Detection of Leukocortical Lesions in Multiple Sclerosis and Their Association with Physical and Cognitive Impairment: A Comparison of Conventional and Synthetic Phase-Sensitive Inversion Recovery MRI

Abstract

BACKGROUND AND PURPOSE: Cortical lesions are common in multiple sclerosis and are included in the latest diagnostic criteria. The limited sensitivity of cortical MS lesions on conventional MR imaging can be improved by phase-sensitive inversion recovery. Synthetic MR imaging could provide phase-sensitive inversion recovery without additional scanning, but the use of synthetic phase-sensitive inversion recovery remains to be validated. We aimed to compare the ability and clinical value of detecting leukocortical lesions with conventional and synthetic phase-sensitive inversion recovery in MS. MATERIALS AND METHODS: Twenty-one patients with MS prospectively underwent conventional and synthetic phase-sensitive inversion recovery, 3D T1-weighted, and T2 FLAIR imaging. Two neuroradiologists independently performed blinded phase-sensitive inversion recovery lesion assessments; a consensus rating with all sequences was considered the criterion standard. Lesion volumes were segmented. All participants underwent standardized cognitive and physical examinations and Fatigue Severity Scale assessment. Results were analyzed with multiple linear regressions. RESULTS: Interrater and criterion standard agreement for leukocortical lesions was excellent for both conventional and synthetic phase-sensitive inversion recovery (intraclass correlation coefficient ϭ 0.79-0.97). Leukocortical lesion volumes for both sequences were associated with lower information-processing speed (P Յ .01) and verbal fluency (P Յ .02). Both phase-sensitive inversion recovery sequences showed a positive effect on the association when combining volumes of leukocortical lesions and white matter lesions with information-processing speed (P Յ .005) and verbal fluency (P Յ .03). No associations were found between leukocortical lesion volumes and physical disability or fatigue. CONCLUSIONS: Synthetic and conventional phase-sensitive inversion recovery have a sensitivity similar to that of leukocortical MS lesions. The detected leukocortical lesions are associated with cognitive dysfunction and thus provide clinically relevant information, which encourages assessment of cortical MS involvement at conventional field strengths. ABBREVIATIONS: DIR ϭ double inversion recovery; EDSS ϭ Expanded Disability Status Scale; ICC ϭ intraclass correlation coefficient; LCL ϭ leukocortical lesions; PSIR ϭ phase-sensitive inversion recovery; R 1 ϭ longitudinal relaxation rate; R 2 ϭ transverse relaxation rate

Evaluating Tissue Contrast and Detecting White Matter Injury in the Infant Brain: A Comparison Study of Synthetic Phase-Sensitive Inversion Recovery

“…Recently, conventional and synthetic PSIR were compared for the detection of cortical lesions in patients with multiple sclerosis. 16 In that study, synthetic PSIR showed similar sensitivity to conventional PSIR. 16 We did not acquire conventional PSIR, so we could not compare its performance with that of synthetic PSIR in the infant brain.…”

“…16 In that study, synthetic PSIR showed similar sensitivity to conventional PSIR. 16 We did not acquire conventional PSIR, so we could not compare its performance with that of synthetic PSIR in the infant brain. A prospective study on this subject is needed in the future.…”

“…Synthetic MR imaging is a time-efficient imaging technique that can generate multiple synthesized images at a single acquisition. 2,16,17 A few studies have shown that synthetic MR imaging can be used in children 2,10,18 as well as in adults. 12,19 However, while one of these previous studies did compare the value of synthetic T1WI, T2WI, and FLAIR with conventional sequences, 2 the value of synthetic PSIR has not been evaluated in any study that we know of.…”

3D Quantitative Synthetic MRI in the Evaluation of Multiple Sclerosis Lesions

“…Quantitative synthetic MR imaging is a time-efficient MR imaging technique that enables simultaneous quantification of T1 and T2 relaxation times and proton attenuation and allows the creation of any contrast-weighted image, including DIR and PSIR, without additional scanning time. [9][10][11][12][13] Previous studies have shown that synthetic MR imaging is useful for detecting and characterizing MS lesions. 10,11,14 However, these studies were based on a multisection 2D acquisition, providing a relatively low resolution in the section direction.…”

Early cognitive dysfunction as a marker for the poor course of multiple sclerosis: a prospective 12-year follow-up

“…Когнитивные функции, наряду с функцией поддержания равновесия и локомоций, а также контроля эмоционального статуса, задействуют большинство отделов переднего мозга и мозжечка [10], следовательно, они могут отражать степень эффективности внутримозговых соотношений. РС как демиелинизирующее заболевание, поражающее преимущественно белое вещество больших полушарий, комиссур и мозжечка, в существенной степени снижает возможности обеспечения интегративной активности мозга [11,12].…”