Abstract
Objectives
Seven-Tesla MRI demonstrated new pathological features of multiple sclerosis (MS) using T2*-weighted sequences. However, a clinical MRI protocol at 7 T has never been investigated. We evaluated the clinical value of 7-T MRI by investigating the sensitivity of lesion detection compared with 3 T.
Methods
Thirty-eight MS patients and eight healthy controls underwent multi-contrast MRI using 3D T1-weighted (3D-T1w), 2D dual-echo T2-weighted (2D-T2w) and 3D fluid-attenuated inversion recovery (3D-FLAIR) at 3 and 7 T. Images were analysed for focal lesions, which were counted and categorised according to anatomical location. The study was approved by the institutional review board.
Results
Lesion-wise analysis showed increased lesion counts in cortical grey matter (GM) at 7 T of 91, 75 and 238 % for 3D-T1w, 2D-T2w and FLAIR sequences, respectively. Patient-wise analysis confirmed this for 2D-T2w and FLAIR (P < 0.023 and P < 0.001). Seven-Tesla white matter (WM) lesion detection was not increased; 3D-FLAIR even detected significantly more WM lesions at 3 T.
Conclusions
Using a clinical multi-contrast MRI protocol, increased lesion detection was observed in cortical GM but not in WM. Given the clinical relevance of GM abnormalities, this may have consequences for clinical outcome measures, prognostic classification and future diagnostic criteria incorporating GM abnormalities.
Key Points
• Standard multi-contrast 7-T magnetic resonance imaging in multiple sclerosis is feasible.
• Seven-Tesla MRI detects more cortical grey matter lesions than 3 T.
• Seven-Tesla MRI fares no better than 3 T in detecting white matter lesions.
• Grey matter abnormalities have high diagnostic and prognostic relevance in MS.
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References
Compston A, Coles A (2002) Multiple sclerosis. Lancet 359:1221–1231
Young I, Hall A, Pallis C, Legg N, Bydder G, Steiner R (1981) Nuclear magnetic resonance imaging of the brain in multiple sclerosis. Lancet 14:1063–1066
Bakshi R, Thompson AJ, Rocca MA, Pelletier D, Dousset V, Barkhof F, Inglese M, Guttmann CRG, Horsfield MA et al (2008) MRI in multiple sclerosis: current status and future prospects. Lancet Neurol 7:615–625
McDonald WI, Compston A, Edan G, Goodkin D, Hartung HP, Lublin FD, McFarland HF, Paty DW, Polman CH et al (2001) Recommended diagnostic criteria for multiple sclerosis: guidelines from the International Panel on the diagnosis of multiple sclerosis. Ann Neurol 50:121–127
Polman CH, Reingold SC, Edan G, Filippi M, Hartung H-P, Kappos L, Lublin FD, Metz LM, Mcfarland HF et al (2005) Diagnostic criteria for multiple sclerosis: 2005 revisions to the McDonald Criteria. Ann Neurol 58:840–846
Polman CH, Reingold SC, Banwell B, Clanet M, Cohen JA, Filippi M, Fujihara K, Havrdova E, Hutchinson M et al (2011) Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria. Ann Neurol 69:292–302
Wattjes MP, Barkhof F (2009) High field MRI in the diagnosis of multiple sclerosis: high field-high yield? Neuroradiology 51:279–292
Wattjes MP, Lutterbey GG, Harzheim M, Gieseke J, Träber F, Klotz L, Klockgether T, Schild HH (2006) Higher sensitivity in the detection of inflammatory brain lesions in patients with clinically isolated syndromes suggestive of multiple sclerosis using high field MRI: an intraindividual comparison of 1.5 T with 3.0 T. Eur Radiol 16:2067–2073
Di Perri C, Dwyer MG, Wack DS, Cox JL, Hashmi K, Saluste E, Hussein S, Schirda C, Stosic M et al (2009) Signal abnormalities on 1.5 and 3 Tesla brain MRI in multiple sclerosis patients and healthy controls. A morphological and spatial quantitative comparison study. NeuroImage 47:1352–1362
Minneboo A, Barkhof F, Polman CH, Uitdehaag BMJ, Knol DL, Castelijns JA (2004) Infratentorial lesions predict long-term disability in patients with initial findings suggestive of multiple sclerosis. Arch Neurol 61:217–221
Kilsdonk ID, de Graaf WL, Barkhof F, Wattjes MP (2012) Inflammation high-field magnetic resonance imaging. Neuroimaging Clin N Am 22:135–157
Kollia K, Maderwald S, Putzki N, Schlamann M, Theysohn JM, Kraff O, Ladd ME, Forsting M, Wanke I (2009) First clinical study on ultra-high-field MR imaging in patients with multiple sclerosis: comparison of 1.5 T and 7 T. AJNR. Am J Neuroradiol 30:699–702
Ge Y, Zohrabian VM, Grossman RI (2008) Seven-Tesla magnetic resonance imaging: new vision of microvascular abnormalities in multiple sclerosis. Arch Neurol 65:812–816
Tallantyre EC, Brookes MJ, Dixon JE, Morgan PS, Evangelou N, Morris PG (2008) Demonstrating the perivascular distribution of MS lesions in vivo with 7-Tesla MRI. Neurology 70:2076–2078
Hammond KE, Metcalf M, Carvajal L, Okuda DT, Srinivasan R, Vigneron D, Nelson SJ, Pelletier D (2008) Quantitative in vivo magnetic resonance imaging of multiple sclerosis at 7 Tesla with sensitivity to iron. Ann Neurol 64:707–713
Yao B, Bagnato F, Matsuura E, Merkle H, van Gelderen P, Cantor FK, Duyn JH (2012) Chronic multiple sclerosis lesions: characterization with high-field-strength MR imaging. Radiology 262:206–215
Pitt D, Boster A, Pei W, Wohleb E, Jasne A, Zachariah CR, Rammohan K, Knopp MV, Schmalbrock P (2010) Imaging cortical lesions in multiple sclerosis with ultra-high-field magnetic resonance imaging. Arch Neurol 67:812–818
Mainero C, Benner T, Radding A, van der Kouwe A, Jensen R, Rosen BR, Kinkel RP (2009) In vivo imaging of cortical pathology in multiple sclerosis using ultra-high field MRI. Neurology 73:941–948
Metcalf M, Xu D, Okuda DT, Carvajal L, Srinivasan R, Kelley DAC, Mukherjee P, Nelson SJ, Vigneron DB et al (2010) High-resolution phased-array MRI of the human brain at 7 Tesla: initial experience in multiple sclerosis patients. J Neuroimaging 20:141–147
Tallantyre EC, Morgan PS, Dixon JE, Al-Radaideh A, Brookes MJ, Morris PG, Evangelou N (2010) 3 Tesla and 7 Tesla MRI of multiple sclerosis cortical lesions. J Magn Reson Imaging 32:971–977
Nielsen AS, Kinkel RP, Tinelli E, Benner T, Cohen-Adad J, Mainero C (2012) Focal cortical lesion detection in multiple sclerosis: 3 tesla DIR versus 7 Tesla FLASH-T2*. J Magn Reson Imaging 35:537–542
Simon JH, Li D, Traboulsee A, Coyle PK, Arnold DL, Barkhof F, Frank JA, Grossman R, Paty DW et al (2006) Standardized MR imaging protocol for multiple sclerosis: Consortium of MS Centers consensus guidelines. AJNR Am J Neuroradiol 27:455–461
Visser F, Zwanenburg JJM, Hoogduin JM, Luijten PR (2010) High-resolution magnetization-prepared 3D-FLAIR imaging at 7.0 Tesla. Magn Reson Med 64:194–202
Geurts JJG, Roosendaal SD, Calabrese M, Ciccarelli O, Agosta F, Chard DT, Gass A, Huerga E, Moraal B et al (2011) Consensus recommendations for MS cortical lesion scoring using double inversion recovery MRI. Neurology 76:418–424
Kurtzke J (1983) Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS). Neurology 33:1444–1452
de Graaf WL, Zwanenburg JJM, Visser F, Wattjes MP, Pouwels PJW, Geurts JJG, Polman CH, Barkhof F, Luijten PR et al (2012) Lesion detection at seven Tesla in multiple sclerosis using magnetisation prepared 3D-FLAIR and 3D-DIR. Eur Radiol 22:221–231
Wattjes MP, Harzheim M, Lutterbey GG, Hojati F, Simon B, Schmidt S, Schild HH, Barkhof F (2008) Does high field MRI allow an earlier diagnosis of multiple sclerosis? J Neurol 255:1159–1163
Kilsdonk ID, Barkhof F, Wattjes MP (2011) 2010 Revisions to McDonald criteria for diagnosis of MS: impact of 3 Tesla MRI. Ann Neurol 70:182–183
Montalban X, Tintoré M, Swanton J, Barkhof F, Fazekas F, Filippi M, Frederiksen J, Kappos L, Palace J et al (2010) MRI criteria for MS in patients with clinically isolated syndromes. Neurology 74:427–434
Simon B, Schmidt S, Lukas C, Gieseke J, Träber F, Knol DL, Willinek WA, Geurts JJG, Schild HH et al (2010) Improved in vivo detection of cortical lesions in multiple sclerosis using double inversion recovery MR imaging at 3 Tesla. Eur Radiol 20:1675–1683
Calabrese M, Gallo P (2009) Magnetic resonance evidence of cortical onset of multiple sclerosis. Mult Scler 15:933–941
Calabrese M, Rocca MA, Atzori M, Mattisi I, Bernardi V, Favaretto A, Barachino L, Romualdi C, Rinaldi L et al (2009) Cortical lesions in primary progressive multiple sclerosis: a 2-year longitudinal MR study. Neurology 72:1330–1336
Calabrese M, Rocca MA, Atzori M, Mattisi I, Favaretto A, Perini P, Gallo P, Filippi M (2010) A 3-year magnetic resonance imaging study of cortical lesions in relapse-onset multiple sclerosis. Ann Neurol 67:376–383
Lucchinetti CF, Popescu BFG, Bunyan RF, Moll NM, Roemer SF, Lassmann H, Brück W, Parisi JE, Scheithauer BW et al (2011) Inflammatory cortical demyelination in early multiple sclerosis. N Engl J Med 365:2188–2197
Calabrese M, Agosta F, Rinaldi F, Mattisi I, Grossi P, Favaretto A, Atzori M, Bernardi V, Barachino L et al (2009) Cortical lesions and atrophy associated with cognitive impairment in relapsing-remitting multiple sclerosis. Arch Neurol 66:1144–1150
Roosendaal SD, Moraal B, Pouwels PJW, Vrenken H, Castelijns JA, Barkhof F, Geurts JJG (2009) Accumulation of cortical lesions in MS: relation with cognitive impairment. Mult Scler 15:708–714
Filippi M, Rocca MA, Calabrese M, Sormani MP, Rinaldi F, Perini P, Comi G, Gallo P (2010) Intracortical lesions: relevance for new MRI diagnostic criteria for multiple sclerosis. Neurology 75:1988–1994
Geurts JJG, Pouwels PJW, Uitdehaag BMJ, Polman CH, Barkhof F, Castelijns JA (2005) Intracortical lesions in multiple sclerosis: improved detection with 3D double inversion-recovery MR imaging. Radiology 236:254–260
Tallantyre EC, Morgan PS, Dixon JE, Al-Radaideh A, Brookes MJ, Evangelou N, Morris PG (2009) A comparison of 3 T and 7 T in the detection of small parenchymal veins within MS lesions. Invest Radiol 44:491–494
Ropele S, de Graaf W, Khalil M, Wattjes MP, Langkammer C, Rocca MA, Rovira A, Palace J, Barkhof F et al (2011) MRI assessment of iron deposition in multiple sclerosis. J Magn Reson Imaging 34:13–21
Acknowledgements
F. Visser is a part-time employee of Philips Healthcare, The Netherlands. Iris Kilsdonk is supported by a grant provided by the Noaber Foundation (Lunteren, the Netherlands).
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de Graaf, W.L., Kilsdonk, I.D., Lopez-Soriano, A. et al. Clinical application of multi-contrast 7-T MR imaging in multiple sclerosis: increased lesion detection compared to 3 T confined to grey matter. Eur Radiol 23, 528–540 (2013). https://doi.org/10.1007/s00330-012-2619-7
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DOI: https://doi.org/10.1007/s00330-012-2619-7