Abstract
Objectives: To assess the ability of 3D amide proton transfer weighted (APTw) imaging based on magnetization transfer analysis to discriminate between multiple sclerosis lesions (MSL) and white matter hyperintensities of presumed vascular origin (WMH) and to compare APTw signal intensity of healthy white matter (healthy WM) with APTw signal intensity of MSL and WHM.Materials and Methods: A total of 27 patients (16 female, 11 males, mean age 39.6 years) with multiple sclerosis, 35 patients (17 females, 18 males, mean age 66.6 years) with small vessel disease (SVD) and 20 healthy young volunteers (9 females, 11 males, mean age 29 years) were included in the MSL, the WMH, and the healthy WM group. MSL and WMH were segmented on fluid attenuated inversion recovery (FLAIR) images underlaid onto APTw images. Histogram parameters (mean, median, 10th, 25th, 75th, 90th percentile) were calculated. Mean APTw signal intensity values in healthy WM were defined by “Region of interest” (ROI) measurements. Wilcoxon rank sum tests and receiver operating characteristics (ROC) curve analyses of clustered data were applied.Results: All histogram parameters except the 75 and 90th percentile were significantly different between MSL and WMH (p = 0.018–p = 0.034). MSL presented with higher median values in all parameters. The histogram parameters offered only low diagnostic performance in discriminating between MSL and WMH. The 10th percentile yielded the highest diagnostic performance with an AUC of 0.6245 (95% CI: [0.532, 0.717]). Mean APTw signal intensity values of MSL were significantly higher than mean values of healthy WM (p = 0.005). The mean values of WMH did not differ significantly from the values of healthy WM (p = 0.345).Conclusions: We found significant differences in APTw signal intensity, based on straightforward magnetization transfer analysis, between MSL and WMH and between MSL and healthy WM. Low AUC values from ROC analyses, however, suggest that it may be challenging to determine type of lesion with APTw imaging. More advanced analysis of the APT CEST signal may be helpful for further differentiation of MSL and WMH.
Highlights
Differentiation between age related white matter hyperintensities of presumed vascular origin (WMH) in patients with small vessel disease (SVD) (1, 2) and demyelinating white matter lesions in patients with multiple sclerosis (MS) called multiple sclerosis lesions (MSL) can be difficult
Conventional magnetic resonance imaging (MRI) techniques such as T2 weighted (T2w) turbo/fast spine echo (TSE/fast spin echo (FSE)) images, proton density weighted (PDw) images, fluid attenuated inversion recovery (FLAIR) and double inversion recovery (DIR) images are highly sensitive to both WMH and MSL but do not provide evidence of the underlying etiology (3, 4, 6) because all these lesions are of similar morphological appearance on T2w MR images (1, 4, 5)
As the diagnosis of MS is based on the number and location of white matter lesions that disseminate in space and time within the central nervous system (4, 6), WMH mimicking MSL can complicate the clinical diagnosis of MS (4)
Summary
Differentiation between age related white matter hyperintensities of presumed vascular origin (WMH) in patients with small vessel disease (SVD) (1, 2) and demyelinating white matter lesions in patients with multiple sclerosis (MS) called multiple sclerosis lesions (MSL) can be difficult. MSL and WMH may have similar lesion morphology on MRI and may coexist in individual patients (3–5). Conventional magnetic resonance imaging (MRI) techniques such as T2 weighted (T2w) turbo/fast spine echo (TSE/FSE) images, proton density weighted (PDw) images, fluid attenuated inversion recovery (FLAIR) and double inversion recovery (DIR) images are highly sensitive to both WMH and MSL but do not provide evidence of the underlying etiology (3, 4, 6) because all these lesions are of similar morphological appearance on T2w MR images (1, 4, 5). Conventional MR imaging sequences do not provide any information on the histologically heterogeneous manifestation of MSL (7, 8) or WMH (2, 9–12). As the diagnosis of MS is based on the number and location of white matter lesions that disseminate in space and time within the central nervous system (4, 6), WMH mimicking MSL can complicate the clinical diagnosis of MS (4). Reliable imaging biomarkers that allow for a precise discrimination between these two entities are of great clinical interest (3–5)
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
