Automated segmentation reveals silent radiographic progression in adult-onset vanishing white-matter disease.

Adult-onset vanishing white-matter disease (VWM) is a rare autosomal recessive disease with neurological symptoms such as ataxia and paraparesis, showing extensive white-matter hyperintensities (WMH) on magnetic resonance (MR) imaging. Besides symptom-specific scores like the International Cooperative Ataxia Rating Scale (ICARS), there is no established tool to monitor disease progression. Because of extensive WMH, visual comparison of MR images is challenging. Here, we report the results of an automated method of segmentation to detect alterations in T2-weighted fluid-attenuated-inversion-recovery (FLAIR) sequences in a one-year follow-up study of a clinically stable patient with genetically diagnosed VWM. Signal alterations in MR imaging were quantified with a recently published WMH segmentation method by means of extreme value distribution (EVD). Our analysis revealed progressive FLAIR alterations of 5.84% in the course of one year, whereas no significant WMH change could be detected in a stable multiple sclerosis (MS) control group. This result demonstrates that automated EVD-based segmentation allows a precise and rapid quantification of extensive FLAIR alterations like in VWM and might be a powerful tool for the clinical and scientific monitoring of degenerative white-matter diseases and potential therapeutic interventions.

High-sensitivity C-reactive protein at different stages of atherosclerosis: results of the INVADE study.

Evidence on the role of high-sensitivity C-reactive protein (hsCRP) at different stages of atherosclerosis is limited. We therefore analyzed the relationship between hsCRP and measures of subclinical and advanced atherosclerosis in a population-based sample of the INVADE study (n = 3,092, >55 years). The parameters of interest were IMT, ABI, and the stage of atherosclerosis. Differences between participants with normal and pathological hsCRP were analyzed by t test for independent samples or Fishers' exact test. Differences of hsCRP between IMT quartiles, ABI quartiles, and different stages of atherosclerosis were analyzed by one-way ANOVA. Adjusted stepwise multiple linear regression analysis (IMT and ABI) and adjusted analysis of variance (stage of atherosclerosis) were performed, including significant baseline parameters as covariates. ANOVA showed significant differences of hsCRP among IMT quartiles, ABI quartiles, and patients with and without atherosclerosis. The adjusted analyses confirmed that the effects of IMT, ABI, and atherosclerosis on hsCRP were independent from other significant baseline parameters, but did not yield a significant difference between subclinical and advanced stages of atherosclerosis. The present analysis indicates an independent relationship between hsCRP and both IMT and ABI as measures of subclinical atherosclerosis. The comparison of subclinical and advanced stages of atherosclerosis yielded no significant difference, indicating that hsCRP is sensitive to identify vascular risk patients, but not suited to monitor progression of the disease.

Neural processes underlying intuitive coherence judgments as revealed by fMRI on a semantic judgment task.

Daily-life decisions and judgments are often made "intuitively", i.e., without an explicit explanation or verbal justification. We conceive of intuition as the capacity for an effortless evaluation of complex situations on the basis of information being activated, but at the moment of decision not being consciously retrieved. Little is known about which neural processes mediate intuitive judgments and whether these are distinct from those neural processes underlying explicit judgments. Employing functional magnetic resonance imaging (fMRI) we show that intuitive compared to explicit judgments in a semantic coherence judgment task are associated with increased neural activity in heteromodal association areas in bilateral inferior parietal and right superior temporal cortex. These results indicate that intuitive coherence judgments activate neural systems that are involved in the integration of remote associates into a coherent representation and, thus, support the assumption that intuitive judgments are based on an activation of widespread semantic networks sparing a conscious representation.