Imaging Analysis Technique and Results



Date of MRI (MM/DD/YYYY):T2 lesions analysisTotal volume of brain lesions on T2W image (cc):Total T2 lesion counts: FORMCHECKBOX Done FORMCHECKBOX Not Done Total number of T2 lesions: Regional T2 lesion counts: FORMCHECKBOX Done FORMCHECKBOX Not Done Regional T2 lesion counts: Number of periventricular lesions: Number of juxtacortical lesions: Number of posterior fossa lesions: Number of cortical lesions: Number of thalamus lesions: Number of basal ganglia lesions: Number of other lesions whose type is not specified***: Technique Used: FORMCHECKBOX Manual tracing FORMCHECKBOX Semi-automated (verified by experienced reader) FORMCHECKBOX Fully automated segmentation (verified by experienced reader) FORMCHECKBOX Other, specify: Image pulse sequence used (Choose all that apply): FORMCHECKBOX FLAIR FORMCHECKBOX PD/T2W FSE FORMCHECKBOX T2W SE FORMCHECKBOX Other, specify: Slice thickness (mm):In slice resolution (mm):Gap (mm):Technique reference (i.e., literature citation(s), MRI Acquisition Manual or Analysis Manual): Gd-enhancing lesions analysisTotal number of Gd-enhancing lesions: Total volume of Gd-enhancing lesions (cc):Technique Used: FORMCHECKBOX T1-weighted spin echo with contrast FORMCHECKBOX T1-weighted 3D gradient-echo with contrast FORMCHECKBOX Other, specify: Image pulse sequence used:Slice thickness (mm):In slice resolution (mm):Gap (mm):Technique reference (i.e., literature citation(s), MRI Acquisition Manual or Analysis Manual): T1 hypointense lesions analysisTotal number of T1 hypointense lesions: Total volume of T1 hypointense lesions (mL):Technique Used: FORMCHECKBOX Visual determination by experienced reader FORMCHECKBOX Semi-automated (calculated through software, verified by experienced reader) FORMCHECKBOX Fully automated segmentation and counting FORMCHECKBOX Other, specify Image pulse sequence used: FORMCHECKBOX T1-weighted spin echo with contrast FORMCHECKBOX T1-weighted spin echo without contrast FORMCHECKBOX Other, specify: Slice thickness (mm):In slice resolution (mm):Gap (mm):Technique reference (i.e., literature citation(s), MRI Acquisition Manual or Analysis Manual): Brain volume analysis – answer question 1 or 2 (and the corresponding sub-questions), not bothBrain volume FORMCHECKBOX Not answered Brain volume (mL): Technique Used: FORMCHECKBOX Automated FORMCHECKBOX Semi-automated FORMCHECKBOX ManualImage pulse sequence used: FORMCHECKBOX Dual echo PD/T2W SE FORMCHECKBOX FLAIR FORMCHECKBOX PD SE FORMCHECKBOX T2W SE FORMCHECKBOX T1W SE FORMCHECKBOX T1W 3D gradient-echo FORMCHECKBOX Other, specify: Slice thickness (mm):In slice resolution (mm):Gap (mm):Technique reference (i.e., literature citation(s), MRI Acquisition Manual or Analysis Manual): Brain volume fractionVentricular volume fraction: FORMCHECKBOX Not answered Brain volume fraction: FORMCHECKBOX Automated FORMCHECKBOX Semi-automated FORMCHECKBOX Manual Image pulse sequence used: FORMCHECKBOX Dual echo PD/T2W SE FORMCHECKBOX FLAIR FORMCHECKBOX PD SE FORMCHECKBOX T2W SE FORMCHECKBOX T1W SE FORMCHECKBOX T1W 3D gradient-echo FORMCHECKBOX Other, specify: Slice thickness (mm):In slice resolution (mm):Gap (mm):Technique reference (i.e., literature citation(s), MRI Acquisition Manual or Analysis Manual): Ventricular volume analysis answer question 1 or 2 (and the corresponding sub-questions), but not bothVentricular volume FORMCHECKBOX Not answered Ventricular volume (mL): Technique Used: FORMCHECKBOX Automated FORMCHECKBOX Semi-automated FORMCHECKBOX ManualImage pulse sequence used: FORMCHECKBOX Dual echo PD/T2W SE FORMCHECKBOX FLAIR FORMCHECKBOX PD SE FORMCHECKBOX T2W SE FORMCHECKBOX T1W SE FORMCHECKBOX T1W 3D gradient-echo FORMCHECKBOX Other, specify: Slice thickness (mm):In slice resolution (mm):Gap (mm):Technique reference (i.e., literature citation(s), MRI Acquisition Manual or Analysis Manual): Ventricular volume fraction Ventricular volume fraction: FORMCHECKBOX Not answered Technique Used: FORMCHECKBOX Automated FORMCHECKBOX Semi-automated FORMCHECKBOX Manual Image pulse sequence used: FORMCHECKBOX Dual echo PD/T2W SE FORMCHECKBOX FLAIR FORMCHECKBOX PD SE FORMCHECKBOX T2W SE FORMCHECKBOX T1W SE FORMCHECKBOX T1W 3D gradient-echo FORMCHECKBOX Other, specify: Slice thickness (mm):In slice resolution (mm):Gap (mm):Technique reference (i.e., literature citation(s), MRI Acquisition Manual or Analysis Manual): Gray matter volume analysis – answer question 1 or 2, but not both, then proceed to question 3Gray matter volume*** FORMCHECKBOX Not answered Gray matter volume fraction***: FORMCHECKBOX Not answered Image pulse sequence used: FORMCHECKBOX Absolute gray matter volume (non-normalized) FORMCHECKBOX Absolute gray matter volume (normalized) FORMCHECKBOX Gray matter fraction FORMCHECKBOX Other, specify: Image pulse sequence used***: FORMCHECKBOX Dual echo PD/T2W SE FORMCHECKBOX FLAIR FORMCHECKBOX PD SE FORMCHECKBOX T2W SE FORMCHECKBOX T1W SE FORMCHECKBOX T1W 3D gradient-echo FORMCHECKBOX Other, specify***: Slice thickness (mm):In slice resolution (mm):Gap (mm):Technique reference (i.e., literature citation(s), MRI Acquisition Manual or Analysis Manual): Gray matter lesions analysis Total number of gray matter lesions:Total volume of gray matter lesions (mL):Technique Used: FORMCHECKBOX Visual determination by experienced reader FORMCHECKBOX Semi-automated (calculated through software, verified by experienced reader) FORMCHECKBOX Fully automated segmentation, localization, and counting FORMCHECKBOX Other, specify: Image pulse sequence used: FORMCHECKBOX FLAIR FORMCHECKBOX T1W 3D gradient-echo FORMCHECKBOX DIR FORMCHECKBOX PSIR FORMCHECKBOX Other, specify: Slice thickness (mm):In slice resolution (mm):Gap (mm):Technique reference (i.e., literature citation(s), MRI Acquisition Manual or Analysis Manual): White matter volume analysis – answer question 1 or 2, but not both, then proceed to question 3White matter volume (mL)***:White matter volume fraction***:White matter volume OR White matter volume fractionTechnique Used: FORMCHECKBOX Absolute white matter volume (non-normalized) FORMCHECKBOX Absolute white matter volume (normalized) FORMCHECKBOX White matter fraction FORMCHECKBOX Other, specifyImage pulse sequence used: FORMCHECKBOX Dual echo PD/T2W SE FORMCHECKBOX FLAIR FORMCHECKBOX PD SE FORMCHECKBOX T2W SE FORMCHECKBOX T1W SE FORMCHECKBOX T1W 3D gradient-echo FORMCHECKBOX Other, specify: Slice thickness (mm):In slice resolution (mm):Gap (mm):Technique reference (i.e., literature citation(s), MRI Acquisition Manual or Analysis Manual): Regional brain volumetric analysisCentral cerebral volume (mL):Cortical thickness (mm)Brain structure volumesHippocampus (mL):Thalamus (mL):Other regional volumetric analyses (complete as many times as needed):Technique Used***: FORMCHECKBOX Central cerebral volume FORMCHECKBOX Cortical thickness FORMCHECKBOX Brain structure volumeIf Brain structure volume, specify structure***: FORMCHECKBOX Hippocampus FORMCHECKBOX Thalamus FORMCHECKBOX Lobes FORMCHECKBOX Other, specify***: Image pulse sequence used: FORMCHECKBOX Dual echo PD/T2W SE FORMCHECKBOX FLAIR FORMCHECKBOX PD SE FORMCHECKBOX T2W SE FORMCHECKBOX T1W SE FORMCHECKBOX T1W 3D gradient-echo FORMCHECKBOX Other, specify: Slice thickness (mm):In slice resolution (mm):Gap (mm)***:Technique reference (i.e., literature citation(s), MRI Acquisition Manual or Analysis Manual): Spinal cord lesions analysisTotal number of spinal cord lesions***: Spinal cord lesion region (choose all that apply)***: FORMCHECKBOX C1-C7 FORMCHECKBOX T1-T12 FORMCHECKBOX L1-L5Spinal cord lesions location (choose all that apply)***: FORMCHECKBOX Anterior FORMCHECKBOX Posterior FORMCHECKBOX Lateral Spinal cord measurement***: FORMCHECKBOX Area (mm2): FORMCHECKBOX Volume (mL): Technique Used***: FORMCHECKBOX Visual determination by experienced reader FORMCHECKBOX Semi-automated (calculated through software, verified by experienced reader) FORMCHECKBOX Fully automated segmentation, localization and counting FORMCHECKBOX Other, specify***: Image pulse sequence used: FORMCHECKBOX T2-weighted (T2) FORMCHECKBOX Proton-density weighted (PD) FORMCHECKBOX Short tau inversion recovery (STIR) FORMCHECKBOX Other, specify***: Slice thickness (mm)***:In slice resolution (mm):Gap (mm):Technique reference (i.e., literature citation(s), MRI Acquisition Manual or Analysis Manual): Spinal cord volume/cross-sectional areaTechnique Used***: FORMCHECKBOX Manual tracing by experienced reader FORMCHECKBOX Semi-automated (calculated through software, verified by experienced reader) FORMCHECKBOX Losseff – 3mm x 5 axial slices from C2-3 up FORMCHECKBOX Fully automated segmentation FORMCHECKBOX Other, specify***: Image pulse sequence used: FORMCHECKBOX T2-weighted (T2) FORMCHECKBOX Proton-density weighted (PD) FORMCHECKBOX Short tau inversion recovery (STIR) FORMCHECKBOX T1W SE FORMCHECKBOX T1W 3D gradient-echo FORMCHECKBOX Other, specify: Slice thickness (mm)***:In slice resolution (mm):Gap (mm):Technique reference (i.e., literature citation(s), MRI Acquisition Manual or Analysis Manual): Tissue Integrity MeasuresTechniques Applied, Parameters, Measurement Regions (indicate all that apply to this study):Table SEQ Table \* ARABIC 1: Tissue Integrity MeasuresTechnique TypeDone?Sequence TypeSlice ThicknessTechnique ReferenceWhole BrainNormal Appearing WMNormal Appearing GMOther Regional MeasurementsMTR FORMCHECKBOX Yes FORMCHECKBOX No FORMCHECKBOX Yes FORMCHECKBOX No FORMCHECKBOX Yes FORMCHECKBOX No FORMCHECKBOX Yes FORMCHECKBOX No FORMCHECKBOX Yes FORMCHECKBOX NoDTI FORMCHECKBOX Yes FORMCHECKBOX No FORMCHECKBOX Yes FORMCHECKBOX No FORMCHECKBOX Yes FORMCHECKBOX No FORMCHECKBOX Yes FORMCHECKBOX No FORMCHECKBOX Yes FORMCHECKBOX NoSpectroscopy FORMCHECKBOX Yes FORMCHECKBOX No FORMCHECKBOX Yes FORMCHECKBOX No FORMCHECKBOX Yes FORMCHECKBOX No FORMCHECKBOX Yes FORMCHECKBOX No FORMCHECKBOX Yes FORMCHECKBOX NoOther FORMCHECKBOX Yes FORMCHECKBOX No FORMCHECKBOX Yes FORMCHECKBOX No FORMCHECKBOX Yes FORMCHECKBOX No FORMCHECKBOX Yes FORMCHECKBOX No FORMCHECKBOX Yes FORMCHECKBOX NoOther FORMCHECKBOX Yes FORMCHECKBOX No FORMCHECKBOX Yes FORMCHECKBOX No FORMCHECKBOX Yes FORMCHECKBOX No FORMCHECKBOX Yes FORMCHECKBOX No FORMCHECKBOX Yes FORMCHECKBOX NoOther FORMCHECKBOX Yes FORMCHECKBOX No FORMCHECKBOX Yes FORMCHECKBOX No FORMCHECKBOX Yes FORMCHECKBOX No FORMCHECKBOX Yes FORMCHECKBOX No FORMCHECKBOX Yes FORMCHECKBOX NoTissue Integrity MeasuresTable SEQ Table \* ARABIC 2: MTR – specify units and valuesUnitsWhole brainNormal-appearing GMNormal-appearing WMMean MTRMTR histogram peak positionMTR histogram peak heightTable SEQ Table \* ARABIC 3: DTI – specify units and valuesUnitsWhole brainNormal-appearing GMNormal-appearing WMMean FAMean ADCMean axial diffusivityMean radial diffusivityGeneral InstructionsThis CRF Module is designed to be used in conjunction with the MRI and Imaging Analysis Results – Follow-Up CRF Modules.Investigators should support use of the MS Imaging CRF Modules with detailed procedure, such as may be contained in the SOPs of their individual intuitions, with particular attention to software versions.All elements on this CRF are classified as Supplemental unless otherwise indicated by an asterisk (*) and should be collected if the research team considers them appropriate for their study.***These elements are considered Exploratory.Specific InstructionsPlease see the Data Dictionary for definitions for each of the data elements included in this CRF Module. ................
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