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Non-invasive brain stimulation in dementia: a complex network story
No full textNon-invasive brain stimulation (NIBS) is emerging as a promising rehabilitation tool for a number of neurodegenerative diseases. However, the therapeutic mechanisms of NIBS are not completely understood. In this review, we will summarize NIBS results in the context of brain imaging studies of functional connectivity and metabolites to gain insight into the possible mechanisms underlying recovery. We will briefly discuss how the clinical manifestations of common neurodegenerative disorders may be related with aberrant connectivity within large-scale neural networks. We will then focus on recent studies combining resting-state functional magnetic resonance imaging with NIBS to delineate how stimulation of different brain regions induce complex network modifications, both at the local and distal level. Moreover, we will review studies combining magnetic resonance spectroscopy and NIBS to investigate how microscale changes are related to modifications of large-scale networks. Finally, we will re-examine previous NIBS studies in dementia in light of this network perspective. A better understanding of NIBS impact on the functionality of large-scale brain networks may be useful to design beneficial treatments for neurodegenerative disorders
Neuroradiology training in EU: international survey of 31 countries within UEMS frame
No full textTo assess the current framework of interventional and diagnostic neuroradiology in Europe METHODS: The UEMS (European Union of Medical Specialists) Section of Radiology and the subspecialty UEMS Division of Neuroradiology collected by e-mail a survey on the situation of diagnostic and Interventional Neuroradiology' training and practice in Europe. The questionnaire was sent to the national delegates from 31 UEMS member countries, belonging to the European Union, the European Economic Area and the Council of Europe. In case of uncertain or discordant replies, the survey envisaged the involvement of neuroradiology scientific societies' experts for providing a decisive answer
ESMRMB Round Table report on "Can Europe Lead in Machine Learning of MRI-Data?"
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Ocrelizumab reduces cortical and deep grey matter loss compared to the S1P-receptor modulator in multiple sclerosis
Full text linkIntroduction: Ocrelizumab (OCR) and Fingolimod (FGL) are two high-efficacy treatments in multiple sclerosis which, besides their strong anti-inflammatory activity, may limit neurodegeneration. Aim: To compare the effect of OCR and FGL on clinical and MRI endpoints. Methods: 95 relapsing-remitting patients (57 OCR, 38 FGL) clinically followed for 36 months underwent a 3-Tesla MRI at baseline and after 24 months. The annualized relapse rate, EDSS, new cortical/white matter lesions and regional cortical and deep grey matter volume loss were evaluated. Results: OCR reduced the relapse rate from 0.48 to 0.04, FGL from 0.32 to 0.05 (both p < 0.001). Compared to FGL, OCR-group experienced fewer new white matter lesions (12% vs 32%, p = 0.005), no differences in new cortical lesions, lower deep grey matter volume loss (- 0.12% vs - 0.66%; p = 0.002, Cohen's d = 0.54), lower global cortical thickness change (- 0.45% vs - 0.70%; p = 0.036; d = 0.42) and reduced cortical thinning/volume loss in several regions of interests, including those of parietal gyrus (d-range = 0.65-0.71), frontal gyrus (d-range = 0.47-0.60), cingulate (d-range = 0.41-0.72), insula (d = 0.36), cerebellum (cortex d = 0.72, white matter d = 0.44), putamen (d = 0.35) and thalamus (d = 0.31). The effect on some regional thickness changes was confirmed in patients without focal lesions. Conclusions: When compared with FGL, patients receiving OCR showed greater suppression of focal MRI lesions accumulation and lower cortical and deep grey matter volume loss
Volume changes of thalamus, hippocampus and cerebellum are associated with specific CSF profile in MS
No full textBackground: The underlying pathogenesis of surface-in grey matter abnormalities in MS, demonstrated by both neuropathology and advanced MRI analyses, is under investigation and it might be related to CSF-mediated mechanism of inflammation and/or damage. Objective: To examine the link of CSF inflammatory profile with the damage of three regions early-involved in MS and bordering with CSF: thalamus, hippocampus and cerebellum. Methods: In this longitudinal, prospective study, we evaluated, in 109 relapsing-remitting MS patients, at diagnosis and after 2-year follow-up, the association between the baseline CSF level of 19 inflammatory mediators and the volume changes of thalamus, hippocampus, cerebellar cortex and control regions (globus pallidus, putamen). Results: The multivariable analysis showed that the CXCL13 and sCD163 CSF levels at baseline were independent predictors of thalamus (R2model=0.80 ; p < 0.001) and hippocampus (R2model=0.47; p < 0.001) volume change after 2-year follow-up. These molecules, plus CCL25, IFN-γ and fibrinogen, were independent predictors of the cerebellar cortex volume loss (R2model=0.60 ; p < 0.001). No independent predictors of volume changes of the control regions were found. Conclusion: Our results indicate an association between the CSF inflammatory profile and grey matter volume loss of regions anatomically close to CSF boundaries, thus supporting the hypothesis of a surface-in GM damage in MS
A visual scale to rate amygdalar atrophy on MRI
No full textBackground: Visual rating scales are routinely used in clinical radiology to assess brain atrophy on scans of patients with suspected neurodegenerative conditions. Limbic predominant age-related TDP-43 encephalopathy (LATE) has recently been described, featuring early and severe atrophy of the amygdala. However, there is currently no scoring system specifically designed to assess amygdalar atrophy on MRI. Objectives: to develop and validate a visual rating scale for amygdalar atrophy. Materials and methods: Stringent criteria were developed for no, mild/moderate, and severe amygdalar atrophy based on axial and coronal volumetric T1-weighted MRI scans. Inter- and intra-rater reliabilities were estimated by three independent expert neuroradiologists in 100 randomly selected scans from the Geneva Memory Center cohort selected to be representative of the variability of medial temporal atrophy. Convergent validity was evaluated versus amygdalar volumes extracted by FreeSurfer on 1943 consecutive patients. Criterion validity versus autopsy-confirmed LATE neuropathologic changes were studied in the pathological subset of the Alzheimer's Disease Neuroimaging Initiative (ADNI) cohort (N = 96). Results: Intra- and inter-rater agreements of amygdalar visual ratings were between substantial and almost perfect (weighted Cohen's Kappa 0.71 to 0.93). Visual ratings were strongly associated with amygdalar volumes (p ≤ 0.001 on the Kruskal-Wallis test). LATE neuropathologic changes were associated with visual ratings of amygdalar atrophy (p = 0.057 on a test for trend). Conclusion: The proposed visual amygdalar atrophy scale is a reliable and valid tool to assess amygdalar atrophy on MRI and can be a useful adjunct in routine radiological reporting. Key points: Question Assessment of amygdalar atrophy is crucial for diagnosing neurodegenerative diseases, as the limbic predominant age-related TDP-43 encephalopathy, yet no validated visual rating scale exists. Findings The proposed amygdalar atrophy scale demonstrated high intra-rater and inter-rater reliability, strong correlation with amygdalar volumetry, and association with limbic predominant age-related TDP-43 encephalopathy (LATE). Clinical relevance The amygdalar atrophy scale provides a reliable practical assessment tool that enhances diagnostic accuracy for dementia-related conditions, particularly aiding in identifying limbic predominant age-related TDP-43 encephalopathy
CSF TNF and osteopontin levels correlate with the response to dimethyl fumarate in early multiple sclerosis
Full text linkBACKGROUND: Disease activity in the first years after a diagnosis of relapsing-remitting multiple sclerosis (RRMS) is a negative prognostic factor for long-term disability. Markers of both clinical and radiological responses to disease-modifying therapies (DMTs) are advocated. OBJECTIVE: The objective of this study is to estimate the value of cerebrospinal fluid (CSF) inflammatory markers at the time of diagnosis in predicting the disease activity in treatment-naïve multiple sclerosis (MS) patients exposed to dimethyl fumarate (DMF). METHODS: In total, 48 RRMS patients (31 females/17 males) treated with DMF after the diagnosis were included in this 2-year longitudinal study. All patients underwent a CSF examination, regular clinical and 3T magnetic resonance imaging (MRI) scans that included the assessment of white matter (WM) lesions, cortical lesions (CLs) and global cortical thickness. CSF levels of 10 pro-inflammatory markers – CXCL13 [chemokine (C-X-C motif) ligand 13 or B lymphocyte chemoattractant], CXCL12 (stromal cell-derived factor or C-X-C motif chemokine 12), tumour necrosis factor (TNF), APRIL (a proliferation-inducing ligand, or tumour necrosis factor ligand superfamily member 13), LIGHT (tumour necrosis factor ligand superfamily member 14 or tumour necrosis factor superfamily member 14), interferon (IFN) gamma, interleukin 12 (IL-12), osteopontin, sCD163 [soluble-CD163 (cluster of differentiation 163)] and Chitinase3-like1 – were assessed using immune-assay multiplex techniques. The combined three-domain status of ‘no evidence of disease activity’ (NEDA-3) was defined by no relapses, no disability worsening and no MRI activity, including CLs. RESULTS: Twenty patients (42%) reached the NEDA-3 status; patients with disease activity showed higher CSF TNF (p = 0.009), osteopontin (p = 0.005), CXCL12 (p = 0.037), CXCL13 (p = 0.040) and IFN gamma levels (p = 0.019) compared with NEDA-3 patients. After applying a random forest approach, TNF and osteopontin revealed the most important variables associated with the NEDA-3 status. Six molecules that emerged at the random forest approach were added in a multivariate regression model with demographic, clinical and MRI measures of WM and grey matter damage as independent variables. TNF levels confirmed to be associated with the absence of disease activity: odds ratio (OR) = 0.25, CI% = 0.04–0.77. CONCLUSION: CSF inflammatory markers may provide prognostic information in predicting disease activity in the first years after DMF initiation. CSF TNF levels are a possible candidate in predicting treatment response, in addition to clinical, demographic and MRI variables
Standards for European training requirements in interventional neuroradiology : Guidelines by the Division of Neuroradiology/Section of Radiology European Union of Medical Specialists (UEMS), in cooperation with the Division of Interventional Radiology/UEMS, the European Society of Neuroradiology (ESNR), and the European Society of Minimally Invasive Neurological Therapy (ESMINT).
Full text linkThis document sets out standards for training in Interventional Neuroradiology (INR) in Europe. These standards have been developed by a working group of the European Society of Neuroradiology (ESNR) and the European Society of Minimally Invasive Neurological Therapy (ESMINT) on the initiative and under the umbrella of the Division of Neuroradiology/Section of Radiology of the European Union of Medical Specialists (UEMS)
Coordinate-Based Meta-Analysis of the Default Mode and Salience Network for Target Identification in Non-Invasive Brain Stimulation of Alzheimer's Disease and Behavioral Variant Frontotemporal Dementia Networks
No full textBackground: The accurate choice of the site of non-invasive brain stimulation (NIBS) is an important factor in trial design. Objective: Based on the observation that Alzheimer's disease (AD) and behavioral frontotemporal dementia (bvFTD) affect specific large-scale networks, i.e., the default mode network (DMN) and the salience network (SN), respectively, we aimed to identify population-average coordinates of these networks that could be used as potential targets in NIBS trials aiming to modulate these circuits. Methods: A systematic literature search of resting-state functional MRI studies reporting DMN and SN stereotactic coordinates was performed according to PRISMA guidelines. Coordinate-based meta-analyses were conducted to identify consistent nodes of the DMN and SN using GingerALE BrainMap software and the activation likelihood estimation method. Results: DMN coordinates mapped primarily to mesial areas (posterior cingulate cortex/precuneus [Brodmann Area-BA 23/31] and medial prefrontal cortex [BA 9/10/32]). More superficial areas mapped to the bilateral parietal (angular gyrus [BA 39]), temporal (middle gyrus [BA 21]) and dorsolateral prefrontal (superior gyrus [BA 8]) cortex. SN coordinates mapped primarily to mesial and deep frontal areas (anterior insula, anterior cingulate cortex [BA 24/32]), but more superficial areas mapped to the bilateral parietal (supramarginal gyrus [BA 40]) and the right dorsolateral prefrontal (middle gyrus [BA 9/10]) cortex. Conclusions: NIBS should target the bilateral angular, the middle temporal cortex, or superior frontal gyri in AD for DMN modulation, and the right middle frontal or supramarginal gyri in bvFTD for SN modulation
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