Abstract
Purpose:
Characterizing orbital lesions remains challenging with imaging. The purpose of this study was to compare 3 Tesla (T) to 7 T magnetic resonance imaging (MRI) for characterizing orbital lesions.
Materials and methods:
This prospective single-center study enrolled participants presenting with orbital lesions from May to October 2019, who underwent both 7 T and 3 T MRI examinations. Two neuroradiologists, blinded to all data, read both datasets independently and randomly. They assessed general characteristics of each orbital lesion as well as image quality and presence of artifacts. Comparison between both datasets was made using Fisher exact test.
Results:
Seven patients (4 women, 3 men) with a median age of 52 years were enrolled. Orbital lesion conspicuity was better scored at 7 T compared to 3 T MRI, with 3/7 lesions (43%) scored as very conspicuous at 7 T compared to 0/7 lesion (0%) at 3 T, although the difference was not significant (P = 0.16). Delineation of lesion margins was better scored at 7 T compared to 3 T with 3/7 lesions (43%) scored as very well delineated on 7 T compared to 0/7 lesions (0%) at 3 T, although the difference was not significant (P = 0.34). Details of internal structure were better assessed at 7 T compared to 3 T, with 4/7 lesions (57%) displaying numerous internal details compared to 0/7 lesions (0%) at 3 T (P = 0.10). Internal microvessels were visible in 3/7 lesions (43%) at 7 T compared to 0/7 lesions (0%) at 3 T (P = 0.19).
Conclusion:
Although no significant differences were found between 7 T and 3 T MRI, assumably due to a limited number of patients, our study suggests that 7 Tesla MRI might help improve the characterization of orbital lesions. However, further studies with more patients are needed.
Keywords: Artifacts, Magnetic resonance imaging, Microvessels, Orbital neoplasms, Orbit
1. Introduction
The orbit is a small anatomical space with a variety of essential structures for visual function. Orbital lesions may arise from these orbital structures or metastasize from the body and cover a wide range of benign and malignant diseases of various histologic types [1,2]. Symptoms remain non-specific and vary considerably according to the nature, location, and extent of the disease, though vision loss, double vision and pain are common presenting symptoms [1,2]. Imaging techniques, such as MRI, proved to be useful to characterize some orbital lesions with specific patterns, such as venous malformation or lymphoma. However, the majority of orbital lesions share similar imaging characteristics, making their diagnosis challenging, even with advanced ultrasound or MRI techniques [2–11]. Histopathological analysis of biopsy specimens remains the gold standard for obtaining a definite diagnosis, though risks are known for potential functional and aesthetic complications. Therefore, achieving an accurate diagnosis with imaging prior to treatment could be crucial for avoiding those complications and optimizing clinical management [12].
The development of 7 Tesla (T) MRI, with its higher signal-to-noise and contrast-to-noise ratios as compared to lower-field MRI, such as 3 T MRI, has resulted in an increase of spatial resolution. 7 T MRI has been reported to improve conspicuity, delineating lesions more precisely and improving anatomical details of various intracranial diseases [13,14]. 7 T MRI has demonstrated utility in ocular and orbital imaging, especially for ocular tumors such as ocular melanoma, but also for various orbital diseases [15–18]. However, to the best of our knowledge, no studies have evaluated the utility of 7 T MRI to characterize orbital lesions.
The purpose of this study was to compare the capabilities of 3 T to those of 7 T MRI for characterizing orbital lesions.
2. Materials and methods
2.1. Study design
A prospective study was conducted in a tertiary referral center specializing in ophthalmic diseases (National Clinical Trial number, NCT02401906). This study was approved by an Institutional Review Board and adhered to the tenets of the Declaration of Helsinki (Institutional Review Board IRB 5-4593-51869). Signed informed consent was obtained from all subjects. This study follows the Standards for Reporting of Diagnostic Accuracy Studies (STARD) guidelines.
2.2. Study population
From May 2019 to October 2019, 10 participants were enrolled in the study. Inclusion criteria were: (i), age over 18 years; (ii), presence of an untreated orbital lesion; and (iii), agreement to undergo both 3 T and 7 T MRI over a two-week period. Exclusion criteria were any contraindications to MRI [19]. Patients were excluded if one MRI was missing. The study flowchart is shown in Fig. 1.
Fig. 1.
Flow chart. 3 T = 3 Tesla; 7 T = 7 Tesla; MRI = Magnetic resonance imaging.
2.3. Clinical data
Clinical charts were systematically reviewed, including ophthalmological findings, results of histopathological analysis and follow-up data examinations. Histopathology was considered the reference standard for analysis. When no surgery was performed, the final diagnosis was established based on clinical, biological and imaging findings, as well as on follow-up data.
2.4. MRI protocol
All MRI examinations were performed on a 3 T General Electric Discovery™ MR 750 device and on a 7 T General Electric Discovery™ MR950 (General Electric Healthcare) device with a 32-channel head coil. Participants were asked to keep their eyes closed and to look at an imaginary fixed point during acquisitions in order to prevent motion artifacts generated from eye movements. Both eyes were covered with a piece of wet gauze to reduce susceptibility artifacts. The MRI protocol is displayed in Table 1.
Table 1.
Detailed MRI sequence parameters at 7 Tesla and 3 Tesla.
| Variable | 7 Tesla | 3 Tesla | ||||
|---|---|---|---|---|---|---|
| Sequence type | 3D T1 FSE | Axial T2 FSE (with and without FS) | Coronal T2 FSE | 3D T1 FSE | Axial T2 FSE (with and without FS) | Coronal T2 FSE |
| Scan mode | 3D | 2D | 2D | 3D | 2D | 2D |
| Acquisition Plane | Axial | Axial | Coronal | Sagittal | Axial | Coronal |
| Repetition time (ms) | 8.8 | 3000 | 3000 | 989 | 5367 | 5567 |
| Echo time (ms) | 3.9 | 14 | 13 | 13 | 98 | 106 |
| Inversion time (ms) | 900 | N.A. | N.A. | N.A. | N.A. | N.A. |
| Flip / Refocusing angle (°) | 6 | 90 | 90 | 90 | 90 | 90 |
| Number of excitations | 1 | 1 | 1 | 1 | 4 | 1 |
| Slice thickness (mm) | 1 | 1 | 1 | 1 | 3 | 3 |
| Number of slices | 312 | 22 | 15 | 320 | 25 | 43 |
| Gap (mm) | 0 | 0 | 0 | 0 | 0 | 0 |
| Voxel size | 0.4 × 0.4 × 1 | 0.4 × 0.4 × 1 | 0.4 × 0.4 × 1 | 0.5 × 0.5 × 1 | 0.35 × 0.35 × 3 | 0.7 × 0.7 × 3 |
| Field of view (mm3) | 200 × 200 × 156 | 200 × 200 | 200 × 200 | 256 × 256 × 160 | 180 × 180 | 180 × 180 |
| Bandwidth (kHz) | 244 | 122 | 122 | 244 | 122 | 244 |
| Acquisition matrix | 512 × 512 × 312 | 512 × 512 | 512 × 512 | 512 × 512 × 320 | 512 × 512 | 256 × 256 |
| Acquisition duration | 2 min 47 s | 3 min 24 s | 1 min 42 s | 4 min 01 s | 3 min 19 s | 3 min 57 s |
| Acceleration factor | 2 | N.A. | N.A. | N.A. | N.A. | N.A. |
| Echo train length | 1 | 12 | 12 | 30 | 20 | 21 |
WI: Weighted-imaging; FSE: Fast spin-echo; FS: Fat suppression; N.A.: Not applicable; 2D: Two dimensional, 3D: Three dimensional; ms: milisecond; mm: millimeter; kHz: kiloHertz
2.5. Imaging analysis
Two neuroradiologists with 2- (L.D.) and 9 years (A.L.) of experience in orbital imaging, blinded to all data, individually read anonymized MR images independently and randomly on a dedicated workstation. Six weeks after the first reading session, a consensus reading session was performed to serve as reference for analysis.
MR images were quantitatively, qualitatively and semi-quantitatively assessed. Quantitative variables included the largest diameter (mm) of the orbital lesions. Qualitative variables included: (i), lesion side; (ii), lesion location, according to the involvement of the following orbital structures: extraocular muscle, lacrimal gland, optic nerve sheath complex, bony wall or orbital fat; (iii), lesion type, defined as well-delineated or infiltrative; (iiii), lesion signal intensity on T1- and T2-weighted images, defined as hypointense, isointense or hyperintense, in comparison to a healthy contralateral extraocular muscle signal; (v), lesion heterogeneity, defined as homogeneous or heterogeneous; (vi), presence of internal microvessels, defined as linear hypointense foci; (vii), presence of an extra-orbital extension; (vii), presence of a perineural spread; (viii), presence of bony erosion; and (ix), presence of artifacts, including distorsion, susceptibility and/or motion artifacts, further classified into absent, minor (not precluding image interpretation) or major (precluding image interpretation).
Semi-quantitative variables (scored using a 1, 2, 3 scale) included: (i), lesion conspicuity, defined as the intrinsic visual quality of the lesion that makes it distinct from the background, with 1 denoting ill-conspicuous lesion, 2 moderately conspicuous and 3 very conspicuous; (ii), lesion margin delineation, with 1 for moderately to ill-defined margins, 2 for well-defined margins and 3 for very well delineated margins; and (iii), internal structure details, with 1 denoting no internal details visible, 2 a few details visible and 3 numerous internal details visible.
2.6. Statistical analysis
Quantitative variables were presented as means ± standard deviations (SD) and ranges or medians (interquartile range [IQR]) and ranges as appropriate. Categorical variables were expressed as raw numbers, proportions and percentages. Categorical variables were compared using Fisher exact test. Inter and intra-observer agreement for MRI reading was assessed using non-weighted Cohen kappa statistics and interpreted as follows: 0.0–0.2: poor correlation; 0.21–0.4: fair correlation; 0.41–0.6: moderate correlation; 0.61–0.8: good correlation; 0.81–1: almost perfect correlation [20]. Due to the multiplicity of statistical tests, a Bonferroni correction was applied and significance was set at P < 0.005. Data were analyzed using the R software version 4.0.3.
3. Results
3.1. Demographic characteristics
Seven patients (4 women and 3 men) with a median age of 52 years (IQR: 35, 65; Mean age, 50 ± 19 [standard deviation]) were enrolled from May to October 2019. Six out of seven (86%) patients had unilateral orbital lesions. Results of histopathological examinations were available for 3/7 (43%) patients (Fig. 1). Two patients had a cavernous hemangioma, two had an orbital melanoma, one had a dacryoadenitis, one had a thyroid eye disease and one had a rectus muscle myositis. Median delay between 3 T and 7 T MRI examinations was 3 days (IQR: 3, 7 days).
3.2. Comparison between 3T and 7T MR imaging
Conspicuity of lesions was higher at 7 T compared to 3 T MRI: 3/7 (43%) vs. 0/7 (0%) were scored as very conspicuous, 2/7 (29%) vs. 5/7 (71%) as moderately conspicuous and 2/7 (29%) as ill-conspicuous, respectively, but the difference was not significant (P = 0.16) (Figs. 2–4). Delineation of lesion margins was better scored at 7 T compared to 3 T MRI: 3/7 (43%) vs. 0/7 (0%) were scored as very well delineated, 3/7 (43%) vs. 5/7 (71%) as well-defined and 1/7 (14%) vs. 2/7 (29%) as moderately to ill-defined, respectively, but the difference was not significant (P = 0.34).
Fig. 2.
65 year-old woman with an orbital melanoma of the right orbit. Axial T2-weighted MR images at 3 Tesla (a, c) and 7 Tesla (b, d) show a mass centered on the apex of the right orbit infiltrating ethmoidal cells medially with a posterior extra-orbital extension through the superior orbital fissure. 7 Tesla MRI shows better delineation of the lesion margins and higher conspicuity of the lesion (arrowheads) as compared to 3 Tesla. 7 Tesla MRI shows more details of the internal structure (arrows).
Fig. 4.
34 year-old woman with a cavernous venous malformation of the left orbit. Coronal T2-weighted MR images at 3 Tesla (a) and 7 Tesla (b) show an intraconal mass of the left orbit displacing the optic nerve medially. 7 Tesla MRI shows internal structure details (white arrows) and internal microvessels (black arrow) not seen at 3 Tesla.
Details of internal structure were better assessed at 7 T compared to 3 T MRI: 4/7 (57%) vs. 0/7 (0%) displayed numerous internal details, 1/7 (14%) vs. 4/7 (57%) a few details and 2/7 (29%) vs. 3/7 (43%) showed no internal details, but the difference was not significant (P = 0.10). Internal microvessels were visible in 3/7 (43%) lesions at 7 T vs. 0/7 (0%) at 3 T MRI (P = 0.19). There were no differences between 3 T and 7 T MRI regarding the other imaging criteria. Detailed imaging data are provided in Table 2.
Table 2.
Detailed imaging results for characterizing orbital lesions at 7 Tesla and 3 Tesla MRI
| 7 Tesla Patients (n = 7) |
3 Tesla Patients (n = 7) |
P | |||
|---|---|---|---|---|---|
| Side | Left | 3/7 (43%) | 3/7 (43%) | > 0.99 | |
| Right | 3/7 (43%) | 3/7 (43%) | |||
| Bilateral | 1/7 (14%) | 1/7 (14%) | |||
| Location | Extraocular muscle | 2/7 (29%) | 2/7 (29%) | > 0.99 | |
| Lacrimal gland | 1/7 (14%) | 1/7 (14%) | |||
| Optic nerve sheath complex | 0/7 (0%) | 0/7 (0%) | |||
| Bony wall | 0/7 (0%) | 0/7 (0%) | |||
| Orbital fat | 4/7 (57%) | 4/7 (57%) | |||
| Type of lesion | Well-delineated | 5/7 (71%) | 5/7 (71%) | > 0.99 | |
| Infiltrative | 2/7 (29%) | 2/7 (29%) | |||
| Largest diameter (IQR) [range] (mm) | 24 (19, 28.5) [5–44] | 22 (18.5, 27) [5–42] | 0.90 | ||
| Signal intensity | T1-WI | Hyposignal | 0/7 (0%) | 0/7 (0%) | > 0.99 |
| Isosignal | 7/7 (100%) | 7/7 (100%) | |||
| Hypersignal | 0/7 (0%) | 0/7 (0%) | |||
| T2-WI | Hyposignal | 1/7 (14%) | 1/7 (14%) | > 0.99 | |
| Isosignal | 0/7 (0%) | 0/7 (0%) | |||
| Hypersignal | 6/7 (86%) | 6/7 (86%) | |||
| Heterogeneity | No | 3/7 (43%) | 3/7 (43%) | > 0.99 | |
| Yes | 4/7 (57%) | 4/7 (57%) | |||
| Conspicuity of the lesion | Ill-conspicuous | 2/7 (29%) | 2/7 (29%) | 0.16 | |
| Moderately conspicuous | 2/7 (29%) | 5/7 (71%) | |||
| Very conspicuous | 3/7 (43%) | 0/7 (0%) | |||
| Delineation of the lesion margins | Moderately to ill-defined margins | 1/7 (14%) | 2/7 (29%) | 0.34 | |
| Well-defined margins | 3/7 (43%) | 5/7 (71%) | |||
| Very well-delineated margins | 3/7 (43%) | 0/7 (0%) | |||
| Details of internal structure | No internal details visible | 2/7 (29%) | 3/7 (43%) | 0.10 | |
| A few details visible | 1/7 (14%) | 4/7 (57%) | |||
| Numerous internal details | 4/7 (57%) | 0/7 (0%) | |||
| Internal microvessels | No | 4/7 (57%) | 7/7 (100%) | 0.19 | |
| Yes | 3/7 (43%) | 0/7 (0%) | |||
| Extra-orbital extension | No | 6/7 (86%) | 6/7 (86%) | > 0.99 | |
| Yes | 1/7 (14%) | 1/7 (14%) | |||
| Perineural spread | No | 7/7 (100%) | 7/7 (100%) | > 0.99 | |
| Yes | 0/7 (0%) | 0/7 (0%) | |||
| Bony erosion | No | 6/7 (86%) | 6/7 (86%) | > 0.99 | |
| Yes | 1/7 (14%) | 1/7 (14%) | |||
| Artifacts | Distorsion | Major | 1/7 (14%) | 0/7 (0%) | 0.27 |
| Minor | 3/7 (43%) | 1/7 (14%) | |||
| No | 3/7 (43%) | 6/7 (86%) | |||
| Susceptibility | Major | 3/7 (43%) | 0/7 (0%) | 0.06 | |
| Minor | 3/7 (43%) | 2/7 (29%) | |||
| No | 1/7 (14%) | 5/7 (71%) | |||
| Motion | Major | 1/7 (14%) | 0/7 (0%) | > 0.99 | |
| Minor | 0/7 (0%) | 1/7 (14%) | |||
| No | 6/7 (86%) | 6/7 (86%) | |||
IQR: Interquartile range. WI: Weighted imaging.
3.3. Artifacts
Distortion artifacts were observed on four MRI examinations obtained at 7 T (4/7; 57%) compared to one MRI examination at 3 T (1/7; 14%), but the difference was not significant (P = 0.27). Susceptibility artifacts were observed on six MRI examinations obtained at 7 T (6/7; 86%) compared to two MRI examinations at 3 T (2/7; 29%) (P = 0.06). Motion artifacts were noted for 1/7 (14%) patients at either 3 T and 7 T.
3.4. Inter-reader agreement
Inter-reader agreement was almost perfect at 7 T (κ = 0.85; 95% CI: 0.58–1) and good at 3 T (κ = 0.74; 95% CI: 0.34–1) when assessing the conspicuity of the lesion. Inter-reader agreement was almost perfect at 7 T (κ = 0.84; 95% CI: 0.57–0.97) and good at 3T (0.74; 95% CI: 0.34–1), when assessing lesion margin delineation. All inter-reader agreements are provided in Table 3.
Table 3.
Results of Kappa test for inter-reader agreements at 7 Tesla and 3 Tesla.
| 7 Tesla Kappa (95% CI) |
3 Tesla Kappa (95% CI) |
||
|---|---|---|---|
| Heterogeneity | 1 (1–1) | 1 (1–1) | |
| Lesion conspicuity | 0.85 (0.58–1) | 0.74 (0.34–1) | |
| Delineation of the lesion margins | 0.84 (0.57–0.97) | 0.74 (0.34–1) | |
| Details of internal structure | 0.71 (0.37–1) | 0.7 (0.17–1) | |
| Intralesional microvessels | 1 (1–1) | 1 (1–1) | |
| Extra–orbital extension | 1 (1–1) | 1 (1–1) | |
| Perineural spread | N.A. | N.A. | |
| Bony erosion | 1 (1–1) | 1 (1–1) | |
| Artifacts | Distorsion | 0.80 (0.42–1) | 1 (1–1) |
| Susceptibility | 0.66 (0.2–1) | 0.59 (0.0.9–1) | |
| Motion | 1 (1–1) | 1 (1–1) |
CI: Confidence interval. N.A.: Not applicable.
4. Discussion
Although no significant differences were found between 7 T and 3 T MRI, assumably due to a limited number of patients, our study suggests that 7 Tesla MRI might help improve the characterization of orbital lesions with higher conspicuity and better delineation of lesion margins by comparison with 3 T MRI. We found that 7 T MRI displays more details of internal structure and internal microvessels as compared to 3 T MRI. To the best of our knowledge, our study is the first that compared 7 T to 3 T MRI for characterizing orbital lesions. Although this is an exploratory study on a few patients, this prospective study paves the way to larger ones [21].
Our study is in line with previous studies published in the literature showing higher conspicuity, contrast, and improved anatomical details of various intracranial and ocular pathologies at 7 T as compared to 3 T MRI [15–18]. The main advantage of 7 T MRI is its capacity for higher signal-to-noise ratio, which can be converted into higher resolution and thinner slices, which is useful when characterizing orbital lesions. Also, shorter scan times can be valuable when imaging mobile regions such as the orbit [22]. In our study, higher resolution at 7 T improved conspicuity, delineation of lesion margins and details of internal structure, which support better characterization of orbital lesions.
On the other hand, artifacts were more frequently observed at 7 T as compared to 3 T MRI in our study, especially distortion and susceptibility artifacts. This issue has been reported in previous studies evaluating 7 T MRI [14,15,18,22,23]. Due to the presence of several air-tissue interfaces, the orbital region is more prone to these artifacts, which might impact the quality of the imaging and which is a clear limitation of 7 T MRI. Several techniques, such as prospective motion correction for improving inhomogeneity artifacts, taping the eyelid, or covering the eyes with a piece of wet gauze, have been developed to reduce artifacts [15,18,23]. In the ocular region, the use of a blinking protocol or automated eye blink detection decreases motion artifacts related to eye movements [15,23]. Despite these artifacts, all main markers for image quality, such as conspicuity, delineation of lesion margins and details of internal structure, were better at 7 T as compared to 3 T. Similarly, our study shows a better inter-reader agreement at 7 T than at 3 T. These results are in line with those of previous studies showing a higher inter-rater agreement at 7 T compared to 3 T in patients with various intracranial diseases [14,22].
Our results are clinically relevant for several reasons. Clinical and imaging characterization of orbital lesions remains challenging, and surgery remains the gold standard for a definite diagnosis in a majority of patients [1,2]. More precisely depicting the internal architecture and structure of orbital lesions might pave the way to new semiology and new biomarkers, which could be useful for diagnosis and to increase provider confidence. Internal microvessels, which are indicative of neovascularity, were visible in 43% of lesions at 7 T versus none at 3 T. Assessing the presence, number and density of internal microvessels might reflect neoangiogenesis and be a relevant biomarker for distinguishing benign from malignant lesions or to diagnose highly vascularized lesions such as vascular hemangioma [24]. By more precisely depicting the internal architecture of orbital lesions, 7 T MRI might become a surrogate for pathological examination, without the functional and aesthetic risks associated with surgery [12,24,25]. Moreover, 7 T MRI might be useful to help ophthalmologists better plan surgical procedures, by showing more precisely the delineation of the lesion margins and their relationships to adjacent structures, as compared to 3 T MRI. In our study, 43% of lesions were very well delineated at 7 T MRI vs. none at 3 T MRI. Properly identifying structures at-risk, which are difficult or impossible to reconstruct before surgery, might help preserve them and reduce complications related to surgery [12]. In addition, properly delineating orbital lesions might increase the accuracy of resection margins and decrease the probability of incomplete resection and/or relapse. Our 7 T MRI protocol was relatively short, with acquisition duration of 2 min 47 s for T1-weighted sequences and 3 min 24 s for T2-weighted sequences, which is suitable for clinical use. One major advantage of using short sequences is to decrease motion artifacts due to ocular movements [18]. Thus, there is less need for time-intensive techniques such as blink detection to remove motion artifacts, which might facilitate the generalizability of 7 T MRI in routine clinical practice [15,23]. The use of artificial intelligence might also allow shorten acquisition times [26].
Our study had some limitations. First, the overall number of patients remains limited due to the exploratory nature of our study. This explains why we could not achieve statistical significance despite the differences in image quality between 3 T and 7 T MRI. Further larger studies are needed to confirm our results. Secondly, we did not have radiological-pathological correlations to confirm that internal details or internal microvessels correspond to anatomical structures. Thirdly, all MRI examinations were not performed at the exact same time, with a median delay between 3 T and 7 T of three days. Even if the delay remains short, we cannot be certain that orbital lesions remained unchanged during this interval of time. Fourthly, we did not use a dedicated orbital coil at 7 T, which might have improved the quality of the 7 T MRI examinations, as reported in studies that investigated ocular diseases [15,17]. Finally, 7 T MRI remains rare worldwide with only a few centers equipped with ultra-high-field magnets, which limits the generalizability of our results. However, the number of ultra-high-fields magnets installed around the world is increasing rapidly, and 7 T MRI was cleared for clinical use by the Food and Drug Administration in 2017, thus it is likely that 7 T MRI becomes more and more available worldwide in routine clinical practice
In conclusion, although no significant differences were found between 7 T and 3 T MRI, assumably due to a limited number of patients, our study suggests that 7 Tesla MRI might help improve the characterization of orbital lesions with higher conspicuity and better delineation of lesion margins by comparison with 3 T MRI. 7 T MRI displays more details of internal structure and internal microvessels as compared to 3T MRI. Further research will be necessary to determine to what extent 7 T MRI has greater clinical utility for the assessment of orbital lesions as compared to 3 T MRI.
Fig. 3.
65 year-old man with right dacryoadenitis. Axial T2-weighted MR images at 3 Tesla (a) and 7 Tesla (b) show a mass arising from the right lacrimal gland. 7 Tesla MRI shows better delineation of the lesion margins and higher conspicuity of the lesion (white arrowhead) as compared to 3 Tesla. 7 Tesla MRI depicts details more precisely around the internal structure (arrow). 7 Tesla MRI more precisely shows the presence of two distinct components of the lesion (black arrowhead).
Funding
This work did not receive any grant from funding agencies in the public, commercial, or not-for-profit sectors.
Abbreviations:
- MRI
Magnetic resonance imaging
- WI
Weighted imaging
- SD
Standard deviation
- IQR
Interquartile range
Footnotes
Human rights
The authors declare that the work described has been performed in accordance with the Declaration of Helsinki of the World Medical Association revised in 2013 for experiments involving humans.
Informed consent and patient details
The authors declare that this report does not contain any personal information that could lead to the identification of the patients.
Credit Author Statement
A. Lecler: conception and design, acquisition of data, analysis and interpretation of data; drafting the article and revising it critically for important intellectual content; final approval of the version to be published; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
B. Rutt: conception and design, acquisition of data, analysis and interpretation of data; final approval of the version to be published; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved
L. Duron, E. Charlson, C. Kolseth, A. Kossler, M. Wintermark, K. Moulin: acquisition of data, analysis and interpretation of data; drafting the article; final approval of the version to be published; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved
Declaration of Competing Interest
The authors declare that they have no known competing financial or personal relationships that could be viewed as influencing the work reported in this paper.
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