Magnetic resonance phase alterations in multiple sclerosis patients with short and long disease duration

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Abstract

Objective: The analysis of the MR phase provides additional information on the tissue microstructure. In multiple sclerosis (MS) lesions phase alterations may reflect different stages of inflammatory activity. Here we investigated lesion morphology in MS patients with short and long disease duration on T2 ∗ weighted, phase, magnitude and susceptibility weighted imaging (SWI) at 7 Tesla (T). Methods: 17 MS or clinically isolated syndrome patients with short (<60 months) and 11 with long (>60 months) disease duration underwent 7T MRI. Lesions were subsequently analyzed side-by-side with regard to morphology and visibility on T2 ∗ weighted, SWI, magnitude and SWI-filtered phase images. Results: 126 of 192 T2 ∗ weighted lesions (65.6%) were characterized by a phase alteration pattern, and hence could be differentiated on phase images. In detail, a significantly reduced proportion of lesions showing phase alterations was detectable in patients with longer disease duration (mean±SD 51±37%, range 0-100%) compared to patients with short disease duration (mean±SD 90±19.5%, range 50-100%, p = 0.003). Conclusion: This cross-sectional study identified different patterns of phase changes in lesions of MS patients with short and long standing disease. Longitudinal studies are warranted to prove that MR phase imaging is useful in determining the activity and the developmental stage of individual MS plaques. Copyright:

Figures

  • Table 1. Cohort description.
  • Fig 1. Methods.MS lesion morphology was assessed on T2*w (top) and phase (bottom) images using a visual analysis. Lesion visibility, the existence of a central vein, and signal alterations indicative for iron deposition were rated. A: confluent T2*w hyperintense lesion not visible on phase images. B: central T2*w hypointensity and positive phase shift indicative of iron deposits (arrow). C: Iron deposits in a perivascular (white arrow) lesion causing a T2*w hypointense rim (black arrowheads) and ring-like paramagnetic (“bright”) phase alterations (white arrowheads). Please note that the dark envelop around the “bright” ring in the phase image likely represents an artifact caused by the dipolar field patterns.
  • Fig 2. Comparison between early and long standing MS. T2*w (top) and phase images (bottom) of three patients are displayed. T2*w lesions (A) are detectable on phase images (B, black arrows) in the MS patient shown on the left (disease onset 9 months prior to MRI). Contrarily, no phase contrasting lesions were found in a patient with longer disease duration (C, D, MS onset 169 months prior to MRI). In addition, only a subgroup of patients with longer disease duration presented lesions with strong T2*w hypointense rims (E, black arrowheads, zoom) and corresponding rim-like phase abnormalities (F, white arrows).
  • Fig 3. Scatter plot. A. The higher proportion of T2*w lesions visible on phase images in early compared to chronic disease stages is displayed. B. The scatter plot indicates an inverse correlation between phase visibility and disease duration.
  • Fig 4. Exemplary chronic MS lesion.MS lesion in T2*w (A), T1w (B), FLAIR (C), SWI (D), phase (E) and magnitude (F) images. Prominent phase (black arrows) and corresponding T2*w/SWI hypointense rim are highlighted (white arrows).
  • Fig 5. Phase abnormalities in MS lesions of patients with short disease duration. T2*w hyperintense (A) lesions of MS patients with short disease duration may be characterized by central phase shift (B, black arrows), and hypointense appearance on SWI (C, white arrows). Please note the higher sensitivity of SWI (C) compared to T2*w images (A) in detecting such alterations that might represent iron deposits.

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Bozin, I., Ge, Y., Kuchling, J., Dusek, P., Chawla, S., Harms, L., … Wuerfel, J. (2015). Magnetic resonance phase alterations in multiple sclerosis patients with short and long disease duration. PLoS ONE, 10(7). https://doi.org/10.1371/journal.pone.0128386

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