MRI for the diagnosis of multiple sclerosis: a pilot study comparing FLAIR* with modified ‘McDonald’ criteria.
| Abstract: |
- Background: Multiple sclerosis (MS) lesions have long been known to have a perivenular distribution from histological studies. There is increasing evidence that the central vein sign, a vein seen centrally in a white matter lesion (WML), could be used as a diagnostic biomarker on MR imaging. FLAIR* is a new post-processing algorithm that combines FLAIR and T2* sequences to better identify the central vein sign.
- Objectives: To determine if the use of FLAIR* is feasible in a clinical setting, and to assess the potential of FLAIR* compared to the 2010 McDonald criteria (the current diagnostic criteria for MS) to diagnose MS based on datasets acquired at a single timepoint.
- Methods: 14 patients with clinically definite relapsing-remitting MS underwent a 3T MRI study. FLAIR* images were assessed for the presence of WMLs and the proportion of lesions demonstrating the central vein sign.
- Results: 198 lesions were identified in 14 patients, of which 83% demonstrated the central vein sign. All patients met a suggested diagnostic criteria of more than 40% of WMLs detected demonstrating the central vein sign (mean 86%). None of the patients met the radiological McDonald criteria.
- Conclusions: FLAIR* is a feasible imaging technique in a clinical context, and demonstrates the highly perivenular distribution of WMLs in patients with MS. Further work is required to determine if the high proportion of WMLs demonstrating the central vein sign is specific to MS, and if so FLAIR* could be of clinical value to support the diagnosis of MS in routine clinical practice.
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- Data acquisition & analysis
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