecutive patients with acute TIA by use of diffusion-weighted imaging. All MR imaging was performed with a 1.5-T whole-body system with 24-mT/m gradient strength and an echo-planar-capable receiver. All patients were imaged within 10 days of stroke onset. Thirty-nine patients (67%) manifested a diffusion imaging abnormality consistent with acute ischemia. Cortical lesions were identified in 54% of these patients; most of them associated with other acute ...
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Research Interests: Immunology, Multiple sclerosis, Biomarkers, Biology, Medicine, and 15 moreCerebrospinal Fluid, Humans, Female, Neuroinflammation, Male, Clinically isolated syndrome, Apolipoprotein B, Clinical Sciences, Middle Aged, Adult, Biological markers, Disease Progression, Neurosciences, Enzyme Linked Immunosorbent Assay, and Demyelinating diseases
Background and Purpose— We sought to evaluate the impact of the speed of recanalization on the evolution of diffusion- weighted imaging (DWI) lesions and outcome in stroke patients treated with tissue-type plasminogen activator (tPA).... more
Background and Purpose— We sought to evaluate the impact of the speed of recanalization on the evolution of diffusion- weighted imaging (DWI) lesions and outcome in stroke patients treated with tissue-type plasminogen activator (tPA). Methods— We evaluated 113 consecutive stroke patients with a middle cerebral artery occlusion who were treated with intravenous tPA. All patients underwent multiparametric magnetic resonance imaging studies, including DWI and perfusion-weighted imaging before and 36 to 48 hours after administration of a tPA bolus. Patients were continuously monitored with transcranial Doppler during the first 2 hours after tPA administration. The pattern of recanalization on transcranial Doppler was defined as sudden (<1 minute), stepwise (1 to 29 minutes), or slow (>30 minutes). Results— During transcranial Doppler monitoring, 13 (12.3%) patients recanalized suddenly, 32 (30.2%) recanalized in a stepwise manner, and 18 (17%) recanalized slowly. Baseline clinical...
Research Interests: Magnetic Resonance Imaging, Evolution, Medicine, Stroke, Humans, and 15 moreFemale, Male, Speed, Clinical Sciences, Aged, Middle Aged, Adult, Lesion, Neurosciences, Predictive value of tests, Middle Cerebral Artery, Magnetic resonance image, Diffusion magnetic resonance imaging, Middle cerebral artery occlusion, and Cardiovascular medicine and haematology
Background and Purpose— Recently, a new definition of transient ischemic attack (TIA) has been proposed based on the duration of symptoms and diffusion-weighted imaging (DWI) findings. We investigate the value of temporal and neuroimaging... more
Background and Purpose— Recently, a new definition of transient ischemic attack (TIA) has been proposed based on the duration of symptoms and diffusion-weighted imaging (DWI) findings. We investigate the value of temporal and neuroimaging data on the prognoses of TIA patients. Methods— Clinical data, symptom duration, DWI, and ultrasonographic findings were collected in 83 consecutive classical TIA patients attended in the emergency department. Stroke recurrence, myocardial infarction, or any vascular event was recorded at follow-up (mean of 389 days). Results— A total of 27 (32.5%) patients revealed focal abnormalities on DWI, whereas 37(44.6%) had symptoms lasting >1 hour. Large-artery disease was detected in 37 (44.6%) patients. Twenty (24.1%) patients experienced an endpoint: 2 (2.4%) myocardial infarctions, 16 (19.3%) cerebral ischemic events, and 2 cases (2.4%) of peripheral arterial disease. Cox proportional hazards multivariate analyses identified the association of sympt...
Research Interests: Cardiology, Medicine, Diffusion MRI, Humans, Internal Medicine, and 15 moreFemale, Male, Clinical Sciences, Aged, Middle Aged, Clinical Data, Cerebral Ischemia, Diffusion Weighted MRI, Emergency Department, Magnetic resonance image, Diffusion magnetic resonance imaging, High risk, Cardiovascular medicine and haematology, multivariate analyses, and hazard ratio
Background and Purpose— Lesions in diffusion-weighted imaging (DWI-L) have been commonly described in transient global amnesia (TGA). We investigated a possible relationship between brain ischemia and TGA. Methods— Twenty-eight patients... more
Background and Purpose— Lesions in diffusion-weighted imaging (DWI-L) have been commonly described in transient global amnesia (TGA). We investigated a possible relationship between brain ischemia and TGA. Methods— Twenty-eight patients underwent transcranial and carotid Doppler ultrasonography (including microembolus detection) and MRI within 24 hours of TGA onset (including DWI, perfusion-weighted imaging and angio-MRI). MRI was repeated at 48 to 96 hours (21 patients) and 30 days (18 patients). Results— Punctate DWI-L were observed in 16 patients (57%) and were not attributable to perfusion abnormalities, arterial stenoses or underlying cardioembolic disease. MRIs performed between 12 and 72 hours showed the highest frequency of DWI-L (88%; P <0.001). No pathological findings were observed at 30 days. Conclusions— These results suggest that TGA is not related to cerebral arterial ischemia.
Research Interests: Magnetic Resonance Imaging, Medicine, Stroke, Humans, Ischemia, and 15 moreUltrasonography, Female, Male, Perfusion, Brain Ischemia, Transient Global Amnesia, Clinical Sciences, Aged, Middle Aged, Transcranial Doppler, Nuclear Magnetic Resonance Imaging, Neurosciences, Magnetic resonance angiography, Carotid Arteries, and Cardiovascular medicine and haematology
Background and Purpose— There has been speculation that the risk of secondary symptomatic intracranial hemorrhage (SICH) may be increased after thrombolytic therapy in ischemic stroke patients who have cerebral microbleeds (CMBs) on... more
Background and Purpose— There has been speculation that the risk of secondary symptomatic intracranial hemorrhage (SICH) may be increased after thrombolytic therapy in ischemic stroke patients who have cerebral microbleeds (CMBs) on T2*-weighted magnetic resonance imaging. Because of this concern, some centers withhold potentially beneficial thrombolytic therapy from these patients. Methods— We analyzed magnetic resonance imaging data acquired within 6 hours after symptom onset from 570 ischemic stroke patients treated with intravenous tissue plasminogen activator in 13 centers in Europe, North America, and Asia. Baseline T2*-weighted magnetic resonance images were evaluated for the presence of CMBs. The primary end point was SICH, defined as clinical deterioration with an increase in the National Institutes of Health Stroke Scale score by ≥4 points, temporally related to a parenchymal hematoma on follow-up-imaging. Results— A total of 242 CMBs were detected in 86 of 570 patients (1...
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Background and Purpose— Matrix metalloproteinases (MMPs) are involved in tissue destruction produced by the neuroinflammatory response that follows ischemic stroke. In the present study we use an MMP array to investigate the blood levels... more
Background and Purpose— Matrix metalloproteinases (MMPs) are involved in tissue destruction produced by the neuroinflammatory response that follows ischemic stroke. In the present study we use an MMP array to investigate the blood levels of several MMPs in stroke patients and its relation with brain tissue damage and neurological outcome. Methods— Twenty-four patients with middle cerebral artery occlusion who received thrombolytic therapy were included. Blood samples were drawn before tissue plasminogen activator treatment and an MMP array (multiplex enzyme-linked immunosorbent assay [ELISA]) was performed including gelatinases (MMP-2 and MMP-9), collagenases (MMP-1, MMP-8, and MMP-13), stromelysines (MMP-3 and MMP-10), and MMP endogen inhibitors (TIMP-1 and TIMP-2). To assess tissue lesion a serial multimodal MRI study was performed (pretreatment and at 24 hours). Results— Neither initial diffusion lesion nor hypoperfused volume was associated with metalloproteinase expression with...
Research Interests: Magnetic Resonance Imaging, Diffusion MRI, Brain, Humans, Diffusion, and 15 moreFemale, Blood sampling, Male, Cell Death, Ischemic Stroke, Brain injury, Difusion, Clinical Sciences, Aged, Lesion, Diffusion Weighted MRI, Enzyme Linked Immunosorbent Assay, Matrix Metalloproteinase, Magnetic resonance image, and Cardiovascular medicine and haematology
Background and Purpose— Angiogenesis may be beneficial in chronic myocardial and limb ischemia, but its role in intracranial atherosclerosis remains unknown. We aimed to investigate the relationship between the pro-angiogenic vascular... more
Background and Purpose— Angiogenesis may be beneficial in chronic myocardial and limb ischemia, but its role in intracranial atherosclerosis remains unknown. We aimed to investigate the relationship between the pro-angiogenic vascular endothelial growth factor (VEGF) and the anti-angiogenic endostatin, and the extent and risk of recurrence of symptomatic intracranial atherosclerosis. Methods— Of a total of 94 consecutive patients with symptomatic intracranial stenoses, 40 fulfilled all inclusion criteria. Intracranial stenoses were confirmed by magnetic resonance angiography. Magnetic resonance imaging (MRI) including diffusion-weighted sequences was conducted. Plasmatic VEGF and endostatin were determined from blood samples obtained 3 months after stroke onset, and patients were followed-up thereafter. Results— A total of 144 intracranial stenoses were confirmed (median number per patient=3). Endostatin/VEGF ratio gradually augmented with the increasing number of intracranial steno...
Research Interests: Magnetic Resonance Imaging, Medicine, Angiogenesis, Prospective studies, Humans, and 15 moreInternal Medicine, Female, Male, Brain Ischemia, Risk factors, Recurrence, Clinical Sciences, Aged, Risk Factors, Neurosciences, Magnetic resonance angiography, Disease Free Survival, Cardiovascular medicine and haematology, Endostatin, and hazard ratio
Background and Purpose —Functional assessment of small arteries and arterioles could provide valuable information regarding the extent of diffuse arteriolosclerosis in patients with small-vessel disease. Therefore we attempted to clarify... more
Background and Purpose —Functional assessment of small arteries and arterioles could provide valuable information regarding the extent of diffuse arteriolosclerosis in patients with small-vessel disease. Therefore we attempted to clarify the role of cerebrovascular reactivity (CVR) as a risk marker for first-ever symptomatic lacunar infarction. Methods —Forty-six patients with lacunar infarction and 46 sex- and age-matched control subjects were prospectively evaluated. Cerebral hemodynamics were studied with transcranial Doppler ultrasonography. CVR was examined by calculating the percent increase in mean flow velocity occurring after 15 mg/kg acetazolamide administration (Diamox test). Results —CVR was significantly ( P <0.0001, Student’s t test) lower in cases (50.0±12.7%) as compared with control subjects (65.2±12.4%). A multiple logistic regression analysis identified male sex (odds ratio [OR] 2.3, P =0.02), age (OR 3.6, P <0.005), and the presence of lacunar infarction on...
Research Interests: Cardiology, Forecasting, Humans, Internal Medicine, Hypertension, and 15 moreHemodynamics, Female, Confidence intervals, Clinical Sciences, Acetazolamide, Chi Square Distribution, Blood Flow Velocity, Logistic Models, Lacunar Stroke, Cerebral Infarction, Case Control Studies, Infarction, Arterioles, Cardiovascular medicine and haematology, and cerebral arteries
Research Interests: Multiple sclerosis, Magnetic Resonance Imaging, Medicine, Brain, Humans, and 12 moreFemale, Male, Longitudinal Studies, Antibody, New England, Myelin Proteins, Disease Progression, New England Journalof Medicine, Autoantibodies, Medical and Health Sciences, myelin associated glycoprotein , and myelin basic protein
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Research Interests: Pathology, Neurology, Magnetic Resonance Imaging, Medicine, Humans, and 15 moreAutoimmune Disease, Neuroradiology, Female, Disease, Differential Diagnosis, Prednisolone, Clinical Sciences, Middle Aged, Mr Imaging, Encephalopathy, Neurosciences, Autoantibodies, Brain Diseases, Methylprednisolone, and autoimmune thyroid disease
To evaluate impact of glucose burden on diffusion-weighted imaging (DWI)-lesion evolution according to ischemia duration in stroke. We studied 47 patients with transcranial Doppler (TCD)-documented artery occlusion treated with... more
To evaluate impact of glucose burden on diffusion-weighted imaging (DWI)-lesion evolution according to ischemia duration in stroke. We studied 47 patients with transcranial Doppler (TCD)-documented artery occlusion treated with intravenous tissue plasminogen activator. Hyperglycemia (HG) was defined as glucose > 140 mg/dL. A subcutaneous device continuously monitored glucose during 24 h. Magnetic resonance imaging was performed pretreatment (1) and at 24 to 36 h (2) in 30 patients. We measured initial PWI lesion (PW1) and DWI growth: DW2–DW1 (DWg). Serial TCD during 24 h determined occlusion time (OT). National Institutes of Health Stroke Scale (NIHSS) scores were obtained at baseline and 48 h. Poor short-term clinical course defined as <50% recovery of initial NIHSS. Baseline NIHSS was 18. On admission 10 patients (21.3%) were hyperglycemic and presented similar NIHSS, DW1, and PW1 lesion extension as those without HG. During monitoring 24 patients (51%) had HG, 21 (45%) of t...
Research Interests: Magnetic Resonance Imaging, Medicine, Brain, Humans, Internal Medicine, and 15 moreHyperglycemia, Blood Glucose, Brain Circulation, Ischemia, Female, Male, Brain Ischemia, Clinical Sciences, Aged, Cerebral, Lesion, Brain Damage, Magnetic resonance image, Diffusion magnetic resonance imaging, and Cardiovascular medicine and haematology
Sixteen patients with acute middle cerebral artery stroke were studied to correlate neuroinflammatory markers with perfusion- and diffusion-weighted magnetic resonance imaging (MRI) lesion volumes (PWI and DWI). At arrival (less than 6... more
Sixteen patients with acute middle cerebral artery stroke were studied to correlate neuroinflammatory markers with perfusion- and diffusion-weighted magnetic resonance imaging (MRI) lesion volumes (PWI and DWI). At arrival (less than 6 hours), plasmatic matrix metalloproteinase (MMP)-9, MMP-2, interleukin (IL)-6, IL-8, intercellular adhesion molecule (ICAM)-1, and tumor necrosis factor (TNF)-α were serially measured (by ELISA), and MRI was performed. In cerebral ischemia, tissue destruction seems related to matrix metalloproteinases expression because baseline MMP-9 was the only predictor of the infarct volume measured as a DWI lesion (lineal regression: b = 0.50, 0.25–0.74; P < 0.001). Moreover, the extent of hypoperfused brain area (PWI) was associated with a proinflammatory cytokine release in the next hours (TNF-α and IL-6).
Research Interests: Magnetic Resonance Imaging, Medicine, Diffusion MRI, Humans, Female, and 15 moreMale, Clinical Sciences, Aged, Middle Aged, Cerebral, Lesion, Cerebral Ischemia, Biological markers, Diffusion Weighted MRI, Effective Diffusion Coefficient, Matrix Metalloproteinase, Interleukin, Acute Disease, Diffusion magnetic resonance imaging, and Cardiovascular medicine and haematology
Research Interests: Cardiology, Risk assessment, Medicine, Stroke, Prospective studies, and 15 moreHumans, Outcome, Internal Medicine, Recurrence, Clinical Sciences, Transient, Aged, Middle Aged, C reactive protein, Proportional hazards model, Age Factors, Biological markers, Risk Assessment, Confidence Interval, and hazard ratio
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Brain magnetic resonance (MR) study has shown metabolic abnormalities and changes in water distribution of the brain tissue that may relate to the pathogenesis of hepatic encephalopathy (HE). We designed a study to investigate the... more
Brain magnetic resonance (MR) study has shown metabolic abnormalities and changes in water distribution of the brain tissue that may relate to the pathogenesis of hepatic encephalopathy (HE). We designed a study to investigate the disturbances in brain water and metabolites during episodic HE using a 3-T MR scanner. Cirrhotic patients with different grades of HE underwent MR during hospitalization ( n = 18). The MR was repeated at 6 weeks' follow-up ( n = 14). The results were compared with those of a group of healthy volunteers ( n = 8). During episodic HE, brain diffusion-weighted imaging showed a high apparent diffusion coefficient (ADC) (12% to 14%) that decreased during follow-up (–1% to −4%). These disturbances were accompanied by high glutamine (581%), low choline (–31%), and low myo-inositol (–86%) peaks on MR spectroscopy. In overt HE, patients showed high glutamine that decreased during follow-up (–22%). In addition, these patients exhibited a rise in plasma S100 beta ...
Research Interests: Magnetic Resonance Spectroscopy, Medicine, Brain, Humans, Liver Cirrhosis, and 15 moreBrain Circulation, Female, Male, Clinical Sciences, Hepatic Encephalopathy, Aged, Middle Aged, Homeostasis, Glutamine, Brain Chemistry, Choline, Glutamic Acid, Brain Edema, Effective Diffusion Coefficient, and Cardiovascular medicine and haematology
Research Interests: Hepatology, Complication, Humans, Liver Cirrhosis, Cerebral Cortex, and 15 moreFemale, Functional Imaging, Magnetic Resonance, Astrocyte, Liver Transplantation, Astrocytes, Clinical Sciences, Hepatic Encephalopathy, Aged, Longitudinal Studies, Adult, Cirrhosis, Healthy Subjects, Control Group, and Electric stimulation
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Purpose To compare available methods for whole-brain and gray matter (GM) atrophy estimation in multiple sclerosis (MS) in terms of repeatability (same magnetic resonance [MR] imaging unit) and reproducibility (different system/field... more
Purpose To compare available methods for whole-brain and gray matter (GM) atrophy estimation in multiple sclerosis (MS) in terms of repeatability (same magnetic resonance [MR] imaging unit) and reproducibility (different system/field strength) for their potential clinical applications. Materials and Methods The softwares ANTs-v1.9, CIVET-v2.1, FSL-SIENAX/SIENA-5.0.1, Icometrix-MSmetrix-1.7, and SPM-v12 were compared. This retrospective study, performed between March 2015 and March 2017, collected data from (a) eight simulated MR images and longitudinal data (2 weeks) from 10 healthy control subjects to assess the cross-sectional and longitudinal accuracy of atrophy measures, (b) test-retest MR images in 29 patients with MS acquired within the same day at different imaging unit field strengths/manufacturers to evaluate precision, and (c) longitudinal data (1 year) in 24 patients with MS for the agreement between methods. Tissue segmentation, image registration, and white matter (WM) ...
Research Interests: Radiology, Multiple sclerosis, Magnetic Resonance Imaging, Nuclear medicine, Medicine, and 15 moreBrain, Humans, Female, Male, Coefficient of Variation, Middle Aged, Atrophy, White matter, Adult, Repeatability, Reproducibility, Reproducibility of Results, Cross Sectional Studies, Gray Matter, and Medical and Health Sciences
The presence of oligoclonal bands in clinically isolated syndromes is an independent risk factor for developing multiple sclerosis and has been largely excluded from the more recent multiple sclerosis diagnostic criteria. Therefore, our... more
The presence of oligoclonal bands in clinically isolated syndromes is an independent risk factor for developing multiple sclerosis and has been largely excluded from the more recent multiple sclerosis diagnostic criteria. Therefore, our objective was to explore the value of oligoclonal bands in the context of the 2010 McDonald criteria, especially in patients fulfilling exclusively dissemination in space at baseline. For this purpose, we selected 566 patients from a clinically isolated syndrome inception cohort who had IgG oligoclonal bands determination and sufficient data on baseline brain MRI to assess dissemination in space and time. We excluded the cases already fulfilling both dissemination in space and time and divided the remaining 398 into 'no dissemination in space and time' (n = 218), 'dissemination in space' (n = 164) and 'dissemination in time' (n = 16). We assessed Cox proportional hazards regression models with 2010 McDonald as the outcome, usi...
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To assess the contributions of cortico-juxtacortical and corpus callosum lesions to multiple sclerosis diagnosis and to compare the value of ≥1 vs ≥3 periventricular lesions in clinically isolated syndromes (CIS). Step 1: We evaluated... more
To assess the contributions of cortico-juxtacortical and corpus callosum lesions to multiple sclerosis diagnosis and to compare the value of ≥1 vs ≥3 periventricular lesions in clinically isolated syndromes (CIS). Step 1: We evaluated lesion topography classifications in 657 patients with CIS with stepwise Cox proportional hazards regression models considering second attack as the outcome. Step 2: We established 2 dissemination in space (DIS) versions according to the periventricular lesion cutoffs of ≥1 and ≥3 and assessed their performance at 10 years with second attack as the outcome, first individually and then combined with dissemination in time (DIT) in all cases (n = 326), by age, and by CIS topography. Step 1: The models (hazard ratios [95% confidence interval]) favored ≥1 over ≥3 periventricular lesions (2.5 [1.7-3.6]) and cortico-juxtacortical over juxtacortical lesions (1.4 [1.0-1.8]). Callosal lesions were not selected. Step 2: DIS specificity with ≥1 periventricular les...
Research Interests: Cognitive Science, Neurology, Multiple sclerosis, Magnetic Resonance Imaging, Medicine, and 15 moreHumans, Corpus Callosum, Cerebral Cortex, Female, Male, Clinical Sciences, Middle Aged, Optic Neuritis, Adult, Lesion, Neurosciences, Age of Onset, Confidence Interval, Cohort Studies, and hazard ratio
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In recent years, many automatic brain structure segmentation methods have been proposed. However, these methods are commonly tested with non-lesioned brains and the effect of lesions on their performance has not been evaluated. Here, we... more
In recent years, many automatic brain structure segmentation methods have been proposed. However, these methods are commonly tested with non-lesioned brains and the effect of lesions on their performance has not been evaluated. Here, we analyze the effect of multiple sclerosis (MS) lesions on three well-known automatic brain structure segmentation methods, namely, FreeSurfer, FIRST and multi-atlas fused by majority voting, which use learning-based, deformable and atlas-based strategies, respectively. To perform a quantitative analysis, 100 synthetic images of MS patients with a total of 2174 lesions are simulated on two public databases with available brain structure ground truth information (IBSR18 and MICCAI'12). The Dice similarity coefficient (DSC) differences and the volume differences between the healthy and the simulated images are calculated for the subcortical structures and the brainstem. We observe that the three strategies are affected when lesions are present. Howev...
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Background: Brain atrophy in multiple sclerosis (MS) patients is present since the very early stages of the disease and it has been related to long-term disability. Objective: To estimate brain volume (BV) at 15 years after a clinically... more
Background: Brain atrophy in multiple sclerosis (MS) patients is present since the very early stages of the disease and it has been related to long-term disability. Objective: To estimate brain volume (BV) at 15 years after a clinically isolated syndrome (CIS) and to evaluate its relationship with disease outcomes. Methods: From a prospective cohort including patients presenting with a CIS, 54 patients with a brain magnetic resonance imaging (MRI) performed 15 years after CIS were included. Brain parenchymal fraction (BPF), grey matter fraction (GMF) and white matter fraction (WMF) at 15-year follow-up were obtained. Regression analyses were conducted to predict BV loss and reaching an Expanded Disability Status Scale (EDSS) of 3.0 in that 15-year period. Results: In multivariable analyses, lower values of BPF and WMF were significantly associated with being male, presenting 3–4 Barkhof criteria at baseline, presenting a second relapse, and with a decision to start treatment. In the...
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Objective: To investigate the association between activity during interferon-beta (IFNβ) therapy and disability outcomes in patients with relapsing–remitting multiple sclerosis (RRMS). Methods: A longitudinal study based on two previously... more
Objective: To investigate the association between activity during interferon-beta (IFNβ) therapy and disability outcomes in patients with relapsing–remitting multiple sclerosis (RRMS). Methods: A longitudinal study based on two previously described cohorts of IFNβ-treated RRMS patients was conducted. Patients were classified according to clinical activity after 2 years (clinical cohort) or to clinical and radiological activity after 1 year (magnetic resonance imaging (MRI) cohort). Multivariate Cox models were calculated for early disease activity predicting long-term disability. Results: A total of 516 patients from two different cohorts were included in the analyses. Persistent clinical disease activity during the first 2 years of therapy predicted severe long-term disability (clinical cohort). In the MRI cohort, modified Rio score and no or minimal evidence of disease activity (NEDA/MEDA) did not identify patients with risk of Expanded Disability Status Scale (EDSS) worsening. Ho...
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Research Interests: Cognitive Science, Neurology, Neurosurgery, Multiple sclerosis, Cognition, and 13 moreMagnetic Resonance Imaging, Neurochemistry, Medicine, Brain, Humans, Consensus, Cognitive impairment, Atrophy, Disease Progression, Neurosciences, Cognition disorders, Outcome assessment (Health care), and brain size
Research Interests: Cognitive Science, Gastroenterology, Magnetic Resonance Imaging, Biomarkers, Brain, and 15 moreHumans, Internal Medicine, Female, Male, Clinically isolated syndrome, Clinical Sciences, Longitudinal Studies, Biomarker, Adult, Disease Progression, Enzyme Linked Immunosorbent Assay, Confidence Interval, Disability Evaluation, Demyelinating diseases, and hazard ratio
Research Interests: Cognitive Science, Neurology, Multiple sclerosis, Magnetic Resonance Imaging, Adolescent, and 15 moreMedicine, Humans, Child, Internal Medicine, Europe, Clinical Sciences, Aged, Middle Aged, Adult, Proportional hazards model, Retrospective Studies, Neurosciences, Confidence Interval, Disability Evaluation, and hazard ratio
Research Interests: Computer Science, Algorithms, Magnetic Resonance Imaging, Medicine, Brain, and 15 moreHumans, Computer Simulation, Europe, Calibration, Neuroimage, Artifacts, Scaling, Image Enhancement, Reproducibility of Results, Statistical models, Sensitivity and Specificity, Equipment Design, Equipment Failure Analysis, Psychology and Cognitive Sciences, and Medical and Health Sciences
Multiple sclerosis is an inflammatory demyelinating disorder of the central nervous system. Its presentation is variable and its course and prognosis are unpredictable. Approximately 85% of individuals present a relapsing-remitting form... more
Multiple sclerosis is an inflammatory demyelinating disorder of the central nervous system. Its presentation is variable and its course and prognosis are unpredictable. Approximately 85% of individuals present a relapsing-remitting form of the disease, but some patients may evolve into a progressive course, accumulating irreversible neurological disability, defining its secondary progressive phase. Despite all the advances that had been reached in terms of diagnosis, many decisions are still taken based only on pure clinical skills. We present the case of a patient that, after being diagnosed with a clinically isolated syndrome many years ago, seemed to be entering in a secondary progressive course, developing a clinical picture dominated by a progressive gait disturbance. Nevertheless, multiple sclerosis heterogeneity asks for some clinical expertise, in order to exclude all other possible causes for patients’ complaints. Here we present an important red flag in the differential di...
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Little is known about the mechanisms leading to neurodegeneration in multiple sclerosis (MS) and the role of peripheral blood cells on this neurodegenerative component. We aimed to correlate brain radiological phenotypes defined by high... more
Little is known about the mechanisms leading to neurodegeneration in multiple sclerosis (MS) and the role of peripheral blood cells on this neurodegenerative component. We aimed to correlate brain radiological phenotypes defined by high and low neurodegeneration with gene expression profiling of peripheral blood mononuclear cells (PBMC) from MS patients. MRI scans from 64 patients with relapsing-remitting MS (RRMS) were classified into radiological phenotypes characterized by low (N=27) and high (N=37) neurodegeneration according to the number of contrast enhancing lesions, the relative volume of non-enhancing black holes on T1-weighted images, and the brain parenchymal fraction. Gene expression profiling was determined in PBMC using microarrays, and validation of selected genes was performed by PCR. B-cell immunophenotyping was conducted by flow cytometry. Microarray analysis revealed the B-cell specific genes FCRL1, FCRL2, FCRL5 (Fc receptor-like 1, 2, and 5 respectively), and CD2...
Research Interests: Multiple sclerosis, Magnetic Resonance Imaging, Flow Cytometry, Biology, Neurodegeneration, and 15 moreMedicine, Neurodegenerative Diseases, Biological Sciences, Humans, Female, Male, Human Molecular Genetics, Middle Aged, Adult, Immunophenotyping, B Lymphocytes, Gene Expression Regulation, Gene expression profiling, Down-Regulation, and Medical and Health Sciences
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To investigate the association between brain volume loss during the first year of interferon treatment and clinical outcome at 4 years. Patients with multiple sclerosis initiating interferon β were clinically evaluated every 6 months for... more
To investigate the association between brain volume loss during the first year of interferon treatment and clinical outcome at 4 years. Patients with multiple sclerosis initiating interferon β were clinically evaluated every 6 months for the presence of relapses and assessment of global disability using the Expanded Disability Status Scale (EDSS). MRI scans were performed at baseline and after 12 months, and the percentage of brain volume change (PBVC), brain parenchymal volume change (BPVc%), gray matter volume change (GMVc%), and white matter volume change (WMVc%) were estimated. Patients were divided based on the cutoff values for predicting confirmed EDSS worsening obtained by receiver operating characteristic analysis for all atrophy measurements. Survival curves and Cox proportional hazards regression to predict disability worsening at last observation were applied, adjusting for demographic, clinical, and radiologic variables. Larger PBVC and WMVc% decreases were observed in ...
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Research Interests: Multiple sclerosis, Medicine, Brain, Humans, Internal Medicine, and 15 moreFemale, Male, Middle Aged, Adult, Proportional hazards model, Prognosis, Disease Progression, Risk Factors, Proportional Hazards Models, Confidence Interval, Cohort Studies, Psychology and Cognitive Sciences, Demyelinating diseases, Medical and Health Sciences, and hazard ratio
We present the serial MR studies of two patients with symptomatic acute large demyelinating lesions that initially showed a drop in apparent diffusion coefficient values. Baseline proton MR spectroscopy showed a slight decrease in... more
We present the serial MR studies of two patients with symptomatic acute large demyelinating lesions that initially showed a drop in apparent diffusion coefficient values. Baseline proton MR spectroscopy showed a slight decrease in N-acetylaspartate and a normal choline level. An excess of lactate was observed at the first examinations and completely disappeared by the final examinations. The time-course evolution of the lesions shown by MR imaging and proton MR spectroscopic examinations suggests that the initial drop in apparent coefficient diffusion may have been related to dense inflammatory cell infiltration and scant tissue destruction or to reversible reduced vascular supply due to the severity of the inflammatory process.
Research Interests: Magnetic Resonance Imaging, Magnetic Resonance Spectroscopy, Medicine, Diffusion MRI, Brain, and 15 moreCase Report, Humans, MR spectroscopy, Female, Apparent Diffusion Coefficient, Clinical Sciences, Adult, Choline, Lactic Acid, Mr Imaging, Neurosciences, Brain Diseases, Effective Diffusion Coefficient, Acute Disease, and Demyelinating diseases
Research Interests: Gastroenterology, Magnetic Resonance Imaging, Medicine, Cerebrospinal Fluid, Brain, and 15 moreHumans, Internal Medicine, Female, Male, Clinically isolated syndrome, Lectins, Cohort, Adipokines, Aged, Biomarker, Adult, Biological markers, Demyelinating diseases, Medical and Health Sciences, and hazard ratio
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Research Interests: Multiple sclerosis, Magnetic Resonance Imaging, Adolescent, Medicine, Multidisciplinary, and 15 moreHumans, Child, Internal Medicine, Female, Male, Incidental Findings, Cohort, Aged, Middle Aged, Adult, Disease Progression, Asymptomatic, Disease Free Survival, Demyelinating diseases, and hazard ratio
Background: Iron accumulation in deep grey matter (GM) structures is a consistent finding in multiple sclerosis (MS) patients. This study focused on the identification of independent determinants of iron accumulation using R2* mapping.... more
Background: Iron accumulation in deep grey matter (GM) structures is a consistent finding in multiple sclerosis (MS) patients. This study focused on the identification of independent determinants of iron accumulation using R2* mapping. Subjects and methods: Ninety-seven MS patients and 81 healthy controls were included in this multicentre study. R2* mapping was performed on 3T MRI systems. R2*in deep GM was corrected for age and was related to disease duration, disability, T2 lesion load and brain volume. Results: Compared to controls, R2* was increased in all deep GM regions of MS patients except the globus pallidus and the substantia nigra. R2* increase was most pronounced in the progressive stage of the disease and independently predicted by disease duration and disability. Reduced cortical volume was not associated with iron accumulation in the deep GM with the exception of the substantia nigra and the red nucleus. In lesions, R2* was inversely correlated with disease duration a...