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Comparative Study
. 2011 Feb 8;76(6):534-9.
doi: 10.1212/WNL.0b013e31820b7630.

Ultra-high-field imaging distinguishes MS lesions from asymptomatic white matter lesions

E C Tallantyre  1 , J E Dixon, I Donaldson, T Owens, P S Morgan, P G Morris, N Evangelou
Affiliations
Comparative Study

Ultra-high-field imaging distinguishes MS lesions from asymptomatic white matter lesions

E C Tallantyre et al. Neurology. .

Abstract

Objectives: To investigate whether multiple sclerosis (MS) and non-MS white matter brain lesions can be distinguished by their appearance on 7 T T2*-weighted MRI.

Methods: This was an observational study of 28 patients with MS and 17 patients with cerebral white matter lesions who did not have MS. Subjects were imaged using 7 T T2*-weighted imaging. White matter lesions were identified and analyzed for volume, location, and perivenous appearance.

Results: Out of 901 lesions identified in patients with MS, 80% were perivenous. In comparison, 19% of 428 lesions identified in patients without MS had a perivenous appearance. Seven-Tesla T2*-weighted MRI reliably distinguished all patients with clinically definite MS (>40% lesions appeared perivenous) from those without clinical MS (<40% lesions appeared perivenous). Perivenous lesion appearance was more predictive of MS (odds ratio [OR] 14, p < 0.001) than subcortical or periventricular lesion location (OR 4.5, p < 0.001, and OR 2.4, p = 0.009). Perivenous lesion appearance was observed with a similar frequency in patients with clinically isolated syndrome of demyelination and in early (gadolinium-enhancing) MS lesions.

Conclusion: Perivenous lesion location on 7 T T2*-weighted imaging is predictive of the presence of demyelination. Optimization of this imaging technique at lower magnetic resonance field strengths would offer benefit for the diagnosis of MS.

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Figures

Figure 1
Figure 1. Multiple sclerosis (MS) and non-MS lesion appearances on 7 T T2*-weighted imaging
(A) A white matter lesion from a patient with MS is shown in 3 orthogonal planes, highlighted by red crosshairs. Inset are enlarged versions of the lesion as it appears in each plane. The lesion can be seen to have a perivenous appearance in each plane. (B) A white matter lesion in a patient without MS is shown for comparison. Even on the enlarged images, no central vessel is evident within this lesion.
Figure 2
Figure 2. Comparison of the proportion of perivenous lesions seen (A) in patients with multiple sclerosis (MS) vs subjects without MS and (B) in subjects with different clinical phenotypes of demyelinating disease
(A) This scatterplot shows the proportion of perivenous lesions which were observed in each subject. Lack of overlap between the patients with MS and subjects without MS supports the discriminatory value of this imaging marker. (B) This scatterplot shows the proportion of perivenous lesions which were observed in subjects with different clinical phenotypes. CIS = clinically isolated syndrome; PP = primary progressive MS; RR = relapsing-remitting MS; SP = secondary progressive MS.
Figure 3
Figure 3. Proportion of perivenous lesions seen in multiple sclerosis (MS) and non-MS groups according to lesion location
Lesions in all 3 locations were more likely to be perivenous in patients with MS. However, even in subjects without MS, a high proportion of periventricular lesions contained at least one vein.
See this image and copyright information in PMC

Comment in

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