3D MPRAGE improves classification of cortical lesions in multiple sclerosis

Abstract

Background-Gray matter lesions are known to be common in multiple sclerosis (MS), and are suspected to play an important role in disease progression and clinical disability. A combination of MRI techniques, double-inversion recovery (DIR) and phase-sensitive inversion recovery (PSIR), has been used for detection and classification of cortical lesions. We now demonstrate that highresolution three-dimensional (3D) magnetization-prepared rapid acquisition with gradient echo (MPRAGE) improves the classification of cortical lesions by allowing more accurate anatomic localization of lesion morphology.

Identification and Clinical Impact of Multiple Sclerosis Cortical Lesions as Assessed by Routine 3T MR Imaging

“…The detected cortical lesion load is comparable with the bulk of cortical lesions assessed by specialized MR imaging methods developed for sensitive cortical lesion delineation. 13,15,16,18,29 While it has been reported that cortical lesions are more conspicuous on 3D double inversion recovery compared with 3D-FLAIR images, 13,17 the former is not yet widely available on clinical scanners. FLAIR hyperintensities might represent lesions, perivenular spaces, or CSFrelated flow artifacts.…”

“…6,8,10,12 While ultra-high-field MR imaging allowed depiction of subpial lesions, 18,19 previous MR imaging studies at field strengths Ͻ4T were similarly to our method unable to visualize them. [14][15][16][17]34 The multiplanar display of our isotropic resolution IR-SPGR images allowed precise anatomic lesion classification in relation to the gray matterϪwhite matter junction and cortical folding patterns. We believe this is a critical step in assigning lesions to their proper subtype.…”

“…We detected cortical lesions in 92.3% of patients, supporting the notion that focal cortical lesions are highly prevalent in MS. 6,11,[13][14][15][16]30 Cortical lesions occurred in all studied clinical subgroups, including 85.7% of patients with Early RR MS. These results are consistent with recent MR imaging studies that detected cortical lesions from the earliest clinical stages of MS, even in patients with clinically isolated syn- drome.…”

“…8,[10][11][12] Recently, novel MR imaging methods have been used to address these challenges, including novel pulse sequences, multichannel and high-resolution imaging, and ultra-high magnetic field strength. [13][14][15][16][17][18][19] None of these techniques have demonstrated broad clinical applicability or vendor dissemination as applied to routine 3T MS imaging. In vivo assess-ment of cortical lesions is of great significance because the pathologic processes that have taken place in the gray matter and their relationship to white matter pathology and gray matter atrophy and clinical outcomes will improve our understanding of MS pathogenesis.…”

MAGNIMS consensus guidelines on the use of MRI in multiple sclerosis—clinical implementation in the diagnostic process

“…DIR improves the sensitivity of MRI to detect cortical lesions in vivo, [62][63][64][65] although it has shown low interobserver concordance, particularly for the detection of pure intracortical lesions, thereby limiting its value in clinical practice. 63 Other sequences, such as phase-sensitive inversion recovery (PSIR) and highresolution 3D magnetization-prepared rapid acquisition with gradient echo (MPRAGE), improve intracortical lesion classification, 62,63,[67][68][69] especially at high magnetic field strengths.…”