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Diffusion Tensor Magnetic Resonance Imaging in the Analysis of Neurodegenerative Diseases
Published on: July 28, 2013
Comparing white matter lesions on T2 and FLAIR MRI in the Sydney Older Persons Study
O Piguet1, L J Ridley, D A Grayson
1Centre for Education and Research on Ageing at Concord Hospital, Department of Medicine, The University of Sydney, Sydney, NSW, Australia. olivier@mit.edu
Abstract:
There is suggestion that magnetic resonance imaging (MRI) fluid-attenuated inversion recovery (FLAIR) sequence may be more accurate than T2 images in detecting white matter lesions (WML) in older people. Comparative ratings of these two image sequences have not been directly investigated in very old individuals to date. We compared the ratings of periventricular and deep WML on these two sequences in a sample of 111 community dwellers (mean age 85.5 years) using semiquantitative methods. Periventricular WML were as commonly detected on T2 as on FLAIR but were more severely rated on the latter sequence. No such bias was observed for the deep WML. With one exception, correlations between the two sets of measures were significant at the P < 0.001 level (range: 0.34-0.75). Intrarater reliability coefficients were moderate to excellent for most ratings. These results suggest that ratings performed on T2-weighted images to detect WML in very old individuals are very comparable with those performed on FLAIR images although FLAIR may allow a finer grading of periventricular lesions. Absence of FLAIR does not preclude the identification of WML in this population. These findings have clinical and epidemiological relevance where the acquisition of supplementary MRI data may not always be possible.
Insights
Magnetic resonance imaging (MRI) T2 and FLAIR sequences are comparable for detecting white matter lesions (WML) in very old adults. FLAIR may offer finer grading of periventricular WML, but T2 is sufficient when FLAIR is unavailable.
Area of Science:
- Neurology
- Radiology
- Gerontology
Background:
- Magnetic resonance imaging (MRI) is crucial for assessing white matter lesions (WML) in aging populations.
- Fluid-attenuated inversion recovery (FLAIR) sequence is suggested to be superior to T2 images for WML detection.
- Direct comparisons of T2 and FLAIR for WML in very old individuals are limited.
Purpose of the Study:
- To compare the accuracy and reliability of T2-weighted and FLAIR MRI sequences in detecting and rating white matter lesions (WML).
- To investigate these sequences specifically in a cohort of very old community-dwelling adults.
Main Methods:
- A semiquantitative rating method was employed to assess periventricular and deep WML.
- 111 community dwellers with a mean age of 85.5 years were included in the study.
- Intrarater reliability was assessed for the ratings.
Main Results:
- Periventricular WML detection rates were similar between T2 and FLAIR sequences.
- Periventricular WML were rated more severely on FLAIR compared to T2 images.
- Deep WML showed no significant difference in detection or severity ratings between the two sequences.
- High correlations (P < 0.001) were found between T2 and FLAIR measures for WML.
- Intrarater reliability for most ratings was moderate to excellent.
Conclusions:
- T2-weighted MRI sequences provide comparable WML detection to FLAIR in very old individuals.
- FLAIR sequences may offer enhanced grading of periventricular WML.
- The absence of FLAIR sequences does not prevent the identification of WML in this demographic.
- Findings support the clinical and epidemiological utility of T2-weighted MRI when FLAIR is not feasible.
