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. 2009 Mar;29(3):537-44.
doi: 10.1002/jmri.21676.

Characterizing iron deposition in multiple sclerosis lesions using susceptibility weighted imaging

E Mark Haacke  1 , Malek Makki, Yulin Ge, Megha Maheshwari, Vivek Sehgal, Jiani Hu, Madeswaran Selvan, Zhen Wu, Zahid Latif, Yang Xuan, Omar Khan, James Garbern, Robert I Grossman
Affiliations

Characterizing iron deposition in multiple sclerosis lesions using susceptibility weighted imaging

E Mark Haacke et al. J Magn Reson Imaging. 2009 Mar.

Abstract

Purpose: To investigate whether the variable forms of putative iron deposition seen with susceptibility weighted imaging (SWI) will lead to a set of multiple sclerosis (MS) lesion characteristics different than that seen in conventional MR imaging.

Materials and methods: Twenty-seven clinically definite MS patients underwent brain scans using magnetic resonance imaging including: pre- and postcontrast T1-weighted imaging, T2-weighted imaging, FLAIR, and SWI at 1.5 T, 3 T, and 4 T. MS lesions were identified separately in each imaging sequence. Lesions identified in SWI were reevaluated for their iron content using the SWI filtered phase images.

Results: There were a variety of new lesion characteristics identified by SWI, and these were classified into six types. A total of 75 lesions were seen only with conventional imaging, 143 only with SWI, and 204 by both. From the iron quantification measurements, a moderate linear correlation between signal intensity and iron content (phase) was established.

Conclusion: The amount of iron deposition in the brain may serve as a surrogate biomarker for different MS lesion characteristics. SWI showed many lesions missed by conventional methods and six different lesion characteristics. SWI was particularly effective at recognizing the presence of iron in MS lesions and in the basal ganglia and pulvinar thalamus.

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Figures

Figure 1
Figure 1
Phase images at 1.5T (a) and 3T (b) of the same patient with B0TE kept constant. The central sulcus (arrow) is clearly seen in both individuals. The gray/white matter contrast in these images comes from the increased MR visible iron content in the gray matter giving it an appearance similar to a T1-weighted scan.
Figure 2
Figure 2
Two SWI processed images of adjacent slices acquired at 3T. Note the connectivity between the iron-containing lesion (the dark nodule, long arrow) and a peripheral vein that curls up toward the lateral right side of the brain (a, short arrow) and a vein that connects to the putamen (b, short arrow).
Figure 3
Figure 3
The rims of lesions (arrows) are seen more clearly in SWI phase (a) than in FLAIR (b). The rims are not defined in magnitude (c) or T2 (d). This data was acquired at 4T.
Figure 4
Figure 4
Lesions with high phase/iron content, as shown in SWI filtered phase images (a) are either not visible or less clearly seen in SWI magnitude (b), T2-weighted (c) or FLAIR images (d) at 4T.
Figure 5
Figure 5
Filtered phase SWI image acquired at 3T showing high iron deposition (white arrows) in the left and right pulvinar thalamus.
Figure 6
Figure 6
Possible gray matter lesions seen in an SWI phase image (a) and a T2W image (b) for data acquired at 1.5T.
Figure 7
Figure 7
Histogram showing the distribution of iron deposition in well-defined lesions of the 26 analyzed patients. (These concentrations were calculated assuming that 180 Siemens phase units correspond to 60 µg Fe/g tissue.)
Figure 8
Figure 8
A plot of signal intensity from T2 versus phase and a plot of phase converted into iron content.
Figure 9
Figure 9
A plot of signal intensity from T2 versus phase and a plot of phase converted into iron content.
See this image and copyright information in PMC

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