1. Idoia Corcuera-Solano, Gerard Reddy, Bradley Delman, Reade De Leacy, Dan Rettmann, Lawrence N Tanenbaum EP-63-2519

2.  L. Tanenbaum is a speaker for GE Healthcare

3.  Multiple Sclerosis (MS) is a chronic inflammatory demyelinating condition associated with significant neurological disability  Supportive imaging findings require display of lesions distributed in space and time  Etiology remains unknown  MR imaging plays a key role in initial diagnosis & monitoring patient progress & response to treatment

4.  Increased utilization of MRI due to increased incidence and changing geographic patterns of disease 1  Increased requirement for imaging to guide treatment decisions 2  T2 and T2 FLAIR are current mainstays of MRI protocols for MS

5.  A novel 3D MPRAGE sequence incorporates an additional inversion pulse to null white matter (WMn)  T1 weighted contrast despite white CSF  Suppression of white matter signal highlights WM pathology  Prospective motion correction (PROMO) MPRAGE

6.  To assess the image quality and added value of WMn-MPRAGE in comparison to conventional techniques in MR imaging of multiple sclerosis MPRAGE FLAIRT2 T1

7.  17 MS patients (9 male, 8 female, median age 43 years) with previously identified MS lesions were included in this study  Patients were prospectively scanned with WMn- MPRAGE in addition to conventional imaging sequences on a clinical 3T MR scanner.  Conventional sequences included: T2 FLAIR, T2 & T1 sequences

8. GE 3.0 T T2T2 FLAIRT1MPRAGE Dimension 2D3D2D3D Orientation AxialSagAxialSag FOV 2224 25.6 Slice thickness 1.2 mm1.6 mm5.0 mm1.6mm Slice spicing 0010 SLICES 3010825120 TR 3190ms6000ms413 ms TE 109msMax7.8Min Full TI -1739ms500ms FA 8

9.  Studies were performed on 3.0 T scanner  3 mm MPRAGE reformatted axial images  3 mm FLAIR reformatted axial images  5 mm direct axial T2  5 mm direct axial T1 MPRAGE FLAIR T2 T1

10.  Images reviewed by two Neuroradiologists who assessed image quality and added value in terms of cortical, subcortical and white matter lesion conspicuity MPRAGE FLAIR T2T1

11.  Lesions were assessed for each patient in 4 pre- determined anatomical levels ▪ Centrum Semiovale ▪ Corona Radiata ▪ Third Ventricle ▪ Posterior Fossa  5 point scale was used to assess lesion conspicuity GRADING SYSTEM 1NOT SEEN 2POORLY SEEN 3ADEQUATE 4ABOVE AVERAGE 5EXCELLENT

12.  Statistical software used for analysis  GraphPad Prism version 5.00 for Mac OSX (GraphPad Software, San Diego, Calif. USA, www.graphpad.com)  Qualitative analysis  Wilcoxon test  Results expressed as a mean with standard deviation  p≤0.05 was considered statistically significant

13. MPRAGEFLAIRp Centrum semiovale 4.36±1.32 4.49±0.81 0.648 Corona Radiata 4.55±1.154.55±1.010.833 Third Ventricle 4.32±1.173.82±1.53 0.085 Posterior Fossa 4.53±0.822.17±1.11<0.001 Comparison: MPRAGE v FLAIR

14. MPRAGET2p Centrum semiovale 4.36±1.32 3.91±1.52 <0.001 Corona Radiata 4.55±1.153.94±1.36<0.001 Third Ventricle 4.32±1.174.00±1.150.225 Posterior Fossa 4.53±0.822.87±1.46<0.001 Comparison: MPRAGE v T2

15. MPRAGET1p Centrum semiovale 4.36±1.32 2.79±1.72 <0.001 Corona Radiata 4.55±1.153.13±1.57<0.001 Third Ventricle 4.32±1.172.68±1.700.014 Posterior Fossa 4.53±0.822.13±1.25<0.001 Comparison: MPRAGE v T1

16. FLAIRT2p Centrum semiovale 4.49±0.81 3.91±1.52 0.013 Corona Radiata 4.55±1.013.94±1.360.023 Third Ventricle 3.82±1.534.00±1.150.748 Posterior Fossa 2.17±1.112.87±1.460.006 Comparison: FLAIR v T2

17. FLAIRT1p Centrum semiovale 4.49±0.81 2.79±1.72 <0.001 Corona Radiata 4.55±1.013.13±1.57<0.001 Third Ventricle 3.82±1.532.68±1.700.05 Posterior Fossa 2.17±1.112.13±1.251.00 Comparison: FLAIR v T1

18. Comparison: T2 v T1 T2T1p Centrum semiovale 3.91±1.52 2.79±1.72 <0.001 Corona Radiata 3.94±1.363.13±1.57<0.001 Third Ventricle 4.00±1.152.68±1.70<0.001 Posterior Fossa 2.87±1.462.13±1.250.006

19. T2 MPRAGE FLAIR T1 CENTRUM SEMIOVALE Mean ± SD p MPRAGE-FLAIR 4.36±1.324.49±0.810.648 MPRAGE-T2 4.36±1.323.91±1.52<0.001 MPRAGE-T1 4.36±1.322.79±1.72<0.001 FLAIR-T2 4.49±0.813.91±1.520.013 FLAIR-T1 4.49±0.812.79±1.72<0.001 T2-T1 3.91±1.522.79±1.72<0.001 Centrum Semiovale

20. MPRAGE FLAIR T2T1 Cortical lesion are more prominently seen on MPRAGE and FLAIR than on T2 and T1- weighted images.

21. MPRAGE FLAIR T2T1 Four discrete lesion can be seen in the MPRAGE and FLAIR images and only 3 in the T2 WI. No discrete lesions are appreciated on the T1 WI at this level.

22. MPRAGE FLAIR T2T1 CORONA RADIATAMean ± SD p MPRAGE-FLAIR 4.55±1.524.55±1.010.833 MPRAGE-T2 4.55±1.523.94±1.36<0.001 MPRAGE-T1 4.55±1.523.13±1.57<0.001 FLAIR-T2 4.55±1.013.94±1.36 0.023 FLAIR-T1 4.55±1.013.13±1.57<0.001 T2-T1 3.94±1.363.13±1.57<0.001 Corona Radiata

23. MPRAGE FLAIR T2T1

24. MPRAGE FLAIR T2T1 Third VentricleMean ± SD p MPRAGE-FLAIR 4.32±1.173.82±1.530.085 MPRAGE-T2 4.32±1.174.00±1.15 0.255 MPRAGE-T1 4.32±1.172.68±1.700.014 FLAIR-T2 3.82±1.534.00±1.15 0.748 FLAIR-T1 3.82±1.53 2.68±1.70 0.05 T2-T1 4.00±1.152.68±1.70<0.001 Third Ventricle

25. MPRAGE FLAIR T2T1

26. MPRAGEFLAIR T2T1 Posterior FossaMean ± SD p MPRAGE-FLAIR 4.53±0.822.17±1.11<0.001 MPRAGE-T2 4.53±0.822.87±1.46 <0.001 MPRAGE-T1 4.53±0.822.13±1.25<0.001 FLAIR-T2 2.17±1.112.87±1.460.006 FLAIR-T1 2.17±1.112.13±1.251.000 T2-T1 2.87±1.462.13±1.250.006 Posterior Fossa

27. MPRAGE FLAIR T2T1

28. MPRAGE -FLAIR MPRAGE -T2 MPRAGE -T1 FLAIR-T2FLAIR-T1T2-T1 Centrum semiovale (n=45) 0.648 b MPRAGE <0.001 a MPRAGE <0.001 a FLAIR 0.013 a FLAIR <0.001 a T2 <0.001 a Corona Radiata (n=51) 0.833 b MPRAGE <0.001 a MPRAGE <0.001 a FLAIR 0.023 a FLAIR <0.001 a T2 <0.001 a Third Ventricle (n=22) 0.085 b 0.255 b MPRAGE 0.014 a 0.748 b FLAIR 0.05 a T2 <0.001 a Posterior Fossa (n=30) MPRAGE <0.001 a MPRAGE <0.001 a MPRAGE <0.001 a T2 0.006 a 1.000 b T2 0.006 a Statistical comparison of MPRAGE, FLAIR, T2 and T1 sequences according to lesion location p≤0.05 was considered the statistical significant level. a : statistically significant; b : not statistically significant

29.  MPRAGE was significantly better than T2 and T1 on the assessment of MS lesions located in the centrum semiovale and corona radiata.  MPRAGE was significantly better than T1 in the evaluation of MS lesions at the level of the 3 rd ventricle.  MPRAGE was significantly better in the assessment of posterior fossa lesions in comparison to all standard sequences.

30.  WMn-MPRAGE is a practical technique providing novel image contrast of value in evaluation of MS brain lesions, specially in the assessment of posterior fossa lesions.  WMn-MPRAGE should be considered for routine use in the evaluation of patients with known or suspected MS

31.  We acknowledge Ginu Abraham, BSRT(R)(MR), for his assistance on the MRI scanners.

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