Contributions
Abstract: P554
Type: Poster
Abstract Category: Pathology and pathogenesis of MS - 21 Imaging
Objective: To evaluate if FLAIR* 3T MRI can differentiate multiple sclerosis (MS) from vasculitic white matter (WM) lesions.
Background: FLAIR* MRI at clinical -high field strength can depict the perivenous nature of inflammatory demyelinating lesions, one of the most specific histopathologic feature of MS(1). Patchy, MS like demyelination can be found in primary and secondary central nervous system (CNS) vasculitis (2). However, vasculitic lesions do not have a preferential perivenular localization(3). Difficult cases with a clinical and radiological presentation suggestive of MS(4), but in the context of another immune-mediated condition potentially affecting the CNS (5), continue to pose diagnostic and therapeutic challenges.
Design and methods: Patients (n=8) with an established MS diagnosis (RRMS), patients (n=6) with an established diagnosis of CNS vasculitis and patients (n=3) with a systemic immune-mediated disorders (SID) and possible MS underwent 3T MRI. Imaging protocol included a post contrast 3D-FLAIR and a 3D T2*-segEPI (0.55 mm3 resolution) acquired during the intravenous injection of gadolinium. FLAIR* images were generated (1) and blindly analyzed for the presence of a central vein.
Results: MS patients had a higher proportion of perivenular lesions compared with CNS vasculitis patients (p< 0.0001). The percentage of perivenular lesions in MS patients was 80%, while 12.3% in CNS vasculitis patients. Two patients with SID and possible MS had a high percentage of perivenular lesions (respectively 100% and 83.3%) while one patient had a lower one (4.8%).
Conclusions: Our results suggest that the percentage of perivenular WM lesions as detected on 3T FLAIR* images is significantly higher in MS compared to CNS vasculitis and that this imaging criteria could help in the differential diagnosis between the two diseases. Difficult cases (MS plus systemic immune-mediated disorders) might particularly benefit from this diagnostic work-up (FLAIR*-central vein assessment), potentially affecting therapeutic strategies.
References:
1. Sati P, et al. Nature reviews Neurology. 2016;12(12):714-22.
2. Kim SS, et al. Mult Scler. 2014;20(1):57-63.
3. Giannini C, et al. Acta Neuropathologica. 2012;123(6):759-72.
4. Filippi M et al. Lancet neurology. 2016;15(3):292-303.
5. Charil A, et al. Lancet neurology. 2006;5(10):841-52.
Disclosure: authors have nothing to disclose
Abstract: P554
Type: Poster
Abstract Category: Pathology and pathogenesis of MS - 21 Imaging
Objective: To evaluate if FLAIR* 3T MRI can differentiate multiple sclerosis (MS) from vasculitic white matter (WM) lesions.
Background: FLAIR* MRI at clinical -high field strength can depict the perivenous nature of inflammatory demyelinating lesions, one of the most specific histopathologic feature of MS(1). Patchy, MS like demyelination can be found in primary and secondary central nervous system (CNS) vasculitis (2). However, vasculitic lesions do not have a preferential perivenular localization(3). Difficult cases with a clinical and radiological presentation suggestive of MS(4), but in the context of another immune-mediated condition potentially affecting the CNS (5), continue to pose diagnostic and therapeutic challenges.
Design and methods: Patients (n=8) with an established MS diagnosis (RRMS), patients (n=6) with an established diagnosis of CNS vasculitis and patients (n=3) with a systemic immune-mediated disorders (SID) and possible MS underwent 3T MRI. Imaging protocol included a post contrast 3D-FLAIR and a 3D T2*-segEPI (0.55 mm3 resolution) acquired during the intravenous injection of gadolinium. FLAIR* images were generated (1) and blindly analyzed for the presence of a central vein.
Results: MS patients had a higher proportion of perivenular lesions compared with CNS vasculitis patients (p< 0.0001). The percentage of perivenular lesions in MS patients was 80%, while 12.3% in CNS vasculitis patients. Two patients with SID and possible MS had a high percentage of perivenular lesions (respectively 100% and 83.3%) while one patient had a lower one (4.8%).
Conclusions: Our results suggest that the percentage of perivenular WM lesions as detected on 3T FLAIR* images is significantly higher in MS compared to CNS vasculitis and that this imaging criteria could help in the differential diagnosis between the two diseases. Difficult cases (MS plus systemic immune-mediated disorders) might particularly benefit from this diagnostic work-up (FLAIR*-central vein assessment), potentially affecting therapeutic strategies.
References:
1. Sati P, et al. Nature reviews Neurology. 2016;12(12):714-22.
2. Kim SS, et al. Mult Scler. 2014;20(1):57-63.
3. Giannini C, et al. Acta Neuropathologica. 2012;123(6):759-72.
4. Filippi M et al. Lancet neurology. 2016;15(3):292-303.
5. Charil A, et al. Lancet neurology. 2006;5(10):841-52.
Disclosure: authors have nothing to disclose