T2 hyperintensity of medial lemniscus: higher threshold application to ROI measurements is more accurate in predicting small vessel disease.
BACKGROUND
Medial lemniscus T2 hyperintensity (MLH) has been recently demonstrated as potential imaging marker for small vessel disease (SVD). Our purpose in this study is to improve accuracy of regions of interest (ROI) analysis for this imaging finding.


METHODS
Two neuroradiologists retrospectively reviewed 103 consecutive outpatient brain MRI. Medial lemniscus signal in dorsal pons was evaluated; visually on FLAIR and with ROI on T2. Original MRI interpretations were divided into three categories; SVD, multiple sclerosis (MS), and nonspecific WM changes (non).


RESULTS
Thirty-seven patients had SVD, 14 patients had MS, 52 had Non. Visual MLH was seen exclusively with SVD and was generally bilateral. Patients with visual MLH belonged to advanced SVD by imaging and clinical parameters. Compared to visual data, ROI analyses of MLH has been known to be compounded by false positives and negatives at low threshold (20% of adjacent to normal brainstem signal). With application of higher ROI threshold (25%), false positives were eliminated but false negatives increased. ROI analyses of MLH by experienced neuroradiologist were more reliable.


CONCLUSIONS
MLH seen on high threshold ROI analysis is a reliable radiologic marker in predicting SVD. ROI analysis of MLH should be performed by an experienced neuroradiologist.
Department of Radiology, Lahey Clinic Medical Center, Burlington, MA 01805, USA.
Michael M
MM
Hakky
Kaan D
KD
Erbay
Edward
E
Brewer
Jennifer B
JB
Midle
Robert
R
French
Sami H
SH
Erbay
D000368:Aged; D000465:Algorithms; D002561:Cerebrovascular Disorders / Q000473:pathology*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D007090:Image Interpretation, Computer-Assisted / Q000379:methods; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008526:Medulla Oblongata / Q000098:blood supply* / Q000473:pathology*; D055806:Microvessels / Q000473:pathology; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000473:pathology*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D066127:White Matter / Q000473:pathology*
Small vessel disease; cerebral white matter; medial lemniscus