Contributions
Abstract: P490
Type: Poster
Abstract Category: Pathology and pathogenesis of MS - Imaging
Introduction: High field strength 3 Tesla (T) MRI improves image resolution and signal-to-noise ratio, but its clinical relevance in clinically isolated syndrome (CIS) remains uncertain. We studied whether 3T MRI improves lesion detection in CIS patients in a multicentre setting, and whether this leads to an earlier MS diagnosis and improved inter-rater agreement.
Methods: We selected 30 patients and 10 controls from our prospective cohort of 67 CIS patients and 27 healthy controls from 6 different European centres. All subjects received baseline 1.5T and 3T brain and spinal cord scan at baseline; patients also follow-up brain MRI after 3 to 6 months.
Four experienced neuroradiologists and four less-experienced raters (PhD-students or radiology residents) scored the number of lesions by anatomical region (juxtacortical, periventricular, infratenorial, spinal cord) and subsequently determined dissemination in space and time (DIS and DIT) and diagnosis of MS according to McDonald 2010 criteria. Differences in lesion load between 1.5T and 3T scans were determined using generalized estimating equations. Kappa scores were calculated to assess inter-rater agreement.
Results: In healthy controls we saw a significant increase in overall number of lesions (mean per rater per subject, 3T vs 1.5T: 0.38 vs 0.05 lesions, p=0.005). However, in the MS group there was no significant difference between field strengths in overall number of lesions (4.40 vs 4.18, p=0.657) or by region. At baseline there was no significant difference in number of cases with DIS, DIT or diagnosis of MS. At follow-up, the number of cases with DIT tended to be higher at 3T (mean per rater: 9.75 vs 8.13, p=0.067), with a significantly more frequent diagnosis of MS (6.38 vs 4.63, p=0.032).Inter-rater agreement for DIS, DIT and diagnosis of MS at baseline was reasonable to good, varying from 0.51 to 0.83. At follow-up, 3T slightly improved the interrater agreement for the experienced raters (DIS 0.51 to 0.55; DIT 0.77 to 0.81; MS 0.61 to 0.75), while the agreement between less-experienced raters slightly decreased (DIS 0.64 to 0.59; DIT 0.65 to 0.63; MS 0.73 to 0.67).
Conclusion: High field MRI had a modest effect on lesion detection in both controls and CIS patients, leading to an increased frequency of diagnosis of MS at follow-up.
Experienced readers seemed to benefit more from 3T imaging than less experienced ones, underlining the need for additional training in reading higher field strength images.
Disclosure:
Marloes Hagens has nothing to disclose.
Jessica Burggraaff has nothing to disclose.
Iris Kilsdonk had nothing to disclose.
Serena Ruggieri has nothing to disclose.
Sara Collorone received meeting compensations from Novartis.
Rosa Cortese has nothing to disclose.
Niamh Cawley has nothing to disclose.
Emilia Sbardella has nothing to disclose.
Michaele Andelova has nothing to disclose.
Michael Amann has nothing to disclose.
Johanna Lieb has nothing to disclose.
Patrizia Pantano has received founding for travel from Novartis, Genzyme and Bracco and speaker honoraria from Biogen.
Birgit Witte has nothing to disclose.
Joep Killestein has accepted speaker and consultancy fees from Merck-Serono, Teva, Biogen, Genzyme, Roche and Novartis.
Celia Oreja-Guevara received honoraria as speaker from Biogen-Idec, Bayer-Schering, Merck-Serono, Teva, Genzyme and Novartis.
Jens Wuerfel received research grants from Novartis and Biogen, speaker honoraria from Bayer, Novartis, Teva, and Biogen, and he served for advisory boards for Novartis and Biogen.
Olga Cicarelli is an Associate Editor of Neurology, and she serves as consultant for Novartis, Roche, Genzyme, and Teva and payments are made to the institution.
Claudio Gasperini received fees as speaker for Bayer-Schering Pharma, Sanofi-Aventis, Genzyme, Biogen, Teva, Novartis and Merck Serono, and received a grant for research by Teva.
Carsten Lukas holds an endowed professorship supported by the Novartis foundation, has received consulting and speaker"s honoraria from BiogenIdec, Bayer Schering, Novartis, Sanofi, Genzyme and TEVA, and has received research scientific grant support from MerckSerono.
Alex Rovira serves on scientific advisory boards for Biogen Idec, Novartis, Genzyme, and OLEA Medical, and on the editorial board of the American Journal of Neuroradiology and Neuroradiology, has received speaker honoraria from Bayer, Genzyme, Sanofi-Aventis, Bracco, Merck-Serono, Teva Pharmaceutical Industries Ltd, Stendhal, Novartis and Biogen Idec, and has research agreements with Siemens AG.
Mike Wattjes serves on the editorial boards of Neuroradiology, Journal of Neuroimaging, European Radiology, Frontiers of Neurology, and serves as a consultant for Roche, Novartis and Biogen.
Frederik Barkhof serves on the editorial boards of Brain, Neurology, Neuroradiology, Multiple Sclerosis Journal and Radiology, and serves as a consultant for Bayer-Schering Pharma, Sanofi-Aventis, Genzyme, Biogen, Teva, Novartis, Roche, Synthon BV and Jansen Research.
Abstract: P490
Type: Poster
Abstract Category: Pathology and pathogenesis of MS - Imaging
Introduction: High field strength 3 Tesla (T) MRI improves image resolution and signal-to-noise ratio, but its clinical relevance in clinically isolated syndrome (CIS) remains uncertain. We studied whether 3T MRI improves lesion detection in CIS patients in a multicentre setting, and whether this leads to an earlier MS diagnosis and improved inter-rater agreement.
Methods: We selected 30 patients and 10 controls from our prospective cohort of 67 CIS patients and 27 healthy controls from 6 different European centres. All subjects received baseline 1.5T and 3T brain and spinal cord scan at baseline; patients also follow-up brain MRI after 3 to 6 months.
Four experienced neuroradiologists and four less-experienced raters (PhD-students or radiology residents) scored the number of lesions by anatomical region (juxtacortical, periventricular, infratenorial, spinal cord) and subsequently determined dissemination in space and time (DIS and DIT) and diagnosis of MS according to McDonald 2010 criteria. Differences in lesion load between 1.5T and 3T scans were determined using generalized estimating equations. Kappa scores were calculated to assess inter-rater agreement.
Results: In healthy controls we saw a significant increase in overall number of lesions (mean per rater per subject, 3T vs 1.5T: 0.38 vs 0.05 lesions, p=0.005). However, in the MS group there was no significant difference between field strengths in overall number of lesions (4.40 vs 4.18, p=0.657) or by region. At baseline there was no significant difference in number of cases with DIS, DIT or diagnosis of MS. At follow-up, the number of cases with DIT tended to be higher at 3T (mean per rater: 9.75 vs 8.13, p=0.067), with a significantly more frequent diagnosis of MS (6.38 vs 4.63, p=0.032).Inter-rater agreement for DIS, DIT and diagnosis of MS at baseline was reasonable to good, varying from 0.51 to 0.83. At follow-up, 3T slightly improved the interrater agreement for the experienced raters (DIS 0.51 to 0.55; DIT 0.77 to 0.81; MS 0.61 to 0.75), while the agreement between less-experienced raters slightly decreased (DIS 0.64 to 0.59; DIT 0.65 to 0.63; MS 0.73 to 0.67).
Conclusion: High field MRI had a modest effect on lesion detection in both controls and CIS patients, leading to an increased frequency of diagnosis of MS at follow-up.
Experienced readers seemed to benefit more from 3T imaging than less experienced ones, underlining the need for additional training in reading higher field strength images.
Disclosure:
Marloes Hagens has nothing to disclose.
Jessica Burggraaff has nothing to disclose.
Iris Kilsdonk had nothing to disclose.
Serena Ruggieri has nothing to disclose.
Sara Collorone received meeting compensations from Novartis.
Rosa Cortese has nothing to disclose.
Niamh Cawley has nothing to disclose.
Emilia Sbardella has nothing to disclose.
Michaele Andelova has nothing to disclose.
Michael Amann has nothing to disclose.
Johanna Lieb has nothing to disclose.
Patrizia Pantano has received founding for travel from Novartis, Genzyme and Bracco and speaker honoraria from Biogen.
Birgit Witte has nothing to disclose.
Joep Killestein has accepted speaker and consultancy fees from Merck-Serono, Teva, Biogen, Genzyme, Roche and Novartis.
Celia Oreja-Guevara received honoraria as speaker from Biogen-Idec, Bayer-Schering, Merck-Serono, Teva, Genzyme and Novartis.
Jens Wuerfel received research grants from Novartis and Biogen, speaker honoraria from Bayer, Novartis, Teva, and Biogen, and he served for advisory boards for Novartis and Biogen.
Olga Cicarelli is an Associate Editor of Neurology, and she serves as consultant for Novartis, Roche, Genzyme, and Teva and payments are made to the institution.
Claudio Gasperini received fees as speaker for Bayer-Schering Pharma, Sanofi-Aventis, Genzyme, Biogen, Teva, Novartis and Merck Serono, and received a grant for research by Teva.
Carsten Lukas holds an endowed professorship supported by the Novartis foundation, has received consulting and speaker"s honoraria from BiogenIdec, Bayer Schering, Novartis, Sanofi, Genzyme and TEVA, and has received research scientific grant support from MerckSerono.
Alex Rovira serves on scientific advisory boards for Biogen Idec, Novartis, Genzyme, and OLEA Medical, and on the editorial board of the American Journal of Neuroradiology and Neuroradiology, has received speaker honoraria from Bayer, Genzyme, Sanofi-Aventis, Bracco, Merck-Serono, Teva Pharmaceutical Industries Ltd, Stendhal, Novartis and Biogen Idec, and has research agreements with Siemens AG.
Mike Wattjes serves on the editorial boards of Neuroradiology, Journal of Neuroimaging, European Radiology, Frontiers of Neurology, and serves as a consultant for Roche, Novartis and Biogen.
Frederik Barkhof serves on the editorial boards of Brain, Neurology, Neuroradiology, Multiple Sclerosis Journal and Radiology, and serves as a consultant for Bayer-Schering Pharma, Sanofi-Aventis, Genzyme, Biogen, Teva, Novartis, Roche, Synthon BV and Jansen Research.