PT  - JOURNAL ARTICLE
AU  - Caruana, G.
AU  - Auger, C.
AU  - Pessini, L.M.
AU  - Calderon, W.
AU  - de Barros, A.
AU  - Salerno, A.
AU  - Sastre-Garriga, J.
AU  - Montalban, X.
AU  - Rovira, À.
TI  - SWI as an Alternative to Contrast-Enhanced Imaging to Detect Acute MS Lesions
AID  - 10.3174/ajnr.A7474
DP  - 2022 Apr 01
TA  - American Journal of Neuroradiology
PG  - 534--539
VI  - 43
IP  - 4
4099  - http://www.ajnr.org/content/43/4/534.short
4100  - http://www.ajnr.org/content/43/4/534.full
SO  - Am. J. Neuroradiol.2022 Apr 01; 43
AB  - BACKGROUND AND PURPOSE: Acute inflammatory activity of MS lesions is traditionally assessed through contrast-enhanced T1-weighted MR images. The aim of our study was to determine whether a qualitative evaluation of non-contrast-enhanced SWI of new T2-hyperintense lesions might help distinguish acute and chronic lesions and whether it could be considered a possible alternative to gadolinium-based contrast agents for this purpose.MATERIALS AND METHODS: Serial MR imaging studies from 55 patients with MS were reviewed to identify 169 new T2-hyperintense lesions. Two blinded neuroradiologists determined their signal pattern on SWI, considering 5 categories (hypointense rings, marked hypointensity, mild hypointensity, iso-/hyperintensity, indeterminate). Two different blinded neuroradiologists evaluated the presence or absence of enhancement in postcontrast T1-weighted images of the lesions. The Fisher exact test was used to determine whether each category of signal intensity on SWI was associated with gadolinium enhancement.RESULTS: The presence of hypointense rings or marked hypointensity showed a strong association with the absence of gadolinium enhancement (P < .001), with a sensitivity of 93.0% and a specificity of 82.9%. The presence of mild hypointensity or isohyperintensity showed a strong association with the presence of gadolinium enhancement (P < .001), with a sensitivity of 68.3% and a specificity of 99.2%.CONCLUSIONS: A qualitative analysis of the signal pattern on SWI of new T2-hyperintense MS lesions allows determining the likelihood that the lesions will enhance after administration of a gadolinium contrast agent, with high specificity albeit with a moderate sensitivity. While it cannot substitute for the use of contrast agent, it can be useful in some clinical settings in which the contrast agent cannot be administered.