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Purpose: To compare postmortem in situ with ex situ MRI parameters, including volumetry, diffusion tensor imaging (DTI), and relaxometry for assessing methodology‐induced alterations, which is a crucial prerequisite when performing MRI biomarker validation. Methods: MRI whole‐brain scans of five deceased patients with amyotrophic lateral sclerosis were performed at 3 T. In situ scans were conducted within 32 h after death (SD 18 h), and ex situ scans after brain extraction and 3 months of formalin fixation. The imaging protocol included MP2RAGE, DTI, and multi‐contrast spin‐echo and multi‐echo gradient‐echo sequences. Volumetry, fractional anisotropy, mean diffusivity, T1, T2, and T2*$$ {T}_2^{\ast } $$ have been assessed for specific brain regions. Results: When comparing ex situ to in situ values, the following results were obtained. Deep gray matter as well as the thalamus and the hippocampus showed a reduced volume. Fractional anisotropy was reduced in the cortex and the whole brain. Mean diffusivity was decreased in white matter and deep gray matter. T1 and T2 were reduced in all investigated structures, whereas T2*$$ {T}_2^{\ast } $$ was increased in the cortex. Conclusion: The results of this study show that the volumes and MRI parameters of several brain regions are potentially affected by tissue extraction and subsequent formalin fixation, suggesting that methodological alterations are present in ex situ MRI. To avoid overlap of indistinguishable methodological and disease‐related changes, we recommend performing in situ postmortem MRI as an additional intermediate step for in vivo MRI biomarker validation. [ABSTRACT FROM AUTHOR]

Background and Purpose: Fatigue is a common and disabling symptom in multiple sclerosis (MS). Educational interventions have shown potential to reduce fatigue. The aim was to systematically review the current best evidence on patient education programmes for MS‐related fatigue. Methods: This was a systematic review and meta‐analysis following Cochrane methodology. A systematic search was conducted in eight databases (September 2023). Moreover, reference lists and trial registers were searched and experts in the field were contacted. Randomized controlled trials were included evaluating patient education programmes for people with MS with the primary aim of reducing fatigue. Results: In total, 1176 studies were identified and assessed by two independent reviewers; 15 studies (1473 participants) were included. All interventions provided information and education about different aspects of MS‐related fatigue with different forms of application, some with components of psychological interventions. Amongst those, the most frequently applied were cognitive behavioural therapy (n = 5) and energy‐conservation‐based approaches (n = 4). Studies differed considerably concerning mode of intervention delivery, number of participants and length of follow‐up. Interventions reduced fatigue severity (eight studies, n = 878, standardized mean difference −0.28; 95% confidence interval −0.53 to −0.03; low certainty) and fatigue impact (nine studies, n = 824, standardized mean difference −0.21; 95% confidence interval −0.42 to 0.00; moderate certainty) directly after the intervention. Mixed results were found for long‐term effects on fatigue, for secondary endpoints (depressive symptoms, quality of life, coping) and for subgroup analyses. Conclusion: Educational interventions for people with MS‐related fatigue may be effective in reducing fatigue in the short term. More research is needed on long‐term effects and the importance of specific intervention components, delivery and context. [ABSTRACT FROM AUTHOR]

Background and purpose: In amyotrophic lateral sclerosis (ALS), there is an unmet need for more precise patient characterization through quantitative, ideally operator‐independent, assessments of disease extent and severity. Radially sampled averaged magnetization inversion recovery acquisitions (rAMIRA) magnetic resonance imaging enables gray matter (GM) and white matter (WM) area quantitation in the cervical and thoracic spinal cord (SC) with optimized contrast. We aimed to investigate rAMIRA‐derived SC GM and SC WM areas and their association with clinical phenotype and disability in ALS. Methods: A total of 36 patients with ALS (mean [SD] age 61.7 [12.6] years, 14 women) and 36 healthy, age‐ and sex‐matched controls (HCs; mean [SD] age 63.1 [12.1] years, 14 women) underwent two‐dimensional axial rAMIRA imaging at the inter‐vertebral disc levels C2/3–C5/C6 and the lumbar enlargement level Tmax. ALS Functional Rating Scale–revised (ALSFRS‐R) score, muscle strength, and sniff nasal inspiratory pressure (SNIP) were assessed. Results: Compared to HCs, GM and WM areas were reduced in patients at all cervical levels (p < 0.0001). GM area (p = 0.0001), but not WM area, was reduced at Tmax. Patients with King's Stage 3 showed significant GM atrophy at all levels, while patients with King's Stage 1 showed significant GM atrophy selectively at Tmax. SC GM area was significantly associated with muscle force at corresponding myotomes. GM area at C3/C4 was associated with ALSFRS‐R (p < 0.001) and SNIP (p = 0.0016). Conclusion: Patients with ALS assessed by rAMIRA imaging show significant cervical and thoracic SC GM and SC WM atrophy. SC GM area correlates with muscle strength and clinical disability. GM area reduction at Tmax may be an early disease sign. Longitudinal studies are warranted. [ABSTRACT FROM AUTHOR]