title: Clinical 3-tesla FLAIR* MRI improves diagnostic accuracy in multiple sclerosis.
abstract: To evaluate clinical fluid-attenuated inversion recovery (FLAIR)* 3T magnetic resonance imaging (MRI), which is sensitive to perivenular inflammatory demyelinating lesions, in diagnosing multiple sclerosis (MS).
  
  
  
  Central veins may be a distinguishing feature of MS lesions. FLAIR*, a combined contrast derived from clinical MRI scans, has not been studied as a clinical tool for diagnosing MS.
  
  
  
  Two experienced MS neurologists evaluated 87 scan pairs (T2-FLAIR/FLAIR*), separately and side-by-side, from 68 MS cases, 8 healthy volunteers, and 11 individuals with other neurological diseases. Raters judged cases based on experience, published criteria, and a visual assessment of the "40% rule," whereby MS is favored if >40% of lesions demonstrate a central vein. Diagnostic accuracy was determined with area under the receiver operating characteristic curve (AUC), and inter-rater reliability was assessed with Cohen's kappa (κ).
  
  
  
  Diagnostic accuracy was high: rater 1, AUC 0.94 (95% confidence interval: 0.89, 0.97) for T2-FLAIR, 0.95 (0.92, 0.98) for FLAIR*; rater 2, 0.94 (0.90, 0.98) and 0.90 (0.85, 0.95). AUC improved when images were considered together: rater 1, 0.99 (0.98, 1.00); rater 2, 0.98 (0.96, 0.99). Inter-rater agreement was substantial for T2-FLAIR (κ = 0.68) and FLAIR* (κ = 0.74), despite low agreement on the 40% rule (κ = 0.47) ([Formula: see text] in all cases).
  
  
  
  Joint clinical evaluation of T2-FLAIR and FLAIR* images modestly improves diagnostic accuracy for MS and does not require counting lesions with central veins.
authors.affiliation: Division of Neuroimmunology and Neurovirology, NINDS, National Institutes of Health (NIH), Bethesda, MD, USA/Yale University, New Haven, CT, USA.
authors.forename: Ilena C
authors.initials: IC
authors.lastname: George
authors.affiliation: Division of Neuroimmunology and Neurovirology, NINDS, National Institutes of Health (NIH), Bethesda, MD, USA.
authors.forename: Pascal
authors.initials: P
authors.lastname: Sati
authors.affiliation: Division of Neuroimmunology and Neurovirology, NINDS, National Institutes of Health (NIH), Bethesda, MD, USA/ Raffaele Scientific Institute, Milan, Italy.
authors.forename: Martina
authors.initials: M
authors.lastname: Absinta
authors.affiliation: Division of Neuroimmunology and Neurovirology, NINDS, National Institutes of Health (NIH), Bethesda, MD, USA.
authors.forename: Irene Cm
authors.initials: IC
authors.lastname: Cortese
authors.affiliation: Division of Neuroimmunology and Neurovirology, NINDS, National Institutes of Health (NIH), Bethesda, MD, USA/ Johns Hopkins School of Public Health, Baltimore, MD, USA.
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Sweeney
authors.affiliation: Division of Neuroimmunology and Neurovirology, NINDS, National Institutes of Health (NIH), Bethesda, MD, USA.
authors.forename: Colin D
authors.initials: CD
authors.lastname: Shea
authors.affiliation: Translational Neuroradiology Unit, Division of Neuroimmunology and Neurovirology, NINDS, National Institutes of Health (NIH), Bethesda, MD, USA/Johns Hopkins School of Public Health, Baltimore, MD, USA reichds@ninds.nih.gov.
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Reich
mesh_terms: D000328:Adult; D002550:Cerebral Veins / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods* / Q000592:standards; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000000981:diagnostic imaging*
keywords: MRI; central veins; diagnosis; multiple sclerosis