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Press Releases

Take a look at a selection of our recent media coverage:

Apremilast benefits in psoriatic arthritis revealed by magnetic resonance imaging

15th June 2023

The impact of apremilast on inflammatory and structural changes in psoriatic arthritis (PsA) can be better understood through magnetic resonance imaging (MRI), according to a recent study presented at the European Congress of Rheumatology (EULAR) 2023.

The data came from the MOSAIC phase 4, multicentre, single-arm, open-label study, in which the researchers used MRI to examine the effect of the oral immunomodulating phosphodiesterase-4 inhibitor apremilast on inflammation in patients with active PsA.

MOSAIC was the first trial to use MRI to assess inflammation in peripheral joints and entheses instead of traditional X-ray methods. Participants received oral apremilast 30 mg daily, either as monotherapy or in combination with stable methotrexate. Treatment continued for 48 weeks and individuals had an MRI scan of the hand performed at baseline and at Weeks 24 and 48.

Researchers set the primary endpoint as the change from baseline in the composite score of hand bone marrow oedema, synovitis and tenosynovitis in fingers two to five, assessed by the PsA MRI Score (PsAMRIS) at Week 24, and for which a negative change reflects disease improvements.

In addition, a total inflammation score, which comprised of bone marrow oedema, synovitis, tenosynovitis and periarticular inflammation in fingers, was also assessed. The team also considered disease activity with the clinical disease activity index for psoriatic arthritis (cDAPSA), which is lowered as disease activity reduces.

Apremilast and inflammatory changes

MOSAIC enrolled 122 patients who received apremilast. The mean age was 47 years (55% women) and the mean duration of PsA was 1.9 years. Some 98 patients provided evaluable data for the primary endpoint.

The least-squares mean change from baseline in the composite inflammation score of bone marrow oedema, synovitis, and tenosynovitis assessed by PsAMRIS was -2.32 at Week 24 and -2.91 at Week 48.

Significant improvements from baseline were also seen in total inflammation scores for those taking apremilast, together with a reduction in cDAPSA score. In addition, no significant structural progression was observed.

The researchers suggested their findings highlighted the value of using MRI and PsAMRIS as measures of disease activity change following PsA treatments.

Cone beam breast CT superior to MRI for detection of preoperative residual tumour

20th January 2023

The use of contrast-enhanced cone beam breast computed tomography was superior to MRI in the assessment of residual preoperative tumour

Using contrast-enhanced cone beam breast CT provides a more accurate assessment of residual tumour following neoadjuvant chemotherapy compared to magnetic resonance imaging (MRI) according to the findings of a comparative study by Chinese researchers.

Neoadjuvant chemotherapy is used prior to breast cancer surgery in patients with locally advanced breast cancer to reduce the size of the tumour. An assessment of the size of unresectable residual tumour is required since this is an important factor in the local recurrence of disease following breast conserving therapy. Radiological examination has an important role in the assessment of residual tumour and MRI has been shown to be more accurate that other imaging modalities for an evaluation of the response to treatment. Cone beam breast CT is a relatively novel technique that has shown promise for the early diagnosis of malignant breast cancer and can also differentiate between malignant and benign breast tissue.

However, to date, no studies have examined the accuracy of cone beam breast CT for the assessment of residual tumour following neoadjuvant chemotherapy. In the current study, the Chinese team compared cone beam breast CT and MRI for the assessment of tumour size following neoadjuvant chemotherapy and retrospectively compared the results of the two methods with those obtained with the findings from pathology. In addition, the researchers examined the predictive value of the two approaches for a pathological complete response. The level of agreement between the tumour size based on the two methods was compared to the findings on pathology and assessed using the intraclass correlation coefficient (ICC).

Cone beam breast CT and assessment of residual tumour

Data were available for 91 women with a median age of 45 years, the majority (73.6%) of whom were premenopausal.

When compared with pathology, there was good agreement for the cone beam breast CT (ICC = 0.64, 95% CI 0.35 – 0.78). In contrast, comparison with MRI was only moderate (ICC= 0.59, 95% CI 0.36 – 0.77). In subgroup analysis, the cone beam was also superior to MRI for residual ductal carcinoma in situ (p < 0.001).

For predictive purposes, the area under the receiver operating characteristics curve for predicting a pathological complete response were similar for both imaging modalities (AUC = 0.749 for cone beam and 0.733 for MRI, p > 0.05).

The authors concluded that cone beam breast CT was superior to MRI for an assessment of residual tumour following neoadjuvant chemotherapy and could therefore be seen as an alternative means of assessment.

Citation
Wang Y et al. Accuracy of Preoperative Contrast-enhanced Cone Beam Breast CT in Assessment of Residual Tumor after Neoadjuvant Chemotherapy: A Comparative Study with Breast MRI. Acad Radiol 2023

Choroid plexus volume and permeability are potential MRI imaging markers for Alzheimer’s disease

1st June 2022

A higher choroid plexus volume and permeability could be useful imaging markers for cognitive impairment in patients with Alzheimer’s disease

An increased choroid plexus (CP) volume as well as higher permeability, might represent useful imaging markers for the severity of cognitive impairment along the Alzheimer’s disease spectrum. This was the conclusion of an imaging study by researchers from South Korea.

It is estimated that across the globe, there are some 55 million people living with dementia, of which, Alzheimer’s disease (AD) is the most common, accounting for 60 to 70% of all dementia cases. Alzheimer’s disease pathology is characterised by the build-up amyloid-β (Aβ) and tau neurofibrillary tangles in the brain.

Nevertheless, in the last decade, it has become recognised that while accumulation of amyloid-β plaques occurs, this might arise due to a reduced clearance rather than simply over-production. One poorly studied area of the brain is the choroid plexus (CP), which is responsible for the manufacture of blood-cerebrospinal fluid (B-CSF).

Moreover, the integrity of the CP is critical for maintaining brain homeostasis and B-CSF barrier permeability and the structure is thought to play a role in the development of neurodegenerative diseases such as AD. In fact, use of choroid plexus epithelial cells transplanted into the brain of animal models of AD revealed a significant reduction in brain Aβ deposits, suggesting neuro-protective potential of these cells in AD.

In a 2020 study, researchers also identified a negative associations between CP volume and CSF proteins (i.e., as the CP volume increased, CSF proteins decreased), leading the authors to suggest that the CP is involved in both the clearance of CSF proteins and that CP dysfunction is present in AD.

Nevertheless, imaging studies of both CP volume and permeability are lacking and in the present study, the Korean team retrospectively examined the relationship between these two factors and cognitive impairment using MRI. They recruited a cohort of patients with either subjective cognitive impairment (SCI), mild cognitive impairment (MCI), late MCI and AD. A subgroup of these patients underwent both MRI and dynamic contrast-enhanced (DCE) imaging. The effect of CP volume on cognition in the different groups was evaluated using multivariable regression analysis and which was adjusted for several factors including age, sex and education.

Choroid plexus and cognitive symptoms

A total of 532 patients with a mean age of 72 years (73% women) were included in the analysis and a subgroup of 132 underwent DCE MRI assessment.

The CP volume was highest in patients with AD (1.3) compared to those with SCI (0.9) and progressively increased as impairment worsened, i.e., from SCI through to AD and these differences were statistically significant (p < 0.01). In addition, AD patients had the lowest hippocampal volume, which is also consistent with cognitive impairment in AD.

According to the results of the DCE MRI, CP volume was greater in AD patients whereas CP permeability was lowest among those with AD. Furthermore, when comparing CP volume with cognition, the researchers found that the CP volume was negatively associated with memory, executive function and visuospatial function.

The authors concluded that the CP volume was highest in those with the most severe cognitive impairment and that changes in CP permeability were also associated with disease severity. They added that both CP volume and permeability might represent imaging markers for cognitive impairment in AD and which was independent of amyloid abnormalities or neurodegeneration.

Citation
Choi JD et al. Choroid Plexus Volume and Permeability at Brain MRI within the Alzheimer Disease Clinical Spectrum Radiology 2022

Atrial fibrillation appears to be linked to a range of cerebrovascular pathologies

1st October 2021

Atrial fibrillation appears to be associated with several cerebrovascular pathologies including strokes, lacunes and silent brain infarcts.

Atrial fibrillation (AF) is the most common arrhythmia diagnosed in clinical practice and an analysis of an international database in 2017 found that a total of 3.046 million new cases were registered. The presence of AF increases the risk of stroke and thus subsequent cognitive impairment but one study also showed that AF is associated with an almost three-fold increased risk of dementia. Moreover, there is a growing body of literature that supports AF as being a risk factor for both cognitive decline and dementia although the mechanisms responsible for this association are diverse and not solely related to the increased risk of stroke.

In trying to understand these associations, a team from the Institute of Neuroscience and Physiology, Sahlgrenska, Gothenburg, Sweden, set out to determine whether AF was associated with cerebrovascular pathologies. The team obtained data from the Gothenburg H70 Birth Cohort Studies, which included individuals born in 1944 who underwent structural brain MRI scans between 2014 – 2017. Using these scans, the team looked for markers of cerebral small vessel disease such as white matter hyper-intensities (WMHs), lacunes, brain infarcts and cerebral micro-bleeds, with the latter two conditions assessed by a radiologist. The patient’s diagnosis of AF was either self-reported or based on electrocardiogram results or data from Sweden’s National Patient Register (NPR). A control group of patients who did not undergo an MRI scan were included for comparative purposes.

Findings

A total of 776 participants were included of whom 65 (8.4%) had a diagnosis of AF. The presence of AF was associated with a history of symptomatic stroke (odds ratio, OR = 4.5 95% CI 2.1–9.5), large infarcts (OR = 5.0), lacunes (OR = 2.7) and silent brain infarcts (OR = 3.5). Additionally, individuals with AF had larger WMH volumes than controls, especially those currently treated for AF.

The authors concluded that AF was associated with broad range of cerebrovascular pathologies and called for further work to establish whether cerebrovascular MRI markers could help to complement current treatment guidelines for patients with AF.

Citation

Ryden L et al. Atrial Fibrillation, Stroke, and Silent Cerebrovascular Disease: A Population-Based MRI Study. Neurology 2021

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