Department of Radiology, University of British Columbia Hospital, 2211 Westbrook Mall, Vancouver, BC, Canada V6T 2B5.
AJR Am J Roentgenol. 2012 Jul;199(1):157-62. doi: 10.2214/AJR.11.7039.
The purpose of our study was to compare axial multiple-echo recombined gradient echo (MERGE) with axial T2-weighted fast spin-echo (FSE) imaging for the detection of multiple sclerosis (MS) lesions in the cervical spinal cord on MRI.
Twenty-nine cervical spine MRI studies of patients with MS lesions and 29 control cases were reviewed retrospectively. Two blinded neuroradiologists independently assessed randomized axial MERGE and axial T2-weighted FSE sequences from each study, documenting the location and number of cord lesions, the degree of confidence in calling each lesion, and the presence of artifacts. The reference standard was determined by an unblinded consensus review of all sequences performed for each case, with lesions considered present if detected on two or more sequences. Lesion detection rates and conspicuity, false-positive findings, and reader confidence and artifact scores were compared for the sequences, and interreader agreement was assessed.
Eighty-three lesions were assessed. The mean true-positive lesion detection rate was 87% (95% CI, 79-93%) with MERGE and 67% (60-75%) with T2-weighted FSE, with interreader positive agreement scores of 74% and 75%, respectively. A greater number of false-positive findings were seen with MERGE for both the MS and control cases. Average confidence and artifact scores were similar for both sequences. Subjectively, lesions were more conspicuous in 21 cases with MERGE and four cases with T2-weighted FSE and were equally conspicuous in four cases.
MERGE and T2-weighted FSE sequences are complementary. MERGE provided greater sensitivity for cord lesions whereas axial T2-weighted FSE provided improved lesion specificity. Further investigation is required to assess the clinical impact of MERGE in the diagnosis and management of MS.
本研究旨在比较轴位多回波重组梯度回波（MERGE）与轴位 T2 加权快速自旋回波（FSE）成像在 MRI 检测颈髓多发性硬化（MS）病变中的作用。
回顾性分析 29 例颈髓 MS 病变患者和 29 例对照病例的 MRI 资料。两名盲法神经放射科医师独立评估每个病例的随机轴位 MERGE 和 T2 加权 FSE 序列，记录脊髓病变的位置和数量、对每个病变的置信度、以及伪影的存在。参考标准是对每个病例进行的所有序列进行盲法共识评估，只有在两个或更多序列上检测到病变时才认为存在病变。比较了两种序列的病变检出率和显著性、假阳性发现、读者信心和伪影评分，并评估了读者间的一致性。
共评估了 83 个病变。MERGE 的平均真阳性病变检出率为 87%（95%CI，79-93%），T2 加权 FSE 的检出率为 67%（60-75%），读者间的阳性一致评分分别为 74%和 75%。MERGE 会产生更多的假阳性发现，无论是 MS 病例还是对照病例。两种序列的平均置信度和伪影评分相似。主观上，MERGE 序列中 21 例病变更明显，4 例 T2 加权 FSE 序列中病变更明显，4 例病变则同样明显。
MERGE 和 T2 加权 FSE 序列是互补的。MERGE 对脊髓病变的敏感性更高，而轴位 T2 加权 FSE 则提高了病变的特异性。需要进一步研究以评估 MERGE 在 MS 诊断和管理中的临床影响。
