Background

Cortical lesions are abundant in multiple sclerosis (MS), yet difficult to visualize in vivo. Ultra-high field (UHF) MRI at 7 T and above provides technological advances suited to optimize the detection of cortical lesions in MS.

Purpose

To provide a narrative and quantitative systematic review of the literature on UHF MRI of cortical lesions in MS.

Methods

A systematic search of all literature on UHF MRI of cortical lesions in MS published before September 2020. Quantitative outcome measures included cortical lesion numbers reported using 3 T and 7 T MRI and between 7 T MRI sequences, along with sensitivity of UHF MRI towards cortical lesions verified by histopathology.

Results

7 T MRI detected on average 52 ± 26% (mean ± 95% confidence interval) more cortical lesions than the best performing image contrast at 3 T, with the largest increase in type II-IV intracortical lesion detection. Across all studies, the mean cortical lesion number was 17 ± 6 per patient. In progressive MS cohorts, approximately four times more cortical lesions were reported than in CIS/early RRMS, and RRMS. Yet, there was no difference in lesion type ratio between these MS subtypes. Furthermore, superiority of one MRI sequence over another could not be established from available data. Post-mortem lesion detection with UHF MRI agreed only modestly with pathological examinations. Mean pro- and retrospective sensitivity was 33 ± 6% and 71 ± 10%, respectively, with the highest sensitivity towards type I and type IV lesions.

Conclusion

UHF MRI improves cortical lesion detection in MS considerably compared to 3 T MRI, particularly for type II-IV lesions. Despite modest sensitivity, 7 T MRI is still capable of visualizing all aspects of cortical lesion pathology and could potentially aid clinicians in diagnosing and monitoring MS, and progressive MS in particular. However, standardization of acquisition and segmentation protocols is needed.

中文翻译：

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用超高场 MRI 成像皮质多发性硬化病变

背景

多发性硬化症 (MS) 中的皮层病变很丰富，但在体内很难观察到。7 T 及以上的超高场 (UHF) MRI 提供了适合优化 MS 皮质病变检测的技术进步。

目的

对 MS 皮质病变的 UHF MRI 文献进行叙述性和定量系统评价。

方法

对 2020 年 9 月之前发表的 MS 皮质病变 UHF MRI 的所有文献进行系统搜索。定量结果测量包括使用 3 T 和 7 T MRI 以及 7 T MRI 序列报告的皮质病变数量，以及 UHF MRI 对皮质病变的敏感性经组织病理学证实。

结果

7 T MRI 检测到的皮质病变平均比 3 T 时表现最好的图像对比度多 52 ± 26%（平均 ± 95% 置信区间），其中 II-IV 型皮质内病变检测的增加最大。在所有研究中，每名患者的平均皮质病变数为 17 ± 6。在进行性 MS 队列中，报告的皮质病变大约是 CIS/早期 RRMS 和 RRMS 的四倍。然而，这些 MS 亚型之间的病变类型比率没有差异。此外，无法从现有数据确定一个 MRI 序列优于另一个序列。验尸UHF MRI 的病变检测与病理学检查仅适度一致。平均前瞻性和回顾性敏感性分别为 33 ± 6% 和 71 ± 10%，对 I 型和 IV 型病变的敏感性最高。

结论

与 3 T MRI 相比，UHF MRI 显着改善了 MS 中的皮质病变检测，特别是对于 II-IV 型病变。尽管灵敏度适中，7 T MRI 仍然能够可视化皮质病变病理的所有方面，并可能有助于临床医生诊断和监测 MS，尤其是进行性 MS。然而，需要对采集和分割协议进行标准化。