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Assessing Cortical Cerebral Microinfarcts on High Resolution MR Images
Published on: November 20, 2015
Consensus recommendations for MS cortical lesion scoring using double inversion recovery MRI
J J G Geurts1, S D Roosendaal, M Calabrese
1VU University Medical Center, Department of Anatomy & Neuroscience, MF G-116, van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands. j.geurts@vumc.nl
Background:
Different double inversion recovery (DIR) sequences are currently used in multiple sclerosis (MS) research centers to visualize cortical lesions, making it difficult to compare published data. This study aimed to formulate consensus recommendations for scoring cortical lesions in patients with MS, using DIR images acquired in 6 European centers according to local protocols.
Methods:
Consensus recommendations were formulated and tested in a multinational meeting.
Results:
Cortical lesions were defined as focal abnormalities on DIR, hyperintense compared to adjacent normal-appearing gray matter, and were not scored unless ≥ 3 pixels in size, based on at least 1.0 mm(2) in-plane resolution. Besides these 2 obligatory criteria, additional, supportive recommendations concerned a priori artifact definition on DIR, use of additional MRI contrasts to verify suspected lesions, and a constant level of displayed image contrast. Robustness of the recommendations was tested in a small dataset of available, heterogeneous DIR images, provided by the different participating centers. An overall moderate agreement was reached when using the proposed recommendations: more than half of the readers agreed on slightly more than half (54%) of the cortical lesions scored, whereas complete agreement was reached in 19.4% of the lesions (usually larger, mixed white matter/gray matter lesions).
Conclusions:
Although not designed as a formal interobserver study, the current study suggests that comparing available literature data on cortical lesions may be problematic, and increased consistency in acquisition protocols may improve scoring agreement. Sensitivity and specificity of the proposed recommendations should now be studied in a more formal, prospective, multicenter setting using similar DIR protocols.
Insights
Standardizing double inversion recovery (DIR) imaging protocols for multiple sclerosis (MS) cortical lesions is crucial for consistent data comparison. This study proposes consensus recommendations to improve the reliability of scoring MS cortical lesions using DIR MRI.
Area of Science:
- Neuroimaging
- Radiology
- Neurology
Background:
- Multiple sclerosis (MS) research faces challenges comparing cortical lesion data due to varied double inversion recovery (DIR) imaging protocols across centers.
- Standardization is needed for reliable assessment of MS cortical lesions.
Purpose of the Study:
- To develop consensus recommendations for scoring cortical lesions in MS patients using DIR MRI.
- To assess the agreement of these recommendations across multiple European centers.
Main Methods:
- Consensus recommendations for scoring cortical lesions on DIR images were formulated in a multinational meeting.
- Recommendations included lesion definition (hyperintense, ≥3 pixels, ≥1.0 mm²), artifact identification, and use of complementary MRI contrasts.
- The recommendations were tested on heterogeneous DIR images from 6 European centers.
Main Results:
- Cortical lesions were defined as focal, hyperintense abnormalities on DIR images, meeting size criteria.
- Moderate agreement (54% lesion agreement) was achieved using the proposed recommendations.
- Complete agreement was observed in 19.4% of lesions, particularly larger, mixed lesions.
Conclusions:
- Current variations in DIR protocols hinder the comparability of published MS cortical lesion data.
- The proposed recommendations show potential for improving scoring consistency, though further validation is needed.
- Prospective, multicenter studies with standardized DIR protocols are recommended to evaluate sensitivity and specificity.
