By M. Filippi, R. I. Grossman, G. Comi (auth.), Massimo Filippi, Robert I. Grossman, Giancarlo Comi (eds.)
We have entered a thrilling interval within the examine of a number of sclerosis and its therapy. valuable to this growth has been the advent of magnetic reso nance thoughts. whilst younger and his colleagues released the 1st photos of the mind in a number of sclerosis on the finish of 1981, it used to be right now seen that magnetic resonance imaging may playa significant position in analysis. Intuitively one felt that it's going to actually have a position in expanding our realizing of the pathogenesis of the sickness and in tracking therapy. And so it has proved. very important difficulties even though stay, probably crucial of which at the moment is the vulnerable predictive strength of ordinary magnetic resonance ima ging tools in deciding upon the potential of development of impairment and incapacity. lately, there were advances which promise to beat a few of these difficulties, yet judgements approximately what method of undertake in settling on sufferers for medical trials and which suggestions to exploit in tracking therapy in the course of their direction are nonetheless tough. during this booklet, Dr. Filippi and his colleagues have assembled a great workforce of individuals whose paintings is principal to the growth that's being made. The insurance of the problems keen on using magnetic resonance thoughts in assessing healing influence is complete and, although the sphere is chan ging swiftly, the foundations and masses of the aspect within the ebook are inclined to have lasting value.
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Additional resources for Magnetic Resonance Techniques in Clinical Trials in Multiple Sclerosis
Final criteria with a specificity of 100% required two of the three following features: (i) lesion size 6 mm or greater; (ii) lesions abutting the ventricle body; and (iii) an infratentorial location. These criteria were subsequently evaluated  by a blinded interpretation of 1500 consecutive brain MRI studies, including 134 cases with a clinical diagnosis of MS. In that analysis, the specificity and sensitivity of the Fazekas criteria were 96% and 81 %, compared to the Paty criteria which had specificity and sensitivity rates of 92% and 87%, respectively.
Ann Neurol 43: 79-87 32. Yetkin FZ, Haughton VM, Papke RA, et al. (1991) Multiple sclerosis: Specificity of MRI for diagnosis. Radiology 178: 447-451 33. Offenbacher H, Fazekas F, Schmidt R, et al. (1993) Assessment of MRI criteria for a diagnosis of MS. Neurology 43: 905-909 34. Lee KH, Hashimoto S, Hooge JP, et al. (1991) Magnetic resonance imaging of the head in the diagnosis of multiple sclerosis: A prospective 2-year follow-up with comparison of clinical evaluation, evoked potentials, oligo clonal banding, and CT.
Most lesion characteristics by MRI are similar in relapsing compared to first-onset MS. The major differences appear in the volume of T2-hyperintense and Tj-hypointense lesions (greater in relapsing MS), and other damage measures such as brain atrophy (greater in relapsing MS patients, on average) be less generally applicable to the targeted patient population. For any trial design, a balanced pre-determined selection criteria taking into consideration sample size will, of course, be optimal. Secondly, MRI-based criteria should be taken as guidelines, as they were in most cases developed from studies involving relatively small patient populations observed over a relatively short period.