5,471 research outputs found
Slowly expanding/evolving lesions as a magnetic resonance imaging marker of chronic active multiple sclerosis lesions.
BACKGROUND:Chronic lesion activity driven by smoldering inflammation is a pathological hallmark of progressive forms of multiple sclerosis (MS). OBJECTIVE:To develop a method for automatic detection of slowly expanding/evolving lesions (SELs) on conventional brain magnetic resonance imaging (MRI) and characterize such SELs in primary progressive MS (PPMS) and relapsing MS (RMS) populations. METHODS:We defined SELs as contiguous regions of existing T2 lesions showing local expansion assessed by the Jacobian determinant of the deformation between reference and follow-up scans. SEL candidates were assigned a heuristic score based on concentricity and constancy of change in T2- and T1-weighted MRIs. SELs were examined in 1334 RMS patients and 555 PPMS patients. RESULTS:Compared with RMS patients, PPMS patients had higher numbers of SELs (p = 0.002) and higher T2 volumes of SELs (p < 0.001). SELs were devoid of gadolinium enhancement. Compared with areas of T2 lesions not classified as SEL, SELs had significantly lower T1 intensity at baseline and larger decrease in T1 intensity over time. CONCLUSION:We suggest that SELs reflect chronic tissue loss in the absence of ongoing acute inflammation. SELs may represent a conventional brain MRI correlate of chronic active MS lesions and a candidate biomarker for smoldering inflammation in MS
T2 lesion location really matters: a 10 year follow-up study in primary progressive multiple sclerosis
Objectives: Prediction of long term clinical outcome in patients with primary progressive multiple sclerosis (PPMS) using imaging has important clinical implications, but remains challenging. We aimed to determine whether spatial location of T2 and T1 brain lesions predicts clinical progression during a 10-year follow-up in PPMS.
Methods: Lesion probability maps of the T2 and T1 brain lesions were generated using the baseline scans of 80 patients with PPMS who were clinically assessed at baseline and then after 1, 2, 5 and 10 years. For each patient, the time (in years) taken before bilateral support was required to walk (time to event (TTE)) was used as a measure of progression rate. The probability of each voxel being ‘lesional’ was correlated with TTE, adjusting for age, gender, disease duration, centre and spinal cord cross sectional area, using a multiple linear regression model. To identify the best, independent predictor of progression, a Cox regression model was used.
Results: A significant correlation between a shorter TTE and a higher probability of a voxel being lesional on T2 scans was found in the bilateral corticospinal tract and superior longitudinal fasciculus, and in the right inferior fronto-occipital fasciculus (p<0.05). The best predictor of progression rate was the T2 lesion load measured along the right inferior fronto-occipital fasciculus (p=0.016, hazard ratio 1.00652, 95% CI 1.00121 to 1.01186).
Conclusion: Our results suggest that the location of T2 brain lesions in the motor and associative tracts is an important contributor to the progression of disability in PPMS, and is independent of spinal cord involvement
Relating multi-sequence longitudinal intensity profiles and clinical covariates in new multiple sclerosis lesions
Structural magnetic resonance imaging (MRI) can be used to detect lesions in
the brains of multiple sclerosis (MS) patients. The formation of these lesions
is a complex process involving inflammation, tissue damage, and tissue repair,
all of which are visible on MRI. Here we characterize the lesion formation
process on longitudinal, multi-sequence structural MRI from 34 MS patients and
relate the longitudinal changes we observe within lesions to therapeutic
interventions. In this article, we first outline a pipeline to extract voxel
level, multi-sequence longitudinal profiles from four MRI sequences within
lesion tissue. We then propose two models to relate clinical covariates to the
longitudinal profiles. The first model is a principal component analysis (PCA)
regression model, which collapses the information from all four profiles into a
scalar value. We find that the score on the first PC identifies areas of slow,
long-term intensity changes within the lesion at a voxel level, as validated by
two experienced clinicians, a neuroradiologist and a neurologist. On a quality
scale of 1 to 4 (4 being the highest) the neuroradiologist gave the score on
the first PC a median rating of 4 (95% CI: [4,4]), and the neurologist gave it
a median rating of 3 (95% CI: [3,3]). In the PCA regression model, we find that
treatment with disease modifying therapies (p-value < 0.01), steroids (p-value
< 0.01), and being closer to the boundary of abnormal signal intensity (p-value
< 0.01) are associated with a return of a voxel to intensity values closer to
that of normal-appearing tissue. The second model is a function-on-scalar
regression, which allows for assessment of the individual time points at which
the covariates are associated with the profiles. In the function-on-scalar
regression both age and distance to the boundary were found to have a
statistically significant association with the profiles
Improving longitudinal spinal cord atrophy measurements for clinical trials in multiple sclerosis by using the generalised boundary shift integral (GBSI)
Spinal cord atrophy is a common and clinically relevant feature of multiple sclerosis (MS), and can be used to monitor disease progression and as an outcome measure in clinical trials. Spinal cord atrophy is conventionally estimated with segmentation-based methods (e.g., cross-sectional spinal cord area (CSA)), where spinal cord change is calculated indirectly by numerical difference between timepoints. In this thesis, I validated the generalised boundary shift integral (GBSI), as the first registration-based method for longitudinal spinal cord atrophy measurement. The GBSI registers the baseline and follow-up spinal cord scans in a common half-way space, to directly determine atrophy on the cord edges. First, on a test dataset (9 MS patients and 9 controls), I have found that GBSI presented with lower random measurement error, than CSA, reflected by lower standard deviation, coefficient of variation and median absolute deviation. Then, on multi-centre, multi-manufacturer, and multi–field‐strength scans (282 MS patients and 82 controls), I confirmed that GBSI provided lower measurement variability in all MS subtypes and controls, than CSA, resulting into better separation between MS patients and controls, improved statistical power, and reduced sample size estimates. Finally, on a phase 2 clinical trial (220 primary-progressive MS patients), I demonstrated that spinal cord atrophy measurements on GBSI could be obtained from brain scans, considering their quality and association with corresponding spinal cord MRI-derived measurements. Not least, 1-year spinal cord atrophy measurements on GBSI, but not CSA, were associated with upper and lower limb motor function. In conclusion, spinal cord atrophy on the GBSI had higher measurement precision and stronger clinical correlates, than the segmentation method, and could be derived from high-quality brain acquisitions. Longitudinal spinal cord atrophy on GBSI could become a gold standard for clinical trials including spinal cord atrophy as an outcome measure, but should remain a secondary outcome measure, until further advancements increase the ease of acquisition and processing
Simultaneous lesion and neuroanatomy segmentation in Multiple Sclerosis using deep neural networks
Segmentation of both white matter lesions and deep grey matter structures is
an important task in the quantification of magnetic resonance imaging in
multiple sclerosis. Typically these tasks are performed separately: in this
paper we present a single segmentation solution based on convolutional neural
networks (CNNs) for providing fast, reliable segmentations of multimodal
magnetic resonance images into lesion classes and normal-appearing grey- and
white-matter structures. We show substantial, statistically significant
improvements in both Dice coefficient and in lesion-wise specificity and
sensitivity, compared to previous approaches, and agreement with individual
human raters in the range of human inter-rater variability. The method is
trained on data gathered from a single centre: nonetheless, it performs well on
data from centres, scanners and field-strengths not represented in the training
dataset. A retrospective study found that the classifier successfully
identified lesions missed by the human raters.
Lesion labels were provided by human raters, while weak labels for other
brain structures (including CSF, cortical grey matter, cortical white matter,
cerebellum, amygdala, hippocampus, subcortical GM structures and choroid
plexus) were provided by Freesurfer 5.3. The segmentations of these structures
compared well, not only with Freesurfer 5.3, but also with FSL-First and
Freesurfer 6.0
Structural neural networks subserving oculomotor function in first-episode schizophrenia
BACKGROUND: Smooth pursuit and antisaccade abnormalities are well documented in schizophrenia, but their neuropathological correlates remain unclear.
METHODS: In this study, we used statistical parametric mapping to investigate the relationship between oculomotor abnormalities and brain structure in a sample of first-episode schizophrenia patients (n = 27). In addition to conventional volumetric magnetic resonance imaging, we also used magnetization transfer ratio, a technique that allows more precise tissue characterization.
RESULTS: We found that smooth pursuit abnormalities were associated with reduced magnetization transfer ratio in several regions, predominantly in the right prefrontal cortex. Antisaccade errors correlated with gray matter volume in the right medial superior frontal cortex as measured by conventional magnetic resonance imaging but not with magnetization transfer ratio.
CONCLUSIONS: These preliminary results demonstrate that specific structural abnormalities are associated with abnormal eye movements in schizophrenia
Assessment and optimisation of MRI measures of atrophy as potential markers of disease progression in multiple sclerosis
There is a need for sensitive measures of disease progression in multiple sclerosis (MS) to
monitor treatment effects and understand disease evolution. MRI measures of brain
atrophy have been proposed for this purpose. This thesis investigates a number of
measurement techniques to assess their relative ability to monitor disease progression in
clinically isolated syndromes (CIS) and early relapsing remitting MS (RRMS).
Presented, is work demonstrating that measurement techniques and MR acquisitions can
be optimised to give small but significant improvements in measurement sensitivity and
precision, which provided greater statistical power. Direct comparison of numerous
techniques demonstrated significant differences between them. Atrophy measurements
from SIENA and the BBSI (registration-based techniques) were significantly more
precise than segmentation and subtraction of brain volumes, although larger percentage
losses were observed in grey matter fraction. Ventricular enlargement (VE) gave similar
statistical power and these techniques were robust and reliable; scan-rescan measurement
error was <0.01% of brain volume for BBSI and SIENA and <0.04ml for VE.
Annual atrophy rates (using SIENA) were -0.78% in RRMS and -0.52% in CIS patients
who progressed to MS, which were significantly greater than the rate observed in controls
(-0.07%). Sample size calculations for future trials of disease-modifying treatments in
RRMS, using brain atrophy as an outcome measure, are described. For SIENA, the BBSI
and VE respectively, an estimated 123, 157 and 140 patients per treatment arm
respectively would be required to show a 30% slowing of atrophy rate over two years. In
CIS subjects brain atrophy rate was a significant prognostic factor, independent of T2
MRI lesions at baseline, for development of MS by five year follow-up. It was also the
most significant MR predictor of disability in RRMS subjects. Cognitive assessment of
RRMS patients at five year follow-up is described, and brain atrophy rate was a
significant predictor of overall cognitive performance, and more specifically, of
performance in tests of memory.
The work in this thesis has identified methods for sensitively measuring progressive brain
atrophy in MS. It has shown that brain atrophy changes in early MS are related to early
clinical evolution, providing complementary information to clinical assessment that could
be utilised to monitor disease progression
Recommendations to improve imaging and analysis of brain lesion load and atrophy in longitudinal studies of multiple sclerosis
Focal lesions and brain atrophy are the most extensively studied aspects of multiple sclerosis (MS), but the image acquisition and analysis techniques used can be further improved, especially those for studying within-patient changes of lesion load and atrophy longitudinally. Improved accuracy and sensitivity will reduce the numbers of patients required to detect a given treatment effect in a trial, and ultimately, will allow reliable characterization of individual patients for personalized treatment. Based on open issues in the field of MS research, and the current state of the art in magnetic resonance image analysis methods for assessing brain lesion load and atrophy, this paper makes recommendations to improve these measures for longitudinal studies of MS. Briefly, they are (1) images should be acquired using 3D pulse sequences, with near-isotropic spatial resolution and multiple image contrasts to allow more comprehensive analyses of lesion load and atrophy, across timepoints. Image artifacts need special attention given their effects on image analysis results. (2) Automated image segmentation methods integrating the assessment of lesion load and atrophy are desirable. (3) A standard dataset with benchmark results should be set up to facilitate development, calibration, and objective evaluation of image analysis methods for MS
Multi-branch Convolutional Neural Network for Multiple Sclerosis Lesion Segmentation
In this paper, we present an automated approach for segmenting multiple
sclerosis (MS) lesions from multi-modal brain magnetic resonance images. Our
method is based on a deep end-to-end 2D convolutional neural network (CNN) for
slice-based segmentation of 3D volumetric data. The proposed CNN includes a
multi-branch downsampling path, which enables the network to encode information
from multiple modalities separately. Multi-scale feature fusion blocks are
proposed to combine feature maps from different modalities at different stages
of the network. Then, multi-scale feature upsampling blocks are introduced to
upsize combined feature maps to leverage information from lesion shape and
location. We trained and tested the proposed model using orthogonal plane
orientations of each 3D modality to exploit the contextual information in all
directions. The proposed pipeline is evaluated on two different datasets: a
private dataset including 37 MS patients and a publicly available dataset known
as the ISBI 2015 longitudinal MS lesion segmentation challenge dataset,
consisting of 14 MS patients. Considering the ISBI challenge, at the time of
submission, our method was amongst the top performing solutions. On the private
dataset, using the same array of performance metrics as in the ISBI challenge,
the proposed approach shows high improvements in MS lesion segmentation
compared with other publicly available tools.Comment: This paper has been accepted for publication in NeuroImag
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