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A Comprehensive Protocol for Manual Segmentation of the Medial Temporal Lobe Structures
Published on: July 2, 2014
Manual Segmentation of MS Cortical Lesions Using MRI: A Comparison of 3 MRI Reading Protocols
J Maranzano1, D A Rudko1, D L Arnold1
1From the Department of Neurology and Neurosurgery, Montreal Neurological Hospital and Institute, McGill University, Montreal, Quebec, Canada.
Background And Purpose:
Double inversion recovery has been suggested as the MR imaging contrast of choice for segmenting cortical lesions in patients with multiple sclerosis. In this study, we sought to determine the utility of double inversion recovery for cortical lesion identification by comparing 3 MR imaging reading protocols that combine different MR imaging contrasts.
Materials And Methods:
Twenty-five patients with relapsing-remitting MS and 3 with secondary-progressive MS were imaged with 3T MR imaging by using double inversion recovery, dual fast spin-echo proton-density/T2-weighted, 3D FLAIR, and 3D T1-weighted imaging sequences. Lesions affecting the cortex were manually segmented by using the following 3 MR imaging reading protocols: Protocol 1 (P1) used all available MR imaging contrasts; protocol 2 (P2) used all the available contrasts except for double inversion recovery; and protocol 3(P3) used only double inversion recovery.
Results:
Six hundred forty-three cortical lesions were identified with P1 (mean = 22.96); 633, with P2 (mean = 22.6); and 280, with P3 (mean = 10). The counts obtained by using P1 and P2 were not significantly different (P = .93). The counts obtained by using P3 were significantly smaller than those obtained by using either P1 (P < .001) or P2 (P < .001). The intraclass correlation coefficients were P1 versus P2 = 0.989, P1 versus P3 = 0.615, and P2 versus P3 = 0.588.
Conclusions:
MR imaging cortical lesion segmentation can be performed by using 3D T1-weighted and 3D FLAIR images acquired with a 1-mm isotropic voxel size, supported by conventional T2-weighted and proton-density images with 3-mm-thick sections. Inclusion of double inversion recovery in this multimodal reading protocol did not significantly improve the cortical lesion identification rate. A multimodal approach is superior to using double inversion recovery alone.
Insights
Double inversion recovery (DIR) is not essential for identifying multiple sclerosis cortical lesions. Combining other MRI sequences like FLAIR and T1-weighted images is sufficient for accurate segmentation, outperforming DIR alone.
Area of Science:
- Radiology
- Neuroimaging
- Medical Imaging
Background:
- Multiple sclerosis (MS) diagnosis relies on detecting brain lesions.
- Cortical lesions are challenging to identify and segment accurately.
- Double inversion recovery (DIR) has been proposed as a key MRI sequence for cortical lesion detection.
Purpose of the Study:
- To evaluate the effectiveness of DIR in segmenting cortical lesions in MS patients.
- To compare the utility of DIR against other MRI sequences in a multimodal approach.
- To determine if DIR enhances cortical lesion identification rates.
Main Methods:
- Twenty-eight MS patients (25 relapsing-remitting, 3 secondary-progressive) underwent 3T MRI.
- Imaging included DIR, dual fast spin-echo PD/T2-weighted, 3D FLAIR, and 3D T1-weighted sequences.
- Cortical lesions were segmented using three protocols: all sequences (P1), all except DIR (P2), and DIR only (P3).
Main Results:
- Protocol 1 identified 643 lesions (mean 22.96), Protocol 2 identified 633 lesions (mean 22.6), and Protocol 3 identified 280 lesions (mean 10).
- No significant difference was found between P1 and P2 lesion counts (P = .93).
- P3 yielded significantly fewer lesions than P1 (P < .001) and P2 (P < .001), with lower intraclass correlation coefficients.
Conclusions:
- Multimodal MRI protocols, including 3D T1-weighted and 3D FLAIR with conventional T2-weighted/PD images, are effective for cortical lesion segmentation.
- Adding DIR to a multimodal protocol does not significantly improve cortical lesion identification.
- A multimodal approach is superior to using DIR alone for MS cortical lesion detection.
