PT  - JOURNAL ARTICLE
AU  - Hosseini, Z.
AU  - Matusinec, J.
AU  - Rudko, D.A.
AU  - Liu, J.
AU  - Kwan, B.Y.M.
AU  - Salehi, F.
AU  - Sharma, M.
AU  - Kremenchutzky, M.
AU  - Menon, R.S.
AU  - Drangova, M.
TI  - Morphology-Specific Discrimination between MS White Matter Lesions and Benign White Matter Hyperintensities Using Ultra-High-Field MRI
AID  - 10.3174/ajnr.A5705
DP  - 2018 Aug 01
TA  - American Journal of Neuroradiology
PG  - 1473--1479
VI  - 39
IP  - 8
4099  - http://www.ajnr.org/content/39/8/1473.short
4100  - http://www.ajnr.org/content/39/8/1473.full
SO  - Am. J. Neuroradiol.2018 Aug 01; 39
AB  - BACKGROUND AND PURPOSE: Recently published North American Imaging in Multiple Sclerosis guidelines call for derivation of a specific radiologic definition of MS WM lesions and mimics. The purpose of this study was to use SWI and magnetization-prepared FLAIR images for sensitive differentiation of MS from benign WM lesions using the morphologic characteristics of WM lesions.MATERIALS AND METHODS: Seventeen patients with relapsing-remitting MS and 18 healthy control subjects were enrolled retrospectively. For each subject, FLAIR and multiecho gradient-echo images were acquired using 7T MR imaging. Optimized postprocessing was used to generate single-slice SWI of cerebral veins. SWI/FLAIR images were registered, and 3 trained readers performed lesion assessment. Morphology, location of lesions, and the time required for assessment were recorded. Analyses were performed on 3 different pools: 1) lesions of >3 mm, 2) nonconfluent lesions of >3 mm, and 3) nonconfluent lesions of >3 mm with no or a single central vein.RESULTS: The SWI/FLAIR acquisition and processing protocol enabled effective assessment of central veins and hypointense rims in WM lesions. Assessment of nonconfluent lesions with ≥1 central vein enabled the most specific and sensitive differentiation of patients with MS from controls. A threshold of 67% perivenous WM lesions separated patients with MS from controls with a sensitivity of 94% and specificity of 100%. Lesion assessment took an average of 12 minutes 10 seconds and 4 minutes 33 seconds for patients with MS and control subjects, respectively.CONCLUSIONS: Nonconfluent lesions of >3 mm with ≥1 central vein were the most sensitive and specific differentiators between patients with MS and control subjects.CVScentral vein signEDSSExpanded Disability Status ScaleHChealthy controlIEV-SWIinter-echo variance susceptibility-weighted imagingLLlesions of >3 mmMP-FLAIRmagnetization-prepared FLAIRNCnonconfluent lesions of >3 mm%PVWMLpercentage of total perivenous white matter lesion countRRMSrelapsing-remitting multiple sclerosisSVnonconfluent lesions of >3 mm with a single central veinWMLwhite matter lesions