Disappearance of multiple sclerosis lesions with severely prolonged T1 on images obtained by a flair pulse sequence

Waesberghe, J.H.T.M. van; Castelijns, Jonas A.; Weerts, Jan G.E.; àNijeholt, Geert J. Lycklama; Hillegers, Joop P.M.; Polman, Chris H.; Barkhof, Frederik

doi:10.1016/0730-725x(95)02053-v

Cited by 11 publications

(3 citation statements)

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“…It is not surprising, therefore, that in the current study, the volume of posterior fossa lesions is greater in CSE and the volume of subcortical lesions is greater in fFLAIR (table 4). It has been reported that heavily T1 weighted lesions in the periventricular regions may disappear on FLAIR images36 and in this context it is notable that we found no significant difference in periventricular lesion volumes. This may be because such high T1 lesions are embedded in high signal areas on fFLAIR images and are therefore measured.…”

Section: Discussionsupporting

confidence: 61%

MRI lesion volume measurement in multiple sclerosis and its correlation with disability: a comparison of fast fluid attenuated inversion recovery (fFLAIR) and spin echo sequences

Gawne-Cain

O'Riordan

Coles

et al. 1998

Journal of Neurology, Neurosurgery & Psychiatry

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Objectives-To assess whether multiple sclerosis lesion volume measurements derived using the fast fluid attenuated inversion recovery (fFLAIR) sequence show better reproducibility or correlation with disability than those derived using the conventional spin echo (CSE) sequence. Methods-Part I: twenty five patients with multiple sclerosis were scanned with CSE, fast spin echo (FSE), and fFLAIR. Lesion volume was determined twice for each sequence using a local threshold segmentation technique. Part II: fifty six patients with multiple sclerosis were scanned with CSE and fFLAIR. Total and regional brain lesion volumes were compared with the Kurtzke extended disability scale (EDSS) and functional systems scores (FSS). Results-Part I: analysis times were significantly longer for CSE than for FSE or fFLAIR. There was no significant diVerence in the reproducibility of the three sequences. Part II: total lesion volumes were similar but posterior fossa lesion volumes were significantly greater for CSE and subcortical lesion volumes significantly greater for fFLAIR. There was a significant correlation between total volume and EDSS with both sequences (CSE r=0.49; fFLAIR r=0.44). Correlations for the two sequences showed minor diVerences when anatomical region and FSS were considered separately. Conclusions-CSE, FSE, and fFLAIR are equally reproducible; FSE yields lower volumes than CSE; fFLAIR gives similar volumes to CSE but underscores the posterior fossa. Overall clinical correlations are similar for CSE and fFLAIR. (J Neurol Neurosurg Psychiatry 1998;64:197-203) Keywords: multiple sclerosis; magnetic resonance imaging; FLAIR; fast spin echo; conventional spin echo; lesion volume; disabilityIn recent years, measurement of the total lesion load or volume detectable lesions on MRI has become a widely used outcome measure for assessing the eYcacy of new therapies in multiple sclerosis.1-3 Ideally, the MR sequence used for measurement of multiple sclerosis lesion volume in a clinical trial should be practical to acquire, convenient to analyse, reproducible (poor reproducibility will obscure small changes in volume), and the change in measured lesion volume should be predictive of outcome.Currently the MR sequence most widely accepted for use in assessment of lesion volume in multiple sclerosis is a conventional moderately T2 weighted spin echo (CSE). Fast spin echo (FSE) gives similar images to CSE with shorter acquisition times but has been reported to give poorer reproducibility of lesion volume measurements. 4 The fast fluid attenuated inversion recovery sequence (fFLAIR) is sensitive to white matter pathology, 5-8 because the inversion pulse can be chosen to null the signal from CSF, and reduces the signal from grey matter allowing optimisation of lesion contrast with surrounding brain.9 Thus several groups have reported better lesion/brain contrast 7 10 and greater lesion detection, 6 particularly in the subcortical regions, using FLAIR sequences but, to our knowledge, no work has been published concerning...

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Section: Discussionsupporting

confidence: 61%

MRI lesion volume measurement in multiple sclerosis and its correlation with disability: a comparison of fast fluid attenuated inversion recovery (fFLAIR) and spin echo sequences

Gawne-Cain

O'Riordan

Coles

et al. 1998

Journal of Neurology, Neurosurgery & Psychiatry

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“…The same may occur with multiple sclerosis lesions severely hypointense on T1-WI. 42 MRI-pathological correlation studies performed to determine the background of age-related subcortical gray and white matter hyperintensities on T2-WI found different types of pathology: infarctions, gliosis, myelin and axonal loss, breakdown of the ependymal lining, and enlarged perivascular spaces. 17,[43][44][45][46][47] Areas of myelin pallor can be hyperintense on T2-WI but isointense on T1-WI, 17,45 and it seems possible that differences in type of pathology can also influence detection on FLAIR.…”

Section: Discussionmentioning

confidence: 99%

Thalamic Lesions in Vascular Dementia

Bastos-Leite

Straaten

Scheltens

et al. 2004

Stroke

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Background and Purpose-The criteria of the National Institute of Neurological Disorders and Stroke (NINDS)-Association Internationale pour la Recherche et l'Enseignement en Neurosciences (AIREN) include thalamic lesions for the diagnosis of vascular dementia (VaD). Although studies concerning VaD and brain aging advocate the use of fluid-attenuated inversion recovery (FLAIR) or T2-weighted images (T2-WI) to detect ischemic lesions, none compared the sensitivity of these sequences to depict thalamic lesions. Methods-We performed a blinded review of T2-WI and FLAIR images in 73 patients fulfilling the radiological part of the NINDS-AIREN criteria (mean age, 71 years; range, 49 to 83 years). This sample was drawn from a large multicenter trial on VaD and was expected to have a high prevalence of thalamic lesions. In a side-by-side review, including T1-weighted images as well, lesions were classified according to presumed underlying pathology. Results-The total number of thalamic lesions was 214. Two hundred eight (97%) were detected on T2-WI, but only 117 (55%) were detected on FLAIR ( 2 ϭ5.1; PϽ0.05). Although the mean size of lesions detected on T2-WI and not on FLAIR (4.4 mm) was significantly lower than the mean size of lesions detected on both sequences (6.7 mm) (PϽ0.001), 5 of the 29 lesions Ͼ10 mm on T2-WI were not visible on FLAIR. FLAIR detected only 81 (51%) of the 158 probable ischemic lesions and 30 (60%) of the 50 probable microbleeds. Conclusions-FLAIR

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“…On the other hand, the FLAIR sequence, which provides T 2 ‐weighted images with attenuated cerebrospinal fluid (CSF) signals, has shown promising results due to its high contrast resolution and decrease in the number of artifacts close to CSF. Although the advantages of the FLAIR sequence over the T 2 ‐weighted sequence have been reported by several authors (1–7), some reports have indicated the disadvantages of the FLAIR sequence (8–10). Currently, the FLAIR sequence is generally used in combination with the T 2 ‐weighted sequence to provide additional information.…”

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confidence: 99%

FASCINATE: A pulse sequence for simultaneous acquisition of T₂‐weighted and fluid‐attenuated images

Takeo

Ishikawa

Okazaki

et al. 2003

Magnetic Resonance in Med

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A pulse sequence that enables simultaneous acquisition of T 2 -weighted and fluid-attenuated images is presented. This sequence is referred to as FASCINATE (Fluid-Attenuated Scan Combined with Interleaved Non-ATtEnuation). In this new technique, the inversion pulse of conventional fast fluid-attenuated inversion recovery (FLAIR) is replaced with a fast spin echo (FSE) acquisition that has an additional 180(y)-90(x) pulse train for driven inversion. By using appropriate scan parameters, the first part of the sequence provides T 2 -weighted images and the second part provides fluid-attenuated images, thus allowing simultaneous acquisition in a single scan time comparable to that of fast FLAIR. FASCINATE was compared with conventional scanning techniques using a normal volunteer and a patient. A signal simulation was also conducted. In the human study, both T 2 -weighted and fluid-attenuated images from FASCI-NATE showed the same image quality as conventional images, suggesting the potential for this technique to replace the combination of fast FLAIR and Key words: brain MRI; driven inversion; FLAIR; T 2 -weighted imagingBoth the T 2 -weighted sequence and fluid-attenuated inversion recovery (FLAIR) (1) sequence are widely used for brain MRI in most centers. The T 2 -weighted sequence has been established as indispensable due to its high sensitivity for most lesions. On the other hand, the FLAIR sequence, which provides T 2 -weighted images with attenuated cerebrospinal fluid (CSF) signals, has shown promising results due to its high contrast resolution and decrease in the number of artifacts close to CSF. Although the advantages of the FLAIR sequence over the T 2 -weighted sequence have been reported by several authors (1-7), some reports have indicated the disadvantages of the FLAIR sequence (8 -10). Currently, the FLAIR sequence is generally used in combination with the T 2 -weighted sequence to provide additional information. Although fastspin-echo (FSE) acquisition is used in current FLAIR techniques (fast FLAIR), the use of a long repetition time (TR) results in substantially longer scanning times.In this article, we introduce a novel pulse sequence that enables simultaneous acquisition of both T 2 -weighted and fluid-attenuated images. We refer to this sequence as FAS-CINATE (Fluid-Attenuated Scan Combined with Interleaved Non-ATtEnuation).In FASCINATE, the preparation of magnetization for fluid-attenuated images is based on the technique referred to as "driven inversion" in Ref. 11. The basic driven inversion technique consists of a 90(x)-180(y)-90(x) pulse combination, in which the remaining transverse magnetization is forced to invert at the point of the last 90(x) pulse. This approach is analogous to the driven equilibrium technique (12), which uses a 90(x)-180(y)-90(-x) pulse combination to force the remaining transverse magnetization to equilibrium. To the best of our knowledge, the driven inversion pulse was first used for MRI in Ref. 11. Recently, Wong et al. (13) reported the application of this ...

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Disappearance of multiple sclerosis lesions with severely prolonged T1 on images obtained by a flair pulse sequence

Cited by 11 publications

References 15 publications

MRI lesion volume measurement in multiple sclerosis and its correlation with disability: a comparison of fast fluid attenuated inversion recovery (fFLAIR) and spin echo sequences

MRI lesion volume measurement in multiple sclerosis and its correlation with disability: a comparison of fast fluid attenuated inversion recovery (fFLAIR) and spin echo sequences

Thalamic Lesions in Vascular Dementia

FASCINATE: A pulse sequence for simultaneous acquisition of T₂‐weighted and fluid‐attenuated images

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Disappearance of multiple sclerosis lesions with severely prolonged T1 on images obtained by a flair pulse sequence

Cited by 11 publications

References 15 publications

MRI lesion volume measurement in multiple sclerosis and its correlation with disability: a comparison of fast fluid attenuated inversion recovery (fFLAIR) and spin echo sequences

MRI lesion volume measurement in multiple sclerosis and its correlation with disability: a comparison of fast fluid attenuated inversion recovery (fFLAIR) and spin echo sequences

Thalamic Lesions in Vascular Dementia

FASCINATE: A pulse sequence for simultaneous acquisition of T2‐weighted and fluid‐attenuated images

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FASCINATE: A pulse sequence for simultaneous acquisition of T₂‐weighted and fluid‐attenuated images