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Clinical 3-tesla FLAIR* MRI improves diagnostic accuracy in multiple sclerosis.


ABSTRACT: OBJECTIVE:To evaluate clinical fluid-attenuated inversion recovery (FLAIR)* 3T magnetic resonance imaging (MRI), which is sensitive to perivenular inflammatory demyelinating lesions, in diagnosing multiple sclerosis (MS). BACKGROUND:Central veins may be a distinguishing feature of MS lesions. FLAIR*, a combined contrast derived from clinical MRI scans, has not been studied as a clinical tool for diagnosing MS. METHODS:Two experienced MS neurologists evaluated 87 scan pairs (T2-FLAIR/FLAIR*), separately and side-by-side, from 68 MS cases, 8 healthy volunteers, and 11 individuals with other neurological diseases. Raters judged cases based on experience, published criteria, and a visual assessment of the "40% rule," whereby MS is favored if >40% of lesions demonstrate a central vein. Diagnostic accuracy was determined with area under the receiver operating characteristic curve (AUC), and inter-rater reliability was assessed with Cohen's kappa (?). RESULTS:Diagnostic accuracy was high: rater 1, AUC 0.94 (95% confidence interval: 0.89, 0.97) for T2-FLAIR, 0.95 (0.92, 0.98) for FLAIR*; rater 2, 0.94 (0.90, 0.98) and 0.90 (0.85, 0.95). AUC improved when images were considered together: rater 1, 0.99 (0.98, 1.00); rater 2, 0.98 (0.96, 0.99). Inter-rater agreement was substantial for T2-FLAIR (??=?0.68) and FLAIR* (??=?0.74), despite low agreement on the 40% rule (??=?0.47) ([Formula: see text] in all cases). CONCLUSIONS:Joint clinical evaluation of T2-FLAIR and FLAIR* images modestly improves diagnostic accuracy for MS and does not require counting lesions with central veins.

SUBMITTER: George IC 

PROVIDER: S-EPMC4945460 | biostudies-literature | 2016 Oct

REPOSITORIES: biostudies-literature

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Clinical 3-tesla FLAIR* MRI improves diagnostic accuracy in multiple sclerosis.

George Ilena C IC   Sati Pascal P   Absinta Martina M   Cortese Irene Cm IC   Sweeney Elizabeth M EM   Shea Colin D CD   Reich Daniel S DS  

Multiple sclerosis (Houndmills, Basingstoke, England) 20160114 12


<h4>Objective</h4>To evaluate clinical fluid-attenuated inversion recovery (FLAIR)* 3T magnetic resonance imaging (MRI), which is sensitive to perivenular inflammatory demyelinating lesions, in diagnosing multiple sclerosis (MS).<h4>Background</h4>Central veins may be a distinguishing feature of MS lesions. FLAIR*, a combined contrast derived from clinical MRI scans, has not been studied as a clinical tool for diagnosing MS.<h4>Methods</h4>Two experienced MS neurologists evaluated 87 scan pairs  ...[more]

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2023-01-30 | GSE215240 | GEO