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Quantitative Magnetic Resonance Imaging of Skeletal Muscle Disease
Published on: December 18, 2016
The sensitivity of thin-slice fast spin echo, fast FLAIR and gadolinium-enhanced T1-weighted MRI sequences in
N Tubridy1, P D Molyneux, I F Moseley
1NMR Unit, Institute of Neurology, London, UK.
Abstract:
Fast fluid-attenuated inversion-recovery (FLAIR) and proton density/T2-weighted fast spin echo (FSE) brain images with 3-mm slices were acquired monthly for 7 months in 37 multiple sclerosis patients. New and enlarging lesions were counted and compared according to the site of lesions seen with each sequence. In addition, the number of new enhancing lesions seen on gadolinium-enhanced T1-weighted brain magnetic resonance imaging at the same time points was counted. All sequences used 3-mm contiguous axial slices. Overall, 126 new or enlarging lesions were seen on FSE and 135 on fast FLAIR (P = 0.25, Wilcoxon signed ranks test). Regional comparisons revealed significantly more fast FLAIR lesions only in the cortical/subcortical areas. There was a total of 295 new enhancing lesions over the same period -- a gain in the number of 'active lesions' of 234% seen with FSE and 218% with FLAIR. It is concluded that serial thin slice fast FLAIR is only slightly superior to FSE in detecting new and enlarging multiple sclerosis lesions but the difference is not sufficient to recommend that FLAIR should replace FSE in short-term, exploratory trials in MS using monthly scanning. Gadolinium-enhanced imaging is more then twice as sensitive as either FSE or fast FLAIR to new multiple sclerosis lesion activity, and enhancing lesions should provide the primary outcome measure in such studies.
Insights
Fast fluid-attenuated inversion-recovery (FLAIR) and fast spin echo (FSE) MRI detect similar numbers of new multiple sclerosis lesions. Gadolinium-enhanced MRI is more sensitive for detecting active lesions in MS studies.
Area of Science:
- Neuroimaging
- Neurology
- Radiology
Background:
- Multiple sclerosis (MS) is a chronic neurological disease.
- Accurate lesion detection is crucial for monitoring MS progression.
- Comparing MRI sequences aids in optimizing imaging protocols.
Purpose of the Study:
- To compare the efficacy of fast fluid-attenuated inversion-recovery (FLAIR) and proton density/T2-weighted fast spin echo (FSE) MRI sequences in detecting new and enlarging lesions in multiple sclerosis patients.
- To evaluate the sensitivity of gadolinium-enhanced T1-weighted imaging in identifying active MS lesions.
Main Methods:
- 37 multiple sclerosis patients underwent monthly MRI scans for 7 months.
- 3-mm contiguous axial slices were used for FLAIR, FSE, and gadolinium-enhanced T1-weighted sequences.
- New and enlarging lesions were counted and compared between sequences, with a focus on lesion site and enhancement.
Main Results:
- Overall, 126 new or enlarging lesions were detected with FSE and 135 with fast FLAIR (P = 0.25).
- Fast FLAIR showed significantly more lesions in cortical/subcortical areas.
- Gadolinium-enhanced MRI revealed 295 new enhancing lesions, indicating significantly higher sensitivity to active lesion activity.
Conclusions:
- Serial thin-slice fast FLAIR MRI offers only a slight advantage over FSE for detecting new/enlarging MS lesions.
- The difference is insufficient to recommend replacing FSE with FLAIR in short-term, monthly MS trials.
- Gadolinium-enhanced imaging is substantially more sensitive and should be the primary outcome measure for assessing new MS lesion activity in such studies.
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