Biplanar MRI for the assessment of the spinal cord in multiple sclerosis

2012 ◽  
Vol 18 (11) ◽  
pp. 1560-1569 ◽  
Author(s):  
Katrin Weier ◽  
Jilla Mazraeh ◽  
Yvonne Naegelin ◽  
Alain Thoeni ◽  
Jochen G Hirsch ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Spinal Cord ◽  
Parallel Imaging ◽  
Proton Density ◽  
Imaging Data ◽  
Lesion Count ◽  
Focal Lesions ◽  
Mri Findings ◽  
Reporting Scheme ◽  
Functional Scores

Objective: To investigate the entire spinal cord (SC) of multiple sclerosis (MS) patients with biplanar MRI and to relate these MRI findings to clinical functional scores. Methods: Two hundred and two patients (140 women, 62 men 24–74 years, Expanded Disability Status Scale (EDSS) scores 0–7.5) were investigated clinically and with biplanar MRI. Sagittal and axial proton density weighted (PDw) and T2 weighted (T2w) images of the whole SC were obtained employing parallel imaging. Data were analyzed by consensus reading using a standardized reporting scheme. Different combinations of findings were compared to EDSS scores with Spearman’s rank correlation coefficient (ρ). Results: The combined analysis of sagittal and axial planes demonstrated slightly differing results in 97/202 (48%) patients. There were 9% additional lesions identified, leading to a higher lesion count in 28% of these patients, but also rejection of equivocal abnormality leading to a lower lesion count in 11% of patients. Considering both sagittal and axial images, SC abnormalities were found in 167/202 (83%) patients. When compared with EDSS scores, the combination of focal lesions, signs of atrophy and diffuse abnormalities showed a moderate correlation (ρ=0.52), that precludes its use for individual patient assessment. Conclusion: Biplanar MRI facilitates a comprehensive identification, localization, and grading of pathological SC findings in MS patients. This improves the confidence and utility of SC imaging.

scholarly journals Multiple Sclerosis Of The Spinal Cord: Is Gadolinium Irreplaceable In Assessing Lesion Activity?

2013 ◽  
Vol 59 (3) ◽  
pp. 158-161
Author(s):  
Constantina Andrada Treabă ◽  
M Buruian ◽  
Rodica Bălașa ◽  
Maria Daniela Podeanu ◽  
I P Simu ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Spinal Cord ◽  
Magnetic Resonance ◽  
Contrast Enhancement ◽  
Signs And Symptoms ◽  
Magnetic Resonance Images ◽  
Type I ◽  
Focal Lesions ◽  
Spinal Cord Lesions ◽  
Active Lesion

Abstract Purpose: To evaluate the relationship between the T2 patterns of spinal cord multiple sclerosis lesions and their contrast uptake. Material and method: We retrospectively reviewed the appearance of spinal cord lesions in 29 patients (with relapsing-remitting multiple sclerosis) who had signs and symptoms of myelopathy on neurologic examination and at least one active lesion visualized on magnetic resonance examinations performed between 2004 and 2011. We correlated the T2 patterns of lesions with contrast enhancement and calculated sensitivity and specificity in predicting gadolinium enhancement. Results: Only focal patterns consisting of a lesion’s center homogenously brighter than its periphery on T2-weighed images (type I) correlated significantly with the presence of contrast enhancement (p = 0.004). Sensitivity was 0.307 and specificity 0.929. In contrast, enhancement was not significantly related to uniformly hyperintense T2 focal lesions (type II) or diffuse (type III) pattern defined as poorly delineated areas of multiple small, confluent, subtle hyperintense T2 lesions (p > 0.5 for both). Conclusions: We believe that information about the activity of multiple sclerosis spinal cord lesions in patients with myelopathy may be extracted not only from contrast enhanced, but also from non-enhanced magnetic resonance images.

scholarly journals Deep learning segmentation of gadolinium-enhancing lesions in multiple sclerosis

2020 ◽  
pp. 135245852092136 ◽  
Author(s):  
Ivan Coronado ◽  
Refaat E Gabr ◽  
Ponnada A Narayana
Keyword(s):  
Multiple Sclerosis ◽  
Deep Learning ◽  
Network Performance ◽  
Three Dimensional ◽  
Proton Density ◽  
Dice Similarity Coefficient ◽  
Lesion Volume ◽  
Imaging Data ◽  
Post Contrast ◽  
Fluid Attenuated Inversion Recovery

Objective: The aim of this study is to assess the performance of deep learning convolutional neural networks (CNNs) in segmenting gadolinium-enhancing lesions using a large cohort of multiple sclerosis (MS) patients. Methods: A three-dimensional (3D) CNN model was trained for segmentation of gadolinium-enhancing lesions using multispectral magnetic resonance imaging data (MRI) from 1006 relapsing–remitting MS patients. The network performance was evaluated for three combinations of multispectral MRI used as input: (U5) fluid-attenuated inversion recovery (FLAIR), T2-weighted, proton density-weighted, and pre- and post-contrast T1-weighted images; (U2) pre- and post-contrast T1-weighted images; and (U1) only post-contrast T1-weighted images. Segmentation performance was evaluated using the Dice similarity coefficient (DSC) and lesion-wise true-positive (TPR) and false-positive (FPR) rates. Performance was also evaluated as a function of enhancing lesion volume. Results: The DSC/TPR/FPR values averaged over all the enhancing lesion sizes were 0.77/0.90/0.23 using the U5 model. These values for the largest enhancement volumes (>500 mm3) were 0.81/0.97/0.04. For U2, the average DSC/TPR/FPR values were 0.72/0.86/0.31. Comparable performance was observed with U1. For all types of input, the network performance degraded with decreased enhancement size. Conclusion: Excellent segmentation of enhancing lesions was observed for enhancement volume ⩾70 mm3. The best performance was achieved when the input included all five multispectral image sets.

Whole spinal cord MRI as a routine screening examination in multiple sclerosis – use of parallel imaging

2006 ◽  
Vol 33 (S 1) ◽  
Author(s):  
K. Weier ◽  
Y. Naegelin ◽  
J. Hirsch ◽  
A. Thoeni ◽  
L. Kappos ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Spinal Cord ◽  
Parallel Imaging ◽  
Routine Screening ◽  
Screening Examination

scholarly journals Grey matter involvement by focal cervical spinal cord lesions is associated with progressive multiple sclerosis

2015 ◽  
Vol 22 (7) ◽  
pp. 910-920 ◽  
Author(s):  
Hugh Kearney ◽  
Katherine A Miszkiel ◽  
Marios C Yiannakas ◽  
Daniel R Altmann ◽  
Olga Ciccarelli ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Spinal Cord ◽  
Grey Matter ◽  
Cervical Spinal Cord ◽  
Spinal Cord Lesion ◽  
Cervical Cord ◽  
Focal Lesions ◽  
Lateral Column ◽  
Cord Lesion

Background: The in vivo relationship of spinal cord lesion features with clinical course and function in multiple sclerosis (MS) is poorly defined. Objective: The objective of this paper is to investigate the associations of spinal cord lesion features on MRI with MS subgroup and disability. Methods: We recruited 120 people: 25 clinically isolated syndrome, 35 relapsing–remitting (RR), 30 secondary progressive (SP), and 30 primary progressive (PP) MS. Disability was measured using the Expanded Disability Status Scale. We performed 3T axial cervical cord MRI, using 3D-fast-field-echo and phase-sensitive-inversion-recovery sequences. Both focal lesions and diffuse abnormalities were recorded. Focal lesions were classified according to the number of white matter (WM) columns involved and whether they extended to grey matter (GM). Results: The proportion of patients with focal lesions involving at least two WM columns and extending to GM was higher in SPMS than in RRMS ( p = 0.03) and PPMS ( p = 0.015). Diffuse abnormalities were more common in both PPMS and SPMS, compared with RRMS (OR 6.1 ( p = 0.002) and 5.7 ( p = 0.003), respectively). The number of lesions per patient involving both the lateral column and extending to GM was independently associated with disability ( p < 0.001). Conclusions: More extensive focal cord lesions, extension of lesions to GM, and diffuse abnormalities are associated with progressive MS and disability.

Proton Density Fat Suppressed MRI in 3T Increases the Sensitivity of Multiple Sclerosis Lesion Detection in the Cervical Spinal Cord

2017 ◽  
Vol 29 (1) ◽  
pp. 45-50
Author(s):  
Efstratios Karavasilis ◽  
George Velonakis ◽  
George Argiropoulos ◽  
Athanasios Athanasakos ◽  
Loukia S Poulou ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Spinal Cord ◽  
Cervical Spinal Cord ◽  
Lesion Detection ◽  
Multiple Sclerosis Lesion ◽  
Proton Density

scholarly journals Comparison of proton density MRI and T2-Weighted Fast Echo for The Detection of Cervical Spinal Cord Multiple Sclerosis Lesions

2019 ◽  
Vol 60 (4) ◽  
pp. 195-201
Author(s):  
Iman Emad Ahmed ◽  
Hayder Kareem Al-Jaberi ◽  
Mohammed M. Jawad Alkahlissi
Keyword(s):  
Multiple Sclerosis ◽  
Spinal Cord ◽  
Cervical Spinal Cord ◽  
Spin Echo ◽  
Fast Spin Echo ◽  
Cervical Cord ◽  
Proton Density ◽  
P Value ◽  
Cross Sectional ◽  
Fast Spin

Background: The prevalence of spinal cord lesions is high in multiple sclerosis particularly in the cervical cord, and their detection can assist in both the diagnosis and follow-up of the patients. For spinal multiple sclerosis, MRI is considered the first line investigation. Objective: To evaluate the value of sagittal 1.5 Tesla proton density-fast spin echo (PD-FSE) MRI in the detecting and increasing conspicuity of multiple sclerosis lesions in cervical cord in comparison with sagittal T2 fast spin-echo (T2-FSE) MRI. Patients and Methods: A cross sectional study carried out from 3rd of January 2017 to 1st of January 2018 in the MRI department of Al-Imamein Al-Kadhimein Medical City, and included 60 selected patients with a known diagnosis of multiple sclerosis. All patients were examined with 1.5 T sagittal PD-FSE, T2-FSE and axial gradient recalled-echo (GRE) MRI. Results: Sixty patients with cervical multiple sclerosis were enrolled in the study, 146 (100%) lesions were detected by PD-FSE imaging, while T2 detected 105 (71.9%), 41 more lesions (28%) were detected by PD-FSE imaging, (P-value <0.001). All extra lesions were confirmed on axial imaging. In 13 patients (21.6%) one lesion or more had been detected on sagittal PD-FSE imaging while on sagittal T2-FSE imaging, no lesion were detected. On PD-FSE imaging, 17 long lesions were detected in 16 patients (26.7%) while 7 long lesions in 7 patients (11.7%) were detected by T2-FSE imaging. So, in 9 patients (16.7%) 10 lesions were detected as long in PD-FSE while short lesion in T2– FSE, the detection of long lesions by PD-FSE was significantly higher than in T2– FSE (100% vs 71.9% with p- value of 0.002). The mean lesion contrast to cord ratio was significantly higher in PD-FSE as compared to T2-FSE (PD-FSE, 79±2.0, against T2-FSE, 61± 2.6; P-value <0.001). Conclusion: Sagittal proton density was more efficient and more accurate in the detection of cervical cord lesions than sagittal T2-FSE sequence, when used in conjunction with sagittal T2-FSE; it can raise the diagnostic assurance via improving the visualization of the lesions. 

Acute to Subacute Spinal Cord Infarction Mimicking Acute Multiple Sclerosis: Usefulness of Diffusion-Weighted MRI for Diagnosis

2022 ◽  
Vol 18 ◽  
Author(s):  
Kyoung Yeon Lee ◽  
Eun Kyung Khil ◽  
Sang Won Jo ◽  
Min Uk Jang ◽  
Jung-Ah Choi ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Spinal Cord ◽  
Brain Infarction ◽  
Brain Magnetic Resonance Imaging ◽  
Visual Field Defects ◽  
Unknown Etiology ◽  
Spinal Cord Infarction ◽  
Mri Findings ◽  
Subacute Phase ◽  
Diffusion Weighted

Background: Spinal cord infarction (SCI) is difficult to diagnose because of its rarity, unknown etiology, and unestablished diagnostic criteria. Additionally, the timeline of SCI has not been studied in detail, as few studies using diffusion-weighted image (DWI) sequences of the spine of a small target population have been previously conducted. Case Study: A 56-year-old male with underlying arrhythmia suddenly developed visual field defects on the right side, pain in the left upper extremity, and a tingling sensation in the left hand. Brain Magnetic resonance imaging (MRI) revealed acute to subacute stages of multifocal brain infarction. On additional cervical spinal MRI, it showed atypical MRI findings of SCI, considered late acute to early subacute phase, which were similar to those seen in the acute phase of multiple sclerosis (MS). Additional DWI revealed restricted diffusion. From these findings, it could be inferred that the patient’s SCI occurred at the same time as the multifocal brain infarctions caused by atrial fibrillation. Conclusion: A DWI sequence of spine MRI could be helpful in the diagnosis of acute to subacute phase SCI and in differentiating with acute MS.

Atrophy and structural variability of the upper cervical cord in early multiple sclerosis

2014 ◽  
Vol 21 (7) ◽  
pp. 875-884 ◽  
Author(s):  
Viola Biberacher ◽  
Christine C Boucard ◽  
Paul Schmidt ◽  
Christina Engl ◽  
Dorothea Buck ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Spinal Cord ◽  
Brain Magnetic Resonance Imaging ◽  
Cervical Cord ◽  
Focal Lesions ◽  
Spinal Cord Atrophy ◽  
Cross Sectional ◽  
Structural Variability ◽  
Upper Cervical ◽  
In Cis

Background: Despite agreement about spinal cord atrophy in progressive forms of multiple sclerosis (MS), data on clinically isolated syndrome (CIS) and relapsing–remitting MS (RRMS) are conflicting. Objective: To determine the onset of spinal cord atrophy in the disease course of MS. Methods: Structural brain magnetic resonance imaging (MRI) was acquired from 267 patients with CIS (85) or RRMS (182) and 64 healthy controls (HCs). The upper cervical cord cross-sectional area (UCCA) was determined at the level of C2/C3 by a segmentation tool and adjusted for focal MS lesions. The coefficient of variation (CV) was calculated from all measurements between C2/C3 and 13 mm above as a measure of structural variability. Results: Compared to HCs (76.1±6.9 mm2), UCCA was significantly reduced in CIS patients (73.5±5.8 mm2, p=0.018) and RRMS patients (72.4±7.0 mm2, p<0.001). Structural variability was higher in patients than in HCs, particularly but not exclusively in case of focal lesions (mean CV HCs/patients without/with lesions: 2.13%/2.55%/3.32%, all p-values<0.007). UCCA and CV correlated with Expanded Disability Status Scale (EDSS) scores ( r =−0.131/0.192, p=0.044/<0.001) and disease duration ( r=−0.134/0.300, p=0.039/< 0.001). CV additionally correlated with hand and arm function ( r=0.180, p=0.014). Conclusion: In MS, cervical cord atrophy already occurs in CIS. In early stages, structural variability may be a more meaningful marker of spinal cord pathology than atrophy.

Cortical relapses in multiple sclerosis

2016 ◽  
Vol 22 (9) ◽  
pp. 1184-1191 ◽  
Author(s):  
Marco Puthenparampil ◽  
Davide Poggiali ◽  
Francesco Causin ◽  
Giuseppe Rolma ◽  
Francesca Rinaldi ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Acute Onset ◽  
Inversion Recovery ◽  
Motor Deficit ◽  
Psychotic Symptoms ◽  
Cognitive Disability ◽  
Cortical Lesions ◽  
Focal Lesions ◽  
Mri Findings ◽  
Magnetic Resonance Imaging Mri

Background: Multiple sclerosis (MS) is a white and grey matter disease of the central nervous system (CNS). It is recognized that cortical damage (i.e. focal lesions and atrophy) plays a role in determining the accumulation of physical and cognitive disability that is observed in patients with progressive MS. To date, an association of cortical lesions with clinical relapses has not been described. Results: We report clinical and magnetic resonance imaging (MRI) findings of five relapsing–remitting MS (RRMS) patients who had clinical relapses characterized by the acute appearance of cortical symptoms, due to the development of large, snake-like, cortical inflammatory lesions. Symptoms were: acute Wernicke’s aphasia mimicking stroke; agraphia with acalculia, not associated to a motor deficit nor linguistic disturbance; hyposthenia of the left arm, followed by muscle twitching of the hand, spreading to arm and face; acute onset of left lower limb paroxysmal hypertonia; and temporal lobe status epilepticus, with psychotic symptoms. Conclusions: Cortical relapses may occur in MS. MRI examination in MS should include sequences, such as double inversion recovery (DIR) or phase sensitive inversion recovery (PSIR), that are aimed at visualizing cortical lesions, especially in the presence of symptoms of cortical dysfunction. Our observation further stresses and extends the clinical relevance of cortical pathology in MS.

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