Diagnosis of multiple sclerosis is frequently easy but over-reliance on the detection of white matter lesions in the brain has led on many occasions to misdiagnosis. At the very beginning, MS brain lesions can be few and sometimes not typical, leading to a delay in diagnosis and sometimes a delay in treatment. Our work aims to provide a safe, simple and reliable diagnostic tests and procedures that can help patients and clinicians plan effective treatments.  

1. DiagnosE using the Central veIn SIgn. A prospective diagnostic superiority study comparing T2* MRI and lumbar puncture in patients presenting with possible Multiple Sclerosis (DECISIVE)

A number of patients complain that lumbar puncture is an invasive procedure and encouraged us to find better way to diagnose MS. This research aims to change the way people are diagnosed with MS and reduce the number of lumbar punctures used. Our team will recruit a large number of people from different hospitals whose doctors suspect they may have MS. We will invite them to have a new MRI scan we have developed here in Nottingham and is based on the detection of a central vein in MS lesions, a very characteristic finding. We will compare the accuracy, speed, costs and acceptability of the different tests needed to make a diagnosis of MS and establish if most lumbar punctures can be replaced by a slightly longer MRI scan.

Funder: NIHR Research for Patient Benefit

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      2. MAGNIMS/RIMS study

We recently collaborated with the MAGNIMS group in Europe and reported the prevalence of veins as detected by clinical scanners across the continent. The study of lesions with paramagnetic iron rims (IRs), which are dark, ring-like features on edges of some MS lesions, has gained attention. Many believe that they are the MRI signs for active white matter lesions as seen in pathology. We work together with our European network of MS centres to put together hundred of scans and find how common this MRI sign is and if we can use it in the diagnosis and prognosis of MS. 

      Funder: Saudi Government supported by MAGNIMS collaboration 

Contact: This email address is being protected from spambots. You need JavaScript enabled to view it. (Amjad Ibrahim AlTokhis)

      3. AI gets real: using routine clinical data and Artificial Intelligence to predict worsening of MS despite treatment (AIMS)

A wealth of clinical and MRI data from patients with MS are acquired every year in clinical practice, but only part of these data are used for clinical decision making. We propose that a set of structural characteristics extracted from the MRI brain scans of people with MS are related to biological changes which are meaningful to MS, and may therefore act as predictive markers for outcome. In this study, we aim to use whole-image brain MRI scans processed with AI techniques and detect the clinical and MRI profiles that predict accumulation of MS-related disability or cognitive impairment. We will take advantage of our MS clinic and the Nottingham MS Society Register. Using clinical information which patients have consented for us to use, and the MRI images before starting treatment, we will train a computer to use mathematical models to predict whether a person's MS will determine accumulating disability or cognitive impairment over the long term. Furthermore, we seek to see if the profile can predict development of disability in other patient groups, by validating the models in large sets of MRI scans obtained from other groups of people with MS using different scanners. We will use a large group of patients from the United States, and also align with a clinical trial ongoing in UK and US, which compares treatments for MS with different strengths. By identifying early, at diagnosis, who is likely to fare worse over the long term, we could offer them a more tailored treatment approach.

Funder: MRC & NIHR

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      4. RADAR-CNS

Wearable and smartphones technology might be used to track the course of conditions such as MS and help patients and clinicians to make clinical decisions and to track the value of new drugs once they are released for clinical care. RADAR-CNS is the largest EU Horizon 2020 grant ever given for health, which has been used to develop on open source operating system to work with wearables and android phones to track symptoms in patients with MS with and without depression, depression or epilepsy across Europe. In particular researchers in Nottingham will be examining the value of such disease monitoring across care pathways for clinical and research purposes.

Funder: EU Horizon2020

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