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Eur Radiol. 2017 Oct;27(10):4257-4263. doi: 10.1007/s00330-017-4822-z. Epub 2017 Apr 13.

FLAIR* to visualize veins in white matter lesions: A new tool for the diagnosis of multiple sclerosis?

Author information

1
Blizard Institute (Neuroscience), Queen Mary University of London, London, UK. thomascampion@nhs.net.
2
Barts Health NHS Trust, Emergency Care and Acute Medicine Clinical Academic Group Neuroscience, The Royal London Hospital, Whitechapel Road, London, UK. thomascampion@nhs.net.
3
Blizard Institute (Neuroscience), Queen Mary University of London, London, UK.
4
Gloucestershire Hospitals NHS Trust, Cheltenham, UK.
5
Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK.
6
Barts Health NHS Trust, Emergency Care and Acute Medicine Clinical Academic Group Neuroscience, The Royal London Hospital, Whitechapel Road, London, UK.
7
Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD, USA.
8
Department of Neurology, Yale School of Medicine, New Haven, CT, USA.
9
William Harvey Research Institute (Cardiovascular Biomedical Research Unit), Queen Mary University of London, London, UK.

Abstract

OBJECTIVE:

To explore the potential of a post-processing technique combining FLAIR and T2* (FLAIR*) to distinguish between lesions caused by multiple sclerosis (MS) from cerebral small vessel disease (SVD) in a clinical setting.

METHODS:

FLAIR and T2* head datasets acquired at 3T of 25 people with relapsing MS (pwRMS) and ten with pwSVD were used. After post-processing, FLAIR* maps were used to determine the proportion of white matter lesions (WML) showing the 'vein in lesion' sign (VIL), a characteristic histopathological feature of MS plaques. Sensitivity and specificity of MS diagnosis were examined on the basis of >45% VIL+ and >60% VIL+ WML, and compared with current dissemination in space (DIS) MRI criteria.

RESULTS:

All pwRMS had >45% VIL+ WML (range 58-100%) whilst in pwSVD the proportion of VIL+ WML was significantly lower (0-64%; mean 32±20%). Sensitivity based on >45% VIL+ was 100% and specificity 80% whilst with >60% VIL+ as the criterion, sensitivity was 96% and specificity 90%. DIS criteria had 96% sensitivity and 40% specificity.

CONCLUSION:

FLAIR* enables VIL+ WML detection in a clinical setting, facilitating differentiation of MS from SVD based on brain MRI.

KEY POINTS:

• FLAIR* in a clinical setting allows visualization of veins in white matter lesions. • Significant proportions of MS lesions demonstrate a vein in lesion on MRI. • Microangiopathic lesions demonstrate a lower proportion of intralesional veins than MS lesions. • Intralesional vein-based criteria may complement current MRI criteria for MS diagnosis.

KEYWORDS:

Central vein; MRI; Multiple sclerosis; Neuroimaging; White matter

PMID:
28409356
PMCID:
PMC5579202
DOI:
10.1007/s00330-017-4822-z
[Indexed for MEDLINE]
Free PMC Article

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