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European Radiology

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Open Access 01-12-2021 | Magnetic Resonance Imaging | Magnetic Resonance

Pre-contrast T1-weighted imaging of the spinal cord may be unnecessary in patients with multiple sclerosis

Authors: Isabelle Riederer, Mark Mühlau, Claus Zimmer, Magaly Gutbrod-Fernandez, Nico Sollmann, Jan S Kirschke

Published in: European Radiology | Issue 12/2021

Abstract

Objectives

Multiple sclerosis (MS) is an inflammatory disease frequently involving the spinal cord, which can be assessed by magnetic resonance imaging (MRI). Here, we hypothesize that pre-contrast T1-w imaging does not add diagnostic value to routine spinal MRI for the follow-up of patients with MS.

Methods

3-T MRI scans including pre- and post-contrast T1-w as well as T2-w images of 265 consecutive patients (mean age: 40 ± 13 years, 169 women) with (suspected) MS were analyzed retrospectively. Images were assessed in two separate reading sessions, first excluding and second including pre-contrast T1-w images. Two independent neuroradiologists rated the number of contrast-enhancing (ce) lesions as well as diagnostic confidence (1 = unlikely to 5 = very high), overall image quality, and artifacts. Results were compared using Wilcoxon matched-pairs signed-rank tests and weighted Cohen’s kappa (κ).

Results

Fifty-six ce lesions were found in 43 patients. There were no significant differences in diagnostic confidence between both readings for both readers (reader 1: p = 0.058; reader 2: p = 0.317). Inter-rater concordance was both moderate regarding artifacts (κ = 0.418) and overall image quality (κ = 0.504). Thirty-one black holes were found in 25 patients with high diagnostic confidence (reader 1: 4.04 ± 0.81; reader 2: 3.80 ± 0.92) and substantial inter-rater concordance (κ = 0.700).

Conclusions

Availability of pre-contrast T1-w images did not significantly increase diagnostic confidence or detection rate of ce lesions in the spinal cord in patients with MS. Thus, pre-contrast T1-w sequences might be omitted in routine spinal MRI for follow-up exams, however not in special unclear clinical situations in which certainty on contrast enhancement is required.

Key Points

Availability of pre-contrast T1-w images does not increase diagnostic confidence or detection rate of contrast-enhancing lesions in the spinal cord of MS patients.
Excluding pre-contrast T1-w sequences reduces scan time, thus providing more time for other sequences or increasing the patients’ compliance.

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Title: Pre-contrast T1-weighted imaging of the spinal cord may be unnecessary in patients with multiple sclerosis
Authors: Isabelle Riederer
Mark Mühlau
Claus Zimmer
Magaly Gutbrod-Fernandez
Nico Sollmann
Jan S Kirschke
Publication date: 01-12-2021
Publisher: Springer Berlin Heidelberg
Keywords: Magnetic Resonance Imaging
Magnetic Resonance Imaging
Multiple Sclerosis
Neuromyelitis Optica Spectrum Disease
Published in: European Radiology / Issue 12/2021
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-021-08077-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Pre-contrast T1-weighted imaging of the spinal cord may be unnecessary in patients with multiple sclerosis

Abstract

Objectives

Methods

Results

Conclusions

Key Points

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusions

Key Points

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