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Updated: Nov 24, 2025
Magnetic Resonance Imaging of Multiple Sclerosis at 7.0 Tesla
Published on: February 19, 2021
Detection of Active Plaques in Multiple Sclerosis using 3 and 12 Directional Diffusion-weighted Imaging: Comparison
Meftahi G H1, Pirzad Jahromi G1, Azari A2
1PhD, Neuroscience Research Centre, Baqiyatallah University of Medical Sciences, Tehran, Iran.
Background:
Multiple Sclerosis (MS), distinguished by aggravating the function of central nervous system because of inflammatory demyelination. The most sensitive method for MS diagnosis is Magnetic resonance imaging (MRI). To distinguish inactive and active MS lesions, contrast-enhanced T1-weighted imaging (CE T1WI) is being used as a gold standard. There are some contraindications in gadolinium based contrast agents (GBCAs) usage. Moreover, diffusion-weighted imaging (DWI) can discover diffusion changes involved inflammatory lesions.
Objective:
The current research aims at investigating if typical DWI (3 directional) and 12 directional DWI could be a substitute for CE T1WI in order to show active lesions of MS.
Material And Methods:
In this cross-sectional study, 138 patients with CNS symptoms were examined. For all patients, along with CE T1WI, 3 & 12 directional DWI were performed. Intraclass correlation coefficient (ICC), receiver operating characteristic (ROC), the sensitivity versus specificity plot and the area under the curve (AUC) were calculated.
Results:
There was a contrast enhancement in CE T1WI for 114 patients (82.6%); in addition, hyper-intense lesions on DWI 3 and DWI 12 were shown in 107 (77.5%) and 117 patients (84.7%) in order. Sensitivity, specificity and AUC were 94.7%, 62.5% and 84% for DWI 12. Moreover, the results were 86%, 62.5 and 79% for the sensitivity, specificity and AUC for DWI 3 respectively.
Conclusion:
In spite of lower sensitivity of 12 directional DWI compared to CE T1WI, it could be used as a diagnostic sequence in differentiating enhanced lesions from non-enhanced ones when CE-MRI is a worry.
Insights
Twelve-directional diffusion-weighted imaging (DWI) shows promise as an alternative to contrast-enhanced MRI for detecting active Multiple Sclerosis (MS) lesions. This method can help identify inflammatory changes in the central nervous system when contrast agents are a concern.
Area of Science:
- Neuroimaging
- Radiology
- Neurology
Background:
- Multiple Sclerosis (MS) involves inflammatory demyelination affecting the central nervous system.
- Magnetic Resonance Imaging (MRI) is crucial for MS diagnosis.
- Contrast-enhanced T1-weighted imaging (CE T1WI) is the gold standard for differentiating active MS lesions, but gadolinium-based contrast agents (GBCAs) have contraindications.
Purpose of the Study:
- To evaluate if 3-directional and 12-directional diffusion-weighted imaging (DWI) can replace CE T1WI in identifying active MS lesions.
- To assess the diagnostic performance of DWI techniques compared to CE T1WI.
Main Methods:
- A cross-sectional study included 138 patients with central nervous system symptoms.
- All patients underwent both CE T1WI and 3 & 12 directional DWI.
- Statistical analyses included Intraclass Correlation Coefficient (ICC), Receiver Operating Characteristic (ROC) curves, and Area Under the Curve (AUC).
Main Results:
- CE T1WI showed contrast enhancement in 82.6% of patients.
- Hyper-intense lesions on DWI 12 and DWI 3 were observed in 84.7% and 77.5% of patients, respectively.
- DWI 12 achieved 94.7% sensitivity, 62.5% specificity, and 84% AUC; DWI 3 achieved 86% sensitivity, 62.5% specificity, and 79% AUC.
Conclusions:
- Twelve-directional DWI demonstrates significant potential as a substitute for CE T1WI in detecting active MS lesions.
- While sensitivity is slightly lower than CE T1WI, DWI offers a valuable alternative when contrast administration is a concern.
- DWI sequences can aid in distinguishing enhanced from non-enhanced lesions in MS patients.
