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From the MS Biosignal Analysis Center (Drs. Filippi and Bressi, and M.A. Rocca), Department of Neurology, Scientific Institute Ospedale San Raffaele, University of Milan, Milan, Italy; the Dutch MS/MR Center (Drs. Waesberghe, Barkhof, and Lycklama à Nijeholt), Department of Diagnostic Radiology, Free University Hospital, Amsterdam, The Netherlands; the Division of Medical Physics (Dr. Horsfield), University of Leicester, Leicester, UK; the Departments of Neurology and Neuroradiology (Drs. Gasperini and Bastianello), Universita "La Sapienza," Rome, Italy; the Department of Neuroradiology (Dr. Yousry), Klinikum Grosshadern, University of Munich, Munich, Germany; the NMR Research Unit (Drs. Gawne-Cain and Miller), Institute of Neurology, University of London, London, UK; and the Department of Neurology (Dr. Morrissey), University of Würzburg, Würzburg, Germany.
Collaboration made possible by the European Community-funded (ERBCHRXCT 940684) European Magnetic Resonance Network in Multiple Sclerosis(MAGNIMS).
Address correspondence and reprint requests to Dr. Massimo Filippi, Department of Neurology, Scientific Institute Ospedale San Raffaele, Via Olgettina, 60, 20132 Milan, Italy.
We evaluated the effect of interscanner variation on brain MRI-measured lesion volumes and measurement reproducibility in MS. Twenty clinically definite MS patients were each scanned on two or three scanners (a total of 14 scanners were used). In addition, a formalin-fixed MS brain was studied on eight scanners from different manufacturers and with different field strengths. For the formalin-fixed MS brain, on each machine we obtained two scans with slice thicknesses of 5 and 3 mm. Only 5-mm-thick slices were obtained from patients. The lesion volume present on each scan was evaluated three times by a single observer in random order, using a local thresholding technique. In two groups of eight patients scanned on machines with different field strengths, the mean lesion volumes present on scans obtained at 1.5 T were significantly higher than those measured on scans obtained with machines operating at 0.5 and 1.0 T (p < 0.01). When a single observer repeatedly evaluated the same scan, a median intraobserver agreement of 98.7%(95% CI, 97.9 to 99.1) was achieved. However, when the observer evaluated the scans from different MRI scanners, the agreement (an interscanner agreement) fell to 91.1% (CI, 90.2 to 94.1). When only scanners operating at 1.5 T were considered, the median interscanner agreement was 96.7% (CI, 95 to 97.5). Also, for the formalin-fixed MS brain, the intraobserver agreements obtained with both slice thicknesses were significantly higher than the corresponding interscanner agreements. The interscanner agreement, but not the intraobserver agreement, obtained with a slice thickness of 3 mm was higher than that obtained with a slice thickness of 5 mm. Our results indicate that lesion volume measurements in MS are influenced significantly by the use of different MR scanners and that a patient included in a serial study should be always scanned with the same MR machine using 3-mm thick slices.
Received October 14, 1996. Accepted in final form March 10, 1997.
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