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  • 101. Tabar, L
    et al.
    Vitak, B
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Radiology. Östergötlands Läns Landsting, Centre for Medical Imaging, Department of Radiology UHL.
    Chen, H-H
    Prevost, T C
    Duffy, S W
    Update of the Swedish two-county trial of breast cancer screening: Histologic grade-specific and age-specific results.1999In: Swiss Surg, ISSN 1023-9332, Vol. 5, p. 199-204Article in journal (Refereed)
  • 102. Tabar, L
    et al.
    Yen, MF
    Vitak, B
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Radiology. Östergötlands Läns Landsting, Centre for Medical Imaging, Department of Radiology UHL.
    Chen, HHT
    Smith, RA
    Duffy, SW
    Mammography service screening and mortality in breast cancer patients: 20-year follow-up before and after introduction of screening2003In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 361, no 9367, p. 1405-1410Article in journal (Refereed)
    Abstract [en]

    Background: The long term effect of mammographic service screening is not well established. We aimed to assess the long-term effect of mammographic screening on death from breast cancer, taking into account potential biases from self-selection, changes in breast cancer incidence, and classification of cause of death. Methods: We compared deaths from breast cancer diagnosed in the 20 years before screening was introduced (1958-77) with those from breast cancer diagnosed in the 20 years after the introduction of screening (1978-97) in two Swedish counties, in 210 000 women aged 20-69 years. We also compared deaths from all cancers and from all causes in patients diagnosed with breast cancer in the 20 years before and after screening was introduced. In the analysis, data were stratified into age-groups invited for screening (40-69 years) and not invited (20-39 years), and by whether or not the women had actually received screening. We also analysed mortality for the 40-49-year age-group separately. Findings: The unadjusted risk of death from breast cancer dropped significantly in the second screening period compared with the first in women aged 40-69 years (relative risk [RR] 0.77 [95% CI 0.7-0.85], p<0.0001). No such decline was seen in 20-39 year olds. After adjustment for age, self-selection bias, and changes in breast-cancer incidence in the 40-69 years age-group, breast-cancer mortality was reduced in women who were screened (0.56, 0.49-0.64 p<0.0001), in those who were not screened (0.84 [0.71-0.99], p=0.03), and in screened and unscreened women combined (0.59 [0.53-0.66], p<0.0001). After adjustment for age, self-selection bias, and changes in incidence in the 40-49-year age-group, deaths from breast cancer fell significantly in those who were screened (0.52 [0.4-0.67], p<0.0001), and in all women, screened and unscreened combined (0.55 [0.44-0.7] p<0.0001) but not in unscreened women (p=0.2). In both 40-69-year and 40-49-year age-groups, reductions in deaths from all cancers and from all-causes in women with breast cancer were consistent with these results. Interpretation Taking account of potential biases, changes in clinical practice and changes in the incidence of breast cancer, mammography screening is contributing to substantial reductions in breast cancer mortality in these two Swedish counties.

  • 103. Tabár, L
    et al.
    Duffy, S W
    Vitak, B
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Radiology. Östergötlands Läns Landsting, Centre for Medical Imaging, Department of Radiology UHL.
    Chen, H-H
    Prevost, T C
    The natural history of breast carcinoma1999In: Cancer, ISSN 0008-543X, E-ISSN 1097-0142, Vol. 86, p. 449-462Article in journal (Refereed)
  • 104.
    Thorelius, Lars
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Radiology. Östergötlands Läns Landsting, Centre for Medical Imaging, Department of Radiology UHL.
    Contrast-enhanced ultrasound: beyond the liver.2003In: European Radiology, ISSN 0938-7994, E-ISSN 1432-1084, Vol. 13, p. 91-108Article in journal (Refereed)
  • 105. Thurfjell, M G
    et al.
    Vitak, B
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Radiology. Östergötlands Läns Landsting, Centre for Medical Imaging, Department of Radiology UHL.
    Azavedo, E
    Svane, G
    Thurfjell, E
    Effect on sensitivity and specificity of mammography screening with or without comparison of old mammograms2000In: Acta Radiologica, ISSN 0284-1851, E-ISSN 1600-0455, Vol. 41, no 1, p. 52-56Article in journal (Refereed)
    Abstract [en]

    Purpose: To evaluate the effect of old mammograms on the specificity and sensitivity of radiologists in mammography screening. Material and Methods: One hundred and fifty sets of screening mammograms were examined by 3 experienced screeners twice: once without and once in comparison with older mammograms. The films came from a population-based screening done during the first half of 1994 and comprised all 35 cancers detected during screening in 1994, 12/24 interval cancers, 14/34 cancers detected in the following screening and 89 normal mammograms. Results: Without old mammograms, the screeners detected an average of 40.3 cancers (range 37-42), with a specificity of 87% (85-88%). With old mammograms, the screeners detected 37.7 cancers (range 34-42) with a specificity of 96% (94-99%). The change in detection rate was not significant. However, the increase in specificity was significant for each screener (p=0.0002-0.03). Conclusion: Mammography screening with old mammograms available for comparison decreased the false-positive recall rate. The effect on sensitivity, however, was unclear.

  • 106.
    Tiselius, H-G
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Urology. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Urology in Östergötland.
    Hellgren, E
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Radiology. Östergötlands Läns Landsting, Centre for Medical Imaging, Department of Radiology UHL.
    Andersson, A
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Urology. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Urology in Östergötland.
    Borrud-Ohlsson, Ann
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Urology. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Urology in Östergötland.
    Eriksson, I
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Urology. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Urology in Östergötland.
    Minimally invasive treatment of infection Staghorn stones with schok wave lithotripsy and chemlysis.1999In: Scand J Urol Nephrol Suppl,1999, 1999, p. 286-290Conference paper (Refereed)
  • 107.
    Tizon, X
    et al.
    Uppsala.
    Smedby, Örjan
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Radiology. Östergötlands Läns Landsting, Centre for Medical Imaging, Department of Radiology UHL. Linköping University, Center for Medical Image Science and Visualization, CMIV.
    Segmentation with gray-scale connectedness can separate arteries and veins in MRA2002In: Journal of Magnetic Resonance Imaging, ISSN 1053-1807, E-ISSN 1522-2586, Vol. 15, no 4, p. 438-445Article in journal (Refereed)
    Abstract [en]

    Purpose: To describe and present some preliminary results for a novel algorithm for segmentation with gray-scale connectedness as a means to separate arteries and veins in magnetic resonance angiography (MRA). Materials and Methods: The proposed algorithm, SeparaSeed, uses the gray-scale degree of connectedness as a tool to find the zone surrounding each vessel, in order to split the original volume into its different vessel components. In contrast to traditional segmentation methods, no gray-scale information is lost in the process. The segmentation is performed in one step, resulting in a partition of the initial volume into a chosen number of regions of interest (ROIs). Finally. visualization is achieved by projecting the 3D vessel trees to 2D using the common maximum intensity projection (MIP). The algorithm was tested in two MRA data sets of the vessels of the pelvis acquired after injection of an intravascular contrast agent and in one data set of the vessels of the neck with gadolinium. Results: In all data sets, a large proportion of the venous signal was removed while preserving that of the arteries, thus improving visualization of the relevant vessels. Conclusion: Separation of arteries and veins is feasible with the proposed algorithm with a moderate amount of interaction. ⌐ 2002 Wiley-Liss, Inc.

  • 108. Verdonck, B
    et al.
    Niijlunsing, R
    Melman, N
    Geijer, Håkan
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Radiology.
    Image quality and x-ray dose for translation reconstruction overview imagaing of the spine, colon and legs. In: Lemke HU, Vannier MW, Inamura K, Farman AG, Doi K editors.2001In: Elsevier Science. Proceedings of Computed Assisted Radiology and Surgery, Berlin 2001,2001, 2001, p. 500-505Conference paper (Refereed)
  • 109.
    Vergis, Anil
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Orthopaedics and Sports Medicine.
    Hammerby, S
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Radiology. Östergötlands Läns Landsting, Centre for Medical Imaging, Department of Radiology UHL.
    Gillquist, Jan
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Orthopaedics and Sports Medicine.
    Fluoroscopic validation of electrogoniometrically measured femorotibial translation in healthy and ACL deficient subjects2002In: Scandinavian Journal of Medicine and Science in Sports, ISSN 0905-7188, E-ISSN 1600-0838, Vol. 12, no 4, p. 223-229Article in journal (Refereed)
    Abstract [en]

    Equipment which measure femorotibial motions indirectly by using a patellar pad are reported to have errors caused by deformation of soft tissues and slippage of the device. For the purpose of validation, the tibial translation in relation to the femur per degree of knee extension was estimated from the slope coefficients of the flexion-displacement curve, obtained by both fluoroscopic and electrogoniometric tests, in the knee of the dominant limb in healthy subjects and in both knees of patients with unilateral anterior cruciate ligament (ACL) deficiency. In addition, the anterior and posterior static knee laxity limits and the tibial resting position were evaluated. Within all knee groups, the tibia moved posteriorly in relation to the femur during extension. The measured movement was similar both with the electrogoniometer and with fluoroscopy thereby indicating that sagittal plane knee translation measurements with the CA-4000 electrogoniometer are reliable and in good agreement with the X-ray measurements, even though the measurements were made separately. The ACL injured knees showed approximately 20% smaller posterior movement of tibia in relation to femur per degree change of knee extension than the non-injured or control knees (p < 0.05) and a more anterior resting position of the tibia relative to femur as compared to the contralateral healthy knee during knee laxity testing (p = 0.002).

  • 110.
    Vitak, B
    et al.
    Linköping University, Department of Medicine and Care, Radiology. Linköping University, Faculty of Health Sciences.
    Olsen, K E
    Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Pathology and Cytology. Linköping University, Faculty of Health Sciences.
    Månson, Jan-Christer
    Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Pathology and Cytology. Linköping University, Faculty of Health Sciences.
    Arnesson, Lars-Gunnar
    Linköping University, Department of Biomedicine and Surgery, Surgery. Linköping University, Faculty of Health Sciences.
    Stål, Olle
    Linköping University, Department of Biomedicine and Surgery, Oncology. Linköping University, Faculty of Health Sciences.
    Tumour characteristics and survival in patients with invasive interval breast cancer classified according to mammographic findings at the latest screening: a comparison of true interval and missed interval cancers1999In: European Radiology, ISSN 0938-7994, E-ISSN 1432-1084, Vol. 9, no 3, p. 460-469Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to investigate whether different mammographic categories of interval cancer classified according to findings at the latest screening are associated with different distributions of prognostic factors or with different survival rates. The series consisted of all patients with invasive interval cancer detected from May 1978 to August 1995 (n = 544). The tumours were evaluated with regard to age, radiological category, interval between the latest screen and diagnosis and tumour characteristics at the time of diagnosis. We investigated possible relationships between the survival rate of patients with interval cancer and the interval between the latest screen and diagnosis, tumour characteristics and radiological category of the interval tumours. The study focused on comparison of patients with true interval and missed interval cancer. Women with mammographically occult tumours were younger than those in the other radiological categories. Comparisons of true interval cancers with overlooked or misinterpreted tumours showed equal distributions of age, tumour size, TNM stage and lymph node status. The overlooked or misinterpreted tumours showed significantly higher proportions of grade-I tumours (22 vs 11 %), tumours with low S-phase fraction (SPF; 44 vs 24 %) and oestrogen receptor (ER) positive tumours (72 vs 57 %). However, analyses of survival rates disclosed no clear differences between the two radiological categories. Radiological category and interval between the latest screen and diagnosis were not genuine predictors of the prognosis in patients with invasive interval breast cancer. No certain prognostic difference existed between true interval cancers and overlooked or misinterpreted interval breast cancers, despite higher proportions of grade-I tumours, ER positive tumours and tumours with low SPF in the latter group.

  • 111. Wallentin, L
    et al.
    Nilsson, T
    Bergfeldt, L
    Thorvinger, B
    Held, C
    Bergstrand, L
    Nilsson, G
    Fransson, Sven Göran
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Radiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Sonnhag, C
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Albertsson, P
    Önskvärt att öka användandet av perkutan kranskälsintervention.1999In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 96, p. 4928-4932Article in journal (Other (popular science, discussion, etc.))
  • 112.
    Westin, Carl-Fredrik
    et al.
    Surgical Planning Laboratory, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
    Wigström, Lars
    Linköping University, Department of Medicine and Care, Clinical Physiology. Linköping University, Department of Biomedical Engineering. Linköping University, Faculty of Health Sciences.
    Loock, Tomas
    Linköping University, Department of Medicine and Care, Radio Physics. Linköping University, Department of Medicine and Care, Radiology. Linköping University, Faculty of Health Sciences.
    Sjöqvist, Lars
    Linköping University, Department of Medicine and Care, Radio Physics. Linköping University, Department of Medicine and Care, Radiology. Linköping University, Faculty of Health Sciences.
    Kikinis, Ron
    Surgical Planning Laboratory, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
    Knutsson, Hans
    Linköping University, Department of Biomedical Engineering. Linköping University, Faculty of Health Sciences.
    Three-dimensional adaptive filtering in magnetic resonance angiography2001In: Journal of Magnetic Resonance Imaging, ISSN 1053-1807, E-ISSN 1522-2586, Vol. 14, no 1, p. 63-71Article in journal (Refereed)
    Abstract [en]

    In order to enhance 3D image data from magnetic resonance angiography (MRA), a novel method based on the theory of multidimensional adaptive filtering has been developed. The purpose of the technique is to suppress image noise while enhancing important structures. The method is based on local structure estimation using six 3D orientation selective filters, followed by an adaptive filtering step controlled by the local structure information. The complete filtering procedure requires approximately 3 minutes of computational time on a standard workstation for a 256 × 256 × 64 data set. The method has been evaluated using a mathematical vessel model and in vivo MRA data (both phase contrast and time of flight (TOF)). 3D adaptive filtering results in a better delineation of small blood vessels and efficiently reduces the high-frequency noise. Depending on the data acquisition and the original data type, contrast-to-noise ratio (CNR) improvements of up to 179% (8.9 dB) were observed. 3D adaptive filtering may provide an alternative to prolonging the scan time or using contrast agents in MRA when the CNR is low.

  • 113.
    Wigström, Lars
    et al.
    Linköping University, Department of Medicine and Care, Clinical Physiology. Linköping University, Faculty of Health Sciences.
    Lindström, Lena
    Linköping University, Department of Medical and Health Sciences, Clinical Physiology. Linköping University, Faculty of Health Sciences.
    Sjöqvist, Lars
    Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Radiation Physics. Linköping University, Faculty of Health Sciences.
    Thuomas, K. Å.
    Linköping University, Department of Medicine and Care, Radiology. Linköping University, Faculty of Health Sciences.
    Wranne, Bengt
    Linköping University, Department of Medical and Health Sciences, Clinical Physiology. Linköping University, Faculty of Health Sciences.
    M-mode magnetic resonance imaging: a new modality for assessing cardiac function1995In: Clinical Physiology, ISSN 0144-5979, E-ISSN 1365-2281, Vol. 15, no 4, p. 397-407Article in journal (Refereed)
    Abstract [en]

    Magnetic resonance imaging (MRI) studies of the heart have been used for some years, but there are few tools available to quantify cardiac motion. A method has been developed that creates an M-mode MRI image, analogous to the one used in echocardiography, to display motion along a line as a function of time. The M-mode image is created from MRI images acquired with an ordinary gradient echo cine sequence. In a cinematographic display of the images, a cursor line can be positioned in order to determine the orientation of the measurement. A resampling algorithm then calculates the appearance of the M-mode image along the cursor line. The MRI method has been compared to echocardiographic M-mode in a phantom study and by measuring mitral and tricuspid annulus motion in 20 normal subjects. The phantom study showed no significant differences between MRI and echocardiographic M-mode measurements (difference mm). The annulus motion exhibits a similar pattern using both methods and the measured amplitudes are in close agreement. M-mode MRI provides similar information to echocardiography, but the cursor line can be placed arbitrarily within the image plane and the method is thus not limited to certain acoustic windows. This makes M-mode MRI a promising technique for assessing cardiac motion.

  • 114. Wikström, J
    et al.
    Holmberg, A
    Johansson, L
    Löfberg, A-M
    Smedby, Örjan
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Radiology. Östergötlands Läns Landsting, Centre for Medical Imaging, Department of Radiology UHL.
    Karacagil, S
    Ahlström, H
    Gadolinium-enhanced magnetic resonance angiography, digital subtraction angiography and duplex of the iliac arteries compared with intra-arterial P.2001In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 19, p. 516-523Article in journal (Refereed)
  • 115.
    Wodlin, Peter
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Ahlström, Per
    Holmberg, Bengt
    Löfström, Lars
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Anaesthesiology. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Fransson, Sven Göran
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Radiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Svedjeholm, Rolf
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Thoracic Surgery. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Karlsson, Erling
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Resultat av koronar revaskulering. 478 patienter i detaljerad uppföljning.2000In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 97, p. 2452-2457Article in journal (Other (popular science, discussion, etc.))
  • 116. Yen, MA
    et al.
    Tabar, L
    Vitak, B
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Radiology. Östergötlands Läns Landsting, Centre for Medical Imaging, Department of Radiology UHL.
    Smith, RA
    Chen, HH
    Duffy, SW
    Quantifying the potential problem of overdiagnosis of ductal carcinoma in situ in breast cancer screening2003In: European Journal of Cancer, ISSN 0959-8049, E-ISSN 1879-0852, Vol. 39, no 12, p. 1746-1754Article in journal (Refereed)
    Abstract [en]

    The relevance of detection of ductal carcinoma in situ (DCIS) in a breast cancer screening programme, and the extent of overdiagnosis of non-progressive lesions, remains controversial. It was the purpose of this paper to estimate the incidence of non-progressive, 'overdiagnosed' DCIS. We defined non-progressive DCIS (DCIS0) as DCIS which could not have progressed to invasive disease if left untreated. Progressive DCIS (DCIS1) was defined as DCIS which has the propensity to progress to invasive disease. We fitted a Markov process model of the incidence of progressive and non-progressive DCIS, the transition of the former to preclinical invasive disease and the subsequent progression to clinical symptomatic cancer. We used data from the Swedish Two-County Trial and from service screening programmes in the UK, Netherlands, Australia and the USA to estimate the incidence of progressive and non-progressive DCIS, and the detection rates of each at the first and subsequent screening. Average incidence of non-progressive DCIS was 1.11 per 100 000 per year. Average incidence of progressive DCIS was 2.1 per 1000 per year. At prevalence screen, 37% of DCIS cases were estimated to be non-progressive. A woman attending prevalence screen has a 19 times greater chance of having a progressive DCIS or an invasive tumour diagnosed than of having a non-progressive DCIS diagnosed. At incidence screen, only 4% of DCIS cases were estimated to be non-progressive. A woman attending an incidence screen has a 166 times higher probability of having a progressive DCIS or invasive lesion diagnosed than of having a non-progressive DCIS diagnosed. There is an element of overdiagnosis of DCIS in breast cancer screening, but the phenomenon is small in both relative and absolute terms. ⌐ 2003 Elsevier Ltd. All rights reserved.

  • 117.
    Ålund, Martin
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics. Linköping University, Faculty of Health Sciences.
    Hoe-Hansen, Carsten
    Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics. Linköping University, Faculty of Health Sciences.
    Tillander, Bo
    Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics. Linköping University, Faculty of Health Sciences.
    Héden, Bengt-Åke
    Linköping University, Department of Medicine and Care, Radiology. Linköping University, Faculty of Health Sciences.
    Norlin, Rolf
    Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics. Linköping University, Faculty of Health Sciences.
    Outcome after cup hemiarthroplasty in the rheumatoid shoulder: A retrospective evaluation of 39 patients followed for 2-6 years2000In: Acta Orthopaedica Scandinavica, ISSN 0001-6470, Vol. 71, no 2, p. 180-184Article in journal (Refereed)
    Abstract [en]

    33 rheumatoid patients, treated with hemispherical cup resurfacing hemiarthroplasty of the shoulder without medullary fixation (6 bilaterally), were reviewed after mean 4.4 (2-6) years. The median Constant score was 30 (15-79), mean proximal migration of the humerus 5.5 (SD 5.2) mm and mean glenoid erosion 2.6 (SD 1.7) mm. Proximal migration and glenoid erosion did not correlate with shoulder function or pain. Radiographic signs of loosening (changes in cup inclination combined with changes in cup distance above the greater tuberosity) occurred in one quarter of the shoulders. At follow-up, 26 patients were satisfied with the procedure, despite poor shoulder function and radiographic deterioration.

  • 118.
    Österberg, Anders
    et al.
    Linköping University, Department of Neuroscience and Locomotion, Neurology. Linköping University, Faculty of Health Sciences.
    Boivie, Jörgen
    Linköping University, Department of Neuroscience and Locomotion, Neurology. Linköping University, Faculty of Health Sciences.
    Thoumas, K-Å
    Linköping University, Department of Medicine and Care, Radiology. Linköping University, Faculty of Health Sciences.
    Central pain in multiple sclerosis: prevalence and clinical characteristics2005In: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 9, no 5, p. 531-542Article in journal (Refereed)
    Abstract [en]

    Pain is more common in multiple sclerosis (MS) than has previously been recognised. In the present study we have investigated the occurrence of central pain (CP) in MS and defined its characteristics. Questionnaires were sent to all 429 patients with definite MS in the patient register at our neurology department. All admitting to pain were interviewed and offered an extended interview and examination. Three hundred and sixty four patients responded (86%), of whom 57.5% reported pain during the course of their disease (21% nociceptive, 2% peripheral neuropathic and 1% related to spasticity). One hundred patients (27.5%) had CP, including 18 patients (4.9%) with trigeminal neuralgia.

    The non-trigeminal CP was, in 87%, located in the lower and in 31% in the upper extremities. It was mostly bilateral (76%) and constant, with 88% experiencing daily pain. Only 2% had paroxysmal attacks. Aching, burning, pricking were the commonest qualities. The pain was intense with small to moderate spontaneous variation. In 5.5% of all patients (20% of the patients with CP), pain was a presenting symptom, alone or in combination with other symptoms.

    The most common neurological symptoms/signs besides CP were sensory abnormalities (98%, dominated by abnormal sensibility to painful stimulus and temperature). Trigeminal neuralgia in MS started later in life and after longer disease duration than non-trigeminal pain. Both types of CP existed either chronically or as a feature of relapse. Central pain is thus an important symptom in MS (around 30%) and causes much suffering.

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