Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy.
Department of Health Sciences (DISSAL) -Radiology Section, University of Genoa, Genoa, Italy.
Eur Radiol. 2020 Jul;30(7):3843-3851. doi: 10.1007/s00330-020-06761-5. Epub 2020 Mar 11.
To retrospectively evaluate the different performances of T1-SE and T1-GE sequences in detecting hypointense lesions in multiple sclerosis (MS), to quantify the degree of microstructural damage within lesions and to correlate them with patient clinical status.
Sixty clinically isolated syndrome (CIS) and MS patients underwent brain magnetic resonance imaging (MRI) on 1.5-T and 3-T scanners. We identified T2 fluid-attenuated inversion recovery hyperintense lesions with no hypointense signal on T1-SE/T1-GE (a), hypointense lesions only on T1-GE (b), and hypointense lesions on both T1-SE and T1-GE sequences (c). We compared mean lesion number (LN) and volume (LV) identified on T1-SE and T1-GE sequences, correlating them with Expanded Disability Status Scale (EDSS); fractional anisotropy (FA) and mean diffusivity (MD) values inside each lesion type were extracted and normal-appearing white matter (NAWM).
Thirty-five patients were female. Mean age was 39.2 (± 7.8); median EDSS was 3 (± 2). There were 23 CIS, 21 relapsing-remitting (RR), and 16 progressive MS. T1-GE and T1-SE LN and LV were significantly different (p < 0.001), both correlating with EDSS. Both FA and MD metrics resulted significantly different among the three lesion groups and NAWM (p < 0.001). FA and MD values extracted from (b) and (c) showed statistically significant differences (p < 0.001), while for (a) and (b), the differences were not significant (p = 0.31 for FA and p = 0.62 for MD).
T1-SE hypointense lesions demonstrated a more pronounced degree of microstructural damage. T1-weighted sequence type must be more carefully evaluated in clinical and research settings.
• T1-weighted spin-echo (T1-SE) images detect chronic hypointense lesions (so called black holes) associated with more severe microstructural changes. • In the last years, three-dimensional (3D) T1-weighted gradient-echo (T1-GE) sequences are often utilized in lieu of T1-SE acquisition, more so at 3 T or higher fields. • T1-weighted sequence type must be more carefully evaluated in clinical and research settings in the definition of "black holes" in MS, in order to avoid the overestimation of the effective severe tissue damage.
回顾性评估 T1-SE 和 T1-GE 序列在检测多发性硬化症（MS）低信号病变中的不同表现，定量评估病变内的微观结构损伤程度，并将其与患者的临床状况相关联。
60 例临床孤立综合征（CIS）和 MS 患者在 1.5-T 和 3-T 扫描仪上进行了脑部磁共振成像（MRI）检查。我们在 T2 液体衰减反转恢复高信号病变中识别出 T1-SE/T1-GE 上无低信号信号的病变（a）、仅 T1-GE 上有低信号信号的病变（b）以及 T1-SE 和 T1-GE 序列上均有低信号信号的病变（c）。我们比较了 T1-SE 和 T1-GE 序列上识别出的平均病变数（LN）和体积（LV），并将其与扩展残疾状况量表（EDSS）相关联；提取每种病变类型内的各向异性分数（FA）和平均扩散系数（MD）值以及正常表现的白质（NAWM）。
35 名患者为女性。平均年龄为 39.2（±7.8）岁；中位 EDSS 为 3（±2）。其中 23 例为 CIS，21 例为复发缓解型（RR），16 例为进展型 MS。T1-GE 和 T1-SE 的 LN 和 LV 差异显著（p<0.001），均与 EDSS 相关。三种病变组和 NAWM 的 FA 和 MD 指标均存在显著差异（p<0.001）。（b）和（c）中提取的 FA 和 MD 值存在统计学差异（p<0.001），而（a）和（b）之间的差异不显著（p=0.31 时为 FA，p=0.62 时为 MD）。
T1-SE 低信号病变显示出更明显的微观结构损伤程度。在临床和研究环境中，必须更仔细地评估 T1 加权序列类型。
T1 加权自旋回波（T1-SE）图像检测与更严重微观结构变化相关的慢性低信号病变（所谓的黑洞）。
在过去几年中，3D T1 加权梯度回波（T1-GE）序列经常替代 T1-SE 采集，在 3T 或更高场强时更为常见。
在 MS 中定义“黑洞”时，必须更仔细地评估 T1 加权序列类型，以避免高估有效严重组织损伤，从而在临床和研究环境中更准确地评估 T1 加权序列类型。
