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6. Use of gadolinium-based contrast agents in multiple sclerosis: a review by the ESMRMB-GREC and ESNR Multiple Sclerosis Working Group.

Author

Rovira, Àlex, Doniselli, Fabio M., Auger, Cristina, Haider, Lukas, Hodel, Jerome, Severino, Mariasavina, Wattjes, Mike P., van der Molen, Aart J., Jasperse, Bas, Mallio, Carlo A., Yousry, Tarek, and Quattrocchi, Carlo C.

Subjects
CONTRAST media, MULTIPLE sclerosis, MAGNETIC resonance imaging, BLOOD-brain barrier, GOVERNMENT agencies
Abstract

Magnetic resonance imaging (MRI) is the most sensitive technique for detecting inflammatory demyelinating lesions in multiple sclerosis (MS) and plays a crucial role in diagnosis and monitoring treatment effectiveness, and for predicting the disease course. In clinical practice, detection of MS lesions is mainly based on T2-weighted and contrast-enhanced T1-weighted sequences. Contrast-enhancing lesions (CEL) on T1-weighted sequences are related to (sub)acute inflammation, while new or enlarging T2 lesions reflect the permanent footprint from a previous acute inflammatory demyelinating event. These two types of MRI features provide redundant information, at least in regular monitoring of the disease. Due to the concern of gadolinium deposition after repetitive injections of gadolinium-based contrast agents (GBCAs), scientific organizations and regulatory agencies in Europe and North America have proposed that these contrast agents should be administered only if clinically necessary. In this article, we provide data on the mode of action of GBCAs in MS, the indications of the use of these agents in clinical practice, their value in MS for diagnostic, prognostic, and monitoring purposes, and their use in specific populations (children, pregnant women, and breast-feeders). We discuss imaging strategies that achieve the highest sensitivity for detecting CELs in compliance with the safety regulations established by different regulatory agencies. Finally, we will briefly discuss some alternatives to the use of GBCA for detecting blood–brain barrier disruption in MS lesions. Clinical relevance statement: Although use of GBCA at diagnostic workup of suspected MS is highly valuable for diagnostic and prognostic purposes, their use in routine monitoring is not mandatory and must be reduced, as detection of disease activity can be based on the identification of new or enlarging lesions on T2-weighted images. Key Points: • Both the EMA and the FDA state that the use of GBCA in medicine should be restricted to clinical scenarios in which the additional information offered by the contrast agent is required. • The use of GBCA is generally recommended in the diagnostic workup in subjects with suspected MS and is generally not necessary for routine monitoring in clinical practice. • Alternative MRI-based approaches for detecting acute focal inflammatory MS lesions are not yet ready to be used in clinical practice. [ABSTRACT FROM AUTHOR]

Published
2024
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11. Intravenous thrombolysis and thrombectomy decisions in acute ischemic stroke: An interrater and intrarater agreement study

Author

Ducroux, C., Fahed, R., Khoury, N. N., Gevry, G., Kalsoum, E., Labeyrie, M-A, Ziegler, D., Sauve, C., Chagnon, M., Darsaut, T. E., Raymond, J., Niclot, Philippe, Ameri, Alain, Hodel, Jerome, Gentric, Jean-Christophe, Merrien, Francois-Mathias, Jourdain, Aurore, Rouhart, Francois, Viakhireva, Irina, Timsit, Serge, Clarencon, Frederic, Pistocchi, Silvia, Rosso, Charlotte, Zavanone, Chiara, Houdart, Emmanuel, Labeyrie, Marc-Antoine, Reiner, Peggy, Gory, Benjamin, Riva, Roberto, Nighoghossian, Norbert, Cho, Tae-Hee, Derex, Laurent, Eugene, Francois, Ferré, Jean-Christophe, Le Bras, Anthony, Vannier, Stephane, Lassalle, Maria, Chivot, Cyril, Arnoux, Audrey, Alla, Philippe, Veyrieres, Jean-Brice, Marnat, Gaultier, Berge, Jerome, Olindo, Stephane, Sibon, Igor, Lapergue, Bertrand, Wang, Adrien, Consoli, Arturo, Di Maria, Federico, Obadia, Michael, Sabben, Candice, Mazighi, Mikael, Redjem, Hocine, Piotin, Michel, Boisseau, William, Razlog, Lilia, Pop, Raoul, Beaujeux, Remy, Mihoc, Dan, Richter, Sebastian, Manisor, Monica, Wolff, Valerie, Quenardelle, Veronique, Zinchenko, Lisa, Diaconu, Mihaela, Yger, Marion, Delorme, Stephen, Iosif, Christina, Moulin, Thierry, Zekri, Hatem, Lallement, Francois, Vercruysse, Olivier, Papagiannaki, Christanthi, Ozkul-Wermester, Ozlem, Dargazanli, Cyril, Costalat, Vincent, Gaillard, Nicolas, Arquizan, Caroline, Cayrecastel, Mireille, Bracard, Serge, Derelle, Anne-Laure, Richard, Sebastien, Humbertjean, Lisa, Herve, Yann, Favrole, Pascal, Le Coz, Patrick, de Brouker, Thomas, Force, Marie-Isabelle, Akono, Serge, Cakmak, Serkan, Florea, Alexandru, Lalu, Thibault, Taurin, Gregory, Duong, Duc Long, Chadenat, Marie-Laure, Pico, Fernando, Allibert, Remi, Evain, Sarah, Tassan, Philippe, Berthier, Eric, Ducrocq, Xavier, Rigal, Matthieu, Boulanger, Marion, Hôpital de la Fondation Ophtalmologique Adolphe de Rothschild [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal (UdeM), CHU Henri Mondor [Créteil], Service de Neuroradiologie [CHU Lariboisière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Lariboisière-Fernand-Widal [APHP], Département de Mathématiques et de statistique [UdeM- Montréal] (DMS), Université du Québec à Montréal = University of Québec in Montréal (UQAM), Troubles cognitifs dégénératifs et vasculaires - U 1171 - EA 1046 (TCDV), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille, Droit et Santé-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), CIC Brest, Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hôpital de la Cavale Blanche, Service de Neurologie [Brest], Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Génétique et Physiopathologie des Maladies Cérébro-Vasculaires (U1161 / UMR_S 1161), Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM), Génétique, génomique fonctionnelle et biotechnologies (UMR 1078) (GGB), EFS-Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Brestois Santé Agro Matière (IBSAM), Université de Brest (UBO), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Institut du Cerveau = Paris Brain Institute (ICM), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU)-Sorbonne Université (SU)-Centre National de la Recherche Scientifique (CNRS), Sorbonne Université (SU), Hôpital Lariboisière-Fernand-Widal [APHP], Imagerie Adaptative Diagnostique et Interventionnelle (IADI), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Hospices Civils de Lyon (HCL), Department of Stroke Medicine [Lyon], Université Claude Bernard Lyon 1 (UCBL), Université de Lyon, Hospices Civils de Lyon, Departement de Neurologie (HCL), Cerebrovascular Unit [Lyon], Hôpital neurologique et neurochirurgical Pierre Wertheimer [CHU - HCL], Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), Health Service and Performance Research (HESPER), Université de Lyon-Université de Lyon, Service de radiologie et imagerie médicale [Rennes] = Radiology [Rennes], CHU Pontchaillou [Rennes], Neuroimagerie: méthodes et applications (Empenn), Institut National de la Santé et de la Recherche Médicale (INSERM)-Inria Rennes – Bretagne Atlantique, Institut National de Recherche en Informatique et en Automatique (Inria)-Institut National de Recherche en Informatique et en Automatique (Inria)-SIGNAUX ET IMAGES NUMÉRIQUES, ROBOTIQUE (IRISA-D5), Institut de Recherche en Informatique et Systèmes Aléatoires (IRISA), Université de Rennes (UR)-Institut National des Sciences Appliquées - Rennes (INSA Rennes), Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Université de Bretagne Sud (UBS)-École normale supérieure - Rennes (ENS Rennes)-Institut National de Recherche en Informatique et en Automatique (Inria)-CentraleSupélec-Centre National de la Recherche Scientifique (CNRS)-IMT Atlantique (IMT Atlantique), Institut Mines-Télécom [Paris] (IMT)-Institut Mines-Télécom [Paris] (IMT)-Université de Rennes (UR)-Institut National des Sciences Appliquées - Rennes (INSA Rennes), Institut Mines-Télécom [Paris] (IMT)-Institut Mines-Télécom [Paris] (IMT)-Institut de Recherche en Informatique et Systèmes Aléatoires (IRISA), Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Université de Bretagne Sud (UBS)-École normale supérieure - Rennes (ENS Rennes)-CentraleSupélec-Centre National de la Recherche Scientifique (CNRS)-IMT Atlantique (IMT Atlantique), Institut Mines-Télécom [Paris] (IMT)-Institut Mines-Télécom [Paris] (IMT), Département de Radiologie [CHU de Rennes], Université de Rennes (UR), Institut de Recherche Technologique b-com (IRT b-com), Service de Neurologie [CHU Rennes], Laboratoire de Psychologie et NeuroCognition (LPNC ), Université Savoie Mont Blanc (USMB [Université de Savoie] [Université de Chambéry])-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), CHU Bordeaux [Bordeaux], Centre Hospitalier Universitaire de Bordeaux (CHU de Bordeaux), Université de Bordeaux (UB), Hôpital Foch [Suresnes], CHU Rothschild [AP-HP], Fondation Ophtalmologique Adolphe de Rothschild [Paris], Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), L'Institut hospitalo-universitaire de Strasbourg (IHU Strasbourg), Institut National de Recherche en Informatique et en Automatique (Inria)-l'Institut de Recherche contre les Cancers de l'Appareil Digestif (IRCAD)-Les Hôpitaux Universitaires de Strasbourg (HUS)-La Fédération des Crédits Mutuels Centre Est (FCMCE)-L'Association pour la Recherche contre le Cancer (ARC)-La société Karl STORZ, Département de Neuroradiologie [Strasbourg], Les Hôpitaux Universitaires de Strasbourg (HUS), Mitochondrie, stress oxydant et protection musculaire (MSP), Université de Strasbourg (UNISTRA), CHU Saint-Antoine [AP-HP], Centre de Recherche Saint-Antoine (CRSA), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), Equipe de Recherche Médicale Appliquée (ERMA), Université de Limoges (UNILIM)-CHU Limoges-Génomique, Environnement, Immunité, Santé, Thérapeutique (GEIST FR CNRS 3503), Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Service de neurologie [Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU), Département de Neuroradiologie[Montpellier], Université Montpellier 1 (UM1)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Gui de Chauliac [CHU Montpellier], Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Université de Montpellier (UM), Département de neuroradiologie diagnostique et thérapeutique [CHRU Nancy], Service de neurologie [CHRU Nancy], Service de Neurologie [Aix-en-Provence], Centre Hospitalier du Pays d'Aix, Neuroépidémiologie, Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de radiologie [Vannes], Centre hospitalier Bretagne Atlantique (Morbihan) (CHBA), Centre hospitalier régional Metz-Thionville (CHR Metz-Thionville), Physiopathologie et imagerie des troubles neurologiques (PhIND), Université de Caen Normandie (UNICAEN), Normandie Université (NU)-Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Troubles cognitifs dégénératifs et vasculaires - U 1171 (TCDV), and Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille)

Subjects
medicine.medical_specialty, Consensus, medicine.medical_treatment, [SDV]Life Sciences [q-bio], Decision Making, Single Center, law.invention, Brain Ischemia, 03 medical and health sciences, 0302 clinical medicine, Combined treatment, Cohen's kappa, Randomized controlled trial, Fibrinolytic Agents, law, Medicine, Humans, Thrombolytic Therapy, 030212 general & internal medicine, Infusions, Intravenous, Acute ischemic stroke, Thrombectomy, business.industry, Reproducibility of Results, Thrombolysis, Mechanical thrombectomy, Stroke, Inter-rater reliability, Neurology, Acute Disease, Physical therapy, Administration, Intravenous, Neurology (clinical), business, 030217 neurology & neurosurgery
Abstract

International audience; Purpose. - We aimed to assess agreement on intravenous tissue-plasminogen activator (IV tPA) and mechanical thrombectomy (MT) management decisions in acute ischemic stroke (AIS) patients. Secondary objectives were to assess agreement on Diffusion-Weighted-Imaging-Alberta-Stroke-Program-EArly-CT-Score (DWI-ASPECTS), and clinicians' willingness to recruit patients in a randomized controlled trial (RCT) comparing medical management with or without MT. Materials and Methods. - Studies assessing agreement of IV tPA and MT were systematically reviewed. An electronic portfolio of 41 AIS patients was sent to randomly selected providers at French stroke centers. Raters were asked 4 questions for each case: (1) What is the DWI-ASPECTS? (2) Would you perform IV tPA? (3) Would you perform MT? (4) Would you include the patient in a RCT comparing standard medical therapy with or without MT? Twenty responders were randomly selected to study intrarater agreement. Agreement was assessed using Fleiss' Kappa statistics. Results. - The review yielded two single center studies involving 2-5 raters, with various results. The electronic survey was answered by 86 physicians (60 vascular neurologists and 26 interventional neuroradiologists). The interrater agreement was moderate for IV tPA treatment decisions (kappa = 0.565 [0.420-0.680]), but only fair for MT (kappa = 0.383 [0.289-0.491]) and for combined treatment decisions (kappa = 0.399 [0.320-0.486]). The intrarater agreement was at least substantial for the majority of raters. The interrater agreement for DWI-ASPECTS was fair (kappa = 0.325 [0.276-0.387]). Physicians were willing to include a mean of 14 +/- 9 patients (33.1% +/- 21.7%) in a RCT. Conclusion. - Disagreements regarding the use of IVtPA or MT in the management of AIS patients remain frequent. Further trials are needed to resolve the numerous areas of uncertainty. (C) 2019 Elsevier Masson SAS. All rights reserved.

Published
2018
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12. Location of the transition zone in CT of small-bowel obstruction: added value of multiplanar reformations.

Author

Hodel, Jerome, Zins, Marc, Desmottes, Loic, Boulay-Coletta, Isabelle, Jullès, Marie Christine, Nakache, Jean Pierre, Rodallec, Mathieu, and Jullès, Marie Christine

Subjects
*BOWEL obstructions, *TOMOGRAPHY, *MEDICAL imaging systems, *EVALUATION of diagnostic imaging, *CROSS-sectional imaging, *DIAGNOSIS
Abstract

Purpose: To assess the additional value of multiplanar reformations (MPR) in comparison with axial images alone for location of the transition zone in CT of mechanical small-bowel obstruction (SBO). Materials and Methods: Sixty-nine consecutive patients with mechanical SBO underwent 16-slice multi detector row CT (MDCT). The gold standard for the precise location of the transition zone was established by two experienced abdominal radiologists, unblinded to clinical and surgical reports, reviewing all CT examinations. On a workstation, two blinded readers independently located the transition zone using first axial slices alone and then 1 month later MPR (axial, coronal, sagittal and oblique views) according to a three-point confidence scale. Diagnostic accuracy and mean confidence score were evaluated for both the transverse and multiplanar data sets. Results: Accuracy of transition zone location for reader 1 and reader 2 was 86% and 84% with axial slices alone, and by using MPR 93% (significant: P = 0.03) and 90% (not significant: P = 0.08), respectively. Mean confidence score was significantly increased for both readers using MPR: 0.3 higher (P = 0.0001) and 0.37 higher (P = 0.0001) respectively. Conclusion: MPR can increase both accuracy and confidence in the location of the transition zone in CT of SBO. [ABSTRACT FROM AUTHOR]

Published
2009
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