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- Title
FLAIR* to visualize veins in white matter lesions: A new tool for the diagnosis of multiple sclerosis?
- Authors
Campion, T.; Smith, R.; Altmann, D.; Brito, G.; Turner, B.; Evanson, J.; George, I.; Sati, P.; Reich, D.; Miquel, M.; Schmierer, K.; Smith, R J P; Altmann, D R; Brito, G C; Turner, B P; George, I C; Reich, D S; Miquel, M E
- Abstract
<bold>Objective: </bold>To explore the potential of a post-processing technique combining FLAIR and T2* (FLAIR*) to distinguish between lesions caused by multiple sclerosis (MS) from cerebral small vessel disease (SVD) in a clinical setting.<bold>Methods: </bold>FLAIR and T2* head datasets acquired at 3T of 25 people with relapsing MS (pwRMS) and ten with pwSVD were used. After post-processing, FLAIR* maps were used to determine the proportion of white matter lesions (WML) showing the 'vein in lesion' sign (VIL), a characteristic histopathological feature of MS plaques. Sensitivity and specificity of MS diagnosis were examined on the basis of >45% VIL+ and >60% VIL+ WML, and compared with current dissemination in space (DIS) MRI criteria.<bold>Results: </bold>All pwRMS had >45% VIL+ WML (range 58-100%) whilst in pwSVD the proportion of VIL+ WML was significantly lower (0-64%; mean 32±20%). Sensitivity based on >45% VIL+ was 100% and specificity 80% whilst with >60% VIL+ as the criterion, sensitivity was 96% and specificity 90%. DIS criteria had 96% sensitivity and 40% specificity.<bold>Conclusion: </bold>FLAIR* enables VIL+ WML detection in a clinical setting, facilitating differentiation of MS from SVD based on brain MRI.<bold>Key Points: </bold>• FLAIR* in a clinical setting allows visualization of veins in white matter lesions. • Significant proportions of MS lesions demonstrate a vein in lesion on MRI. • Microangiopathic lesions demonstrate a lower proportion of intralesional veins than MS lesions. • Intralesional vein-based criteria may complement current MRI criteria for MS diagnosis.
- Subjects
MULTIPLE sclerosis diagnosis; CEREBRAL small vessel diseases; THROMBOTIC thrombocytopenic purpura; MAGNETIC resonance imaging; VEINS
- Publication
European Radiology, 2017, Vol 27, Issue 10, p4257
- ISSN
0938-7994
- Publication type
journal article
- DOI
10.1007/s00330-017-4822-z