7T MR of intracranial pathology: Preliminary observations and comparisons to 3T and 1.5T

There have been an increasing number of studies involving ultra-high-field 7T of intracranial pathology, however, comprehensive clinical studies of neuropathology at 7T still remain limited. 7T has the advantage of a higher signal-to-noise ratio and a higher contrast-to-noise ratio, compared to current low field clinical MR scanners. We hypothesized 7T applied clinically, may improve detection and characterization of intracranial pathology. We performed an IRB-approved 7T prospective study of patients with neurological disease who previously had lower field 3T and 1.5T. All patients underwent 7T scans, using comparable clinical imaging protocols, with the aim of qualitatively comparing neurological lesions at 7T with 3T or 1.5T. To qualitatively assess lesion conspicuity at 7T compared with low field, 80-paired images were viewed by 10 experienced neuroradiologists and scored on a 5-point scale. Inter-rater agreement was characterized using a raw percent agreement and mean weighted kappa. One-hundred and four patients with known neurological disease have been scanned to date. Fifty-five patients with epilepsy, 18 patients with mild traumatic brain injury, 11 patients with known or suspected multiple sclerosis, 9 patients with amyotrophic lateral sclerosis, 4 patients with intracranial neoplasm, 2 patients with orbital melanoma, 2 patients with cortical infarcts, 2 patients with cavernous malformations, and 1 patient with cerebral amyloid angiopathy. From qualitative observations, we found better resolution and improved detection of lesions at 7T compared to 3T. There was a 55% raw inter-rater agreement that lesions were more conspicuous on 7T than 3T/1.5T, compared with a 6% agreement that lesions were more conspicuous on 3T/1.5T than 7T. Our findings show that the primary clinical advantages of 7T magnets, which include higher signal-to-noise ratio, higher contrast-to-noise ratio, smaller voxels and stronger susceptibility contrast, may increase lesion conspicuity, detection and characterization compared to low field 1.5T and 3T. However, low field which detects a plethora of intracranial pathology remains the mainstay for diagnostic imaging until limitations at 7T are addressed and further evidence of utility provided.