Extended perfusion protocol for MS lesion quantification

• Main Authors: Kontopodis Eleftherios, Marias Kostas, Manikis Georgios C., Nikiforaki Katerina, Venianaki Maria, Maris Thomas G., Mastorodemos Vasileios, Papadakis Georgios Z., Papadaki Efrosini
• Format: Article
• Language: English
• Published: De Gruyter 2020-06-01
• Series: Open Medicine
• Subjects: dce-mri; perfusion protocol; ms; active demyelinating lesions
• Online Access: https://doi.org/10.1515/med-2020-0100

This study aims to examine a time-extended dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) protocol and report a comparative study with three different pharmacokinetic (PK) models, for accurate determination of subtle blood–brain barrier (BBB) disruption in patients with multiple sclerosis (MS). This time-extended DCE-MRI perfusion protocol, called Snaps, was applied on 24 active demyelinating lesions of 12 MS patients. Statistical analysis was performed for both protocols through three different PK models. The Snaps protocol achieved triple the window time of perfusion observation by extending the magnetic resonance acquisition time by less than 2 min on average for all patients. In addition, the statistical analysis in terms of adj-R2 goodness of fit demonstrated that the Snaps protocol outperformed the conventional DCE-MRI protocol by detecting 49% more pixels on average. The exclusive pixels identified from the Snaps protocol lie in the low ktrans range, potentially reflecting areas with subtle BBB disruption. Finally, the extended Tofts model was found to have the highest fitting accuracy for both analyzed protocols. The previously proposed time-extended DCE protocol, called Snaps, provides additional temporal perfusion information at the expense of a minimal extension of the conventional DCE acquisition time.