Diagnostic value of DWI-MRI for the detection of acute plaques in the relapse phase of multiple sclerosis

Abstract

Background. The 2010 revision of the McDonald criteria, widely used for the diagnosis of multiple sclerosis (MS), has established that dissemination in time (DIT) can be demonstrated by the simultaneous presence of asymptomatic gadolinium-enhancing and non-enhancing plaques on a single magnetic resonance imaging (MRI). When the use of gadolinium contrast agents is contraindicated, diffusion-weighted imaging (DWI) is utilized to confirm diffusion alterations in active inflammatory plaques. This study intended to examine whether DWI can be a viable alternative to contrast-enhanced T1-weighted imaging for demonstrating DIT in MS. Material and methods.We assessed 30 previously diagnosed MS patients during acute relapse (based on the 2010 McDonald criteria) and evaluated their brain MRI via DWI‚ contrast-enhanced T1-weighted imaging, and FLAIR sequences. Asymptomatic plaques were defined as either hyperintense or non-hyperintense in DWI and enhancing or non-enhancing in T1GAD-MRI. Statistical indices for the prediction of plaque enhancement in T1 GAD-MRI via DWI-MRI were calculated and compared. Results. The 30 participants in our study had a total of 925 demyelinating plaques that were larger than 3mm in size and presented to be hyperintense in FLAIR-MRI. Diffusion hyperintensity and plaque enhancement were significantly correlated. The sensitivity‚ specificity, positive predictive value‚ negative predictive value, and accuracy of DWI were calculated to be 69.66%‚ 99.76%‚ 96.88%‚ 96.86%, and 96.86%, respectively. Conclusions. Hyperintense DWI findings do not necessarily overlap with contrast enhancements in T1 GAD-MRI. DWI was shown to produce a higher rate of false-positive results. Our study concludes that although T1 GAD-MRI should not be replaced by DWI to determine DIT due to its lower specificity, DWI’s continued use as a surrogate screening imaging sequence whenever the use of T1GAD-MRI is of concern is not without its merits.

Multimodal diagnostics in multiple sclerosis: predicting disability and conversion from relapsing-remitting to secondary progressive disease course – protocol for systematic review and meta-analysis

“…Although DWI-MRI findings are consistent with the T1GAD-MRI sequence, Yousefi et al found contrast-enhanced imaging to be superior to DWI. The latter had 66.99% sensitivity (Sn) and 99.76% specificity (Sp) in detecting acute MS lesions from the total number of plaques in patients with active relapses when T1GAD was used as a standard 23. Another critical identifier of MS is the paramagnetic rim at the edge of non-gadolinium-enhancing lesions, which is characteristic of an aggressive disease form.…”

“…The latter had 66.99% sensitivity (Sn) and 99.76% specificity (Sp) in detecting acute MS lesions from the total number of plaques in patients with active relapses when T1GAD was used as a standard. 23 Another critical identifier of MS is the paramagnetic rim at the edge of non-gadolinium-enhancing lesions, which is characteristic of an aggressive disease form. Three-dimensional echo-planar imaging detects the paramagnetic rim more accurately than T1w brain imaging with routine settings.…”