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Martin A, Emorine T, Megdiche I, Créange A, Kober T, Massire A, Bapst B. Accurate Diagnosis of Cortical and Infratentorial Lesions in Multiple Sclerosis Using Accelerated Fluid and White Matter Suppression Imaging. Invest Radiol 2023; 58:337-345. [PMID: 36730698 DOI: 10.1097/rli.0000000000000939] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES The precise location of multiple sclerosis (MS) cortical lesions can be very challenging at 3 T, yet distinguishing them from subcortical lesions is essential for the diagnosis and prognosis of the disease. Compressed sensing-accelerated fluid and white matter suppression imaging (CS-FLAWS) is a new magnetic resonance imaging sequence derived from magnetization-prepared 2 rapid acquisition gradient echo with promising features for the detection and classification of MS lesions. The objective of this study was to compare the diagnostic performances of CS-FLAWS (evaluated imaging) and phase sensitive inversion recovery (PSIR; reference imaging) for classification of cortical lesions (primary objective) and infratentorial lesions (secondary objective) in MS, in combination with 3-dimensional (3D) double inversion recovery (DIR). MATERIALS AND METHODS Prospective 3 T scans (MS first diagnosis or follow-up) acquired between March and August 2021 were retrospectively analyzed. All underwent 3D CS-FLAWS, axial 2D PSIR, and 3D DIR. Double-blinded reading sessions exclusively in axial plane and final consensual reading were performed to assess the number of cortical and infratentorial lesions. Wilcoxon test was used to compare the 2 imaging datasets (FLAWS + DIR and PSIR + DIR), and intraobserver and interobserver agreement was assessed using the intraclass correlation coefficient. RESULTS Forty-two patients were analyzed (38 with relapsing-remitting MS, 29 women, 42.7 ± 12.6 years old). Compressed sensing-accelerated FLAWS allowed the identification of 263 cortical lesions versus 251 with PSIR ( P = 0.74) and 123 infratentorial lesions versus 109 with PSIR ( P = 0.63), corresponding to a nonsignificant difference between the 2 sequences. Compressed sensing-accelerated FLAWS exhibited fewer false-negative findings than PSIR either for cortical lesions (1 vs 13; P < 0.01) or infratentorial lesions (1 vs 15; P < 0.01). No false-positive findings were found with any of the 2 sequences. Diagnostic confidence was high for each contrast. CONCLUSION Three-dimensional CS-FLAWS is as accurate as 2D PSIR imaging for classification of cortical and infratentorial MS lesions, with fewer false-negative findings, opening the way to a reliable full brain MS exploration in a clinically acceptable duration (5 minutes 15 seconds).
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Shen Y, Zhao B, Yan L, Jann K, Wang G, Wang J, Wang B, Pfeuffer J, Qian T, Wang DJJ. Cerebral Hemodynamic and White Matter Changes of Type 2 Diabetes Revealed by Multi-TI Arterial Spin Labeling and Double Inversion Recovery Sequence. Front Neurol 2017; 8:717. [PMID: 29312135 PMCID: PMC5743674 DOI: 10.3389/fneur.2017.00717] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 12/12/2017] [Indexed: 01/07/2023] Open
Abstract
Diabetes has been reported to affect the microvasculature and lead to cerebral small vessel disease (SVD). Past studies using arterial spin labeling (ASL) at single post-labeling delay reported reduced cerebral blood flow (CBF) in patients with type 2 diabetes. The purpose of this study was to characterize cerebral hemodynamic changes of type 2 diabetes using a multi-inversion-time 3D GRASE pulsed ASL (PASL) sequence to simultaneously measure CBF and bolus arrival time (BAT). Thirty-six patients with type 2 diabetes (43-71 years, 17 male) and 36 gender- and age-matched control subjects underwent MRI scans at 3 T. Mean CBF/BAT values were computed for gray and white matter (GM and WM) of each subject, while a voxel-wise analysis was performed for comparison of regional CBF and BAT between the two groups. In addition, white matter hyperintensities (WMHs) were detected by a double inversion recovery (DIR) sequence with relatively high sensitivity and spatial resolution. Mean CBF of the WM, but not GM, of the diabetes group was significantly lower than that of the control group (p < 0.0001). Regional CBF decreases were detected in the left middle occipital gyrus (p = 0.0075), but failed to reach significance after correction of partial volume effects. BAT increases were observed in the right calcarine fissure (p < 0.0001), left middle occipital gyrus (p < 0.0001), and right middle occipital gyrus (p = 0.0011). Within the group of diabetic patients, BAT in the right middle occipital gyrus was positively correlated with the disease duration (r = 0.501, p = 0.002), BAT in the left middle occipital gyrus was negatively correlated with the binocular visual acuity (r = -0.408, p = 0.014). Diabetic patients also had more WMHs than the control group (p = 0.0039). Significant differences in CBF, BAT, and more WMHs were observed in patients with diabetes, which may be related to impaired vision and risk of SVD of type 2 diabetes.
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Affiliation(s)
- Yelong Shen
- School of Medicine, Shandong Medical Imaging Research Institute, Shandong University, Jinan, China.,Laboratory of FMRI Technology (LOFT), Keck School of Medicine, Mark and Mary Stevens Neuroimaging and Informatics Institute, University of Southern California (USC), Los Angeles, CA, United States
| | - Bin Zhao
- School of Medicine, Shandong Medical Imaging Research Institute, Shandong University, Jinan, China
| | - Lirong Yan
- Laboratory of FMRI Technology (LOFT), Keck School of Medicine, Mark and Mary Stevens Neuroimaging and Informatics Institute, University of Southern California (USC), Los Angeles, CA, United States
| | - Kay Jann
- Laboratory of FMRI Technology (LOFT), Keck School of Medicine, Mark and Mary Stevens Neuroimaging and Informatics Institute, University of Southern California (USC), Los Angeles, CA, United States
| | - Guangbin Wang
- School of Medicine, Shandong Medical Imaging Research Institute, Shandong University, Jinan, China
| | - Junli Wang
- School of Medicine, Shandong Medical Imaging Research Institute, Shandong University, Jinan, China
| | - Bao Wang
- School of Medicine, Shandong Medical Imaging Research Institute, Shandong University, Jinan, China
| | | | - Tianyi Qian
- Siemens Healthcare, MR Collaborations NE Asia, Beijing, China
| | - Danny J J Wang
- Laboratory of FMRI Technology (LOFT), Keck School of Medicine, Mark and Mary Stevens Neuroimaging and Informatics Institute, University of Southern California (USC), Los Angeles, CA, United States
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Abidi Z, Faeghi F, Mardanshahi Z, Mortazavi H. Assessment of the diagnostic accuracy of double inversion recovery sequence compared with FLAIR and T2W_TSE in detection of cerebral multiple sclerosis lesions. Electron Physician 2017; 9:4162-4170. [PMID: 28607651 PMCID: PMC5459288 DOI: 10.19082/4162] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 12/17/2016] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Multiple sclerosis (MS) is a demyelinating disease of the central nervous system. MRI has an important role in early diagnosis of MS within diagnostic criteria. AIM To determine the diagnostic value of the double inversion recovery (DIR) sequence in detection of brain MS lesions. METHODS In this cross-sectional study, 55 patients were admitted to the MRI department in Vali-E-Asr Hospital in Qaemshahr, Iran, from May 2016 to February 2016. Imaging was performed on a 1.5T Philips MR system using DIR, fluid attenuated inversion recovery (FLAIR), and T2-weighted turbo spin echo (T2W_TSE) sequences with the same parameters, including field of view (FOV), matrix, slice thickness, voxel size, and number of signal averaging (NSA). The DIR sequence has two different time inversions (TI1=3400, TI2=325ms): suppressing cerebrospinal fluid (CSF) and white matter signal. Data analysis was performed using the SPSS version 20, and p-value was gained from the patient-wise analysis by Wilcoxon analysis and paired samples t-test for matched pairs. RESULTS More lesions in number and size were depicted on the DIR sequence compared with FLAIR (p=0.000 with a relative ratio of 6) and T2W_TSE (p=0.000 with a relative ratio of 10). DIR demonstrated significantly more intracortical lesions compared with FLAIR (p=0.000 with a relative ratio of 2.53) and T2W_TSE (p=0.000 and relative ratio of 8.87). There was significantly higher contrast ratio between the white matter lesions and the normal appearing white matter (NAWM) in all anatomical regions especially in deep white matter (p=0.001). CONCLUSION An increasing total number of MS lesions can be detected by DIR sequence; thus, we recommend adding DIR sequence in routine MR protocols for MS patients.
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Affiliation(s)
- Zahra Abidi
- M.Sc. Student of Medical Imaging Technology, Radiology Technology Department, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fariborz Faeghi
- Ph.D. of Medical Physics, Radiology Technology Department, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Mardanshahi
- M.D., Radiologist, Assistant Professor, Radiology Department, Mazandaran University of Medical Sciences, Sari, Iran
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Geisseler O, Pflugshaupt T, Bezzola L, Reuter K, Weller D, Schuknecht B, Brugger P, Linnebank M. The relevance of cortical lesions in patients with multiple sclerosis. BMC Neurol 2016; 16:204. [PMID: 27769199 PMCID: PMC5073896 DOI: 10.1186/s12883-016-0718-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 10/12/2016] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Recent studies suggest that cortical lesions in multiple sclerosis (MS) substantially contribute to clinical disease severity. The present study aimed at investigating clinical, neuroanatomical, and cognitive correlates of these cortical lesions with a novel approach, i.e. by comparing two samples of relapsing-remitting multiple sclerosis (RRMS) patients, one group with and the other without cortical lesions. METHODS High-resolution structural MRI was acquired from 42 RRMS patients and 43 controls (HC). The patient group was dichotomized based on the presence versus absence of DIR-hyperintense cortex-involving lesions, resulting in a cortical lesion group (CL, n = 32) and a non-cortical lesion group (nCL, n =10). Cognitive functioning was assessed in all participants with a comprehensive neuropsychological battery, covering mnestic, executive, and attentional functions. RESULTS Highest densities of cortical lesions in the CL group were observed in the bilateral parahippocampal gyrus. Relative to HC, patients with cortical lesions - but not those without - showed significant global cortical thinning and mnestic deficits. The two patient groups did not differ from each other regarding demographic and basic disease characteristics such as EDSS scores. CONCLUSION The appearance of cortical lesions in MS patients is associated with cortical thinning as well as mnestic deficits, which might be key characteristics of a 'cortically dominant' MS subtype.
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Affiliation(s)
- Olivia Geisseler
- Department of Neurology, University Hospital Zurich, Frauenklinikstrasse 26, 8091, Zurich, Switzerland. .,Department of Psychology, University of Zurich, Binzmühlestrasse 14/1, 8050, Zürich, Switzerland.
| | - Tobias Pflugshaupt
- Neurology and Neurorehabilitation Center, Luzerner Kantonsspital/State Hospital, 6000, Lucerne 16, Switzerland
| | - Ladina Bezzola
- URPP Dynamics of Healthy Aging, University of Zurich, Andreasstrasse 15/Box 2, 8050, Zurich, Switzerland
| | - Katja Reuter
- Department of Neurology, University Hospital Zurich, Frauenklinikstrasse 26, 8091, Zurich, Switzerland
| | - David Weller
- Department of Neurology, University Hospital Zurich, Frauenklinikstrasse 26, 8091, Zurich, Switzerland
| | - Bernhard Schuknecht
- Medizinisch Radiologisches Institut, Bahnhofplatz 3, 8001, Zurich, Switzerland
| | - Peter Brugger
- Department of Neurology, University Hospital Zurich, Frauenklinikstrasse 26, 8091, Zurich, Switzerland
| | - Michael Linnebank
- Department of Neurology, University Hospital Zurich, Frauenklinikstrasse 26, 8091, Zurich, Switzerland.,Department of Neurology, Helios-Klinik Hagen-Ambrock, Ambrocker Weg 60, 58091, Hagen, Germany
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Wang Y, Yan H, Ding Q, Mao C, Shen Y, Wang G. 3D-DIR for early differential diagnostic and prognostic evaluation of NMO. Exp Ther Med 2016; 12:1464-1468. [PMID: 27588068 PMCID: PMC4998000 DOI: 10.3892/etm.2016.3474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 06/23/2016] [Indexed: 01/04/2023] Open
Abstract
Neuromyelitis optica (NMO) is an acute or subacute lesion of demyelinating disease involving the optic nerve and spinal cord, and imaging techniques and their effects have been the focus of investigations. The aim of the present study was to examine the value of three-dimensional double inversion recovery (3D-DIR) in the early differential diagnostic and prognostic evaluation of NMO. Forty-eight patients with suspicious NMO were included into the study and underwent a combination of serum NMO-IgG quantitative detection and 3D-DIR examination. Forty cases (83.3%) of the suspicious cases were confirmed with NMO. The average time from onset to definite diagnosis was 3.5±0.6 days. The brain showed high T2W and fluid-attenuated inversion recovery (FLAIR) signals, involving 5.8±1.2 sites on average, distributed in the peripheral lateral ventricle, medulla, cerebral white matter, the third ventricle, peripheral aqueduct of sylvius, pons and diencephalon. The average T2W signal strength was 2.73±0.12. The signal intensity of DIR was significantly higher than that of T2W and FLAIR, and the difference was statistically significant. The optic nerve and chiasma showed a high FLAIR signal, with an average signal intensity of 2.13±0.14. The spinal cord showed swelling, necrosis and cavity lesion, involving the gray and white matter of the central site, transversely, with an average lesion length of 4.7±0.6 centrum. The relative signal intensity of DIR was significantly higher than that of T2W and FLAIR. Following treatment, the signal intensity of the brain, optic nerve, optic chiasma and spinal cord decreased significantly (P<0.05). In conclusion, 3D-DIR has great application value in the early differential diagnostic and prognostic evaluation of NMO.
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Affiliation(s)
- Yanbing Wang
- Shandong Medical Imaging Research Institute, Shandong University, Jinan, Shandong 250021, P.R. China; Department of Radiology, Rizhao People's Hospital, Rizhao, Shandong 276826, P.R. China
| | - Hong Yan
- Department of Radiology, Rizhao People's Hospital, Rizhao, Shandong 276826, P.R. China
| | - Qixing Ding
- Department of Radiology, Rizhao People's Hospital, Rizhao, Shandong 276826, P.R. China
| | - Cunhua Mao
- The Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong 250012, P.R. China
| | - Yelong Shen
- Shandong Medical Imaging Research Institute, Shandong University, Jinan, Shandong 250021, P.R. China
| | - Guangbin Wang
- Shandong Medical Imaging Research Institute, Shandong University, Jinan, Shandong 250021, P.R. China
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Maranzano J, Rudko DA, Arnold DL, Narayanan S. Manual Segmentation of MS Cortical Lesions Using MRI: A Comparison of 3 MRI Reading Protocols. AJNR Am J Neuroradiol 2016; 37:1623-8. [PMID: 27197988 DOI: 10.3174/ajnr.a4799] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 03/04/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Double inversion recovery has been suggested as the MR imaging contrast of choice for segmenting cortical lesions in patients with multiple sclerosis. In this study, we sought to determine the utility of double inversion recovery for cortical lesion identification by comparing 3 MR imaging reading protocols that combine different MR imaging contrasts. MATERIALS AND METHODS Twenty-five patients with relapsing-remitting MS and 3 with secondary-progressive MS were imaged with 3T MR imaging by using double inversion recovery, dual fast spin-echo proton-density/T2-weighted, 3D FLAIR, and 3D T1-weighted imaging sequences. Lesions affecting the cortex were manually segmented by using the following 3 MR imaging reading protocols: Protocol 1 (P1) used all available MR imaging contrasts; protocol 2 (P2) used all the available contrasts except for double inversion recovery; and protocol 3(P3) used only double inversion recovery. RESULTS Six hundred forty-three cortical lesions were identified with P1 (mean = 22.96); 633, with P2 (mean = 22.6); and 280, with P3 (mean = 10). The counts obtained by using P1 and P2 were not significantly different (P = .93). The counts obtained by using P3 were significantly smaller than those obtained by using either P1 (P < .001) or P2 (P < .001). The intraclass correlation coefficients were P1 versus P2 = 0.989, P1 versus P3 = 0.615, and P2 versus P3 = 0.588. CONCLUSIONS MR imaging cortical lesion segmentation can be performed by using 3D T1-weighted and 3D FLAIR images acquired with a 1-mm isotropic voxel size, supported by conventional T2-weighted and proton-density images with 3-mm-thick sections. Inclusion of double inversion recovery in this multimodal reading protocol did not significantly improve the cortical lesion identification rate. A multimodal approach is superior to using double inversion recovery alone.
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Affiliation(s)
- J Maranzano
- From the Department of Neurology and Neurosurgery, Montreal Neurological Hospital and Institute, McGill University, Montreal, Quebec, Canada
| | - D A Rudko
- From the Department of Neurology and Neurosurgery, Montreal Neurological Hospital and Institute, McGill University, Montreal, Quebec, Canada
| | - D L Arnold
- From the Department of Neurology and Neurosurgery, Montreal Neurological Hospital and Institute, McGill University, Montreal, Quebec, Canada
| | - S Narayanan
- From the Department of Neurology and Neurosurgery, Montreal Neurological Hospital and Institute, McGill University, Montreal, Quebec, Canada.
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Kolber P, Montag S, Fleischer V, Luessi F, Wilting J, Gawehn J, Gröger A, Zipp F. Identification of cortical lesions using DIR and FLAIR in early stages of multiple sclerosis. J Neurol 2015; 262:1473-82. [DOI: 10.1007/s00415-015-7724-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 03/25/2015] [Accepted: 03/26/2015] [Indexed: 01/06/2023]
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