ABSTRACT
Background and Purpose
The central vein sign (CVS) is a diagnostic imaging biomarker for multiple sclerosis (MS). FLAIR* is a combined MRI contrast that provides high conspicuity for CVS at 3 Tesla (3T), enabling its sensitive and accurate detection in clinical settings. This study evaluated whether CVS conspicuity of 3T FLAIR* is reliable across imaging sites and MRI vendors and whether gadolinium (Gd) contrast increases CVS conspicuity.
Methods
A cross-sectional, multicenter study recruited adults referred for possible diagnosis of MS at 10 sites. FLAIR* contrast was generated using high-resolution T2*-weighted (acquired pre- and post-injection of Gd) and T2-weighted fluid-attenuated inversion recovery (T2-FLAIR) brain images at 3T from two MRI vendors. Lesions and veins were segmented to compute lesion-to-vein contrast-to-noise ratio (CNRlesion-to-vein), a quantitative measure of CVS conspicuity. CNRlesion-to-vein measures for pre- and post-Gd FLAIR* were compared across sites and vendors.
Results
Eighty-seven participants from nine sites were included in the analysis. There was no significant difference in mean CNRlesion-to-vein between sites for pre-Gd (p-value = 0.07) or post-Gd (p-value = 0.27) FLAIR*. There were also no significant differences between vendors for pre-Gd (p-value = 0.10) or post-Gd (p-value = 0.31) FLAIR*. Patient-level pairwise differences in CNRlesion-to-vein between pre-Gd and post-Gd FLAIR* revealed a significant increase for post-Gd FLAIR* (p-value < 0.001).
Conclusions
CVS conspicuity on 3T FLAIR* is consistent across imaging sites and MRI vendors. Moreover, Gd-based contrast agent significantly improved CVS conspicuity on 3T FLAIR*. These findings support the implementation of FLAIR* in clinical settings for MS.
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This post is Copyright: Melissa Lynne Martin,
Quy Cao,
Elaina Luskin,
Brian Renner,
Lynn Daboul,
Carly M. O’Donnell,
Paulo Rodrigues,
John Derbyshire,
Christina J. Azevedo,
Amit Bar‐Or,
Eduardo Caverzasi,
Peter Calabresi,
Bruce A. C. Cree,
Léorah Freeman,
Roland G. Henry,
Erin E. Longbrake,
Jiwon Oh,
Nico Papinutto,
Daniel Pelletier,
Vesna Prchkovska,
Marc Ramos,
Rohini D. Samudralwar,
Matthew K. Schindler,
Elias S. Sotirchos,
Nancy L. Sicotte,
Andrew J. Solomon,
Daniel S. Reich,
Daniel Ontaneda,
Russell T. Shinohara,
Pascal Sati | January 22, 2025
Wiley: Journal of Neuroimaging: Table of Contents