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AJNR Am J Neuroradiol. 2018 Aug;39(8):1473-1479. doi: 10.3174/ajnr.A5705. Epub 2018 Jun 21.

Morphology-Specific Discrimination between MS White Matter Lesions and Benign White Matter Hyperintensities Using Ultra-High-Field MRI.

Author information

1
From the Biomedical Engineering Graduate Program (Z.H., R.S.M., M.D.).
2
Imaging Research Laboratories (Z.H., J.L., R.S.M., M.D.), Robarts Research Institute.
3
Departments of Medicine (J.M.).
4
Department of Neurology and Neurosurgery (D.A.R.), McConnell Brain Imaging Centre, Montreal Neurological Institute.
5
Department of Biomedical Engineering (D.A.R.), McGill University, Montreal, Quebec, Canada.
6
Medical Imaging (B.Y.M.K., F.S., M.S.).
7
Department of Clinical Neurological Sciences (M.S., M.K.), Western University and London Health Sciences Centre, London, Ontario, Canada.
8
Medical Biophysics (R.S.M., M.D.), Schulich School of Medicine and Dentistry; Western University, London, Ontario, Canada.
9
From the Biomedical Engineering Graduate Program (Z.H., R.S.M., M.D.) mdrangova@robarts.ca.

Abstract

BACKGROUND AND PURPOSE:

Recently published North American Imaging in Multiple Sclerosis guidelines call for derivation of a specific radiologic definition of MS WM lesions and mimics. The purpose of this study was to use SWI and magnetization-prepared FLAIR images for sensitive differentiation of MS from benign WM lesions using the morphologic characteristics of WM lesions.

MATERIALS AND METHODS:

Seventeen patients with relapsing-remitting MS and 18 healthy control subjects were enrolled retrospectively. For each subject, FLAIR and multiecho gradient-echo images were acquired using 7T MR imaging. Optimized postprocessing was used to generate single-slice SWI of cerebral veins. SWI/FLAIR images were registered, and 3 trained readers performed lesion assessment. Morphology, location of lesions, and the time required for assessment were recorded. Analyses were performed on 3 different pools: 1) lesions of >3 mm, 2) nonconfluent lesions of >3 mm, and 3) nonconfluent lesions of >3 mm with no or a single central vein.

RESULTS:

The SWI/FLAIR acquisition and processing protocol enabled effective assessment of central veins and hypointense rims in WM lesions. Assessment of nonconfluent lesions with ≥1 central vein enabled the most specific and sensitive differentiation of patients with MS from controls. A threshold of 67% perivenous WM lesions separated patients with MS from controls with a sensitivity of 94% and specificity of 100%. Lesion assessment took an average of 12 minutes 10 seconds and 4 minutes 33 seconds for patients with MS and control subjects, respectively.

CONCLUSIONS:

Nonconfluent lesions of >3 mm with ≥1 central vein were the most sensitive and specific differentiators between patients with MS and control subjects.

PMID:
29930096
DOI:
10.3174/ajnr.A5705
[Indexed for MEDLINE]
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