Application of Post-Contrast T2 FLAIR Imaging in the Diagnosis of Multiple Sclerosis

Magnetic resonance imaging (MRI) is one of the key tools for confirming the diagnosis of multiple sclerosis (MS). It also enables differential diagnosis, monitoring of treatment effectiveness, and assessment of disease activity using contrast agents. T1-weighted images are traditionally considered the gold standard for detecting contrast enhancement in demyelinating lesions. However, recent hypotheses suggest that post-contrast T2 FLAIR mode may increase the diagnostic yield in identifying active MS lesions. This study evaluates the potential of postcontrast T2 FLAIR imaging in the diagnosis of multiple sclerosis.

Aim. To assess the role of postcontrast T2 FLAIR imaging in detecting demyelinating lesions in the brain in patients with multiple sclerosis.

Materials and Methods. The study included 60 patients with multiple sclerosis aged 20– 59 years. MRI was performed on two scanners: Siemens Magnetom Avanto (1.5 T, n = 30) and Siemens Magnetom Prisma (3.0 T, n = 30). The protocol included standard modes, as well as T1 MPRAGE and T2 FLAIR before and after administration of gadobutrol (0.1 mmol/kg). Contrast enhancement was evaluated using the contrast index (CI) before and after contrast administration, followed by calculation of the signal intensity increase (ΔCI). Lesions were also compared based on the pattern of contrast accumulation in T1 MPRAGE and T2 FLAIR modes. The study further assessed whether visual contrast enhancement in T2 FLAIR could predict enhancement in T1 MPRAGE, and whether ΔCI in T2 FLAIR could be used as a predictive marker.

Results. A total of 132 demyelinating lesions were identified in 60 patients undergoing contrast-enhanced MRI. Of these, 35 lesions (26.5 %) showed enhancement in the T1 MPRAGE mode. Notably, 16.5 % of lesions showed enhancement in T2 FLAIR despite the absence of enhancement in T1 MPRAGE. There was a statistically significant correlation between enhancement in T2 FLAIR and T1 MPRAGE (p < 0.001). CI and ΔCI calculations confirmed intergroup differences. The diagnostic performance of T2 FLAIR visual analysis in predicting T1 MPRAGE enhancement showed a sensitivity of 94.3 %, specificity of 83.5 %, and accuracy of 86.4 %. ROC analysis revealed an AUC of 0.934 (95 % CI: 0.875–0.994), indicating excellent predictive ability of ΔCI in T2 FLAIR for contrast accumulation in T1 MPRAGE.

Conclusion. Incorporating post-contrast T2 FLAIR into standard MRI protocols for MS patients is a valuable diagnostic tool that may provide additional information. Further studies with larger cohorts are warranted to explore the full potential of post-contrast T2 FLAIR imaging in clinical practice.

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