Gadolinium-Enhanced 3D T1-Weighted Black-Blood MR Imaging for the Detection of Acute Optic Neuritis

I. Riederer; N. Sollmann; M. Mühlau; C. Zimmer; J.S. Kirschke

doi:10.3174/ajnr.A6807

Abstract

BACKGROUND AND PURPOSE: A 3D T1-weighted black-blood sequence was recently shown to improve the detection of contrast-enhancing lesions in the brain in patients with MS compared with a 3D T1-weighted MPRAGE sequence. We compared a contrast-enhanced 3D T1-weighted black-blood sequence with a dedicated orbital contrast-enhanced T1-weighted Dixon sequence in patients with acute optic neuritis.

MATERIALS AND METHODS: MR imaging data (3T) of 51 patients showing symptoms of acute optic neuritis were analyzed retrospectively, including whole-brain contrast-enhanced 3D T1-weighted black-blood and dedicated orbital coronal 2D or 3D contrast-enhanced T1-weighted Dixon sequences. Two neuroradiologists assessed the images for overall image quality, artifacts, diagnostic confidence, and visual contrast enhancement. Furthermore, the standardized contrast-to-noise ratio was calculated. The final diagnosis of acute optic neuritis was established on the basis of clinical presentation, visually evoked potentials, and optical coherence tomography.

RESULTS: Thirty of 51 patients were diagnosed with acute optic neuritis. Of those, 21 showed contrast-enhancing lesions in the optic nerves, similarly detectable on contrast-enhanced T1-weighted Dixon and contrast-enhanced T1-weighted black-blood images. Thus, the accuracy for each sequence was identical, with a resulting sensitivity of 70% and specificity of 90% or 100% (depending on the reader). Overall image quality, diagnostic confidence, visual contrast enhancement, and artifacts were rated similarly in contrast-enhanced 3D T1-weighted black-blood and dedicated orbital contrast-enhanced T1-weighted Dixon sequences. There was no significant difference (P = .27) in the mean standardized contrast-to-noise ratio between contrast-enhanced T1-weighted black-blood (1.76 ± 1.07) and contrast-enhanced T1-weighted Dixon (2.29 ± 2.49) sequences.

CONCLUSIONS: Contrast-enhanced 3D T1-weighted black-blood imaging is comparable in accuracy and qualitative/quantitative features with dedicated orbital contrast-enhanced T1-weighted Dixon imaging for the detection of acute optic neuritis. Therefore, when used, it has the potential to considerably shorten total patient imaging time.

ABBREVIATIONS:

BB: black-blood
DIR: double inversion recovery
FS: fat-suppressed
OCT: optical coherence tomography
ON: optic neuritis
VEP: visually evoked potentials

Footnotes

Paper previously presented, in part, at: Annual Meeting of the European Society for Neuroradiology, September 19–20, Oslo, Norway, and Annual Meeting of the German Society for Neuroradiology, October 9–10, Frankfurt, Germany, as oral presentations, and Annual Meeting of the European Committee for Treatment and Research in Multiple Sclerosis, September 11–13, 2019, Stockholm, Sweden as a poster.
Disclosures: Mark Mühlau—RELATED: Grant: research fund, Comments: German Federal Ministry for Education and Research, German Competence Network Multiple Sclerosis, grant No. 01GI1604A.* Claus Zimmer—RELATED: C. Zimmer disclosed no relevant relationships regarding activities related to the present article. UNRELATED: He has served on scientific advisory boards for Philips and Bayer Schering, serves as co-editor on the Advisory Board of Clinical Neuroradiology, has received speaker honoraria from Bayer Schering and Philips Healthcare; the institution has received research support and investigator fees for clinical studies from Biogen Idec, Quintiles Transnational, Merck Sharp & Dome, Boehringer Ingelheim, Inventive Health Clinical UK Ltd, AdvanceCor Biotechnologie, BrainsGate, Pfizer, Bayer Schering, Novartis, Roche, Servier, Penumbra, WCT GmbH, Syngis, SSS International Clinical Research, PPD Germany GmbH, Worldwide Clinical Trials Ltd, phenox, Covidien, Actelion, Medivation, Medtronic, Harrison Clinical Research, Concentric, PharmTrace, Reverse Medical Corp, Premier Research Germany Ltd, Surpass Medical Ltd, GlaxoSmithKline, AXON Neuroscience, Bristol-Myers Squibb, Genentech, Acandis, Eisai, NeuroRx, Italfarmaco, BioClinica, MIAC Analytics, and IXICO.* No patents issued and pending. Jan S. Kirschke—UNRELATED: Grants/Grants Pending: Deutsche Forschungsgemeinschaft, European Research Council, Nvidia Corporation*; Payment for Lectures Including Service on Speakers Bureaus: Philips Healthcare. *Money paid to the institution.