"Central vessel sign" on 3T FLAIR* MRI for the differentiation of multiple sclerosis from migraine

Andrew J Solomon, Matthew K Schindler, Diantha B Howard, Richard Watts, Pascal Sati, Joshua P Nickerson, Daniel S Reich, Andrew J Solomon, Matthew K Schindler, Diantha B Howard, Richard Watts, Pascal Sati, Joshua P Nickerson, Daniel S Reich

Abstract

Objective: The diagnosis of multiple sclerosis (MS) presently relies on radiographic assessments of imperfect specificity. Recent data using T2* methodology for the detection of the "central vessel sign" (CVS) in MS lesions suggests this novel MRI technique may distinguish MS from other disorders. Our aim was to determine if evaluation for CVS on 3T FLAIR* MRI differentiates MS from migraine.

Methods: Patients with MS or migraine and a prior brain MRI demonstrating at least two hyperintense lesions ≥3 mm were recruited. Exclusion criteria included any additional comorbidity known to cause brain MRI abnormalities. 3T MRI was performed in each participant with administration of gadopentetate dimeglumine, and FLAIR* images were generated in postprocessing. The total number of discrete ovoid lesions ≥3 mm were counted on FLAIR, per participant, and subsequently evaluated for presence of CVS on FLAIR*. An exploratory method evaluating for CVS in a maximum of 12 lesions per subject was also completed.

Results: Ten participants with MS and 10 with migraine completed the study. The median percentage (quartiles) of lesions in MS participants with CVS was 84 (79, 94) compared to 22 (15, 54) in migraine (P = 0.008). In a subanalysis by brain region, in the subcortical and deep white matter, the median percentage (quartiles) of lesions in MS participants with CVS was 88 (81, 100) compared to 19 (11, 54) in migraine (P = 0.004). This difference was not identified in juxtacortical, periventricular, or infratentorial regions.

Interpretation: Identification of CVS using FLAIR* on 3T MRI helps differentiate MS from migraine, particularly in the subcortical and deep white matter.

Figures

Figure 1
Figure 1
Total number of lesions compared to the percentage of lesions with central vessels in participants with multiple sclerosis and migraine.
Figure 2
Figure 2
Examples of 3T FLAIR* imaging demonstrating the “central vessel sign” in multiple sclerosis (A) and absence of the “central vessel sign” in migraine (B).

References

    1. Polman CH, Reingold SC, Banwell B, et al. Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria. Ann Neurol 2011;69:292–302.
    1. Miller DH, Weinshenker BG, Filippi M, et al. Differential diagnosis of suspected multiple sclerosis: a consensus approach. Mult Scler 2008;14:1157–1174.
    1. Charil A, Yousry TA, Rovaris M, et al. MRI and the diagnosis of multiple sclerosis: expanding the concept of “no better explanation”. Lancet Neurol 2006;5:841–852.
    1. Solomon AJ, Klein EP, Bourdette D. “Undiagnosing” multiple sclerosis: the challenge of misdiagnosis in MS. Neurology 2012;78:1986–1991.
    1. Solomon AJ, Weinshenker BG. Misdiagnosis of multiple sclerosis: frequency, causes, effects, and prevention. Curr Neurol Neurosci Rep 2013;13:1–7.
    1. Herndon RMBB. Misdiagnosis of multiple sclerosis. Semin Neurol 1985;5:94–98.
    1. Rudick RA, Schiffer RB, Schwetz KM, Herndon RM. Multiple sclerosis. The problem of incorrect diagnosis. Arch Neurol 1986;43:578–583.
    1. Rudick RA, Miller AE. Multiple sclerosis or multiple possibilities: the continuing problem of misdiagnosis. Neurology 2012;78:1904–1906.
    1. Solomon AJ, Klein E. Disclosing a misdiagnosis of multiple sclerosis: do no harm? Continuum (Minneapolis, Minn) 2013;19:1087–1091.
    1. Quinn MP, Kremenchutzky M, Menon RS. Venocentric lesions: an MRI marker of MS? Front Neurol 2013;4:98.
    1. Fog T. On the vessel‐plaque relationships in the brain in multiple sclerosis. Acta Neurol Scand Suppl 1964;40(Suppl 10):9–15.
    1. Mistry N, Dixon J, Tallantyre E, et al. Central veins in brain lesions visualized with high‐field magnetic resonance imaging: a pathologically specific diagnostic biomarker for inflammatory demyelination in the brain. JAMA Neurol 2013;70:623–628.
    1. Gaitan MI, Maggi P, Wohler J, et al. Perivenular brain lesions in a primate multiple sclerosis model at 7‐tesla magnetic resonance imaging. Mult Scler 2013;20:64–71.
    1. Tallantyre EC, Dixon JE, Donaldson I, et al. Ultra‐high‐field imaging distinguishes MS lesions from asymptomatic white matter lesions. Neurology 2011;76:534–539.
    1. Kollia K, Maderwald S, Putzki N, et al. First clinical study on ultra‐high‐field MR imaging in patients with multiple sclerosis: comparison of 1.5T and 7T. AJNR. Am J Neuroradiol 2009;30:699–702.
    1. Lummel N, Boeckh‐Behrens T, Schoepf V, et al. Presence of a central vein within white matter lesions on susceptibility weighted imaging: a specific finding for multiple sclerosis? Neuroradiology 2011;53:311–317.
    1. Sinnecker T, Dorr J, Pfueller CF, et al. Distinct lesion morphology at 7‐T MRI differentiates neuromyelitis optica from multiple sclerosis. Neurology 2012;79:708–714.
    1. Kau T, Taschwer M, Deutschmann H, et al. The “central vein sign”: is there a place for susceptibility weighted imaging in possible multiple sclerosis? Eur Radiol 2013;23:1956–62.
    1. Luo J, Yablonskiy DA, Hildebolt CF, et al. Gradient echo magnetic resonance imaging correlates with clinical measures and allows visualization of veins within multiple sclerosis lesions. Mult Scler 2013;20:349–55.
    1. Sati P, George IC, Shea CD, et al. FLAIR*: a combined MR contrast technique for visualizing white matter lesions and parenchymal veins. Radiology 2012;265:926–932.
    1. Grabner G, Dal‐Bianco A, Schernthaner M, et al. 2011. Analysis of multiple sclerosis lesions using a fusion of 3.0 T FLAIR and 7.0 T SWI phase: FLAIR SWI. J Magn Reson Imaging 33:543–549.
    1. Campion T, Smith P, Turner B, et al. FLAIR* for the non‐invasive histological diagnosis of multiple sclerosis. Abstract S29003 Presented at the 2015 American Academy of Neurology Annual Meeting. 2015.
    1. Mistry N, Dixon JE, Tallantyre EC, et al. 3 Tesla T2*‐weighted brain MRI distinguishes multiple sclerosis from incidental white matter microangiopathic lesions. Mult Scler 2013b;19(11 Suppl):8–597.
    1. George I, Sati P, Absinta M, et al. FLAIR* MRI improves diagnostic accuracy in multiple sclerosis. Abstract S29002 Presented at the American Academy of Neurology 2015 Annual Meeting.
    1. Liu S, Kullnat J, Bourdette D, et al. Prevalence of brain magnetic resonance imaging meeting Barkhof and McDonald criteria for dissemination in space among headache patients. Mult Scler 2013;19:1101–5.
    1. Takano T, Tian GF, Peng W, et al. Cortical spreading depression causes and coincides with tissue hypoxia. Nat Neurosci 2007;10:754–762.
    1. Kister I, Herbert J, Zhou Y, Ge Y. Ultrahigh‐field MR (7 T) imaging of brain lesions in neuromyelitis optica. Multiple Sclerosis International 2013;2013:1–7.
    1. Kilsdonk ID, Wattjes MP, Lopez‐Soriano A, et al. Improved differentiation between MS and vascular brain lesions using FLAIR* at 7 Tesla. Eur Radiol 2013;24:841–9.
    1. Wuerfel J, Sinnecker T, Ringelstein EB, et al. Lesion morphology at 7 Tesla MRI differentiates Susac syndrome from multiple sclerosis. Mult Scler 2012;18:1592–1599.
    1. Tallantyre EC, Morgan PS, Dixon JE, et al. A comparison of 3T and 7T in the detection of small parenchymal veins within MS lesions. Invest Radiol 2009;44:491–494.
    1. Dixon JE, Simpson A, Mistry N, et al. Optimisation of T(2)*‐weighted MRI for the detection of small veins in multiple sclerosis at 3 T and 7 T. Eur J Radiol 2013;82:719–727.
    1. Sati P, Thomasson DM, Li N, et al. Rapid, high‐resolution, whole‐brain, susceptibility‐based MRI of multiple sclerosis. Mult Scler 2014;20:1464–1470.
    1. Samaraweera A, Clarke M, Mougin O, et al. A comparison of FLAIR* and T2*‐weighted imaging in detecting white matter lesions and central veins in patients with MS and ischaemic lesions at 3T. Abstract 4361 presented at The International Society for Magnetic Resonance in Medicine, Toronto Canada, May 2015.
    1. Lipton RB, Bigal ME, Diamond M, et al. Migraine prevalence, disease burden, and the need for preventive therapy. Neurology 2007;68:343–349.
    1. Stewart WF, Shechter A, Rasmussen BK. Migraine prevalence. A review of population‐based studies. Neurology 1994;44(6 Suppl 4):S17–S23.
    1. Orton SM, Herrera BM, Yee IM, et al. Sex ratio of multiple sclerosis in Canada: a longitudinal study. Lancet Neurol 2006;5:932–936.
    1. Alonso A, Hernan MA. Temporal trends in the incidence of multiple sclerosis: a systematic review. Neurology 2008;71:129–135.
    1. Koch‐Henriksen N, Sorensen PS. The changing demographic pattern of multiple sclerosis epidemiology. Lancet Neurol 2010;9:520–532.
    1. Lebrun C. The radiologically isolated syndrome. Rev Neurol (Paris) 2015;171:698–706.

Source: PubMed

스폰서 및 공동 작업자

건강 상태

약물 개입

3
구독하다