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Altered signal intensity of active enhancing inflammatory lesions using post-contrast double inversion recovery MR sequence

  • Magnetic Resonance
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

We aimed at establishing the impact upon gadolinium administration on the conspicuity of active enhancing multiple sclerosis (MS) lesions using double inversion recovery (DIR) at 3T.

Methods

15 consecutive patients with MS (n=8) or a clinically isolated syndrome (n=7) underwent pre and post-contrast DIR in addition to T2-weighted, FLAIR, pre and post-contrast T1-weighted sequences. First, two neuroradiologists located and marked all the enhancing MS lesions visible in consensus. Second, two other neuroradiologists, blinded to other sequences than DIR, independently assessed the SI changes from pre to post-contrast DIR images for each enhancing lesion, according to a 4-point-scale: increased SI (grade 1), absence of change (grade 2), lesion being partially (grade 3) or completely masked on post-contrast DIR images (grade 4).

Results

246 MS lesions were detected including 26 enhancing on post-contrast T1-weighted images in 9 patients. The two blinded readers concluded to a decreased signal-intensity on post-contrast DIR images for all the 26 enhancing MS lesions (14 of grade 3 and 12 of grade 4). Inter-observer agreement was excellent, Kappa=0.85 (0.75 - 0.94). Using DIR post-contrast leads to altered signal-intensity of enhancing active MS lesions, ranging from partial to complete signal-loss.

Conclusion

Our study strongly suggests the use of DIR before gadolinium administration.

Key Points

• DIR has gained widespread use in MS.

• MRI protocols for MS patients usually contain several post-contrast sequences.

• Signal-intensity of enhancing MS lesions is altered using DIR post-contrast.

• Our study strongly suggests the use of DIR before gadolinium administration.

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Abbreviations

MS:

Multiple sclerosis

RRMS:

Relapsing remitting multiple sclerosis

CIS:

Clinically isolated syndrome

DIS:

Dissemination of brain lesions in space

DIT:

Dissemination of brain lesions in time

SI:

Signal-intensity

DIR:

Double inversion recovery

FLAIR:

Fluid-attenuated inversion recovery

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Acknowledgments

The scientific guarantor of this publication is Prof Xavier Leclerc. David Chechin is an employee of Philips. All the other 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. One of the authors has significant statistical expertise: Mr Mohamed Amine Benadjaoud kindly provided statistical advice for this manuscript. No complex statistical methods were necessary for this paper. Our institutional review board waived the requirement to obtain a signed informed consent from the subjects included since the present imaging protocol was similar to that used in clinical routine and did not require any additional gadolinium injection.

Our institutional review board waived the requirement to obtain a signed informed consent from the subjects included because the additional acquisition time related to the post-contrast DIR sequence remained limited. No study subjects or cohorts have been previously reported. Methodology: prospective, observational, performed at one institution.

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Authors and Affiliations

  1. Departments of Neuroradiology, AP-HP, Hôpitaux Universitaires Henri Mondor, Créteil, France

    Jérôme Hodel

  2. Faculty of Medicine, Université Paris Est Créteil, Créteil, France

    Jérôme Hodel

  3. CHU Lille, Department of Neuroradiology, F-59000, Lille, France

    Jérôme Hodel, Sammy Badr & Paul Lebert

  4. Uniersity of Lille, CHU Lille, LIRIC - INSERM U995, FHU Imminent, F-59000, Lille, France

    Olivier Outteryck & Patrick Vermersch

  5. University of Lille, CHU Lille, INSERM U1171, FHU VasCog, F-59000, Lille, France

    Jean-Pierre Pruvo & Xavier Leclerc

  6. Inserm, U1018, Radiation Epidemiology Team, Villejuif, France

    Mohamed Amine Benadjaoud

  7. Philips, Suresnes, France

    David Chechin

Authors
  1. Jérôme Hodel
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  2. Sammy Badr
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  3. Olivier Outteryck
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  4. Paul Lebert
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  5. David Chechin
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  6. Mohamed Amine Benadjaoud
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  7. Jean-Pierre Pruvo
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  8. Patrick Vermersch
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  9. Xavier Leclerc
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Corresponding author

Correspondence to Jérôme Hodel.

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Hodel, J., Badr, S., Outteryck, O. et al. Altered signal intensity of active enhancing inflammatory lesions using post-contrast double inversion recovery MR sequence. Eur Radiol 27, 637–641 (2017). https://doi.org/10.1007/s00330-016-4416-1

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  • DOI: https://doi.org/10.1007/s00330-016-4416-1

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