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Multiple Sclerosis

Improved Detection of Active Cerebral Lesions With 3-Dimensional T1 Black-Blood Magnetic Resonance Imaging Compared With Conventional 3-Dimensional T1 GRE Imaging

Sommer, Nora N. MD*; Saam, Tobias MD*†; Coppenrath, Eva MD*; Kooijman, Hendrik PhD; Kümpfel, Tania MD§; Patzig, Maximilian MD; Beyer, Sebastian E. MD*; Sommer, Wieland H. MD*; Reiser, Maximilian F. MD*; Ertl-Wagner, Birgit MD*; Treitl, Karla M. MD

doi: 10.1097/RLI.0000000000000410
Original Articles

Objectives The aim of this study was to assess the diagnostic accuracy of a modified high-resolution whole-brain three-dimensional T1-weighted black-blood sequence (T1-weighted modified volumetric isotropic turbo spin echo acquisition [T1-mVISTA]) in comparison to a standard three-dimensional T1-weighted magnetization-prepared rapid gradient echo (MP-RAGE) sequence for detection of contrast-enhancing cerebral lesions in patients with relapsing-remitting multiple sclerosis (MS).

Materials and Methods After institutional review board approval and informed consent, 22 patients (8 men; aged 31.0 ± 9.2 years) with relapsing-remitting MS were included in this monocentric prospective cohort study.

Contrast-enhanced T1-mVISTA and MP-RAGE, both with 0.8 mm3 resolution, were performed in all patients. In a substudy of 12 patients, T1-mVISTA was compared with a T1-mVISTA with 1.0 mm3 resolution (T1-mVISTA_1.0). Reference lesions were defined by an experienced neuroradiologist using all available sequences and served as the criterion standard. T1-mVISTA, T1-mVISTA_1.0, and MP-RAGE sequences were read in random order 4 weeks apart. Image quality, visual contrast enhancement, contrast-to-noise-ratio (CNR), diagnostic confidence, and lesion size were assessed and compared by Wilcoxon and Mann-Whitney U tests.

Results Eleven of 22 patients displayed contrast-enhancing lesions. Visual contrast enhancement, CNR, and diagnostic confidence of contrast-enhancing MS lesions were significantly increased in T1-mVISTA compared with MP-RAGE (P < 0.001). Significantly more contrast-enhancing lesions were detected with T1-mVISTA than with MP-RAGE (71 vs 39, respectively; P < 0.001). With MP-RAGE, 25.6% of lesions were missed in the initial reading, whereas only 4.2% of lesions were missed with T1-mVISTA. Increase of the voxel volume from 0.8 mm to 1.0 mm isotropic in T1-mVISTA_1.0 did not affect the detectability of lesions, whereas scan time was decreased from 4:43 to 1:55 minutes.

Conclusions Three-dimensional T1-mVISTA improves the detection rates of contrast-enhancing cerebral MS lesions compared with conventional 3D MP-RAGE sequences by increasing CNR of lesions and might, therefore, be useful in patient management.

From the *Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital, Munich; †Radiologisches Zentrum Rosenheim, Rosenheim; ‡Philips Healthcare, Hamburg; §Institute of Clinical Neuroimmunology, University Hospital and Biomedical Center, ∥Department of Neuroradiology, Ludwig-Maximilians-University Hospital; and ¶German Center for Cardiovascular Disease Research, Munich, Germany.

Received for publication April 25, 2017; and accepted for publication, after revision, July 1, 2017.

Conflicts of interests and sources of funding: Dr Hendrik Kooijman is an employee of Philips Healthcare. For the remaining authors, no conflicts of interest were declared. Funding was received from the Friedrich-Baur-Stiftung.

Correspondence to: Nora N. Sommer, MD, Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital, Ziemssenstraße 1, 80336 Munich, Germany. E-mail:

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