Morphology-Specific Discrimination between MS White Matter Lesions and Benign White Matter Hyperintensities Using Ultra-High-Field MRI

Hosseini, Zahra; Matusinec, J.; Rudko, David A.; Liu, J.; Kwan, Benjamin Y. M.; Salehi, Fateme; Sharma, Manas; Kremenchutzky, Marcelo; Menon, Ravi S.; Drangova, Maria

doi:10.3174/ajnr.a5705

Cited by 21 publications

(34 citation statements)

References 34 publications

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“…A higher diagnostic performance may be achieved by combining APTw histogram parameters with other metrics and MRI technologies (especially MR sequences) that may facilitate differentiation of MSL and WMH. Specifically preclinical studies have shown that morphological features of lesions as T2 * /FLAIR characteristics may be useful for differentiation of lesions (3)(4)(5) and thus may offer additional value when combined with APTw histogram parameters. Lastly, more advanced analysis of the APT CEST signal may also be helpful for further differentiation of MSL and WMH.…”

Section: Discussionmentioning

confidence: 99%

“…Differentiation between age related white matter hyperintensities of presumed vascular origin (WMH) in patients with small vessel disease (SVD) (1,2) and demyelinating white matter lesions in patients with multiple sclerosis (MS) called multiple sclerosis lesions (MSL) can be difficult. MSL and WMH may have similar lesion morphology on MRI and may coexist in individual patients (3)(4)(5). Conventional magnetic resonance imaging (MRI) techniques such as T2 weighted (T2w) turbo/fast spine echo (TSE/FSE) images, proton density weighted (PDw) images, fluid attenuated inversion recovery (FLAIR) and double inversion recovery (DIR) images are highly sensitive to both WMH and MSL but do not provide evidence of the underlying etiology (3,4,6) because all these lesions are of similar morphological appearance on T2w MR images (1,4,5).…”

Section: Introductionmentioning

confidence: 99%

“…MSL and WMH may have similar lesion morphology on MRI and may coexist in individual patients (3)(4)(5). Conventional magnetic resonance imaging (MRI) techniques such as T2 weighted (T2w) turbo/fast spine echo (TSE/FSE) images, proton density weighted (PDw) images, fluid attenuated inversion recovery (FLAIR) and double inversion recovery (DIR) images are highly sensitive to both WMH and MSL but do not provide evidence of the underlying etiology (3,4,6) because all these lesions are of similar morphological appearance on T2w MR images (1,4,5). Moreover, conventional MR imaging sequences do not provide any information on the histologically heterogeneous manifestation of MSL (7,8) or WMH (2,(9)(10)(11)(12).…”

Section: Introductionmentioning

confidence: 99%

“…As the diagnosis of MS is based on the number and location of white matter lesions that disseminate in space and time within the central nervous system (4,6), WMH mimicking MSL can complicate the clinical diagnosis of MS (4). Thus, reliable imaging biomarkers that allow for a precise discrimination between these two entities are of great clinical interest (3)(4)(5).…”

Section: Introductionmentioning

confidence: 99%

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Amide Proton Transfer Weighted Imaging Shows Differences in Multiple Sclerosis Lesions and White Matter Hyperintensities of Presumed Vascular Origin

Sartoretti

Wyss

et al. 2019

Front. Neurol.

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Objectives: To assess the ability of 3D amide proton transfer weighted (APTw) imaging based on magnetization transfer analysis to discriminate between multiple sclerosis lesions (MSL) and white matter hyperintensities of presumed vascular origin (WMH) and to compare APTw signal intensity of healthy white matter (healthy WM) with APTw signal intensity of MSL and WHM. Materials and Methods: A total of 27 patients (16 female, 11 males, mean age 39.6 years) with multiple sclerosis, 35 patients (17 females, 18 males, mean age 66.6 years) with small vessel disease (SVD) and 20 healthy young volunteers (9 females, 11 males, mean age 29 years) were included in the MSL, the WMH, and the healthy WM group. MSL and WMH were segmented on fluid attenuated inversion recovery (FLAIR) images underlaid onto APTw images. Histogram parameters (mean, median, 10th, 25th, 75th, 90th percentile) were calculated. Mean APTw signal intensity values in healthy WM were defined by "Region of interest" (ROI) measurements. Wilcoxon rank sum tests and receiver operating characteristics (ROC) curve analyses of clustered data were applied. Results: All histogram parameters except the 75 and 90th percentile were significantly different between MSL and WMH (p = 0.018-p = 0.034). MSL presented with higher median values in all parameters. The histogram parameters offered only low diagnostic performance in discriminating between MSL and WMH. The 10th percentile yielded the highest diagnostic performance with an AUC of 0.6245 (95% CI: [0.532, 0.717]). Mean APTw signal intensity values of MSL were significantly higher than mean values of healthy WM (p = 0.005). The mean values of WMH did not differ significantly from the values of healthy WM (p = 0.345). Sartoretti et al. APTw of White Matter Lesions Conclusions: We found significant differences in APTw signal intensity, based on straightforward magnetization transfer analysis, between MSL and WMH and between MSL and healthy WM. Low AUC values from ROC analyses, however, suggest that it may be challenging to determine type of lesion with APTw imaging. More advanced analysis of the APT CEST signal may be helpful for further differentiation of MSL and WMH.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Amide Proton Transfer Weighted Imaging Shows Differences in Multiple Sclerosis Lesions and White Matter Hyperintensities of Presumed Vascular Origin

Sartoretti

Wyss

et al. 2019

Front. Neurol.

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“…The North American Imaging in MS (NAIMS) Cooperative has recently provided a consensus document which illustrates guidelines for CVS assessment [25]. Validation of the NAIMS criteria has been recently performed in a real-world setting, showing that nonconfluent lesions greater than 3 mm with at least one central vein were the most sensitive and specific differentiators between patients with MS and control subjects [27]. Recently, an international, multicentre crosssectional 3-T MRI study within the MAGNIMS Study Group [8] was conducted with the aim to investigate the sensitivity and specificity of various CVS-based criteria in differentiating MS from MS mimickers.…”

Section: The Central Vein Signmentioning

confidence: 99%

Ultra-high-field 7-T MRI in multiple sclerosis and other demyelinating diseases: from pathology to clinical practice

2020

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Magnetic resonance imaging (MRI) is essential for the early diagnosis of multiple sclerosis (MS), for investigating the disease pathophysiology, and for discriminating MS from other neurological diseases. Ultra-high-field strength (7-T) MRI provides a new tool for studying MS and other demyelinating diseases both in research and in clinical settings. We present an overview of 7-T MRI application in MS focusing on increased sensitivity and specificity for lesion detection and characterisation in the brain and spinal cord, central vein sign identification, and leptomeningeal enhancement detection. We also discuss the role of 7-T MRI in improving our understanding of MS pathophysiology with the aid of metabolic imaging. In addition, we present 7-T MRI applications in other demyelinating diseases. 7-T MRI allows better detection of the anatomical, pathological, and functional features of MS, thus improving our understanding of MS pathology in vivo. 7-T MRI also represents a potential tool for earlier and more accurate diagnosis.

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Emerging imaging markers in radiologically isolated syndrome: implications for earlier treatment initiation

Moura,

Granziera,

Marta

et al. 2024

Neurol Sci

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Morphology-Specific Discrimination between MS White Matter Lesions and Benign White Matter Hyperintensities Using Ultra-High-Field MRI

Cited by 21 publications

References 34 publications

Amide Proton Transfer Weighted Imaging Shows Differences in Multiple Sclerosis Lesions and White Matter Hyperintensities of Presumed Vascular Origin

Amide Proton Transfer Weighted Imaging Shows Differences in Multiple Sclerosis Lesions and White Matter Hyperintensities of Presumed Vascular Origin

Ultra-high-field 7-T MRI in multiple sclerosis and other demyelinating diseases: from pathology to clinical practice

Emerging imaging markers in radiologically isolated syndrome: implications for earlier treatment initiation

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