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Updated: Jul 9, 2026
Magnetic Resonance Imaging of Multiple Sclerosis at 7.0 Tesla
Published on: February 19, 2021
7 T Lesion-Attenuated Magnetization-Prepared Gradient Echo Acquisition for Detection of Posterior Fossa Demyelinating
Erik H Middlebrooks1, Vishal Patel, Xiangzhi Zhou
1From the Department of Radiology, Mayo Clinic, Jacksonville, FL (E.H.M., V.P., X.Z., S.S., J.V.M.J., A.K.A., L.O., R.B.S., E.M.W., V.G., S.J.S.S., S.T.); and Department of Neurology, Mayo Clinic, Jacksonville, FL (A.S.L.C., I.V.M.).
Objectives:
Detection of infratentorial demyelinating lesions in multiple sclerosis (MS) presents a challenge in magnetic resonance imaging (MRI), a difficulty that is further heightened in 7 T MRI. This study aimed to assess the efficacy of a novel MRI approach, lesion-attenuated magnetization-prepared gradient echo acquisition (LAMA), for detecting demyelinating lesions within the posterior fossa and upper cervical spine on 7 T MRI and contrast its performance with conventional double-inversion recovery (DIR) and T2-weighted turbo spin echo sequences.
Materials And Methods:
We conducted a retrospective cross-sectional study in 42 patients with a confirmed diagnosis of MS. All patients had 7 T MRI that incorporated LAMA, 3D DIR, and 2D T2-weighted turbo spin echo sequences. Three readers assessed lesion count in the brainstem, cerebellum, and upper cervical spinal cord using both DIR and T2-weighted images in one session. In a separate session, LAMA was analyzed alone. Contrast-to-noise ratio was also compared between LAMA and the conventional sequences. Lesion counts between methods were assessed using nonparametric Wilcoxon signed rank test. Interrater agreement in lesion detection was estimated by intraclass correlation coefficients.
Results:
LAMA identified a significantly greater number of lesions than DIR + T2 (mean 6.4 vs 3.0; P < 0.001). LAMA also exhibited better interrater agreement (intraclass correlation coefficient [95% confidence interval], 0.75 [0.41-0.88] vs 0.61 [0.35-0.78]). The contrast-to-noise ratio for LAMA (3.7 ± 0.9) significantly exceeded that of DIR (1.94 ± 0.7) and T2 (1.2 ± 0.7) (all P 's < 0.001). In cases with no lesions detected using DIR + T2, at least 1 lesion was identified in 83.3% with LAMA. Across all analyzed brain regions, LAMA consistently detected more lesions than DIR + T2.
Conclusions:
LAMA significantly improves the detection of infratentorial demyelinating lesions in MS patients compared with traditional methods. Integrating LAMA with standard magnetization-prepared 2 rapid acquisition gradient echo acquisition provides a valuable tool for accurately characterizing the extent of MS disease.
Insights
A new MRI technique, LAMA, significantly improves detection of infratentorial demyelinating lesions in multiple sclerosis (MS) patients. This advanced method offers superior lesion identification compared to traditional MRI sequences.
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- Multiple sclerosis (MS) diagnosis relies heavily on detecting demyelinating lesions.
- Infratentorial lesions in the posterior fossa and upper cervical spine are challenging to detect with conventional MRI techniques, especially at 7 Tesla (7T).
- Accurate lesion detection is crucial for disease monitoring and treatment efficacy in MS.
Purpose of the Study:
- To evaluate the efficacy of a novel MRI sequence, lesion-attenuated magnetization-prepared gradient echo acquisition (LAMA), for detecting infratentorial demyelinating lesions in MS patients using 7T MRI.
- To compare the performance of LAMA against conventional MRI sequences, specifically 3D double-inversion recovery (DIR) and 2D T2-weighted turbo spin echo (T2).
Main Methods:
- A retrospective cross-sectional study involving 42 MS patients who underwent 7T MRI.
- Acquisition of imaging data using LAMA, 3D DIR, and 2D T2-weighted turbo spin echo sequences.
- Lesion counting by three readers in the brainstem, cerebellum, and upper cervical spinal cord, with separate analysis for LAMA and conventional sequences. Contrast-to-noise ratio (CNR) comparison and interrater agreement assessment.
Main Results:
- LAMA identified significantly more lesions (mean 6.4) compared to combined DIR + T2 sequences (mean 3.0; P < 0.001).
- LAMA demonstrated superior interrater agreement (ICC 0.75) versus DIR + T2 (ICC 0.61).
- The contrast-to-noise ratio for LAMA (3.7 ± 0.9) was significantly higher than for DIR (1.94 ± 0.7) and T2 (1.2 ± 0.7) (all P < 0.001). LAMA detected lesions in 83.3% of cases missed by conventional methods.
Conclusions:
- The LAMA sequence significantly enhances the detection of infratentorial demyelinating lesions in MS patients compared to traditional MRI methods.
- Integrating LAMA with standard magnetization-prepared rapid acquisition gradient echo (MPRAGE) sequences provides a valuable tool for precise MS disease characterization.
- This novel MRI approach improves diagnostic accuracy for MS lesions in challenging anatomical regions.
