A longitudinal study of T1 hypointense lesions in relapsing MS

Simon, Jack H.; Lull, Julia M.; Jacobs, L. D.; Rudick, Richard A.; Cookfair, Diane L.; Herndon, Robert M.; Richert, John R.; Salazar, Andrés M.; Sheeder, Jeanelle; Miller, David H.; McCabe, K.; Serra, Alessandro; Campion, Marilyn; Fischer, Jill S.; Goodkin, Donald E.; Simonian, Nancy A.; Lajaunie, M.; Wende, Karl; Martens-Davidson, A.; Kinkel, R. Philip; Munschauer, Frederick E.

doi:10.1212/wnl.55.2.185

Cited by 127 publications

(79 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Over the last decade, a number of immunomodulatory and immunosuppressive therapies have been approved for clinical use based primarily on demonstration of their ability to suppress focal inflammatory activity, i.e., lesion formation, and clinical relapses (Comi et al, 2001;Leary et al, 2003;Li and Paty, 1999;Li et al, 2001;Miller et al, 1999;Paty and Li, 1993;Simon et al, 1998;Simon et al, 2000;Zhao et al, 2000). Development of these therapies has been critically dependent on MRI because of the ability of MRI to visualize lesion formation with an order of magnitude greater sensitivity than clinical observation is able to detect relapses The number and volume of MS lesions represent the "burden of disease" and are predictive of patients' clinical course over the long term (O'Riordan et al, 1998).…”

Section: Introductionmentioning

confidence: 99%

Review of automatic segmentation methods of multiple sclerosis white matter lesions on conventional magnetic resonance imaging

García-Lorenzo

Francis

Narayanan

et al. 2013

Medical Image Analysis

319

268

View full text Add to dashboard Cite

Magnetic resonance (MR) imaging is often used to characterize and quantify multiple sclerosis (MS) lesions in the brain and spinal cord. The number and volume of lesions have been used to evaluate MS disease burden, to track the progression of the disease and to evaluate the effect of new pharmaceuticals in clinical trials. Accurate identification of MS lesions in MR images is extremely difficult due to variability in lesion location, size and shape in addition to anatomical variability between subjects. Since manual segmentation requires expert knowledge, is time consuming and is subject to intra-and interexpert variability, many methods have been proposed to automatically segment lesions.The objective of this study was to carry out a systematic review of the literature to evaluate the state of the art in automated multiple sclerosis lesion segmentation. From 1240 hits found initially with PubMed and Google scholar, our selection criteria identified 80 papers that described an automatic lesion segmentation procedure applied to MS. Only 47 of these included quantitative validation with at least one realistic image. In this paper, we describe the complexity of lesion segmentation, classify the automatic MS lesion segmentation methods found, and review the validation methods applied in each of the papers reviewed. Although many segmentation solutions have been proposed, including some with promising results using MRI data obtained on small groups of patients, no single method is widely employed due to performance issues related to the high variability of MS lesion appearance and differences in image acquisition. The challenge remains to provide segmentation techniques that work in all cases regardless of the type of MS, duration of the disease, or MRI protocol, and this within a comprehensive, standardized validation framework. MS lesion segmentation remains an open problem.

show abstract

Section: Introductionmentioning

confidence: 99%

Review of automatic segmentation methods of multiple sclerosis white matter lesions on conventional magnetic resonance imaging

García-Lorenzo

Francis

Narayanan

et al. 2013

Medical Image Analysis

319

268

View full text Add to dashboard Cite

show abstract

“…For example, post hoc analysis of MRI data from the MSCRG study of IM IFNβ-1a for MS revealed that treatment with the DMT IM IFNβ-1a reduced T 1 hypointensity formation by 68% versus placebo. 64 In this analysis, the median change from baseline over a 2-year interval in brain MRI T 1 lesion load was 40.0 cubic millimeters ([mm 3 ]; range, -2,424 to 4,042) for patients treated with IFNβ-1a (P = 0.164) and 124.5 mm 3 for placebo (P < 0.001). Although the cohort treated with IM IFNβ-1a showed reduced accumulation of T 1 hypointense lesions over 2 years, this difference was not statistically significant (P = 0.065).…”

Section: ■■ Conclusionmentioning

confidence: 87%

Emerging Methods for Evaluating the Effectiveness of Intramuscular Interferon Beta-1a for Relapsing-Remitting Multiple Sclerosis

Foley¹,

Barnes²,

Nair³

2013

JMCP

View full text Add to dashboard Cite

Newer outcome-based assessment methods have been developed that complement and improve upon the ability of historical clinical and magnetic resonance imaging (MRI) outcome measures to measure multiple sclerosis (MS) disease activity, patient functionality, treatment efficacy, and the risk of MS disease progression. These newer MS outcome assessments include instruments to evaluate cognitive function and patient quality of life; enhanced measures of disability, such as the Multiple Sclerosis Functional Composite instrument; and newer MRI measures of MS disease activity and neuronal changes, such as permanent T 1 hypointensities and central nervous system atrophy. When utilized in conjunction with standard MS outcome measures, these newer MS outcomes provide a more comprehensive picture of disease status and course and hold promise as tools for use in the development and testing of future MS therapies. The well-established first-line MS therapy intramuscular interferon beta-1a, which has been evaluated using a broad range of assessment methods, was used as a reference MS disease-modifying therapy to provide specific examples of studies utilizing newer evaluation methods. Utilization of evolving disease and assessment measures for patients with MS should improve MS patient diagnosis, treatment decisions, and monitoring of therapy. • Multiple sclerosis (MS) is a chronic, immune-mediated neurologic disease that is associated with progressive patient disability and diminished quality of life (QoL).• Historical clinical outcomes, such as MS relapses, physical disability measures, and magnetic resonance imaging (MRI) endpoints, do not capture important elements of MS, such as the impact of MS and MS therapies on a patient's perceived QoL.• This article provides an overview of several key newer MS patient outcomes, including instruments used to assess MS patient cognition, QoL, composite disability measures, and emerging MRI clinical endpoints.• Newer MS patient outcomes have the potential to improve MS patient care and the development and testing of future therapeutics for the treatment of MS. Summary Points Presented in this ArticleHowever, older measures do not capture the entire impact of the disease (e.g., cognition, upper limb function, etc.) on patient function and well-being. Newer outcome measures are being developed with the purpose of capturing additional aspects of the disease and facilitating a more comprehensive assessment of MS disability, progression, and therapeutic efficacy. The primary purpose of this article is to provide the managed care audience with an overview of the most prominent newer MS measures. The potential benefits of these newer outcomes are illustrated using published clinical data on intramuscular interferon beta-1a (IM IFNβ-1a) as an extensively evaluated, representative first-line MS therapy.

show abstract

“…Atrophy and neurodegeneration are conditions that are encountered in advanced stages of MS, and they are related to progression of the disease. It has been shown radiologically that long-term use of IMTs might decrease atrophy (32,33,34). Only early-period data (the first 2 years) were included in our study, so atrophy was not evaluated.…”

Section: Discussionmentioning

confidence: 99%

Clinical, Radiological and Electrophysiological Comparison of Immunomodulatory Therapies in Multiple Sclerosis

Genç¹,

Demirkaya

Bek

et al. 2017

Arch Neuropsychiatr

View full text Add to dashboard Cite

Multiple sclerosis (MS) is an autoimmune inflammatory demyelinating disease of the central nervous system (CNS) usually presenting with episodes of relapses and remissions, and sometimes progression of the disease can be triggered by environmental factors and the genetic background (1). Magnetic resonance imaging (MRI) provides significant data in MS regarding diagnosis, demonstration of the clinical-lesion relationship, disease activity and treatment follow-up (2). Examination of evoked potentials (EPs) is a simple and non-invasive method that is important in confirming clinical signs and symptoms as well as revealing silent lesions and multisystem involvement. Visual evoked potentials (VEPs), brainstem auditory evoked potentials (BAEPs), and somatosensory evoked potentials (SEPs) are used to electrophysiologically define lesions in CNS afferent pathways, and they reveal the multifocal characteristics of the disease.Because episodes might recover on their own and progression varies among patients or even in the same patient over time, it is difficult to decide whether treatment in MS is effective in the short run. Treatment interventions vary depending on the disease type and clinical period. In all randomized, placebo-controlled studies, interferon beta (IFN-B) and glatiramer acetate (GA) have been shown to reduce the frequency of episodes and MRI activity in relapsing-remitting multiple sclerosis (RRMS). These treatments should be given to patients diagnosed with RRMS with an Expanded Disability Status Scale (EDSS) score <5.5 who have had two or more episodes lasting longer than 24 hours with new symptoms or deterioration of previous symptoms and no fever. Debates as to which agent should be selected for which patient, the time to start treatment, the duration of treatment, and the roles of side effects in efficacy are ongoing. We aimed to compare these agents in terms of clinical, radiological, and electrophysiological measurements and to determine whether these agents showed any differences in efficacy or side effects. METHODS Study PopulationWe chose a cohort of 85 patients older than 18 years of age who applied to the MS outpatient clinic of the Gülhane Military Medical Academy between April 2006 and April 2009 and who were being followed up with a "Clinically Definite MS" diagnosis according to the Poser and Introduction: Although it has been shown that immunomodulatory therapies (IMTs) in multiple sclerosis (MS) can modify the course of the disease by reducing the relapse rate and delaying the progression of disability, no study comparing IMTs head-to-head in terms of clinical, radiological, and electrophysiological changes is available. We aimed to investigate the effects of interferon-beta (IFN-B) 1b, IFN-B-1a subcutaneous (sc), IFN-B-1a intramuscular (im), and glatiramer acetate (GA) therapies on clinical, electrophysiological, and radiological findings. Methods:We studied a cohort of 85 MS patients who were followed up for at least 2 years and had complete charting, including pre-treatment and post-...

show abstract

A longitudinal study of T1 hypointense lesions in relapsing MS

Abstract: The development of T1 hypointense lesions is strongly influenced by prior inflammatory disease activity, as indicated by enhancing lesions. These results suggest that treatment with once weekly IM IFNbeta-1a (30 mcg) slows the 2-year accumulation of these lesions in the brain.

Cited by 127 publications

References 27 publications

Review of automatic segmentation methods of multiple sclerosis white matter lesions on conventional magnetic resonance imaging

Review of automatic segmentation methods of multiple sclerosis white matter lesions on conventional magnetic resonance imaging

Emerging Methods for Evaluating the Effectiveness of Intramuscular Interferon Beta-1a for Relapsing-Remitting Multiple Sclerosis

Clinical, Radiological and Electrophysiological Comparison of Immunomodulatory Therapies in Multiple Sclerosis

Contact Info

Product

Resources

About