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Pre-contrast T1-weighted imaging of the spinal cord may be unnecessary in patients with multiple sclerosis

Isabelle Riederer1, Mark Mühlau2,3, Claus Zimmer4

  • 1Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany. isabelle.riederer@tum.de.

European Radiology
|June 10, 2021
PubMed
Abstract

Insights

Pre-contrast T1-weighted imaging does not improve diagnostic confidence for spinal multiple sclerosis (MS) follow-up MRI scans. Omitting this sequence can reduce scan time without compromising diagnostic value, enhancing patient compliance.

Area of Science:

  • Neurology
  • Radiology
  • Medical Imaging

Background:

  • Multiple sclerosis (MS) is an inflammatory condition often affecting the spinal cord.
  • Magnetic resonance imaging (MRI) is crucial for assessing spinal cord involvement in MS.
  • Pre-contrast T1-weighted (T1-w) imaging is a standard component of spinal MRI protocols.

Purpose of the Study:

  • To evaluate the diagnostic value of pre-contrast T1-w imaging in routine spinal MRI for MS follow-up.
  • To determine if pre-contrast T1-w sequences significantly enhance diagnostic confidence or lesion detection.
  • To assess the impact of omitting pre-contrast T1-w sequences on scan time and patient compliance.

Main Methods:

  • Retrospective analysis of 3-T MRI scans from 265 patients with suspected or confirmed MS.
  • Two independent neuroradiologists assessed images in sessions with and without pre-contrast T1-w sequences.
  • Evaluation included contrast-enhancing (ce) lesions, diagnostic confidence, image quality, and artifacts.

Main Results:

  • No significant difference in diagnostic confidence was found between readings with and without pre-contrast T1-w images.
  • The detection rate of ce lesions and black holes remained comparable.
  • Inter-rater agreement for artifacts and image quality was moderate, while for black holes it was substantial.

Conclusions:

  • Pre-contrast T1-w sequences do not significantly increase diagnostic confidence or lesion detection in spinal MS follow-up.
  • Omitting pre-contrast T1-w imaging can reduce MRI scan duration, potentially improving patient experience.
  • These sequences may still be valuable in specific clinical scenarios requiring absolute certainty of contrast enhancement.
Keywords:
Contrast mediaMagnetic resonance imagingMultiple sclerosisSpinal cord

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