MS cortical lesions on DIR: Not quite what they seem?

Varun Sethi, Nils Muhlert, Maria Ron, Xavier Golay, Claudia A. Wheeler-Kingshott, David H. Miller, Declan T. Chard, Tarek A. Yousry

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Article numbere78879
JournalPLoS One
Volume8
Issue number11
DOIs
StatePublished - Nov 11 2013
Externally publishedYes

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lesions (animal)
Recovery
Gray Matter
scanners
Noise
Anatomy
cortex
Magnetic resonance imaging
White Matter

ASJC Scopus subject areas

  • Agricultural and Biological Sciences(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Medicine(all)

Cite this

Sethi, V., Muhlert, N., Ron, M., Golay, X., Wheeler-Kingshott, C. A., Miller, D. H., ... Yousry, T. A. (2013). MS cortical lesions on DIR: Not quite what they seem? PLoS One, 8(11), [e78879]. https://doi.org/10.1371/journal.pone.0078879

MS cortical lesions on DIR : Not quite what they seem? / Sethi, Varun; Muhlert, Nils; Ron, Maria; Golay, Xavier; Wheeler-Kingshott, Claudia A.; Miller, David H.; Chard, Declan T.; Yousry, Tarek A.

In: PLoS One, Vol. 8, No. 11, e78879, 11.11.2013.

Research output: Contribution to journalArticle

Sethi, V, Muhlert, N, Ron, M, Golay, X, Wheeler-Kingshott, CA, Miller, DH, Chard, DT & Yousry, TA 2013, 'MS cortical lesions on DIR: Not quite what they seem?', PLoS One, vol. 8, no. 11, e78879. https://doi.org/10.1371/journal.pone.0078879
Sethi V, Muhlert N, Ron M, Golay X, Wheeler-Kingshott CA, Miller DH et al. MS cortical lesions on DIR: Not quite what they seem? PLoS One. 2013 Nov 11;8(11). e78879. https://doi.org/10.1371/journal.pone.0078879
Sethi, Varun ; Muhlert, Nils ; Ron, Maria ; Golay, Xavier ; Wheeler-Kingshott, Claudia A. ; Miller, David H. ; Chard, Declan T. ; Yousry, Tarek A. / MS cortical lesions on DIR : Not quite what they seem?. In: PLoS One. 2013 ; Vol. 8, No. 11.
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abstract = "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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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.

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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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