White matter lesions by magnetic resonance: an assessment between DWI and T2 FLAIR techniques
DOI:
https://doi.org/10.25758/set.594Keywords:
Diffusion, T2 FLAIR, MRI, White matter diseaseAbstract
Objectives – To determine the sensitivity and specificity of diffusion-weighted (DWI) and Fluid-Attenuated Inversion Recovery (T2 FLAIR) in the evaluation of white matter lesions and to verify what is his extended complement in order to create a set of best practices in the MRI routine of the brain. Methodology – Was carried out a quantitative study with retrospective analysis. From the database, were selected 30 patients, 20 with and 10 without the disease. We obtained a sample of 60 images, including 30-weighted images of T2 FLAIR and 30 of DWI. Using the program Viewdex®, the set of images was observed by three observers. The images were assessed according to seven criteria: visibility, detection, consistency, location, size, margins of the lesion, and diagnostic capability. We used the calculation of sensitivity and specificity by ROC curves, as well as statistical analysis, namely, T-test, Kappa index, and Pearson’s correlation coefficient between the variables under study. Results – The sensitivity and specificity obtained for the weighted T2 FLAIR were higher (0,915 and 0,038 respectively) than the weighting DWI (0.08 and 0.100 respectively). There were no significant population variances. We obtained a high linear correlation between variables with an r value located between 0.8 and 0.99. There was considerable variability among observers. Conclusions – Although the values of sensitivity and specificity for DWI have been lower than expected, we suggest that this sequence should be included in the routine protocol of the brain to help the differential diagnosis with other pathologies.
Downloads
References
Braunwald E, Fauci AS, Hauser SL, Longo DL, Kasper DL, Jameson JL. Harrison – Princípios de medicina interna. 17ª ed. Rio de Janeiro: McGraw-Hill Interamericana; 2008. ISBN 8577260496
Reimer P, Parizel PM, Stichnoth FA. Clinical MR imaging: a practical approach. 2nd ed. New York: Springer; 2006. ISBN 9783540315308
Vieira IM, Oliveira NM. Detecção semi-automática de esclerose múltipla em imagens de ressonância magnética. Porto: Instituto Superior de Engenharia do Porto; 2009.
Kealey SM, Kim Y, Provenzale JM. Redefinition of multiple sclerosis plaque size using diffusion tensor MRI. AJR Am J Roentegenol. 2004;183(2):497-503.
Schaefer PW, Grant PE, Gonzalez RG. Diffusion-weighted MR imaging of the brain. Radiology. 2000; 217(2):331-45.
Santos AV, Saraiva P, Goulão A. Novas modalidades diagnósticas na investigação da doença cerebrovascular [Advanced neuroimaging in the diagnosis of cerebrovascular disease]. Acta Med Port. 2006;19(6):471-6. Portuguese
Lima RR, Costa AM, Souza RD, Santos CD, Guimarães-Silva J, Leal WG. Lesão da substância branca e doenças neurodegenerativas [White matter injuryand neurodegenerative diseases]. Rev Paraense Med. 2006;20(4):41-5. Portuguese
Qayyum A. Diffusion-weighted imaging in the abdomen and pelvis: concepts and applications. Radiographics. 2009;29(6):1797-810.
Gama C, Bahia C, Pazos A, Fernandes A. A imagiologia na era digital: a propósito dos avanços e perspectivas em foco no Congresso Europeu de Radiologia [Imagiology in digital era: news from the European Congresso of Radiology]. Barvalento Med. 2008;1(1): 42-3. Portuguese
Westbrook C, Kaut C. Ressonância magnética prática. 2ª ed. Rio de Janeiro: Guanabara Koogan; 1993. ISBN 9788527705844
Cruz Jr L, Gasparetto EL, Domingues RC, Domingues RC. Diffusion-weighted MR imaging in brain tumor. Magnetom Flash. 2008;(2):21-9. Available from: www.siemens.com/magnetom-world
Okuda T, Korogi Y, Shigematsu Y, Sugahara T, Hirai T, Ikushima I, et al. Brain lesions: when should fluid-attenuated inversion-recovery sequences be used in MR evaluation? Radiology. 1999;212(3):793-8.
American College of Radiology. ACR-ASNR practice guideline for the performance and interpretation of magnetic resonance imaging (MRI) of the brain [Internet]. Washington: ACR; 2008. Available from: http://www.asnr.org/sites/default/files/guidelines/MRI_Brain.pdf
Westbrook C. MRI at a glance. Oxford: Blackwell Science; 2002. ISBN 0632056193
Stuckey SL, Goh TD, Hefferman T, Rowan D. Hyperintensity in the subarachnoid space on FLAIR MRI. AJR Am J Roentegenol. 2007;189(4):913-21.
Simonson TM, Magnotta VA, Ehrhardt JC, Crosby DL, Fisher DJ, Yuh WT. Echo-planar FLAIR imaging in evaluation of intracranial lesions. Radiographics. 1996;16(3):575-84.
Runge VM, Price AC, Kirshner HS, Allen JH, Partain CL, James AE Jr. The evaluation of multiple sclerosis by magnetic resonance imaging. Radiographics. 1986;6(2):203-12.
Engelhardt E, Moreira DM. A substância branca cerebral: localização dos principais feixes com anisotropia fracionada direcional [The cerebral white matter: localization of the main tracts with directional fractional anisotropy]. Rev Bras Neurol. 2008;44(2):19-34. Available from: http://files.bvs.br/upload/S/0101-8469/2008/v44n2/a19-34.pdf. Portuguese
Hesselink JR. Demyelinating diseases of the brain [Internet]. San Diego: University of California. Available from: http://spinwarp.ucsd.edu/neuroweb/Text/br-840.htm
Abbehusen C. Esclerose múltipla e imagem [Internet]. 2005. Available from: http://www.andradeneuro.com/site/index2.php?option=com_docman&task=doc_view&gid=26&Itemid=64
McKinney AM, Kieffer SA, Paylor RT, SantaCruz KS, Kendi A, Lucato L. Acute toxic leukoencephalopathy: potential for reversibility clinically and on MRI with diffusion-weighted and FLAIR imaging. AJR Am J Roentegenol. 2009;193(1):192-206.
Anjaneyulu S. Radiology of multiple sclerosis [Internet]. Slideshare.net; 2010 [cited 2011 Jun]. Available from: http://www.slideshare.net/anjupaed/radiology-of-multiple-sclerosis
Geurts JJ, Reuling IE, Vrenken H, Uitdehaag BM, Polman CH, Castelijns JA, et al. MR spectroscopic evidence for thalamic and hippocampal, but not cortical, damage in multiple sclerosis. Magn Reson Med. 2006;55(3):478-83.
Nucifora PG, Verma R, Lee SK, Melhem ER. Diffusion-tensor MR imaging and tractography: exploring brain microstructure and connectivity. Radiology. 2007;245(2):367-84.
Poonawalla AH, Hasan KM, Gupta RK, Ahn CW, Nelson F, Wolinsky JS, et al. Diffusion-tensor MR imaging of cortical lesions in multiple sclerosis: initial findings. Radiology. 2008;246(3):880-6.
Bitar R, Leung G, Perng R, Tadros S, Moody AR, Sarrazin J, et al. MR pulse sequences: what every radiologist wants to know but is afraid to ask. Radiographics. 2006;26(2):513-37.
Rovaris M, Iannucci G, Cercignani M, Sormani MP, De Stefano N, Gerevini S, et al. Age-related changes in conventional, magnetization transfer, and diffusion-tensor MR imaging findings: study with whole-brain tissue histogram analysis. Radiology. 2003;227(3):731-8.
Braga AC. Curvas ROC: aspectos funcionais e aplicações. Braga: Universidade do Minho; 2000. Available from: http://repositorium.sdum.uminho.pt/handle/1822/195
Rockette HE, Obuchowski NA, Gur D. Nonparametric estimation of degenerated ROC sets used for comparison of imaging systems. Invest Radiol. 1990;25(7):835-7.
Pestana MH, Gageiro JN. Análise de dados para ciências sociais: a complementaridade do SPSS. 3ª ed. Lisboa: Sílabo; 2003.
Walker GA. Common statistical methods for clinical research with SAS example. 3rd ed. SAS Publishing; 2002.
Pagani E, Bammer R, Horsfield MA, Rovaris M, Gass A, Ciccarelli O, et al. Diffusion MR imaging in multiple sclerosis: technical aspects and challenges. AJNR Am J Neuroradiol. 2007;28(3):411-20.
Prayer D, Barkovich AJ, Kirschner DA, Prayer LM, Roberts TP, Kucharczyk J, et al. Visualization of nonstructural changes in early white matter development on diffusion-weighted MR images: evidence supporting premyelination anisotropy. AJNR Am J Neuroradiol. 2001;22(8):1572-6.
Castriota Scanderbeg A, Tomaiuolo F, Sabartini U, Nocentini U, Grasso MG, Caltagirone C. Demyelinating plaques in relapsing-remitting and secondary-progressive multiple sclerosis: assessment with diffusion MR imaging. AJNR Am J Neuroradiol. 2000;21(5):862-8.
Filippi M, Iannucci G, Cercignani M, Assunta Rocca M, Pratesi A, Comi G. A quantitative study of water diffusion in multiple sclerosis lesions an normal-appearing white matter using echo-planar imaging. Arch Neurol. 2000;57(7):1017-21.
Kupperman V. Magnetic resonance imaging: physical principles and applications. New York: Academic Press; 2000. ISBN 9780123886651
Barboriak DP, Provenzale JM, MacFall JR. White matter lesion contrast in fast spin-echo fluid-attenuated inversion recovery imaging: effect of varying effective echo time and echo train length. AJR Am J Roentegenol. 1999;173(4):1091-6.
Salvolini U, Scarabino T. High field brain MRI: use in clinical practice. New York: Springer-Verlag; 2006. ISBN 9783540317760
Bhatia R, Garg A. Diffusion abnormality detects an acute demyelinating lesion due to probable multiple sclerosis. Indian J Neuroradiol Imaging. 2007;17(1):20-1.
Buckle C, Castillo M. Use of diffusion-weighted imaging to evaluate the initial response of progressive multifocal leukoencephalopathy to highly active antiretroviral therapy: early experience. AJNR Am J Neuradiol. 2010;31(6):1031-5.
Bhatt A, Masih A, Grothous HF, Farooq MU, Naravetla B, Kassab MY. Diffusion-weighted imaging: not all that glitters is gold. South Med J. 2009;102(9):923-8.
Reis E, Moreira R. Pesquisa de mercado. Lisboa: Sílabo; 1992.
Downloads
Published
Issue
Section
License
Copyright (c) 2022 Saúde e Tecnologia
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
The journal Saúde & Tecnologia offers immediate free access to its content, following the principle that making scientific knowledge available to the public free of charge provides greater worldwide democratization of knowledge.
The journal Saúde & Tecnologia does not charge authors any submission or article processing charges (APC).
All content is licensed under a Creative Commons CC-BY-NC-ND license. Authors have the right to: reproduce their work in physical or digital form for personal, professional, or teaching use, but not for commercial use (including the sale of the right to access the article); deposit on their website, that of their institution or in a repository an exact copy in electronic format of the article published by Saúde & Tecnologia, provided that reference is made to its publication in Saúde & Tecnologia and its content (including symbols identifying the journal) is not altered; publish in a book of which they are authors or editors the total or partial content of the manuscript, provided that reference is made to its publication in Saúde & Tecnologia.
