Improved differentiation between MS and vascular brain lesions using FLAIR* at 7 Tesla
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- Kilsdonk, I.D., Wattjes, M.P., Lopez-Soriano, A. et al. Eur Radiol (2014) 24: 841. doi:10.1007/s00330-013-3080-y
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To investigate whether a new magnetic resonance image (MRI) technique called T2*-weighted fluid attenuation inversion recovery (FLAIR*) can differentiate between multiple sclerosis (MS) and vascular brain lesions, at 7 Tesla (T).
We examined 16 MS patients and 16 age-matched patients with (risk factors for) vascular disease. 3D-FLAIR and T2*-weighted images were combined into FLAIR* images. Lesion type and intensity, perivascular orientation and presence of a hypointense rim were analysed.
In total, 433 cerebral lesions were detected in MS patients versus 86 lesions in vascular patients. Lesions in MS patients were significantly more often orientated in a perivascular manner: 74 % vs. 47 % (P < 0.001). Ten MS lesions (2.3 %) were surrounded by a hypointense rim on FLAIR*, and 24 MS lesions (5.5 %) were hypointense on T2*. No lesions in vascular patients showed any rim or hypointensity. Specificity of differentiating MS from vascular lesions on 7-T FLAIR* increased when the presence of a central vessel was taken into account (from 63 % to 88 %), most obviously for deep white matter lesions (from 69 % to 94 %). High sensitivity remained (81 %).
7-T FLAIR* improves differentiation between MS and vascular lesions based on lesion location, perivascular orientation and presence of hypointense (rims around) lesions.
• A new MRI technique T2*-weighted fluid attenuation inversion recovery (FLAIR*) was investigated.
• FLAIR* at 7-T MRI combines FLAIR and T2* images into a single image.
• FLAIR* at 7 T does not require enhancement with contrast agents.
•High-resolution 7-T FLAIR* improves differentiation between MS and vascular brain lesions.
• FLAIR* revealed a central vessel more frequently in MS than vascular lesions.