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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]
Copyright of European Radiology is the property of Springer Nature and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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  Data: FLAIR* to visualize veins in white matter lesions: A new tool for the diagnosis of multiple sclerosis?
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  Data: <searchLink fieldCode="AR" term="%22Campion%2C+T%2E%22">Campion, T.</searchLink><i> thomascampion@nhs.net</i><br /><searchLink fieldCode="AR" term="%22Smith%2C+R%2E%22">Smith, R.</searchLink><br /><searchLink fieldCode="AR" term="%22Altmann%2C+D%2E%22">Altmann, D.</searchLink><relatesTo>1</relatesTo><br /><searchLink fieldCode="AR" term="%22Brito%2C+G%2E%22">Brito, G.</searchLink><relatesTo>2</relatesTo><br /><searchLink fieldCode="AR" term="%22Turner%2C+B%2E%22">Turner, B.</searchLink><br /><searchLink fieldCode="AR" term="%22Evanson%2C+J%2E%22">Evanson, J.</searchLink><relatesTo>3</relatesTo><br /><searchLink fieldCode="AR" term="%22George%2C+I%2E%22">George, I.</searchLink><br /><searchLink fieldCode="AR" term="%22Sati%2C+P%2E%22">Sati, P.</searchLink><relatesTo>4</relatesTo><br /><searchLink fieldCode="AR" term="%22Reich%2C+D%2E%22">Reich, D.</searchLink><relatesTo>4</relatesTo><br /><searchLink fieldCode="AR" term="%22Miquel%2C+M%2E%22">Miquel, M.</searchLink><br /><searchLink fieldCode="AR" term="%22Schmierer%2C+K%2E%22">Schmierer, K.</searchLink><br /><searchLink fieldCode="AR" term="%22Smith%2C+R+J+P%22">Smith, R J P</searchLink><relatesTo>5,6</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Altmann%2C+D+R%22">Altmann, D R</searchLink><relatesTo>7</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Brito%2C+G+C%22">Brito, G C</searchLink><relatesTo>5</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Turner%2C+B+P%22">Turner, B P</searchLink><relatesTo>5,8</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22George%2C+I+C%22">George, I C</searchLink><relatesTo>9,10</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Reich%2C+D+S%22">Reich, D S</searchLink><relatesTo>9</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Miquel%2C+M+E%22">Miquel, M E</searchLink><relatesTo>8,11</relatesTo> (AUTHOR)
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  Data: <searchLink fieldCode="JN" term="%22European+Radiology%22">European Radiology</searchLink>. Oct2017, Vol. 27 Issue 10, p4257-4263. 7p.
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  Data: <searchLink fieldCode="DE" term="%22Multiple+sclerosis+diagnosis%22">Multiple sclerosis diagnosis</searchLink><br /><searchLink fieldCode="DE" term="%22Cerebral+small+vessel+diseases%22">Cerebral small vessel diseases</searchLink><br /><searchLink fieldCode="DE" term="%22Thrombotic+thrombocytopenic+purpura%22">Thrombotic thrombocytopenic purpura</searchLink><br /><searchLink fieldCode="DE" term="%22Magnetic+resonance+imaging%22">Magnetic resonance imaging</searchLink><br /><searchLink fieldCode="DE" term="%22Veins%22">Veins</searchLink>
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: <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]
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  Data: <i>Copyright of European Radiology is the property of Springer Nature and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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