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Redefinition of Multiple Sclerosis Plaque Size Using Diffusion Tensor MRI

¹ All authors: Department of Neuroradiology, Duke University Medical Center, Box 3808, Erwin Rd., Durham, NC 27710.

View larger version (118K): [in a new window]   Fig. 1A. —Series of images of 25-year-old woman shows process used to compare region of abnormal white matter (WM) on conventional MR images and fractional anisotropy (FA) maps in patients with multiple sclerosis (MS). Axial T2-weighted MR image shows multiple foci of hyperintensity representing plaques of demyelination in periventricular WM.

View larger version (117K): [in a new window]   Fig. 1B. —Series of images of 25-year-old woman shows process used to compare region of abnormal white matter (WM) on conventional MR images and fractional anisotropy (FA) maps in patients with multiple sclerosis (MS). Two regions of interest (ROIs) have been placed on MS plaque (1) and mirror-image site (2) in normal-appearing WM.

View larger version (119K): [in a new window]   Fig. 1C. —Series of images of 25-year-old woman shows process used to compare region of abnormal white matter (WM) on conventional MR images and fractional anisotropy (FA) maps in patients with multiple sclerosis (MS). Area of abnormal WM, as determined by FA values, was entered on FA maps by placing small ROIs around MS plaque (3) and at mirror-image site (4) on contralateral side. Threshold of 40% decrease in FA values was chosen because that number represented average reduction in FA values in all plaques in this study. ROIs that had FA value at least 40% reduced compared with that of contralateral side were recorded. Area of these periplaque regions was added to area of plaque to give total area of abnormal-appearing WM on FA maps. ROIs have been placed on T2-weighted image for purposes of clarity. The ROIs marked 1 and 2 are the same as those seen in B.

View larger version (127K): [in a new window]   Fig. 1D. —Series of images of 25-year-old woman shows process used to compare region of abnormal white matter (WM) on conventional MR images and fractional anisotropy (FA) maps in patients with multiple sclerosis (MS). Final area of periplaque WM having FA reduction of at least 40% was then drawn around MS plaque (1). Using this threshold, area of abnormal-appearing WM was frequently markedly greater than could be seen on standard MR sequences alone.

View larger version (99K): [in a new window]   Fig. 1E. —Series of images of 25-year-old woman shows process used to compare region of abnormal white matter (WM) on conventional MR images and fractional anisotropy (FA) maps in patients with multiple sclerosis (MS). FA map corresponding to MR image in D depicts region of abnormal-appearing WM surrounding MS plaque (1).

View larger version (115K): [in a new window]   Fig. 2A. —Series of T2-weighted images of 29-year-old woman illustrates centrifugal method of interrogating normal-appearing white matter (WM) adjacent to multiple sclerosis (MS) plaque. Axial T2-weighted MR image shows demyelinating plaque adjacent to anterior horn of left lateral ventricle.

View larger version (115K): [in a new window]   Fig. 2B. —Series of T2-weighted images of 29-year-old woman illustrates centrifugal method of interrogating normal-appearing white matter (WM) adjacent to multiple sclerosis (MS) plaque. Region of interest (ROI) corresponding to area of T2 signal abnormality has been traced around margins of plaque.

View larger version (115K): [in a new window]   Fig. 2C. —Series of T2-weighted images of 29-year-old woman illustrates centrifugal method of interrogating normal-appearing white matter (WM) adjacent to multiple sclerosis (MS) plaque. In initial image of normal-appearing WM adjacent to this MS plaque, three ROIs (shown) reached 40% fractional anisotropy (FA) reduction threshold and were recorded.

View larger version (114K): [in a new window]   Fig. 2D. —Series of T2-weighted images of 29-year-old woman illustrates centrifugal method of interrogating normal-appearing white matter (WM) adjacent to multiple sclerosis (MS) plaque. Normal-appearing WM adjacent to these three ROIs was then imaged using same technique. Only one further ROI (shown) reached 40% FA reduction threshold and was recorded. This method was repeated until no further ROIs placed peripherally to more central ROIs reached 40% threshold.

View larger version (116K): [in a new window]   Fig. 2E. —Series of T2-weighted images of 29-year-old woman illustrates centrifugal method of interrogating normal-appearing white matter (WM) adjacent to multiple sclerosis (MS) plaque. Final area of abnormal-appearing WM is shown that comprises original plaque and four ROIs reaching 40% FA reduction threshold.

View larger version (13K): [in a new window]   Fig. 3. —Bar graph comparing plaque size as seen on diffusion tensor imaging (DTI) studies (gray bars) versus T2-weighted images (black bars) depicts increase (if any) in plaque size as determined by DTI for all plaques studied.

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