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Interscanner variation in brain MR lesion load measurements in multiple sclerosis using conventional spin-echo, rapid
M Filippi1, M A Rocca, C Gasperini
1Department of Neuroscience, Scientific Institute Ospedale San Raffaele, Milan, Italy.
Background And Purpose:
Different MR pulse sequences have been proposed for measuring multiple sclerosis (MS)-related abnormalities. The reproducibility of measured brain MS lesion volumes was compared for MR images performed using different scanners and different pulse sequences.
Methods:
Nine patients with relapsing-remitting MS were each imaged on two scanners and, on each occasion, dual-echo conventional spin-echo, dual-echo rapid-acquisition relaxation-enhanced (RARE), and fast fluid-attenuated inversion recovery (fast-FLAIR) images were obtained. The lesion volume present on each image was evaluated three times by a single observer in random order, using a local thresholding technique.
Results:
The mean lesion volumes present on fast-FLAIR images were significantly higher than those measured on dual-echo conventional spin-echo and RARE images. The mean intraobserver coefficients of variation for the different sequences and scanners ranged from 3.0% to 4.2% (no statistically significant difference). For each of the sequences, the use of different scanners introduced a variability that was higher than the intraobserver variability: the interscanner coefficient of variation was 7.4% for conventional spin-echo, 9.5% for RARE, and 18.5% for fast-FLAIR images.
Conclusion:
Our study confirms that the use of different scanners significantly influences lesion loads measured from MR images of patients with MS and establishes that newer sequences are more susceptible to measurement variability. It also indicates that, if newer sequences are to be used in clinical trials, careful standardization is needed.
Insights
Comparing magnetic resonance imaging (MRI) sequences for multiple sclerosis (MS) lesion volume measurement reveals that different scanners significantly impact results. Newer sequences like fast fluid-attenuated inversion recovery (fast-FLAIR) show greater variability, necessitating standardization for clinical trials.
Area of Science:
- Neuroimaging
- Radiology
- Medical Physics
Background:
- Multiple sclerosis (MS) diagnosis and monitoring rely on detecting brain abnormalities using magnetic resonance imaging (MRI).
- Various MRI pulse sequences exist for quantifying MS-related lesions, but their reproducibility across different scanners and sequences is crucial for reliable assessment.
Purpose of the Study:
- To compare the reproducibility of brain lesion volume measurements in multiple sclerosis (MS) patients using different MRI scanners and pulse sequences.
- To evaluate the impact of scanner variability and sequence choice on the accuracy of MS lesion load quantification.
Main Methods:
- Nine relapsing-remitting MS patients underwent MRI scans on two different scanners.
- Dual-echo conventional spin-echo, dual-echo rapid-acquisition relaxation-enhanced (RARE), and fast fluid-attenuated inversion recovery (fast-FLAIR) sequences were acquired.
- Lesion volumes were assessed three times by a single observer using local thresholding.
Main Results:
- Fast-FLAIR sequences yielded significantly higher mean lesion volumes compared to conventional spin-echo and RARE sequences.
- Intraobserver variability was consistent across sequences and scanners (3.0%-4.2%).
- Interscanner variability was higher than intraobserver variability, particularly for fast-FLAIR (18.5%), RARE (9.5%), and conventional spin-echo (7.4%).
Conclusions:
- Scanner differences significantly influence MS lesion load measurements derived from MRI.
- Newer MRI sequences, such as fast-FLAIR, are more susceptible to measurement variability.
- Standardization of MRI sequences and protocols is essential for multi-center clinical trials involving MS patients.