Contributions
Abstract: P300
Type: Poster
Abstract Category: Clinical aspects of MS - 1 Diagnosis and differential diagnosis
Introduction: Multiple Sclerosis (MS) is a demyelinating process that affects not only white matter, but also cortical gray matter. Cortical plaques can be classified by location and pathologic substract. Juxtacortical lesions remain part of the differential diagnosis of cortical lesions, since the imaging differentiation can be challenging with the standard Magnetic Resonance (MRI) sequences. However, new pulse sequences have demonstrated better results in detection and differentiation of this lesions, like Double Inversion Recovery (DIR) and Phase Sensitive Inversion Recovery (PSIR), which shows accuracy 4-5 times greater than DIR in some studies.
Objectives: The study aims to assess the performance of PSIR in detection and differential diagnosis of cortical plaques in patients with diagnosis of MS, in comparison with FLAIR.
Methods: We retrospectively evaluated patients with diagnosis of MS confirmed by McDonald criteria (2010) who underwent MRI examination in our service between March 2016 and April 2017 and were studied with the sequences FLAIR and PSIR in a 3T equipment. The images were evaluated by two radiologists that quantified the number of lesions detected first in FLAIR sequence and after in PSIR sequence. After, they estimated how many lesions were reclassified using PSIR sequence. The incoherences in the first evaluation were solved by a third radiologist.
Results: 71 patients were included, with median age of 45.4 years and average of 12.7 years of disease evolution. 52 patients (73.2%) presented with juxtacortical lesions. Of this, 43 (82.7%) had lesions that were reclassified as leucocortical or cortical using PSIR, with a median number of 2.55 lesions per patient. 38 patients (54.3%) presented supratentorial lesions identified only in PSIR, with a median number of 1.44 lesions per patient. 23 patients (32.9%) presented infratentorial lesions identified only in PSIR, with a median number of 1.43 lesions per patient. PSIR sequence showed better detection performance than FLAIR in identifying MS lesions either in supratentorial and infratentorial compartments (p< 0.001 for both), detecting an average of 1.5 more lesions in supratentorial and 0.42 more lesions in infratentorial compartment.
Conclusion: The evaluation of MS lesions with PSIR shows greater performance for diagnosis and classification in comparison with FLAIR sequence, either in supratentorial or infratentorial compartment and its use should be encouraged in the clinical practice.
Disclosure: The authors declare no conflict of interests
Abstract: P300
Type: Poster
Abstract Category: Clinical aspects of MS - 1 Diagnosis and differential diagnosis
Introduction: Multiple Sclerosis (MS) is a demyelinating process that affects not only white matter, but also cortical gray matter. Cortical plaques can be classified by location and pathologic substract. Juxtacortical lesions remain part of the differential diagnosis of cortical lesions, since the imaging differentiation can be challenging with the standard Magnetic Resonance (MRI) sequences. However, new pulse sequences have demonstrated better results in detection and differentiation of this lesions, like Double Inversion Recovery (DIR) and Phase Sensitive Inversion Recovery (PSIR), which shows accuracy 4-5 times greater than DIR in some studies.
Objectives: The study aims to assess the performance of PSIR in detection and differential diagnosis of cortical plaques in patients with diagnosis of MS, in comparison with FLAIR.
Methods: We retrospectively evaluated patients with diagnosis of MS confirmed by McDonald criteria (2010) who underwent MRI examination in our service between March 2016 and April 2017 and were studied with the sequences FLAIR and PSIR in a 3T equipment. The images were evaluated by two radiologists that quantified the number of lesions detected first in FLAIR sequence and after in PSIR sequence. After, they estimated how many lesions were reclassified using PSIR sequence. The incoherences in the first evaluation were solved by a third radiologist.
Results: 71 patients were included, with median age of 45.4 years and average of 12.7 years of disease evolution. 52 patients (73.2%) presented with juxtacortical lesions. Of this, 43 (82.7%) had lesions that were reclassified as leucocortical or cortical using PSIR, with a median number of 2.55 lesions per patient. 38 patients (54.3%) presented supratentorial lesions identified only in PSIR, with a median number of 1.44 lesions per patient. 23 patients (32.9%) presented infratentorial lesions identified only in PSIR, with a median number of 1.43 lesions per patient. PSIR sequence showed better detection performance than FLAIR in identifying MS lesions either in supratentorial and infratentorial compartments (p< 0.001 for both), detecting an average of 1.5 more lesions in supratentorial and 0.42 more lesions in infratentorial compartment.
Conclusion: The evaluation of MS lesions with PSIR shows greater performance for diagnosis and classification in comparison with FLAIR sequence, either in supratentorial or infratentorial compartment and its use should be encouraged in the clinical practice.
Disclosure: The authors declare no conflict of interests