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The value of qualitative and quantitative assessment of lesion to cerebral cortex signal ratio on double inversion recovery sequence in the differentiation of demyelinating plaques from non-specific T2 hyperintensities

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Abstract

Objectives

To assess the usefulness of the visual assessment and to determine diagnostic value of the lesion-to-cerebral cortex signal ratio (LCSR) measurement in the differentiation of demyelinating plaques and non-specific T2 hyperintensities on double inversion recovery (DIR) sequence.

Material and methods

DIR and fluid-attenuated inversion recovery (FLAIR) sequences of 25 clinically diagnosed multiple sclerosis (MS) patients and 25 non-MS patients with non-specific T2-hyperintense lesions were evaluated visually and LCSRs were measured by two observers independently.

Results

On DIR sequence, the calculated mean LCSR ± SD for demyelinating plaques and non-specific T2-hyperintense lesions were 1.60 ± 0.26 and 0.75 ± 0.19 for observer1, and 1.61 ± 0.27 and 0.74 ± 0.19 for observer2. LCSRs of demyelinating plaques were significantly higher than other non-specific T2-hyperintense lesions on DIR sequence. By using the visual assessment demyelinating plaques were differentiated from non-specific T2-hyperintensities with 92.8 % sensitivity, 97.5 % specificity and 95.1 % accuracy for observer1 and 92.8 % sensitivity, 95 % specificity and 93.9 % accuracy for observer2.

Conclusion

Visual assessment and LCSR measurement on DIR sequence seems to be useful for differentiating demyelinating MS plaques from supratentorial non-specific T2 hyperintensities. This feature can be used for diagnosis of MS particularly in patients with only supratentorial T2-hyperintense lesions who are categorized as radiologically possible MS.

Key Points

• Demyelinating plaques and non-specific T2-hyperintensities have different SI on DIR images.

• These differences can be assessed by LCSR measurement or visual assessment.

• There is an excellent inter-observer agreement for both methods.

• This feature can be used in radiologically possible MS cases.

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Abbreviations

LCSR:

Lesion to cerebral cortex signal ratio

DIR:

Double inversion recovery

FLAIR:

Fluid-attenuated inversion recovery

GE:

Gradient echo

MRI:

Magnetic resonance imaging

MS:

Multiple sclerosis

SE:

Spin-echo

UBO:

Unidentified bright objects

VEP:

Visual evoked potential

SEP:

Somatosensory evoked potentials

CSF:

Cerebrospinal fluid

ROC:

Receiver operating characteristic

ICC:

Intraclass correlation coefficient

PPV:

Positive Predictive value

NPV:

Negative predictive value

SI:

Signal intensity

TR:

Repetition time

TE:

Echo time

EDSS:

Expanded disability status scale

RRMS:

Relapsing-remitting MS

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Acknowledgments

The scientific guarantor of this publication is Bilal Battal. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. Complex statistical methods were necessary for this paper. The statistical analysis was performed by Prof.Dr.Selim Kilic (Gulhane Military Medical Academy, Department of Epidemiology, Ankara, Turkey). Institutional Review Board approval was obtained. Written informed consent was not required for this study because of its retrospective design.

None of the study subjects or cohorts have been previously reported. Methodology: retrospective, diagnostic, performed at one institution.

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Authors and Affiliations

  1. Department of Radiology, Gulhane Military Medical School, 06018, Etlik, Ankara, Turkey

    Salih Hamcan, Bilal Battal, Veysel Akgun, Sebahattin Sari & Mustafa Tasar

  2. Department of Neurology, Gulhane Military Medical School, Ankara, Turkey

    Oguzhan Oz & Serdar Tasdemir

  3. Department of Radiology, Golcuk Military Hospital, Kocaeli, Turkey

    Yalcin Bozkurt

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  1. Salih Hamcan
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  2. Bilal Battal
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  3. Veysel Akgun
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  7. Sebahattin Sari
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Correspondence to Bilal Battal.

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Hamcan, S., Battal, B., Akgun, V. et al. The value of qualitative and quantitative assessment of lesion to cerebral cortex signal ratio on double inversion recovery sequence in the differentiation of demyelinating plaques from non-specific T2 hyperintensities. Eur Radiol 27, 763–771 (2017). https://doi.org/10.1007/s00330-016-4379-2

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  • DOI: https://doi.org/10.1007/s00330-016-4379-2

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