This time, I have translated the original German interview with Prof. Dr. Mike P. Wattjes on the importance of MRI as an imaging technique for diagnosis, progression assessment, therapy decisions, and monitoring of disease-modifying therapies in MS patients into English. Prof. Wattjes is the lead author of the MAGNIMS Guideline 2021, which provides global recommendations and standards for MRI examinations in people with MS.
He explains the ten most important things about MRI in multiple sclerosis in an easy-to-understand way. He also discusses well-established MRI imaging options that will hopefully soon be available to all MS patients and the importance of standardization in order to harness the potential of magnetic resonance imaging.
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Introduction Prof. Dr. Mike P. Wattjes
Nele von Horsten: Hi Mike, I’m really happy to have you as my guest today to give us a bit more insight into MRI. But first, a warm hello to Hannover!
Prof. Dr. Mike Wattjes: Thank you so much, dear Nele, for the kind invitation.
Nele von Horsten: Before we dive in, would you briefly introduce yourself?
Prof. Dr. Mike Wattjes: Of course! I’m a radiologist with a specialization in neuroimaging, particularly in the context of multiple sclerosis and other neurological diseases. I’ve spent nearly seven years working in Hannover, and as of May 2024, I’ve taken on a new role as Professor of Neuroradiology and Head of the Department of Neuroradiology at Charité – Universitätsmedizin Berlin. Before that, I spent over a decade at the MS Center in Amsterdam and have been actively involved with the MAGNIMS network, a European consortium of MS imaging experts. I remain deeply passionate about exploring this complex and fascinating condition from a neuroradiological perspective.
Editor’s note: Mike Wattjes’s current position at Charité has been added for context. The interview originally took place in July 2023, while he was still based in Hannover.
Personal motivation for the job?
Prof. Dr. Mike Wattjes: That’s a great question. Choosing a medical specialty is a bit like relationships – sometimes you have to try a few things to find the right fit. I went through phases thinking I’d become an internist, a surgeon, maybe a pediatrician.
But toward the end of my studies, I became really fascinated by neuroscience—and also by imaging. I started wondering how I could combine both, and that’s when neuroradiology came onto my radar. It wasn’t an obvious choice back then, but it offered a way to bridge both worlds.
While doing my final year in the U.S., I had a very inspiring radiologist as a mentor. That really helped me find my path. I first started in neurology for a year, then switched to radiology—and I’ve never regretted it. It’s such an innovative field, and I enjoy the interdisciplinary aspect: working not just with doctors, but also with pharma, MS nurses, and other healthcare professionals. I really value that exchange.
Nele von Horsten: That’s lovely to hear. I’ve always had a soft spot for radiologists—my MS diagnosis actually came from a radiologist friend. So when Prof. Tjalf Ziemssen jokes about radiologists, I just smile and think: I like them! (laughs)
Magnetic resonance imaging (MRI) in multiple sclerosis
How important is the MRI examination for the diagnosis and progression of MS?
Prof. Dr. Mike Wattjes: MRI is incredibly powerful—but also seductive. Over the past 10–20 years, imaging has advanced tremendously. What used to take ten minutes with a CT scan or was limited to conventional X-rays on lightboxes has become a high-resolution, fast, and sensitive diagnostic tool.
Especially in MS, imaging plays a central role. But it’s crucial to remember: MS is still a clinical diagnosis. Imaging supports the diagnosis, but it can’t replace a thorough clinical evaluation and additional lab tests. I always tell my residents: don’t rely on images alone—always ask about the patient’s history and symptoms. Without clinical context, even the best MRI can mislead.
When it comes to diagnosis, MRI is highly sensitive for detecting demyelinating lesions in both the brain and spinal cord. It allows us to confirm spatial and temporal dissemination, as required by current diagnostic criteria—even before patients notice any symptoms. That makes early diagnosis and treatment decisions more precise.
In terms of monitoring disease progression, MRI has become an essential tool. Even when patients feel fine, we sometimes detect new lesions that suggest ongoing inflammation. This lets neurologists reassess therapy early and switch to a more effective treatment if needed. We can also use MRI markers to estimate future disability progression and tailor therapy accordingly.
Finally, MRI helps with safety monitoring—detecting rare but serious complications, like infections, early on. So, from diagnosis and prognosis to therapy evaluation and safety: MRI supports MS care throughout the patient journey.
Nele von Horsten: Right, and with my limited background, even I’ve seen how important that is. In one of my recent podcast episodes, I spoke to a woman who was misdiagnosed with MS for years—but it turned out to be migraine. That shows how critical it is to get it right.
Prof. Dr. Mike Wattjes: Absolutely. A false-positive MS diagnosis can lead to unnecessary and inappropriate treatment. Migraine, small vessel disease—these can mimic MS on MRI. I’ve seen so many cases, even one where the chairperson of a patient organization in the Netherlands turned out not to have MS at all. That’s why I always say: never base a diagnosis on MRI alone—no matter how convincing it may seem.
Is the MRI scan dangerous?
Prof. Dr. Mike Wattjes: That’s an easy one: MRI is not dangerous. Unlike CT scans, which use ionizing radiation, MRI does not involve X-rays.
To clarify: a CT scan uses a rotating X-ray beam that passes through the body and creates images based on how the beam is absorbed. It’s very fast, but comes with two downsides—radiation exposure and poor soft tissue contrast.
MRI works completely differently. It uses a high-frequency magnetic pulse in a superconducting magnet. This pulse excites the body’s protons, especially those bound in water, fat, or proteins. As they return to their resting state, they release energy—this is what’s measured to generate the image.
Because this is a magnetic rather than a radiation-based process, it’s perfectly safe for the body. The main downsides? It takes longer, and the scanner can feel very narrow and loud. For people with claustrophobia, it’s definitely not pleasant—I know from experience! The older I get, the less fun it is to lie still in there.
Also, metal implants like pacemakers or certain older devices can be a problem due to the strong magnetic field. Modern pacemakers can sometimes be reprogrammed, but it’s still important to screen carefully beforehand. If there’s any magnetic metal in the body, it could heat up and cause tissue damage.
So, all in all: MRI is a safe, non-invasive imaging technique with excellent resolution and contrast, but it takes time, it’s loud, and it can feel tight inside the scanner.
Nele von Horsten: Right, I know a few people who take a mild sedative beforehand to make it more bearable. And yes, I had to remove all my piercings for it.
When I was working in nuclear medicine in Chicago, that was a whole different story—fascinating, but definitely not as gentle on the body!
What are the quality characteristics of a good MRI scan?
Nele von Horsten: You mentioned that you’re the lead author of the global imaging guidelines. So, let me ask—what actually makes a good MRI scan? Because not all MRIs are created equal.
Prof. Dr. Mike Wattjes: Exactly. The keyword is standardization. And that applies not just to MS, but to all diseases. Before performing an MRI, it’s crucial to ask: What sequences do I need? What tissue contrasts will give me the clearest, most useful information to answer the neurologist’s and the patient’s question?
For MS specifically, we know certain sequences are particularly good at detecting demyelinating lesions—like FLAIR, T2-weighted, and T1 post-contrast images. These are the basic building blocks of an MS MRI protocol.
But here’s the critical part: consistency. You can’t change the protocol from one scan to the next. If one scan is done on one machine with one protocol, and the next is on a different scanner with different settings, you lose comparability. And that’s a big problem—especially when you’re trying to monitor disease activity or treatment effectiveness over time.
That’s why standardization is key—same scanner, same field strength, same head coil, same sequences. Only then can you reliably compare results and detect new inflammation, which could mean it’s time to consider a different therapy.
This applies to many neurological conditions, but for MS, it’s especially critical. That’s why I’m proud we were able to contribute to the MAGNIMS-CMSC recommendations, which now help set a global standard for MS imaging.
Nele von Horsten: Right, and just to break it down in really simple terms—it’s like tracking how you’re aging, but one portrait is painted by Van Gogh and the next one by Picasso. If you don’t keep things consistent, you can’t compare them—it’s just all over the place! (laughs)
Prof. Dr. Mike Wattjes: (laughs) That’s actually a perfect analogy! Different artists use different contrasts—and that’s exactly what happens when you change the imaging protocol. The overall look of the image changes completely.
What are T1, T2 and flair-weighted sequences?
Nele von Horsten: You already mentioned some key terms—T1, T2, FLAIR. Many of us receive MRI reports that include these terms, but for the average person living with MS, they can be hard to understand. Could you explain what each of these sequences actually shows?
Prof. Dr. Mike Wattjes: Absolutely. In FLAIR and T2-weighted sequences, MS lesions—also called demyelinating lesions—show up as bright or white spots. On T1-weighted images, they can vary: sometimes they appear similar to normal white matter, sometimes darker, depending on how advanced the lesion is. And with contrast agents, we can also detect whether a lesion is actively inflamed.
What makes FLAIR so valuable is that the brain’s fluid (CSF) appears dark, while MS lesions appear bright. Since many MS lesions occur near the brain’s ventricles—fluid-filled spaces—or close to the cortical gray matter (also near fluid), this contrast makes the lesions stand out more clearly. FLAIR gives us excellent tissue contrast and is, in fact, our diagnostic workhorse for MS imaging.
In the past, MRI scans were done in 2D—slice by slice. Today, we use 3D volumetric datasets, which allow us to view and reconstruct the images in any direction. This gives us a more detailed look at the lesions and increases diagnostic confidence even further.
Why is an MRI scan of the spinal cord important, but also difficult?
Nele von Horsten: Great. So, what does the MAGNIMS guideline recommend when it comes to spinal cord imaging? And why is it so difficult to get good images of the spinal cord?
Prof. Dr. Mike Wattjes: That’s an excellent question. The biggest enemy of MS imaging—especially in MRI—is motion. With a CT scan, things move so quickly that small movements rarely matter. But MRIs take much longer—sometimes 20 to 30 minutes—and that gives plenty of opportunity for both voluntary and involuntary movement to affect image quality.
We’re not just talking about patient movement, which can be minimized. There’s also internal motion that you can’t control: your heart beats, blood vessels pulse, and even your cerebrospinal fluid (CSF) moves with every heartbeat.
In the brain, these effects are less noticeable, because the heart is relatively far away. But in the spinal cord, it’s a completely different story. The spinal cord sits close to the heart, the aorta, and other large vessels—and everything is pulsing around it, including the CSF. On top of that, the spinal cord itself is small—roughly the width of a thumb. So even minor motion creates major artifacts, making it hard to get clear images.
That’s why spinal cord MRIs are much harder to interpret, and why the risk of false positives or false negatives is higher. And that’s particularly unfortunate, because the spinal cord is critically important in MS—both for diagnosis and especially for tracking disease progression.
We know that when patients enter the progressive phase of MS, there’s often a rapid increase in spinal cord lesions. So it’s tragic in a way: the spinal cord is so central to MS, but it’s technically challenging to image it well.
Interestingly, spinal cord imaging was sometimes easier with older, lower field strength scanners. Now, with stronger gradients and higher magnetic field strengths, the technical demands increase—and good images are even harder to obtain. It’s a dilemma.
That’s why, in the MAGNIMS-CMSC recommendations, we decided to focus monitoring efforts primarily on the brain. If you have a strong spinal cord protocol and a neurologist who knows exactly what to look for, it can still be helpful. But due to the high risk of misinterpretation, we strongly advise caution. The last thing we want is to make treatment decisions based on inaccurate spinal cord results.
Is the contrast agent dangerous?
Nele von Horsten: In the past, contrast agents were used quite frequently. I remember always having to get my kidney function tested beforehand. How safe is MRI contrast, and how important is it for diagnosis and monitoring?
Prof. Dr. Mike Wattjes: Overall, MRI contrast agents are very safe. It’s important to note that MRI contrast is different from what’s used in CT scans. CT contrast contains iodine, which can affect the thyroid and is more allergenic—so allergic reactions are more common there.
For MRI, we use gadolinium-based contrast agents (GBCAs). Gadolinium is a rare-earth heavy metal and highly toxic in its raw form. But we don’t inject it directly. It’s bound in a chelate complex, which keeps the gadolinium locked in and allows it to be safely excreted via the kidneys.
There used to be two types of chelates: linear and macrocyclic. Research showed that the linear chelates were less stable—meaning a small amount of gadolinium could escape and deposit in the brain. And because the brain is a deep compartment, that gadolinium can stay there for life. Understandably, no one wants that.
So regulators responded quickly and recommended switching to the more stable macrocyclic agents, which bind gadolinium so tightly that practically none escapes. These are what we now use almost exclusively—they’re extremely safe.
But like Dutch football legend Johan Cruyff once said, “Every disadvantage has its advantage.” The concern about gadolinium buildup led to important questions: Do we really need contrast every time? Back in 2015, our guidelines still recommended it for all follow-ups. But in the 2021 update, we took a fresh look and concluded: No, we don’t always need it.
For diagnosis, contrast is still important. But for monitoring, we often don’t need it anymore—T2 and FLAIR sequences are sensitive enough to detect new lesions without it. Contrast mainly shows us if the blood-brain barrier is disrupted—that’s its only added value in many follow-ups.
So now, many hospitals—ours included—only use contrast in about 20–30% of cases. That doesn’t mean we avoid it completely. There are still valid indications, and if needed, we absolutely use it. But the key is: ask yourself if it’s necessary—and that’s often a joint decision between neurology and neuroradiology. In the end, though, the radiologist decides whether or not to administer contrast.
Nele von Horsten: That makes sense. I haven’t had contrast in my last few scans either. To explain it more simply: the older contrast agents were like Bubble Tea balls—a bit soft, and the gadolinium could leak out. The newer ones are more like a bouncy ball—really solid, and the gadolinium stays locked in.
Prof. Dr. Mike Wattjes: Exactly! The bouncy ball—macrocyclic contrast—has actually been around for a while. But in the past, people could choose between the two. Now, thankfully, we’ve standardized on the bouncy ball—and regulatory authorities have made that very clear.
What do you see on an MRI scan for multiple sclerosis?
Prof. Dr. Mike Wattjes: It really depends on how deeply you dive into the imaging. In MS, we typically see these demyelinating lesions in both the white and gray matter. And that’s something important to emphasize: MS is not just a white matter disease, as many of us were taught in medical school. It also affects gray matter, where the nerve cell bodies are located—not just the myelin sheaths.
We now know that gray matter lesions are highly relevant to MS. They’re closely linked to clinical symptoms, especially cognitive changes like memory loss. With MRI, we can visualize where inflammation is occurring—in the brain, spinal cord, or even the optic nerves—and how intense that inflammation is.
One key marker is the blood-brain barrier (BBB). In a healthy brain, this barrier keeps contrast agents out. But during strong inflammation, the BBB becomes leaky, allowing contrast agents to enter brain tissue. When we see this on MRI, it tells us there’s active, ongoing inflammation.
We can also assess whether neurodegeneration has already occurred—for example, if there’s brain volume loss, and whether it’s affecting gray or white matter, the brain or the spinal cord. That too can be measured.
Additionally, we can characterize lesion types more precisely. Some lesions show a chronic active border—where inflammation is slowly eating away at the tissue from the outside, while the core remains inactive. These so-called chronic active/inactive lesions are particularly destructive and often seen in progressive MS. They typically don’t remyelinate or recover.
With advanced MRI techniques, we can even assess this on a microstructural level. Some methods help us evaluate whether remyelination is occurring—whether repair mechanisms in the brain are kicking in. And with functional MRI, we can study how brain networks reorganize in response to damage—for example, by activating compensatory mechanisms.
So we now have a whole toolbox—ranging from conventional MRI, which most MS patients are familiar with, to volumetric imaging for tracking brain or spinal cord atrophy, to quantitative and functional MRI, which offer insights into neural damage and recovery.
Is the measurement of atrophy, i.e. brain volume loss, useful in routine clinical practice?
Prof. Dr. Mike Wattjes: Brain atrophy contains a wealth of clinical information. We know that early atrophy has a strong predictive value for future disability progression and overall disease development in MS. We can also detect the acceleration of atrophy later in the disease course, and we know from clinical trials that many MS therapies can slow down this atrophy compared to placebo.
But there are three main challenges in bringing this into clinical routine:
First, you need strict standardization to track atrophy over time. You can’t change even a millisecond in sequence parameters like echo time or repetition time. You must use the same scanner, same protocol, and same head coil—otherwise, comparisons between scans become meaningless. That’s difficult in real-world practice, especially in places like Germany where resources are often stretched and scanner access varies.
Second, brain volume is influenced not only by neurodegeneration, but by many other factors: age, hydration, alcohol use, smoking, genetic factors like APOE status, and even MS medications themselves. For example, anti-inflammatory drugs can reduce fluid retention in the brain, which affects volume. So, it’s hard to say whether observed atrophy is due to actual cell loss or other, less pathological factors. That makes interpretation in routine care very tricky.
Third, there’s currently no clinical threshold that tells a neurologist: “Now is the time to escalate treatment from Drug A to Drug B.” So, while we know atrophy is meaningful, it’s hard to act on it decisively. These limitations are the reason atrophy isn’t yet used as a reliable progression marker in everyday MS care.
It’s a pity, and I hope this will change in the coming years. But for now, we have to acknowledge the complexity.
Nele von Horsten: I think it’s fascinating—being at a research-oriented MS center in Dresden, they actually monitor my brain volume and neurofilament levels. I’m on a very mild therapy, but when I see all these data points come together—combined with my app that tracks me daily—I feel reassured. It’s not just a feeling of stability; the numbers say it too.
Prof. Dr. Mike Wattjes: That’s great—but we have to be realistic: not everyone has access to that level of care. Most outpatient practices and imaging centers operate under tight economic constraints—typically 15–20 minutes per MRI—so there’s little room for extras. And volumetric or advanced quantitative analyses aren’t reimbursed properly, which is why they’re not routinely used outside of research. It’s unfortunate, but that’s the reality.
Nele von Horsten: Hopefully, what’s now a pioneering approach will eventually become the standard for everyone.
What quantitative MRI techniques are available and when are they used?
Prof. Dr. Mike Wattjes: There are many quantitative MRI techniques we can use today. For example, we can measure the diffusion of water molecules—or more precisely, protons—in brain tissue. In a healthy brain, diffusion mostly follows the direction of the myelin sheaths, because water doesn’t easily pass through them. So, if we see a change in this anisotropic diffusion, it may indicate damage to the myelin. Conversely, if anisotropy increases again, that may suggest remyelination—the repair of damaged myelin.
We can also measure relaxation times of protons—some of which are bound to myelin structures, while others are free-floating. This helps us determine whether myelin is intact or recovering.
With functional imaging, we can analyze brain networks—whether they’re functioning normally or showing increased activity as a potential compensation for damage. Then there’s MR spectroscopy, which lets us quantify metabolites in the brain. Some metabolites are markers for healthy neurons, so when their levels drop, it may indicate neuronal damage. Others, like inositol, increase during glial activation, and can point to inflammatory or reactive changes.
We also use advanced T1 and T2 measurements to explore relaxation properties of brain tissue—looking for signs of repair processes or neurodegeneration. However, there’s still no clear consensus on which technique is best for which clinical question, especially when it comes to detecting repair mechanisms. So there’s more work to be done—but we already have a robust toolbox at our disposal.
Nele von Horsten: That’s great! We’ve had some exciting lectures on that too, and I actually spoke with Ines Pereira from the FAMRI study here on the podcast, where they used functional MRI to study fatigue in MS. Really fascinating stuff.
And to those of you listening: if you ever have the chance to take part in a clinical study, go for it! You’ll learn more, contribute to science—and it’s always an exciting opportunity. Just say yes if you’re asked. 😊
Farewell
What developments would you like to see in the field of MRI in MS over the next 5 years?
Prof. Dr. Mike Wattjes: I’ll put it this way: I’m not even wishing for more innovation, because we’ve already made huge strides in recent years. What I really wish for is the ability to bring those innovations into everyday clinical practice—and to have them properly reimbursed by healthcare systems. That would allow us to make patient monitoring more personalized and precise, using tools we already have.
That’s the most important thing to me right now: that our healthcare system gives us the chance to get these “horses on the road,” so to speak—we’ve already got the horsepower under the hood.
It’s a bit frustrating, to be honest. You feel powerless. You can work on advancing your field, but actually applying that knowledge—that’s a question of health policy. And as a neuroradiologist, there’s only so much I can do. So yes, I hope we gain the freedom and the support to bring individualized imaging into clinical routine.
Nele von Horsten: That would be amazing. And even if we just look at it in plain economic terms—MS patients are often diagnosed young. If we’re not treated properly, we drop out of the workforce, stop paying taxes, and place long-term demands on the system. So, really, it’s a smart investment. And aside from that, we’re lovely people, too! 😉 Let’s hope things start to move in the right direction.
Where can I find more information about MRI and interesting research in MS?
Prof. Dr. Mike Wattjes: Yes, there are several important platforms and organizations. In each country, you’ll usually find a national MS patient organization and a national neuroradiology society—both excellent sources for up-to-date information. You can also check with the manufacturers of MRI equipment and with medical specialty societies. For example, MAGNIMS.eu is a great resource at the European level, especially for imaging-related questions.
National neurological societies often provide guidelines and educational materials that now include a strong focus on imaging in MS. There are plenty of ways to stay informed, and I always encourage people: don’t hesitate to reach out directly to experts—send an email and ask your questions. Most specialists are happy to explain things or provide guidance. The key is: don’t bury your head in the sand. Be proactive—engage with your condition, learn about your options, and make use of the wealth of information that’s available.
Nele von Horsten: I completely agree—it really helps to break out of that feeling of helplessness.
Prof. Dr. Mike Wattjes: Exactly. That’s absolutely right.
Complete the sentence "For me, multiple sclerosis is..."
Prof. Dr. Mike Wattjes: MS is honestly one of the most fascinating neurological diseases, and a prime example of how neurology has evolved—and continues to evolve. Just think: 20 years ago, MS was barely treatable. It was often associated with decline and disability.
Thanks to major advances—also in collaboration with the pharmaceutical industry, we’ve transformed MS from a condition that once meant inevitable deterioration into one that, while still not curable, is now very treatable. Today, many patients can live full, active lives.
Let me give you a personal example: a very close friend of mine—he’s a neurologist and psychiatrist himself—also has MS. He’s on effective therapy and honestly, he runs faster and longer than I do. We go jogging regularly, and he absolutely beats me at tennis every time. That’s a real-life example of how far we’ve come.
MS has truly become a showcase of innovation—not only in diagnostics and monitoring, but especially in therapy development. That’s what makes it such a dynamic and hopeful field. And I really notice how grateful patients are—not just for the diagnostic clarity, but especially for the treatment options.
I believe MS is a model for where neurology as a whole is headed in the coming years.
Is there anything else you would like to give the listeners along the way?
Prof. Dr. Mike Wattjes: If you are living with MS, my message to you is: engage with your condition—learn about it, ask questions, stay informed. And above all, know that you are not alone.
MS is one of the most treatable neurological diseases today. It’s certainly not a diagnosis anyone wants—but thanks to modern imaging tools like MRI, we can diagnose and monitor it with great precision. That’s what I’ve tried to share with you today—how we in neuroradiology are here to support you, every step of the way.
But it’s not just us. You have amazing neurologists at your side, too—experts with powerful new tools, like serum neurofilament light chain (NfL) and other emerging biomarkers that help track disease activity more precisely than ever before. And then there’s the incredible progress in therapies—with new medications constantly on the horizon, including the exciting class of BTK inhibitors now knocking on the door.
So yes, MS is a serious diagnosis—but you now have many more options than just 10 or 15 years ago. Most people today have a very good chance of living well with MS. Not everyone—but many, many do. And I urge you: take that chance. Use the resources, ask for help—we are here for you. And we will continue to do everything we can to support you.
Nele von Horsten: Thank you so much, Mike—and also a huge thanks to you and the colleagues you work with around the world. One real advantage we have as people living with MS is that it’s a disease that affects many young adults, especially in the Western world—so there’s a lot of research, focus, and innovation.
And like you mentioned, BTK inhibitors are super exciting—and there’s so much more happening, like efforts to promote remyelination and repair damage. It’s a fascinating time, with so much progress in so many areas.
And something I always try to share from my own MS journey: if there’s a positive takeaway from this condition, it’s this—MS helps you refocus on what really matters to you. You stop worrying so much about pleasing others and start focusing on your own goals and quality of life.
There’s so much to be hopeful about. And accepting the disease—saying “Okay, I have this, now let me understand it and do the best I can with it”—that’s a very powerful mindset. It has helped many people lead fulfilling, focused lives.
Mike, thank you again for this valuable insight, and for explaining everything so clearly! And by the way, I smiled at something you said earlier—the Dutch word “lecker” meaning “good.” It reminded me of a trip to Namibia I took with my now-husband. There’s a lot of Dutch influence there, and people would say “lekker slaap” in the evenings—meaning “sleep well.” That really stuck with me—and so did your warm tone today.
Thank you again, and take care!
Prof. Dr. Mike Wattjes: My pleasure.
See you soon and try to make the best out of your life,
Nele
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