Utility of paramagnetic rim lesions on 1.5-T susceptibility phase imaging for the diagnosis of pediatric multiple sclerosis.

BACKGROUND: Studies have suggested that paramagnetic rim lesions on 7-tesla (T) and 3-T susceptibility-based brain MRI are specific features of multiple sclerosis (MS) lesions in adults. OBJECTIVE: The aim of this study was to investigate whether the presence of paramagnetic rim lesions on 1.5-T phase images can help discriminate pediatric patients with MS from those with other demyelinating diseases. MATERIALS AND METHODS: In this retrospective study we reviewed brain MRIs performed on 1.5-T scanners that included susceptibility-weighted imaging (SWI) sequences with phase images in children younger than 18 years diagnosed with MS and other acquired demyelinating syndromes. In each case, five white matter lesions were selected using T2/fluid-attenuated inversion recovery images for further paramagnetic rim evaluation on SWI. Two researchers performed independent assessments of the presence of paramagnetic rim lesions. Discrepancies between them were settled by consensus, with input from a senior neuroradiologist. RESULTS: We included 13 children diagnosed with MS and 16 children diagnosed with non-MS demyelinating diseases and analyzed a total of 132 focal white matter lesions. Seventy-one percent of the lesions in the MS group had paramagnetic rims, while none of the lesions in the non-MS group had rims. All but one of the children with MS had at least one lesion with a paramagnetic rim. The presence of one lesion with a paramagnetic rim on 1.5-T phase-contrast images resulted in 70% sensitivity and 100% specificity for MS. CONCLUSION: Paramagnetic rim lesions detected on 1.5-T phase-contrast MR images can help discriminate MS from other acquired demyelinating syndromes in the pediatric population.

Quantitative characterization of extraocular orbital lesions in children using diffusion-weighted imaging.

BACKGROUND: Diffusion-weighted imaging (DWI) has been shown to be helpful in providing information about cellular density and also predicting the histological features of aggressive tumors. Several studies have evaluated this technique for orbital tumors. However, very few articles have focused exclusively on evaluating pediatric orbital masses and, within those, only a small number of patients were included in the study. OBJECTIVE: This study aimed to evaluate the use of DWI and apparent diffusion coefficient (ADC) values to differentiate between benign and malignant extraocular orbital lesions in children. MATERIALS AND METHODS: This retrospective study included 73 patients under the age of 18 seen in our hospital between October 2016 and February 2019. The extraocular orbital lesions were evaluated clinically and radiologically using DWI. The diagnosis was confirmed by either histological examination (after biopsy or surgery) or based on clinical and radiologic evaluation. RESULTS: The malignant lesions were found to have increased diffusion restriction in comparison to the benign lesions. The ADC values of the malignant lesions were significantly lower (P<0.0001). The use of a cutoff value of 0.99×10-3 mm2/s allowed for the differentiation of the benign lesions and malignant lesions with a sensitivity of 75% and a specificity of 100% while the cutoff point of 1.26×10-3 mm2/s had a sensitivity of 100% and a specificity of 73%. CONCLUSION: Measurement of ADC in extraocular orbital lesions in children may help differentiate malignant lesions from benign lesions.