RT Journal Article
SR Electronic
T1 Low-Field (64 mT) Portable MRI for Rapid Point-of-Care Diagnosis of Dissemination in Space in Patients Presenting with Optic Neuritis
JF American Journal of Neuroradiology
JO Am. J. Neuroradiol.
FD American Society of Neuroradiology
SP 1819
OP 1825
DO 10.3174/ajnr.A8395
VO 45
IS 11
A1 Lim, Timothy Reynold
A1 Suthiphosuwan, Suradech
A1 Micieli, Jonathan
A1 Vosoughi, Reza
A1 Schneider, Raphael
A1 Lin, Amy W.
A1 Chen, Yingming Amy
A1 Muccilli, Alexandra
A1 Marriott, James J.
A1 Selchen, Daniel
A1 Mathur, Shobhit
A1 Oh, Jiwon
A1 Bharatha, Aditya
YR 2024
UL http://www.ajnr.org/content/45/11/1819.abstract
AB BACKGROUND AND PURPOSE: Low-field 64 mT portable brain MRI has recently shown diagnostic promise for MS. This study aimed to evaluate the utility of portable MRI (pMRI) in assessing dissemination in space (DIS) in patients presenting with optic neuritis and determine whether deploying pMRI in the MS clinic can shorten the time from symptom onset to MRI.MATERIALS AND METHODS: Newly diagnosed patients with optic neuritis referred to a tertiary academic MS center from July 2022 to January 2024 underwent both point-of-care pMRI and subsequent 3T conventional MRI (cMRI). Images were evaluated for periventricular (PV), juxtacortical (JC), and infratentorial (IT) lesions. DIS was determined on brain MRI per 2017 McDonald criteria. Test characteristics were computed by using cMRI as the reference. Interrater and intermodality agreement between pMRI and cMRI were evaluated by using the Cohen κ. Time from symptom onset to pMRI and cMRI during the study period was compared with the preceding 1.5 years before pMRI implementation by using Kruskal-Wallis with post hoc Dunn tests.RESULTS: Twenty patients (median age: 32.5 years [interquartile range {IQR}, 28−40]; 80% women) were included, of whom 9 (45%) and 5 (25%) had DIS on cMRI and pMRI, respectively. Median time interval between pMRI and cMRI was 7 days (IQR, 3.5−12.5). Interrater agreement was very good for PV (95%, κ = 0.89), and good for JC and IT lesions (90%, κ = 0.69 for both). Intermodality agreement was good for PV (90%, κ = 0.80) and JC (85%, κ = 0.63), and moderate for IT lesions (75%, κ = 0.42) and DIS (80%, κ = 0.58). pMRI had a sensitivity of 56% and specificity of 100% for DIS. The median time from symptom onset to pMRI was significantly shorter (8.5 days [IQR 7−12]) compared with the interval to cMRI before pMRI deployment (21 days [IQR 8−49], n = 50) and after pMRI deployment (15 days [IQR 12−29], n = 30) (both P < .01). Time from symptom onset to cMRI in those periods was not significantly different (P = .29).CONCLUSIONS: In patients with optic neuritis, pMRI exhibited moderate concordance, moderate sensitivity, and high specificity for DIS compared with cMRI. Its integration into the MS clinic reduced the time from symptom onset to MRI. Further studies are warranted to evaluate the role of pMRI in expediting early MS diagnosis and as an imaging tool in resource-limited settings.cMRIconventional MRIDISdissemination in spaceDITdissemination in timeIQRinterquartile rangeITinfratentorialJCjuxtacorticalLMIClow- and middle-income countriespMRIportable MRIPPVpositive predictive valuePVperiventricularpwMSpatients with MSSNsensitivity