From the Departments of Neuroradiology.
Siemens Healthcare SAS, Saint-Denis, France.
Invest Radiol. 2023 May 1;58(5):337-345. doi: 10.1097/RLI.0000000000000939. Epub 2022 Nov 10.
The precise location of multiple sclerosis (MS) cortical lesions can be very challenging at 3 T, yet distinguishing them from subcortical lesions is essential for the diagnosis and prognosis of the disease. Compressed sensing-accelerated fluid and white matter suppression imaging (CS-FLAWS) is a new magnetic resonance imaging sequence derived from magnetization-prepared 2 rapid acquisition gradient echo with promising features for the detection and classification of MS lesions. The objective of this study was to compare the diagnostic performances of CS-FLAWS (evaluated imaging) and phase sensitive inversion recovery (PSIR; reference imaging) for classification of cortical lesions (primary objective) and infratentorial lesions (secondary objective) in MS, in combination with 3-dimensional (3D) double inversion recovery (DIR).
Prospective 3 T scans (MS first diagnosis or follow-up) acquired between March and August 2021 were retrospectively analyzed. All underwent 3D CS-FLAWS, axial 2D PSIR, and 3D DIR. Double-blinded reading sessions exclusively in axial plane and final consensual reading were performed to assess the number of cortical and infratentorial lesions. Wilcoxon test was used to compare the 2 imaging datasets (FLAWS + DIR and PSIR + DIR), and intraobserver and interobserver agreement was assessed using the intraclass correlation coefficient.
Forty-two patients were analyzed (38 with relapsing-remitting MS, 29 women, 42.7 ± 12.6 years old). Compressed sensing-accelerated FLAWS allowed the identification of 263 cortical lesions versus 251 with PSIR ( P = 0.74) and 123 infratentorial lesions versus 109 with PSIR ( P = 0.63), corresponding to a nonsignificant difference between the 2 sequences. Compressed sensing-accelerated FLAWS exhibited fewer false-negative findings than PSIR either for cortical lesions (1 vs 13; P < 0.01) or infratentorial lesions (1 vs 15; P < 0.01). No false-positive findings were found with any of the 2 sequences. Diagnostic confidence was high for each contrast.
Three-dimensional CS-FLAWS is as accurate as 2D PSIR imaging for classification of cortical and infratentorial MS lesions, with fewer false-negative findings, opening the way to a reliable full brain MS exploration in a clinically acceptable duration (5 minutes 15 seconds).
在 3T 下，多发性硬化症（MS）皮质病变的确切位置非常具有挑战性，但区分它们与皮质下病变对于疾病的诊断和预后至关重要。基于磁化准备 2 快速获取梯度回波的压缩感知加速液体和白质抑制成像（CS-FLAWS）是一种新的磁共振成像序列，具有检测和分类 MS 病变的良好特征。本研究的目的是比较 CS-FLAWS（评估成像）和相位敏感反转恢复（PSIR；参考成像）在 MS 中的皮质病变（主要目标）和小脑下病变（次要目标）分类的诊断性能，结合三维（3D）双反转恢复（DIR）。
回顾性分析了 2021 年 3 月至 8 月间采集的前瞻性 3T 扫描（MS 首次诊断或随访）。所有患者均接受了 3D CS-FLAWS、轴向 2D PSIR 和 3D DIR 检查。仅在轴位进行双盲阅读，并进行最终的共识阅读，以评估皮质和小脑下病变的数量。采用 Wilcoxon 检验比较 2 种成像数据集（FLAWS + DIR 和 PSIR + DIR），并使用组内相关系数评估观察者内和观察者间的一致性。
共分析了 42 例患者（38 例为复发缓解型 MS，29 例为女性，年龄 42.7±12.6 岁）。CS-FLAWS 可识别 263 个皮质病变，而 PSIR 可识别 251 个（P=0.74），CS-FLAWS 可识别 123 个小脑下病变，而 PSIR 可识别 109 个（P=0.63），2 种序列之间无显著差异。CS-FLAWS 与 PSIR 相比，皮质病变（1 例 vs 13 例；P<0.01）和小脑下病变（1 例 vs 15 例；P<0.01）的假阴性发现更少。2 种序列均未发现假阳性发现。对于每种对比，诊断信心均很高。
3D CS-FLAWS 与 2D PSIR 成像一样准确，可用于分类皮质和小脑下 MS 病变，假阴性发现更少，为在临床可接受的时间内（5 分 15 秒）可靠地全面探索 MS 病变开辟了道路。
