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Updated: May 23, 2025
Magnetic Resonance Imaging of Multiple Sclerosis at 7.0 Tesla
Published on: February 19, 2021
Post-contrast Susceptibility Weighted Imaging in Multiple Sclerosis MRI Improves the Detection of Enhancing Lesions
Pablo Naval-Baudin1,2,3,4, Karen Pérez-Alfonso5, Albert Castillo-Pinar5
1Radiology Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Carrer de Feixa Llarga SN, 08907, Barcelona, Spain. pablo.naval.idi@gencat.cat.
Objectives:
MRI is essential for monitoring multiple sclerosis (MS). Contrast-enhanced T1-weighted imaging (T1WI+C) detects active inflammatory lesions indicating blood-brain barrier breakdown and is relevant for disease monitoring and treatment optimization. Susceptibility-weighted imaging (SWI) may be included in the imaging protocol for detecting MS-specific features, such as the presence of central veins or paramagnetic rim lesions. However, post-contrast SWI (SWI+C) has an inherent "T1 shine-through effect" that enables the visualization of contrast-enhancing lesions. This study evaluates whether SWI+C in addition to standard T1WI+C improves the detection of enhancing lesions in patients with MS.
Materials And Methods:
The images of 310 patients with MS who underwent a standardized MRI protocol including T1WI+C and SWI+C using a 3T scanner were retrospectively reviewed. A neuroradiologist and radiology resident independently evaluated the images obtained on T1WI+C alone and T1WI+C plus SWI+C. The efficacy of T1WI+C alone was compared with that of T1WI+C plus SWI+C for detecting active enhancing MS lesions.
Results:
The neuroradiologist detected 117 lesions on T1WI+C and 123 lesions on T1WI+C plus SWI+C. The resident detected 108 lesions on T1WI+C and 121 lesions on T1WI+C plus SWI+C. The interobserver agreement improved from 0.981 to 1.00 with the addition of SWI+C.
Conclusion:
Adding SWI+C to standard T1WI+C consistently enhances the detection of active enhancing inflammatory MS lesions and the interobserver agreement. If standardized, this combined approach may allow for earlier detection of disease activity and improve monitoring of MS progression, potentially leading to optimized treatment decisions and improved patient outcomes.
Insights
Adding post-contrast susceptibility-weighted imaging (SWI+C) to standard contrast-enhanced T1-weighted imaging (T1WI+C) improves the detection of active inflammatory lesions in multiple sclerosis (MS) patients. This enhanced MRI approach also increases agreement between observers for MS lesion identification.
Area of Science:
- Neuroimaging
- Radiology
- Neurology
Background:
- Magnetic Resonance Imaging (MRI) is crucial for monitoring multiple sclerosis (MS).
- Contrast-enhanced T1-weighted imaging (T1WI+C) identifies active inflammatory lesions by visualizing blood-brain barrier breakdown.
- Susceptibility-weighted imaging (SWI) can detect MS-specific features, and post-contrast SWI (SWI+C) may reveal contrast-enhancing lesions due to a "T1 shine-through effect".
Purpose of the Study:
- To evaluate if SWI+C, in addition to T1WI+C, improves the detection of enhancing lesions in MS patients.
- To assess the impact of combined SWI+C and T1WI+C on lesion detection and interobserver agreement.
Main Methods:
- Retrospective review of MRI scans from 310 MS patients acquired with a 3T scanner.
- Standardized MRI protocol included both T1WI+C and SWI+C.
- Independent image evaluation by a neuroradiologist and a radiology resident comparing T1WI+C alone versus T1WI+C plus SWI+C.
Main Results:
- The neuroradiologist detected 117 lesions on T1WI+C and 123 lesions with the addition of SWI+C.
- The resident detected 108 lesions on T1WI+C and 121 lesions with the addition of SWI+C.
- Interobserver agreement improved from 0.981 to 1.00 with the combined imaging approach.
Conclusions:
- SWI+C consistently enhances the detection of active inflammatory MS lesions compared to T1WI+C alone.
- The addition of SWI+C improves interobserver agreement in lesion detection.
- Standardized combined T1WI+C and SWI+C may enable earlier detection of MS disease activity and improve monitoring, potentially optimizing treatment decisions.
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