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 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 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 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

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.

Acute severe memory impairment as a presenting symptom of multiple sclerosis: a clinical case study with 3D double inversion recovery MR imaging

2010 ◽  
Vol 16 (12) ◽  
pp. 1521-1524 ◽  
Author(s):  
JAF Coebergh ◽  
SD Roosendaal ◽  
CH Polman ◽  
JJ Geurts ◽  
TCAM van Woerkom
Keyword(s):  
Multiple Sclerosis ◽  
Memory Impairment ◽  
Clinical Symptoms ◽  
Neuropsychological Testing ◽  
Three Dimensional ◽  
Inversion Recovery ◽  
Double Inversion Recovery ◽  
Cortical Lesions ◽  
Mri Imaging ◽  
Clinical Case Study

We present the case of a 21-year-old woman with acute memory impairment. It was initially not recognized as organic in nature. Repeated neuropsychological testing confirmed severely disturbed encoding and recall. Three-dimensional double inversion recovery (3D-DIR) MRI confirmed hippocampal and cortical lesions. Further clinical symptoms, visual evoked potential and MRI suggested a diagnosis of multiple sclerosis (MS). The amnestic syndrome has remained for 5 years. This case illustrates that MS can present with acute cortical symptoms which can be difficult to recognize. The hippocampus can be acutely affected and DIR MRI imaging can help to demonstrate cortical lesions that explain the clinical picture.

Cortical lesion load correlates with diffuse injury of multiple sclerosis normal appearing white matter

2013 ◽  
Vol 20 (2) ◽  
pp. 227-233 ◽  
Author(s):  
Niraj Mistry ◽  
Rasha Abdel-Fahim ◽  
Olivier Mougin ◽  
Christopher Tench ◽  
Penny Gowland ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
White Matter ◽  
Cortical Lesion ◽  
Cortical Lesions ◽  
Magnetisation Transfer ◽  
Magnetisation Transfer Ratio ◽  
Lesion Load ◽  
Transfer Ratio ◽  
Normal Appearing White Matter ◽  
Axon Loss

Background:Degeneration of central nervous system normal appearing white matter (NAWM) underlies disability and progression in multiple sclerosis (MS). Axon loss typifies NAWM degeneration.Objective:The objective of this paper is to assess correlation between cortical lesion load and magnetisation transfer ratio (MTR) of the NAWM in MS. This was in order to test the hypothesis that cortical lesions cause NAWM degeneration.Methods:Nineteen patients with MS underwent 7 Tesla magnetisation-prepared-rapid-acquisition-gradient-echo (MPRAGE), and magnetisation transfer ratio (MTR) brain magnetic resonance imaging (MRI). Cortical lesions were identified using MPRAGE and MTR images of cortical ribbons. White matter lesions (WMLs) were segmented using MPRAGE images. WML maps were subtracted from white matter volumes to produce NAWM masks. Pearson correlation was calculated for NAWM MTR vs cortical lesion load, and WML volumes.Results:Cortical lesion volumes and counts all had significant correlation with NAWM mean MTR. The strongest correlation was with cortical lesion volumes obtained using MTR images ( r = −0.6874, p = 0.0006). WML volume had no significant correlation with NAWM mean MTR ( r = −0.08706, p = 0.3615).Conclusion:Our findings are consistent with the hypothesis that cortical lesions cause NAWM degeneration. This implicates cortical lesions in the pathogenesis of NAWM axon loss, which underpins long-term disability and progression in MS.

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