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Efficacy of diffusion-weighted imaging in symptomatic and asymptomatic multiple sclerotic plaques
Farzad Tahmasebi Arashloo1, Farnaz Fahimi Hanzaei1, Behnaz Sedighi2
1Clinical Research Unit, Afzalipour Hospital, Kerman University of Medical Sciences, Kerman, Iran.
Introduction:
Magnetic resonance imaging (MRI) currently accompanies clinical findings in disease diagnosis, patients' follow-up, assessment of drugs complications, and evaluation of treatment response. Although contrast-enhanced MRI (CE-MRI) is considered as the imaging modality of choice for multiple sclerosis (MS), due to disease chronicity, applying multiple doses of gadolinium-based contrast agents (GBCAs) increases the risk of nephrogenic syndrome in patients with acute (ARF) and chronic renal syndromes (CRF). Moreover, the effect of gadolinium on the fetus is not well-known in pregnant patients. Therefore, this study evaluates the possibility of replacing postcontrast images with physiologically based MRI sequences such as diffusion weighted imaging (DWI) and apparent diffusion coefficient (ADC).
Method:
We prospectively evaluated 26 patients with known multiple sclerosis. The patients with MS attacks and the asymptomatic patients who were referred for follow-up were enrolled. Conventional MRI including postcontrast T1W, DWI, and ADC were performed for all patients. The signal intensity (SI) of all enhancing and nonenhancing plaques of more than 10 × 10 mm size were investigated in all sequences and analyzed.
Results:
A total of 83 plaques were detected in T2-FLAIR sequences of which 51 plaques were enhanced (68%) after gadolinium administration. While 42 MS plaques had hypersignal intensity in DWI (56%), 32 plaques had iso- or hyposignal intensities in DWI (44%). No statistically significant values were obtained.
Conclusion:
Although DWI could not replace CE-MRI, using these two modalities together could increase detection of active MS plaques and alter patients' therapy and prognosis.
Insights
Diffusion weighted imaging (DWI) and apparent diffusion coefficient (ADC) MRI sequences show potential alongside contrast-enhanced MRI (CE-MRI) for detecting multiple sclerosis (MS) plaques. Combining these methods may improve patient therapy and prognosis.
Area of Science:
- Radiology
- Neurology
- Medical Imaging
Background:
- Magnetic resonance imaging (MRI) is crucial for diagnosing and monitoring diseases like multiple sclerosis (MS).
- Contrast-enhanced MRI (CE-MRI) is the preferred method for MS, but repeated gadolinium-based contrast agent (GBCA) doses pose risks, especially for patients with renal issues or during pregnancy.
- There's a need for safer imaging alternatives to GBCAs in MS management.
Purpose of the Study:
- To evaluate if diffusion weighted imaging (DWI) and apparent diffusion coefficient (ADC) MRI sequences can replace postcontrast images in multiple sclerosis (MS) assessment.
- To determine the utility of DWI and ADC in detecting active MS lesions compared to conventional CE-MRI.
Main Methods:
- Prospective evaluation of 26 patients with known multiple sclerosis (MS).
- Conventional MRI including postcontrast T1-weighted, DWI, and ADC sequences were performed.
- Signal intensity of MS plaques (>10x10 mm) was analyzed across all sequences.
Main Results:
- Out of 83 detected plaques, 51 (68%) enhanced with gadolinium.
- Hypersignal intensity on DWI was observed in 42 plaques (56%), while 32 (44%) showed iso- or hyposignal.
- No statistically significant differences were found between DWI/ADC and CE-MRI in plaque detection.
Conclusions:
- Diffusion weighted imaging (DWI) cannot fully replace contrast-enhanced MRI (CE-MRI) for multiple sclerosis (MS) plaque detection.
- Combining DWI and CE-MRI may enhance the detection of active MS plaques.
- Integrated use of these MRI sequences could potentially influence patient therapy and prognosis.
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