Open Access 01-10-2017 | Neuro
FLAIR* to visualize veins in white matter lesions: A new tool for the diagnosis of multiple sclerosis?
Published in: European Radiology | Issue 10/2017
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Objective
To explore the potential of a post-processing technique combining FLAIR and T2* (FLAIR*) to distinguish between lesions caused by multiple sclerosis (MS) from cerebral small vessel disease (SVD) in a clinical setting.
Methods
FLAIR and T2* head datasets acquired at 3T of 25 people with relapsing MS (pwRMS) and ten with pwSVD were used. After post-processing, FLAIR* maps were used to determine the proportion of white matter lesions (WML) showing the ‘vein in lesion’ sign (VIL), a characteristic histopathological feature of MS plaques. Sensitivity and specificity of MS diagnosis were examined on the basis of >45% VIL+ and >60% VIL+ WML, and compared with current dissemination in space (DIS) MRI criteria.
Results
All pwRMS had >45% VIL+ WML (range 58–100%) whilst in pwSVD the proportion of VIL+ WML was significantly lower (0–64%; mean 32±20%). Sensitivity based on >45% VIL+ was 100% and specificity 80% whilst with >60% VIL+ as the criterion, sensitivity was 96% and specificity 90%. DIS criteria had 96% sensitivity and 40% specificity.
Conclusion
FLAIR* enables VIL+ WML detection in a clinical setting, facilitating differentiation of MS from SVD based on brain MRI.
Key points
• FLAIR* in a clinical setting allows visualization of veins in white matter lesions.
• Significant proportions of MS lesions demonstrate a vein in lesion on MRI.
• Microangiopathic lesions demonstrate a lower proportion of intralesional veins than MS lesions.
• Intralesional vein-based criteria may complement current MRI criteria for MS diagnosis.