White Matter Nulled Motion Corrected MPRAGE MR

Provides Added Value in MR Imaging of Multiple Sclerosis

Idoia Corcuera-Solano, Gerard Reddy, Bradley Delman, Reade De Leacy, Dan Rettmann,

Lawrence N Tanenbaum

EP-63-2519

Financial Disclosure

L. Tanenbaum is a speaker for GE Healthcare

Background

Multiple Sclerosis (MS) is a chronic inflammatory demyelinating condition associated with significant neurological disability

Supportive imaging findings require display of lesions distributed in space and time

Etiology remains unknown MR imaging plays a key role in initial

diagnosis & monitoring patient progress & response to treatment

Background

Increased utilization of MRI due to increased incidence and changing geographic patterns of disease 1

Increased requirement for imaging to guide treatment decisions 2

T2 and T2 FLAIR are current mainstays of MRI protocols for MS

White Matter Nulled Motion Corrected MPRAGE MR Technique

A novel 3D MPRAGE sequence incorporates an additional inversion pulse to null white matter (WMn)

T1 weighted contrast despite white CSF

Suppression of white matter signal highlights WM pathology

Prospective motion correction (PROMO)

MPRAGE

MPRAGE

Purpose

To assess the image quality and added value of WMn-MPRAGE in comparison to conventional techniques in MR imaging of multiple sclerosis

MPRAGE FLAIR T2 T1

Material and Methods

17 MS patients (9 male, 8 female, median age 43 years) with previously identified MS lesions were included in this study

Patients were prospectively scanned with WMn-MPRAGE in addition to conventional imaging sequences on a clinical 3T MR scanner.

Conventional sequences included: T2 FLAIR, T2 & T1 sequences

MRI Protocol GE 3.0 T

T2 T2 FLAIR T1 MPRAGE

Dimension 2D 3D 2D 3D

Orientation Axial Sag Axial Sag

FOV 22 24 24 25.6

Slice thickness 1.2 mm 1.6 mm 5.0 mm 1.6mm

Slice spicing 0 0 1 0

SLICES 30 108 25 120

TR 3190ms 6000ms 413 ms

TE 109ms Max 7.8 Min Full

TI - 1739ms 500ms

FA 8

Materials & Methods

Studies were performed on 3.0 T scanner 3 mm MPRAGE reformatted axial images 3 mm FLAIR reformatted axial images 5 mm direct axial T2 5 mm direct axial T1

MPRAGE FLAIR T2 T1

Image analysis

Images reviewed by two Neuroradiologists who assessed image quality and added value in terms of cortical, subcortical and white matter lesion conspicuity

MPRAGE FLAIR T2 T1

Image Analysis Methodology

Lesions were assessed for each patient in 4 pre-determined anatomical levels

▪ Centrum Semiovale▪ Corona Radiata▪ Third Ventricle▪ Posterior Fossa

5 point scale was used to assess lesion conspicuity

GRADING SYSTEM

1 NOT SEEN

2 POORLY SEEN

3 ADEQUATE

4 ABOVE AVERAGE

5 EXCELLENT

Statistical Analysis

Statistical software used for analysis GraphPad Prism version 5.00 for Mac

OSX (GraphPad Software, San Diego, Calif. USA, www.graphpad.com)

Qualitative analysis Wilcoxon test Results expressed as a mean with

standard deviation p≤0.05 was considered statistically

significant

MPRAGE FLAIR p

Centrum semiovale 4.36±1.32 4.49±0.81 0.648

Corona Radiata

4.55±1.15 4.55±1.01 0.833

Third Ventricle

4.32±1.17 3.82±1.530.085

Posterior Fossa

4.53±0.82 2.17±1.11 <0.001

Comparison: MPRAGE v FLAIR

MPRAGE T2 p

Centrum semiovale 4.36±1.32 3.91±1.52 <0.001

Corona Radiata

4.55±1.15 3.94±1.36 <0.001

Third Ventricle

4.32±1.17 4.00±1.15 0.225

Posterior Fossa

4.53±0.82 2.87±1.46 <0.001

Comparison: MPRAGE v T2

MPRAGE T1 p

Centrum semiovale 4.36±1.32 2.79±1.72 <0.001

Corona Radiata

4.55±1.15 3.13±1.57 <0.001

Third Ventricle

4.32±1.17 2.68±1.70 0.014

Posterior Fossa

4.53±0.82 2.13±1.25 <0.001

Comparison: MPRAGE v T1

FLAIR T2 p

Centrum semiovale 4.49±0.81 3.91±1.52 0.013

Corona Radiata

4.55±1.01 3.94±1.36 0.023

Third Ventricle

3.82±1.53 4.00±1.15 0.748

Posterior Fossa

2.17±1.11 2.87±1.46 0.006

Comparison: FLAIR v T2

FLAIR T1 p

Centrum semiovale 4.49±0.81 2.79±1.72 <0.001

Corona Radiata

4.55±1.01 3.13±1.57 <0.001

Third Ventricle

3.82±1.53 2.68±1.70 0.05

Posterior Fossa

2.17±1.11 2.13±1.25 1.00

Comparison: FLAIR v T1

Comparison: T2 v T1

T2 T1 p

Centrum semiovale 3.91±1.52 2.79±1.72 <0.001

Corona Radiata

3.94±1.36 3.13±1.57 <0.001

Third Ventricle 4.00±1.15 2.68±1.70 <0.001

Posterior Fossa

2.87±1.46 2.13±1.25 0.006

T2MPRAGE FLAIR T1

CENTRUM SEMIOVALE

Mean ± SD Mean ± SD p

MPRAGE-FLAIR4.36±1.32 4.49±0.81 0.648

MPRAGE-T24.36±1.32 3.91±1.52 <0.001

MPRAGE-T14.36±1.32 2.79±1.72 <0.001

FLAIR-T24.49±0.81 3.91±1.52 0.013

FLAIR-T14.49±0.81 2.79±1.72 <0.001

T2-T13.91±1.52 2.79±1.72 <0.001

Centrum Semiovale

Centrum Semiovale

MPRAGE FLAIR T2 T1

Cortical lesion are more prominently seen on MPRAGE and FLAIR than on T2 and T1-weighted images.

Centrum Semiovale

MPRAGE FLAIR T2 T1

Four discrete lesion can be seen in the MPRAGE and FLAIR images and only 3 in the T2 WI. No discrete lesions are appreciated on the T1 WI at this level.

MPRAGE FLAIR T2 T1

CORONA RADIATA

Mean ± SD Mean ± SD p

MPRAGE-FLAIR4.55±1.52 4.55±1.01 0.833

MPRAGE-T24.55±1.52 3.94±1.36 <0.001

MPRAGE-T14.55±1.52 3.13±1.57 <0.001

FLAIR-T24.55±1.01 3.94±1.36

0.023

FLAIR-T14.55±1.01 3.13±1.57 <0.001

T2-T13.94±1.36 3.13±1.57 <0.001

Corona Radiata

Corona Radiata

MPRAGE FLAIR T2 T1

MPRAGE FLAIR T2 T1

Third Ventricle Mean ± SD Mean ± SD p

MPRAGE-FLAIR 4.32±1.17 3.82±1.53 0.085

MPRAGE-T2 4.32±1.17 4.00±1.150.255

MPRAGE-T1 4.32±1.17 2.68±1.70 0.014

FLAIR-T2 3.82±1.53 4.00±1.150.748

FLAIR-T1 3.82±1.532.68±1.70

0.05

T2-T1 4.00±1.15 2.68±1.70 <0.001

Third Ventricle

Third Ventricle

Third Ventricle

MPRAGE

FLAIR T2 T1

MPRAGE FLAIR T2 T1

Posterior Fossa Mean ± SD Mean ± SD p

MPRAGE-FLAIR 4.53±0.82 2.17±1.11 <0.001

MPRAGE-T2 4.53±0.82 2.87±1.46<0.001

MPRAGE-T1 4.53±0.82 2.13±1.25 <0.001

FLAIR-T2 2.17±1.11 2.87±1.46 0.006

FLAIR-T1 2.17±1.11 2.13±1.25 1.000

T2-T1 2.87±1.46 2.13±1.25 0.006

Posterior Fossa

Posterior Fossa

Posterior Fossa

MPRAGE FLAIR T2 T1

MPRAGE-

FLAIR

MPRAGE-T2

MPRAGE-T1

FLAIR-T2

FLAIR-T1

T2-T1

Centrum

semiovale

(n=45)

0.648b MPRAGE<0.001a

MPRAGE<0.001a

FLAIR0.013a

FLAIR<0.001a

T2<0.001a

Corona Radiata(n=51)

0.833b MPRAGE<0.001a

MPRAGE<0.001a

FLAIR0.023a

FLAIR<0.001a

T2<0.001a

Third Ventricl

e(n=22)

0.085b 0.255b MPRAGE0.014a

0.748b FLAIR0.05a

T2<0.001a

Posterior Fossa(n=30)

MPRAGE<0.001a

MPRAGE<0.001a

MPRAGE<0.001a

T20.006a

1.000b T20.006a

Statistical comparison of MPRAGE, FLAIR, T2 and T1 sequences according to lesion location

• p≤0.05 was considered the statistical significant level. a: statistically significant; b: not statistically significant

Conclusions

MPRAGE was significantly better than T2 and T1 on the assessment of MS lesions located in the centrum semiovale and corona radiata.

MPRAGE was significantly better than T1 in the evaluation of MS lesions at the level of the 3rd ventricle.

MPRAGE was significantly better in the assessment of posterior fossa lesions in comparison to all standard sequences.

Conclusions

WMn-MPRAGE is a practical technique providing novel image contrast of value in evaluation of MS brain lesions, specially in the assessment of posterior fossa lesions.

WMn-MPRAGE should be considered for routine use in the evaluation of patients with known or suspected MS

Acknowledgements

We acknowledge Ginu Abraham, BSRT(R)(MR), for his assistance on the MRI scanners.

References

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