title: Consensus recommendations for MS cortical lesion scoring using double inversion recovery MRI.
abstract: BACKGROUND
  Different double inversion recovery (DIR) sequences are currently used in multiple sclerosis (MS) research centers to visualize cortical lesions, making it difficult to compare published data. This study aimed to formulate consensus recommendations for scoring cortical lesions in patients with MS, using DIR images acquired in 6 European centers according to local protocols.
  
  
  METHODS
  Consensus recommendations were formulated and tested in a multinational meeting.
  
  
  RESULTS
  Cortical lesions were defined as focal abnormalities on DIR, hyperintense compared to adjacent normal-appearing gray matter, and were not scored unless ≥ 3 pixels in size, based on at least 1.0 mm(2) in-plane resolution. Besides these 2 obligatory criteria, additional, supportive recommendations concerned a priori artifact definition on DIR, use of additional MRI contrasts to verify suspected lesions, and a constant level of displayed image contrast. Robustness of the recommendations was tested in a small dataset of available, heterogeneous DIR images, provided by the different participating centers. An overall moderate agreement was reached when using the proposed recommendations: more than half of the readers agreed on slightly more than half (54%) of the cortical lesions scored, whereas complete agreement was reached in 19.4% of the lesions (usually larger, mixed white matter/gray matter lesions).
  
  
  CONCLUSIONS
  Although not designed as a formal interobserver study, the current study suggests that comparing available literature data on cortical lesions may be problematic, and increased consistency in acquisition protocols may improve scoring agreement. Sensitivity and specificity of the proposed recommendations should now be studied in a more formal, prospective, multicenter setting using similar DIR protocols.
authors.affiliation: VU University Medical Center, Department of Anatomy & Neuroscience, MF G-116, van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands. j.geurts@vumc.nl
authors.forename: J J G
authors.initials: JJ
authors.lastname: Geurts
authors.forename: S D
authors.initials: SD
authors.lastname: Roosendaal
authors.forename: M
authors.initials: M
authors.lastname: Calabrese
authors.forename: O
authors.initials: O
authors.lastname: Ciccarelli
authors.forename: F
authors.initials: F
authors.lastname: Agosta
authors.forename: D T
authors.initials: DT
authors.lastname: Chard
authors.forename: A
authors.initials: A
authors.lastname: Gass
authors.forename: E
authors.initials: E
authors.lastname: Huerga
authors.forename: B
authors.initials: B
authors.lastname: Moraal
authors.forename: D
authors.initials: D
authors.lastname: Pareto
authors.forename: M A
authors.initials: MA
authors.lastname: Rocca
authors.forename: M P
authors.initials: MP
authors.lastname: Wattjes
authors.forename: T A
authors.initials: TA
authors.lastname: Yousry
authors.forename: B M J
authors.initials: BM
authors.lastname: Uitdehaag
authors.forename: F
authors.initials: F
authors.lastname: Barkhof
mesh_terms: D016477:Artifacts; D002540:Cerebral Cortex / Q000473:pathology*; D004185:Disability Evaluation; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D008279:Magnetic Resonance Imaging / Q000379:methods* / Q000592:standards*; D015337:Multicenter Studies as Topic / Q000379:methods / Q000592:standards; D009103:Multiple Sclerosis / Q000175:diagnosis* / Q000473:pathology*; D009413:Nerve Fibers, Myelinated / Q000473:pathology*; D015588:Observer Variation; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012720:Severity of Illness Index