TY - JOUR
T1 - MS cortical lesions on DIR
T2 - Not quite what they seem?
AU - Sethi, Varun
AU - Muhlert, Nils
AU - Ron, Maria
AU - Golay, Xavier
AU - Wheeler-Kingshott, Claudia A.
AU - Miller, David H.
AU - Chard, Declan T.
AU - Yousry, Tarek A.
N1 - Funding Information:
The authors have read the journal's policy and have the following conflicts: V. Sethi receives research support from Biogen Idec and Novartis. T. A. Yousry serves as Editor for European Radiology Journal and has received honoraria (Board Membership) from UCB, Bristol-Myers Squibb, Biogen Idec, and grants (PI or Co-PI Coordinator) from NIHR CBRC, MRC, MS Society, PSP, Stroke, BHF, Wellcome Trust, GSK, Biogen Idec, Novartis; N. Muhlert and M. Ron report no disclosures; X. Golay has acted as a consultant for Philips Healthcare regarding the implementation of our ASL sequence in their product; C.A. Wheeler-Kingshott is on the advisory board for BG12 (Biogen); D.H. Miller has received honoraria from Biogen Idec, Novartis, GlaxoSmithKline, and Bayer Schering, and research grant support for doing MRI analysis in multiple sclerosis trials sponsored by GlaxoSmithKline, Biogen Idec, and Novartis; D.T. Chard receives research support from the Multiple Sclerosis Society of Great Britain and Northern Ireland and holds stock in GlaxoSmithKline and has received honoraria for educational work and advisory board membership from Teva and Bayer. This does not alter the authors' adherence to all the PLOS ONE policies on sharing data and materials.
PY - 2013/11/11
Y1 - 2013/11/11
N2 - Objective: Accurate identification and localization of cortical gray matter (CGM) lesions in MS is important when determining their clinical relevance. Double inversion recovery (DIR) scans have been widely used to detect MS CGM lesions. Phase sensitive inversion recovery (PSIR) scans have a higher signal to noise, and can therefore be obtained at a higher resolution within clinically acceptable times. This enables detection of more CGM lesions depicting a clearer cortical and juxtacortical anatomy. In this study, we systematically investigated if the use of high resolution PSIR scans changes the classification of CGM lesions, when compared with standard resolution DIR scans. Methods: 60 patients [30 RR(Relapsing remitting) and 15 each with PP(Primary progressive) and SP(Secondary progressive) MS] were scanned on a 3T Philips Achieva MRI scanner. Images acquired included DIR (1x1x3 mm resolution) and PSIR (0.5x0.5x2 mm). CGM lesions were detected and classified on DIR as intracortical (IC) or leucocortical (LC). We then examined these lesions on corresponding slices of the high resolution PSIR scans and categorized them as IC, LC, Juxtacortical white matter (JC-WM, abutting but not entering cortex) and other white matter (WM, not juxtacortical). Classifications using both scans were noted. Results: 282 IC and 483 LC were identified on DIR. Of the IC lesions, 61% were confirmed as IC on PSIR, 35.5% were reclassified as LC and 3.5% as JC-WM or other WM only. Of the LC DIR lesions, 43.9% were confirmed at LC on PSIR, 16.1% were reclassified as IC and 40% as JC-WM or other WM only. Overall, 50% (381/765) of CGM lesions seen on DIR were reclassified, and 26.5% (203/765) affected WM only. Conclusions: When compared with higher resolution PSIR, a significant proportion of lesions classified as involving CGM on DIR appear to either contain more white matter than expected or to not involve CGM at all.
AB - Objective: Accurate identification and localization of cortical gray matter (CGM) lesions in MS is important when determining their clinical relevance. Double inversion recovery (DIR) scans have been widely used to detect MS CGM lesions. Phase sensitive inversion recovery (PSIR) scans have a higher signal to noise, and can therefore be obtained at a higher resolution within clinically acceptable times. This enables detection of more CGM lesions depicting a clearer cortical and juxtacortical anatomy. In this study, we systematically investigated if the use of high resolution PSIR scans changes the classification of CGM lesions, when compared with standard resolution DIR scans. Methods: 60 patients [30 RR(Relapsing remitting) and 15 each with PP(Primary progressive) and SP(Secondary progressive) MS] were scanned on a 3T Philips Achieva MRI scanner. Images acquired included DIR (1x1x3 mm resolution) and PSIR (0.5x0.5x2 mm). CGM lesions were detected and classified on DIR as intracortical (IC) or leucocortical (LC). We then examined these lesions on corresponding slices of the high resolution PSIR scans and categorized them as IC, LC, Juxtacortical white matter (JC-WM, abutting but not entering cortex) and other white matter (WM, not juxtacortical). Classifications using both scans were noted. Results: 282 IC and 483 LC were identified on DIR. Of the IC lesions, 61% were confirmed as IC on PSIR, 35.5% were reclassified as LC and 3.5% as JC-WM or other WM only. Of the LC DIR lesions, 43.9% were confirmed at LC on PSIR, 16.1% were reclassified as IC and 40% as JC-WM or other WM only. Overall, 50% (381/765) of CGM lesions seen on DIR were reclassified, and 26.5% (203/765) affected WM only. Conclusions: When compared with higher resolution PSIR, a significant proportion of lesions classified as involving CGM on DIR appear to either contain more white matter than expected or to not involve CGM at all.
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U2 - 10.1371/journal.pone.0078879
DO - 10.1371/journal.pone.0078879
M3 - Article
C2 - 24244381
AN - SCOPUS:84892904711
VL - 8
JO - PLoS One
JF - PLoS One
SN - 1932-6203
IS - 11
M1 - e78879
ER -