{"id":54563,"date":"2023-12-31T10:00:39","date_gmt":"2023-12-31T10:00:39","guid":{"rendered":"https:\/\/biomedpharmajournal.org\/?p=54563"},"modified":"2024-01-05T08:05:11","modified_gmt":"2024-01-05T08:05:11","slug":"a-comparative-diagnostic-study-for-using-the-contrast-agent-in-active-and-non-active-multiple-sclerosis-by-region-of-interest-parameter","status":"publish","type":"post","link":"https:\/\/biomedpharmajournal.org\/staging\/vol16no4\/a-comparative-diagnostic-study-for-using-the-contrast-agent-in-active-and-non-active-multiple-sclerosis-by-region-of-interest-parameter\/","title":{"rendered":"A Comparative Diagnostic Study for Using the Contrast Agent in Active and Non-Active Multiple Sclerosis by Region of Interest Parameter"},"content":{"rendered":"\n

Introduction<\/strong><\/p>\n\n\n\n

The basic principle of MRI lies in\nthe magnetization of the body protons, which are positively charged particles.\nMRI in Neurological examination uses a strong magnetic field and radio waves to\nproduce detailed pictures of the inside of the body1,2<\/sup>. The most\ncommon scans in MRI are Longitudinal Relaxation (T1), weighted Longitudinal\nRelaxation (T1W), Transverse Relaxation (T2), and Fluid Attenuated Inversion\nRecovery (FLAIR). The T1W used when a contrast agent is injected into the\npatient represents the differences in the T1 times of the tissues. The region\nof interest (ROI) is a programming method used in radiology. It is considered\nan essential parameter for diagnostic imaging. It aims to increase the image\nresolution depending on the shape and size of the selected part of the image to\nacquire the best accuracy and information. The ROI statisticas obtained from\nthe signal that reached the voxel of the image 3<\/sup>.\nThe ROI is a magnetic resonance imaging (MRI) device parameter set. <\/p>\n\n\n\n

In MRI, the\nintensity and appearance of two common brain diseases are approximately the\nsame. These diseases are multiple sclerosis (MS) and ischemia. Multiple\nsclerosis (MS) is an inflammatory demyelinating central nervous system disease\n(CNS). It occurs when the immune system of the body attacks the CNS. So, the\nneural signal transmission from the brain to the spinal cord will be disturbed4<\/sup>. Multiple sclerosis (MS) is identified by\nthe presence of demyelination patches in the white matter of the central nervous\nsystem, typically initiating in the optic nerve, spinal cord, or cerebellum.\nThe degradation of myelin sheaths and subsequent removal by microglial cells\nare characteristic features of this condition. Despite its prevalence, the\nprecise cause of MS remains unclear. However, some researchers suggest a\npotential link between a viral infection and the host’s immune response as a\ncontributing factor 5,6<\/sup>. The progress time of transforming from\nactive to non-active depends on the patient 7<\/sup>. The Better diagnostic\ndevice for MS suggested using the MRI with T1, T2, T2W, and FLAIR 8,9<\/sup>.<\/p>\n\n\n\n

This study\naimed to distinguish between active and non-active multiple sclerosis by\nmeasuring the region for the main MRI sequences T1W without or with a double\ndose of contrast after 10 minutes only and T2W and FLAIR to acquire a better\ndiagnosis of the new injury to use it as an alternative to the contrast.<\/p>\n\n\n\n

Patient and\nMethod<\/strong><\/p>\n\n\n\n

This is a prospective clinical study performed in the MRI unit of Saad Alwitry, a neuroscience teaching hospital. Neurologists and radiologists diagnosed all the patients with multiple sclerosis. The patients were scanned using the magnetic resonance imaging of 3.0 Tesla. Table 1 provides a comprehensive overview of the patients’ attributes considered for this research. The signal intensity ranges of the three sequences, namely T1W, T2W, and FLAIR, were assessed using the ROI option and recorded individually for each patient. Our study specifically focused on patients exhibiting early MS symptoms to discern between active and non-active cases of brain MS. Then, the patient was injected with the contrast agent (OmniscanTM0.5 mmol\/ mL) and scanned with the TIW sequence.<\/p>\n\n\n\n

Table 1: The Characteristics of Multiple Sclerosis Patients. <\/strong><\/p>\n\n\n\n\n\n\n\n\n
\n

Characteristics <\/strong><\/p>\n<\/td>\n

\n

 <\/strong><\/p>\n<\/td>\n<\/tr>\n

\n

Gender<\/strong><\/p>\n

Male<\/strong><\/p>\n

Female<\/strong><\/p>\n<\/td>\n

\n

 <\/p>\n

9<\/p>\n

11<\/p>\n<\/td>\n<\/tr>\n

\n

Age Range (years)<\/strong><\/p>\n<\/td>\n

\n

27.5 (20 \u2013 37)<\/p>\n<\/td>\n<\/tr>\n

\n

Weight (kg)<\/strong><\/p>\n<\/td>\n

\n

70 (58 \u2013 91)<\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

 <\/p>\n\n\n

Statistical\nAnalysis<\/strong><\/p>\n\n\n\n

The data analysis was conducted\nusing SPSS-24 (Statistical Packages for Social Sciences, version 24), a\ncommonly available statistical package. The presentation of data involved\nsimple measures such as mean, standard deviation, and range (minimum-maximum values).\nFurthermore, appropriate statistical tests were employed to assess the\nsignificance of differences between various means (quantitative data).\nSpecifically, the Student’s t-test was used to compare two independent means,\nthe Paired t-test to compare paired observations (or two dependent means), and\nthe ANOVA test to compare more than two independent means. Any result with a\nP-value equal to or less than 0.05 was considered statistically significant.<\/p>\n\n\n\n

Results<\/strong><\/p>\n\n\n\n

The ROI signal value of the T1W sequence compared with and without using contrast and presented in Table (2) and Figure (1). The MS patients were injected with a contrast agent to enhance the T1W signal. The value includes the minimum. Maximum, mean, and range of the value showed significantly higher with contrast than without. <\/p>\n\n\n\n

Table 2:  A comparison of T1W sequence parameters with and without contrast<\/strong>.<\/p>\n\n\n\n\n\n\n\n\n
\n

T1W<\/strong><\/p>\n<\/td>\n

\n

Without contrast<\/strong><\/p>\n<\/td>\n

\n

With contrast<\/strong><\/p>\n<\/td>\n

\n

P value<\/strong><\/p>\n<\/td>\n<\/tr>\n

\n

T1W Min<\/p>\n<\/td>\n

\n

715.3\u00b191.2<\/p>\n

(510-913)<\/p>\n<\/td>\n

\n

1019.2\u00b165.3<\/p>\n

(891-1098)<\/p>\n<\/td>\n

\n

<0.0001*<\/p>\n<\/td>\n<\/tr>\n

\n

T1W Max<\/p>\n<\/td>\n

\n

781.1\u00b180.9<\/p>\n

(635-971)<\/p>\n<\/td>\n

\n

1407.5\u00b169.1<\/p>\n

(1167-1441)<\/p>\n<\/td>\n

\n

0.001*<\/p>\n<\/td>\n<\/tr>\n

\n

T1W Mean<\/p>\n<\/td>\n

\n

724.7\u00b187.1<\/p>\n

(541-940.8)<\/p>\n<\/td>\n

\n

1176.9\u00b166.6<\/p>\n

(1033.5-1321.7)<\/p>\n<\/td>\n

\n

0.002*<\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

*Significant difference between two dependent means using Paired t-test at 0.05 level.<\/p>\n\n\n

The ROI boundary ranges of the TW2 and FLAIR sequences are important to investigate to estimate early MS’s predicting value. Therefore, these resulting values of ROI are shown in the Table. Also, figures 2 and 3 presented the values of T2W and FLAIR, respectively.<\/p>\n\n\n\n

Table 3:  A comparison of T2W sequence parameters with and without contrast<\/strong>.<\/p>\n\n\n\n\n\n\n\n\n
 <\/td>\n\n

T2W<\/strong><\/p>\n<\/td>\n

\n

FLAIR<\/strong><\/p>\n<\/td>\n<\/tr>\n

\n

Min<\/p>\n<\/td>\n

\n

855.4 \u00b1 52.1<\/p>\n

(763 \u2013 941)<\/p>\n<\/td>\n

\n

1121.2 \u00b1 117.2<\/p>\n

(944-1438)<\/p>\n<\/td>\n<\/tr>\n

\n

Max<\/p>\n<\/td>\n

\n

1139.4 \u00b1 67.8<\/p>\n

(975 \u2013 1219)<\/p>\n<\/td>\n

\n

2439.2 \u00b1 301.08<\/p>\n

(1094-13021)<\/p>\n<\/td>\n<\/tr>\n

\n

T2W: T2 weighted images             <\/p>\n

FLAIR: Fluid-attenuated inversion recovery<\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n
\"\"<\/td>\n\n

Figure 1<\/strong>: compares the using and not using contrast agents in T1W sequence examination.<\/strong><\/p>\n

<\/p>\n

Click here to view Figure<\/a><\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n
\"\"<\/td>\n\n

Figure 2:<\/strong> illustrates the minimum and maximum ROI values in the T2W sequence examination.<\/strong><\/p>\n

<\/p>\n

Click here to view Figure<\/a><\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n
\"\"<\/td>\n\n

Figure 3:<\/strong> illustrates minimum and maximum ROI values in the FLAIR sequence examination.<\/strong><\/p>\n

<\/p>\n

Click here to view Figure<\/a><\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n

Discussion<\/strong><\/p>\n\n\n\n

The ROI parameter is an image processing added in the magnetic resonance imaging device to read the range of several voxels for the radiographic image precisely10-15<\/sup>. The signal intensity was enhanced for MS protocol when the patient was injected with contrast after and reexamined with T1W-MSE sequence after 30 min. In this study, we used the double dose of contrast and examined the patient after 10 minutes only. Not all the MS cells of the brain uptake the contrast, only the new injury because the neural cells will be destroyed and converted to non-active cells16,17<\/sup>. However, the high uptake of the newer injury was observed in the ROI value after the contrast agent injection. Therefore, this technique shows a significantly more effective method of distinguishing the recent sclerosis cells than the T1W sequence. <\/p>\n\n\n\n

After a period depending on the patient’s status, the axonal loss is a\nfunction that plays a major role in determining permanent neurologic\ndysfunction in patients with MS18<\/sup>.<\/p>\n\n\n\n

The present study’s findings are\nconsistent with Pretorius PM and Quaghebeur G 13<\/sup>, who reported a\n15-minute delay in scanning after receiving a double dose of intravenous\ncontrast. Trip S. and Miller D. state that a 5-minute delay scanning after IV\ncontrast injection improves T1 imaging scanning. Newly active enhancing lesions\noften remain for one month, making them an excellent marker for monitoring\ndisease activity. Both triple-dose gadolinium and magnetization transfer\nimaging may help identify active lesions 19,20<\/sup>.<\/p>\n\n\n\n

From the statistical observation, the ranges of T2W and the FLAIR have\noverlapped ranges of signals, iso their values are not precisely dependable and\ncannot give a predictable value. Severe, Highly Active, or Aggressive Multiple\nSclerosis 21,22<\/sup>. <\/p>\n\n\n\n

A study reported that the FLAIR\nsequence is better than others for detecting MS lesions. Periventricular\nlesions are often indistinguishable from the surrounding cerebrospinal fluid,\nwhich has a strong signal with T2 weighting 23-28<\/sup>.<\/p>\n\n\n\n

According to Ma S . study.20<\/sup>\nand Sweeney RH. study. 2<\/sup>1<\/sup>,\nT2W.FLAIR is the optimal MRI imaging sequence for multiple sclerosis when\nutilizing a 3 Tesla MRI with a TE of 120 ms, comparable to the parameters\nutilized in the present research. By using a TE of 120ms, the contrast-to-noise\nratio of the white matter lesion is significantly increased, thus improving the\ndetectability of MRI and the spatial resolution of the picture 29-35<\/sup>.\nAdditionally, the present study findings corroborate Ge. Y 28<\/sup>, who claimed that T2W.Flair is a\nmore sensitive detector of lesions in the white and gray matter of the brain in\nMS patients.<\/p>\n\n\n\n

Furthermore, image contrast\nenhancement and accurate disease state categorization can be influenced by\nvarious factors, such as the size of MS lesions, the type of disease-modifying\ntherapy, and the stage of disease activity involving inflammation, demyelination,\naxonal loss, and gliosis. Gaj   and his\ncolleagues have supported the impact of lesion size on image contrast35-39<\/sup>.\nTheir study utilized automatic segmentation analysis for gadolinium-enhanced MS\nlesions, similar to the technique used in our current research, albeit focusing\non covering and identifying the MS lesion. In contrast, our study implemented\nthis technique to cover and identify the MS lesion, thereby investigating its\neffects 39-45<\/sup>. Our work\nhas shown that lesion location and form, in addition to lesion size, are\nimportant determinants. Particular brain areas, including the periventricular\nzone, might develop lesions that have a more noticeable impact on neurological\nprocesses. Our results, which are consistent with those of recent research by\nAlhussaniy research. and DeLuca, suggest that the form and perimeter of the\nlesions may also reflect the rate of disease development and severity46-49<\/sup>.\nFurthermore, we also investigate patient-specific characteristics that impact\nthe effectiveness of MRI imaging in multiple sclerosis. Age, gender, and\ngenetic predispositions have all been demonstrated to have differing effects on\nhow the disease manifests itself and reacts to imaging methods.<\/p>\n\n\n\n

Conclusion<\/strong><\/p>\n\n\n\n

The results of\nthis comparative diagnostic investigation highlight the important developments\nin Multiple Sclerosis (MS) detection and monitoring magnetic resonance imaging\n(MRI) approaches. Utilizing Region of Interest (ROI) characteristics has shown\nto be an essential technique for improving MRI reading accuracy. This study\ndemonstrated how well contrast agents work to identify active MS lesions in\nparticular. Signal intensity and lesion detectability were significantly\nimproved in active MS cases by using a twofold dose of contrast and shortening\nthe test period to 10 minutes.<\/p>\n\n\n\n

Finally, our\nresearch emphasizes how crucial it is to take into account a number of\nvariables for precise image contrast enhancement and disease state\nclassification, including lesion size, disease-modifying medication, and\ndisease stage. The results of Gaj research. about how lesion size affects\npicture contrast are especially important since they support our approach of\nusing automated segmentation analysis to improve lesion detection.<\/p>\n\n\n\n

We conclude\nthat the ROI readings are an effective parameter to diagnose early active\nmultiple sclerosis by values instead of a radiographic picture and can predict\nthe disease from the T1W sequence levels.<\/p>\n\n\n\n

Acknowledgment<\/strong><\/p>\n\n\n\n

This research received ethical approval number 928-12-2017 from the ethical committee of the College of Medicine \u2013 almustansria University and followed the decoration of Helsinki and the recommendation of the Iraqi Medical research center. <\/p>\n\n\n\n

Conflict of Interest<\/strong> <\/p>\n\n\n\n

There are no conflict of interest<\/p>\n\n\n\n

Funding Sources<\/strong><\/p>\n\n\n\n

This research did not receive any specific grant from funding agencies in the public, commercial, or notfor- profit sectors <\/p>\n\n\n\n

References<\/strong><\/p>\n\n\n\n

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