BACKGROUND: We recently described magnetic resonance imaging (MRI) features of children with transverse myelitis (TM) at first event with important and unique differences depending on the underlying disease entity. OBJECTIVE: To study the resolution of lesions over time in children with TM due to MOG-antibody associated disorders (MOGAD), multiple sclerosis (MS), neuromyelitis optica spectrum disorders (NMOSD) or double seronegative TM. PATIENTS AND METHODS: In this prospective study, 78 children from 29 different medical centres with TM as part of MOGAD (n = 34), MS (n = 20), NMOSD (n = 5) and in double seronegative children (n = 19) were included. A grading system consisting of 4 grades (grade 0 = complete resolution; grade 3 = no resolution at all) was used to compare the degree of lesion resolution over time in the different disease entities. Time to lesion resolution was evaluated by Kaplan-Meier statistics and log-rank test. RESULTS: Significant differences of the interval between first MRI until resolution of lesions were observed between the four disease entities. The most rapid and complete resolution was seen in MOGAD, followed by double seronegative, MS and NMOSD. Median periods until total resolution (grade 0) were 191 days (MOGAD), 750 days (double seronegative), 1117 days (MS), while none of the patients with NMOSD reached a complete resolution during the observation period. The better prognosis of MOGAD compared to MS was independent of sex, age, oligoclonal bands and cell count in the multivariate Cox analysis (P < 0.001). CONCLUSION: Children with TM and antibodies to MOG show a faster resolution of radiological lesions compared to children with MS and NMOSD.

• MeSH
• Autoantibodies blood   MeSH
• Child MeSH
• Myelin-Oligodendrocyte Glycoprotein immunology   MeSH
• Humans MeSH
• Magnetic Resonance Imaging * MeSH
• Spinal Cord diagnostic imaging   pathology   MeSH
• Adolescent MeSH
• Follow-Up Studies MeSH
• Neuromyelitis Optica * diagnostic imaging   MeSH
• Child, Preschool MeSH
• Prospective Studies MeSH
• Multiple Sclerosis * diagnostic imaging   pathology   MeSH
• Myelitis, Transverse * diagnostic imaging   MeSH
• Check Tag
• Child MeSH
• Humans MeSH
• Adolescent MeSH
• Male MeSH
• Child, Preschool MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Multicenter Study MeSH

The spinal cord plays a pivotal role in the central nervous system, providing communication between the brain and the body and containing critical motor and sensory networks. Recent advancements in spinal cord MRI data acquisition and image analysis have shown a potential to improve the diagnostics, prognosis, and management of a variety of pathological conditions. In this review, we first discuss the significance of standardized spinal cord MRI acquisition protocol in multi-center and multi-manufacturer studies. Then, we cover open-access spinal cord MRI datasets, which are important for reproducible science and validation of new methods. Finally, we elaborate on the recent advances in spinal cord MRI data analysis techniques implemented in the open-source software package Spinal Cord Toolbox (SCT).

• MeSH
• Humans MeSH
• Magnetic Resonance Imaging * methods   MeSH
• Spinal Cord * diagnostic imaging   MeSH
• Image Processing, Computer-Assisted methods   MeSH
• Reproducibility of Results MeSH
• Software * MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Review MeSH

Cílem článku je ukázat aktuální mezinárodní doporučení, která jsou zaměřena na co nejčasnější diagnostiku roztroušené sklerózy (RS), vyhodnocení negativních prognostických markerů a optimalizaci monitorace za účelem časné detekce pacientů s nedostatečnou odpovědí na léčbu. Je prezentován bazální diagnostický protokol, který splňuje nároky na co nejčasnější diagnostiku, tedy vysokou senzitivitu, zároveň však umožňuje i odlišení jiných onemocnění v rámci diferenciální diagnostiky. Krátce jsou zmíněny doplňující sekvence, které jsou doporučovány ve specifických případech. Je uveden interval a modifikace protokolu v následujících MR kontrolách, když nejsou splněny podmínky pro diagnózu. Hlavní změnou je, že diagnostický protokol zahrnuje nejen vyšetření mozku, ale i míchy. Pro monitoraci v klinické praxi je uveden základní sledovací protokol a intervaly vyšetření. Je diskutováno vyšetření s podáním kontrastní látky – kde je nezbytné, kdy je ke zvážení a kdy je doporučeno nativní vyšetření s pečlivým vyhodnocením MR aktivních ložisek. Nedílnou součástí doporučení pro využití MR u RS je i standardizace vyhodnocení tak, aby vyhodnocení bylo srozumitelné, porovnatelné napříč RS centry v České republice, což umožní i možnost sběru dat v rámci národního registru. V závěru je krátce zmíněna i bezpečnostní monitorace.

The article presents basic imaging protocols for diagnosis and monitoring in clinical practice. A basic protocol that meets the requirements for the earliest possible diagnosis is presented, therefore, high sensitivity, but it also allows differentiation of other diseases in the differential diagnosis. Additional sequences, which are recommended in specific cases, are briefly mentioned as well. The interval and modification of the protocol in subsequent MRI is when the conditions for diagnosis are not fulfilled. The main change is that the diagnostic protocol includes not only brain but also spinal cord examination. For monitoring in clinical practice, a basic follow-up protocol and examination intervals are given. Examination with contrast agent is discussed where necessary, it is being considered when a native examination with careful MRI evaluation of active lesion is recommended. An integral part of the recommendations for the use of MRI in multiple sclerosis is the standardization of the evaluation, so that the evaluation is understandable and comparable across MS centers in the Czech Republic, which will also allow the possibility of data collection within a national registry. Finally, we will briefly mention safety monitoring.

• MeSH
• Early Diagnosis MeSH
• Diagnosis, Differential MeSH
• Clinical Protocols MeSH
• Humans MeSH
• Magnetic Resonance Imaging * standards   MeSH
• Spinal Cord diagnostic imaging   MeSH
• Brain diagnostic imaging   MeSH
• Multiple Sclerosis * diagnostic imaging   diagnosis   MeSH
• Practice Guidelines as Topic MeSH
• Check Tag
• Humans MeSH
• Publication type
• Research Support, Non-U.S. Gov't MeSH

• MeSH
• Central Nervous System * anatomy & histology   diagnostic imaging   MeSH
• Diencephalon anatomy & histology   MeSH
• Humans MeSH
• Limbic System anatomy & histology   MeSH
• Spinal Cord anatomy & histology   diagnostic imaging   MeSH
• Brain anatomy & histology   diagnostic imaging   blood supply   MeSH
• Brain Stem anatomy & histology   MeSH
• Telencephalon anatomy & histology   MeSH
• Cerebrum anatomy & histology   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Review MeSH

Neuromyelitis optica a onemocněníjejího širšího spektra patří mezi autoimunitní onemocnění neznámé etiologie, kteréje charakterizováno postižením optických nervů a míchy. K hlavním znakům bylo přidánoještě postižení dorzální části prodloužené míchy (area postrema), primárně je u tohoto onemocnění postižení astrocytů. V MR obraze jsou ložiska především v oblastech, kde je astrocyty nebo ependymálními buňkami exprimován vodní kanál - akvaporin 4 (AQP4). Až u 80 % pacientů nacházíme v séru autoproti látky proti této molekule, tzv. AQP4-IgG. Jedná se o postižení v oblasti diencefalon, periependymálně v okolí postranních komor nebo IV. komory. Na MR mozku mohou býti nespecifická ložiska v bílé hmotě nebo v průběhu pyramidové dráhy, které není spjato se zvýšenou expresí akvaporinu 4. Intramedulámí postižení je nejčastěji ve formě longitudinální extenzivní transverzální myelitidy, kdy ložisko svojí délkou dosahuje alespoň tří obratlových těl, ložisko primárně postihuje šedou hmotu, často je rozsáhlé a zaujímá více než 50 % plochy míchy. Postižení zrakových nervuje typicky v dorzální části, v oblasti chiasmatu a optického traktu. Onemocnění asociované s protilátkami proti myelinovému oligodendrocytámímu glykoproteinu je v nedávné době popsané demyelinizační autoimunitní onemocnění, které může mít monofázický nebo relaps remitentní průběh. Vyskytuje sejak v dospělosti, tak i u dětí. Klinická manifestace a tím i nález na MR závisí na věku pacienta. U dětí převažuje akutní diseminovaná encefalomyelitida, u dospělých je nejčastějším příznakem optická neuritida. Typickyje postižen přední segment optického nervu, často oboustranně. Dalším patologickým nálezem je longitudinální extenzivní transverzální myelitida, u které bývá častěji postižen míšní kónus. V mozkovém parenchymu bývají patologické změny nespecifické jak v bílé, tak v šedé hmotě, ložiska častěji zasahují subkortikálně.

Neuromyelitis optica is an autoimmune disease of unknown etiology, characterized by involvement of the optic nerves and spinal cord, the main features of which have been widened to include involvement of the dorsal part of the medulla oblongata (area postrema). The disease primarily involves astrocytes. In MRI, the lesions are mainly in the areas where the water channel - aquaporin 4 is expressed. These are the lesions in the diencephalon, periependymally around the lateral ventricles orventricle IV. The brain MRI may also show non-specific white matter lesions or pyramidal pathway involvement, which is not associated with increased aquaporin 4 expression. Intramedullary involvement is most often in the form of longitudinal extensive transverse myelitis, when the lesion reaches the height of at least three vertebral bodies. The lesions primarily affect the grey matter, are often extensive and cover more than 50% of the spinal cord area. Optic nerve involvement is typically dorsal, affecting the chiasma and optic tract. Myelin oligodendrocyte glycoprotein antibody-associated disease is a recently identified autoimmune disease that manifests as CNS demyelination, occurs in both adults and children, and can be both relapsing-remitting and monophasic. MRI features depend on the age of the patient; in children the predominant involvement is as in acute disseminated encephalomyelitis, in adults optic neuritis is the most common sign. Typically, the anterior segment of the optic nerve is affected bilaterally. Another area that may be affected is the spinal cord, where longitudinal extensive transverse myelitis tends to occur; the spinal conus is more commonly affected. In the brain parenchyma, the features tend to be nonspecific, with lesions affecting both white and grey matter.

• MeSH
• Demyelinating Autoimmune Diseases, CNS * diagnostic imaging   epidemiology   pathology   MeSH
• Diagnosis, Differential MeSH
• Humans MeSH
• Magnetic Resonance Imaging MeSH
• Spinal Cord diagnostic imaging   pathology   MeSH
• Brain diagnostic imaging   pathology   MeSH
• Myelitis diagnostic imaging   pathology   MeSH
• Neuromyelitis Optica * diagnostic imaging   pathology   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Research Support, Non-U.S. Gov't MeSH
• Review MeSH

Úvod: Cílem naší studie u zdravých jedinců bylo posoudit změnu tvaru a délky míchy při dynamickém MR C páteře s míšními funkcemi hodnocenými evokovanými potenciály (EPs). Metodika: Do studie bylo zařazeno pět mužů a pět žen. Vyšetření MR stejně jako EPs (SEPs i MEPs) bylo provedeno v neutrální poloze, předklonu a záklonu. Na MR C páteře byla měřena přední (PD) a zadní délka míchy (ZD), příčný (PR) a předozadní rozměr míchy (PZ) a plocha míchy (P). Byl registrován SEPs n. medianus a n. tibialis, MEPs z mm. BB, APB a TA. Výsledky: Při flexi došlo ke statisticky významnému prodloužení ZD (o 9,2 mm) a PD míchy (o 5,6 mm). Při extenzi pak došlo ke statisticky významnému zkrácení ZD (o 4,3 mm) i PD míchy (o 2 mm). Při extenzi došlo k rozšíření jak PZ, PR i P rozměru míchy. Při flexi došlo ke zvětšení amplitudy míšní komponenty N13. MEPs a SEP n. tibialis byly beze změn. Závěr: Přestože grafické vyšetření prokazuje změnu tvaru a délky míchy v závislosti na změně osy krční páteře, na funkci míchy to u zdravých jedinců nemá zásadní vliv.

Introduction: The aim of our study in healthy individuals was to assess the changes in spinal cord shape and length measured by dynamic C spine MRI with spinal functions assessed by evoked potentials (EPs). Methodology: The study included 5 men and 5 women. MR examination as well as EPs (SEPs and MEPs) were performed in the neutral position, in the flexion and in the extension. The anterior (PD) and posterior spinal cord length (ZD) were measured on the C spine MRI. Then transverse spinal cord dimension (PR), the anteroposterior spinal cord dimension (PZ) and the spinal cord area (P). SEPs n. medianus, SEPs n. tibialis and MEPs were registered. Results: There was a statistically significant increase in ZD (by 9.2 mm) and PD (by 5.6 mm) during flexion. At extension bends, there was a statistically significant shortening of ZD (by 4.3 mm) and PD (by 2 mm). During the extension, the PZ, PR and P dimensions of the spinal cord widened. There was a statistically significant increase in the amplitude of the spinal cord component N13 during flexion for median nerve SEPs. MEPs from lower and upper limbs muscles and tibial nerve SEPs were unchanged. Conclusion: Although the graphical examination shows a change in the shape and length of the spinal cord depending on the change in the axis of the cervical spine, it has no significant effect on the spinal cord function in healthy individuals.

• MeSH
• Axis, Cervical Vertebra anatomy & histology   MeSH
• Adult MeSH
• Cervical Vertebrae * anatomy & histology   diagnostic imaging   MeSH
• Middle Aged MeSH
• Humans MeSH
• Magnetic Resonance Imaging methods   MeSH
• Spinal Cord * anatomy & histology   diagnostic imaging   MeSH
• Evoked Potentials, Motor physiology   MeSH
• Evoked Potentials, Somatosensory physiology   MeSH
• Statistics as Topic MeSH
• Body Constitution MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Female MeSH
• Publication type
• Clinical Study MeSH

Onemocnění asociované s protilátkami proti myelinovému oligodendrocytárnímu glykoproteinu je v nedávné době popsané autoimunitní demyelinizační onemocnění CNS, které se manifestuje jak v dospělosti, tak i u dětí. Klinické projevy této nemoci se mohou překrývat s RS či neuromyelitis optica a onemocněním jejího širšího spektra. Kromě průkazu autoprotilátek v séru je pro diagnostiku onemocnění důležitý nález na zobrazení MR mozku a míchy. Byly publikovány práce s popisy patologických nálezů při zobrazení pomocí MR, kde byla snaha o definici typického postižení pro tuto jednotku a odlišení od dalších demyelinizačních onemocnění. Někteří pacienti byli v minulosti vedeni pod jiným typem diagnózy. Chtěli bychom sdělit naše zkušenosti s diagnostikou pomocí MR u tohoto onemocnění a prezentovat nálezy souboru sedmi pacientů.

Myelin oligodendrocyte glycoprotein antibody-associated disease is a recently identified autoimmune demyelinating disease that occurs both in adults and children. Clinical symptoms of this disease may overlap with MS or neuromyelitis optica spectrum disorders clinical presentation. In addition to the presence of serum autoantibodies, MRI findings in the brain and spinal cord are important for the diagnosis of the disease. Articles have been published describing pathological findings on MRI in an attempt to define the typical pattern of involvement for this disease and to distinguish it from other demyelinating diseases. Some patients were diagnosed under other medical conditions in the past. We would like to share our experience with MRI diagnosis of this disease and present the findings of a cohort of seven patients.

• MeSH
• Demyelinating Autoimmune Diseases, CNS * diagnostic imaging   pathology   MeSH
• Myelin-Associated Glycoprotein analysis   MeSH
• Clinical Studies as Topic MeSH
• Humans MeSH
• Magnetic Resonance Imaging methods   MeSH
• Spinal Cord diagnostic imaging   MeSH
• Brain diagnostic imaging   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Research Support, Non-U.S. Gov't MeSH

BACKGROUND: Early infratentorial and focal spinal cord lesions on magnetic resonance imaging (MRI) are associated with a higher risk of long-term disability in patients with multiple sclerosis (MS). The role of diffuse spinal cord lesions remains less understood. The purpose of this study was to evaluate focal and especially diffuse spinal cord lesions in patients with early relapsing-remitting MS and their association with intracranial lesion topography, global and regional brain volume, and spinal cord volume. METHODS: We investigated 58 MS patients with short disease duration (< 5 years) from a large academic MS center and 58 healthy controls matched for age and sex. Brain, spinal cord, and intracranial lesion volumes were compared among patients with- and without diffuse spinal cord lesions and controls. Binary logistic regression models were used to analyse the association between the volume and topology of intracranial lesions and the presence of focal and diffuse spinal cord lesions. RESULTS: We found spinal cord involvement in 75% of the patients (43/58), including diffuse changes in 41.4% (24/58). Patients with diffuse spinal cord changes exhibited higher volumes of brainstem lesion volume (p = 0.008). The presence of at least one brainstem lesion was associated with a higher probability of the presence of diffuse spinal cord lesions (odds ratio 47.1; 95% confidence interval 6.9-321.6 p < 0.001) as opposed to focal spinal cord lesions (odds ratio 0.22; p = 0.320). Patients with diffuse spinal cord lesions had a lower thalamus volume compared to patients without diffuse spinal cord lesions (p = 0.007) or healthy controls (p = 0.002). CONCLUSIONS: Diffuse spinal cord lesions are associated with the presence of brainstem lesions and with a lower volume of the thalamus. This association was not found in patients with focal spinal cord lesions. If confirmed, thalamic atrophy in patients with diffuse lesions could increase our knowledge on the worse prognosis in patients with infratentorial and SC lesions.

• MeSH
• Humans MeSH
• Magnetic Resonance Imaging MeSH
• Spinal Cord diagnostic imaging   pathology   MeSH
• Brain pathology   MeSH
• Brain Stem diagnostic imaging   pathology   MeSH
• Spinal Cord Diseases * pathology   MeSH
• Disability Evaluation MeSH
• Multiple Sclerosis, Relapsing-Remitting * diagnostic imaging   pathology   MeSH
• Multiple Sclerosis * diagnostic imaging   pathology   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH

PURPOSE: Spinal cord gray-matter imaging is valuable for a number of applications, but remains challenging. The purpose of this work was to compare various MRI protocols at 1.5 T, 3 T, and 7 T for visualizing the gray matter. METHODS: In vivo data of the cervical spinal cord were collected from nine different imaging centers. Data processing consisted of automatically segmenting the spinal cord and its gray matter and co-registering back-to-back scans. We computed the SNR using two methods (SNR_single using a single scan and SNR_diff using the difference between back-to-back scans) and the white/gray matter contrast-to-noise ratio per unit time. Synthetic phantom data were generated to evaluate the metrics performance. Experienced radiologists qualitatively scored the images. We ran the same processing on an open-access multicenter data set of the spinal cord MRI (N = 267 participants). RESULTS: Qualitative assessments indicated comparable image quality for 3T and 7T scans. Spatial resolution was higher at higher field strength, and image quality at 1.5 T was found to be moderate to low. The proposed quantitative metrics were found to be robust to underlying changes to the SNR and contrast; however, the SNR_single method lacked accuracy when there were excessive partial-volume effects. CONCLUSION: We propose quality assessment criteria and metrics for gray-matter visualization and apply them to different protocols. The proposed criteria and metrics, the analyzed protocols, and our open-source code can serve as a benchmark for future optimization of spinal cord gray-matter imaging protocols.

• MeSH
• White Matter * diagnostic imaging   MeSH
• Cervical Cord * MeSH
• Humans MeSH
• Magnetic Resonance Imaging methods   MeSH
• Spinal Cord diagnostic imaging   MeSH
• Multicenter Studies as Topic MeSH
• Image Processing, Computer-Assisted methods   MeSH
• Gray Matter diagnostic imaging   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Research Support, N.I.H., Extramural MeSH

In a companion paper by Cohen-Adad et al. we introduce the spine generic quantitative MRI protocol that provides valuable metrics for assessing spinal cord macrostructural and microstructural integrity. This protocol was used to acquire a single subject dataset across 19 centers and a multi-subject dataset across 42 centers (for a total of 260 participants), spanning the three main MRI manufacturers: GE, Philips and Siemens. Both datasets are publicly available via git-annex. Data were analysed using the Spinal Cord Toolbox to produce normative values as well as inter/intra-site and inter/intra-manufacturer statistics. Reproducibility for the spine generic protocol was high across sites and manufacturers, with an average inter-site coefficient of variation of less than 5% for all the metrics. Full documentation and results can be found at https://spine-generic.rtfd.io/ . The datasets and analysis pipeline will help pave the way towards accessible and reproducible quantitative MRI in the spinal cord.

• MeSH
• Adult MeSH
• Humans MeSH
• Magnetic Resonance Imaging * MeSH
• Spinal Cord diagnostic imaging   ultrastructure   MeSH
• Neuroimaging * MeSH
• Image Processing, Computer-Assisted MeSH
• Reproducibility of Results MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Dataset MeSH
• Research Support, Non-U.S. Gov't MeSH
• Research Support, N.I.H., Extramural MeSH