Improved differentiation between MS and vascular brain lesions using FLAIR* at 7 Tesla

Kilsdonk, Iris D.; Wattjes, Mike P.; Lopez-Soriano, Alexandra; Kuijer, Joost P.A.; Jong, Marcus C. de; Graaf, Wolter L. de; Conijn, Mandy M.A.; Polman, Chris H.; Luijten, Peter R.; Geurts, Jeroen J. G.; Geerlings, Mirjam I.; Barkhof, Frederik

doi:10.1007/s00330-013-3080-y

Cited by 90 publications

(100 citation statements)

References 32 publications

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“…This perivenous configuration of MS lesions has been recently demonstrated using T2*‐weighted ultrahigh‐field 7T MRI,13, 15 and in studies that have included non‐MS populations, the quantification of CVs has predicted a diagnosis of MS 12, 14, 17, 27, 28, 29. Several studies reported detection of CVs in lesions of MS patients more frequently than other populations, including patients with Susac syndrome29 and neuromyelitis optica spectrum disorder,17 and controls with high risk for vascular disease 28. A number of studies have suggested that a finding of >40% of lesions with CVS may predict MS 12, 14.…”

Section: Discussionmentioning

confidence: 83%

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“Central vessel sign” on 3T FLAIR* MRI for the differentiation of multiple sclerosis from migraine

Solomon

Schindler

Howard³

et al. 2015

Ann Clin Transl Neurol

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ObjectiveThe diagnosis of multiple sclerosis (MS) presently relies on radiographic assessments of imperfect specificity. Recent data using T2* methodology for the detection of the “central vessel sign” (CVS) in MS lesions suggests this novel MRI technique may distinguish MS from other disorders. Our aim was to determine if evaluation for CVS on 3T FLAIR* MRI differentiates MS from migraine.MethodsPatients with MS or migraine and a prior brain MRI demonstrating at least two hyperintense lesions ≥3 mm were recruited. Exclusion criteria included any additional comorbidity known to cause brain MRI abnormalities. 3T MRI was performed in each participant with administration of gadopentetate dimeglumine, and FLAIR* images were generated in postprocessing. The total number of discrete ovoid lesions ≥3 mm were counted on FLAIR, per participant, and subsequently evaluated for presence of CVS on FLAIR*. An exploratory method evaluating for CVS in a maximum of 12 lesions per subject was also completed.ResultsTen participants with MS and 10 with migraine completed the study. The median percentage (quartiles) of lesions in MS participants with CVS was 84 (79, 94) compared to 22 (15, 54) in migraine (P = 0.008). In a subanalysis by brain region, in the subcortical and deep white matter, the median percentage (quartiles) of lesions in MS participants with CVS was 88 (81, 100) compared to 19 (11, 54) in migraine (P = 0.004). This difference was not identified in juxtacortical, periventricular, or infratentorial regions.InterpretationIdentification of CVS using FLAIR* on 3T MRI helps differentiate MS from migraine, particularly in the subcortical and deep white matter.

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Section: Discussionmentioning

confidence: 83%

“…A number of studies have suggested that a finding of >40% of lesions with CVS may predict MS 12, 14. Several of these studies have also suggested that MS cohorts had more CVs in lesions specifically located in the “subcortical” and “deep” locations compared to other regions 14, 27, 28…”

Section: Discussionmentioning

confidence: 99%

“Central vessel sign” on 3T FLAIR* MRI for the differentiation of multiple sclerosis from migraine

Solomon

Schindler

Howard³

et al. 2015

Ann Clin Transl Neurol

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“…Another approach, first tested by Kilsdonk et al, combines the number and location of lesions with the percentage of lesions with a central vein 16 . In a cohort of 16 patients with MS and 16 individuals with risk factors for vascular disease, the authors reported that MS could be diagnosed with a sensitivity of 100% (95% CI 83-100%) and a specificity of 88% (95% CI 62-98%) when all lesions in the brain were considered.…”

Section: Statements and Recommendationsmentioning

confidence: 99%

“…The other approach, proposed by Sati et al 34 and known as FLAIR*, uses 1 mm isotropic 3D FLAIR (for lesion detection) and 0.55 mm isotropic 3D EPI (for vein detection) sequences -both acquired in <10 min -and provides high-resolution isotropic images of the whole brain. Recent studies reported on the utility of FLAIR* at various field strengths for differentiating MS from other diseases 16,20,64 , and for improving diagnostic accuracy 31,44,48 . T2*-based imaging of the spinal cord is much more challenging, owing to factors such as the small physical dimensions of the spinal cord, strong magnetic field inhomogeneity caused by surrounding tissues (bones, soft tissues and air), and physiological motion (pulsation of cerebrospinal fluid flow, and cardiac and respiratory movement).…”

Section: O N S E N S U S S Tat E M E N Tmentioning

confidence: 99%

“…The 'central vein sign' (CVS) has been investigated in various neurological conditions by several groups, and evidence has accumulated that the CVS may have the ability to accurately differentiate MS from its mimics [15][16][17][18][19][20][21] . As a consequence, recent guidelines from the Magnetic Resonance Imaging in MS (MAGNIMS) group 1,4 and the Consortium of MS Centers (CMSC) task force 22 have acknowledged the potential of the CVS and its dedicated MRI acquisitions for the differential diagnosis of MS, while calling for further research before considering a possible modification of the diagnostic criteria.…”

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confidence: 99%

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The central vein sign and its clinical evaluation for the diagnosis of multiple sclerosis: a consensus statement from the North American Imaging in Multiple Sclerosis Cooperative

et al. 2016

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At present, the diagnosis of multiple sclerosis (MS) relies heavily on the use of MRI, which can demonstrate disease dissemination in space and time [1][2][3][4] . The current 2010 McDonald criteria have enabled earlier diagnosis 5,6 and initiation of disease-modifying treatment, with substantial benefits for disease outcome 7,8 , but they still have imperfect sensitivity and specificity 9,10 . The limited accuracy of the criteria results in challenging cases and misdiagnosis, which are prevalent problems in MS 11,12 . Therefore, more-accurate and pathologically specific MRI criteria are still needed to exclude other disorders that can mimic MS 13,14 .The MRI-detectable central vein inside white matter lesions has recently been proposed as a biomarker of inflammatory demyelination and, thus, may aid the diagnosis of MS 15 . The 'central vein sign' (CVS) has been investigated in various neurological conditions by several groups, and evidence has accumulated that the CVS may have the ability to accurately differentiate MS from its mimics [15][16][17][18][19][20][21] . As a consequence, recent guidelines from the Magnetic Resonance Imaging in MS (MAGNIMS) group 1,4 and the Consortium of MS Centers (CMSC) task force 22 have acknowledged the potential of the CVS and its dedicated MRI acquisitions for the differential diagnosis of MS, while calling for further research before considering a possible modification of the diagnostic criteria. However, the lack of standardization for the definition and imaging of the CVS, as well as a dearth of large-scale prospective studies evaluating the CVS for MS diagnosis, are currently preventing the clinical validation of this potential biomarker 1,23 .This Consensus Statement aims to provide recommendations for the definition, standardization and clinical evaluation of the CVS in the diagnosis of MS. These statements are based on a thorough review of the existing literature on the CVS and the consensus opinion of the members of the North American Imaging in Multiple Sclerosis (NAIMS) Cooperative. E X P E RT C O N S E N S U S D O C U M E N T on behalf of the NAIMS CooperativeAbstract | Over the past few years, MRI has become an indispensable tool for diagnosing multiple sclerosis (MS). However, the current MRI criteria for MS diagnosis have imperfect sensitivity and specificity. The central vein sign (CVS) has recently been proposed as a novel MRI biomarker to improve the accuracy and speed of MS diagnosis. Evidence indicates that the presence of the CVS in individual lesions can accurately differentiate MS from other diseases that mimic this condition. However, the predictive value of the CVS for the development of clinical MS in patients with suspected demyelinating disease is still unknown. Moreover, the lack of standardization for the definition and imaging of the CVS currently limits its clinical implementation and validation. On the basis of a thorough review of the existing literature on the CVS and the consensus opinion of the members of the North American Imaging in Mult...

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Robust nonadiabatic T₂ preparation using universal parallel‐transmit k_T‐point pulses for 3D FLAIR imaging at 7 T

Gras

Pracht

Mauconduit

et al. 2019

Magnetic Resonance in Med

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Purpose The fluid attenuated inversion recovery sequence is a pillar technique to detect brain lesions in MRI. At ultrahigh field, the lengthening of T1 often advocates a T2‐weighting preparation module to regain signal and contrast between tissues, which can be affected by transmit RF field inhomogeneity. In this note, we report an extension of a previous fluid attenuated inversion recovery study that now incorporates the T2 preparation with parallel transmission calibration‐free universal pulses to mitigate the problem. Methods The preparation consisted of a 90°‐τ‐180°‐τ‐90° module to implement an effective inversion in the CSF and a saturation in the brain tissues. Care was taken for the pulses to have the desired phase relationship in every voxel by appropriate pulse design. The RF pulse design made use of the kT‐point parametrization and was based on a database of 20 B1+ and ΔB0 maps previously acquired on different subjects at 7 T. Simulations and experiments on 5 volunteers, not contained in the database, were performed for validation. Results Simulations reported very good inversion efficiency for the preparation module with 8% variation, with respectively 4 and 6 times less power and specific absorption rate than for the adiabatic version. Experiments revealed fluid attenuated inversion recovery images free of B1+ artifacts. Conclusion This work contributes further to the panel of 3D sequences validated and now available with universal pulses at 7 T. The drop in power and specific absorption rate demand compared with adiabatic pulses in the T2 preparation leads to more freedom for the design of the readout train.

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Improved differentiation between MS and vascular brain lesions using FLAIR* at 7 Tesla

Cited by 90 publications

References 32 publications

“Central vessel sign” on 3T FLAIR* MRI for the differentiation of multiple sclerosis from migraine

“Central vessel sign” on 3T FLAIR* MRI for the differentiation of multiple sclerosis from migraine

The central vein sign and its clinical evaluation for the diagnosis of multiple sclerosis: a consensus statement from the North American Imaging in Multiple Sclerosis Cooperative

Robust nonadiabatic T₂ preparation using universal parallel‐transmit k_T‐point pulses for 3D FLAIR imaging at 7 T

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Improved differentiation between MS and vascular brain lesions using FLAIR* at 7 Tesla

Cited by 90 publications

References 32 publications

“Central vessel sign” on 3T FLAIR* MRI for the differentiation of multiple sclerosis from migraine

“Central vessel sign” on 3T FLAIR* MRI for the differentiation of multiple sclerosis from migraine

The central vein sign and its clinical evaluation for the diagnosis of multiple sclerosis: a consensus statement from the North American Imaging in Multiple Sclerosis Cooperative

Robust nonadiabatic T2 preparation using universal parallel‐transmit kT‐point pulses for 3D FLAIR imaging at 7 T

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Robust nonadiabatic T₂ preparation using universal parallel‐transmit k_T‐point pulses for 3D FLAIR imaging at 7 T