Clinical 3-tesla FLAIR∗ MRI improves diagnostic accuracy in multiple sclerosis

Ilena C. George, Pascal Sati, Martina Absinta, Irene C M Cortese, Elizabeth M. Sweeney, Colin D. Shea, Daniel S. Reich

Research output: Contribution to journalArticle

Abstract

Objective: To evaluate clinical fluid-attenuated inversion recovery (FLAIR)∗ 3T magnetic resonance imaging (MRI), which is sensitive to perivenular inflammatory demyelinating lesions, in diagnosing multiple sclerosis (MS). Background: Central veins may be a distinguishing feature of MS lesions. FLAIR∗, a combined contrast derived from clinical MRI scans, has not been studied as a clinical tool for diagnosing MS. Methods: Two experienced MS neurologists evaluated 87 scan pairs (T2-FLAIR/FLAIR∗), separately and side-by-side, from 68 MS cases, 8 healthy volunteers, and 11 individuals with other neurological diseases. Raters judged cases based on experience, published criteria, and a visual assessment of the "40% rule," whereby MS is favored if >40% of lesions demonstrate a central vein. Diagnostic accuracy was determined with area under the receiver operating characteristic curve (AUC), and inter-rater reliability was assessed with Cohen's kappa. Results: Diagnostic accuracy was high: rater 1, AUC 0.94 (95% confidence interval: 0.89, 0.97) for T2-FLAIR, 0.95 (0.92, 0.98) for FLAIR∗; rater 2, 0.94 (0.90, 0.98) and 0.90 (0.85, 0.95). AUC improved when images were considered together: rater 1, 0.99 (0.98, 1.00); rater 2, 0.98 (0.96, 0.99). Inter-rater agreement was substantial for T2-FLAIR (= 0.68) and FLAIR∗ (= 0.74), despite low agreement on the 40% rule (= 0.47) (p ‰ 0. 001 in all cases). Conclusions: Joint clinical evaluation of T2-FLAIR and FLAIR∗ images modestly improves diagnostic accuracy for MS and does not require counting lesions with central veins.

Original languageEnglish (US)
Pages (from-to)1578-1586
Number of pages9
JournalMultiple Sclerosis
Volume22
Issue number12
DOIs
StatePublished - Oct 1 2016

Fingerprint

Multiple Sclerosis
Magnetic Resonance Imaging
Area Under Curve
Veins
ROC Curve
Healthy Volunteers
Confidence Intervals

Keywords

  • central veins
  • diagnosis
  • MRI
  • multiple sclerosis

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

Cite this

George, I. C., Sati, P., Absinta, M., Cortese, I. C. M., Sweeney, E. M., Shea, C. D., & Reich, D. S. (2016). Clinical 3-tesla FLAIR∗ MRI improves diagnostic accuracy in multiple sclerosis. Multiple Sclerosis, 22(12), 1578-1586. https://doi.org/10.1177/1352458515624975

Clinical 3-tesla FLAIR∗ MRI improves diagnostic accuracy in multiple sclerosis. / George, Ilena C.; Sati, Pascal; Absinta, Martina; Cortese, Irene C M; Sweeney, Elizabeth M.; Shea, Colin D.; Reich, Daniel S.

In: Multiple Sclerosis, Vol. 22, No. 12, 01.10.2016, p. 1578-1586.

Research output: Contribution to journalArticle

George, IC, Sati, P, Absinta, M, Cortese, ICM, Sweeney, EM, Shea, CD & Reich, DS 2016, 'Clinical 3-tesla FLAIR∗ MRI improves diagnostic accuracy in multiple sclerosis', Multiple Sclerosis, vol. 22, no. 12, pp. 1578-1586. https://doi.org/10.1177/1352458515624975
George, Ilena C. ; Sati, Pascal ; Absinta, Martina ; Cortese, Irene C M ; Sweeney, Elizabeth M. ; Shea, Colin D. ; Reich, Daniel S. / Clinical 3-tesla FLAIR∗ MRI improves diagnostic accuracy in multiple sclerosis. In: Multiple Sclerosis. 2016 ; Vol. 22, No. 12. pp. 1578-1586.
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abstract = "Objective: To evaluate clinical fluid-attenuated inversion recovery (FLAIR)∗ 3T magnetic resonance imaging (MRI), which is sensitive to perivenular inflammatory demyelinating lesions, in diagnosing multiple sclerosis (MS). Background: Central veins may be a distinguishing feature of MS lesions. FLAIR∗, a combined contrast derived from clinical MRI scans, has not been studied as a clinical tool for diagnosing MS. Methods: Two experienced MS neurologists evaluated 87 scan pairs (T2-FLAIR/FLAIR∗), separately and side-by-side, from 68 MS cases, 8 healthy volunteers, and 11 individuals with other neurological diseases. Raters judged cases based on experience, published criteria, and a visual assessment of the {"}40{\%} rule,{"} whereby MS is favored if >40{\%} of lesions demonstrate a central vein. Diagnostic accuracy was determined with area under the receiver operating characteristic curve (AUC), and inter-rater reliability was assessed with Cohen's kappa. Results: Diagnostic accuracy was high: rater 1, AUC 0.94 (95{\%} confidence interval: 0.89, 0.97) for T2-FLAIR, 0.95 (0.92, 0.98) for FLAIR∗; rater 2, 0.94 (0.90, 0.98) and 0.90 (0.85, 0.95). AUC improved when images were considered together: rater 1, 0.99 (0.98, 1.00); rater 2, 0.98 (0.96, 0.99). Inter-rater agreement was substantial for T2-FLAIR (= 0.68) and FLAIR∗ (= 0.74), despite low agreement on the 40{\%} rule (= 0.47) (p ‰ 0. 001 in all cases). Conclusions: Joint clinical evaluation of T2-FLAIR and FLAIR∗ images modestly improves diagnostic accuracy for MS and does not require counting lesions with central veins.",
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AU - George, Ilena C.

AU - Sati, Pascal

AU - Absinta, Martina

AU - Cortese, Irene C M

AU - Sweeney, Elizabeth M.

AU - Shea, Colin D.

AU - Reich, Daniel S.

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N2 - Objective: To evaluate clinical fluid-attenuated inversion recovery (FLAIR)∗ 3T magnetic resonance imaging (MRI), which is sensitive to perivenular inflammatory demyelinating lesions, in diagnosing multiple sclerosis (MS). Background: Central veins may be a distinguishing feature of MS lesions. FLAIR∗, a combined contrast derived from clinical MRI scans, has not been studied as a clinical tool for diagnosing MS. Methods: Two experienced MS neurologists evaluated 87 scan pairs (T2-FLAIR/FLAIR∗), separately and side-by-side, from 68 MS cases, 8 healthy volunteers, and 11 individuals with other neurological diseases. Raters judged cases based on experience, published criteria, and a visual assessment of the "40% rule," whereby MS is favored if >40% of lesions demonstrate a central vein. Diagnostic accuracy was determined with area under the receiver operating characteristic curve (AUC), and inter-rater reliability was assessed with Cohen's kappa. Results: Diagnostic accuracy was high: rater 1, AUC 0.94 (95% confidence interval: 0.89, 0.97) for T2-FLAIR, 0.95 (0.92, 0.98) for FLAIR∗; rater 2, 0.94 (0.90, 0.98) and 0.90 (0.85, 0.95). AUC improved when images were considered together: rater 1, 0.99 (0.98, 1.00); rater 2, 0.98 (0.96, 0.99). Inter-rater agreement was substantial for T2-FLAIR (= 0.68) and FLAIR∗ (= 0.74), despite low agreement on the 40% rule (= 0.47) (p ‰ 0. 001 in all cases). Conclusions: Joint clinical evaluation of T2-FLAIR and FLAIR∗ images modestly improves diagnostic accuracy for MS and does not require counting lesions with central veins.

AB - Objective: To evaluate clinical fluid-attenuated inversion recovery (FLAIR)∗ 3T magnetic resonance imaging (MRI), which is sensitive to perivenular inflammatory demyelinating lesions, in diagnosing multiple sclerosis (MS). Background: Central veins may be a distinguishing feature of MS lesions. FLAIR∗, a combined contrast derived from clinical MRI scans, has not been studied as a clinical tool for diagnosing MS. Methods: Two experienced MS neurologists evaluated 87 scan pairs (T2-FLAIR/FLAIR∗), separately and side-by-side, from 68 MS cases, 8 healthy volunteers, and 11 individuals with other neurological diseases. Raters judged cases based on experience, published criteria, and a visual assessment of the "40% rule," whereby MS is favored if >40% of lesions demonstrate a central vein. Diagnostic accuracy was determined with area under the receiver operating characteristic curve (AUC), and inter-rater reliability was assessed with Cohen's kappa. Results: Diagnostic accuracy was high: rater 1, AUC 0.94 (95% confidence interval: 0.89, 0.97) for T2-FLAIR, 0.95 (0.92, 0.98) for FLAIR∗; rater 2, 0.94 (0.90, 0.98) and 0.90 (0.85, 0.95). AUC improved when images were considered together: rater 1, 0.99 (0.98, 1.00); rater 2, 0.98 (0.96, 0.99). Inter-rater agreement was substantial for T2-FLAIR (= 0.68) and FLAIR∗ (= 0.74), despite low agreement on the 40% rule (= 0.47) (p ‰ 0. 001 in all cases). Conclusions: Joint clinical evaluation of T2-FLAIR and FLAIR∗ images modestly improves diagnostic accuracy for MS and does not require counting lesions with central veins.

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