ABSTRACT
The specificity and implementation of current MRI-based diagnostic criteria for multiple sclerosis (MS) are imperfect. Approximately 1 in 5 of individuals diagnosed with MS are eventually determined not to have the disease, with overreliance on MRI findings a major cause of MS misdiagnosis. The central vein sign (CVS), a proposed MRI biomarker for MS lesions, has been extensively studied in numerous cross sectional studies and may increase diagnostic specificity for MS. CVS has desirable analytical, measurement, and scalability properties. "Central Vein Sign: A Diagnostic Biomarker in Multiple Sclerosis (CAVS-MS)" is an NIH-supported, 2-year, prospective, international, multicenter study conducted by the North American Imaging in MS Cooperative (NAIMS) to evaluate CVS as a diagnostic biomarker for immediate translation into clinical care. Study objectives include determining the concordance of CVS and McDonald Criteria to diagnose MS, the sensitivity of CVS to detect MS in those with typical presentations, and the specificity of CVS among those with atypical presentations. The study will recruit a total of 400 participants (200 with typical and 200 with atypical presentations) across 11 sites. T2*-weighted, high-isotropic-resolution, segmented echo-planar MRI will be acquired at baseline and 24 months on 3-tesla scanners, and FLAIR* images (combination of FLAIR and T2*) will be generated for evaluating CVS. Data will be processed on a cloud-based platform that contains clinical and CVS rating modules. Imaging quality control will be conducted by automated methods and neuroradiologist review. CVS will be determined by Select6* and Select3* lesion methods following published criteria at each site and by central readers, including neurologists and neuroradiologists. Automated CVS detection and algorithms for incorporation of CVS into McDonald Criteria will be tested. Diagnosis will be adjudicated by three neurologists who served on the 2017 International Panel on the Diagnosis of MS. The CAVS-MS study aims to definitively establish CVS as a diagnostic biomarker that can be applied broadly to individuals presenting for evaluation of the diagnosis of MS.
Subject(s)
Multiple Sclerosis , Biomarkers , Cross-Sectional Studies , Humans , Magnetic Resonance Imaging , Multicenter Studies as Topic , Multiple Sclerosis/diagnostic imaging , Prospective StudiesABSTRACT
Segmenting regions of high angiogenic activity corresponding to malignant tumors from DCE-MRI is a time-consuming task requiring processing of data in 4 dimensions. Quantitative analyses developed thus far are highly sensitive to external factors and are valid only under certain operating assumptions, which need not be valid for breast carcinomas. In this paper, we have developed a novel Statistical Learning Algorithm for Tumor Segmentation (SLATS) for automatically segmenting cancer from a region selected by the user on DCE-MRI. In this preliminary study, SLATS appears to demonstrate high accuracy (78%) and sensitivity (100%) in segmenting cancers from DCE-MRI when compared to segmentations performed by an expert radiologist. This may be a useful tool for delineating tumors for image-guided interventions.
Subject(s)
Breast Neoplasms/diagnostic imaging , Breast/pathology , Lymphoma, Follicular/diagnostic imaging , Lymphoma, Non-Hodgkin/diagnostic imaging , Aged , Aged, 80 and over , Breast Neoplasms/pathology , Female , Humans , Lymphoma, Follicular/pathology , Lymphoma, Non-Hodgkin/pathology , Mammography , Ultrasonography, MammaryABSTRACT
Involvement of anomalies of the bladder and urethra in recurrent urinary tract infections and micturition disorders in children are examined in the light of published evidence and of the authors' own observations. The data of 300 children followed up for a wide bladder neck and posterior urethra at the Nephrology Clinic of Heim Pál Children's Hospital, Budapest, are reviewed. The dilatation in question is regarded as functional, attributable to a congenital neurogenic or myogenic defect. For the management and prevention of the recurrent ascending infections long-term urinary disinfection and meticulous toilet of the external meatus are recommended. The symptoms are expected to subside spontaneously at the age of menarche. The importance of a close nephrologic follow-up is emphasized.
Subject(s)
Enuresis/etiology , Urethra/abnormalities , Urinary Bladder/abnormalities , Urinary Tract Infections/etiology , Adolescent , Child , Child, Preschool , Female , Humans , Infant , Infant, Newborn , Male , Radiography , Urinary Bladder/diagnostic imaging , Vesico-Ureteral Reflux/diagnosisSubject(s)
Antigens, Bacterial , Glomerulonephritis/immunology , Leukocyte Migration-Inhibitory Factors/biosynthesis , Lymphokines/biosynthesis , Streptococcus pyogenes/immunology , Adolescent , Adult , Cell Membrane/immunology , Child , Female , Humans , Male , Middle Aged , Protoplasts/immunology , Streptodornase and Streptokinase/immunology , Time FactorsSubject(s)
Antigens, Bacterial , Glomerulonephritis/immunology , Glomerulosclerosis, Focal Segmental/immunology , Immunity, Cellular , Streptococcus/immunology , Adult , Antigens , Cell Membrane/immunology , Deoxyribonucleases/immunology , Female , Humans , Lectins , Lymphocyte Activation , Male , Streptokinase/immunology , Tuberculin/immunologyABSTRACT
Uraemia depresses immune response by altering cellular reactivity to mitogenic and antigenic stimulation. One might expect that amelioration of uraemia by dialysis would improve immune responses. We have investigated the effect of haemodialysis on in-vitro parameters of cellular immunity. Our data suggest that haemodialysis leads to loss of a factor or factors from both uraemic and normal plasma essential for DNA synthesis. Our data do not suggest that measurements of celluar immunity are useful in monitoring adequacy of haemodialysis in chronic uraemic patients.
