Skip to main content
SpringerLink
Log in

Improved differentiation between MS and vascular brain lesions using FLAIR* at 7 Tesla

  • Neuro
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To investigate whether a new magnetic resonance image (MRI) technique called T2*-weighted fluid attenuation inversion recovery (FLAIR*) can differentiate between multiple sclerosis (MS) and vascular brain lesions, at 7 Tesla (T).

Methods

We examined 16 MS patients and 16 age-matched patients with (risk factors for) vascular disease. 3D-FLAIR and T2*-weighted images were combined into FLAIR* images. Lesion type and intensity, perivascular orientation and presence of a hypointense rim were analysed.

Results

In total, 433 cerebral lesions were detected in MS patients versus 86 lesions in vascular patients. Lesions in MS patients were significantly more often orientated in a perivascular manner: 74 % vs. 47 % (P < 0.001). Ten MS lesions (2.3 %) were surrounded by a hypointense rim on FLAIR*, and 24 MS lesions (5.5 %) were hypointense on T2*. No lesions in vascular patients showed any rim or hypointensity. Specificity of differentiating MS from vascular lesions on 7-T FLAIR* increased when the presence of a central vessel was taken into account (from 63 % to 88 %), most obviously for deep white matter lesions (from 69 % to 94 %). High sensitivity remained (81 %).

Conclusion

7-T FLAIR* improves differentiation between MS and vascular lesions based on lesion location, perivascular orientation and presence of hypointense (rims around) lesions.

Key Points

• A new MRI technique T2*-weighted fluid attenuation inversion recovery (FLAIR*) was investigated.

• FLAIR* at 7-T MRI combines FLAIR and T2* images into a single image.

• FLAIR* at 7 T does not require enhancement with contrast agents.

•High-resolution 7-T FLAIR* improves differentiation between MS and vascular brain lesions.

• FLAIR* revealed a central vessel more frequently in MS than vascular lesions.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Montalban X, Tintoré M, Swanton J et al (2010) MRI criteria for MS in patients with clinically isolated syndromes. Neurology 74:427–434

    Article  CAS  PubMed  Google Scholar 

  2. Polman CH, Reingold SC, Banwell B et al (2011) Diagnostic criteria for multiple sclerosis: 2010 revisions to the “McDonald criteria. Ann Neurol 69:292–302

    Article  PubMed Central  PubMed  Google Scholar 

  3. Fazekas F, Barkhof F, Filippi M et al (1999) The contribution of magnetic resonance imaging to the diagnosis of multiple sclerosis. Neurology 53:448–456

    Article  CAS  PubMed  Google Scholar 

  4. Charil A, Yousry TA, Rovaris M et al (2006) MRI and the diagnosis of multiple sclerosis: expanding the concept of “no better explanation. Lancet Neurol 5:841–852

    Article  PubMed  Google Scholar 

  5. Schmidt R, Schmidt H, Haybaeck J et al (2011) Heterogeneity in age-related white matter changes. Acta neuropathol 122:171–185

    Article  PubMed  Google Scholar 

  6. Pantoni L (2010) Cerebral small vessel disease: from pathogenesis and clinical characteristics to therapeutic challenges. Lancet Neurol 9:689–701

    Article  PubMed  Google Scholar 

  7. Kollia K, Maderwald S, Putzki N et al (2009) First clinical study on ultra-high-field MR imaging in patients with multiple sclerosis: comparison of 1.5 T and 7 T. AJNR Am J Neuroradiol 30:699–702

    Article  CAS  PubMed  Google Scholar 

  8. Mainero C, Benner T, Radding A et al (2009) In vivo imaging of cortical pathology in multiple sclerosis using ultra-high field MRI. Neurology 73:941–948

    Article  PubMed Central  PubMed  Google Scholar 

  9. Pitt D, Boster A, Pei W et al (2010) Imaging cortical lesions in multiple sclerosis with ultra-high-field magnetic resonance imaging. Arch Neurol 67:812–818

    Article  PubMed  Google Scholar 

  10. De Graaf WL, Kilsdonk ID, Lopez-Soriano A et al (2013) Clinical application of multi-contrast 7-T MR imaging in multiple sclerosis: increased lesion detection compared to 3 T confined to grey matter. Eur Radiol 23:528–540

    Article  PubMed  Google Scholar 

  11. Wattjes MP, Barkhof F (2009) High field MRI in the diagnosis of multiple sclerosis: high field-high yield? Neuroradiology 51:279–292

    Article  PubMed  Google Scholar 

  12. Dawson J (1916) The histology of disseminated sclerosis. Trans R Soc Edinburgh 50:517–740

    Article  Google Scholar 

  13. Fog T (1965) The topography of plaques in multiple sclerosis with special reference to cerebral plaques. Act Neurol Scan Suppl 15:1–161

    CAS  Google Scholar 

  14. Ge Y, Zohrabian VM, Grossman RI (2008) Seven-Tesla magnetic resonance imaging: new vision of microvascular abnormalities in multiple sclerosis. Arch Neurol 65:812–816

    PubMed Central  PubMed  Google Scholar 

  15. Tallantyre EC, Brookes MJ, Dixon JE et al (2008) Demonstrating the perivascular distribution of MS lesions in vivo with 7-Tesla MRI. Neurology 70:2076–2078

    Article  CAS  PubMed  Google Scholar 

  16. Hammond KE, Metcalf M, Carvajal L et al (2008) Quantitative in vivo magnetic resonance imaging of multiple sclerosis at 7 Tesla with sensitivity to iron. Ann Neurol 64:707–713

    Article  PubMed  Google Scholar 

  17. Ropele S, de Graaf W, Khalil M et al (2011) MRI assessment of iron deposition in multiple sclerosis. J Magn Reson Imaging 34:13–21

    Article  PubMed  Google Scholar 

  18. Sati P, George IC, Shea CD et al (2012) FLAIR*: a combined MR contrast technique for visualizing white matter lesions and parenchymal veins. Radiology 265:926–932

    Article  PubMed Central  PubMed  Google Scholar 

  19. Conijn MMA, Geerlings MI, Luijten PR et al (2010) Visualization of cerebral microbleeds with dual-echo T2*-weighted magnetic resonance imaging at 7.0 T. J Magn Resance imaging: JMRI 32:52–59

    Article  PubMed  Google Scholar 

  20. Polman CH, Reingold SC, Edan G et al (2005) Diagnostic criteria for multiple sclerosis: 2005 revisions to the “McDonald Criteria. Ann Neurol 58:840–846

    Article  PubMed  Google Scholar 

  21. Visser F, Zwanenburg JJM, Hoogduin JM, Luijten PR (2010) High-resolution magnetization-prepared 3D-FLAIR imaging at 7.0 Tesla. Magn Reson Med 64:194–202

    Article  PubMed  Google Scholar 

  22. Bian W, Harter K, Hammond-Rosenbluth KE et al (2013) A serial in vivo 7 T magnetic resonance phase imaging study of white matter lesions in multiple sclerosis. Mult Scler 19:69–75

    Article  PubMed  Google Scholar 

  23. Grabner G, Dal-Bianco A, Schernthaner M et al (2011) Analysis of multiple sclerosis lesions using a fusion of 3.0 T FLAIR and 7.0 T SWI phase: FLAIR SWI. J Magn Reson Imaging 33:543–549

    Article  PubMed  Google Scholar 

  24. Böhning D, Holling H, Patilea V (2011) A limitation of the diagnostic-odds ratio in determining an optimal cut-off value for a continuous diagnostic test. Stat Methods Med Res 20:541–550

    Article  PubMed  Google Scholar 

  25. Barkhof F, Filippi M, Miller DH et al (1997) Comparison of MRI criteria at first presentation to predict conversion to clinically definite multiple sclerosis. Brain 120:2059–2069

    Article  PubMed  Google Scholar 

  26. Bø L, Vedeler CA, Nyland H et al (2003) Intracortical multiple sclerosis lesions are not associated with increased lymphocyte infiltration. Mult Scler 9:323–331

    Article  PubMed  Google Scholar 

  27. Kilsdonk ID, de Graaf WL, Barkhof F, Wattjes MP (2012) Inflammation high-field magnetic resonance imaging. Neuroimaging Clin N Am 22:135–157

    Article  PubMed  Google Scholar 

  28. Tan IL, van Schijndel RA, Pouwels PJW et al (2000) MR venography of multiple sclerosis. AJNR Am J Neuroradiol 21:1039–1042

    CAS  PubMed  Google Scholar 

  29. Tallantyre EC, Dixon JE, Donaldson I et al (2011) Ultra-high-field imaging distinguishes MS lesions from asymptomatic white matter lesions. Neurology 76:534–539

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  30. Wuerfel J, Sinnecker T, Ringelstein EB et al (2012) Lesion morphology at 7 Tesla MRI differentiates Susac syndrome from multiple sclerosis. Mult Scler 18:1592–1599

    Article  PubMed  Google Scholar 

  31. Sinnecker T, Dörr J, Pfueller CF et al (2012) Distinct lesion morphology at 7-T MRI differentiates neuromyelitis optica from multiple sclerosis. Neurology 79:708–714

    Article  PubMed  Google Scholar 

  32. Lummel N, Boeckh-Behrens T, Schoepf V et al (2011) Presence of a central vein within white matter lesions on susceptibility weighted imaging: a specific finding for multiple sclerosis? Neuroradiology 53:311–317

    Article  PubMed  Google Scholar 

  33. Kau T, Taschwer M, Deutschmann H et al (2013) The “central vein sign”: is there a place for susceptibility weighted imaging in possible multiple sclerosis? Eur Radiol 23:1956–1962

    Article  PubMed  Google Scholar 

  34. Tallantyre EC, Morgan PS, Dixon JE et al (2009) A comparison of 3 T and 7 T in the detection of small parenchymal veins within MS lesions. Invest Radiol 44:491–494

    Article  PubMed  Google Scholar 

  35. Tan IL, Pouwels PJW, van Schijndel RA et al (2002) Isotropic 3D fast FLAIR imaging of the brain in multiple sclerosis patients: initial experience. Eur Radiol 12:559–567

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

This work was supported by the Dutch MS Research Foundation (grant nr 11–769).

Author information

Authors and Affiliations

  1. Department of Radiology, VU University Medical Center, De Boelelaan 1118, 1081, HZ, Amsterdam, The Netherlands

    Iris D. Kilsdonk, Mike P. Wattjes, Alexandra Lopez-Soriano, Marcus C. de Jong, Wolter L. de Graaf, Mandy M. A. Conijn & Frederik Barkhof

  2. Department of Physics and Medical Technology, VU University Medical Center, Amsterdam, The Netherlands

    Joost P. A. Kuijer

  3. Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands

    Chris H. Polman

  4. Department of Radiology, University Medical Center, Utrecht, The Netherlands

    Peter R. Luijten

  5. Department of Anatomy and Neurosciences, VU University, Amsterdam, The Netherlands

    Jeroen J. G. Geurts

  6. Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, The Netherlands

    Mirjam I. Geerlings

Authors
  1. Iris D. Kilsdonk
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mike P. Wattjes
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Alexandra Lopez-Soriano
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Joost P. A. Kuijer
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Marcus C. de Jong
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Wolter L. de Graaf
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Mandy M. A. Conijn
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Chris H. Polman
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Peter R. Luijten
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Jeroen J. G. Geurts
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Mirjam I. Geerlings
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Frederik Barkhof
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Iris D. Kilsdonk.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kilsdonk, I.D., Wattjes, M.P., Lopez-Soriano, A. et al. Improved differentiation between MS and vascular brain lesions using FLAIR* at 7 Tesla. Eur Radiol 24, 841–849 (2014). https://doi.org/10.1007/s00330-013-3080-y

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-013-3080-y

Keywords

Search

Navigation