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Abstract
Background: Different double inversion recovery (DIR) sequences are currently used in multiple sclerosis (MS) research centers to visualize cortical lesions, making it difficult to compare published data. This study aimed to formulate consensus recommendations for scoring cortical lesions in patients with MS, using DIR images acquired in 6 European centers according to local protocols.
Methods: Consensus recommendations were formulated and tested in a multinational meeting.
Results: Cortical lesions were defined as focal abnormalities on DIR, hyperintense compared to adjacent normal-appearing gray matter, and were not scored unless ≥3 pixels in size, based on at least 1.0 mm2 in-plane resolution. Besides these 2 obligatory criteria, additional, supportive recommendations concerned a priori artifact definition on DIR, use of additional MRI contrasts to verify suspected lesions, and a constant level of displayed image contrast. Robustness of the recommendations was tested in a small dataset of available, heterogeneous DIR images, provided by the different participating centers. An overall moderate agreement was reached when using the proposed recommendations: more than half of the readers agreed on slightly more than half (54%) of the cortical lesions scored, whereas complete agreement was reached in 19.4% of the lesions (usually larger, mixed white matter/gray matter lesions).
Conclusions: Although not designed as a formal interobserver study, the current study suggests that comparing available literature data on cortical lesions may be problematic, and increased consistency in acquisition protocols may improve scoring agreement. Sensitivity and specificity of the proposed recommendations should now be studied in a more formal, prospective, multicenter setting using similar DIR protocols.
Footnotes
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Study funding: The MS Center Amsterdam is supported by the Dutch MS Research Foundation (05-358c). The NMR Research Unit of the Department of Neuroinflammation is supported by the MS Society Great Britain and Northern Ireland, and Department of Health's NIHR Comprehensive Biomedical Research Centre at UCLH.
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- DIR
- double inversion recovery
- EDSS
- Expanded Disability Status Scale
- GM
- gray matter
- MS
- multiple sclerosis
- WM
- white matter.
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Editorial, page 412
- Received May 18, 2010.
- Accepted August 30, 2010.
- Copyright © 2011 by AAN Enterprises, Inc.
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