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Hidden Pitfall in Multiple Sclerosis Imaging: How Standard Susceptibility-Weighted Imaging (SWI) May Miss

Yuki Sonoda1,2, Akifumi Hagiwara1,2, Yuji Tomizawa3

  • 1Department of Radiology, Juntendo University School of Medicine, Tokyo, Japan.

Magnetic Resonance in Medical Sciences : MRMS : an Official Journal of Japan Society of Magnetic Resonance in Medicine
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PubMed
Summary

Paramagnetic rim lesions (PRLs) in multiple sclerosis are visible on susceptibility-weighted imaging (SWI) but depend on scan parameters. Optimizing echo time (TE) and flip angle (FA) is crucial for accurate PRL detection.

Keywords:
flip anglemultiple sclerosisparamagnetic rim lesionphase imagesusceptibility-weighted imaging

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Area of Science:

  • Radiology
  • Neuroimaging
  • Multiple Sclerosis

Background:

  • Paramagnetic rim lesions (PRLs) are indicators of chronic active lesions in multiple sclerosis.
  • Susceptibility-weighted imaging (SWI) is used to detect microbleeds and other lesions.

Purpose of the Study:

  • To investigate the impact of SWI scan parameters on the visibility of PRLs.
  • To determine optimal parameters for detecting PRLs using SWI.

Main Methods:

  • Case report detailing SWI acquisition in a patient with multiple sclerosis.
  • Varied SWI parameters including echo time (TE) and flip angle (FA).
  • Analysis of lesion visibility on magnitude and phase images.

Main Results:

  • Routine SWI with low flip angle (FA) and standard echo time (TE) settings failed to visualize PRLs.
  • Increased TE and higher FA significantly improved PRL visibility.
  • Phase images consistently demonstrated PRLs across different parameters.

Conclusions:

  • PRL visibility on SWI is highly dependent on specific scan parameters.
  • Optimizing TE and FA is essential for reliable PRL detection in multiple sclerosis.
  • Suboptimal SWI settings can lead to missed PRL diagnoses.