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Assessment of 2D conventional and synthetic MRI in multiple sclerosis

  • Diagnostic Neuroradiology
  • Published:
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Abstract

Purpose

To qualitatively and quantitatively compare synthetic and conventional MRI sequences acquired on a 1.5-T system for patients with multiple sclerosis (MS).

Methods

Prospective study that involved twenty-seven consecutive relapsing–remitting MS patients scanned on a 1.5-T MRI scanner. The MRI protocol included 2D transverse conventional spin-echo sequences: proton density-weighted (PD), T2-weighted, T2-FLAIR, and T1-weighted. Synthetic images were generated using 2D transverse QRAPMASTER and SyMRI software with the same voxel size, repetition, echo, and inversion times as the conventional sequences. Four raters performed a crosstab qualitative analysis that involved evaluating global image quality, contrast, flow artefacts, and confidence in lesion assessment introducing the concepts of predominance, agreement, and disagreement. A quantitative analysis was also performed and included evaluating the number of lesions (periventricular, juxtacortical, brainstem, and cerebellum) and the contrast-to-noise ratio between regions (CSF, white matter, grey matter, lesions).

Results

The global image quality assessment showed predominance for better scores for conventional sequences over synthetic sequences, whereas contrast, confidence in lesion assessment, and flow artefacts showed predominance for agreement between sequences. There was predominance for disagreement between all pairs of raters in most of the evaluated qualitative parameters. Synthetic PD and T2-FLAIR images showed higher contrast-to-noise ratios than the corresponding conventional images for most comparison between regions. There were no significant differences in the number of lesions detected for most of the study regions between conventional and synthetic images.

Conclusion

Synthetic MRI can be potentially used as an alternative to conventional brain MRI sequences in the assessment of MS.

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Abbreviations

A cq :

Acquisition

A cs :

Agreement between conventional and synthetic images

A r k r l :

Agreement between raters

CLWM:

Contrast of lesions to white matter

CNR:

Contrast-to-noise ratio

CSF:

Cerebrospinal fluid

DAr k r l :

Disagreement between raters

DF:

Distance factor

EDSS:

Kurtzke expanded disability status scale

FA:

Flip angle

FAPF:

Flow artefacts in the posterior fossa

FOV:

Field of view

FLAIR:

Fluid attenuated inversion recovery

GIC:

Global image contrast

GIQ:

Global image quality

GM:

Grey matter

iPAT:

Integrated parallel acceleration techniques

LA:

Whole lesion

LCLA infra:

Level of confidence in the assessment of lesions in the infratentorial location

LCLA supra:

Level of confidence in the assessment of lesions in the supratentorial location

LI:

Inner lesion

MRI:

Magnetic resonance imaging

MS:

Multiple sclerosis

Pc :

Predominance on conventional images

PD:

Proton density

P rl :

Predominance of rate l

P rk :

Predominance of rater k

P s :

Predominance on synthetic images

ROI:

Region of interest

RRMS:

Relapsing-remitting multiple sclerosisSS

SD:

Standard deviation

TA:

Acquisition time

TE:

Echo time

TI:

Inversion time

TR:

Repetition time

WM:

White matter

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Acknowledgements

We thank Martin Uppman, MSc, Tobias Granberg, MD PhD (Karolinska University Hospital, Stockholm, Sweden), and Frederik Testud, PhD (Siemens Healthcare AB, Sweden) for their work on the MDME (formerly known as QRAPMASTER) sequence.

Funding

No funding was received for this study.

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Authors and Affiliations

Authors

Corresponding author

Correspondence to Francesc Xavier Aymerich.

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Ethical approval

All procedures performed in the studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Conflicts of interest

J. Sastre-Garriga declares grants and personal fees from Genzyme; personal fees from Almirall, Biogen, Celgene, Merck, Novartis, Roche and Teva; and is a member of the Editorial Committee of Multiple Sclerosis Journal and Director of the Scientific Committee of Revista de Neurologia. M.A. Clarke declares personal fees from Novartis and received 2018 ECTRIMS-MAGNIMS fellowship. G. Arrambide has received compensation for consulting services or participation in advisory boards from Sanofi and Merck; research support from Novartis; travel expenses for scientific meetings from Novartis and Roche; and speaking honoraria from Stendhal, Sanofi, and Merck. A. Rovira serves on scientific advisory boards for Novartis, Sanofi-Genzyme, Synthetic MR, Roche, Biogen, and OLEA Medical, and has received speaker honoraria from Sanofi-Genzyme, Bracco, Merck-Serono, Teva Pharmaceutical Industries Ltd, Novartis, Roche, and Biogen. F.X. Aymerich, C. Auger, J. Alonso, A. Barros, J. Mora, A. Andrino, and J.F. Corral have nothing to disclose.

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Aymerich, F.X., Auger, C., Alonso, J. et al. Assessment of 2D conventional and synthetic MRI in multiple sclerosis. Neuroradiology 64, 2315–2322 (2022). https://doi.org/10.1007/s00234-022-02973-2

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  • DOI: https://doi.org/10.1007/s00234-022-02973-2

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