INTRODUCTION: This study aimed to assess the impact of midline lumbar fusion with cortical bone trajectory screws (MIDLF/CBT) on the multifidus muscles, focusing on the evaluation of their postoperative atrophy. CLINICAL RATIONALE FOR THE STUDY: MIDLF/CBT is a relatively new technique increasingly used to treat spinal instability. Despite its reduced invasiveness compared to traditional posterior lumbar interbody fusion with traditional pedicle screws (PLIF/TP), concerns remain about potential damage to the multifidus muscles that are crucial for spinal stability. Understanding the extent of muscular atrophy post-MIDLF/CBT is vital for improving surgical outcomes, and potentially patient rehabilitation strategies. MATERIAL AND METHODS: This study retrospectively analysed preoperative and postoperative MRI scans of patients who underwent MIDLF/CBT for degenerative segmental spondylolisthesis. The bilateral width of the multifidus muscles at the operated segment and adjacent segments was measured using axial T2-weighted MRI scans. Statistical comparisons were made using a paired t test, with significance set at p < 0.05. RESULTS: The study included 16 patients with an average age of 57 ± 10 years, 10 of whom (62.5%) were women, and featured a mean follow-up period of 37 ± 25 months. Postoperative measurements showed a significant reduction in the width of the multifidus muscles at the operated segment (mean difference -3.3mm, p = 0.02) and the inferior adjacent segment (-7.4 mm, p < 0.01). A decrease in muscle width at the superior adjacent segment was also observed, although this was not statistically significant. CONCLUSIONS AND CLINICAL IMPLICATIONS: Our study concluded that MIDLF/CBT results in significant multifidus muscle atrophy at and below the operated segment, potentially impacting postoperative rehabilitation and recovery. These findings highlight the need for further research comparing MIDLF/CBT to other spinal stabilisation techniques. Additionally, incorporating functional electromyographic assessments of paraspinal muscles could provide deeper insights into the long-term consequences of spinal surgeries and helpdevelop new approaches and strategies to mitigate paravertebral muscles atrophy, thus enhancing patient outcomes.

• Keywords
• cortical bone trajectory, midline lumbar fusion, multifidus muscles, spinal fusion, spinal instability, spinal stabilisation,
• MeSH
• Lumbar Vertebrae * surgery   MeSH
• Adult MeSH
• Spinal Fusion * adverse effects   methods   MeSH
• Paraspinal Muscles * diagnostic imaging   pathology   MeSH
• Middle Aged MeSH
• Humans MeSH
• Magnetic Resonance Imaging MeSH
• Pedicle Screws adverse effects   MeSH
• Retrospective Studies MeSH
• Aged MeSH
• Spondylolisthesis * surgery   MeSH
• Muscular Atrophy * etiology   diagnostic imaging   MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

PURPOSE: MRI-only adaptive brachytherapy (MRI-ABT) is the state-of-the-art for treating locally advanced cervical cancer (LACC) in combination with concurrent chemoradiotherapy. We aimed to evaluate the pattern of pelvic recurrence after the treatment. MATERIAL AND METHODS: A total of one hundred LACC patients were treated between January 2017 and December 2023 with concurrent chemoradiotherapy of 45 Gy in 25 fractions ± boost to lymphadenopathy (up to a maximum dose of 60 Gy in 25 fractions) with concurrent weekly cisplatin chemotherapy at the dose of 40 mg/m2/week, and MR-ABT. RESULTS: At a median follow-up of 30.2 months, there were 2 local recurrences (2%) and 9 regional pelvic recurrences (9%). The median time to local/regional recurrence was 11 months (range 6-21). For all stages, the 3-year local control was 97.66%, and the 3-year pelvic control was 89.45%. Twenty-four patients died during follow-up; the 3-year overall survival was 75.11%, and the 3-year disease-free survival was 70.97%. CONCLUSION: MRI-ABT combined with external beam radiotherapy and concurrent chemotherapy for LACC demonstrates excellent local and regional pelvic control. Most local/regional recurrences occur inside or at the edge of the external-beam irradiated field. Recurrences inside the field of brachytherapy are rare. Distant recurrences are the predominant cause of death in LACC patients treated with definitive CRT and MRI-ABT.

• Keywords
• Adaptive brachytherapy, Cervical cancer, MRI-only brachytherapy, Recurrence,
• MeSH
• Brachytherapy * methods   MeSH
• Chemoradiotherapy methods   MeSH
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Neoplasm Recurrence, Local * MeSH
• Magnetic Resonance Imaging * methods   MeSH
• Uterine Cervical Neoplasms * pathology   radiotherapy   diagnostic imaging   therapy   mortality   MeSH
• Retrospective Studies MeSH
• Aged MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

During hypoxia, tissues are subjected to an inadequate oxygen supply, disrupting the balance needed to maintain normal function. This deficiency can occur due to reduced oxygen delivery caused by impaired blood flow or a decline in the blood's ability to carry oxygen. In tumors, hypoxia and vascularization play crucial roles, shaping their microenvironments and influencing cancer progression, response to treatment and metastatic potential. This chapter provides guidance on the use of non-invasive imaging methods including Positron Emission Tomography and Magnetic Resonance Imaging to study tumor oxygenation in pre-clinical settings. These imaging techniques offer valuable insights into tumor vascularity and oxygen levels, aiding in understanding tumor behavior and treatment effects. For example, PET imaging uses tracers such as [18F]-fluoromisonidazole (FMISO) to visualize hypoxic areas within tumors, while MRI complements this with anatomical and functional images. Although directly assessing tumor hypoxia with MRI remains challenging, techniques like Blood Oxygen Level Dependent (BOLD) and Dynamic Contrast-Enhanced MRI (DCE-MRI) provide valuable information. BOLD can track changes in oxygen levels during oxygen challenges, while DCE-MRI offers real-time access to perfusion and vessel permeability data. Integrating data from these imaging modalities can help assess oxygen supply, refine treatment strategies, enhance therapeutic effectiveness, and ultimately improve patient outcomes.

• Keywords
• BOLD, DCE-MRI, FMISO, Hypoxia, Magnetic resonance imaging, Positron emission tomography, Preclinical, Tumor oxygenation, Vascularity,
• MeSH
• Hypoxia * diagnostic imaging   MeSH
• Oxygen metabolism   MeSH
• Humans MeSH
• Magnetic Resonance Imaging * methods   MeSH
• Misonidazole analogs & derivatives   MeSH
• Mice MeSH
• Tumor Hypoxia MeSH
• Neoplasms * diagnostic imaging   blood supply   pathology   MeSH
• Neovascularization, Pathologic * diagnostic imaging   MeSH
• Positron-Emission Tomography * methods   MeSH
• Animals MeSH
• Check Tag
• Humans MeSH
• Mice MeSH
• Animals MeSH
• Publication type
• Journal Article MeSH
• Names of Substances
• fluoromisonidazole MeSH Browser
• Oxygen MeSH
• Misonidazole MeSH

BACKGROUND AND OBJECTIVES: Isolated REM sleep behavior disorder (iRBD) is the strongest prodromal marker of synucleinopathies, including Parkinson disease (PD) and dementia with Lewy bodies (DLB). Identifying brain biomarkers that predict progression and distinguish phenoconversion trajectories remains a challenge. The glymphatic system is involved in interstitial waste clearance, and its dysfunction has been associated with pathologic protein accumulation and neurodegeneration. Diffusion tensor imaging along the perivascular space (DTI-ALPS) has been proposed as a noninvasive proxy for glymphatic function. The aim of this study was to determine whether patients with iRBD show a reduced DTI-ALPS index compared with controls and whether a lower DTI-ALPS index predicts future phenoconversion to PD or DLB. METHODS: We conducted a longitudinal, multicenter cohort study using brain MRI scans from patients with polysomnography-confirmed iRBD and healthy controls recruited across 5 international centers. All participants underwent T1-weighted and diffusion-weighted MRI. DTI-ALPS indices were computed from diffusivity along projection and associative fibers adjacent to the lateral ventricles. The primary outcome was time to phenoconversion to synucleinopathy. Linear models assessed baseline group differences and clinical correlates, and Cox proportional hazard models assessed the predictive value of DTI-ALPS for time to phenoconversion. RESULTS: A total of 250 patients with iRBD (mean age: 66.5 ± 6.8 years; 87% male) and 178 controls (65.7 ± 6.8 years; 81% male) were included. Patients with iRBD showed a lower left DTI-ALPS index compared with controls (mean difference = -0.034, 95% CI -0.067 to -0.001; p = 0.043). Of 224 patients with iRBD followed for a mean of 6.1 ± 3.5 years, 65 phenoconverted to a synucleinopathy. Converters had a lower left DTI-ALPS index than nonconverters (mean difference = -0.050, 95% CI -0.098 to -0.003; p = 0.038). Lower left DTI-ALPS index was associated with an increased risk of conversion to PD over time (hazard ratio = 2.43, 95% CI 1.13-5.25; p = 0.012). Other diffusion metrics inside periventricular masks, namely fractional anisotropy, diffusivity metrics, and free water, did not differ between groups. DISCUSSION: Patients with iRBD exhibit a reduced DTI-ALPS index, suggesting altered glymphatic function. This reduction was associated with future phenoconversion to PD, supporting the DTI-ALPS index as a potential prognostic MRI biomarker of progression in prodromal synucleinopathies.

• MeSH
• Lewy Body Disease diagnostic imaging   MeSH
• Glymphatic System * diagnostic imaging   MeSH
• Cohort Studies MeSH
• Middle Aged MeSH
• Humans MeSH
• Longitudinal Studies MeSH
• Magnetic Resonance Imaging MeSH
• Brain * diagnostic imaging   MeSH
• Parkinson Disease diagnostic imaging   MeSH
• Polysomnography MeSH
• REM Sleep Behavior Disorder * diagnostic imaging   MeSH
• Prodromal Symptoms MeSH
• Disease Progression MeSH
• Aged MeSH
• Synucleinopathies diagnostic imaging   MeSH
• Diffusion Tensor Imaging * methods   MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Multicenter Study MeSH

BACKGROUND: Combining two oral therapies with different mechanisms could be an attractive treatment strategy for multiple sclerosis (MS) to increase efficacy; however, evidence of such efficacy and safety is lacking. OBJECTIVES: The phase 3 randomized, double-blind, placebo-controlled POINT study evaluated efficacy and safety of ponesimod 20 mg versus placebo as an add-on therapy to ongoing dimethyl fumarate (DMF) treatment in patients with active relapsing MS despite DMF monotherapy. METHODS: Patients (18-55 years) were randomized (1:1) to ponesimod+DMF or placebo+DMF orally once-daily for ≤156 weeks. Primary endpoint was annualized relapse rate (ARR) at end-of-study (EOS). Secondary endpoints were 12-week confirmed disability accumulation (CDA), time-to-first confirmed relapse, and number of combined unique active lesions (CUALs) on brain Magnetic resonance imaging (MRI) at EOS. RESULTS: The study was prematurely terminated due to slow recruitment; of 600 planned patients, 136 (23 %; [ponesimod: n = 68, placebo: n = 68]) were randomized. Primary endpoint (ARR) was not met (rate ratio, ponesimod+DMF versus placebo+DMF: 1.2; p = 0.5252). Ponesimod+DMF group showed a lower mean number of CUALs/year (rate ratio: 0.37; p = 0.0072). Other efficacy outcomes did not differ between the treatment groups. Adverse events (AEs) were comparable between groups (ponesimod+DMF: 48 [71.6 %]; placebo+DMF: 53 [77.9 %]); dizziness was the most commonly reported AE in the ponesimod+DMF group (10.4 %). CONCLUSIONS: This terminated study did not demonstrate the superiority of ponesimod+DMF on clinical efficacy endpoints. In the exploratory analysis ponesimod+DMF versus DMF alone appeared associated with a lower disease activity as assessed by MRI. No new safety signals were reported for ponesimod+DMF. GOV IDENTIFIER: NCT02907177 URL: https://clinicaltrials.gov/study/NCT02907177.

• Keywords
• Annualized relapse rate, Combination therapy, Dimethyl fumarate, MRI lesions, Multiple sclerosis, Ponesimod,
• MeSH
• Dimethyl Fumarate * therapeutic use   administration & dosage   adverse effects   MeSH
• Adult MeSH
• Double-Blind Method MeSH
• Immunosuppressive Agents * therapeutic use   administration & dosage   adverse effects   MeSH
• Drug Therapy, Combination MeSH
• Middle Aged MeSH
• Humans MeSH
• Magnetic Resonance Imaging MeSH
• Adolescent MeSH
• Young Adult MeSH
• Multiple Sclerosis, Relapsing-Remitting * drug therapy   diagnostic imaging   MeSH
• Thiazoles * adverse effects   therapeutic use   administration & dosage   MeSH
• Treatment Outcome MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Adolescent MeSH
• Young Adult MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Clinical Trial, Phase III MeSH
• Randomized Controlled Trial MeSH
• Names of Substances
• Dimethyl Fumarate * MeSH
• Immunosuppressive Agents * MeSH
• ponesimod MeSH Browser
• Thiazoles * MeSH

BACKGROUND: Axial involvement in psoriatic arthritis (axPsA) is associated with more severe disease and increased pain, yet no consensus definition of axPsA exists. This study aims to describe the occurrence and characteristics of MRI and radiographic sacroiliac joint (SIJ) involvement in a European PsA cohort. METHODS: Patients with a clinical diagnosis of PsA or of axial spondyloarthritis with psoriasis and available routine care SIJ MRIs were included from five European registries in the EuroSpA collaboration. SIJ MRIs and radiographs were centrally assessed for inflammatory and structural lesions, differential diagnoses, and globally evaluated for SpA-indicative findings. RESULTS: Among 581 PsA patients (mean age 45 years, 47% male), 31% exhibited SpA-indicative SIJ-MRI findings (MRI-axPsA). In MRI-axPsA patients, the most common lesions were bone marrow edema (BME) (69%), erosions (68%), and fat lesions (58%), generally present bilaterally. BME ≥ 1 cm, inflammation in an erosion cavity, capsulitis, fat lesions ≥ 1 cm, backfill, and ankylosis were observed almost exclusively in MRI-AxPsA patients. Differential diagnoses included osteitis condensans ilii (8%), probable strain-related BME (11%) and degenerative disease (16%). Among 259 patients with radiographs, 29% met the radiographic mNY criteria for ankylosing spondylitis and 38% had SpA-indicative MRI findings. Male sex, HLA-B27 positivity, elevated CRP and history of inflammatory back pain (but not current back pain) were independently associated with MRI-detected axial involvement. CONCLUSION: In this large European cohort, one-third of routine care PsA patients had axial involvement, based on global SIJ MRI assessment. The study supports incorporating MRI into the future definition of axPsA to enable early identification.

• Keywords
• Axial psoriatic arthritis, Axial spondyloarthritis, Imaging, Magnetic resonance imaging,
• MeSH
• Axial Spondyloarthritis diagnostic imaging   MeSH
• Adult MeSH
• Cohort Studies MeSH
• Middle Aged MeSH
• Humans MeSH
• Magnetic Resonance Imaging * methods   MeSH
• Arthritis, Psoriatic * diagnostic imaging   epidemiology   pathology   MeSH
• Radiography MeSH
• Registries MeSH
• Sacroiliac Joint * diagnostic imaging   pathology   MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Geographicals
• Europe epidemiology   MeSH

BACKGROUND: Postoperative speech impairment (POSI) and cranial nerve deficits (CND) are common complications of pediatric posterior fossa (PF) tumor surgery. Intraoperative MRI (ioMRI) has proven a useful tool in achieving gross total resection. The risk of POSI and CND with ioMRI remains unclear, making it the primary scope of this study. Additionally, we assessed whether POSI was associated with CND. METHODS: We prospectively included pediatric patients undergoing PF tumor surgery in 36 centers across 15 European countries. Neurological status and speech were assessed preoperatively and 1-4 weeks postoperatively. Surgical details, including tumor location and use of ioMRI, were recorded within 72 h of surgery. Postoperative CND were categorized as 0, 1, 2, or ≥ 3 nerves affected; POSI as habitual, reduced speech, or mutism. Proportional odds models estimated odds ratios (OR) for 1) POSI with stepwise adjustment for tumor location and age, and 2) CND with adjustment for preoperative CND and tumor location. Subgroup analyses assessed systematic differences, missing data, center-level effects, and histology adjustment. RESULTS: Of 790 primary PF tumor surgeries, 141 (18%) involved ioMRI. POSI occurred in 183/790 (23%) and postoperative CND in 213/790 (27%). POSI-risk with ioMRI showed non-significant unadjusted OR (95% CI) 0.83 (0.53;1.30); adjusted OR 0.76 (0.43;1.35). Fewer CNDs were observed with ioMRI (unadjusted OR 0.63 (0.40;1.00), adjusted OR 0.58 (0.33;0.94), p = 0.03). POSI-risk was associated with more CNDs (adjusted OR for 1 CND: 2.06 (1.15;3.68); 2 CND: 2.13 (1.02;4.42); ≥ 3 CND: 4.15 (1.98;8.70), p < 0.05). CONCLUSIONS: ioMRI was not associated with increased risk of postoperative complications in this multicenter cohort. The reduction in CND among ioMRI cases may reflect derived effects on surgical decision-making, expertise, case-load and case-mix. Results should be interpreted with caution due to limited intraoperative data. The association between POSI-risk and cumulative CND may indicate extensive brainstem involvement. Our findings highlight the need to further explore how ioMRI-guided strategies affect functional outcomes in pediatric PF tumour surgery. CLINICAL TRIALS ID: NCT02300766 (October 2014).

• Keywords
• Cerebellar mutism syndrome, Cranial Nerve Deficits, Intraoperative Magnetic Resonance Imaging, Pediatric Neurosurgery, Posterior Fossa Tumor, Posterior Fossa syndrome,
• MeSH
• Child MeSH
• Infratentorial Neoplasms * surgery   MeSH
• Infant MeSH
• Humans MeSH
• Magnetic Resonance Imaging * methods   MeSH
• Adolescent MeSH
• Cranial Nerve Diseases * etiology   epidemiology   MeSH
• Neurosurgical Procedures * adverse effects   MeSH
• Postoperative Complications * epidemiology   etiology   MeSH
• Speech Disorders * etiology   epidemiology   MeSH
• Child, Preschool MeSH
• Prospective Studies MeSH
• Check Tag
• Child MeSH
• Infant MeSH
• Humans MeSH
• Adolescent MeSH
• Male MeSH
• Child, Preschool MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Multicenter Study MeSH
• Observational Study MeSH
• Geographicals
• Europe MeSH

Our understanding of the neural basis of consciousness is mostly restricted to large-scale brain activity patterns as measured by methods such as functional magnetic resonance imaging (fMRI) and magneto/electro-encephalography (M/EEG). In contrast, we lack even basic understanding of circuit-level mechanisms supporting consciousness - particularly in humans - despite the fundamental role that such mechanisms likely play in instantiating larger-scale brain activity patterns supporting conscious states and contents. Here, we review what progress has been made on circuit-level theories of consciousness (e.g., apical amplification theory, dendritic integration theory) and argue that such theories can be tested in humans using recently developed, state-of-the-art methods. Doing so will further facilitate translation of consciousness science into clinical settings and strengthen the bridge between circuit- and network-level theories of consciousness.

• Keywords
• apical amplification theory, biophysical modeling, consciousness, dendritic integration theory, neuroimaging, pyramidal neurons,
• Publication type
• Journal Article MeSH
• Review MeSH

PURPOSE: To investigate the current practice patterns in image-guided proton therapy (IGPT) for extremities. METHODS: A multi-institutional survey was distributed to European particle therapy centres to analyse the current practice of IGPT for tumours of the extremities. A Delphi consensus analysis was developed to define minimum requirements and optimal workflow for clinical practice within eight centres participating in the European Particle Therapy Network (EPTN). RESULTS: Eight centres participated in the survey. Patient immobilization methods varied, with supine position being optimal for selected tumor locations in most of the centres and prone position being optional in some centres. Multimodal imaging, in particular magnetic resonance imaging (MRI), was routinely used for across all centres, especially for delineation. Setup verification involved 2D imaging predominantly, with a few centres employing 3D imaging. Imaging for treatment evaluation varied, with differing intervals between treatment and first control computer tomography (CT) scans. Current limitations highlighted the need for improved software tools, streamlined workflow processes, and more comprehensive guidelines. Five centres participated in the Delphi consensus analysis. The full consensus was reached on the use of specific imaging modalities, adaptive techniques, and dedicated protocols for paediatric patients, with a need for standardization and guidelines. CONCLUSION: There are differences in extremity IGPT clinical practice among European particle therapy centres. The optimal workflow identified by the expert consensus has not yet been reached, partly due to the small number of patients treated annually. To standardize clinical practice and improve IGPT quality for extremity tumours, consensus guidelines are strongly needed.

• Keywords
• Extremities, Image guided proton therapy, Immobilization, Positioning, Proton therapy,
• MeSH
• Delphi Technique MeSH
• Extremities * diagnostic imaging   MeSH
• Humans MeSH
• Magnetic Resonance Imaging MeSH
• Neoplasms * radiotherapy   diagnostic imaging   MeSH
• Proton Therapy * methods   MeSH
• Surveys and Questionnaires MeSH
• Radiotherapy, Image-Guided * methods   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Multicenter Study MeSH
• Geographicals
• Europe MeSH

Collagen membranes are widely used in tissue and bone engineering, including guided bone regeneration (GBR). For effective and uninterrupted bone healing, a GBR membrane must maintain its functionality for an initial critical period of 4 weeks. A novel carp collagen sponge has already shown promise as a wound coating and vascular graft coating, making it a candidate for GBR applications as well. To enhance the mechanical properties and longevity of GBR membranes, we modified the basic carp collagen membrane with combinations of l-lactide, ε-caprolactone, d,l-lactide, and glycolide in various molar ratios. While traditional methods rely on histological evaluation to assess the degradation pattern and therefore suitability of GBR membranes ex vivo, this study employed micro-MRI as an innovative, noninvasive approach to monitor the in vivo degradation of carp collagen membrane and its polymer-modified variants. Our findings demonstrated that micro-MRI is a reliable and effective method for visualizing collagen membrane degradation in vivo, up to scaffold disintegration. Among the variants tested, collagen GBR membrane coated with d,l-lactide and glycolide in a 50:50 M ratio emerged as the most suitable for GBR purposes. However, since this study was conducted in the subcutaneous tissue of a rat model, further research is required to determine the behavior of carp collagen GBR membrane variants on bony surfaces.

• Keywords
• GBR membrane, TERM, carp skin collagen, guided bone regeneration, in vivo collagen degradation, inflammatory reaction, micro‐MRI analysis,
• MeSH
• Carps MeSH
• Collagen * chemistry   metabolism   MeSH
• Rats MeSH
• Magnetic Resonance Imaging MeSH
• Membranes, Artificial * MeSH
• Bone Regeneration MeSH
• Tissue Engineering MeSH
• Tissue Scaffolds chemistry   MeSH
• Animals MeSH
• Check Tag
• Rats MeSH
• Animals MeSH
• Publication type
• Journal Article MeSH
• Names of Substances
• Collagen * MeSH
• Membranes, Artificial * MeSH