Cortical plaques visualised by fluid-attenuated inversion recovery imaging in relapsing multiple sclerosis

Area of Science:

• Neuroimaging
• Radiology
• Neurology

Background:

• Multiple Sclerosis (MS) is a demyelinating disease affecting the central nervous system.
• Conventional MRI sequences (T2-weighted, proton density) have limitations in visualizing all MS lesions.
• Cerebrospinal fluid signal can obscure lesions on standard MRI.

Purpose of the Study:

• To evaluate the sensitivity of Fluid-Attenuated Inversion Recovery (FLAIR) MRI sequences in detecting brain lesions in patients with relapsing-remitting Multiple Sclerosis (MS).
• To compare lesion detection rates between FLAIR and conventional MRI sequences (T2-weighted, proton density).
• To assess the distribution and characteristics of MS lesions, including cortical lesions, using FLAIR imaging.

Main Methods:

• Ten patients with clinically definite relapsing MS were examined.
• FLAIR, T2-weighted, proton density (PD), and gadolinium-enhanced T1-weighted MRI sequences were utilized.
• Image acquisition was performed on a 0.5 T imager, assessing feasibility, acquisition time, and image quality.
• Lesion number, distribution, and blood-brain barrier breakdown were analyzed.

Main Results:

• FLAIR sequences demonstrated feasibility and good image quality at 0.5 T.
• FLAIR imaging identified 45% more high-signal lesions compared to T2-weighted or PD images.
• Specifically, 60% more cortical and grey-white interface lesions were detected with FLAIR.
• Cortical lesions, which did not enhance with gadolinium, were present in 70% of patients, accounting for 8% of all identified lesions.

Conclusions:

• FLAIR MRI sequences are more sensitive for detecting cortical and subcortical lesions in MS patients.
• FLAIR imaging enhances visualization of abnormalities missed by conventional MRI techniques.
• This advanced neuroimaging method improves the assessment of lesion burden in active demyelination.