Comparative evaluation of EPI and SWI for the assessment of PRL and CVS in Multiple Sclerosis

Stölting, Anna;van Doninck, Eline;Borrelli, Serena;Vanden Bulcke, Colin;Maggi, Pietro;et.al.
(2026) (2026)

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  • Stölting, Annaorcid-logoNeuroinflammation Imaging Lab (NIL), Institute of NeuroScience, Université catholique de Louvain, Brussels, Belgium
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  • van Doninck, Elineorcid-logoNeuroinflammation Imaging Lab (NIL), Institute of NeuroScience, Université catholique de Louvain, Brussels, Belgium
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  • Borrelli, Serenaorcid-logoNeuroinflammation Imaging Lab (NIL), Institute of NeuroScience, Université catholique de Louvain, Brussels, Belgium
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  • Vanden Bulcke, Colinorcid-logoUCLouvain
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  • Maggi, Pietroorcid-logoNeuroinflammation Imaging Lab (NIL), Institute of NeuroScience, Université catholique de Louvain, Brussels, Belgium
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Abstract
<jats:title>Abstract</jats:title> <jats:sec> <jats:title>Introduction</jats:title> <jats:p>The 2024 McDonald criteria incorporate the central vein sign (CVS) and paramagnetic rim lesions (PRL) as supportive imaging biomarkers for MS diagnosis. While susceptibility-weighted-imaging (SWI) and T2*-weighted echo-planar-imaging (EPI) are generally used to assess CVS/PRL, their relative performance remains unclear. This study compared high-resolution isotropic-T2*-EPI with non-isotropic SWI for CVS/PRL detection.</jats:p> </jats:sec> <jats:sec> <jats:title>Materials and Methods</jats:title> <jats:p>In this multi-centre study, 21 patients with MS underwent harmonized 3T-MRI including EPI and SWI. CVS and PRL were evaluated according to NAIMS criteria. Whole-brain and controlled lesion analyses on 120 pre-selected lesions were performed independently for each contrast, with EPI serving as reference standard.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>In whole-brain analyses, SWI showed good sensitivity for CVS eligibility and positivity (AC1=0.68-0.78) but significant directional disagreement with EPI (p&lt;0.0001). Discrepancies were primarily attributed to limited lesion-parenchyma contrast and venous visibility on SWI, which improved using low-flip-angle SWI. Controlled lesion analyses supported these observations. For PRL, SWI demonstrated high sensitivity (88%) and precision (97%) compared to EPI, though systematic bias persisted (p&lt;0.001). Controlled lesion analyses showed more balanced, albeit moderate performance.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusion</jats:title> <jats:p>SWI diverged systematically from EPI for CVS and PRL detection. When available, EPI should be preferred, while optimised low-flip-angle SWI may serve as an alternative to conventional SWI.</jats:p> </jats:sec>
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Stölting, A., van Doninck, E., Borrelli, S., Vanden Bulcke, C., Martire, M. S., Guisset, F., Wynen, M., Duchêne, G., Moiola, L., Popescu, V., Willekens, B., Filippi, M., Absinta, M., & Maggi, P. (2026). Comparative evaluation of EPI and SWI for the assessment of PRL and CVS in Multiple Sclerosis. Submitted. https://doi.org/10.64898/2026.02.05.26345463 (Original work published 2026)