Predicting gadolinium enhancement status in MS patients eligible for randomized clinical trials

Barkhof, Frederik; Held, Ulrike; Simon, Jack H.; Däumer, Martin; Fazekas, Franz; Filippi, Massimo; Frank, Joseph A.; Kappos, Ludwig; Li, D.; Menzler, Susanne; Miller, David H.; Petkau, John; Wolinsky, J. S.

doi:10.1212/01.wnl.0000183149.87975.32

Cited by 48 publications

(42 citation statements)

References 25 publications

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“…This finding supports the observation that the presence of Gd lesions is correlated with subsequent lesion activity. 21,22 In contrast, we showed that the favorable treatment effect of interferon beta-1b on subsequent lesion development per se was largely independent of the presence of active lesions at the time of the CIS (Table 3). This is in line with the fact that the treatment effect of interferon beta-1b on the conversion to CDMS was robust throughout the BENEFIT study population and numerically even more pronounced in patients without Gd enhancement on the initial MRI.…”

Section: Commentmentioning

confidence: 76%

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Magnetic Resonance Imaging Effects of Interferon Beta-1b in the BENEFIT Study

Barkhof¹,

Polman²,

Radue³

et al. 2007

Arch Neurol

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Section: Commentmentioning

confidence: 76%

“…Were lost to follow-up in double-blind study 21 Did not enter extension study 10 Had no month 24 MRI in extension study 13…”

mentioning

confidence: 99%

Magnetic Resonance Imaging Effects of Interferon Beta-1b in the BENEFIT Study

Barkhof¹,

Polman²,

Radue³

et al. 2007

Arch Neurol

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“…All new white matter lesions go through this phase of enhancement that lasts between 2 and 8 weeks (Barkhof 1999). A number of studies have evaluated sex-based differences in the number of Gd-enhancing lesions in MS and most (Weatherby et al 2000;Pozzilli et al 2003;Tomassini et al 2005), but not all (Barkhof et al 2005) of these studies observed a higher number in women. However, the number of Gd-enhancing lesions correlates only weakly with concurrent EDSS scores and is thus not considered to be a good indicator of disease progression (Barkhof 1999).…”

Section: White Matter Changesmentioning

confidence: 99%

Sex-Based Differences in Multiple Sclerosis (MS): Part II: Rising Incidence of Multiple Sclerosis in Women and the Vulnerability of Men to Progression of this Disease

Dunn

Gunde

Lee

2015

Emerging and Evolving Topics in Multiple Sclerosis Pathogenesis and Treatments

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It is well known that a number of autoimmune diseases including multiple sclerosis (MS) predominantly affect women and there has been much attention directed toward understanding why this is the case. Past research has revealed a number of sex differences in autoimmune responses that can account for the female bias in MS. However, much less is known about why the incidence of MS has increased exclusively in women over the past half century. The recency of this increase suggests that changing environmental or lifestyle factors are interacting with biological sex to increase MS risk predominantly in females. Indeed, a number of recent studies have identified sex-specific differences in the effect of environmental factors on MS incidence. The first part of this chapter will overview this evidence and will discuss the possible scenarios of how the environment may be interacting with autoimmune mechanisms to contribute to the preferential rise in MS incidence in women. Despite the strong female bias in MS incidence, culminating evidence from natural history studies, and imaging and pathology studies suggests that males who develop MS may exhibit a more rapid decline in disability and cognitive functioning than women. Very little is known about the biological basis of this more rapid deterioration, but some insights have been provided by studies in rodent models of demyelination/remyelination. The second part of this chapter will overview the evidence that males with relapsing-onset MS undergo a more rapid progression of disease than females and will discuss potential biological mechanisms that account for this sex difference.

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“…A number of studies have demonstrated that Gd enhancement is correlated with the occurrence of clinical relapses in MS (1)(2)(3). The number or volume of Gd-enhancing lesions is useful for evaluating biologically relevant treatment effects (4,5).…”

mentioning

confidence: 99%

Segmentation of gadolinium‐enhanced lesions on MRI in multiple sclerosis

Datta

Sajja

et al. 2007

Magnetic Resonance Imaging

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Purpose: To develop and implement a method for identification and quantification of gadolinium (Gd) enhancements with minimal human intervention. Materials and Methods:Dual fast spin echo (FSE), fluid attenuation inversion recovery (FLAIR), and pre-and postcontrast T1-weighted spin echo were acquired on 22 subjects. The enhancements were identified on the postcontrast T1-weighted images based on morphological operations. A single threshold based on the ratio of the difference of postcontrast and precontrast T1 images with that of precontrast T1 images is applied to the reconstructed images to reduce the false classifications. False classification of enhancements arising from enhancing vasculature and structures such as the choroid plexus that lack a blood-brain barrier were reduced by assuming that the true enhancements are always associated with hyperintense lesions on T2-weighted images (T2 lesions). The enhanced lesions were further delineated based on fuzzy connectivity. Results:The segmented Gd enhancements were evaluated quantitatively with manually identified enhancements based on similarity measures. The average similarity index (SI) of 0.76 suggests excellent performance of the proposed methodology. The Bland-Altman plot shows a close agreement between the results obtained manually and those based on the proposed methodology. Conclusion:The proposed algorithm identifies and quantifies Gd enhancements accurately with minimal human intervention.

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Predicting gadolinium enhancement status in MS patients eligible for randomized clinical trials

Abstract: Gadolinium status can be predicted by a set of baseline variables, certainly when T2 burden of disease is included. These findings may benefit the design and statistical power of future randomized clinical trials.

Cited by 48 publications

References 25 publications

Magnetic Resonance Imaging Effects of Interferon Beta-1b in the BENEFIT Study

Magnetic Resonance Imaging Effects of Interferon Beta-1b in the BENEFIT Study

Sex-Based Differences in Multiple Sclerosis (MS): Part II: Rising Incidence of Multiple Sclerosis in Women and the Vulnerability of Men to Progression of this Disease

Segmentation of gadolinium‐enhanced lesions on MRI in multiple sclerosis

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