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• W2079236234 abstract "•Magnetisation transfer ratio (MTR) at 7 T within reasonable time is able to detect cortical lesions. •MTR was able to detect all types of cortical lesions including subpial lesions. •7 T MTR detected more lesions than 7 T MPRAGE, 7 T FLASH T2⁎ and 3 T 3D DIR. •The number of lesions detected on MTR correlated with the lesions detected on 7 T MPRAGE, 7 T FLASH T2⁎ and 3 T 3D DIR. •97.8% of the lesions detected on DIR were detected on MTR. Background Cortical lesions account for a larger proportion of brain demyelination than white matter (WM) lesions. They are often missed on conventional MRI. Recently studies improved the detection of cortical lesions using 7 T T2⁎, 7 T MPRAGE and 3 T DIR but it seems that we are still able to detect only “the tip of the iceberg”. In this study we report for the first time the systematic use of high resolution MTR in MS and compare MTR lesion detection with 7 T MPRAGE, 7 T T2⁎ and 3 T 3D DIR. Objectives We report the use of high resolution, fast, magnetisation transfer imaging (MTI) at 7 T in MS focusing on the detection of cortical lesions. Subjects and methods Eighteen patients with MS were scanned (Expanded Disability Status Scale score: 3.0, mean age: 48 years, mean disease duration: 7.25 years). The scans were compared to nine healthy control subjects (mean age 36.5 years). Data acquisition We acquired 7 T MPRAGE images, 7 T MTR maps, 7 T T2⁎and 3 T 3D DIR. The WM was segmented from the MPRAGE and removed to obtain only the cortical grey matter ribbon (cGMR) mask. The mask was then applied to the different modalities (MPRAGE, MTR, DIR, T2⁎w) previously registered onto the MPRAGE volume. The analysis of the cGMR was performed by two observers blinded to the disease state. Results In patients with MS 365 lesions in total were detected with 7 T MTR (mean 20.28 lesions per patient), 289 lesions were detected with 7 T MPRAGE (mean 16.06 lesions) and 231 lesions were detected with 7 T T2⁎ (mean 12.83 lesions). In the 8 MS subjects who had 3 T 3D DIR acquired on the same day, a total of 136 lesions (mean 17 lesions per patient) were detected as opposed to 171 lesions with 7 T MTR, 147 lesions were detected with 7 T MPRAGE and 126 lesions with 7 T T2⁎ in the same patients. Conclusion We found that 7 T MTR, in less than 10 min scanning time, was able to detect cortical lesions. In this study we found that 7 T MTR was better in detecting intracortical lesions in comparison with 7 T T2⁎, 7 T MPRAGE, and 3 T 3D DIR. since only a very few intracortical lesions were detected in healthy controls in our blind assessment, it is likely that the lesions detected represent focal grey matter demyelination. High resolution MT imaging has especially revealed cortical changes that have not been recognised by other MR sequences. MTR maps were noisier than MPRAGE, T2⁎ and DIR, but also better in localising cortical lesions. As MTR is more pathologically specific than other sequences in detecting tissue myelination, it raises the possibility that high resolution MTR will be able to demonstrate cortical remyelination in vivo. Cortical lesions account for a larger proportion of brain demyelination than white matter (WM) lesions. They are often missed on conventional MRI. Recently studies improved the detection of cortical lesions using 7 T T2⁎, 7 T MPRAGE and 3 T DIR but it seems that we are still able to detect only “the tip of the iceberg”. In this study we report for the first time the systematic use of high resolution MTR in MS and compare MTR lesion detection with 7 T MPRAGE, 7 T T2⁎ and 3 T 3D DIR. We report the use of high resolution, fast, magnetisation transfer imaging (MTI) at 7 T in MS focusing on the detection of cortical lesions. Eighteen patients with MS were scanned (Expanded Disability Status Scale score: 3.0, mean age: 48 years, mean disease duration: 7.25 years). The scans were compared to nine healthy control subjects (mean age 36.5 years). We acquired 7 T MPRAGE images, 7 T MTR maps, 7 T T2⁎and 3 T 3D DIR. The WM was segmented from the MPRAGE and removed to obtain only the cortical grey matter ribbon (cGMR) mask. The mask was then applied to the different modalities (MPRAGE, MTR, DIR, T2⁎w) previously registered onto the MPRAGE volume. The analysis of the cGMR was performed by two observers blinded to the disease state. In patients with MS 365 lesions in total were detected with 7 T MTR (mean 20.28 lesions per patient), 289 lesions were detected with 7 T MPRAGE (mean 16.06 lesions) and 231 lesions were detected with 7 T T2⁎ (mean 12.83 lesions). In the 8 MS subjects who had 3 T 3D DIR acquired on the same day, a total of 136 lesions (mean 17 lesions per patient) were detected as opposed to 171 lesions with 7 T MTR, 147 lesions were detected with 7 T MPRAGE and 126 lesions with 7 T T2⁎ in the same patients. We found that 7 T MTR, in less than 10 min scanning time, was able to detect cortical lesions. In this study we found that 7 T MTR was better in detecting intracortical lesions in comparison with 7 T T2⁎, 7 T MPRAGE, and 3 T 3D DIR. since only a very few intracortical lesions were detected in healthy controls in our blind assessment, it is likely that the lesions detected represent focal grey matter demyelination. High resolution MT imaging has especially revealed cortical changes that have not been recognised by other MR sequences. MTR maps were noisier than MPRAGE, T2⁎ and DIR, but also better in localising cortical lesions. As MTR is more pathologically specific than other sequences in detecting tissue myelination, it raises the possibility that high resolution MTR will be able to demonstrate cortical remyelination in vivo." @default.
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• W2079236234 date "2014-03-01" @default.
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• W2079236234 title "Improved detection of focal cortical lesions using 7T magnetisation transfer imaging in patients with multiple sclerosis" @default.
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