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Multiple sclerosis lesion detection in the brain: a comparison of fast fluid-attenuated inversion recovery and
M L Gawne-Cain1, J I O'Riordan, A J Thompson
1NMR Research Unit, Institute of Neurology, London, UK.
Abstract:
We performed fast fluid-attenuated inversion recovery (fFLAIR) and conventional spin echo (CSE) brain MRI in 32 multiple sclerosis (MS) patients (eight each benign, relapsing-remitting, primary progressive, and secondary progressive). We compared number and site of lesions detected on each sequence. With initial separate assessment, we identified a total of 3,668 lesions-2,892 by CSE and 2,943 by fFLAIR. Following simultaneous review of the sequences, we identified an additional 217 lesions on fFLAIR and 229 on CSE. fFLAIR detected fewer lesions in the posterior fossa (66 versus 138, p = 0.001), fewer small (< 5 mm) discrete cerebral white matter lesions (671 versus 829, p = 0.0002), more subcortical lesions (542 versus 306, p < 0.0001), and more large discrete lesions (419 versus 385, p = 0.0006). Its relatively poor detection of posterior fossa lesions makes it premature for fFLAIR to replace CSE as the primary sequence for detecting MS lesions in clinical trials.
Insights
Fast fluid-attenuated inversion recovery (fFLAIR) MRI detects more subcortical and large lesions in multiple sclerosis (MS) patients. However, conventional spin echo (CSE) remains superior for posterior fossa lesion detection in MS.
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- Multiple sclerosis (MS) is a chronic neurological disease characterized by demyelination and axonal damage in the central nervous system.
- Accurate lesion detection in MS is crucial for diagnosis, monitoring disease progression, and evaluating treatment efficacy.
- Conventional spin echo (CSE) and fast fluid-attenuated inversion recovery (fFLAIR) are MRI sequences used to visualize brain lesions.
Purpose of the Study:
- To compare the lesion detection capabilities of fFLAIR and CSE MRI sequences in patients with multiple sclerosis.
- To assess the differences in lesion number and location between fFLAIR and CSE across various MS subtypes.
Main Methods:
- Brain MRI was performed using fFLAIR and CSE sequences in 32 patients with multiple sclerosis (eight each of benign, relapsing-remitting, primary progressive, and secondary progressive subtypes).
- Lesions were initially assessed separately for each sequence, followed by a simultaneous review.
- Statistical analysis was used to compare lesion counts and locations between the two MRI sequences.
Main Results:
- A total of 3,668 lesions were identified, with 2,892 by CSE and 2,943 by fFLAIR. An additional 217 lesions were detected by fFLAIR and 229 by CSE upon simultaneous review.
- fFLAIR detected significantly fewer posterior fossa lesions (66 vs. 138, p = 0.001) and smaller discrete cerebral white matter lesions (< 5 mm) (671 vs. 829, p = 0.0002).
- fFLAIR identified more subcortical lesions (542 vs. 306, p < 0.0001) and more large discrete lesions (419 vs. 385, p = 0.0006) compared to CSE.
Conclusions:
- While fFLAIR demonstrates advantages in detecting subcortical and large lesions in MS, its lower sensitivity in the posterior fossa suggests it is not yet suitable to replace CSE as the primary sequence for MS lesion detection in clinical trials.
- Further research may be needed to optimize fFLAIR parameters or combine sequences for comprehensive MS lesion detection.