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FLAIR* to visualize veins in white matter lesions: A new tool for the diagnosis of multiple sclerosis?

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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. thomascampion@nhs.net, Smith, R., Altmann, D.1, Brito, G.2, Turner, B., Evanson, J.3, George, I., Sati, P.4, Reich, D.4, Miquel, M., Schmierer, K., Smith, R J P5,6 (AUTHOR), Altmann, D R7 (AUTHOR), Brito, G C5 (AUTHOR), Turner, B P5,8 (AUTHOR), George, I C9,10 (AUTHOR), Reich, D S9 (AUTHOR), Miquel, M E8,11 (AUTHOR)
Source: European Radiology. Oct2017, Vol. 27 Issue 10, p4257-4263. 7p.
Subjects: Multiple sclerosis diagnosis, Cerebral small vessel diseases, Thrombotic thrombocytopenic purpura, Magnetic resonance imaging, Veins
Abstract: Objective: 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.Methods: 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.Results: 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.Conclusion: FLAIR* enables VIL+ WML detection in a clinical setting, facilitating differentiation of MS from SVD based on brain MRI.Key Points: • 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. [ABSTRACT FROM AUTHOR]
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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. [ABSTRACT FROM AUTHOR]
ISSN:09387994
DOI:10.1007/s00330-017-4822-z