scholarly journals Histopathology-validated recommendations for cortical lesion imaging in multiple sclerosis

Brain ◽  
2020 ◽  
Vol 143 (10) ◽  
pp. 2988-2997
Author(s):  
Piet M Bouman ◽  
Martijn D Steenwijk ◽  
Petra J W Pouwels ◽  
Menno M Schoonheim ◽  
Frederik Barkhof ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Sensitivity And Specificity ◽  
Inversion Recovery ◽  
Double Inversion Recovery ◽  
Cortical Lesion ◽  
Proton Density ◽  
Cortical Lesions ◽  
Phase Sensitive Inversion Recovery ◽  
Mri Sequences ◽  
Phase Sensitive

Abstract Cortical demyelinating lesions are clinically important in multiple sclerosis, but notoriously difficult to visualize with MRI. At clinical field strengths, double inversion recovery MRI is most sensitive, but still only detects 18% of all histopathologically validated cortical lesions. More recently, phase-sensitive inversion recovery was suggested to have a higher sensitivity than double inversion recovery, although this claim was not histopathologically validated. Therefore, this retrospective study aimed to provide clarity on this matter by identifying which MRI sequence best detects histopathologically-validated cortical lesions at clinical field strength, by comparing sensitivity and specificity of the thus far most commonly used MRI sequences, which are T2, fluid-attenuated inversion recovery (FLAIR), double inversion recovery and phase-sensitive inversion recovery. Post-mortem MRI was performed on non-fixed coronal hemispheric brain slices of 23 patients with progressive multiple sclerosis directly after autopsy, at 3 T, using T1 and proton-density/T2-weighted, as well as FLAIR, double inversion recovery and phase-sensitive inversion recovery sequences. A total of 93 cortical tissue blocks were sampled from these slices. Blinded to histopathology, all MRI sequences were consensus scored for cortical lesions. Subsequently, tissue samples were stained for proteolipid protein (myelin) and scored for cortical lesion types I–IV (mixed grey matter/white matter, intracortical, subpial and cortex-spanning lesions, respectively). MRI scores were compared to histopathological scores to calculate sensitivity and specificity per sequence. Next, a retrospective (unblinded) scoring was performed to explore maximum scoring potential per sequence. Histopathologically, 224 cortical lesions were detected, of which the majority were subpial. In a mixed model, sensitivity of T1, proton-density/T2, FLAIR, double inversion recovery and phase-sensitive inversion recovery was 8.9%, 5.4%, 5.4%, 22.8% and 23.7%, respectively (20, 12, 12, 51 and 53 cortical lesions). Specificity of the prospective scoring was 80.0%, 75.0%, 80.0%, 91.1% and 88.3%. Sensitivity and specificity did not significantly differ between double inversion recovery and phase-sensitive inversion recovery, while phase-sensitive inversion recovery identified more lesions than double inversion recovery upon retrospective analysis (126 versus 95; P < 0.001). We conclude that, at 3 T, double inversion recovery and phase-sensitive inversion recovery sequences outperform conventional sequences T1, proton-density/T2 and FLAIR. While their overall sensitivity does not exceed 25%, double inversion recovery and phase-sensitive inversion recovery are highly pathologically specific when using existing scoring criteria and their use is recommended for optimal cortical lesion assessment in multiple sclerosis.

scholarly journals Correlation of cortical lesions of multiple sclerosis at double inversion recovery with cognition screening scores

2021 ◽  
Vol 57 (1) ◽  
Author(s):  
Sally Mohamed Shaaban ◽  
Azza Elmongui Elmongui ◽  
Ahmed Abdel Khalek Abdel Razek ◽  
Tamer Mohamed Belal
Keyword(s):  
Multiple Sclerosis ◽  
Gray Matter ◽  
Inverse Correlation ◽  
Inversion Recovery ◽  
Double Inversion Recovery ◽  
Cortical Lesion ◽  
Cortical Lesions ◽  
Lesion Load ◽  
Significant Inverse Correlation ◽  
Lesion Number

Abstract Background Multiple sclerosis is a chronic inflammatory disease affecting both white and gray matters of the central nervous system. It has been approved that the degree of gray matter involvement is closely associated with the degree of physical disability and the extent of cognitive impairment. Thus, it is necessary to incorporate widely available simple methods for neurocognitive evaluation and gray matter detection in the periodic assessment of MS patients that will influence treatment decisions. Objectives To assess the correlation of cortical lesions of multiple sclerosis (MS) at double inversion recovery (DIR) with cognition screening scores Methods This study was conducted on 30 patients with MS with an average age of 31.3±13.6 years. All of them underwent MRI and clinical assessment with the calculation of Expanded Disability Status Scale (EDSS), Montreal Cognitive Assessment (MoCA), and Symbol Digit Modality Test (SDMT) scores. The image analysis was performed by 2 reviewers for cortical lesion number, shape, and subtypes, and total lesion load. Results Both MoCA and SDMT scales had a significant inverse correlation with cortical lesions number (r=− 0.68, − 0.72) respectively and total lesion load (r=− 0.53, − 0.65) respectively. Besides, there was a significant inverse correlation between the MoCA test, varied cortical subtypes: leukocortical, juxtacortical, and intracortical subtypes (r = − 0.63, − 0.56, − 0.52) respectively, and different cortical lesion shapes: oval, wedge, and curvilinear shaped (r = − 0.62, − 0.69, − 0.49) respectively. As well, the SDMT scale showed a significant inverse correlation with varied cortical subtypes: intracortical, leukocortical, and juxtacortical subtypes (r = − 0.63, − 0.61, − 0.57) respectively, and different cortical lesion shapes: oval, curvilinear, and wedge shaped (r = − 0.61, − 0.59, − 0.46) respectively. Interestingly, there was an excellent inter-observer correlation of cortical lesion number (r = 0.96), total lesion load (r = 0.95), subtypes of cortical lesion (r = 0.94), and cortical lesion shapes (r = 0.77). Conclusion We concluded that DIR can detect cortical lesions of MS, and MRI findings were well-correlated with cognitive dysfunction in these patients.

scholarly journals Artificial double inversion recovery images for (juxta)cortical lesion visualization in multiple sclerosis

2021 ◽  
pp. 135245852110298
Author(s):  
Piet M Bouman ◽  
Victor IJ Strijbis ◽  
Laura E Jonkman ◽  
Hanneke E Hulst ◽  
Jeroen JG Geurts ◽  
...  
Keyword(s):  
Clinical Care ◽  
Intraclass Correlation ◽  
Lesion Detection ◽  
Inversion Recovery ◽  
Double Inversion Recovery ◽  
Cortical Lesion ◽  
Proton Density ◽  
Cortical Lesions ◽  
Good Reliability ◽  
Ex Post

Background: Cortical lesions are highly inconspicuous on magnetic resonance imaging (MRI). Double inversion recovery (DIR) has a higher sensitivity than conventional clinical sequences (i.e. T1, T2, FLAIR) but is difficult to acquire, leading to overseen cortical lesions in clinical care and clinical trials. Objective: To evaluate the usability of artificially generated DIR (aDIR) images for cortical lesion detection compared to conventionally acquired DIR (cDIR). Methods: The dataset consisted of 3D-T1 and 2D-proton density (PD) T2 images of 73 patients (49RR, 20SP, 4PP) at 1.5 T. Using a 4:1 train:test-ratio, a fully convolutional neural network was trained to predict 3D-aDIR from 3D-T1 and 2D-PD/T2 images. Randomized blind scoring of the test set was used to determine detection reliability, precision and recall. Results: A total of 626 vs 696 cortical lesions were detected on 15 aDIR vs cDIR images (intraclass correlation coefficient (ICC) = 0.92). Compared to cDIR, precision and recall were 0.84 ± 0.06 and 0.76 ± 0.09, respectively. The frontal and temporal lobes showed the largest differences in discernibility. Conclusion: Cortical lesions can be detected with good reliability on artificial DIR. The technique has potential to broaden the availability of DIR in clinical care and provides the opportunity of ex post facto implementation of cortical lesions imaging in existing clinical trial data.

scholarly journals Improved in vivo detection of cortical lesions in multiple sclerosis using double inversion recovery MR imaging at 3 Tesla

2010 ◽  
Vol 20 (7) ◽  
pp. 1675-1683 ◽  
Author(s):  
Birgit Simon ◽  
Stephan Schmidt ◽  
Carsten Lukas ◽  
Jürgen Gieseke ◽  
Frank Träber ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Mr Imaging ◽  
Inversion Recovery ◽  
3 Tesla ◽  
Double Inversion Recovery ◽  
Cortical Lesions ◽  
In Vivo Detection

scholarly journals Comparison of Phase-Sensitive Inversion Recovery and Conventional Magnetic Resonance Imaging for Detection of Cortical Plaques in MS Patients

2021 ◽  
Vol 18 (3) ◽  
Author(s):  
Hassan Hashemi ◽  
Maryam Mohammadzadeh ◽  
Mohammad Hossein Dianat ◽  
Amir Reza Azimi ◽  
Hamed Naghibi ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Disease Progression ◽  
Inversion Recovery ◽  
Cortical Lesions ◽  
Resonance Imaging ◽  
Phase Sensitive Inversion Recovery ◽  
Fluid Attenuated Inversion Recovery ◽  
Phase Sensitive ◽  
The Mean

Background: Precise detection and classification of intracortical (IC) lesions in multiple sclerosis (MS) patients are very important for understanding their role in disease progression and determining their effects on the clinical presentations of the disease. Objectives: This study aimed to evaluate the efficacy of phase-sensitive inversion recovery (PSIR) in delineation of cortical lesions in MS patients. Patients and Methods: This cross-sectional, single-center study was performed among 38 patients with the mean age of 31 years, who were recruited from December 2018 to August 2020. All MS patients underwent magnetic resonance imaging (MRI), using a 1.5-Tesla scanner. Two expert neuroradiologists interpreted the fluid-attenuated inversion recovery (FLAIR), T2-weighted turbo spin echo (T2W-TSE), and PSIR images. The lesions were classified as purely IC, mixed gray/white matter (WM) [leukocortical (LC)], and juxtacortical (JC). The number of lesions in each region was compared between the FLAIR, T2W-TSE, and PSIR sequences. Results: The number of cortical lesions (IC and LC) was significantly higher in PSIR compared to T2W-TSE and Fluid attenuated inversion recovery (FLAIR) (P < 0.001), while the number of JC lesions was lower; in other words, the mean number of plaques was higher in T2W-TSE and FLAIR as compared to PSIR. Conclusion: The PSIR sequence significantly improved the delineation of cortical lesions and could be useful in monitoring cortical injuries and disease progression in MS patients.

scholarly journals Reliability of cortical lesion detection on double inversion recovery MRI applying the MAGNIMS-Criteria in multiple sclerosis patients within a 16-months period

PLoS ONE ◽  
2017 ◽  
Vol 12 (2) ◽  
pp. e0172923 ◽  
Author(s):  
Tobias Djamsched Faizy ◽  
Christian Thaler ◽  
Tim Ceyrowski ◽  
Gabriel Broocks ◽  
Natascha Treffler ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Lesion Detection ◽  
Inversion Recovery ◽  
Double Inversion Recovery ◽  
Cortical Lesion ◽  
Multiple Sclerosis Patients
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