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Journals / Uludağ Üniversitesi Tıp Fakültesi Dergisi / 2026 / Cilt: 52

T2W-FLAIR Histogram Analysis of White Matter Lesions in Multiple Sclerosis, Migraine, and Nonspecific Gliotic Lesions

Multipl Skleroz, Migren ve Nonspesifik Gliotik Odaklarda Beyaz Cevher Lezyonlarının T2A-FLAIR Histogram Analizi

Duygu Erkal(Giresun University Faculty of Medicine, Department of Radiology, Giresun, Türkiye.)0000-0002-8201-1568
Mehmet Tonkaz(Giresun University Faculty of Medicine, Department of Radiology, Giresun, Türkiye.)0000-0002-8746-4443
Pages
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Publication Date
2026-10-12
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AI Summary & Key Takeaways

AI Insight
⚡ TL;DR(Too Long; Didn't Read)

These findings suggest that T2W-FLAIR-based histogram radiomics provides useful quantitative information for differentiating MS lesions from other white matter lesions, particularly through heterogeneity-related features that may serve as supportive imaging biomarkers in the characterization of MS lesions.

📌 3 Key Takeaways

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Objective & Hypothesis:This study aimed to investigate the value of T2-weighted fluid-attenuated inversion recovery (T2W-FLAIR)-based histogram radiomics for differentiating multiple sclerosis (MS) lesions from non-specific and migraine-related white matter lesions.
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Key Findings & Data:A total of 56 patients were classified into three groups: non-specific white matter lesions (Group 1, n=20), migraine-related lesions (Group 2, n=16), and MS lesions (Group 3, n=20).
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Conclusion & Impact:These findings suggest that T2W-FLAIR-based histogram radiomics provides useful quantitative information for differentiating MS lesions from other white matter lesions, particularly through heterogeneity-related features that may serve as supportive imaging biomarkers in the characterization of MS lesions.
🔬Design:Modeling & Simulation
📍Scope:Comprehensive Sample
⚙️Variables:Multipl skleroz · Beyaz cevher hastalıkları · Radyomik

Abstract

This study aimed to investigate the value of T2-weighted fluid-attenuated inversion recovery (T2W-FLAIR)-based histogram radiomics for differentiating multiple sclerosis (MS) lesions from non-specific and migraine-related white matter lesions. A total of 56 patients were classified into three groups: non-specific white matter lesions (Group 1, n=20), migraine-related lesions (Group 2, n=16), and MS lesions (Group 3, n=20). Lesions were manually segmented by two independent observers using 3D Slicer, and histogram-based first-order features were extracted. Group comparisons were performed using the Kruskal–Wallis test, followed by pairwise Mann–Whitney U tests. Binary logistic regression assessed the independent predictive value of significant parameters, diagnostic performance was evaluated by receiver operating characteristic (ROC) analysis, and inter-observer reliability by the intraclass correlation coefficient (ICC). Significant differences were found among the three groups for entropy, variance, uniformity, mean, and median values (all adjusted p<0.05), mainly driven by the MS group. MS lesions showed higher entropy, variance, mean, and median values, and lower uniformity. After adjustment for age and sex, all five parameters remained significant predictors of MS, and logistic regression confirmed their independent predictive value (all adjusted p<0.05). Entropy, variance, and uniformity showed high discrimination (univariate AUC: 0.832–0.838); the adjusted entropy model reached an AUC of 0.879. Inter-observer reliability was good to excellent (ICC 0.818–0.999). These findings suggest that T2W-FLAIR-based histogram radiomics provides useful quantitative information for differentiating MS lesions from other white matter lesions, particularly through heterogeneity-related features that may serve as supportive imaging biomarkers in the characterization of MS lesions.

Özet

Bu çalışmada, multipl skleroz (MS) lezyonlarını non-spesifik ve migren ilişkili beyaz cevher lezyonlarından ayırt etmede T2-ağırlıklı fluid-attenuated inversion recovery (T2A-FLAIR) tabanlı histogram radyomik analizinin değeri araştırıldı. Toplam 56 hasta üç gruba ayrıldı: non-spesifik lezyonlar (Grup 1, n=20), migren ilişkili lezyonlar (Grup 2, n=16) ve MS lezyonları (Grup 3, n=20). Lezyonlar iki bağımsız gözlemci tarafından 3D Slicer kullanılarak manuel olarak segmente edildi ve histogram tabanlı birinci derece özellikler çıkarıldı. Grup karşılaştırmaları Kruskal–Wallis testi ile yapıldı ve ardından ikili Mann–Whitney U testleri uygulandı. Anlamlı parametrelerin bağımsız öngörü değerini değerlendirmek için ikili lojistik regresyon kullanıldı; tanısal performans alıcı işletim karakteristiği (ROC) analizi ile, gözlemciler arası güvenilirlik ise sınıf içi korelasyon katsayısı (ICC) ile değerlendirildi. Entropi, varyans, uniformite, ortalama ve medyan değerleri açısından üç grup arasında anlamlı farklılıklar saptandı (tüm düzeltilmiş p<0,05) ve bu farklılıklar temel olarak MS grubundan kaynaklandı. MS lezyonları daha yüksek entropi, varyans, ortalama ve medyan değerleri ile daha düşük uniformite gösterdi. Yaş ve cinsiyet için düzeltme yapıldıktan sonra beş parametrenin tamamı MS için anlamlı öngörücü olmaya devam etti ve lojistik regresyon bu parametrelerin bağımsız öngörü değerini doğruladı (tüm düzeltilmiş p<0,05). Entropi, varyans ve uniformite yüksek ayırt edicilik (tekli AUC: 0,832-0,838), düzeltilmiş entropi modeli ise 0,879'luk bir AUC değeri gösterdi. Gözlemciler arası güvenilirlik iyi ile mükemmel düzeydeydi (ICC 0,818–0,999). Bu bulgular, T2A-FLAIR tabanlı histogram radyomik analizinin MS lezyonlarını diğer beyaz cevher lezyonlarından ayırt etmede yararlı kantitatif bilgiler sağlayabileceğini ve özellikle heterojenite ilişkili özelliklerin MS lezyonlarının karakterizasyonunda destekleyici görüntüleme biyobelirteçleri olarak kullanılabileceğini düşündürmektedir.

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Cite This Article

Erkal, D., Tonkaz, M., *, D. E. (2026). T2W-FLAIR Histogram Analysis of White Matter Lesions in Multiple Sclerosis, Migraine, and Nonspecific Gliotic Lesions. Uludağ Üniversitesi Tıp Fakültesi Dergisi, Cilt: 52. https://doi.org/10.32708/uutfd.1970026

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