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<meta name="DC.Title" content="Improved Precision of Automatic Brain Volume Measurements in Patients with Clinically Isolated Syndrome and Multiple Sclerosis Using Edema Correction" />
<meta name="DC.Identifier" content="10.3174/ajnr.A5476" />
<meta name="DC.Date" content="2017-12-14" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
<meta name="DC.Rights" content="© 2018 by American Journal of Neuroradiology" />
<meta name="DC.AccessRights" content="restricted" />
<meta name="DC.Description" content="BACKGROUND AND PURPOSE: The presence of edema will result in increased brain volume, which may obscure progressing brain atrophy. Similarly, treatment-induced edema reduction may appear as accelerated brain tissue loss (pseudoatrophy). The purpose of this study was to correlate brain tissue properties to brain volume, to investigate the possibilities for edema correction and the resulting improvement of the precision of automated brain volume measurements.

MATERIALS AND METHODS: A group of 38 patients with clinically isolated syndrome or newly diagnosed MS were imaged at inclusion and after 1, 2, and 4 years using an MR quantification sequence. Brain volume, relaxation rates (R1 and R2), and proton density were measured by automated software.

RESULTS: The reduction of normalized brain volume with time after inclusion was 0.273%/year. The mean SDs were 0.508%, 0.526%, 0.454%, and 0.687% at baseline and 1, 2, and 4 years. Linear regression of the relative change of normalized brain volume and the relative change of R1, R2, and proton density showed slopes of −0.198 ( P &lt; .001), 0.156 ( P = .04), and 0.488 ( P &lt; .001), respectively. After we applied the measured proton density as a correction factor, the mean SDs decreased to 24.2%, 4.8%, 33.3%, and 17.4%, respectively. The observed atrophy rate reduced from 0.273%/year to 0.238%/year.

CONCLUSIONS: Correlations between volume and R1, R2, and proton density were observed in the brain, suggesting that a change of brain tissue properties can affect brain volume. Correction using these parameters decreased the variation of brain volume measurements and may have reduced the effect of pseudoatrophy.

BPF
:   brain parenchymal fraction
BPV
:   brain parenchymal volume
ICV
:   intracranial volume
NEDA
:   no evidence of disease activity
PD
:   proton density
R1 and R2
:   relaxation rates
SR1, SR2, and SPD
:   correlation slopes" />
<meta name="DC.Contributor" content="J.B.M. Warntjes" />
<meta name="DC.Contributor" content="A. Tisell" />
<meta name="DC.Contributor" content="I. Håkansson" />
<meta name="DC.Contributor" content="P. Lundberg" />
<meta name="DC.Contributor" content="J. Ernerudh" />
<meta name="article:published_time" content="2018-12-14" />
<meta name="article:section" content="ADULT BRAIN" />
<meta name="citation_title" content="Improved Precision of Automatic Brain Volume Measurements in Patients with Clinically Isolated Syndrome and Multiple Sclerosis Using Edema Correction" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;The presence of edema will result in increased brain volume, which may obscure progressing brain atrophy. Similarly, treatment-induced edema reduction may appear as accelerated brain tissue loss (pseudoatrophy). The purpose of this study was to correlate brain tissue properties to brain volume, to investigate the possibilities for edema correction and the resulting improvement of the precision of automated brain volume measurements.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;A group of 38 patients with clinically isolated syndrome or newly diagnosed MS were imaged at inclusion and after 1, 2, and 4 years using an MR quantification sequence. Brain volume, relaxation rates (R&lt;sub&gt;1&lt;/sub&gt; and R&lt;sub&gt;2&lt;/sub&gt;), and proton density were measured by automated software.&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;The reduction of normalized brain volume with time after inclusion was 0.273%/year. The mean SDs were 0.508%, 0.526%, 0.454%, and 0.687% at baseline and 1, 2, and 4 years. Linear regression of the relative change of normalized brain volume and the relative change of R&lt;sub&gt;1&lt;/sub&gt;, R&lt;sub&gt;2&lt;/sub&gt;, and proton density showed slopes of −0.198 (&lt;i&gt;P&lt;/i&gt; &amp;lt; .001), 0.156 (&lt;i&gt;P&lt;/i&gt; = .04), and 0.488 (&lt;i&gt;P&lt;/i&gt; &amp;lt; .001), respectively. After we applied the measured proton density as a correction factor, the mean SDs decreased to 24.2%, 4.8%, 33.3%, and 17.4%, respectively. The observed atrophy rate reduced from 0.273%/year to 0.238%/year.&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;Correlations between volume and R&lt;sub&gt;1&lt;/sub&gt;, R&lt;sub&gt;2&lt;/sub&gt;, and proton density were observed in the brain, suggesting that a change of brain tissue properties can affect brain volume. Correction using these parameters decreased the variation of brain volume measurements and may have reduced the effect of pseudoatrophy.&lt;/p&gt;" />
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<meta name="twitter:title" content="Improved Precision of Automatic Brain Volume Measurements in Patients with Clinically Isolated Syndrome and Multiple Sclerosis Using Edema Correction" />
<meta name="twitter:card" content="summary" />
<meta name="twitter:description" content="BACKGROUND AND PURPOSE: The presence of edema will result in increased brain volume, which may obscure progressing brain atrophy. Similarly, treatment-induced edema reduction may appear as accelerated brain tissue loss (pseudoatrophy). The purpose of this study was to correlate brain tissue properties to brain volume, to investigate the possibilities for edema correction and the resulting improvement of the precision of automated brain volume measurements.

MATERIALS AND METHODS: A group of 38 patients with clinically isolated syndrome or newly diagnosed MS were imaged at inclusion and after 1, 2, and 4 years using an MR quantification sequence. Brain volume, relaxation rates (R1 and R2), and proton density were measured by automated software.

RESULTS: The reduction of normalized brain volume with time after inclusion was 0.273%/year. The mean SDs were 0.508%, 0.526%, 0.454%, and 0.687% at baseline and 1, 2, and 4 years. Linear regression of the relative change of normalized brain volume and the relative change of R1, R2, and proton density showed slopes of −0.198 ( P &lt; .001), 0.156 ( P = .04), and 0.488 ( P &lt; .001), respectively. After we applied the measured proton density as a correction factor, the mean SDs decreased to 24.2%, 4.8%, 33.3%, and 17.4%, respectively. The observed atrophy rate reduced from 0.273%/year to 0.238%/year.

CONCLUSIONS: Correlations between volume and R1, R2, and proton density were observed in the brain, suggesting that a change of brain tissue properties can affect brain volume. Correction using these parameters decreased the variation of brain volume measurements and may have reduced the effect of pseudoatrophy.

BPF
:   brain parenchymal fraction
BPV
:   brain parenchymal volume
ICV
:   intracranial volume
NEDA
:   no evidence of disease activity
PD
:   proton density
R1 and R2
:   relaxation rates
SR1, SR2, and SPD
:   correlation slopes" />
<meta name="og-title" property="og:title" content="Improved Precision of Automatic Brain Volume Measurements in Patients with Clinically Isolated Syndrome and Multiple Sclerosis Using Edema Correction" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/early/2017/12/14/ajnr.A5476" />
<meta name="og-site-name" property="og:site_name" content="American Journal of Neuroradiology" />
<meta name="og-description" property="og:description" content="BACKGROUND AND PURPOSE: The presence of edema will result in increased brain volume, which may obscure progressing brain atrophy. Similarly, treatment-induced edema reduction may appear as accelerated brain tissue loss (pseudoatrophy). The purpose of this study was to correlate brain tissue properties to brain volume, to investigate the possibilities for edema correction and the resulting improvement of the precision of automated brain volume measurements.

MATERIALS AND METHODS: A group of 38 patients with clinically isolated syndrome or newly diagnosed MS were imaged at inclusion and after 1, 2, and 4 years using an MR quantification sequence. Brain volume, relaxation rates (R1 and R2), and proton density were measured by automated software.

RESULTS: The reduction of normalized brain volume with time after inclusion was 0.273%/year. The mean SDs were 0.508%, 0.526%, 0.454%, and 0.687% at baseline and 1, 2, and 4 years. Linear regression of the relative change of normalized brain volume and the relative change of R1, R2, and proton density showed slopes of −0.198 ( P &lt; .001), 0.156 ( P = .04), and 0.488 ( P &lt; .001), respectively. After we applied the measured proton density as a correction factor, the mean SDs decreased to 24.2%, 4.8%, 33.3%, and 17.4%, respectively. The observed atrophy rate reduced from 0.273%/year to 0.238%/year.

CONCLUSIONS: Correlations between volume and R1, R2, and proton density were observed in the brain, suggesting that a change of brain tissue properties can affect brain volume. Correction using these parameters decreased the variation of brain volume measurements and may have reduced the effect of pseudoatrophy.

BPF
:   brain parenchymal fraction
BPV
:   brain parenchymal volume
ICV
:   intracranial volume
NEDA
:   no evidence of disease activity
PD
:   proton density
R1 and R2
:   relaxation rates
SR1, SR2, and SPD
:   correlation slopes" />
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      <div class="highwire-cite-overline"><span  class="highwire-cite-metadata-article-type highwire-cite-metadata">Research Article</span><span class="separator-pipe"></span><span  class="highwire-cite-metadata-art-cat highwire-cite-metadata"><span class="wrapper">ADULT BRAIN</span></span></div>
  
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      <h1 class="highwire-cite-title" id="page-title">Improved Precision of Automatic Brain Volume Measurements in Patients with Clinically Isolated Syndrome and Multiple Sclerosis Using Edema Correction</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">J.B.M. Warntjes</span>, <span class="highwire-citation-author" data-delta="1">A. Tisell</span>, <span class="highwire-citation-author" data-delta="2">I. Håkansson</span>, <span class="highwire-citation-author" data-delta="3">P. Lundberg</span> and <span class="highwire-citation-author" data-delta="4">J. Ernerudh</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">December 2017,  </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A5476 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-57620--6305807408" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">J.B.M. Warntjes </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Center for Medical Image Science and Visualization (J.B.M.W., A.T., P.L.)</div><div class='author-affiliation'><span class='nlm-sup'>b</span>Division of Cardiovascular Medicine (J.B.M.W.)</div><div class='author-affiliation'><span class='nlm-sup'>g</span>SyntheticMR AB (J.B.M.W.), Linköping, Sweden.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=J.B.M.%2BWarntjes%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Warntjes%20J&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AJ.B.M.%2BWarntjes%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0002-3037-4201" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for J.B.M. Warntjes</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">A. Tisell </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Center for Medical Image Science and Visualization (J.B.M.W., A.T., P.L.)</div><div class='author-affiliation'><span class='nlm-sup'>c</span>Radiation Physics (A.T., P.L.), Department of Medical and Health Sciences</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=A.%2BTisell%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Tisell%20A&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AA.%2BTisell%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0003-0928-7282" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for A. Tisell</a></li></ul></div><div class="author-tooltip-2"><div class="author-tooltip-name">I. Håkansson </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>d</span>Department of Neurology (I.H.), Department of Clinical and Experimental Medicine</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=I.%2BH%C3%A5kansson%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=H%C3%A5kansson%20I&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AI.%2BH%25C3%25A5kansson%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0002-0135-6485" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for I. Håkansson</a></li></ul></div><div class="author-tooltip-3"><div class="author-tooltip-name">P. Lundberg </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Center for Medical Image Science and Visualization (J.B.M.W., A.T., P.L.)</div><div class='author-affiliation'><span class='nlm-sup'>c</span>Radiation Physics (A.T., P.L.), Department of Medical and Health Sciences</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=P.%2BLundberg%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Lundberg%20P&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AP.%2BLundberg%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0001-8661-2232" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for P. Lundberg</a></li></ul></div><div class="author-tooltip-4"><div class="author-tooltip-name">J. Ernerudh </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>e</span>Department of Clinical Immunology and Transfusion Medicine (J.E.)</div><div class='author-affiliation'><span class='nlm-sup'>f</span>Department of Clinical and Experimental Medicine (J.E.), Linköping University, Sweden</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=J.%2BErnerudh%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Ernerudh%20J&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AJ.%2BErnerudh%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0001-9456-2044" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for J. Ernerudh</a></li></ul></div></div></div>  </div>

  
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    <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" class="content-block-markup" xmlns:xhtml="http://www.w3.org/1999/xhtml"><div xmlns:xhtml="http://www.w3.org/1999/xhtml" class="contributors"><ol class="contributor-list" id="contrib-group-1"><li class="contributor" id="contrib-1"><span class="name">J.B.M. Warntjes</span><a id="xref-aff-1-1" class="xref-aff" href="#aff-1">a</a><span class="xref-sep">,</span><a id="xref-aff-2-1" class="xref-aff" href="#aff-2">b</a><span class="xref-sep">,</span><a id="xref-aff-7-1" class="xref-aff" href="#aff-7">g</a>, </li><li class="contributor" id="contrib-2"><span class="name">A. Tisell</span><a id="xref-aff-1-2" class="xref-aff" href="#aff-1">a</a><span class="xref-sep">,</span><a id="xref-aff-3-1" class="xref-aff" href="#aff-3">c</a>, </li><li class="contributor" id="contrib-3"><span class="name">I. Håkansson</span><a id="xref-aff-4-1" class="xref-aff" href="#aff-4">d</a>, </li><li class="contributor" id="contrib-4"><span class="name">P. Lundberg</span><a id="xref-aff-1-3" class="xref-aff" href="#aff-1">a</a><span class="xref-sep">,</span><a id="xref-aff-3-2" class="xref-aff" href="#aff-3">c</a> and </li><li class="last" id="contrib-5"><span class="name">J. Ernerudh</span><a id="xref-aff-5-1" class="xref-aff" href="#aff-5">e</a><span class="xref-sep">,</span><a id="xref-aff-6-1" class="xref-aff" href="#aff-6">f</a></li></ol><ol class="affiliation-list"><li class="aff"><a id="aff-1" name="aff-1"></a><address><sup>a</sup>From the Center for Medical Image Science and Visualization (J.B.M.W., A.T., P.L.)</address></li><li class="aff"><a id="aff-2" name="aff-2"></a><address><sup>b</sup>Division of Cardiovascular Medicine (J.B.M.W.)</address></li><li class="aff"><a id="aff-3" name="aff-3"></a><address><sup>c</sup>Radiation Physics (A.T., P.L.), Department of Medical and Health Sciences</address></li><li class="aff"><a id="aff-4" name="aff-4"></a><address><sup>d</sup>Department of Neurology (I.H.), Department of Clinical and Experimental Medicine</address></li><li class="aff"><a id="aff-5" name="aff-5"></a><address><sup>e</sup>Department of Clinical Immunology and Transfusion Medicine (J.E.)</address></li><li class="aff"><a id="aff-6" name="aff-6"></a><address><sup>f</sup>Department of Clinical and Experimental Medicine (J.E.), Linköping University, Sweden</address></li><li class="aff"><a id="aff-7" name="aff-7"></a><address><sup>g</sup>SyntheticMR AB (J.B.M.W.), Linköping, Sweden.</address></li></ol><ol class="corresp-list"><li class="corresp" id="corresp-1">Please address correspondence to J.B.M. Warntjes, MD, <span class="addr-line">Center for Medical Image Science and Visualization (CMIV), Linköping University, 58185 Linköping, Sweden</span>; e-mail: <span class="em-link"><span class="em-addr">marcel.warntjes{at}cmiv.liu.se</span></span></li></ol></div></div><a href="http://ajnr-stage2.stage.highwire.org/content/early/2017/12/14/ajnr.A5476.full" class="hw-link hw-link-article-full-text" data-icon-position="" data-hide-link-title="0">View Full Text</a></div>  </div>

  
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