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Updated: Jan 28, 2026
Magnetic Resonance Imaging of Multiple Sclerosis at 7.0 Tesla
Published on: February 19, 2021
Gadolinium-Enhanced Susceptibility-Weighted Imaging in Multiple Sclerosis: Optimizing the Recognition of Active
L L F do Amaral1,2, D C Fragoso3,4,5, R H Nunes3,4
1From the Division of Neuroradiology (L.L.F.A, D.C.F., R.H.N., I.A.L., A.J.R.), Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil neuro.medimagem@gmail.com.
Background And Purpose:
Gadolinium SWI is MR imaging that has recently been reported to be effective in the evaluation of several neurologic disorders, including demyelinating diseases. Our aim was to analyze the accuracy of gadolinium SWI for detecting the imaging evidence of active inflammation on MS plaques when a BBB dysfunction is demonstrated by a focal gadolinium-enhanced lesion and to compare this technique with gadolinium-enhanced T1 spin-echo and T1 spin-echo with magnetization transfer contrast.
Materials And Methods:
MR imaging studies of 103 patients (170 examinations) were performed using a 1.5T scanner. Two neuroradiologists scrutinized signal abnormalities of the demyelinating plaques on gadolinium SWI and compared them with gadolinium T1 before and after an additional magnetization transfer pulse. Interrater agreement was evaluated among gadolinium T1 magnetization transfer contrast, gadolinium SWI, and gadolinium T1 spin-echo using the κ coefficient. The T1 magnetization transfer contrast sequence was adopted as the criterion standard in this cohort. Thus, the sensitivity, specificity, positive predictive value, and negative predictive value were calculated for gadolinium T1 spin-echo and gadolinium SWI sequences.
Results:
Differences in BBB dysfunction were evident among gadolinium SWI, gadolinium T1 spin-echo, and gadolinium T1 magnetization transfer contrast. Gadolinium T1 magnetization transfer contrast demonstrated the highest number of active demyelinating plaques. Gadolinium SWI was highly correlated with gadolinium T1 magnetization transfer contrast in depicting acute demyelinating plaques (κ coefficient = 0.860; sensitivity = 0.837), and these techniques provided better performance compared with gadolinium T1 spin-echo (κ coefficient = 0.78; sensitivity = 0.645).
Conclusions:
Gadolinium SWI was able to better detect BBB dysfunction in MS plaques and had a better performance than gadolinium T1 spin-echo. Increasing SWI sequence applications in clinical practice can improve our knowledge of MS, likely allowing the addition of BBB dysfunction analysis to the striking findings of the previously reported central vein sign.
Insights
Gadolinium SWI accurately detects blood-brain barrier dysfunction in multiple sclerosis plaques, outperforming T1 spin-echo. This advanced MRI technique enhances the detection of active inflammation in MS, improving diagnostic capabilities.
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- Multiple Sclerosis (MS) is a demyelinating neurologic disorder.
- Gadolinium-enhanced Susceptibility-Weighted Imaging (SWI) shows promise in evaluating neurologic conditions.
- Assessing active inflammation in MS plaques is crucial for disease management.
Purpose of the Study:
- To evaluate the accuracy of gadolinium SWI in detecting blood-brain barrier (BBB) dysfunction in active MS plaques.
- To compare the performance of gadolinium SWI with conventional MRI techniques: gadolinium-enhanced T1 spin-echo and T1 spin-echo with magnetization transfer contrast.
Main Methods:
- 103 patients with MS underwent 1.5T MRI scans.
- Two neuroradiologists analyzed signal abnormalities in demyelinating plaques using gadolinium SWI and gadolinium T1 sequences.
- Interrater agreement was assessed using the κ coefficient, with T1 magnetization transfer contrast as the criterion standard.
Main Results:
- Gadolinium SWI demonstrated high correlation with T1 magnetization transfer contrast in identifying acute MS plaques (κ = 0.860, sensitivity = 0.837).
- Gadolinium SWI exhibited superior performance compared to gadolinium T1 spin-echo (κ = 0.78, sensitivity = 0.645).
- T1 magnetization transfer contrast identified the highest number of active demyelinating plaques.
Conclusions:
- Gadolinium SWI is effective in detecting BBB dysfunction in MS plaques, outperforming gadolinium T1 spin-echo.
- Increased clinical application of SWI can advance understanding of MS by adding BBB dysfunction analysis.
- SWI may complement existing imaging markers like the central vein sign in MS diagnosis.
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