Article Figures & Data
Figures
- FIG 1.
Flow chart shows the included and excluded participants and the TP and FP determination procedure including blinded readers' and senior readers' image review. CIS indicates clinically isolated syndrome; RIS, radiologically isolated syndrome.
- FIG 2.
Illustrative case of nodular vFP enhancement. A tiny juxtacortical enhancement source on SPACE (circle in A), corresponding to a triangle-shaped hypointensity on the high-resolution susceptibility-weighted image (A1), is not detected on MPRAGE and VIBE images (circles in B and C, respectively). The corresponding FLAIR T2-weighed image (D) shows no evidence of demyelinating lesions at this level. This vFP was reported by ER 1 and the BR.
- FIG 3.
The upper panel shows an open-ring vFP enhancement consistent with a developmental venous anomaly and mimicking a TP enhancing juxtacortical CEL on SPACE images. Characteristic arcuate enhancement on SPACE image with subtle margins (circles) in the juxtacortical white matter (A), associated with faint hyperintensity on FLAIR T2 image (B), is barely visible on MPRAGE (C) and VIBE (D) images. This vFP was reported by the BR only. TP CELs with morphology similar to that of A on SPACE image (E) exhibits characteristic T2-FLAIR hyperintensity (F). In this case, CEL enhancement is clearly detected on MPRAGE (G) and VIBE (H) images as well.
- FIG 4
A, Relationships between CNR and volume variables in TP (red) and vFP (cyan) findings. Higher CNR and larger volume values are more frequently represented in TP than in vFP (marginal density plots). The variables are significantly correlated in TP (ρ = 0.644, P < .001), but not in vFP (ρ = 0.096, P = .568). B, Boxplots represent CNR value-distribution differences between TP and vFP after median split categorization into small (≤14 mm3) and large (>14 mm3). CNR values are lower in vFP compared with TP in the large category only, but similar in the small category.
Tables
Demographics No. of evaluable patients 232 Relapsing-emitting MS 177 (76.3%) Secondary-progressive MS 20 (8.6%) Primary-progressive MS 10 (4.3%) CIS (%) 21 (9.1%) RIS (%) 4 (1.7%) Age (mean) (yr) 46 (SD, 12.65) Sex (men/women) 81:151 EDSSa (median) (interquartile range) 2.5/2 Disease durationa (median) (interquartile range) 11/11 DMT efficacyb Moderatec 126 (60.9%) Highd 9 (4.3%) Very highe 36 (17.4%) No DMT 36 (17.4%) Note:—CIS indicates clinically isolated syndrome; RIS, radiologically isolated syndrome; EDSS, Expanded Disability Status Scale; DMT, disease-modifying treatment.
↵a Patients with relapsing-remitting, secondary-progressive, or primary-progressive MS only.
↵b According to Dobson et al.28
↵c Includes dimethyl fumarate, glatiramer acetate, interferon-β 1-α, interferon-β-1b, and teriflunomide.
↵d Includes fingolimod, siponimod, and ozanimod.
↵e Includes alemtuzumab, cladribine, mitoxantrone, natalizumab, and ocrelizumab.
- Table 2:
Frequency of TP and FP sources of enhancement for each SPACE, MPRAGE, VIBE sequence, and blind readers
SPACE MPRAGE VIBE Pa (SPACE vs MPRAGE) Pa (SPACE vs VIBE) TP enhancement sources (No. of patients) ER 1 50 (19) 44 (16) 42 (15) .070 .042b ER 2 53 (15) 42 (15) 41 (15) .026b .008b BR 42 (14) 34 (13) 36 (12) .006b .016b FP enhancement sources (No. of patients) ER 1 22 (20) 8 (6) 8 (7) .004b .008b ER 2 24 (23) 7 (7) 9 (8) .004b .006b BR 31 (28) 6 (6) 11 (11) <.001b .006b SPACE vs MPRAGE SPACE vs VIBE P (SPACE vs MPRAGE) P (SPACE vs VIBE) Chance of detecting more patients with TP ER 1 1.20 (0.6–2.4) 1.29 (0.6–2.6) .598 .478 ER 2 1.00 (0.48–2.09) 1.00 (0.48–2.09) 1.000 1.000 BR 1.08 (0.5–2.4) 1.18 (0.53–2.6) .686 .687 Chance of detecting more patients with FP ER 1 3.55 (1.4–9.1) 3.03 (1.25–7.3) .015b .027b ER 2 3.53 (1.5–8.4) 3.08 (1.3–7.1) .008b .015b BR 5.17 (2.1–12.7) 2.76 (1.3–5.7) <.001b .012b - Table 4:
Quantitative characteristics of vFP and TP contrast-enhancement sources on SPACE imagesa
vFP TP P vFPsmall TPsmall P vFPlarge TPlarge P No. 38 66 28 29 10 37 Volume (mm3) Median 11.5 16 .027b,d 7.5 9 .981b 34 49 .730b Range 3–84 3–565 3–14 3–14 30–84 15–565 CNR Median 7.73 11.18 .003b,d 7.66 8.38 .544b 7.85 15.87 .015b,d Range 1.67–22.67 2.18–44.06 1.67–22.37 2.18–20.28 3.92–22.67 5.67–44.06 Morphology (No.) (%) Nodular 26 (68.4%) 52 (78.8%) .078c 22 (78.6%) 26 (89.7%) .292c 4 (40%) 26 (70.3%) .036c,d Tubular 4 (10.5%) 0 (0%) 2 (7.1%) 0 (0%) 2 (20%) 0 (0%) Ring/open-ring 8 (28.1%) 14 (21.2%) 4 (14.3%) 3 (10.3%) 4 (40%) 11 (29.7%)
