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, M. L.; O'Riordan, J I; Coles, Alasdair; Newell, B; Thompson, Alan J.; Miller, David H.

doi:10.1136/jnnp.64.2.197

Cited by 51 publications

(38 citation statements)

References 32 publications

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“…This is consistent with the results of previous studies of untreated cohorts. 18,19 In the placebo-treated group, median TLV increased significantly year after year. The overall percentage increases from baseline (1.6%, 2.4%, and 10%, at 1, 2, and 3 years, respectively) are somewhat lower than those reported in previous relapsing-remitting placebo cohorts (ϳ5-10% per annum); this largely reflects the much higher baseline TLV in the secondary progressive cohort, and the absolute increase in TLV is similar to that found in early relapsing-remitting cohorts.…”

Section: Discussionmentioning

confidence: 99%

Effect of interferon-?1b on magnetic resonance imaging outcomes in secondary progressive multiple sclerosis: Results of a European multicenter, randomized, double-blind, placebo-controlled trial

Miller¹,

Molyneux²,

Barker³

et al. 1999

Ann Neurol.

147

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A randomized placebo‐controlled trial of interferon‐β1b was performed on 718 patients with secondary progressive multiple sclerosis with follow‐up of up to 3 years. In addition to clinical variables, serial magnetic resonance imaging (MRI) studies were performed to determine the effect of treatment on the pathological evolution of the disease. All patients eligible for MRI had annual proton density/T2‐weighted brain scans from which total lesion volume was measured and the number of new and enlarging lesions noted. A subgroup of 125 patients also underwent monthly gadolinium‐enhanced and proton density/T2‐weighted brain MRI from months 0 to 6 and 18 to 24 to determine the effect of treatment on the frequency of new lesion activity, defined as new enhancing lesions and new/enlarging T2 lesions not enhancing with gadolinium. The difference in total lesion volume between treatment groups was highly significant. In the placebo group, there was an increase of 15% from baseline to last scan, whereas in the interferon‐β1b group, a reduction of 2% was seen. Within the placebo group, there was a significant year‐on‐year increase in total lesion volume, with a mean increase of 16% at year 3 compared with baseline. In the treated group, there was a significant reduction at year 1 (4%) and year 2 (5%) compared with baseline; the 2% decrease at year 3 was not significant. The number of new or enlarging proton density/T2 lesions was also significantly reduced by treatment. In the frequent MRI subgroup, treatment was associated with a significant 65% reduction in new lesion activity between months 1 and 6, and 78% reduction from months 19 to 24. Interferon‐β1b has a substantial and sustained effect on reducing the accumulation of new inflammatory disease foci in secondary progressive MS. This therapeutic mechanism may contribute to the positive clinical benefits of treatment on the progression of sustained neurological disability and relapse activity that were also identified in this trial.

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Section: Discussionmentioning

confidence: 99%

Effect of interferon-?1b on magnetic resonance imaging outcomes in secondary progressive multiple sclerosis: Results of a European multicenter, randomized, double-blind, placebo-controlled trial

Miller¹,

Molyneux²,

Barker³

et al. 1999

Ann Neurol.

147

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“…To increase the sensitivity of MRI in detecting active MS lesions and, as a consequence, the statistical power of such trials [25,30], the value of several unenhanced MRI techniques has been recently assessed [2,4,8,10,11,29,31]. Dual-echo fast spin echo imaging (FSE) [4,29,31] can detect as many new MS lesions as conventional spin echo imaging (CSE), with significantly shorter scanning times, whereas the use of monthly fast fluid-attenuated inversion recovery (FLAIR) scans [10,11,31] can detect about 10% more new lesions than CSE [8].…”

Section: Introductionmentioning

confidence: 99%

Multiple sclerosis: interobserver agreement in reporting active lesions on serial brain MRI using conventional spin echo, fast spin echo, fast fluid-attenuated inversion recovery and post-contrast T1-weighted images

Rovaris

Barkhof

Bastianello

et al. 1999

Journal of Neurology

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Previous studies have addressed the question of the precision in assessing multiple sclerosis (MS) activity by counting enhancing lesions on gadolinium enhanced brain magnetic resonance imaging (MRI). However, counting the active lesions on serial unenhanced MRI obtained by various pulse sequences has not been yet considered. We compared the interobserver levels of agreement in reporting active MS lesions on serial enhanced and unenhanced MRI to assess whether the use of various unenhanced techniques may change the degree of interobserver measurement reproducibility. Dual-echo conventional spin echo (CSE), dual-echo fast spin echo (FSE), fast fluid-attenuated inversion recovery (FLAIR) and Gd-enhanced T1-weighted brain MRI were obtained from five MS patients at baseline and monthly for 2 months. Six experienced observers independently identified and counted active MS lesions on the two follow-up MRI scans. Active lesions were considered to be all the enhancing lesions and any new or enlarging lesion on enhanced and unenhanced scans. Interobserver levels of agreement were calculated by weighted kappa values. Very good agreement was reached only for counting total and new Gd-enhancing lesions. Good agreement was achieved for counting new lesions on the three unenhanced techniques, whereas the agreement for counting enlarging lesions was poor with all the MRI techniques. The level of agreement was significantly heterogeneous for various MRI techniques but not for various lesion sites. These results confirm that counting enhancing lesions is the most reliable method for assessing MS activity, but the use of any of the available unenhanced MRI techniques did not result in different levels of interobserver agreement when reporting new and enlarging MS lesions on serial scans.

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“…A cross-sectional study comparing fast FLAIR and T2-weighted images showed similar, modest correlations between lesion load and EDSS (Gawne-Cain et al 1998), with somewhat better correlations in RR than progressive forms of MS. Overall, current evidence in established MS indicates that the total extent of brain lesions correlates only modestly with locomotor disability.…”

Section: (I) Clinical Scalesmentioning

confidence: 94%

Nuclear magnetic resonance monitoring of treatment and prediction of outcome in multiple sclerosis

Miller

Thompson

1999

Phil. Trans. R. Soc. Lond. B

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Magnetic resonance (MR) techniques provide an objective, sensitive and quantitative assessment of the evolving pathology in multiple sclerosis. There is an increasing de¢nition of the pathological speci¢city of newer techniques, and more robust correlations with clinical evolution are emerging. As the pathophysiological basis of in vivo nuclear MR signal abnormalities is further elucidated, it is likely that the importance of MR as a tool to monitor new therapies will increase.

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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

Cited by 51 publications

References 32 publications

Effect of interferon-?1b on magnetic resonance imaging outcomes in secondary progressive multiple sclerosis: Results of a European multicenter, randomized, double-blind, placebo-controlled trial

Effect of interferon-?1b on magnetic resonance imaging outcomes in secondary progressive multiple sclerosis: Results of a European multicenter, randomized, double-blind, placebo-controlled trial

Multiple sclerosis: interobserver agreement in reporting active lesions on serial brain MRI using conventional spin echo, fast spin echo, fast fluid-attenuated inversion recovery and post-contrast T1-weighted images

Nuclear magnetic resonance monitoring of treatment and prediction of outcome in multiple sclerosis

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