title: Juxtacortical Lesions in Multiple Sclerosis: Assessment of Gray Matter Involvement Using Phase Difference-enhanced Imaging (PADRE).
abstract: OBJECTIVE
  In multiple sclerosis (MS), a juxtacortical lesion at the border between the gray matter (GM) and subcortical white matter (WM) may often involve the GM. A recently developed, phase-weighted magnetic resonance imaging (MRI) technique "phase difference enhanced imaging (PADRE)" can delineate the GM and WM clearly due to the difference in myelin concentration. We evaluated whether PADRE is useful for the detection of GM involvement in the juxtacortical MS lesions.
  
  
  METHODS
  One neuroradiologist reviewed the conventional MRI in 13 MS patients and selected 48 juxtacortical lesions. At the first reading session with the conventional MRI alone (T2-weighted imaging, and two-dimensional and three-dimensional fluid-attenuated inversion recovery), two other neuroradiologists classified the lesions into three patterns according to their anatomical locations: (a) subcortical WM lesions involving the subcortical WM alone; (b) intracortical (IC) lesions involving the GM alone; (c) mixed GM/subcortical WM (mixed) lesions involving the both subcortical WM and GM. We defined the subcortical WM as a WM within a distance of 10 mm from inner edge of the GM. For the analyses, we excluded the white matter lesions further than 10 mm from inner edge of the GM. At the second reading session MRI and PADRE were available and the radiologists re-evaluated their prior classification.
  
  
  RESULTS
  At the first reading session, 27 lesions were classified as (a), 1 as (b), and 20 as (c). Therefore, a total of 21 lesions (44%) were judged to involve the GM. At the second reading session, the classification of 15 (31%) lesions changed; all 15 lesions were judged to involve the GM on the PADRE. Interobserver agreement (kappa value) was 0.84 for the first- and 0.95 for the second reading session.
  
  
  CONCLUSIONS
  PADRE is useful for detecting GM involvement of the juxtacortical MS lesions.
authors: Department of Radiology, University of Occupational and Environmental Health, School of Medicine.
authors: Koichiro
authors: K
authors: Futatsuya
authors: Shingo
authors: S
authors: Kakeda
authors: Tetsuya
authors: T
authors: Yoneda
authors: Issei
authors: I
authors: Ueda
authors: Keita
authors: K
authors: Watanabe
authors: Junji
authors: J
authors: Moriya
authors: Yu
authors: Y
authors: Murakami
authors: Satoru
authors: S
authors: Ide
authors: Atsushi
authors: A
authors: Ogasawara
authors: Norihiro
authors: N
authors: Ohnari
authors: Kazumasa
authors: K
authors: Okada
authors: Hiroaki
authors: H
authors: Adachi
authors: Yukunori
authors: Y
authors: Korogi
mesh_terms: D000328:Adult; D016477:Artifacts; D005260:Female; D066128:Gray Matter / Q000000981:diagnostic imaging* / Q000473:pathology; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D007091:Image Processing, Computer-Assisted / Q000379:methods / Q000706:statistics & numerical data; D021621:Imaging, Three-Dimensional / Q000379:methods / Q000706:statistics & numerical data; D008279:Magnetic Resonance Imaging / Q000379:methods* / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000000981:diagnostic imaging* / Q000473:pathology; D015588:Observer Variation; D066127:White Matter / Q000000981:diagnostic imaging* / Q000473:pathology; D055815:Young Adult