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BackgroundVitamin D insufficiency is a risk factor for multiple sclerosis (MS), and patients do not always show the expected response to vitamin D supplementation.ObjectiveWe aimed to determine if vitamin D supplementation leads to a similar increase in serum 25-hydroxyvitamin-D (25(OH)D) levels in patients with MS and healthy controls (HCs).MethodsParticipants in this open-label study were female, white, aged 18-60 years, had 25(OH)D levels ⩽ 75 nmol/l at screening, and had relapsing-remitting MS (RRMS) or were HCs. Participants received 5000 IU/day of vitamin D3 for 90 days. Utilizing generalized estimating equations we examined the relationship between the primary outcome (serum 25(OH)D level) and the primary (MS versus HC status) and secondary predictors.ResultsFor this study 27 MS patients and 30 HCs were enrolled. There was no significant difference in baseline 25(OH)D level or demographics except for higher body mass index (BMI) in the MS group (25.3 vs. 23.6 kg/m(2), p=0.035). In total, 24 MS subjects and 29 HCs completed the study. In a multivariate model accounting for BMI, medication adherence, and oral contraceptive use, MS patients had a 16.7 nmol/l (95%CI: 4.2, 29.2, p=0.008) lower increase in 25(OH)D levels compared with HCs.ConclusionsPatients with MS had a lower increase in 25(OH)D levels with supplementation, even after accounting for putative confounders.

BACKGROUND: MRI is used to diagnose and monitor people with multiple sclerosis (PwMS). Standard T1-weighted (T1w) images, which emphasize the contrast between gray and white matter, often fail to distinctly reveal key regions of interest such as the thalamus. Thalamic lesions are present in a significant proportion of PwMS and correlate with disability. Hence, a more effective approach to assessing this region involves acquiring 2 T1w images with different inversion times (TIs), allowing the calculation of proton density and T1 parameter maps. These maps can then generate various T1w images at any TI, thus enhancing visibility of specific regions for segmentation. However, acquiring T1w images with varied TIs is uncommon in MS clinical practice. OBJECTIVES: To demonstrate the ability to synthesize multi-TIs images using a T1w, T2w, and T2w fluid-attenuated inversion recovery (T2w-FLAIR) MRI. METHODS: We used 3-dimensional high-resolution T1w, T2w, and T2w-FLAIR brain MR images (n = 18) acquired from the University of Maryland (UMD) for training our U-Net model. The T1w images were acquired with similar acquisition parameters and 2 different TIs, 400 milliseconds and 1400 milliseconds. This allowed for direct calculation of the parameter maps. After training, we applied our model to images acquired according to the Consortium of Multiple Sclerosis Centers guidelines in the TREAT-MS trial (n = 20). We used 3 images: T1w, T2w, and T2w-FLAIR. We used HACA3 to harmonize the TREAT-MS trial images with the UMD training images. We used the synthetic parameter maps to calculate multi-TI images ranging from 400 milliseconds to 1400 milliseconds. The T1w image has a 1400-millisecond TI that we can directly compare with the corresponding synthetic multi-TI image. Since the other multi-TI images do not have ground truths, we cannot compute the same imaging metrics. RESULTS: For the synthetic T1w image, the peak-signal-to-noise ratio and structural similarity index measure are 22.82 ± 1.23 and 0.9737 ± 0.0031, respectively. These calculations were computed using only the brain voxels (excluding the background and skull). CONCLUSIONS: We demonstrated that multi-TI images can be accurately synthesized using 3 images that are commonly acquired following the Consortium of Multiple Sclerosis Centers guidelines. When interested in the thalamus, we can use a 400-millisecond TI to robustly identify individual thalamic nuclei. With the high presence of thalamic lesions in PwMS, the synthesis of these images could lead to better lesion segmentation and stronger associations with disability. [ABSTRACT FROM AUTHOR]

BACKGROUND: The central vein sign (CVS) is a new criterion to improve the sensitivity and specificity of diagnosis of multiple sclerosis (MS). Clinical T2*- weighted (T2*-w) scans may have anisotropic resolutions with up to 7-mm slice thickness, as in findings from the multisite clinical trial Traditional Versus Early Aggressive Therapy for MS (TREAT-MS; NCT03500328). Although thick slices improve signal-to-noise ratio and total scan time, it is unknown whether this resolution is clinically useful with regard to detection of the CVS. OBJECTIVES: To investigate whether the CVS can be identified at various slice thicknesses on T2*-w brain MRI. METHODS: We selected CVS-positive isotropic high-resolution T2*-w brain images (N = 15) acquired on a 3T scanner from an in-house longitudinal data set, where a scan is determined to be CVS positive by the Select3* lesion method. Each of these 3-dimensional volumes was then artificially degraded along the superior-inferior axis to simulate axial anisotropic 2-dimensional acquisition at 1-, 2-, 3-, 4-, 5-, 6-, and 7-mm slice thicknesses. After degradation, each scan was interpolated to isotropic digital resolution using cubic B-splines. A human rater (SWR) identified CVS lesions solely using the T2*-w scan and manually determined whether each of the scans was CVS positive at each resolution. RESULTS: Acquisitions of T2*-w images in clinical scenarios are nearly always anisotropic. In the TREAT-MS study findings, 83.3% of all T2*-w scans have 1 x 1 mm2 or lower in-plane resolution. Regarding through-plane thicknesses, the distribution is as follows: 3%, 2 mm to 2.9 mm; 10%, 3 mm to 3.9 mm; 12%, 4 mm to 4.9 mm; 23%, 5 mm to 5.9 mm; 44%, 6 mm to 6.9 mm; and 8%, 7 mm or greater. In our simulation experiment, the following describes the percentage of scans identified as CVS positive according to Select3* at each simulated slice thickness: 100% at 1 mm, 86.67% at 2 mm, 86.67% at 3 mm, 86.67% at 4 mm, 46.67% at 5 mm, 40% at 6 mm, and 40% at 7 mm. CONCLUSIONS: Detection of CVS in MRI relies on the resolution of the acquired image. Although Select3* is more liberal than Select6*, for example, it becomes increasingly difficult to determine whether a scan is CVS positive at 5 mm compared with the original high-resolution isotropic scan. Postprocessing techniques such as susceptibility-weighted imaging processing, minimum-intensity projection, computation of the fluid-attenuated inversion recovery contrast, and superresolution may improve detection rates at lower resolutions and will be investigated in a future study. [ABSTRACT FROM AUTHOR]

Purpose: While quality of life surveys have been conducted in trachomatous trichiasis (TT) surgery populations, little is known about patients' perceptions of the surgical experience and outcomes. Methods: We interviewed a subset of Partnership for the Rapid Elimination of Trachoma (PRET) surgery trial participants 24 months after surgery. Questions focused on current ocular symptoms, perceived daily functioning, physical appearance, and overall perception of surgery. We stratified participants based on surgical outcomes: normal upper eyelid, postoperative TT, or eyelid contour abnormality (ECA) in one or both eyelids. We compared responses between sexes and surgical outcome groups using contingency tables and Fisher's exact tests. Results: A total of 483 individuals participated and 86% were very satisfied with surgery results; 96% reported ocular symptom improvement. Participants with moderate to severe ECA or postoperative TT were more likely to report current ocular problems than those with normal eyelids (46% and 58% vs 34%, respectively; p = 0.01 for each comparison). The most common symptom among participants with moderate to severe postoperative TT was feeling lashes touching (blurred vision was the most common among participants with moderate to severe ECA). Overall, 83% stated surgery improved daily life; participants with ECA were less likely to report improvement than others ( p = 0.002). Participants who had moderate or severe postoperative TT were least likely to state that they would undergo repeat surgery (80%), followed by participants with ECA (86%). Conclusions: Postoperative TT and ECA both reduced satisfaction with surgery, but appeared to influence different aspects of life. Improving surgical outcomes both by reducing recurrence rates and limiting ECAs are essential. [ABSTRACT FROM AUTHOR]