Where is VALDO? VAscular Lesions Detection and segmentatiOn challenge at MICCAI 2021

Imaging markers of cerebral small vessel disease provide valuable information on brain health, but their manual assessment is time-consuming and hampered by substantial intra- and interrater variability. Automated rating may benefit biomedical research, as well as clinical assessment, but diagnostic reliability of existing algorithms is unknown. Here, we present the results of the VAscular Lesions DetectiOn and Segmentation (Where is VALDO?) challenge that was run as a satellite event at the international conference on Medical Image Computing and Computer Aided Intervention (MICCAI) 2021. This challenge aimed to promote the development of methods for automated detection and segmentation of small and sparse imaging markers of cerebral small vessel disease, namely enlarged perivascular spaces (EPVS) (Task 1), cerebral microbleeds (Task 2) and lacunes of presumed vascular origin (Task 3) while leveraging weak and noisy labels. Overall, 12 teams participated in the challenge proposing solutions for one or more tasks (4 for Task 1-EPVS, 9 for Task 2-Microbleeds and 6 for Task 3-Lacunes). Multi-cohort data was used in both training and evaluation. Results showed a large variability in performance both across teams and across tasks, with promising results notably for Task 1-EPVS and Task 2-Microbleeds and not practically useful results yet for Task 3-Lacunes. It also highlighted the performance inconsistency across cases that may deter use at an individual level, while still proving useful at a population level

Training dataset for the VALDO 2021 challenge - Vascular Lesion Detection

VALDO Challenge 2021 Training dataset This work is licensed under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-sa/4.0/ or send a letter to Creative Commons, PO Box 1866, Mountain View, CA 94042, USA. This dataset corresponds to the training data of the VALDO Challenge 2021 - For more information about the challenge and to participate, please see website In order to register a team, remember to fill in the registration form The challenge is separated in 3 tasks Task 1 - Perivascular spaces segmentation Task 2 - Cerebral micro bleeds segmentation Task 3 - Lacunes segmentation Details of the contents and organisation of the data is described in the README.md file Data reference and acknowledgement When using this data, we kindly ask for the following funding sources to be acknowledged: Wellcome Trust (082464/Z/07/Z), British Heart Foundation (SP/07/001/23603, PG/08/103, PG/12/29/29497 and CS/13/1/30327), Erasmus MC University Medical Center, the Erasmus University Rotterdam, the Netherlands Organization for Scientific Research (NWO) Grant 918-46-615, the Netherlands Organization for Health Research and Development (ZonMW), the Research Institute for Disease in the Elderly (RIDE), and the European Union Seventh Framework Programme (FP7/2007–2013) under grant agreement No. 601055, VPHDARE@IT, the Dutch Technology Foundation STW For all publications, please add references noted below in the reference section When using data from Task 2, please add "for the ALFA Study" as corporate author in your publication and indicate the following list of contributors: Müge Akinci, Annabella Beteta, Raffaele Cacciaglia, Alba Cañas, Irene Cumplido, Carme Deulofeu, Ruth Dominguez, Maria Emilio, Carles Falcón, Karine Fauria, Sherezade Fuentes, Juan Domingo Gispert, Oriol Grau-Rivera, José M. González-de-Echávarri, Laura Hernandez, Gema Huesa, Jordi Huguet, Iva Knezevic, Eider M. Arenaza-Urquijo, Eva M Palacios, Paula Marne, Tania Menchón, Marta Milà-Alomà, Carolina Minguillon, José Luis Molinuevo, Grégory Operto, Albina Polo, Gemma Salvadó, Sandra Pradas, Blanca Rodríguez, Aleix Sala-Vila, Gonzalo Sánchez-Benavides, Mahnaz Shekari, Anna Soteras, Marc Suárez-Calvet, Laura Stankeviciute, Marc Vilanova and Natalia Vilor-Tejedor

Training dataset for the VALDO 2021 challenge - Vascular Lesion Detection

VALDO Challenge 2021 Training dataset This work is licensed under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-sa/4.0/ or send a letter to Creative Commons, PO Box 1866, Mountain View, CA 94042, USA. This dataset corresponds to the training data of the VALDO Challenge 2021 - For more information about the challenge and to participate, please see website In order to register a team, remember to fill in the registration form The challenge is separated in 3 tasks Task 1 - Perivascular spaces segmentation Task 2 - Cerebral micro bleeds segmentation Task 3 - Lacunes segmentation Details of the contents and organisation of the data is described in the README.md file Data reference and acknowledgement When using this data, we kindly ask for the following funding sources to be acknowledged: Wellcome Trust (082464/Z/07/Z), British Heart Foundation (SP/07/001/23603, PG/08/103, PG/12/29/29497 and CS/13/1/30327), Erasmus MC University Medical Center, the Erasmus University Rotterdam, the Netherlands Organization for Scientific Research (NWO) Grant 918-46-615, the Netherlands Organization for Health Research and Development (ZonMW), the Research Institute for Disease in the Elderly (RIDE), and the European Union Seventh Framework Programme (FP7/2007–2013) under grant agreement No. 601055, VPHDARE@IT, the Dutch Technology Foundation STW For all publications, please add references noted below in the reference section When using data from Task 2, please add "for the ALFA Study" as corporate author in your publication and indicate the following list of contributors: Müge Akinci, Annabella Beteta, Raffaele Cacciaglia, Alba Cañas, Irene Cumplido, Carme Deulofeu, Ruth Dominguez, Maria Emilio, Carles Falcón, Karine Fauria, Sherezade Fuentes, Juan Domingo Gispert, Oriol Grau-Rivera, José M. González-de-Echávarri, Laura Hernandez, Gema Huesa, Jordi Huguet, Iva Knezevic, Eider M. Arenaza-Urquijo, Eva M Palacios, Paula Marne, Tania Menchón, Marta Milà-Alomà, Carolina Minguillon, José Luis Molinuevo, Grégory Operto, Albina Polo, Gemma Salvadó, Sandra Pradas, Blanca Rodríguez, Aleix Sala-Vila, Gonzalo Sánchez-Benavides, Mahnaz Shekari, Anna Soteras, Marc Suárez-Calvet, Laura Stankeviciute, Marc Vilanova and Natalia Vilor-Tejedor

Safety and efficacy of losartan for the reduction of brain atrophy in clinically diagnosed Alzheimer's disease (the RADAR trial): a double-blind, randomised, placebo-controlled, phase 2 trial

BACKGROUND: Drugs modifying angiotensin II signalling could reduce Alzheimer's disease pathology, thus decreasing the rate of disease progression. We investigated whether the angiotensin II receptor antagonist losartan, compared with placebo, could reduce brain volume loss, as a measure of disease progression, in clinically diagnosed mild-to-moderate Alzheimer's disease. METHODS: In this double-blind, multicentre, randomised controlled trial, eligible patients aged 55 years or older, previously untreated with angiotensin II drugs and diagnosed (National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association criteria) with mild-to-moderate Alzheimer's disease, and who had capacity to consent, were recruited from 23 UK National Health Service hospital trusts. After undergoing a 4-week, open-label phase of active treatment then washout, participants were randomly assigned (1:1) oral over-encapsulated preparations of either 100 mg losartan (after an initial two-dose titration stage) or matched placebo daily for 12 months. Randomisation, minimised by age and baseline medial temporal lobe atrophy score, was undertaken online or via pin-access service by telephone. Participants, their study companions, and study personnel were masked to group assignment. The primary outcome, analysed by the intention-to-treat principle (ie, participants analysed in the group to which they were randomised, without imputation for missing data), was change in whole brain volume between baseline and 12 months, measured using volumetric MRI and determined by boundary shift interval (BSI) analysis. The trial is registered with the International Standard Randomised Controlled Trial Register (ISRCTN93682878) and the European Union Drug Regulating Authorities Clinical Trials Database (EudraCT 2012-003641-15), and is completed. FINDINGS: Between July 22, 2014, and May 17, 2018, 261 participants entered the open-label phase. 211 were randomly assigned losartan (n=105) or placebo (n=106). Of 197 (93%) participants who completed the study, 171 (81%) had complete primary outcome data. The mean brain volume (BSI) reduction was 19·1 mL (SD 10·3) in the losartan group and 20·0 mL (10·8) in the placebo group. The difference in total volume reduction between groups was -2·29 mL (95% CI -6·46 to 0·89; p=0·14). The number of adverse events was low (22 in the losartan group and 20 in the placebo group) with no differences between treatment groups. There was one treatment-related death per treatment group. INTERPRETATION: 12 months of treatment with losartan was well tolerated but was not effective in reducing the rate of brain atrophy in individuals with clinically diagnosed mild-to-moderate Alzheimer's disease. Further research is needed to assess the potential therapeutic benefit from earlier treatment in patients with milder cognitive impairment or from longer treatment periods. FUNDING: Efficacy and Mechanism Evaluation Programme (UK Medical Research Council and National Institute for Health Research)

Temporal Trends in Transcatheter Aortic Valve Replacement in France: FRANCE 2 to FRANCE TAVI

International audienceBackground - Transcatheter aortic valve replacement (TAVR) is standard therapy for patients with severe aortic stenosis who are at high surgical risk. However, national data regarding procedural characteristics and clinical outcomes over time are limited. Objectives - The aim of this study was to assess nationwide performance trends and clinical outcomes of TAVR during a 6-year period. Methods - TAVRs performed in 48 centers across France between January 2013 and December 2015 were prospectively included in the FRANCE TAVI (French Transcatheter Aortic Valve Implantation) registry. Findings were further compared with those reported from the FRANCE 2 (French Aortic National CoreValve and Edwards 2) registry, which captured all TAVRs performed from January 2010 to January 2012 across 34 centers. Results - A total of 12,804 patients from FRANCE TAVI and 4,165 patients from FRANCE 2 were included in this analysis. The median age of patients was 84.6 years, and 49.7% were men. FRANCE TAVI participants were older but at lower surgical risk (median logistic European System for Cardiac Operative Risk Evaluation [EuroSCORE]: 15.0% vs. 18.4%; p < 0.001). More than 80% of patients in FRANCE TAVI underwent transfemoral TAVR. Transesophageal echocardiography guidance decreased from 60.7% to 32.3% of cases, whereas more recent procedures were increasingly performed in hybrid operating rooms (15.8% vs. 35.7%). Rates of Valve Academic Research Consortium-defined device success increased from 95.3% in FRANCE 2 to 96.8% in FRANCE TAVI (p < 0.001). In-hospital and 30-day mortality rates were 4.4% and 5.4%, respectively, in FRANCE TAVI compared with 8.2% and 10.1%, respectively, in FRANCE 2 (p < 0.001 for both). Stroke and potentially life-threatening complications, such as annulus rupture or aortic dissection, remained stable over time, whereas rates of cardiac tamponade and pacemaker implantation significantly increased. Conclusions - The FRANCE TAVI registry provided reassuring data regarding trends in TAVR performance in an all-comers population on a national scale. Nonetheless, given that TAVR indications are likely to expand to patients at lower surgical risk, concerns remain regarding potentially life-threatening complications and pacemaker implantation. (Registry of Aortic Valve Bioprostheses Established by Catheter [FRANCE TAVI]; NCT01777828)