Abstract
BackgroundMultiple sclerosis (MS) is a common chronic inflammatory demyelinating disorder more common in young adults. MS is characterized mainly with white matter (WM) affection; however, considerable gray matter (GM) involvement is also noted in many patients. MRI is used for diagnosis and follow up of the disease using different pulse sequences; FLAIR imaging provides the highest sensitivity in the detection of supratentorial, juxtacortical, and the periventricular lesions but is less sensitive in the posterior fossa. A double inversion recovery (DIR) pulse sequence was recently introduced to improve the visibility of GM lesions and especially cortical lesions. The aim of this study is to assess the role of DIR sequence in the detection of brain lesions in patients with MS compared to FLAIR sequence.ResultsDIR showed a significantly higher number of MS lesions in infratentorial region (2.9 ± 0.4 compared to 2.25 ± 0.3 in FLAIR) with a statistically significant difference (p = 0.002) and also in supratentorial periventricular regions (11.84 ± 8.07 in DIR and 11.31 ± 8.07 in FLAIR, p < 0.001). DIR imaging also demonstrated significantly more intracortical lesions (7.12 ± 1.2 compared to 1.4 ± 0.9 in FLAIR imaging) with a statistically significant difference (p < 0.001). On the other hand, corpus callosum lesions were significantly higher on FLAIR (0.84 ± 0.1) with respect to DIR imaging (0.68 ± 0.1) with a statistically significant difference in between (p = 0.025).ConclusionDIR is a powerful conventional MRI sequence for visualization of brain lesions in patients with MS and is superior to FLAIR sequence in detecting lesions in different locations, namely cortical, periventricular, and infratentorial regions; hence, DIR can be added to the MRI protocol of MS patients or even can replace FLAIR which would be of a good diagnostic value with only 80 s added to the scan time.
Highlights
Multiple sclerosis (MS) is a common chronic inflammatory demyelinating disorder more common in young adults
Comparison between double inversion recovery (DIR) and fluid-attenuated inversion recovery (FLAIR) sequences at different brain regions DIR showed a significantly higher total number of MS lesions in the 32 patients included in the study (Table 2 and Figs. 1, 2, 3 and 4)
DIR detected higher number of lesions compared to FLAIR with a statistically significant difference (p = 0.002)
Summary
Multiple sclerosis (MS) is a common chronic inflammatory demyelinating disorder more common in young adults. MRI is used for diagnosis and follow up of the disease using different pulse sequences; FLAIR imaging provides the highest sensitivity in the detection of supratentorial, juxtacortical, and the periventricular lesions but is less sensitive in the posterior fossa. Multiple sclerosis (MS) is one of the most common chronic inflammatory demyelinating diseases and a common cause of neurological disability in middle-aged and young adults. In January 2016, an updated version of the magnetic resonance imaging in multiple sclerosis (MAGNIMS) consensus MRI guidelines for the diagnosis of MS has been published, which further underlines the significance and importance of a proper assessment of cortical lesions (CL) and its potential role for the individual patient [3]. MR imaging for the diagnosis of MS is performed using a multisequence protocol including T2-weighted, fluid-attenuated inversion recovery (FLAIR), precontrast, and postcontrast T1-weighted sequences [4]
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