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Updated: Jun 6, 2025
Magnetic Resonance Imaging of Multiple Sclerosis at 7.0 Tesla
Published on: February 19, 2021
Improved MR Detection of Optic Nerve Demyelination With MP2RAGE-FLAWS Compared With T 2 -Weighted Fat-Saturated
Randa Aichour1, Thibaut Emorine, Nadia Oubaya
1From the Department of Neuroradiology, AP-HP, Henri Mondor University Hospital, Créteil, France (R.A., T.E., I.M., B.B.); University Paris Est Créteil, INSERM, IMRB, Créteil, France (N.O.); Department of Public Health, AP-HP, Henri Mondor University Hospital, Créteil, France (N.O.); EA 4391, Université Paris Est Créteil, Créteil, France (A.C., B.B.); Department of Neurology, AP-HP, Henri Mondor University Hospital, Créteil, France (A.C.); Department of Neuroradiology, A. Rothschild Foundation Hospital, Paris, France (A.L.); Paris Cité University, Paris, France (A.L.); Advanced Clinical Imaging Technology, Siemens Healthineers International AG, Lausanne, Switzerland (T.K.); Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland (T.K.); Signal Processing Laboratory (LTS 5), École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland (T.K.); and Siemens Healthcare SAS, Courbevoie, France (A.M.).
Objectives:
Nonenhanced T 1 -w sequences such as magnetization-prepared 2 rapid acquisition gradient echo (MP2RAGE) and derived fluid and white matter suppression (FLAWS) have demonstrated high performance for detecting brain parenchymal and cervical spine demyelinating lesions in multiple sclerosis. However, their potential for identifying optic nerve (ON) demyelination remains unexplored. The aim of this study was to evaluate the performance of compressed sensing-accelerated (CS) MP2RAGE-FLAWS imaging for detection of ON demyelination lesions compared with T2-w fat-saturated (FS) TSE imaging in a clinical setting.
Materials And Methods:
We conducted a retrospective study of magnetic resonance scans acquired on patients with central nervous system demyelinating disorders between January and December 2022. Inclusion criteria were the acquisition in the same session of a brain CS-MP2RAGE-FLAWS imaging and a combination of axial + coronal T2-w FS orbital sequences. A 4-step radiological analysis-including blinded and consensus readings-assessed ON lesion detection. The reference standard was the final reading session of radiologists using the entire patient file. Sensitivities and specificities of both sequences were computed and compared using McNemar χ 2 tests.
Results:
Thirty-nine patients (mean age: 43 ± 14 years; 25 women) were analyzed, including 34 with multiple sclerosis, 2 with MOGAD (myelin oligodendrocyte glycoprotein antibody-associated disease), 1 with NMOSD (neuromyelitis optica spectrum disorder), and 2 with indeterminate demyelinating disease. Among the 78 ONs analyzed, 64 lesions were detected with CS-MP2RAGE-FLAWS as opposed to 37 with 2D T2-w FS imaging, corresponding to a total of 41 and 27 affected nerves, respectively. CS-MP2RAGE-FLAWS exhibited higher sensitivity for overall detection of ON lesions compared with 2D T2-w FS imaging (97.5% vs 67.5%, P = 0.001) without reducing the specificity. Improved lesion detectability with CS-MP2RAGE-FLAWS was significant compared with 2D T2-w FS in intraorbital and intracanalicular segments (respectively, 92.3% vs 50% and 96.3% vs 66.7%; P < 0.05). There was no difference in sensitivity ( P = 0.69) or specificity ( P = 0.99) regarding the intracranial segment analysis.
Conclusions:
CS-MP2RAGE-FLAWS sequence improves ON lesion detection compared with conventional 2D T2-w FS, especially in the intraorbital segment, while simultaneously providing whole-brain and cervical spinal cord imaging at no additional time cost.
Insights
Compressed sensing-accelerated MP2RAGE-FLAWS MRI significantly improves optic nerve (ON) demyelination detection compared to standard T2-w fat-saturated imaging. This advanced sequence offers higher sensitivity, particularly in the intraorbital segment, aiding in diagnosing demyelinating diseases.
Area of Science:
- Neuroimaging
- Radiology
- Multiple Sclerosis Research
Background:
- Nonenhanced T1-weighted sequences like MP2RAGE and FLAWS are effective for brain and cervical spine demyelination in multiple sclerosis.
- The utility of these sequences for detecting optic nerve (ON) demyelination has not been previously evaluated.
- Optic nerve involvement is a common manifestation of demyelinating diseases, impacting visual function.
Purpose of the Study:
- To assess the performance of compressed sensing-accelerated (CS) MP2RAGE-FLAWS imaging for detecting optic nerve (ON) demyelination.
- To compare the efficacy of CS-MP2RAGE-FLAWS with conventional T2-weighted fat-saturated (FS) TSE imaging in a clinical setting.
- To evaluate lesion detection sensitivity and specificity in different segments of the optic nerve.
Main Methods:
- Retrospective analysis of MRI scans from patients with central nervous system demyelinating disorders (January-December 2022).
- Inclusion criteria: simultaneous acquisition of brain CS-MP2RAGE-FLAWS and axial/coronal T2-w FS orbital sequences.
- Four-step radiological analysis with blinded and consensus readings; reference standard was final radiologist assessment. Sensitivity and specificity calculated using McNemar's test.
Main Results:
- Thirty-nine patients (34 with MS, 2 MOGAD, 1 NMOSD, 2 indeterminate) were analyzed, evaluating 78 optic nerves.
- CS-MP2RAGE-FLAWS detected 64 lesions (41 nerves) versus 37 lesions (27 nerves) with 2D T2-w FS imaging.
- CS-MP2RAGE-FLAWS showed significantly higher sensitivity (97.5% vs. 67.5%, P=0.001) without compromising specificity, especially in intraorbital and intracanalicular segments.
Conclusions:
- CS-MP2RAGE-FLAWS imaging significantly enhances the detection of optic nerve demyelination compared to standard 2D T2-w FS sequences.
- The improved detection is most notable in the intraorbital segment of the optic nerve.
- This advanced sequence provides simultaneous whole-brain and cervical spinal cord imaging, offering efficiency without additional time cost.
