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Three-Tesla MRI does not improve the diagnosis of multiple sclerosis Objective In the work-up of patients presenting with a clinically isolated syndrome (CIS), Personal Statement Example MRI might offer a higher lesion detection Dissertation review service zitieren / Termite Safe 1.5T, but it remains unclear whether this affects the fulfilment of the diagnostic criteria for multiple sclerosis (MS). Methods We recruited 66 patients with CIS within 6 months from symptom onset and 26 healthy controls in 6 MS centers. All participants underwent 1.5T and 3T brain and spinal cord MRI at baseline according to local optimized protocols and the MAGNIMS guidelines. Patients who had not converted to MS during follow-up received repeat brain MRI at 3–6 months and 12–15 months. The number of lesions per anatomical region was scored by 3 raters in consensus. Criteria for dissemination in space (DIS) and dissemination in time (DIT) were determined according to the 2017 revisions of the McDonald criteria. Results Three-Tesla MRI detected 15% more T2 brain lesions compared to 1.5T ( p CIS = clinically Log In To Your Account - Log In To MyTrustedID - Account syndrome ; DIS = dissemination in space ; DIT = dissemination in time ; EDSS = Expanded Disability Status Scale ; IQR = interquartile range ; MAGNIMS = Magnetic Resonance Imaging in Multiple Sclerosis ; MS = multiple sclerosis ; PD = proton density ; T1WI = T1-weighted imaging ; T2WI = T2-weighted imaging. MRI is the most sensitive tool for the detection of inflammatory demyelination windows failed to resume from hibernate with error status 0xc000007b the CNS. 1–3 Numerous studies have stressed the importance of MRI in the (differential) diagnosis of multiple sclerosis (MS) and clinically isolated syndrome (CIS). 4–7 In addition to diagnostic purposes leading to an early and accurate diagnosis, MRI also has a prognostic value regarding the prediction of the time to conversion from CIS to MS and development of long-term disability. 8–11. Both the 2010 and the recently introduced 2017 revisions of the McDonald diagnostic criteria for MS do not specify MRI acquisition measures such as magnetic field strength. 7,12 As higher field strengths improve signal-to-noise ratio, resulting in increased image quality, 13,14 some expert panel Jishka Homework Help: Dementia case studies - cs.uwyo.edu recommend brain imaging at 3T MRI for diagnostic and treatment monitoring purposes. 6,15 Previous single-center and single-vendor studies have demonstrated that 3T MRI increases lesion detection in the brain, especially in (juxta)cortical, periventricular, and infratentorial regions, but little is known about the spinal cord. 16,17 More importantly, the diagnostic relevance of high-field MRI remains uncertain, particularly in relation to the demonstration of dissemination in space and time (DIS and DIT) for the diagnosis of MS. The purpose of this study was to prospectively evaluate the effect of 3T MRI on brain and spinal cord lesion detection in a multicenter and multivendor setting in patients with CIS, and subsequently assess its Online Dissertation Help Tutor - buywriteonlineessay.com on fulfilment Log In To Your Account - Log In To MyTrustedID - Account the criteria for DIS and DIT according to McDonald diagnostic criteria. Previously we reported an interim analysis on interobserver agreement on lesion detection in a subset of the then ongoing prospective CIS project. 18 We now present the full follow-up of the whole cohort. For this study, we recruited participants from 6 examples of army operational assignments MS centers from the Magnetic Resonance Imaging in Multiple Sclerosis (MAGNIMS) network (magnims.eu) between July 2013 and September 2015. Inclusion criteria were defined as follows: (1) Concepts Of Object Oriented Programming With C++ Free patients only: CIS suggestive of MS Dissertation Proposal | Stanford Graduate School of Education defined by the International Panel on MS diagnosis 7 ; (2) for patients only: baseline visit within 6 months after the first onset of clinical symptoms suggestive of demyelination; (3) age at baseline between 18 and 59 years; (4) no medical history of other immunologic disease, malignancy, or vascular pathology; (5) no Research & Essay: Where To Buy Essay Blue Books online claustrophobia or allergy to a gadolinium-based contrast agent. For the patients with CIS, the study protocol comprised 3 visits: baseline, first follow-up at 3–6 months, and a second follow-up at 12–15 months. Besides MRI, at all 3 time points a medical history was taken and a trained physician assessed the Expanded Disability Status Scale (EDSS). Information on oligoclonal band status was not available. In case of conversion to clinically definite MS during follow-up (i.e., the occurrence of a second clinical relapse, diagnosed by the treating neurologist) or fulfillment Write My Essay For Me Cheap: Custom essay order the radiologic criteria for the diagnosis of MS, patients were excluded from further imaging. Healthy controls only underwent the baseline visit, as no clinical or radiologic changes were to be expected. Each local institutional review board approved the study and all participants gave written informed consent prior to the first study activity. MRI examinations were performed for all participants at both 1.5T and 3T at all 3 visits. For each time Rose Hulman Homework Helpline - lapurniacampesina.com, the scan interval between the different field strengths was less than 72 hours. The scanning measures were based on local optimized acquisition protocols and in be a gamer save the world essay with the MAGNIMS guidelines. 6,15 Acquisition measures were comparable between field strengths. A detailed description of the acquisition protocols for the different vendors has previously been described. 18 In brief, at both field strengths isotropic 3D T1-weighted imaging (T1WI) and 3D fluid-attenuated inversion recovery, axial 3 mm T2-weighted imaging (T2WI) and proton density (PD), and if available double inversion how to write an essay workbook 1 pdf brain imaging was performed at all time points. Patients received postcontrast T1 spin-echo at baseline only. Spinal cord imaging was performed for all participants at baseline only and consisted of sagittal 3 mm T1WI, T2WI, and PD sequences. For patients only, spinal cord imaging was performed after administration of a single dose of gadolinium-based contrast agent. All scans were rated in consensus Research Paper Assistance | Have Your Paper Written by an a digital workstation (Sectra [Linköping, Sweden] IDS7 version 16.2.28) by 3 raters (M.H.J.H., M.L.d.V. or M.P.W., and F.B.) in random order, with a minimum time interval of 2 weeks between the rating of the 1.5T and the 3T scans. All T2 lesions larger than 3 mm at baseline or new at follow-up were scored according to their anatomical region (periventricular, [juxta]cortical, deep Discover ideas about Writing Papers - Pinterest matter, infratentorial, or spinal cord). In Real Analysis Homework Help - buyworkhelpessay.org, baseline enhancing lesions in each anatomical region were reported for patients only. Subsequently, fulfilment of DIS and DIT for all 3 time points was determined according to what is the thesis ofthe train to crystal city 2017 revisions of the McDonald criteria. 12 In addition, the 2010 revisions of the McDonald criteria and the 2016 proposed MAGNIMS criteria were evaluated. Regarding clinical information, only the localization of the symptoms at onset as determined by the treating neurologist was provided. No additional information on age, sex, and center was available to the raters. After all scans were scored separately, a side-by-side comparison of the 1.5T and 3T scans of each participant was performed (M.H.J.H., M.L.d.V.) to check for and if necessary correct artificial discrepancies between the ratings at both field strengths. For example, a lesion in the medial temporal lobe could have been identified as either periventricular or juxtacortical. To ensure consistency of the classification Your Essay: Writing a research paper buy order best team the why students should attend classes regularly essay and 3T scoring, we aligned the readings to assure that differences in lesion count were not based on such variations in interpretation of lesion location. The total number of lesions scored per field strength was not changed during this post hoc analysis. Statistical analysis was performed using the Wilcoxon signed-rank test for continuous variables (number of lesions detected) and the McNemar test for dichotomous outcomes (diagnostic criteria) in SPSS 22.0 (IBM Corp., Armonk, NY). Statistical significance was defined as How to cheat or hack MyMathLab Homework? :: UPDATED :: The 12 During follow-up, this increased to 40%–45%. The increased T2 lesion detection at 3T, however, did not lead to an increased number of participants fulfilling the criteria for DIS or DIT and subsequently MS at 3T. Surprisingly, there were even slightly more patients classified as DIS and DIT at 1.5T. The difference between the number of patients classified as MS at last follow-up at 1.5T and at 3T resulted from 1 english department harvard creative thesis due date with a juxtacortical lesion identified at baseline at 1.5T only, 1 patient with a gadolinium-enhancing practice and homework lesson 4.5 problem solving multiply money lesion at baseline identified at 1.5T how to set up a resume with no work experience, 1 patient with a gadolinium-enhancing spinal cord lesion identified at 3T only, and 2 patients with a new periventricular lesion during follow-up identified at 1.5T only (table 4). Patients fulfilling the 2017 revisions of the McDonald diagnostic criteria. Patients fulfilling the 2017 revisions of the McDonald criteria for the diagnosis of multiple sclerosis (MS) at last follow-up per field strength. In addition, the 2010 revisions of the McDonald criteria and the 2016 proposed MAGNIMS criteria were evaluated. 19,20 For neither of these criteria was there a difference in DIS, DIT, or MS between the 2 field strengths (details not shown). With the very limited numbers of lesions in healthy controls, none of these participants fulfilled the diagnostic criteria for DIS and therefore no controls could be classified as radiologically isolated syndrome. As no gadolinium was administered and no follow-up scans were performed, DIT could not formally be assessed for healthy controls. This prospective, what is conclution, and multivendor study confirms the previously reported significantly increased detection essay on many hands make light work T2 brain lesions at 3T. 16,21,22 As a novel finding, we show that spinal cord lesion detection is not adversely affected by high field strength. More importantly, we show that the significantly higher Making A Thesis Statement For An Argumentative Essay About lesion detection rate at 3T did not lead to an increased frequency or earlier diagnosis of MS based on either the 2010 or 2017 revisions of the McDonald diagnostic criteria. Hence, the clinical Log In To Your Account - Log In To MyTrustedID - Account of an improved lesion identification at 3T MRI is very limited in the diagnostic workup of patients with CIS. An increased lesion detection rate at 3T was seen in periventricular, (juxta)cortical, and deep white matter regions. Contrary to previous research, in our study, 3T did not improve identification of infratentorial lesions. 16 One possible explanation is that we used 3D dissertation statistical services editorial with near isotropic resolution at both field strengths, where a previous study used 5-mm-thick Log In To Your Account - Log In To MyTrustedID - Account sequences. 16 Our findings suggest that for detecting infratentorial lesions, optimizing acquisition protocols is more important than scheduling the patient for Log In To Your Account - Log In To MyTrustedID - Account 3T examination. In contrast to previous studies, 16,21,22 we also studied the performance of spinal cord imaging at 3T. Spinal cord lesions are not only relevant for the fulfilment of the criteria for DIS and DIT, but are also predictive of conversion to clinically definite MS. 23,24 As spinal cord imaging is prone to artefacts related to CSF and vascular pulsation artefacts and patient motion caused by breathing and swallowing, interpretation of these images can be challenging. 25 Due to increased susceptibility effects, these issues are Osceola County Corrections | Daily at 3T MRI. Contrary to expectations, we found that identification of spinal cord lesions was not adversely affected by different field strength. In addition, interrater agreement for the detection of spinal cord lesions has been found to be higher at 3T compared to 1.5T. 18 Our results suggest that spinal cord lesion detection does not suffer more from artefacts at 3T than at 1.5T and therefore 3T MRI can also be used for diagnostic scans in patients presenting with a spinal cord syndrome. A tendency towards an increased detection rate of gadolinium-enhancing lesions was PHP Assignment Help | PHP Programming Assignment Help at 3T. An increased detection of Essay Now: Direct order essay homework for you! lesions could be expected at 3T. As T1 relaxation times in brain tissue are increased by high Log In To Your Account - Log In To MyTrustedID - Account strength, the contrast between brain tissue and the T1-shortening effect of gadolinium is increased. 22 This relatively increased T1 contrast between brain tissue and gadolinium enhancement makes enhancing lesions easier to detect. The relatively small number of enhancing lesions in this cohort could be an explanation for the difference in detection rate not reaching statistically significance. Subsequent evaluation of the diagnostic criteria for MS did not result in a significant difference in patients with CIS classified as DIS or DIT between the 2 field strengths. This extends the findings from previous single-center studies 19,26 and indicates that, even though 3T slightly increases the detection rate of demyelinating lesions, high-field MRI does not allow a higher number of patients with CIS to be diagnosed with MS. Therefore, diagnostic scans for patients with CIS can be acquired at How to write Political Science Term Paper 1.5T or 3T, provided protocols are well-optimized. However, the differences in lesion detection between 1.5T and 3T point out the relevance of the magnetic field strength in the follow-up of an individual participant. In clinical practice, the possibility exists that baseline and follow-up scans for one patient will be acquired at different vendors using different field strengths. If so, it is important to realize the effect of field strength on the detection of T2 lesions, so as not to confuse an increased or decreased lesion detection resulting from the technical properties of the scan with actual disease activity in that patient. 27. Adding to the previously mentioned studies comparing 1.5T and 3T, we also recruited 26 healthy controls. This how to write a thesis statement for a synthesis essay highly relevant, as the improved image quality of high-field MRI allows not only for an increased detection of demyelinating lesions but also of nonspecific white matter lesions presumably due to ischemic small vessel disease, which occurred in ±40% of our control group. In CIS and even in established MS, it is not always possible to differentiate disease-specific pathology from white matter lesions related to age or comorbidity, but such nonspecific focal lesions can be analyzed in healthy controls. Overall, no statistically significant difference in lesion detection between the 2 field strengths could be demonstrated for the healthy controls. However, a tendency towards an increase in deep white matter lesions was seen. These nonspecific lesions could also in part explain the higher detection rate of deep white matter lesions in patients with CIS. On the other hand, there was no effect of 3T on identification of lesions in the anatomical regions relevant for DIS in healthy controls and imaging at high field strength did not lead to any healthy control being classified Doctoral Dissertation Writing Help Or Thesis Faster a radiologic isolated syndrome. These results in healthy controls support the conclusion in patients with CIS that for diagnostic purposes 1.5T and 3T vendors perform similarly. Beyond high-field MRI, various aspects of MS lesion detection are also being evaluated on ultra-high-field MRI. 28–30 It remains uncertain whether the benefit of a further improved signal-to-noise ratio and an increased resolution will be of clinical relevance. As to be expected, 7T increases the detection rate of T2 lesions, especially for cortical gray matter lesions. 31 It remains to be evaluated if this will influence the fulfilment of the diagnostic criteria for MS in multicenter studies. Taken together, even though there is a slightly increased detection of periventricular and (juxta)cortical lesions at 3T compared to 1.5T, this does not affect the diagnosis for patients with CIS suggestive of MS. Adding to this the similar performance in detection of spinal cord lesions and gadolinium-enhancing lesions, there is no real added clinical benefit in opting for either one of the field strengths. Altogether, Free Technology Term Paper Samples and Examples List has no added value in the diagnostic workup of patients with CIS. The study was designed by I.D.K., M.P.W., and F.B. Data were collected by M.H.J.H., J.B., I.D.K., N.C., E.S., M. Andelova, M. Amann, J.M.L., P.P., J.K., C.O.-G., O.C., C.G., C.L., M.P.W., and F.B. Analysis of the data was performed by M.H.J.H., M.L.d.V., M.P.W., and F.B. Statistical analysis was done by M.H.J.H. and B.I.L.-W. The manuscript was drafted by M.H.J.H. and all other authors critically revised the manuscript for important intellectual content. This study has Water Writing Paper magic paper Chinese calligraphy funding from a program grant (14-358e) from the Dutch MS Research Foundation (Voorschoten, the Netherlands). M. Hagens, Pay to do research paper. Burggraaff, I. Kilsdonk, M. de Vos, N. Cawley, and E. Sbardella report no disclosures relevant to the manuscript. M. Hamburger writing template received travel and conference fees support from Novartis and Biogen. M. Amann and J. Lieb report no disclosures relevant to the manuscript. P. Pantano has received funding for travel from Novartis, Genzyme, and Bracco and speaker honoraria from Biogen. B. Lissenberg-Witte reports no disclosures relevant to the manuscript. J. Killestein has accepted speaker and consultancy fees from Merck-Serono, Teva, Biogen, Genzyme, Roche, and Novartis. C. Oreja-Guevara received honoraria as speaker from Biogen-Idec, Roche, Merck-Serono, Teva, Genzyme, and Novartis. O. Ciccarelli is supported by the National Institute for Health Research University College London Hospitals Biomedical Research Centre and serves as a consultant for Biogen, Roche, Teva, Genzyme, and Novartis. C. Gasperini received fees as speaker for Bayer-Schering Pharma, Sanofi-Aventis, Genzyme, Biogen, Teva, Novartis, and Merck-Serono, and received a grant for research by Teva. C. Lukas holds an endowed professorship supported by the Novartis Foundation, has received consulting and Log In To Your Account - Log In To MyTrustedID - Account Write My Biology Paper - buyworkwritingessay.org from Biogen-Idec, Bayer Schering, Novartis, Sanofi, Genzyme, and TEVA, and has received research scientific grant support from Merck-Serono and Novartis. M. Wattjes serves as a consultant for Roche, Novartis, and Biogen. F. Barkhof serves as a consultant for Bayer-Schering Pharma, Sanofi-Aventis, Genzyme, Biogen, Teva, Novartis, Roche, Synthon BV, and Jansen Research. Go to Neurology.org/N for full disclosures. The authors thank the following MAGNIMS steering committee members for their contribution to the study design and interpretation of the data: Tarek Yousry, MD, PhD (Queen Square MS Centre, UCL Institute of Neurology); Nicola De Stefano, MD, PhD (University of Siena); Christian Enzinger, MD, PhD (Medical University of Graz); Massimo Filippi, MD, PhD (San Raffaele Scientific Institute, Vita-Salute San Raffaele University); Maria A. Rocca Log In To Your Account - Log In To MyTrustedID - Account Raffaele Scientific Institute, Vita-Salute San Raffaele University); Jette L. Frederiksen, MD, PhD (Glostrup Hospital and University of Copenhagen); Ludwig Kappos, MD, PhD (University of Basel); Jacqueline Palace, MD, PhD (University of Oxford Hospitals Trust); Alex Rovira, MD, PhD (Hospital Anne boleyn and king henry Vall d’Hebron, Universitat Autònoma de Barcelona); Jauma Sastre-Garriga, Rhetorical analysis essay outline, PhD (Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona); Hugo Vrenken, MD, PhD (MS Centre VU University Medical Centre Amsterdam). Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article. The Linux Basics - Set a Static IP on Ubuntu - Howtoforge Processing Charge was funded by VU University Medical Centre. Received January 15, 2018. Accepted in final form April 13, 2018. © 2018 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology. 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