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At 7T, 2D multiecho spin-echo T2WI and 3D gradient-echo T2*WI were acquired from 27 formalin-fixed coronal hemispheric brain sections of 15 patients and 4 healthy controls. Proteolipid-stained tissue sections were matched to the corresponding MR images, and lesions were manually scored on both MR imaging sequences and tissue sections. The T2WI sequence detected slightly more lesions than the T2*WI sequence (28% and 16%). When histopathologic information (type, location) was revealed to the reader, the sensitivity went up to 84%. Many lesions are still missed prospectively.

Abstract

Section stained with anti-proteolipid protein antibodies (A), matched with T2*WI (B) and T2WI (C and D). Note that the histologic section corresponds with multiple slices of the MR image; the top part of image B and D corresponds to the top part of image A, and the bottom part of image C corresponds to the bottom part of image A. The border between successive MR imaging slices is depicted by the blue dotted line. Lesions are indicated with arrows (WML is blue; GML is red). The type of GM lesion is indicated by I–IV. Also indicated is whether histologic lesions were retrospectively seen on MR imaging (asterisk) or missed on MR imaging (number sign). All other histologic lesions were prospectively detected. Degree of magnification: 50×.

BACKGROUND AND PURPOSE

At 7T MR imaging, T2*-weighted gradient echo has been shown to provide high-resolution anatomic images of gray matter lesions. However, few studies have verified T2*WI lesions histopathologically or compared them with more standard techniques at ultra-high-field strength. This study aimed to determine the sensitivity of T2WI and T2*WI sequences for detecting cortical GM lesions in MS.

MATERIALS AND METHODS

At 7T, 2D multiecho spin-echo T2WI and 3D gradient-echo T2*WI were acquired from 27 formalin-fixed coronal hemispheric brain sections of 15 patients and 4 healthy controls. Proteolipid-stained tissue sections (8 μm) were matched to the corresponding MR images, and lesions were manually scored on both MR imaging sequences (blinded to histopathology) and tissue sections (blinded to MR imaging). The sensitivity of MR imaging sequences for GM lesion types and white matter lesions was calculated. An unblinded retrospective scoring was also performed.

RESULTS

If all cortical GM lesions were taken into account, the T2WI sequence detected slightly more lesions than the T2*WI sequence: 28% and 16%, respectively (P = .054). This difference disappeared when only intracortical lesions were considered. When histopathologic information (type, location) was revealed to the reader, the sensitivity went up to 84% (T2WI) and 85% (T2*WI) (not significant). Furthermore, the false-positive rate was 8.6% for the T2WI and 10.5% for the T2*WI sequence.

CONCLUSIONS

There is no strong advantage of the T2*WI sequence compared with a conventional T2WI sequence in the detection of cortical lesions at 7T. Retrospectively, a high percentage of lesions could be detected with both sequences. However, many lesions are still missed prospectively. This could possibly be minimized with better a priori observer training.

Read this article: http://bit.ly/UHF-MRI-CorticalMSLesions

Ultra-High-Field MRI Visualization of Cortical Multiple Sclerosis Lesions with T2 and T2*: A Postmortem MRI and Histopathology Study

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