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MS cortical lesions on DIR: not quite what they seem?

Sethi, Varun, Muhlert, Nils, Ron, Maria, Golay, Xavier, Wheeler-Kingshott, Claudia, Miller, David, Chard, Declan and Yousry, Tarek 2013. MS cortical lesions on DIR: not quite what they seem? Plos One 8 (11) , e78879. 10.1371/journal.pone.0078879

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Abstract

Objective: Accurate identification and localization of cortical gray matter (CGM) lesions in MS is important when determining their clinical relevance. Double inversion recovery (DIR) scans have been widely used to detect MS CGM lesions. Phase sensitive inversion recovery (PSIR) scans have a higher signal to noise, and can therefore be obtained at a higher resolution within clinically acceptable times. This enables detection of more CGM lesions depicting a clearer cortical and juxtacortical anatomy. In this study, we systematically investigated if the use of high resolution PSIR scans changes the classification of CGM lesions, when compared with standard resolution DIR scans. Methods: 60 patients [30 RR(Relapsing remitting) and 15 each with PP(Primary progressive) and SP(Secondary progressive) MS] were scanned on a 3T Philips Achieva MRI scanner. Images acquired included DIR (1×1×3 mm resolution) and PSIR (0.5×0.5×2 mm). CGM lesions were detected and classified on DIR as intracortical (IC) or leucocortical (LC). We then examined these lesions on corresponding slices of the high resolution PSIR scans and categorized them as IC, LC, Juxtacortical white matter (JC-WM, abutting but not entering cortex) and other white matter (WM, not juxtacortical). Classifications using both scans were noted. Results: 282 IC and 483 LC were identified on DIR. Of the IC lesions, 61% were confirmed as IC on PSIR, 35.5% were reclassified as LC and 3.5% as JC-WM or other WM only. Of the LC DIR lesions, 43.9% were confirmed at LC on PSIR, 16.1% were reclassified as IC and 40% as JC-WM or other WM only. Overall, 50% (381/765) of CGM lesions seen on DIR were reclassified, and 26.5% (203/765) affected WM only. Conclusions: When compared with higher resolution PSIR, a significant proportion of lesions classified as involving CGM on DIR appear to either contain more white matter than expected or to not involve CGM at all.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Psychology
Subjects: R Medicine > RC Internal medicine > RC0321 Neuroscience. Biological psychiatry. Neuropsychiatry
Publisher: Public Library of Science
ISSN: 1932-6203
Funders: MS Society of Great Britain and Northern Ireland, UCL UCLH Comprehensive Biomedical Research Centre
Date of First Compliant Deposit: 30 March 2016
Last Modified: 04 Jun 2017 05:46
URI: http://orca-mwe.cf.ac.uk/id/eprint/53403

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