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Axial vs sagittal T2-weighted brain MR images in the evaluation of multiple sclerosis
G Wilms1, G Marchal, E Kersschot
1Department of Radiology, University Hospitals K.U. Leuven, Belgium.
Abstract:
Axial and sagittal proton density and T2-weighted MR images (TR 2,500-3,000 ms, TE 15-22 and 85-90 ms) were performed in 50 patients with multiple sclerosis (MS) on a 1.5 T superconductive system. The number of plaques on the axial and sagittal images in the periventricular white matter, the corpus callosum, the brain stem, the cerebellum, and the basal ganglia were counted separately by two independent observers. A total of 858 lesions (mean 17.40 +/- 21.57) were seen on the axial series and 1,196 (mean 24.32 +/- 26.22) on the sagittal scans. More lesions were visualized on sagittal images in the periventricular region (mean 18.79 +/- 21.69 versus 13.34 +/- 16.45; p less than 0.001) and the corpus callosum (mean 3.00 +/- 2.72 versus 0.57 +/- 1.19; p less than 0.001). In the brain stem more lesions were visualized on the axial images (mean 1.55 +/- 2.55 versus 0.87 +/- 1.20; p less than 0.05). In the cerebellum and basal ganglia, scans in the two planes were equivalent (p greater than 0.5). In three patients lesions were seen on the sagittal series, while the axial scans were normal. Sagittal T2-weighted images appear to demonstrate significantly more MS plaques than transverse images, especially in the periventricular region and the corpus callosum. This is explained by partial volume averaging, by the orientation of some cerebral structures (e.g., corpus callosum) with regard to the section plane, and by the longer diameter of the lesions in the axial plane.
Insights
Sagittal MRI scans detect more multiple sclerosis (MS) plaques than axial scans, particularly in the periventricular white matter and corpus callosum. This improved detection is due to lesion orientation and partial volume effects.
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- Multiple sclerosis (MS) is a chronic inflammatory disease affecting the central nervous system.
- Accurate lesion detection is crucial for diagnosis and monitoring MS progression.
- Conventional MRI sequences may have limitations in visualizing all MS lesions.
Purpose of the Study:
- To compare the efficacy of sagittal versus axial MRI planes in detecting multiple sclerosis plaques.
- To determine if specific brain regions show differential lesion visualization between imaging planes.
Main Methods:
- Fifty patients diagnosed with multiple sclerosis underwent MRI using a 1.5 T system.
- Axial and sagittal proton density and T2-weighted sequences were acquired.
- Two independent observers meticulously counted MS plaques in predefined brain regions.
Main Results:
- Sagittal MRI visualized significantly more MS plaques overall (mean 24.32) compared to axial MRI (mean 17.40).
- Lesion detection was notably higher on sagittal images in the periventricular region and corpus callosum (p < 0.001).
- Axial imaging showed a slight advantage in visualizing lesions within the brain stem (p < 0.05).
Conclusions:
- Sagittal T2-weighted MRI sequences offer superior visualization of multiple sclerosis plaques compared to axial sequences.
- The enhanced detection on sagittal views is attributed to lesion orientation and partial volume averaging.
- Routine implementation of sagittal imaging may improve MS lesion detection and patient management.