Guest guest Posted October 17, 2004 Report Share Posted October 17, 2004 Yes, but returning to the question - " Are MRIs useful? " Just because a change in plaque size is considered significant, the question remains, " Is that useful? " . What I am getting at is, how often is a therapy change directed based on MRI results? And when a change in therapy occurs, does that improve symptoms? Are MRIs (beyond use in the establishment of a diagnosis) going to improve overall health, or are they just more money down the toilet? Perhaps a better way to follow the MS patient is by their symptoms. Had to throw that out there. > > This paper discusses the question which has plagued many on the > board. Are MRI's useful?. The answer is that T2 lesion changes > greater than 0.65 ml in volume (size) are significant and not due to > technical error. > > A > > Mult Scler. 2004 Aug;10(4):402-6. > > Has your patient's multiple sclerosis lesion burden or brain atrophy > actually changed? > > Wei X, Guttmann CR, Warfield SK, Eliasziw M, JR. > > Seaman Family MR Research Center, Departments of Radiology and > Clinical Neurosciences, University of Calgary, Calgary, AB, Canada. > > Changes in mean magnetic resonance imaging (MRI)-derived > measurements between patient groups are often used to determine > outcomes in therapeutic trials and other longitudinal studies of > multiple sclerosis (MS). However, in day-to-day clinical practice > the changes within individual patients may also be of interest In > this paper, we estimated the measurement error of an automated brain > tissue quantification algorithm and determined the thresholds for > statistically significant change of MRI-derived T2 lesion volume and > brain atrophy in individual patients. Twenty patients with MS were > scanned twice within 30 min. Brain tissue volumes were measured > using the computer algorithm. Brain atrophy was estimated by > calculation of brain parenchymal fraction. The threshold of change > between repeated scans that represented statistically significant > change beyond measurement error with 95% certainty was 0.65 mL for > T2 lesion burden and 0.0056 for brain parenchymal fraction. Changes > in lesion burden and brain atrophy below these thresholds can be > safely (with 95% certainty) explained by measurement variability > alone. These values provide clinical neurologists with a useful > reference to interpret MRI-derived measures in individual patients. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 17, 2004 Report Share Posted October 17, 2004 What the study shows is the degree of change required (0.65 ml), before a change is considered significant. If this change is in response to therapy (e.g. LDN), I would consider this as objective response to therapy. Symptoms of MS can occur without objective signs of disease, conversely, it is possible to have MRI lesions without symptoms of disease. But over the long run, an increase in MRI lesions WILL result in progression of disease..no doubt about that. Physicians treat mostly based on symptoms and not MRI's. But they monitor progression based on MRI's and EDSS and less by symptoms.. A > > > > This paper discusses the question which has plagued many on the > > board. Are MRI's useful?. The answer is that T2 lesion changes > > greater than 0.65 ml in volume (size) are significant and not due > to > > technical error. > > > > A > > > > Mult Scler. 2004 Aug;10(4):402-6. > > > > Has your patient's multiple sclerosis lesion burden or brain > atrophy > > actually changed? > > > > Wei X, Guttmann CR, Warfield SK, Eliasziw M, JR. > > > > Seaman Family MR Research Center, Departments of Radiology and > > Clinical Neurosciences, University of Calgary, Calgary, AB, Canada. > > > > Changes in mean magnetic resonance imaging (MRI)-derived > > measurements between patient groups are often used to determine > > outcomes in therapeutic trials and other longitudinal studies of > > multiple sclerosis (MS). However, in day-to-day clinical practice > > the changes within individual patients may also be of interest In > > this paper, we estimated the measurement error of an automated > brain > > tissue quantification algorithm and determined the thresholds for > > statistically significant change of MRI-derived T2 lesion volume > and > > brain atrophy in individual patients. Twenty patients with MS were > > scanned twice within 30 min. Brain tissue volumes were measured > > using the computer algorithm. Brain atrophy was estimated by > > calculation of brain parenchymal fraction. The threshold of change > > between repeated scans that represented statistically significant > > change beyond measurement error with 95% certainty was 0.65 mL for > > T2 lesion burden and 0.0056 for brain parenchymal fraction. > Changes > > in lesion burden and brain atrophy below these thresholds can be > > safely (with 95% certainty) explained by measurement variability > > alone. These values provide clinical neurologists with a useful > > reference to interpret MRI-derived measures in individual patients. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 18, 2004 Report Share Posted October 18, 2004 I have to throw a thought out, my MRI results show large plague in many areas of my brain. However, to look at me, you would never know something was wrong?? Sure, I have some disability, can't walk a straight line heel to toe and have ON in right eye. But MRI results don't tell the whole story! I've managed my MS over 23 years through diet, exercise, it's a whole mind,body and spirit process. I'm a real MS Rebel, sure I've had my ups and downs but the last 10 years have been great especially the LDN since February. -----Original Message----- From: aegis_on_ms [mailto:aegis_on_ms@...] Sent: Sunday, October 17, 2004 8:43 AM low dose naltrexone Subject: [low dose naltrexone] MRI's in MS This paper discusses the question which has plagued many on the board. Are MRI's useful?. The answer is that T2 lesion changes greater than 0.65 ml in volume (size) are significant and not due to technical error. A Mult Scler. 2004 Aug;10(4):402-6. Has your patient's multiple sclerosis lesion burden or brain atrophy actually changed? Wei X, Guttmann CR, Warfield SK, Eliasziw M, JR. Seaman Family MR Research Center, Departments of Radiology and Clinical Neurosciences, University of Calgary, Calgary, AB, Canada. Changes in mean magnetic resonance imaging (MRI)-derived measurements between patient groups are often used to determine outcomes in therapeutic trials and other longitudinal studies of multiple sclerosis (MS). However, in day-to-day clinical practice the changes within individual patients may also be of interest In this paper, we estimated the measurement error of an automated brain tissue quantification algorithm and determined the thresholds for statistically significant change of MRI-derived T2 lesion volume and brain atrophy in individual patients. Twenty patients with MS were scanned twice within 30 min. Brain tissue volumes were measured using the computer algorithm. Brain atrophy was estimated by calculation of brain parenchymal fraction. The threshold of change between repeated scans that represented statistically significant change beyond measurement error with 95% certainty was 0.65 mL for T2 lesion burden and 0.0056 for brain parenchymal fraction. Changes in lesion burden and brain atrophy below these thresholds can be safely (with 95% certainty) explained by measurement variability alone. These values provide clinical neurologists with a useful reference to interpret MRI-derived measures in individual patients. Quote Link to comment Share on other sites More sharing options...
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