Brain atrophy assessment in multiple sclerosis: technical- and subject-related barriers for translation to real-world application in individual subjects.

IF 3.4 2区 医学 Q2 CLINICAL NEUROLOGY
Expert Review of Neurotherapeutics Pub Date : 2024-11-01 Epub Date: 2024-09-04 DOI:10.1080/14737175.2024.2398484
Robert Zivadinov, Ashley Tranquille, Jack A Reeves, Michael G Dwyer, Niels Bergsland
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引用次数: 0

Abstract

Introduction: Brain atrophy is a well-established MRI outcome for predicting clinical progression and monitoring treatment response in persons with multiple sclerosis (pwMS) at the group level. Despite the important progress made, the translation of brain atrophy assessment into clinical practice faces several challenges.

Areas covered: In this review, the authors discuss technical- and subject-related barriers for implementing brain atrophy assessment as part of the clinical routine at the individual level. Substantial progress has been made to understand and mitigate technical barriers behind MRI acquisition. Numerous research and commercial segmentation techniques for volume estimation are available and technically validated, but their clinical value has not been fully established. A systematic assessment of subject-related barriers, which include genetic, environmental, biological, lifestyle, comorbidity, and aging confounders, is critical for the interpretation of brain atrophy measures at the individual subject level. Educating both medical providers and pwMS will help better clarify the benefits and limitations of assessing brain atrophy for disease monitoring and prognosis.

Expert opinion: Integrating brain atrophy assessment into clinical practice for pwMS requires overcoming technical and subject-related challenges. Advances in MRI standardization, artificial intelligence, and clinician education will facilitate this process, improving disease management and potentially reducing long-term healthcare costs.

多发性硬化症的脑萎缩评估:将技术和受试者相关障碍转化为个体受试者的实际应用。
简介脑萎缩是一种成熟的磁共振成像结果,可用于预测多发性硬化症患者(pwMS)的临床进展并在群体水平上监测治疗反应。尽管取得了重要进展,但将脑萎缩评估转化为临床实践还面临着一些挑战:在这篇综述中,作者讨论了在个人层面将脑萎缩评估作为临床常规的一部分所面临的技术和主体相关障碍。在理解和缓解核磁共振成像采集技术障碍方面已取得了长足的进步。目前已有许多用于体积估算的研究和商业分割技术,并在技术上得到了验证,但其临床价值尚未完全确定。系统地评估与受试者相关的障碍(包括遗传、环境、生物、生活方式、合并症和老化等混杂因素)对于解释受试者个体水平的脑萎缩测量结果至关重要。对医疗服务提供者和老年人进行教育将有助于更好地阐明评估脑萎缩对疾病监测和预后的益处和局限性:将脑萎缩评估纳入 pwMS 的临床实践需要克服技术和受试者方面的挑战。核磁共振成像标准化、人工智能和临床医生教育方面的进步将促进这一进程,改善疾病管理并可能降低长期医疗成本。
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来源期刊
Expert Review of Neurotherapeutics
Expert Review of Neurotherapeutics Medicine-Neurology (clinical)
CiteScore
7.00
自引率
2.30%
发文量
61
审稿时长
4-8 weeks
期刊介绍: Expert Review of Neurotherapeutics (ISSN 1473-7175) provides expert reviews on the use of drugs and medicines in clinical neurology and neuropsychiatry. Coverage includes disease management, new medicines and drugs in neurology, therapeutic indications, diagnostics, medical treatment guidelines and neurological diseases such as stroke, epilepsy, Alzheimer''s and Parkinson''s. Comprehensive coverage in each review is complemented by the unique Expert Review format and includes the following sections: Expert Opinion - a personal view of the data presented in the article, a discussion on the developments that are likely to be important in the future, and the avenues of research likely to become exciting as further studies yield more detailed results Article Highlights – an executive summary of the author’s most critical points
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