The Parallel Analysis of Phase Sensitive Inversion Recovery (PSIR) and Double Inversion Recovery (DIR) Images Significantly Improves the Detection of Cortical Lesions in Multiple Sclerosis (MS) since Clinical Onset.

Alice Favaretto,Davide Poggiali,Andrea Lazzarotto,Paolo Gallo,Francesco Causin,Giuseppe Rolma

doi:10.1371/journal.pone.0127805

Alice Favaretto, Davide Poggiali + Show 4 more

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https://doi.org/10.1371/journal.pone.0127805

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Journal: PloS one	Publication Date: May 26, 2015
Citations: 36	License type: CC BY 4.0

Affiliation: University of Padua

Abstract

BackgroundDouble inversion recovery (DIR) detects only a minority (<20%) of cortical lesions (CL) in multiple sclerosis (MS). Phase-sensitive inversion recovery (PSIR) was suggested to be substantially superior to DIR in the detection of cortical lesions (CL). These two sequences might be complementary.ObjectivesTo analyze CL frequency and type in MS patients having different disease duration and disability, including patients at clinical onset, and to discern more correctly the artifacts, by combining DIR and PSIR images.Patients and Methods40 patients were enrolled in the study: 10 clinically isolated syndrome/early relapsing remitting MS (CIS/eRRMS), 24 relapsing remitting MS (RRMS), 6 secondary progressive MS (SPMS). DIR and PSIR images were jointly used to classify lesions as purely intracortical (IC), leukocortical (LC) and juxtacortical (JC).ResultsPSIR disclosed CL in 100% of the patients and was capable of identifying more than four times lesions (455.5%, p<0.00001), especially IC (mean numbers: 36.5 in CIS/eRRMS, 45.0 in RRMS and 52.3 in SPMS) and LC (mean numbers: 10.9 in CIS/eRRMS, 20.1 in RRMS and 25.3 in SPMS), compared to DIR (p<0.00001). CL number was significantly higher in SPMS compared to RRMS (p<0.0001). Artifacts were more accurately identified by comparing the two sequences.ConclusionsOur study confirms the higher ability of PSIR in disclosing and classifying CL. The presence of CL in all CIS patients further points out the relevance of cortical pathology in MS. Whether the parallel analysis of DIR and PSIR images may be useful for diagnostic purposes, especially when a diagnosis of MS is suspected but not confirmed by routine MRI, needs to be evaluated in larger patient series. The analysis of the cortex by DIR and PSIR may also allow a better stratification of the patients for prognostic and counseling purposes, as well as for their inclusion in clinical studies.

Highlights

Increasing evidence indicates that cortical pathology plays a major role in determining the progressive accumulation of physical and cognitive disability observed in multiple sclerosis (MS) patients [1,2,3,4]
Phase-sensitive inversion recovery (PSIR) disclosed cortical lesions (CL) in 100% of the patients and was capable of identifying more than four times lesions (455.5%, p
The presence of CL in all clinically isolated syndromes [20] (CIS) patients further points out the relevance of cortical pathology in MS

Summary

Introduction

Increasing evidence indicates that cortical pathology plays a major role in determining the progressive accumulation of physical and cognitive disability observed in multiple sclerosis (MS) patients [1,2,3,4]. Even when high-resolution DIR sequence is applied [3,5,8,13,14], two main pitfalls of DIR cannot be avoided It does not always allow a correct identification of the two main CL subtypes recognized histologically, i.e., pure intracortical (IC) and leukocortical (LC, mixed white/grey matter lesions) [15]. Phase-sensitive inversion recovery (PSIR) was suggested to be substantially superior to DIR in the detection of cortical lesions (CL)

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