L Danieli1, L Roccatagliata2, D Distefano, E Prodi1, G C Riccitelli3,4, A Diociasi2, L Carmisciano5, A Cianfoni1,4, T Bartalena6, A Kaelin-Lang3,4, C Gobbi3,4, C Zecca3,4, E Pravatà7,4. 1. Form the Department of Neuroradiology (L.D., E. Prodi, A.C., E. Pravatà), Neurocenter of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland. 2. Dipartimento di Scienze della Salute (L.R., A.D.), Università degli Studi di Genova, Genoa, Italy. 3. Department of Neurology (G.C.R., A.K.-L., C.G., C.Z., E. Pravatà), Neurocenter of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland. 4. Faculty of Biomedical Sciences (G.C.R., A.C., A.K.-L., C.G., C,Z., E. Pravatà), Università della Svizzera Italiana, Lugano, Switzerland. 5. Department of Health Sciences, Section of Biostatistics (L.C.), Università degli Studi di Genova, Genoa, Italy. 6. Department of Radiology (T.B.), Pol. Zappi Bartalena, Imola, Italy. 7. Form the Department of Neuroradiology (L.D., E. Prodi, A.C., E. Pravatà), Neurocenter of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland emanuele.pravata@eoc.ch.
Abstract
BACKGROUND AND PURPOSE: We hypothesized that 3D T1-TSE "black-blood" images may carry an increased risk of contrast-enhancing lesion misdiagnosis in patients with MS because of the misinterpretation of intraparenchymal vein enhancement. Thus, the occurrence of true-positive and false-positive findings was compared between standard MPRAGE and volumetric interpolated brain examination techniques. MATERIALS AND METHODS: Sampling perfection with application-optimized contrasts by using different flip-angle evolution (SPACE) images obtained from 232 patients with MS, clinically isolated syndrome, or radiologically isolated syndrome were compared with standard MPRAGE and volumetric interpolated brain examination images. The intraparenchymal vein contrast-to-noise ratio was estimated at the level of the thalami. Contrast-enhancing lesions were blindly detected by 2 expert readers and 1 beginner reader. True- and false-positives were determined by senior readers' consensus. True-positive and false-positive frequency differences and patient-level diagnosis probability were tested with the McNemar test and OR. The contrast-to-noise ratio and morphology were compared using the Mann-Whitney U and χ2 tests. RESULTS: The intraparenchymal vein contrast-to-noise ratio was higher in SPACE than in MPRAGE and volumetric interpolated brain examination images (P < .001, both). There were 66 true-positives and 74 false-positives overall. SPACE detected more true-positive and false-positive results (P range < .001-.07) but did not increase the patient's true-positive likelihood (OR = 1 1.29, P = .478-1). However, the false-positive likelihood was increased (OR = 3.03-3.55, P = .008-.027). Venous-origin false-positives (n = 59) with contrast-to-noise ratio and morphology features similar to small-sized (≤14 mm3 P = .544) true-positives occurred more frequently in SPACE images (P < .001). CONCLUSIONS: Small intraparenchymal veins may confound the diagnosis of enhancing lesions on postgadolinium black-blood SPACE images.
BACKGROUND AND PURPOSE: We hypothesized that 3D T1-TSE "black-blood" images may carry an increased risk of contrast-enhancing lesion misdiagnosis in patients with MS because of the misinterpretation of intraparenchymal vein enhancement. Thus, the occurrence of true-positive and false-positive findings was compared between standard MPRAGE and volumetric interpolated brain examination techniques. MATERIALS AND METHODS: Sampling perfection with application-optimized contrasts by using different flip-angle evolution (SPACE) images obtained from 232 patients with MS, clinically isolated syndrome, or radiologically isolated syndrome were compared with standard MPRAGE and volumetric interpolated brain examination images. The intraparenchymal vein contrast-to-noise ratio was estimated at the level of the thalami. Contrast-enhancing lesions were blindly detected by 2 expert readers and 1 beginner reader. True- and false-positives were determined by senior readers' consensus. True-positive and false-positive frequency differences and patient-level diagnosis probability were tested with the McNemar test and OR. The contrast-to-noise ratio and morphology were compared using the Mann-Whitney U and χ2 tests. RESULTS: The intraparenchymal vein contrast-to-noise ratio was higher in SPACE than in MPRAGE and volumetric interpolated brain examination images (P < .001, both). There were 66 true-positives and 74 false-positives overall. SPACE detected more true-positive and false-positive results (P range < .001-.07) but did not increase the patient's true-positive likelihood (OR = 1 1.29, P = .478-1). However, the false-positive likelihood was increased (OR = 3.03-3.55, P = .008-.027). Venous-origin false-positives (n = 59) with contrast-to-noise ratio and morphology features similar to small-sized (≤14 mm3 P = .544) true-positives occurred more frequently in SPACE images (P < .001). CONCLUSIONS: Small intraparenchymal veins may confound the diagnosis of enhancing lesions on postgadolinium black-blood SPACE images.
Authors: Tobias Granberg; Juha Martola; Maria Kristoffersen-Wiberg; Peter Aspelin; Sten Fredrikson Journal: Mult Scler Date: 2012-07-03 Impact factor: 6.312
Authors: L Danieli; G C Riccitelli; D Distefano; E Prodi; E Ventura; A Cianfoni; A Kaelin-Lang; M Reinert; E Pravatà Journal: AJNR Am J Neuroradiol Date: 2019-06-20 Impact factor: 3.825
Authors: Nora N Sommer; Tobias Saam; Eva Coppenrath; Hendrik Kooijman; Tania Kümpfel; Maximilian Patzig; Sebastian E Beyer; Wieland H Sommer; Maximilian F Reiser; Birgit Ertl-Wagner; Karla M Treitl Journal: Invest Radiol Date: 2018-01 Impact factor: 6.016
Authors: Chris H Polman; Stephen C Reingold; Brenda Banwell; Michel Clanet; Jeffrey A Cohen; Massimo Filippi; Kazuo Fujihara; Eva Havrdova; Michael Hutchinson; Ludwig Kappos; Fred D Lublin; Xavier Montalban; Paul O'Connor; Magnhild Sandberg-Wollheim; Alan J Thompson; Emmanuelle Waubant; Brian Weinshenker; Jerry S Wolinsky Journal: Ann Neurol Date: 2011-02 Impact factor: 10.422