Quantified volume and count of white-matter lesions based on magnetic resonance (MR) images are important biomarkers in several neurodegenerative diseases. For a routine extraction of these biomarkers an accurate and reliable automated lesion segmentation is required. To objectively and reliably determine a standard automated method, however, creation of standard validation datasets is of extremely high importance. Ideally, these datasets should be publicly available in conjunction with standardized evaluation methodology to enable objective validation of novel and existing methods. For validation purposes, we present a novel MR dataset of 30 multiple sclerosis patients and a novel protocol for creating reference white-matter lesion segmentations based on multi-rater consensus. On these datasets three expert raters individually segmented white-matter lesions, using in-house developed semi-automated lesion contouring tools. Later, the raters revised the segmentations in several joint sessions to reach a consensus on segmentation of lesions. To evaluate the variability, and as quality assurance, the protocol was executed twice on the same MR images, with a six months break. The obtained intra-consensus variability was substantially lower compared to the intra- and inter-rater variabilities, showing improved reliability of lesion segmentation by the proposed protocol. Hence, the obtained reference segmentations may represent a more precise target to evaluate, compare against and also train, the automatic segmentations. To encourage further use and research we will publicly disseminate on our website http://lit.fe.uni-lj.si/tools the tools used to create lesion segmentations, the original and preprocessed MR image datasets and the consensus lesion segmentations.

Background There is insufficient knowledge about how aerobic exercise impacts the disease process of multiple sclerosis, which is characterized by accumulation of white matter lesions and accelerated brain atrophy. Objective To examine the effect of aerobic exercise on neuroinflammation and neurodegeneration by magnetic resonance imaging and clinical measures of disease activity and progression in persons with multiple sclerosis. Patients and methods An exploratory 12-week randomized control trial including an intervention group ( n = 14, 12 weeks of aerobic exercise twice weekly) and a control group ( n = 14, continuation of usual lifestyle). Primary outcomes were magnetic resonance imaging measures (lesion load, brain structure volume change), while secondary outcomes included disability measures, blood cytokine levels, cognitive tests and patient-reported outcomes. Results The effects of aerobic exercise on whole brain and grey matter atrophy were minor. Surprisingly, the observed effect on volume (atrophy) in selected brain substructures was heterogeneous. Putaminal and posterior cingulate volumes decreased, parahippocampal gyrus volume increased, thalamus and amygdala volume remained the same, and active lesion load and count decreased. However, apart from weak improvements in walking speed and brain-derived neurotrophic factor levels, there was no effect of aerobic exercise on other clinical, cognitive or patient-reported outcomes. Conclusion These results suggest that aerobic exercise in persons with multiple sclerosis has a positive effect on the volume of some of the substructures of the brain, possibly indicating a slowing of the neurodegenerative process in these regions, but a negative impact on the volume of some other substructures, with unclear implications. Further research is needed to determine whether the slight decrease in active lesion volume and count implies an anti- inflammatory effect of aerobic exercise, and the exact significance of the heterogeneous results of volumetric assessments. LAY ABSTRACT The aim of this study was to evaluate the effects of aerobic exercise (physical exercise in the form of aerobics) on people with multiple sclerosis who were being treated with fingolimod. Two groups of patients with multiple sclerosis were studied: an intervention group ( n = 14) who undertook 12 weeks of exercise training, and a control group ( n = 14) who continued with their usual lifestyle. Magnetic resonance imaging, bloodwork analysis and some other clinical assessments were performed before and after the 12-week period, and the patients completed several questionnaires about their wellbeing and accompanying symptoms of multiple sclerosis. The results suggest that aerobic exercise (combined with appropriate phar...

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Soft palate-tongue contact and automatically calculated pharyngeal narrowing ratio (PNR), defined as a ratio between the airway cross-section at the hard palate level and the narrowest cross-section from the hard palate to the epiglottis, could assist in earlier identification of potential obstructive sleep apnea syndrome (OSA) patients even on awake individuals. Parameters were studied on carotid CTA images from 67 consecutively included awake Caucasians who were later classified by second independent physician into the primary snorers (SNORE, n = 34) or obstructive sleep apnea syndrome patient (OSA, n = 33) group according to the clinical examination, laboratory testing and a full-night video polysomnography (PSG) in the sleep laboratory. Imaging and clinical data were statistically compared between groups. The odd's ratio calculation showed a 2.95 (P = 0.0354) higher risk for OSA development in snoring person with a PNR greater than 8.6. The loose-contact subgroup among OSA patients showed significantly (P = 0.002) higher values of AHI in contrast to the in-contact subgroup.

A 42-year-old man was evaluated for snoring and sleep apnea. Overnight polysomnography revealed 28 events per hour on the apnea-hypopnea index. To determine the site of obstruction and determine treatment, dynamic MRI with concurrent EEG monitoring in natural sleep was performed. We recorded 2 mechanisms of total occlusion: at the oropharyngeal level and due to movement of the uvula during snoring (videos 1 and 2).1 Two different mechanisms suggested against surgical therapy; he was treated with a continuous positive airway pressure mask at 7 cm H 2 O, with a good outcome.