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Hosseini Z, Matusinec J, Rudko DA, Liu J, Kwan BYM, Salehi F, Sharma M, Kremenchutzky M, Menon RS, Drangova M. Morphology-Specific Discrimination between MS White Matter Lesions and Benign White Matter Hyperintensities Using Ultra-High-Field MRI. AJNR Am J Neuroradiol 2018; 39:1473-1479. [PMID: 29930096 DOI: 10.3174/ajnr.a5705] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 05/05/2018] [Indexed: 11/07/2022]
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.
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Affiliation(s)
- Z Hosseini
- From the Biomedical Engineering Graduate Program (Z.H., R.S.M., M.D.).,Imaging Research Laboratories (Z.H., J.L., R.S.M., M.D.), Robarts Research Institute
| | | | - D A Rudko
- Department of Neurology and Neurosurgery (D.A.R.), McConnell Brain Imaging Centre, Montreal Neurological Institute.,Department of Biomedical Engineering (D.A.R.), McGill University, Montreal, Quebec, Canada
| | - J Liu
- Imaging Research Laboratories (Z.H., J.L., R.S.M., M.D.), Robarts Research Institute
| | | | - F Salehi
- Medical Imaging (B.Y.M.K., F.S., M.S.)
| | - M Sharma
- Medical Imaging (B.Y.M.K., F.S., M.S.).,Department of Clinical Neurological Sciences (M.S., M.K.), Western University and London Health Sciences Centre, London, Ontario, Canada
| | - M Kremenchutzky
- Department of Clinical Neurological Sciences (M.S., M.K.), Western University and London Health Sciences Centre, London, Ontario, Canada
| | - R S Menon
- From the Biomedical Engineering Graduate Program (Z.H., R.S.M., M.D.).,Imaging Research Laboratories (Z.H., J.L., R.S.M., M.D.), Robarts Research Institute.,Medical Biophysics (R.S.M., M.D.), Schulich School of Medicine and Dentistry; Western University, London, Ontario, Canada
| | - M Drangova
- From the Biomedical Engineering Graduate Program (Z.H., R.S.M., M.D.) .,Imaging Research Laboratories (Z.H., J.L., R.S.M., M.D.), Robarts Research Institute.,Medical Biophysics (R.S.M., M.D.), Schulich School of Medicine and Dentistry; Western University, London, Ontario, Canada
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