A comparison of conventional and fast spin-echo sequences for the measurement of lesion load in multiple sclerosis using a semi-automated contour technique

Abstract

Changes on serial assessments of brain MRI lesion load are used for monitoring therapeutic efficacy in patients with multiple sclerosis (MS). We assessed the accuracy and reliability of conventional spin-echo (CSE) and fast spin-echo (FSE) sequences for measurement of lesion volume using a semiautomated contour technique. Cranial CSE and FSE examinations of 18 patients with secondary progressive MS were studied. The mean lesion load was slightly higher with the CSE sequence (p = 0.002). Intraobserver variability was significantly higher for FSE than for CSE, according to both the coefficient of variation between two measurements (mean 2.48% and 1.35% respectively, p < 0.05) and back-transformed 95% limits of agreement (1.005-1.060 for FSE; 0.988-1.019 for CSE). Although FSE sequences are quicker and the total lesion volume measurements are similar to those obtained with CSE, the poorer reproducibility raises doubts about the use of FSE to replace CSE in clinical trials.

Reproducibility of Brain MRI Lesion Volume Measurements in Multiple Sclerosis Using a Local Thresholding Technique: Effects of Formal Operator Training

“…The intra-observer COVs obtained in the present study were within the range of values previously reported [3, 4, 10, 16, 17]and we demonstrated that the performance of naive operators can be significantly improved for both enhanced and unenhanced T1-weighted MRI by a relatively short-term and cost-effective training. The lack of a significant training effect for PD-weighted images seems to be due to the good reproducibility obtained by one of the raters in the pretraining measurement sessions (COV 1.3%), whose value slightly worsened (2.0%) after the training.…”

“…Given the relatively small size of long-term LL changes, the effect of other factors influencing the reproducibility of serial measurements should be reduced as much as possible. Several previous studies evaluated the effects due to the use of multiple scanners [13], the quality of patient’s head repositioning within the scanner [14, 15]and the image acquisition schemes [16, 17, 18], and suggested several strategies to reduce them.…”

“…Nowadays, there is general consensus that semiautomated techniques, which take advantage from the human capability of lesion identification coupled with the automated detection of lesion edges, are the best approach in the context of large multicenter studies, like clinical trials [7]; the use of these techniques enables an intra- and inter-observer measurement variation of about 3 and 5% to be achieved [3, 4, 16, 17, 18]. It has already been demonstrated [8]that a specific training of radiologists performing a preliminary lesion identification significantly reduces the computer-assisted LL measurement variability.…”

Predictors of Brain Morphology for the Men of the NHLBI Twin Study

“…Although fast spin-echo imaging was originally felt to be of equal sensitivity to conventional echo with improved imaging speed, quantitation of WMHI from fast spin-echo imaging has been recently shown to be less reliable. 33 Repeat WMHI determination from these images was therefore performed using operator guided tracing. This method has been previously shown to be reliable and correlates well with WMHI quantification by the mathematical method described above.…”

The contribution of fast-FLAIR MRI for lesion detection in the brain of patients with systemic autoimmune diseases

“…TSE sequences provide the same image quality as conventional spin echo (CSE), but require significantly shorter acquisition times. Their sensitivity does not significantly differ from that of CSE in a variety of brain diseases, including cerebrovascular and white matter disorders [4,22,28].Abstract Fast fluid-attenuated inversion recovery (fFLAIR) is more sensitive that conventional or fast spin echo T2-weighted magnetic resonance imaging (MRI) for detecting lesions in the brain of patients with ischemic, inflammatory, or demyelinating diseases of the CNS. We investigated whether the use of fFLAIR also increases the sensitivity of brain MRI assessment in patients with systemic autoimmune disorders.…”