9 research outputs found
Consenso expandido do BCTRIMS para o tratamento da esclerose mĂșltipla: I. As evidĂȘncias para o uso de imunossupressores, plasmafĂ©rese e transplante autĂłlogo de cĂ©lulas tronco
Lesion Volume Quantification Using Two Convolutional Neural Networks in MRIs of Multiple Sclerosis Patients
Background: Multiple sclerosis (MS) is a neurologic disease of the central nervous system which affects almost three million people worldwide. MS is characterized by a demyelination process that leads to brain lesions, allowing these affected areas to be visualized with magnetic resonance imaging (MRI). Deep learning techniques, especially computational algorithms based on convolutional neural networks (CNNs), have become a frequently used algorithm that performs feature self-learning and enables segmentation of structures in the image useful for quantitative analysis of MRIs, including quantitative analysis of MS. To obtain quantitative information about lesion volume, it is important to perform proper image preprocessing and accurate segmentation. Therefore, we propose a method for volumetric quantification of lesions on MRIs of MS patients using automatic segmentation of the brain and lesions by two CNNs. Methods: We used CNNs at two different moments: the first to perform brain extraction, and the second for lesion segmentation. This study includes four independent MRI datasets: one for training the brain segmentation models, two for training the lesion segmentation model, and one for testing. Results: The proposed brain detection architecture using binary cross-entropy as the loss function achieved a 0.9786 Dice coefficient, 0.9969 accuracy, 0.9851 precision, 0.9851 sensitivity, and 0.9985 specificity. In the second proposed framework for brain lesion segmentation, we obtained a 0.8893 Dice coefficient, 0.9996 accuracy, 0.9376 precision, 0.8609 sensitivity, and 0.9999 specificity. After quantifying the lesion volume of all patients from the test group using our proposed method, we obtained a mean value of 17,582 mm3. Conclusions: We concluded that the proposed algorithm achieved accurate lesion detection and segmentation with reproducibility corresponding to state-of-the-art software tools and manual segmentation. We believe that this quantification method can add value to treatment monitoring and routine clinical evaluation of MS patients
Qualidade de vida em portadores de esclerose mĂșltipla
Multiple sclerosis (MS) is a chronic disease which may exert significant effects on the life of patients. Traditional outcome measures in MS lack in consider the effects of the disease on health-related quality of life (HRQoL). The goal of this study is to measure HRQoL in MS patients in the city of UberlĂąn-dia, State of Minas Gerais, Brazil. The Brazilian version of the SF-36 was applied in 23 MS patients and in 69 subjects of general population (blood donors) in UberlĂąndia. MS patients scored lower in all SF-36 scales than do the general population, principally in physical function domains. Patients with EDSS scores â€3.5 had higher mean scores in four domains than do the patients with EDSS scores â„4.0, and lower in all domains than control group. Depressive symptoms and heat intolerance showed correlation with SF-36 domains and components. In conclusion, MS patients have a significant negative impact on all HRQoL domains measured by SF-36, compared with general population, even in the stages with lower disability
Consenso expandido do BCTRIMS para o tratamento da esclerose mĂșltipla: III. Diretrizes baseadas em evidĂȘncias e recomendaçÔes
Em razĂŁo dos avanços no conhecimento da esclerose mĂșltipla (EM), dos novos critĂ©rios diagnĂłsticos e ensaios terapĂȘuticos publicados, a atualização e expansĂŁo das diretrizes para orientação do neurologista brasileiro em relação ao tratamento da EM se tornam necessĂĄrias. O Consenso Expandido do BCTRIMS enfatiza a individualização do tratamento a critĂ©rio do neurologista, e a necessidade de informação do paciente quanto aos potenciais benefĂcios e riscos das drogas, assim como do Consentimento Informado e compromisso de realização de controles periĂłdicos. Na ausĂȘncia de evidĂȘncias cientĂficas favorecendo uma determinada droga o mĂ©dico deve considerar o custo diferencial dos imunomoduladores ao fazer sua opção terapĂȘutica. As vĂĄrias situaçÔes clĂnicas e os diferentes agentes modificadores da doença, assim como as outras intervençÔes terapĂȘuticas de eficĂĄcia no tratamento sĂŁo consideradas Ă luz das classes de evidĂȘncias cientĂficas e dos tipos de recomendação, aceitos pela comunidade cientĂfica internacional. O Consenso Expandido do BCTRIMS pode servir de modelo para outros paĂses em desenvolvimento
Consenso expandido do BCTRIMS para o tratamento da esclerose mĂșltipla: II. As evidĂȘncias para o uso de glicocorticĂłides e imunomoduladores The BCTRIMS expanded consensus on treatment of multiple sclerosis: II. The evidences for the use of glucocorticoids and immunomodulatory treatments
A esclerose mĂșltipla (EM) Ă© doença inflamatĂłria em que mecanismos imunolĂłgicos desempenham importante papel na patogĂȘnese das lesĂ”es do sistema nervoso central. Drogas que agem em diferentes etapas destes mecanismos tĂȘm sido usadas em seu tratamento. O presente artigo analisa com base nas classes de evidĂȘncias cientĂficas e tipos de recomendaçÔes propostos pela comunidade cientĂfica, os mais importantes ensaios clĂnico-terapĂȘuticos com os glicocorticĂłides e os imunomoduladores, incluindo a imunoglobulina humana endovenosa, no tratamento da esclerose mĂșltipla. Ele tem por objetivo fornecer subsĂdios para a formulação do Consenso Expandido para o Tratamento da Esclerose MĂșltipla.<br>Multiple sclerosis is an inflammatory disease in which immunological mechanisms play an important role in causing demyelinating lesions in the central nervous system. A number of drugs acting in different stages of these mechanisms have been tested for its treatment. This paper analyses the most important clinical trials with glucocorticoids and immunomodulatory treatments, including human immunoglobulin, using the classes of evidences and types of recommendations as have been defined and widely accepted by the international scientific community. It aims to provide sufficient information to support the BCTRIMS Expanded Consensus on Treatment of MS