From the Department of Diagnostic and Interventional Neuroradiology (P.E., S.S., H.Z., J.K., C.Z., B.W.), Department of Neurology (V.P., M.B., M.M.H., A.B., B.H., M.M.), and TUM-NIC, NeuroImaging Center (V.P., M.B., M.M.), Klinikum rechts der Isar, Technische Universität München, Ismaninger Strasse 22, 81675 Munich, Germany; Department of Psychiatry and Psychotherapy, Isar-Amper-Klinikum München-Ost, Haar, Germany (H.W.); and Munich Cluster for Systems Neurology (SyNergy), Munich, Germany (B.H.).
Radiology. 2019 May;291(2):429-435. doi: 10.1148/radiol.2019181568. Epub 2019 Mar 12.
Background Administration of a gadolinium-based contrast material is widely considered obligatory for follow-up imaging of patients with multiple sclerosis (MS). However, advances in MRI have substantially improved the sensitivity for detecting new or enlarged lesions in MS. Purpose To investigate whether the use of contrast material has an effect on the detection of new or enlarged MS lesions and, consequently, the assessment of interval progression. Materials and Methods In this retrospective study based on a local prospective observational cohort, 507 follow-up MR images obtained in 359 patients with MS (mean age, 38.2 years ± 10.3; 246 women, 113 men) were evaluated. With use of subtraction maps, nonenhanced images (double inversion recovery [DIR], fluid-attenuated inversion recovery [FLAIR]) and contrast material-enhanced (gadoterate meglumine, 0.1 mmol/kg) T1-weighted images were separately assessed for new or enlarged lesions in independent readings by two readers blinded to each other's findings and to clinical information. Primary outcome was the percentage of new or enlarged lesions detected only on contrast-enhanced T1-weighted images and the assessment of interval progression. Interval progression was defined as at least one new or unequivocally enlarged lesion on follow-up MR images. Results Of 507 follow-up images, 264 showed interval progression, with a total of 1992 new or enlarged and 207 contrast-enhancing lesions. Four of these lesions (on three MR images) were retrospectively detected on only the nonenhanced images, corresponding to 1.9% (four of 207) of the enhancing and 0.2% (four of 1992) of all new or enlarged lesions. Nine enhancing lesions were not detected on FLAIR-based subtraction maps (nine of 1442, 0.6%). In none of the 507 images did the contrast-enhanced sequences reveal interval progression that was missed in the readouts of the nonenhanced sequences, with use of either DIR- or FLAIR-based subtraction maps. Interrater agreement was high for all three measures, with intraclass correlation coefficients of 0.91 with FLAIR, 0.94 with DIR, and 0.99 with contrast-enhanced T1-weighted imaging. Conclusion At 3.0 T, use of a gadolinium-based contrast agent at follow-up MRI did not change the diagnosis of interval disease progression in patients with multiple sclerosis. © RSNA, 2019 See also the editorial by Saindane in this issue.
背景 对于多发性硬化症（MS）患者的随访成像，通常认为钆基造影剂的应用是强制性的。然而，MRI 的进步大大提高了检测 MS 中新出现或扩大病灶的敏感性。目的 研究对比剂的应用是否会影响新出现或扩大的 MS 病变的检测，进而影响对间隔进展的评估。材料与方法 本研究为基于局部前瞻性观察队列的回顾性研究，纳入 359 例 MS 患者的 507 份随访 MRI 图像（平均年龄 38.2 岁±10.3；246 例女性，113 例男性）。使用减影图，对非增强图像（双反转恢复[DIR]、液体衰减反转恢复[FLAIR]）和增强（钆特酸葡甲胺，0.1 mmol/kg）T1 加权图像进行分别评估，由两位彼此之间以及与临床信息均不知情的读者进行独立阅读，以评估新出现或扩大的病变。主要结局是仅在增强 T1 加权图像上检测到的新出现或扩大病变的百分比和间隔进展的评估。间隔进展定义为随访 MRI 图像上至少出现一个新出现或明确扩大的病变。结果 在 507 份随访图像中，264 份显示间隔进展，共有 1992 个新出现或扩大病灶和 207 个强化病灶。其中 4 个病灶（3 份 MRI 图像上）仅在非增强图像上被回顾性检出，相当于强化病灶的 1.9%（207 个中的 4 个）和所有新出现或扩大病灶的 0.2%（1992 个中的 4 个）。9 个强化病灶在基于 FLAIR 的减影图上未被检出（1442 个中的 9 个，0.6%）。在增强序列中未发现任何一个新出现或扩大病灶的诊断结果在非增强序列的读片结果中被遗漏，使用 DIR 或 FLAIR 减影图均如此，这在 507 份图像中均未发生。三种方法的观察者间一致性均较高，FLAIR 为 0.91，DIR 为 0.94，增强 T1 加权成像为 0.99。结论 在 3.0T 下，MS 患者随访 MRI 中使用钆基造影剂并未改变对间隔疾病进展的诊断。 ©RSNA，2019 本期还包含 Saindane 的社论。
