Imaging cortical multiple sclerosis lesions with ultra-high field MRI

Mads A J Madsen; Vanessa Wiggermann; Stephan Bramow; Jeppe Romme Christensen; Finn Sellebjerg; Hartwig R Siebner

doi:10.1016/j.nicl.2021.102847

Imaging cortical multiple sclerosis lesions with ultra-high field MRI

Neuroimage Clin. 2021:32:102847. doi: 10.1016/j.nicl.2021.102847. Epub 2021 Oct 6.

Authors

Mads A J Madsen¹, Vanessa Wiggermann², Stephan Bramow³, Jeppe Romme Christensen³, Finn Sellebjerg⁴, Hartwig R Siebner⁵

Affiliations

¹ Danish Research Centre for Magnetic Resonance, Copenhagen University Hospital - Amager & Hvidovre, Kettegard Allé 30, 2650 Hvidovre, Denmark. Electronic address: madsjm@drcmr.dk.
² Danish Research Centre for Magnetic Resonance, Copenhagen University Hospital - Amager & Hvidovre, Kettegard Allé 30, 2650 Hvidovre, Denmark.
³ Danish Multiple Sclerosis Center, Department of Neurology, Copenhagen University Hospital - Rigshospitalet, Valdemar Hansens Vej 1-23, 2600 Glostrup, Denmark.
⁴ Danish Multiple Sclerosis Center, Department of Neurology, Copenhagen University Hospital - Rigshospitalet, Valdemar Hansens Vej 1-23, 2600 Glostrup, Denmark; Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3b, 2200 Copenhagen, Denmark.
⁵ Danish Research Centre for Magnetic Resonance, Copenhagen University Hospital - Amager & Hvidovre, Kettegard Allé 30, 2650 Hvidovre, Denmark; Department of Neurology, Copenhagen University Hospital - Bispebjerg, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3b, 2200 Copenhagen, Denmark.

Abstract

Background: Cortical lesions are abundant in multiple sclerosis (MS), yet difficult to visualize in vivo. Ultra-high field (UHF) MRI at 7 T and above provides technological advances suited to optimize the detection of cortical lesions in MS.

Purpose: To provide a narrative and quantitative systematic review of the literature on UHF MRI of cortical lesions in MS.

Methods: A systematic search of all literature on UHF MRI of cortical lesions in MS published before September 2020. Quantitative outcome measures included cortical lesion numbers reported using 3 T and 7 T MRI and between 7 T MRI sequences, along with sensitivity of UHF MRI towards cortical lesions verified by histopathology.

Results: 7 T MRI detected on average 52 ± 26% (mean ± 95% confidence interval) more cortical lesions than the best performing image contrast at 3 T, with the largest increase in type II-IV intracortical lesion detection. Across all studies, the mean cortical lesion number was 17 ± 6 per patient. In progressive MS cohorts, approximately four times more cortical lesions were reported than in CIS/early RRMS, and RRMS. Yet, there was no difference in lesion type ratio between these MS subtypes. Furthermore, superiority of one MRI sequence over another could not be established from available data. Post-mortem lesion detection with UHF MRI agreed only modestly with pathological examinations. Mean pro- and retrospective sensitivity was 33 ± 6% and 71 ± 10%, respectively, with the highest sensitivity towards type I and type IV lesions.

Conclusion: UHF MRI improves cortical lesion detection in MS considerably compared to 3 T MRI, particularly for type II-IV lesions. Despite modest sensitivity, 7 T MRI is still capable of visualizing all aspects of cortical lesion pathology and could potentially aid clinicians in diagnosing and monitoring MS, and progressive MS in particular. However, standardization of acquisition and segmentation protocols is needed.

Keywords: 7T MRI; Cortical lesions; Multiple sclerosis; Systematic review; Ultra-high field MRI.

Publication types

Research Support, Non-U.S. Gov't
Systematic Review

MeSH terms

Autopsy
Humans
Magnetic Resonance Imaging
Multiple Sclerosis* / diagnostic imaging
Multiple Sclerosis, Chronic Progressive*
Retrospective Studies