Research Article

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

Volume: 52 October 12, 2026
TR EN

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

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.

Keywords

References

  1. 1.Weidauer S, Wagner M, Hattingen E. White Matter Lesions inAdults - a Differential Diagnostic Approach. Läsionen derweißen Substanz im Erwachsenenalter – ein differenzialdiagnostischer Ansatz. Rofo. 2020;192(12):1154-73.
  2. 2.Wardlaw JM, Valdés Hernández MC, Muñoz-Maniega S. Whatare white matter hyperintensities made of? Relevance tovascular cognitive impairment. J Am Heart Assoc.2015;4:001140.
  3. 3.Lin J, Wang D, Lan L, et al. Multiple Factors Involved in thePathogenesis of White Matter Lesions. Biomed Res Int.2017;9372050.
  4. 4.Solomon AJ, Bourdette DN, Cross AH, et al. The contemporary spectrum of multiple sclerosis misdiagnosis: A multicenterstudy. Neurology. 2016;87:1393-9.
  5. 5.Eikermann-Haerter K, Huang SY. White Matter Lesions inMigraine. Am J Pathol. 2021;191:1955-62.
  6. 6.Kamson DO, Illés Z, Aradi M, et al. Volumetric comparisons ofsupratentorial white matter hyperintensities on FLAIR MRI inpatients with migraine and multiple sclerosis. J Clin Neurosci.2012;19:696-701.
  7. 7.Whiting P, Harbord R, Main C, et al. Accuracy of magneticresonance imaging for the diagnosis of multiple sclerosis:systematic review. BMJ. 2006;332:875-84.
  8. 8.Mayerhoefer, M. E., Materka, A., Langs, G., et al. Introductionto Radiomics. J Nucl Med. 2020;61:488-95.

Details

Primary Language

English

Subjects

Radiology and Organ Imaging

Journal Section

Research Article

Publication Date

October 12, 2026

Submission Date

June 13, 2026

Acceptance Date

September 16, 2026

Published in Issue

Year 2026 Volume: 52

APA
Erkal, D., & Tonkaz, M. (2026). T2W-FLAIR Histogram Analysis of White Matter Lesions in Multiple Sclerosis, Migraine, and Nonspecific Gliotic Lesions. Journal of Uludağ University Medical Faculty, 52. https://doi.org/10.32708/uutfd.1970026
AMA
1.Erkal D, Tonkaz M. T2W-FLAIR Histogram Analysis of White Matter Lesions in Multiple Sclerosis, Migraine, and Nonspecific Gliotic Lesions. J Uludag Univ Med Fac. 2026;52. doi:10.32708/uutfd.1970026
Chicago
Erkal, Duygu, and Mehmet Tonkaz. 2026. “T2W-FLAIR Histogram Analysis of White Matter Lesions in Multiple Sclerosis, Migraine, and Nonspecific Gliotic Lesions”. Journal of Uludağ University Medical Faculty 52 (October). https://doi.org/10.32708/uutfd.1970026.
EndNote
Erkal D, Tonkaz M (October 1, 2026) T2W-FLAIR Histogram Analysis of White Matter Lesions in Multiple Sclerosis, Migraine, and Nonspecific Gliotic Lesions. Journal of Uludağ University Medical Faculty 52
IEEE
[1]D. Erkal and M. Tonkaz, “T2W-FLAIR Histogram Analysis of White Matter Lesions in Multiple Sclerosis, Migraine, and Nonspecific Gliotic Lesions”, J Uludag Univ Med Fac, vol. 52, Oct. 2026, doi: 10.32708/uutfd.1970026.
ISNAD
Erkal, Duygu - Tonkaz, Mehmet. “T2W-FLAIR Histogram Analysis of White Matter Lesions in Multiple Sclerosis, Migraine, and Nonspecific Gliotic Lesions”. Journal of Uludağ University Medical Faculty 52 (October 1, 2026). https://doi.org/10.32708/uutfd.1970026.
JAMA
1.Erkal D, Tonkaz M. T2W-FLAIR Histogram Analysis of White Matter Lesions in Multiple Sclerosis, Migraine, and Nonspecific Gliotic Lesions. J Uludag Univ Med Fac. 2026;52. doi:10.32708/uutfd.1970026.
MLA
Erkal, Duygu, and Mehmet Tonkaz. “T2W-FLAIR Histogram Analysis of White Matter Lesions in Multiple Sclerosis, Migraine, and Nonspecific Gliotic Lesions”. Journal of Uludağ University Medical Faculty, vol. 52, Oct. 2026, doi:10.32708/uutfd.1970026.
Vancouver
1.Duygu Erkal, Mehmet Tonkaz. T2W-FLAIR Histogram Analysis of White Matter Lesions in Multiple Sclerosis, Migraine, and Nonspecific Gliotic Lesions. J Uludag Univ Med Fac. 2026 Oct. 1;52. doi:10.32708/uutfd.1970026

ISSN: 1300-414X, e-ISSN: 2645-9027

Creative Commons License
Journal of Uludag University Medical Faculty is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
2023