TY - JOUR
T1 - Clinical 3-tesla FLAIR∗ MRI improves diagnostic accuracy in multiple sclerosis
AU - George, Ilena C.
AU - Sati, Pascal
AU - Absinta, Martina
AU - Cortese, Irene C.M.
AU - Sweeney, Elizabeth M.
AU - Shea, Colin D.
AU - Reich, Daniel S.
N1 - Publisher Copyright:
© SAGE Publications.
PY - 2016/10/1
Y1 - 2016/10/1
N2 - Objective: To evaluate clinical fluid-attenuated inversion recovery (FLAIR)∗ 3T magnetic resonance imaging (MRI), which is sensitive to perivenular inflammatory demyelinating lesions, in diagnosing multiple sclerosis (MS). Background: Central veins may be a distinguishing feature of MS lesions. FLAIR∗, a combined contrast derived from clinical MRI scans, has not been studied as a clinical tool for diagnosing MS. Methods: Two experienced MS neurologists evaluated 87 scan pairs (T2-FLAIR/FLAIR∗), separately and side-by-side, from 68 MS cases, 8 healthy volunteers, and 11 individuals with other neurological diseases. Raters judged cases based on experience, published criteria, and a visual assessment of the "40% rule," whereby MS is favored if >40% of lesions demonstrate a central vein. Diagnostic accuracy was determined with area under the receiver operating characteristic curve (AUC), and inter-rater reliability was assessed with Cohen's kappa. Results: Diagnostic accuracy was high: rater 1, AUC 0.94 (95% confidence interval: 0.89, 0.97) for T2-FLAIR, 0.95 (0.92, 0.98) for FLAIR∗; rater 2, 0.94 (0.90, 0.98) and 0.90 (0.85, 0.95). AUC improved when images were considered together: rater 1, 0.99 (0.98, 1.00); rater 2, 0.98 (0.96, 0.99). Inter-rater agreement was substantial for T2-FLAIR (= 0.68) and FLAIR∗ (= 0.74), despite low agreement on the 40% rule (= 0.47) (p ‰ 0. 001 in all cases). Conclusions: Joint clinical evaluation of T2-FLAIR and FLAIR∗ images modestly improves diagnostic accuracy for MS and does not require counting lesions with central veins.
AB - Objective: To evaluate clinical fluid-attenuated inversion recovery (FLAIR)∗ 3T magnetic resonance imaging (MRI), which is sensitive to perivenular inflammatory demyelinating lesions, in diagnosing multiple sclerosis (MS). Background: Central veins may be a distinguishing feature of MS lesions. FLAIR∗, a combined contrast derived from clinical MRI scans, has not been studied as a clinical tool for diagnosing MS. Methods: Two experienced MS neurologists evaluated 87 scan pairs (T2-FLAIR/FLAIR∗), separately and side-by-side, from 68 MS cases, 8 healthy volunteers, and 11 individuals with other neurological diseases. Raters judged cases based on experience, published criteria, and a visual assessment of the "40% rule," whereby MS is favored if >40% of lesions demonstrate a central vein. Diagnostic accuracy was determined with area under the receiver operating characteristic curve (AUC), and inter-rater reliability was assessed with Cohen's kappa. Results: Diagnostic accuracy was high: rater 1, AUC 0.94 (95% confidence interval: 0.89, 0.97) for T2-FLAIR, 0.95 (0.92, 0.98) for FLAIR∗; rater 2, 0.94 (0.90, 0.98) and 0.90 (0.85, 0.95). AUC improved when images were considered together: rater 1, 0.99 (0.98, 1.00); rater 2, 0.98 (0.96, 0.99). Inter-rater agreement was substantial for T2-FLAIR (= 0.68) and FLAIR∗ (= 0.74), despite low agreement on the 40% rule (= 0.47) (p ‰ 0. 001 in all cases). Conclusions: Joint clinical evaluation of T2-FLAIR and FLAIR∗ images modestly improves diagnostic accuracy for MS and does not require counting lesions with central veins.
KW - MRI
KW - central veins
KW - diagnosis
KW - multiple sclerosis
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U2 - 10.1177/1352458515624975
DO - 10.1177/1352458515624975
M3 - Article
C2 - 26769065
AN - SCOPUS:84991392284
SN - 1352-4585
VL - 22
SP - 1578
EP - 1586
JO - Multiple Sclerosis
JF - Multiple Sclerosis
IS - 12
ER -