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Updated: Jun 14, 2026
Magnetic Resonance Imaging of Multiple Sclerosis at 7.0 Tesla
Published on: February 19, 2021
Imaging of active multiple sclerosis plaques: efficiency of contrast-enhanced magnetization transfer subtraction
Oktay Algin1, Bahattin Hakyemez, Ozlem Taşkapilioğlu
1Department of Radiology, Uludağ University Faculty of Medicine, Bursa, Turkey. droktayalgin@gmail.com
Purpose:
T1-weighted (T1W) magnetic resonance images with magnetization transfer (MT) are widely used in the evaluation of multiple sclerosis (MS) plaques. We aimed to evaluate the contribution of the subtraction technique with MT in the detection of acute MS plaques.
Materials And Methods:
Sixty-four patients during an MS attack were enrolled in the study. Axial T1W spin echo (SE) with MT, axial-sagittal T2W fast SE, axial FLAIR and postcontrast axial T1W SE magnetic resonance imaging sequence with MT were acquired from all patients. The subtraction (postcontrast-precontrast) images were obtained on the workstation. FLAIR and T2W images were used as reference for plaque imaging. Contrast material enhanced plaques were considered as acute plaques. Qualitatively, both subtracted and contrast-enhanced with MT images were evaluated visually. Quantitatively, signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were calculated.
Results:
A total of 464 plaques were detected on T2W and FLAIR images. Thirty-five acute plaques were detected on both postcontrast MT and subtracted images. Additionally, 66 acute plaques were only detected on subtracted images visually. CNR and SNR values of acute MS plaques were significantly higher on subtracted MT images than on postcontrast MT images (P < 0.001).
Conclusion:
The subtraction technique seems to facilitate the detection of acute MS plaques by intensifying the visibility of poorly enhanced plaques without use of high dose contrast medium. We suggest the use of subtraction technique in routine imaging work-up of MS patients with acute attacks.
Insights
The subtraction technique enhances the detection of acute multiple sclerosis (MS) plaques on T1-weighted (T1W) magnetic resonance images with magnetization transfer (MT). This method improves visibility of subtle lesions, aiding in MS plaque diagnosis.
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- T1-weighted (T1W) magnetic resonance imaging (MRI) with magnetization transfer (MT) is crucial for evaluating multiple sclerosis (MS) plaques.
- Detecting acute MS plaques is essential for effective treatment and monitoring.
Purpose of the Study:
- To evaluate the contribution of the subtraction technique combined with MT in detecting acute MS plaques.
- To assess if subtraction imaging improves the identification of active MS lesions.
Main Methods:
- Sixty-four patients experiencing an MS attack underwent various MRI sequences, including T1W with MT, T2W, FLAIR, and postcontrast T1W with MT.
- Subtraction images (postcontrast minus precontrast) were generated, and both subtracted and contrast-enhanced MT images were evaluated qualitatively and quantitatively (SNR, CNR).
Main Results:
- A total of 464 plaques were identified across all sequences.
- The subtraction technique visually detected 66 additional acute plaques not visible on standard postcontrast MT images.
- Subtracted MT images showed significantly higher contrast-to-noise ratio (CNR) and signal-to-noise ratio (SNR) for acute MS plaques compared to postcontrast MT images.
Conclusions:
- The subtraction technique enhances the visibility of poorly enhancing acute MS plaques, facilitating their detection.
- This method offers a valuable tool for routine MS imaging, potentially reducing the need for high contrast doses.
- The study recommends incorporating the subtraction technique into the standard imaging protocol for MS patients with acute attacks.
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