Double Inversion Recovery Sequence Research Articles

Distortion correction for a double inversion-recovery sequence with an echo-planar imaging readout

A double inversion-recovery (DIR) sequence with an echo-planar imaging (EPI) readout can be used to image selectively the grey matter of the brain, and this has previously been applied to improve the sensitivity of the statistical analysis of functional magnetic resonance imaging (fMRI) data. If a procedure were to be implemented to remove the distortions that are inherent in the EPI-based fMRI data set, then a similar technique would have to be applied to the DIR-EPI image also to ensure that it matches the geometry of the functional data. A comparison of candidate methodologies for correcting distortions in DIR-EPI images, based on the reversed-gradient method, is presented. A corrected image could be calculated from two DIR-EPI images acquired with k-space traversal in opposite directions, but that method was not able to cope with the large regions of low signal intensity corresponding to the nulled white matter. It was found that the optimal procedure to apply the reversed-gradient method to DIR-EPI images was to acquire two additional EPI images (without the two inversion pulses) with opposite-direction k-space traversal; the distortion-correction information calculated from those EPI images was then applied to the DIR-EPI data.

The place of conventional MRI and newly emerging MRI techniques in monitoring different aspects of treatment outcome

Magnetic resonance imaging (MRI) is the most important paraclinical measure for assessing and monitoring the pathologic changes implicated in the onset and progression of multiple sclerosis (MS). Conventional MRI sequences, such as T1-weighted gadolinium (Gd) enhanced and spin-echo T2-weighted imaging, only provide an incomplete picture of the degree of inflammation and underlying neurodegenerative changes in this disease. Two- and three-dimensional fluid-attenuated inversion recovery and double inversion recovery sequences allow better identification of cortical, periventricular and infratentorial lesions. Ultra-high field strength MRI has the potential to detect subpial cortical and deep gray matter lesions. Unenhanced T1-weighted imaging can reveal hypointense black holes, a measure of chronic neurodegeneration. Magnetization transfer imaging (MTI) is increasingly used to characterize the evolution of MS lesions and normal-appearing brain tissue. Evidence suggests that the dynamics of magnetization transfer changes correlate with the extent of demyelination and remyelination. Magnetic resonance spectroscopy, which provides details on tissue biochemistry, metabolism, and function, also has the capacity to reveal neuroprotective mechanisms. By measuring the motion of water, diffusion imaging can provide information about the orientation, size, and geometry of tissue damage in white and gray matter. These advanced non-conventional MRI techniques relate better to clinical impairment, disease progression, accumulation of disability, and have the potential to detect neuroprotective effects of treatment. Although detecting the status of neuronal integrity using MRI techniques continues to improve, a "gold standard" model remains to be established.

Extensive cortical inflammation is associated with epilepsy in multiple sclerosis

Epilepsy is three to six times more frequent in MS than in the general population. Previous studies based on conventional magnetic resonance (MR) imaging have suggested a possible correlation between cortical inflammatory pathology and epileptic seizures. However, pure intracortical lesions (ICLs) are unlikely to be demonstrated with conventional MR. We applied the double inversion recovery (DIR) sequence in relapsing remitting MS (RRMS) patients with or without epileptic seizures in order to clarify the relationship between ICLs and epilepsy in MS in vivo. Twenty RRMS patients who had epileptic seizures (RRMS/E) during the course of the disease were studied for the presence of ICLs. A group of 80 RRMS patients with no history of seizures and matched for gender, age, disease duration, Expanded Disability Status Scale (EDSS) grading, and T2 lesion volume (T2-WMLV) was selected as reference population. ICLs were detected by applying the DIR sequence. ICLs were observed in 18/20 (90%) RRMS/E and in 39/80 (48%) RRMS (p = 0.001). RRMS/E showed five times more ICLs (7.2 +/- 8.4) than RRMS (1.5 +/- 2.4; p = 0.015). The total ICLs volume was 6 times larger in RRMS/E than in RRMS (1.2 +/- 1.7 cm3 versus 0.2 +/- 0.2 cm3, p = 0.016). No significant difference was observed between RRMS and RRMS/E with regard to the number and volume of juxtacortical lesions and T2-WMLV. Our findings indicate that RRMS/E have more extensive cortical inflammation than RRMS patients with no history of epilepsy. Inflammatory ICLs may be responsible for epilepsy in MS.

Extent of myocardial noncompaction: comparison between MRI and echocardiographic evaluation

Non-compaction of the left ventricular myocardium is an important cause of cardiomyopathy. There is no clear consensus about its diagnostic criteria or the diagnostic test of choice. MRI is increasingly used in the pediatric cardiac field because of its superior and objective image quality. To compare the echocardiographic and MRI findings in four patients with recently diagnosed ventricular non-compaction. We compared the extent of myocardial involvement shown at MRI and echocardiography in four individuals, two patients with echocardiographic diagnosis of left ventricular non-compaction, and two family members of one of the patients. In all patients, MRI showed wider area of involvement than echocardiography. A definite diagnosis was entertained in only two patients by echocardiography but in all by MRI. Cine imaging was diagnostic of the disease in all patients. Black-blood pool imaging with double-inversion recovery sequence also helped to visualize the abnormal areas by showing slow flow artifacts in the four- and two-chamber images. MRI provided better delineation of the extent of the abnormal trabeculation in patients with non-compaction of the left ventricular myocardium. It was particularly useful when the myocardial involvement was subtle, as in the asymptomatic family members.

Intracortical Lesions in Multiple Sclerosis: Improved Detection with 3D Double Inversion-Recovery MR Imaging

To prospectively compare the depiction of intracortical lesions by using multislab three-dimensional (3D) double inversion-recovery (DIR), multislab 3D fluid-attenuated inversion-recovery (FLAIR), and T2-weighted spin-echo (SE) magnetic resonance (MR) imaging in patients with multiple sclerosis. Local ethics review board approval and informed consent were obtained. Conventional T2-weighted SE and multislab 3D FLAIR and DIR images were acquired in 10 patients with multiple sclerosis (five women, five men) and 11 age-matched healthy control subjects (seven women, four men). Mean age was 40 years (range, 25-54 years) in patients and 34 years (range, 24-55 years) in control subjects. Lesions were classified according to seven anatomic regions: intracortical, mixed white matter-gray matter, juxtacortical, deep gray matter, periventricular white matter, deep white matter, and infratentorial lesions. The numbers of lesions per category were compared between techniques (Dunnett-corrected analysis of variance). Gain or loss (with 95% confidence intervals [CIs]) of numbers of lesions detected at 3D DIR imaging was calculated in comparison with those detected at T2-weighted SE and 3D FLAIR imaging. Total number of lesions did not differ between 3D DIR and 3D FLAIR sequences, but the 3D DIR sequence showed a gain of 21% (95% CI: 4%, 41%) in comparison with the T2-weighted SE sequence. Because of high gray matter-white matter contrast, DIR images depicted more intracortical lesions (80 lesions in 10 patients) than both SE (10 lesions) and FLAIR (31 lesions) images; gains with DIR were 538% (95% CI: 191%, 1297%) and 152% (95% CI: 15%, 453%) compared with SE and FLAIR, respectively. Only four intracortical lesions were detected in control subjects. Also, DIR imaging enabled a better definition of mixed white matter-gray matter lesions because of greater contrast between the lesion and its surroundings. MR imaging with 3D DIR enables increased intracortical lesion detection in the multiple sclerosis brain, as well as improved distinction between juxtacortical and white matter-gray matter lesions.

Optimized interleaved whole-brain 3D double inversion recovery (DIR) sequence for imaging the neocortex.

For a substantial number of individuals with neurological disorders, a conventional MRI scan does not reveal any obvious etiology; however, it is believed that abnormalities in the neocortical gray matter (GM) underlie many of these disorders. Attempts to image the neocortex are hindered by its thin, convoluted structure, and the partial volume (PV) effect. Therefore, we developed a 3D version of the double inversion recovery (DIR) sequence that incorporates an optimized interleaved (OIL) strategy to improve efficiency and allow high-quality, high-resolution imaging of GM.

Implementation and evaluation of a new pulse sequence for rapid acquisition of double inversion recovery images for simultaneous suppression of white matter and CSF.

We describe a fast double inversion recovery (DIR) imaging sequence that effectively attenuates signal from both white matter and cerebrospinal fluid (CSF). The pulse sequence uses a novel inversion/excitation scheme and fast spin-echo readout to maximize scan efficiency. The white matter/CSF suppressed images can be acquired from the entire brain in approximately 6 minutes. Evaluation of the fast DIR sequence on patients with multiple sclerosis (MS) demonstrates high lesion conspicuity.

Technical note: use of a double inversion recovery pulse sequence to image selectively grey or white brain matter.

The design of a double inversion recovery (DIR) sequence, to image selectively grey or white brain matter, is described. Suitable choice of inversion times allows either cerebrospinal fluid (CSF) and white matter to be suppressed, to image the cortex alone, or CSF and grey matter to be suppressed, to image the white matter. The DIR sequence was found to give clear delineation of the cerebral cortex.

Imaging gray brain matter with a double-inversion pulse sequence to suppress CSF and white matter signals

The design of a double-inversion recovery (DIR) sequence, to selectively image gray brain matter, is described. A suitable choice of inversion times allows the cerebrospinal fluid (CSF) and white matter to be suppressed, to image the cortex alone. Consistently good results were achieved in a group of normal volunteers using the same inversion times throughout. The DIR sequence was found give clear delineation of the complex folds of the cerebral cortex.

Renal artery stenosis due to abdominal aortic aneurysm.

<h3>BACKGROUND AND PURPOSE:</h3> The diagnosis of subacute subarachnoid hemorrhage is important because rebleeding may occur with subsequent life-threatening hemorrhage. Our aim was to determine the sensitivity of the 3D double inversion recovery sequence compared with CT, 2D and 3D FLAIR, 2D T2*, and 3D SWI sequences for the detection of subacute SAH. <h3>MATERIALS AND METHODS:</h3> This prospective study included 25 patients with a CT-proved acute SAH. Brain imaging was repeated between days 14 and 16 (mean, 14.75 days) after clinical onset and included MR imaging (2D and 3D FLAIR, 2D T2*, SWI, and 3D double inversion recovery) after CT (median delay, 3 hours; range, 2–5 hours). A control group of 20 healthy volunteers was used for comparison. MR images and CT scans were analyzed independently in a randomized order by 3 blinded readers. For each subject, the presence or absence of hemorrhage was assessed in 4 subarachnoid areas (basal cisterns, Sylvian fissures, interhemispheric fissure, and convexity) and in brain ventricles. The diagnosis of subacute SAH was defined by the presence of at least 1 subarachnoid area with hemorrhage. <h3>RESULTS:</h3> For the diagnosis of subacute SAH, the double inversion recovery sequence had a higher sensitivity compared with CT (<i>P</i> &lt; .001), 2D FLAIR (<i>P</i> = .005), T2* (<i>P</i> = .02), SWI, and 3D FLAIR (<i>P</i> = .03) sequences. Hemorrhage was present for all patients in the interhemispheric fissure on double inversion recovery images, while no signal abnormality was noted in healthy volunteers. Interobserver agreement was excellent with double inversion recovery. <h3>CONCLUSIONS:</h3> Our study showed that the double inversion recovery sequence has a higher sensitivity for the detection of subacute SAH than CT, 2D or 3D FLAIR, 2D T2*, and SWI.