Impact of 3 Tesla MRI on interobserver agreement in clinically isolated syndrome : A MAGNIMS multicentre study

The author(s) disclosed receipt of the following financial support for the research, authorship and/or publication of this article: This research has been supported by a programme grant (14-358e) from the Dutch MS Research Foundation (Voorschoten, The Netherlands). The study in London was supported by the National Institute for Health Research University College London Hospitals Biomedical Research Centre.Background: Compared to 1.5 T, 3 T magnetic resonance imaging (MRI) increases signal-to-noise ratio leading to improved image quality. However, its clinical relevance in clinically isolated syndrome suggestive of multiple sclerosis remains uncertain. Objectives: The purpose of this study was to investigate how 3 T MRI affects the agreement between raters on lesion detection and diagnosis. Methods: We selected 30 patients and 10 healthy controls from our ongoing prospective multicentre cohort. All subjects received baseline 1.5 and 3 T brain and spinal cord MRI. Patients also received follow-up brain MRI at 3-6 months. Four experienced neuroradiologists and four less-experienced raters scored the number of lesions per anatomical region and determined dissemination in space and time (McDonald 2010). Results: In controls, the mean number of lesions per rater was 0.16 at 1.5 T and 0.38 at 3 T (p = 0.005). For patients, this was 4.18 and 4.40, respectively (p = 0.657). Inter-rater agreement on involvement per anatomical region and dissemination in space and time was moderate to good for both field strengths. 3 T slightly improved agreement between experienced raters, but slightly decreased agreement between less-experienced raters. Conclusion: Overall, the interobserver agreement was moderate to good. 3 T appears to improve the reading for experienced readers, underlining the benefit of additional training

Ocrelizumab versus Interferon Beta-1a in Relapsing Multiple Sclerosis

Supported by F. Hoffmann–La Roche

Aeromonas hydrophila subsp. dhakensis – a causative agent of gastroenteritis imported into the Czech Republic

Out of the twenty-one A. hydrophila complex isolates obtained during a routine examination of human diarrhoeal faeces, two A. hydrophila subsp. dhakensis isolates (P1097 = CCM 7329 and P1165) were successfully identified by ribotyping. The correct taxonomic position of the A. hydrophila subsp. dhakensis CCM 7329 was verified by cpn60 sequencing (GeneBank accession number HM536193). The remaining A. hydrophila complex isolates were identified as A. hydrophila subsp. hydrophila. The ability of biochemical tests and fatty acid methyl ester analysis to reliably discern both A. hydrophila subsp. dhakensis and A. hydrophila subsp. hydrophila was limited. In contrast to the A. hydrophila subsp. hydrophila, the faecal isolates of A. hydrophila subsp. dhakensis did not produce acid from arbutin. When compared in a two-dimensional plot, the A. hydrophila subsp. dhakensis faecal isolates contained higher amounts of the two minor fatty acids C13:0 and C17:1 ω8c than the A. hydrophila subsp. hydrophila reference strain. This is the first detected occurrence of the less frequent A. hydrophila subsp. dhakensis in our region and ribotyping was proved as a suitable method for the identification of A. hydrophila subsp. dhakensis

Treatment of secondary progressive multiple sclerosis by boosting CD8 T cell immunity to Epstein-Barr virus using a novel adoptive immunotherapy

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Brainstem lesions are associated with diffuse spinal cord involvement in early multiple sclerosis.

Early infratentorial and focal spinal cord lesions on magnetic resonance imaging (MRI) are associated with a higher risk of long-term disability in patients with multiple sclerosis (MS). The role of diffuse spinal cord lesions remains less understood. The purpose of this study was to evaluate focal and especially diffuse spinal cord lesions in patients with early relapsing-remitting MS and their association with intracranial lesion topography, global and regional brain volume, and spinal cord volume. We investigated 58 MS patients with short disease duration (< 5 years) from a large academic MS center and 58 healthy controls matched for age and sex. Brain, spinal cord, and intracranial lesion volumes were compared among patients with- and without diffuse spinal cord lesions and controls. Binary logistic regression models were used to analyse the association between the volume and topology of intracranial lesions and the presence of focal and diffuse spinal cord lesions. We found spinal cord involvement in 75% of the patients (43/58), including diffuse changes in 41.4% (24/58). Patients with diffuse spinal cord changes exhibited higher volumes of brainstem lesion volume (p = 0.008). The presence of at least one brainstem lesion was associated with a higher probability of the presence of diffuse spinal cord lesions (odds ratio 47.1; 95% confidence interval 6.9-321.6 p < 0.001) as opposed to focal spinal cord lesions (odds ratio 0.22; p = 0.320). Patients with diffuse spinal cord lesions had a lower thalamus volume compared to patients without diffuse spinal cord lesions (p = 0.007) or healthy controls (p = 0.002). Diffuse spinal cord lesions are associated with the presence of brainstem lesions and with a lower volume of the thalamus. This association was not found in patients with focal spinal cord lesions. If confirmed, thalamic atrophy in patients with diffuse lesions could increase our knowledge on the worse prognosis in patients with infratentorial and SC lesions

Three-tesla mri does not improve the diagnosis of multiple sclerosis. a multicenter study

OBJECTIVE: In the work-up of patients presenting with a clinically isolated syndrome (CIS), 3T MRI might offer a higher lesion detection than 1.5T, but it remains unclear whether this affects the fulfilment of the diagnostic criteria for multiple sclerosis (MS). METHODS: We recruited 66 patients with CIS within 6 months from symptom onset and 26 healthy controls in 6 MS centers. All participants underwent 1.5T and 3T brain and spinal cord MRI at baseline according to local optimized protocols and the MAGNIMS guidelines. Patients who had not converted to MS during follow-up received repeat brain MRI at 3-6 months and 12-15 months. The number of lesions per anatomical region was scored by 3 raters in consensus. Criteria for dissemination in space (DIS) and dissemination in time (DIT) were determined according to the 2017 revisions of the McDonald criteria. RESULTS: Three-Tesla MRI detected 15% more T2 brain lesions compared to 1.5T (p < 0.001), which was driven by an increase in baseline detection of periventricular (12%, p = 0.015), (juxta)cortical (21%, p = 0.005), and deep white matter lesions (21%, p < 0.001). The detection rate of spinal cord lesions and gadolinium-enhancing lesions did not differ between field strengths. Three-Tesla MRI did not lead to a higher number of patients fulfilling the criteria for DIS or DIT, or subsequent diagnosis of MS, at any of the 3 time points. CONCLUSION: Scanning at 3T does not influence the diagnosis of MS according to McDonald diagnostic criteria