Double Inversion Recovery Magnetic Resonance Research Articles

Detection of multiple sclerosis lesions in the cervical cord: which of the MAGNIMS 'mandatory' non-gadolinium enhanced sagittal sequences is optimal at 3T?

The magnetic resonance imaging in multiple sclerosis consensus guidelines currently mandate three sagittal non-contrast enhanced sequences of T2-weighted fast spin echo, proton density-weighted fast spin echo and short tau inversion recovery; however, these particular three sequences have not previously been compared at 3T. This study compared T2-weighted fast spin echo, proton density-weighted fast spin echo, short tau inversion recovery as well as the double inversion recovery sequence for the sagittal detection of multiple sclerosis lesions in the cervical spinal cord at 3T. Nineteen multiple sclerosis patients underwent magnetic resonance imaging with 3T sagittal T2-weighted fast spin echo, proton density-weighted fast spin echo, short tau inversion recovery and double inversion recovery between November 2012 and April 2013. Two neuroradiologists independently reviewed the images, and the number of lesions detected on each sequence was recorded. Lesion conspicuity was quantitatively assessed with the lesion-to-cord-contrast ratio and lesion contrast-to-noise ratio. The Wilcoxon signed rank test was performed for statistical analysis. Proton density-weighted fast spin echo and short tau inversion recovery detected 32% more lesions compared to T2-weighted fast spin echo, and 37% more lesions compared to double inversion recovery. The lesion-to-cord-contrast ratio was highest in short tau inversion recovery, while the lesion contrast-to-noise ratio was highest for proton density-weighted fast spin echo. This study provides the necessary evidentiary support at 3T for the magnetic resonance imaging in multiple sclerosis spinal magnetic resonance imaging protocol consensus guidelines. At 3T sagittal proton density-weighted fast spin echo and short tau inversion recovery sequences allowed improved detection of cervical spinal cord multiple sclerosis lesions, compared to T2-weighted fast spin echo and three-dimensional double inversion recovery magnetic resonance imaging. Utilising T2-weighted fast spin echo alone at 3T is insufficient for lesion detection.

The added value of double inversion recovery magnetic resonance imaging of the brain in evaluation of patients with epilepsy

BACKGROUND: The double inversion recovery (DIR) pulse sequence was introduced several years ago and since that it grew important value in clinical neuroimaging. We aimed to assess the added value of double inversion recovery in evaluation of epileptic patients.AIM OF THE WORK:The aim of this study is to assess the added value of double inversion recovery MRI to the basic brain MRI protocols in assessment of patients with epilepsy.PATIENTS AND METHODS:Twenty five patients presented with epilepsy were examined by MRI. Examination was done using 3T MRI machines including conventional MRI epilepsy protocol sequences (T1, T2 & FLAIR) as well as double inversion recovery.RESULTS:In mesial temporal sclerosis, the measured contrast parameters (SNR, CR, CNR & AI) were found to be significantly higher in the DIR than in the FLAIR and T2 sequences.In the cases of focal cortical dysplasia, significantly higher CNR and AI in the DIR than in the T2 and FLAIR. Also DIR showed higher detection of the increased cortical thickness and cortical signal intensity than the T2 and FLAIR sequences.In tuberous sclerosis cases, the DIR showed higher visibility of the lesions than the T2 and FLAIR. Also DIR showed higher ability to detected grey-white matters junction blurring.CONCLUSIONS:Our study concluded that the greatest value of the double inversion recovery sequence is its higher ability in detecting multiple characteristics of the lesions in a one sequence.

Comparison of double inversion recovery magnetic resonance imaging (DIR-MRI) and dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) in detection of prostate cancer: A pilot study

IntroductionDCE-MRI is established for detecting prostate cancer (PCa). However, it requires a gadolinium contrast agent, with potential risks for patients. The application of DIR-MRI is simple and may allow cancer detection without the use of an intravenous contrast agent by differentially nullifying signal from normal and abnormal prostate tissue, creating contrast between the cancer and background normal prostate. In this pilot study we gathered data from DIR-MRI and DCE-MRI of the prostate for an equivalence trial. We also looked at how the DIR-MRI appearance varies with the aggressiveness of PCa. MethodDIR-MRI and DCE-MRI were acquired. The images were assessed by an experienced Consultant Radiologist and a novice reporter (Radiographer). The potential PCa lesions were quantified using a lesion to normal ratio (LNR). Radiological pathological correlation was made to identify the MRI lesions that represented significant PCa. A Wilcoxon sign rank was used to compare DCE-LNR and DIR-LNR for PCa containing lesions. Pearson's correlation was used to look at the relationship between DIR-LNR and PCa grade group (aggressiveness). ResultsDCE-LNR and DIR-LNR were found to be significantly different (Z = −5.910, p < 0.001). However, a significant correlation was found between PCa grade group and DIR-LNR. ConclusionDIR and DCE sequences are not equivalent and significant cancer is more conspicuous on the DCE sequence. However, DIR-LNR does correlate with PCa aggressiveness. Implications for practiceWith the correlation of PCa grade group with DIR-LNR this may be a useful sequence in evaluation of the prostate; stratifying the risk of there being clinically significant PCa before biopsy is performed. Furthermore, given that DIR-LNR appears to predict PCa aggressiveness DIR might be used as part of a multiparametric MRI protocol designed to avoid biopsy.

Voxel-based morphometry analysis of double inversion-recovery magnetic resonance imaging for detecting microscopic lesions: a simulation study.

Double inversion-recovery (DIR) imaging has the potential to improve the detection of subcortical lesions through the use of voxel-based morphometry (VBM) analysis. The aim of this study was to clarify the characteristics of detectable lesions by performing a VBM analysis on DIR images of simulated lesions. Twenty healthy volunteers underwent magnetic resonance imaging using a head three-dimensional DIR sequence. The images were processed using SPM12; then, the selected images with simulated lesions were analyzed via VBM. The VBM results were evaluated using free-response receiver-operating characteristic curves and a receiver-operating characteristic analysis. The sensitivity was 100% (5/5), with 5.6 false-positive objects per case, in simulated lesions with a contrast of 0.6 and a size of 2.4mm. The sensitivity was 80% (4/5), with 5.4 false-positive objects per case, in simulated lesions with a contrast of 0.5 and a size of 2.4mm. The mean area under the curve value was increased from 0.783 to 0.883 using VBM, with a statistically significant difference (p < 0.01). The VBM analysis of the DIR images using SPM alone showed the potential to detect subcortical microscopic lesions. Early detection of Alzheimer's disease may be possible by adapting VBM in the clinical setting.

Efficacy of double inversion recovery magnetic resonance imaging for the evaluation of the synovium in the femoro-patellar joint without contrast enhancement.

To investigate the efficacy of double inversion recovery (DIR) sequence for evaluating the synovium of the femoro-patellar joint without contrast enhancement (CE). Two radiologists independently evaluated the axial DIR and CE T1-weighted fat-saturated (CET1FS) images of 33 knees for agreement; the visualisation and distribution of the synovium were evaluated using a four-point visual scaling system at each of the five levels of the femoro-patellar joint and the location of the thickest synovium. The maximal synovial thickness at each sequence was measured by consensus. The interobserver agreement was good (κ = 0.736) for the four-point scale, and was excellent for the location of the thickest synovium on DIR and CET1FS (κ = 0.955 and 0.954). The intersequential agreement for the area with the thickest synovium was also excellent (κ = 0.845 and κ = 0.828). The synovial thickness on each sequence showed excellent correlation (r = 0.872). The DIR showed as good a correlation as CET1FS for the evaluation of the synovium at the femoro-patellar joint. DIR may be a useful MR technique for evaluating the synovium without CE. • DIR can be useful for evaluating the synovium of the femoro-patellar joint. • Interobserver and intersequential agreements between DIR and CET1FS were good. • Mean thickness of the synovium was significantly different between two sequences.

3T Double Inversion Recovery Magnetic Resonance Imaging: diagnostic advantages in the evaluation of cortical development anomalies

PurposeThe aim of this work was to investigate the diagnostic value of the DIR sequence at 3T MR imaging operating in the evaluation of cortical development anomalies. MethodsWe studied 40 patients, with a previous diagnosis of cortical dysplasia, by FLAIR-3D, DIR, FSE T2 and MPR-GE T1 sequences at 3T MRI. Two independent observers evaluated, for each sequence and lesion, some semiological aspects (cortical thickness, cortical signal intensity, white-gray matter blurring, subcortical white matter intensity). We made also a quantitative evaluation of the cortical signal intensity in lesion site, drawing a ROI on each MRI sequences and comparing them to the correspondent normal contralateral cortical area. ResultsWe identified 44 cortical development anomalies. Qualitative analyses showed a high level of agreement between the observers concerning DIR potentialities in detecting and characterizing the cortical development disorders. Particularly DIR sequence was able to demonstrate the blurring and the subcortical white matter anomalies. The quantitative analyses didn’t show a significant difference between DIR and traditional sequences in the evaluation of the cortical signal intensity. Conclusion3T MRI-DIR sequence is a useful and better suitable sequence compared to the traditional sequences in the characterization of some semiological aspects of the cortical development disorders, particularly blurring and subcortical white matter hyperintensity.

Added value of double inversion recovery magnetic resonance sequence in detection of cortical and white matter brain lesions in multiple sclerosis

ObjectiveThe aim of this study was to evaluate the value of double inversion recovery (DIR) magnetic resonance (MR) sequence in the detection of brain cortical and white matter lesions in multiple sclerosis (MS). Patients and methodsFifteen patients with remitting relapsing MS were included in this study. Imaging was performed on a 1.T MR system using DIR, fluid-attenuated inversion-recovery (FLAIR), and T2-weighted image (T2WI) sequences. The sensitivity of DIR was compared with the corresponding sensitivity of FLAIR and T2WI sequences. The contrast between lesions and normal-appearing gray matter (NAGM), normal-appearing white matter (NAWM), and cerebrospinal fluid (CSF) was determined for all sequences. ResultsDIR showed significantly more MS lesion load overall when compared to T2WI or FLAIR. Significantly higher number of lesions was seen in the supra- and infratentorial locations. DIR detected higher periventricular white matter lesions when compared to FLAIR, but did not detect significantly higher lesions when compared to T2WI. Significantly higher deep white matter, juxtacortical, and intracortical lesions were seen on DIR when compared to both T2WI and FLAIR. The image contrast measurements between the MS lesions and the NAWM in all anatomical locations were significantly higher in DIR sequence compared to both T2WI and FLAIR sequences. However, there was no significant statistical difference between the DIR and both T2WI and FLAIR sequences regarding the contrast of intracortical lesions compared to NAGM. ConclusionDIR sequence is valuable in the imaging workup of MS as it can detect more MS lesions compared to the T2W and FLAIR sequences in all anatomical locations. DIR showed better delineation between the white matter, gray matter, and the MS lesions due to its high image contrast. DIR sequence should be included in the routine MR protocol of MS patients especially to answer the question about intra-cortical and juxta-cortical MS lesions.

Abstract 2971: Atheromatous Plaques of the Middle Cerebral Artery in the Lateral Lenticulostriate Artery Territory Infarction

OBJECTIVES: We evaluated the utility of black-blood double inversion recovery magnetic resonance imaging (BBDIR-MRI) for depiction of the intracranial branch atheromatous disease caused by occlusion at the vessel orifices of lager-caliber penetrating arteries. METHODS: BBDIR-MRI was performed on 15 consecutive patients with acute cerebral infarcts in the territories of lateral lenticulostriate arteries, which were classified into small artery occlusion by TOAST criteria. Abnormal wall thickening of the horizontal part (M1) of the middle cerebral artery was considered as the atheromatous plaque causing the occlusion of the vessel orifices. The clinical characteristics including the prevalence of various vascular risk factors, the final size of infarcts and the rate of disease progression were compared between two groups with and without the atheromatous plaque. RESULTS: By BBDIR-MRI, the atheromatous plaques were detected in 8 patiennts (53%), while Time of flight (TOF)-MRA revealed the irregular stenosis in one patient. All of them had the eccentric wall thickening with iso-signal intensity on T1- and T2-weighted images of BBDIR-MRI. The large infarcts exceeding 1.5 cm in diameter tended to be more often in patients with the atheromatous plaque (100%) than those without it (57%). However, there were no significant differences of clinical characteristics between the two groups with and without the atheromatous plaque. CONCLUSIONS: BBDIR-MRI could reveal the atheromatous plaque at M1 portion of the middle cerebral artery more easily than TOF-MRA. It might be useful to distinguish the intracranial branch atheromatous diseases from the other types of infarcts in the territories of lateral lenticulostriate arteries.

Double Inversion Recovery Magnetic Resonance Imaging (MRI) in the Preoperative Evaluation of Hippocampal Sclerosis

To determine whether the finding of hyperintense hippocampal signal intensity on double inversion recovery (DIR) magnetic resonance imaging is correlated with hippocampal volume loss and metabolic abnormalities in patients with mesial temporal lobe epilepsy (MTLE). This retrospective study had institutional review board approval, and informed consent was obtained. Thirteen patients with unilateral hippocampal sclerosis and 13 age-matched healthy control subjects were included. Quantitative assessment for hippocampus of the patients and the control subjects was determined, including DIR, 3-dimensional T1-weighted imaging and proton magnetic resonance spectroscopy. Hippocampal relative signal intensity on DIR images (RSIDIR), volumes, and N-acetylaspartate-to-choline and creatine/phosphocreatine ratios were measured during one magnetic resonance imaging session, and asymmetry indexes (AI) of bilateral hippocampi were calculated. Hippocampal RSIDIR and AIDIR were compared between the patients and the control subjects. The RSIDIR and AIDIR were further correlated with the quantitative MR measures and with the age at onset and duration of MTLE. Statistical analyses were performed with Student t test, 1-way analysis of variance, and Pearson correlation. On DIR images, the hippocampi ipsilateral to the seizure focus demonstrated relatively extreme hyperintensity. The ipsilateral hippocampi showed significantly increased RSIDIR compared with contralateral hippocampi and the healthy subjects (F = 197.956, P < 0.001). The hippocampal AIDIR in the patients was also significantly higher than that in the control group (t = 24.896, P < 0.001). Significant Pearson correlations (2-tailed) were obtained between the RSIDIR and the volume of the ipsilateral hippocampi (r = -0.762, P < 0.01) and between the RSIDIR and duration of epilepsy (r = 0.557, P < 0.05). Moreover, there were significant correlations between the AIDIR and the AIvolume (r = 0.609, P < 0.05) and between the AIDIR and the duration of epilepsy (r = 0.610, P < 0.05). However, no significant correlations of hippocampal DIR measures with proton magnetic resonance spectroscopy were obtained. Double inversion recovery imaging of the brain can yield complementary information about hippocampal pathology and efficiently lateralize the hippocampal sclerosis in patients with MTLE.

Imaging of Intracranial Plaques with Black-Blood Double Inversion Recovery MR Imaging and CT

We evaluated the feasibility of black-blood double inversion recovery magnetic resonance imaging (BBDIR) and CT imaging (CTI) for depiction of IAPs. We performed BBDIR on 20 control subjects and 13 patients with acute ischemic stroke. We measured the thickness of the normal vessel wall in control subjects and the maximal and minimal thickness of IAPs in patients on BBDIR. We evaluated signal intensity (SI) and the eccentricity of the IAP on BBDIR, and abnormal wall thickening and CT attenuation of IAPs on CTI. We correlated imaging features of BBDIR and CTI in the patients. The difference of wall thickness between control and patient group was statistically significant (control subjects; basilar artery 0.6 mm, MCA 0.51 mm, and patients; maximal 2.34 mm, minimal 1.3 mm, P value≤.001). The IAP showed eccentric remodeling and heterogeneous SI with the regions of high SI on BBDIR. CTI could not reveal abnormality in 10 patients. Suspicious intraplaque hemorrhage and calcification was demonstrated in 3 patients by CTI. BBDIR could reveal normal and abnormal wall of large intracranial arteries. CTI had limited role for detection of IAP, however, correlation of BBDIR and CTI could provide further characterization of the IAP's in terms of intraplaque calcification and hemorrhage.

Double Inversion Recovery Magnetic Resonance Imaging at 3 T

The objective of the study was to examine the utility of double inversion recovery (DIR) magnetic resonance imaging (MRI) using a 3-T magnetic resonance imager in the preoperative evaluation of hippocampal sclerosis (HS) in patients with mesial temporal lobe epilepsy. This retrospective study had institutional review board approval, and informed consent was obtained. Twelve patients with unilateral HS and 12 age-matched healthy control subjects were included. Imaging was performed using DIR, fluid-attenuated inversion recovery (FLAIR), and T2-weighted turbo spin-echo (T2 TSE) sequences vertical to the hippocampal axis. Quantitative assessment for hippocampus of the patients and control subjects was determined. Regions of interest (ROIs) were placed on bilateral hippocampi, and signal intensity was measured. The signal-to-noise ratio (SNR) of ipsilateral hippocampus, contrast ratio of ipsilateral-to-contralateral side, contrast-to-noise ratio (CNR), and asymmetry index of bilateral hippocampi were calculated and compared among the 3 sequences. Statistical analyses were performed with 1-way analysis of variance and Student t test. On DIR images, HS demonstrated extremely high signal intensity. The hippocampi ipsilateral to the seizure focus showed significantly increased signal intensity, as compared with contralateral hippocampi and healthy subjects (F = 47.876, P < 0.001). The higher SNR of ipsilateral hippocampus on DIR was significant compared with the FLAIR and T2 TSE (P < 0.01). The CNR of bilateral hippocampi on DIR was also significantly higher than that on the FLAIR and T2 TSE (P < 0.01). However, compared with the FLAIR, no significant differences of contrast ratio and asymmetry index between bilateral hippocampi were observed on DIR. Double inversion recovery brain imaging reveals characteristically extremely high signal intensity of hippocampus in patients with HS. Double inversion recovery images can describe HS with high SNR and CNR superior to conventional magnetic resonance sequences and can be valuable for the diagnosis of HS.

Double Inversion Recovery MRI with fat suppression at 7 tesla: initial experience.

Double Inversion Recovery Magnetic Resonance Imaging (DIR) consists of two adiabatic non-selective inversion pulses applied before a Turbo Spin Echo (TSE) sequence, in order to suppress the signal from two tissues with different longitudinal relaxation times T(1) simultaneously. In the brain, DIR is used to selectively image the gray matter (GM) by nulling the signal from white matter (WM) and cerebrospinal fluid (CSF). The main limitation of the technique remains the intrinsic low SNR due to the specific preparation of the longitudinal magnetization. The recent availability of high field magnets operating at 7 T for human imaging offers the advantage of higher SNR. This study shows the feasibility of brain Double Inversion Recovery Magnetic Resonance Imaging (DIR-MRI) at 7 T in vivo in healthy volunteers. The MRI experiments were performed on phantoms at 7 T and on four healthy volunteers at 7 and 3 T. For fat suppression, a chemical shift selective Fat Inversion Recovery (csFatIR) technique was used and compared to the standard fat saturation (FatSat). The csFatIR method resulted to be significantly more efficient than the Fatsat at 7 T and slightly more efficient at 3 T, enabling a clear delineation of GM. DIR is feasible at 7 T despite the problems associated with B(1) in-homogeneity.

Detection of Cortical Inflammatory Lesions by Double Inversion Recovery Magnetic Resonance Imaging in Patients With Multiple Sclerosis

A significant inflammatory pathologic disorder in the cortex of patients with multiple sclerosis (MS) has been demonstrated by ex vivo studies. To determine the frequency, time of appearance, and clinical relevance of intracortical lesions (ICLs) in MS in vivo. Double inversion recovery sequence study. Multiple Sclerosis Centre of the Veneto Region. Patients We enrolled 380 patients (116 with clinically isolated syndrome [CIS], 163 with relapsing-remitting MS [RRMS], and 101 with secondary progressive MS [SPMS]) and 40 age- and sex-matched healthy volunteers between May 1, 2005, and December 31, 2006. We assessed the frequency and number of ICLs and brain parenchyma fraction, white matter T2 lesion volume, and clinical disability. Although never observed in healthy volunteers, ICLs were detected in 58% of patients (36% of patients with CIS, 64% of patients with RRMS, and 73% of patients with SPMS). The number of ICLs was higher in patients with SPMS than in those with CIS or RRMS (P <.001), and patients with ICLs had a higher Expanded Disability Status Scale score (P = .004), a higher white matter T2 lesion volume (P = .008), a lower brain parenchyma fraction (P = .009), and a higher frequency of IgG oligoclonal bands (IgGOBs) (P <.001) than patients without ICLs. Patients positive for IgGOBs had more ICLs than patients negative for IgGOBs (P = .02). The number of ICLs correlated with the Expanded Disability Status Scale score (r = 0.48, P <.001), white matter T2 lesion volume (r = 0.38, P = .001), and brain parenchyma fraction (r = -0.47, P = .001). A significant association between ICLs and male sex was observed. Although more frequent in patients with SPMS, ICLs were observed from the early disease stages. The ICLs were more frequently detected in patients with IgGOBs and were associated with a higher clinical disability score and male sex. The ICLs may help to define MS clinical heterogeneity and prognosis in clinical settings.