title: Improved differentiation between MS and vascular brain lesions using FLAIR* at 7 Tesla.
abstract: OBJECTIVE
  To investigate whether a new magnetic resonance image (MRI) technique called T2*-weighted fluid attenuation inversion recovery (FLAIR*) can differentiate between multiple sclerosis (MS) and vascular brain lesions, at 7 Tesla (T).
  
  
  METHODS
  We examined 16 MS patients and 16 age-matched patients with (risk factors for) vascular disease. 3D-FLAIR and T2*-weighted images were combined into FLAIR* images. Lesion type and intensity, perivascular orientation and presence of a hypointense rim were analysed.
  
  
  RESULTS
  In total, 433 cerebral lesions were detected in MS patients versus 86 lesions in vascular patients. Lesions in MS patients were significantly more often orientated in a perivascular manner: 74 % vs. 47 % (P < 0.001). Ten MS lesions (2.3 %) were surrounded by a hypointense rim on FLAIR*, and 24 MS lesions (5.5 %) were hypointense on T2*. No lesions in vascular patients showed any rim or hypointensity. Specificity of differentiating MS from vascular lesions on 7-T FLAIR* increased when the presence of a central vessel was taken into account (from 63 % to 88 %), most obviously for deep white matter lesions (from 69 % to 94 %). High sensitivity remained (81 %).
  
  
  CONCLUSIONS
  7-T FLAIR* improves differentiation between MS and vascular lesions based on lesion location, perivascular orientation and presence of hypointense (rims around) lesions.
  
  
  CONCLUSIONS
  • A new MRI technique T2*-weighted fluid attenuation inversion recovery (FLAIR*) was investigated. • FLAIR* at 7-T MRI combines FLAIR and T2* images into a single image. • FLAIR* at 7 T does not require enhancement with contrast agents. •High-resolution 7-T FLAIR* improves differentiation between MS and vascular brain lesions. • FLAIR* revealed a central vessel more frequently in MS than vascular lesions.
authors: Department of Radiology, VU University Medical Center, De Boelelaan 1118, 1081, HZ, Amsterdam, The Netherlands, i.kilsdonk@vumc.nl.
authors: Iris D
authors: ID
authors: Kilsdonk
authors: Mike P
authors: MP
authors: Wattjes
authors: Alexandra
authors: A
authors: Lopez-Soriano
authors: Joost P A
authors: JP
authors: Kuijer
authors: Marcus C
authors: MC
authors: de Jong
authors: Wolter L
authors: WL
authors: de Graaf
authors: Mandy M A
authors: MM
authors: Conijn
authors: Chris H
authors: CH
authors: Polman
authors: Peter R
authors: PR
authors: Luijten
authors: Jeroen J G
authors: JJ
authors: Geurts
authors: Mirjam I
authors: MI
authors: Geerlings
authors: Frederik
authors: F
authors: Barkhof
mesh_terms: D000328:Adult; D001921:Brain / Q000098:blood supply / Q000473:pathology*; D016022:Case-Control Studies; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000473:pathology*; D012680:Sensitivity and Specificity