Double Inversion Recovery Sequence Research Articles

Dual Inversion Recovery Magnetic Resonance Imaging's Diagnostic Value for Estimating the Overall Load of Multiple Sclerosis Lesions and its Anatomical Distribution

B Background: In young adults, multiple sclerosis is a prevalent chronic inflammatory demyelinating condition. It is characterized by white matter affection, but many individuals also have significant gray matter involvement. A double inversion recovery pulse pattern was recently proposed to improve the detectability of multiple sclerosis lesions. Objectives: To evaluate the diagnostic value of double inversion recovery sequence in the detection of cortical and white matter multiple sclerosis plaques in different brain anatomical locations. Subjects and methods: A total of 37 patients with an established diagnosis of multiple sclerosis were included in this cross-sectional study. Brain MRI was done using double inversion recovery, T2 and FLAIR sequences. The number of lesions was counted and compared in the three sequences. Results: Dual Inversion Recovery sequence was highly significant and superior to both T2 and FLAIR sequences (P < 0.001) in depicting the lesions regardless of anatomical distribution. Dual Inversion Recovery was significantly superior to T2 (P =<0.001) and FLAIR (P =<0.001) in detecting lesions in cortical and juxtacortical. However, Dual Inversion Recovery shows less periventricular and deep white matter lesions in comparison to T2 and FLAIR sequences. Conclusion: The Dual Inversion Recovery sequence detected more multiple sclerosis lesions in cortical, subcortical and infratentorial than the traditional T2W and FLAIR sequences. It also demonstrated greater delineation between the white matter, grey matter, and multiple sclerosis lesions, which became more easily visualized.

7 T Lesion-Attenuated Magnetization-Prepared Gradient Echo Acquisition for Detection of Posterior Fossa Demyelinating Lesions in Multiple Sclerosis.

Detection of infratentorial demyelinating lesions in multiple sclerosis (MS) presents a challenge in magnetic resonance imaging (MRI), a difficulty that is further heightened in 7 T MRI. This study aimed to assess the efficacy of a novel MRI approach, lesion-attenuated magnetization-prepared gradient echo acquisition (LAMA), for detecting demyelinating lesions within the posterior fossa and upper cervical spine on 7 T MRI and contrast its performance with conventional double-inversion recovery (DIR) and T2-weighted turbo spin echo sequences. We conducted a retrospective cross-sectional study in 42 patients with a confirmed diagnosis of MS. All patients had 7 T MRI that incorporated LAMA, 3D DIR, and 2D T2-weighted turbo spin echo sequences. Three readers assessed lesion count in the brainstem, cerebellum, and upper cervical spinal cord using both DIR and T2-weighted images in one session. In a separate session, LAMA was analyzed alone. Contrast-to-noise ratio was also compared between LAMA and the conventional sequences. Lesion counts between methods were assessed using nonparametric Wilcoxon signed rank test. Interrater agreement in lesion detection was estimated by intraclass correlation coefficients. LAMA identified a significantly greater number of lesions than DIR + T2 (mean 6.4 vs 3.0; P < 0.001). LAMA also exhibited better interrater agreement (intraclass correlation coefficient [95% confidence interval], 0.75 [0.41-0.88] vs 0.61 [0.35-0.78]). The contrast-to-noise ratio for LAMA (3.7 ± 0.9) significantly exceeded that of DIR (1.94 ± 0.7) and T2 (1.2 ± 0.7) (all P 's < 0.001). In cases with no lesions detected using DIR + T2, at least 1 lesion was identified in 83.3% with LAMA. Across all analyzed brain regions, LAMA consistently detected more lesions than DIR + T2. LAMA significantly improves the detection of infratentorial demyelinating lesions in MS patients compared with traditional methods. Integrating LAMA with standard magnetization-prepared 2 rapid acquisition gradient echo acquisition provides a valuable tool for accurately characterizing the extent of MS disease.

Predicting the apolipoprotein E ε4 allele carrier status based on gray matter volumes and cognitive function.

Apolipoprotein E (ApoE) ε4 carriers have a higher risk of developing Alzheimer's disease (AD) and show brain atrophy and cognitive decline even before diagnosis. To predict ApoE ε4 status using gray matter volume (GMV) obtained from magnetic resonance imaging images and demographic data with machine learning (ML) methods. We recruited 74 participants (25 probable AD, 24 amnestic mild cognitive impairment, and 25 cognitively normalolder people) with known ApoE genotype (22 ApoE ε4 carriers and 52 noncarriers) and scanned them with three-dimensional (3D) T1-weighted (T1W) and 3D double inversion recovery (DIR) sequences. We extracted GMV from regions of interestrelated to AD pathology and used them as features along with age and mini-mental state examination (MMSE) scores to train different ML models. We performed both receiver operating characteristiccurve analysis and the prediction analysis of the ApoE ε4 carrier with different ML models. The best model of ML analyses was a cubic support vector machine (SVM3) that used age, the MMSE score, and DIR GMVs at the amygdala, hippocampus, and precuneus as features (AUC=.88). This model outperformed models using T1W GMV or demographic data alone. Our results suggest that brain atrophy with DIR GMV and cognitive decline with aging can be useful biomarkers for predicting ApoE ε4 status and identifying individuals at risk of AD progression.

The added value of double inversion recovery (DIR) sequence compared to fluid attenuation inversion recovery (FLAIR) in identifying multiple sclerosis lesions and different cortical subtypes

Background. Diabetic here is a rising concern about multiple sclerosis (MS) lesions that occur in the cortical gray matter (GM), owing to its direct relationship with the disability and cognition dysfunction that occur during the MS course. Two magnetic resonance imaging (MRI) sequences that aid in the precise identification of these lesions are the Double Inversion Recovery (DIR) and Fluid Attenuation Inversion Recovery (FLAIR) sequences. Objective. To study the importance of the DIR for brain lesion detection and the various cortical subtypes distinction in MS-diagnosed patients and its correlations to the level of patient disability by comparing it to FLAIR. Patients and Methods: Thirty MS patients participated in this retrospective cross-sectional study, who had been previously diagnosed with MS and were routinely followed up at the Radiology Department at Ain-Shams University. Results. Comparing the DIR sequence to FLAIR, the overall MS lesion detection enhanced by 8% (p&lt;0.001). Regarding the detection of cortical lesion subtypes (I–IV), it was discovered that the DIR sequence revealed significantly more lesions than FLAIR (p&lt;0.001). The cortical lesions detected by DIR or FLAIR were found to have positive, highly significant correlations with both patients’ disability and the MS duration. Conclusion. For lesion identification, DIR is more effective than FLAIR, particularly for cortical and juxtacortical lesions in MS patients.

Detection of Multiple Sclerosis Lesions in Supra- and Infra-Tentorial Anatomical Regions by Double Inversion Recovery, Flair, and T2 MRI Sequences: A Comparative Study in Iraqi Patients

Background: In young adults, multiple sclerosis is a prevalent chronic inflammatory demyelinating condition. It is characterized by white matter affection, but many individuals also have significant gray matter involvement. A double-inversion recovery pulse (DIR) pattern was recently proposed to improve the visibility of multiple sclerosis lesions. Objective: To find out how well a DIR sequence, FLAIR, and T2-weighted pulse sequences can find MS lesions in the supratentorial and infratentorial regions. Methods: A total of 37 patients with established diagnoses of multiple sclerosis were included in this cross-sectional study. Brain MRI was done using double inversion recovery, T2, and FLAIR sequences. The number of lesions was counted and compared in the three sequences. Results: The DIR sequence detected more infratentorial lesions when compared to the T2 and FLAIR sequences. In the supratentorial region, DIR detected more lesions than T2 and FLAIR. Conclusion: The DIR sequence is highly superior to both the T2 and FLAIR sequences in depicting the lesions, regardless of their anatomical distribution. Moreover, the DIR sequence detected more multiple sclerosis lesions in the infratentorial region than the traditional T2W and FLAIR sequences.

Single-slab 3D double inversion recovery for magnetic resonance brain imaging in clinically healthy dogs.

In veterinary medicine, magnetic resonance imaging (MRI) is widely utilized for brain imaging. But the complex structures of brain tissues can give rise to artifacts such as partial volume averaging in conventional sequences. To address this issue, several studies about double inversion recovery (DIR) sequences have been conducted in human medicine. However, published clinical studies about brain MRI using DIR sequences in dogs are currently lacking. The purpose of this study was to evaluate the magnetic resonance features of single-slab 3D DIR sequences in the normal canine brain. Five healthy Beagle dogs were examined and the following pulse sequences were acquired for each: (1) spin-echo T2-weighted (T2W), (2) fluid attenuated inversion recovery (FLAIR), (3) gray matter (GM) selective, and (4) white matter (WM) selective single-slab 3D DIR sequence. For qualitative analysis, the distinction between gray and white matter of the cerebral cortex, presence and severity of the image artifacts were assessed for each pulse sequence. In addition, reconstructed images of single-slab 3D DIR sequences were qualitatively evaluated. For quantitative analysis, contrast ratios (CRs), signal-to-noise ratios (SNRs), and contrast-to-noise ratios (CNRs) of the GM, WM and cerebrospinal fluid (CSF) were measured for each pulse sequence. GM selective 3D DIR was superior to T2W and FLAIR in delineating the boundaries between GM and WM in the overall brain area. Whereas WM selective 3D DIR provided better gray-white matter distinction of the cerebral cortex than T2W and FLAIR at the level of the medulla oblongata, where T2W and FLAIR images exhibited severe partial volume averaging artifacts. In general, the 3D DIR images demonstrated fewer artifacts compared to other sequences, and the reconstructed sagittal and dorsal images of these sequences maintained same spatial resolution as the original transverse images without any image degradation. Both gray and white matter selective 3D DIR sequences effectively suppressed unwanted signals, thereby providing high contrast between gray and white matter. Findings from this study could serve as a foundation for further studies on DIR sequences for the evaluation of brain diseases in dogs.

Diagnostic performance of double inversion recovery MRI sequence for synovitis of the wrist joints in rheumatoid arthritis.

To assess the diagnostic accuracy of double inversion recovery (DIR) magnetic resonance imaging (MRI) sequences for synovitis of the wrist joints in patients with rheumatoid arthritis (RA). Participants with newly diagnosed RA were enrolled between November 2019 and November 2020. MRI examinations of the wrist joints were performed using a contrast-enhanced T1-weighted imaging sequence (CE-T1WI) and DIR sequence. We measured synovitis score, number of synovial areas, synovial volume, mean synovium-to-bone signal ratio (SBR), and synovial contrast-to-noise ratio (SNR). The inter-reviewer agreement rated on a four-point scale was evaluated by calculating the weighted k statistics. Two MRI sequences were assessed using Bland-Altman analyses, and the diagnostic performance of DIR images was calculated using the chi-square test. A total of 47 participants were evaluated, and 282 joint regions in 5076 images were reviewed by two readers. There was no significant difference in synovitis scores (P = 0.67), number of synovial areas (P = 0.89), and synovial volume (P = 0.086) between the two MRI sequences. DIR images showed better SBR and SNR (all P < 0.01). There was good agreement between the two reviewers in terms of synovitis distribution (κ = 0.79). The synovitis was well agreed upon by the two readers according to Bland-Altman analyses. Using CE-T1WI as the reference standard, DIR imaging demonstrated a sensitivity of 94.1% and a specificity of 84.6% at the patient level. The non-contrast DIR sequence showed good consistency with CE-T1WI and potential for evaluating synovitis in patients with RA.

Improved detection of juxtacortical lesions using highly accelerated double inversion-recovery MRI in patients with multiple sclerosis

PurposeThe purpose of this study was to compare a highly-accelerated double inversion recovery (fast-DIR) sequence using a recent parallel imaging technique (CAIPIRINHA) with a conventional DIR (conv-DIR) sequence for image quality and the detection of juxtacortical and infratentorial multiple sclerosis (MS) lesions. Materials and methodsA total of 38 patients with MS who underwent brain MRI at 3 T between 2020 and 2021 were included. There were 27 women and 12 men with a mean age of 40 ± 12.8 (standard deviation) years (range: 20–59 years). All patients underwent conv-DIR sequence and fast-DIR sequence. Fast-DIR was obtained with a T2-preparation module to improve contrast and an iterative denoising algorithm to compensate noise enhancement. Two blinded readers reported the number of juxtacortical and infratentorial MS lesions for fast-DIR and conv-DIR, confirmed by further consensus reading that was used as the standard of reference. Image quality and contrast were evaluated for fast-DIR and conv-DIR sequences. Comparisons between fast-DIR and conv-DIR sequences were performed using Wilcoxon test and Lin concordance correlation coefficient. ResultsThirty-eight patients were analyzed. Fast-DIR imaging allowed detection of 289 juxtacortical lesions vs. 238 with conv-DIR, corresponding to a significant improved detection rate with fast-DIR (P < 0.001). Conversely, 117 infratentorial lesions were detected with conv-DIR sequence vs. 80 with fast-DIR sequence (P < 0.001). Inter-observer agreement for lesion detection with fast-DIR and conv-DIR was very high (Lin concordance correlation coefficient ranging between 0.86 and 0.96). ConclusionFast-DIR improves the detection of juxtacortical MS lesions, but is limited for the detection of infratentorial MS lesions.

Advanced magnetic resonance imaging (MRI) technique (double inversion recovery sequence) in the diagnosis of multiple sclerosis (MS) grey matter lesions.

Advanced magnetic resonance imaging (MRI) technique (double inversion recovery sequence) in the diagnosis of multiple sclerosis (MS) grey matter lesions.

Prediction of Retinal Loss Based on Lesion of the Optic Nerve in Acute Stage of Optic-Neuritis

Aim: To assess the predictive features of optic neuritis in retinal loss through optic nerve lesion identification. Study design: Prospectively longitudinal study Place and duration of study: Ghulam Muhammad Mahar Medical College Sukkur and Shaheed Mohtarma Benazir Bhutto Medical University Larkana from 1st January 2021 to 30th June 2022. Methodology: One hundred and ten patients suffering from acute optic neuritis ≤8 weeks were enrolled. Retinal optical-coherence tomography was performed in all patients. Fifty five patients in the whole cohort while clinically isolated syndrome (CIS) 25 patients and relapsing remitting multiple sclerosis (RRMS) as well as neuromyelitis-optica spectrum disorders (NMOSD) and isolated optic neuritis as 20, 3 and 7 respectively. Brain optic nerve magnetic resonance imaging which included three-dimensional double inversion recovery sequence was also conducted at acute phase (M0) and then post 12 months (M12). Results: The mean age of the cases was 30.85±8.9 years. There was a higher frequency of males then females. The duration of the disease was found highest in RRMS cases with 50.31±77.45 months. The variance in estimated and standard error of the ganglion cell-inner plexiform layer volume change was significantly different in whole acute optic neuritis cases as well as the one with CIS and multiple sclerosisat cohort. Conclusion: Optic nerve-lesion length in prediction of retinal-neuroaxonal loss in cases of optic neuritis. The optic-nerve lesion length can also be considered as a biomarker for the process of retinal remodeling as well as visual impairment. Key words: Optic nerve lesion, Acute phase, Optic neuritis (ON), Retinal neuronal loss

Synthetic double inversion recovery imaging in brain MRI: quantitative evaluation and feasibility of synthetic MRI and a comparison with conventional double inversion recovery and fluid-attenuated inversion recovery sequences

Background and purposeSynthetic MR imaging (SyMRI) allows the reconstruction of various contrast images, including double inversion recovery (DIR), from a single scan. This study aimed to investigate the advantages of SyMRI by comparing synthetic DIR images with synthetic T2-weighted fluid-attenuated inversion recovery (T2W-FLAIR) and conventional DIR images.Materials and methodsWe retrospectively reviewed the imaging data of 100 consecutive patients who underwent brain MRI between December 2018 and March 2019. Synthetic DIR, T2W-FLAIR, T1-weighted, and phase-sensitive inversion recovery (PSIR) images were generated from SyMRI data. For synthetic DIR, the two inversion times required to suppress white matter and cerebrospinal fluid (CSF) were manually determined by two radiologists. Quantitative analysis was performed by manually tracing the region of interest (ROI) at the sites of the lesion, white matter, and CSF. Synthetic DIR, synthetic T2W-FLAIR, and conventional DIR images were compared on the basis of using the gray matter-to-white matter, lesion-to-white matter, and lesion-to-CSF contrast-to-noise ratios.ResultsThe two radiologists showed no differences in setting inversion time (TI) values, and their evaluations showed excellent interobserver agreement. The mean signal intensities obtained with synthetic DIR were significantly higher than those obtained with synthetic T2W-FLAIR and conventional DIR.ConclusionSynthetic DIR images showed a higher contrast than synthetic T2WFLAIR and conventional DIR images.

Retinal Hyperreflecting Foci Associate With Cortical Pathology in Multiple Sclerosis.

Background and ObjectivesMicroglia, the resident immune cell of the brain and retina, is widespread activated in the white and gray matter (GM) in multiple sclerosis (MS). The objective of this study is to evaluate the presence and number of hyperreflecting foci (HRF), considered clusters of activated and proliferating retinal microglia, and their association with clinical and radiologic disease parameters in relapsing-remitting MS (RRMS).MethodsAt baseline, 80 patients with RRMS underwent optical coherence tomography (OCT) and 3T-MRI (including 3-dimensional T1, fluid-attenuated inversion recovery, and double inversion recovery sequences), closed to their disease onset (6.3 ± 5.1 months). These patients were then clinically and radiologically followed up for a mean of 43 months, evaluating the no evidence of disease activity (NEDA) condition, further divided into clinical (cNEDA) and radiologic (rNEDA). Patients with a clinical history or MRI/OCT findings suggestive of optic neuritis (ON) were excluded from the study.ResultsCompared with healthy controls, the HRF number was significantly higher in the inner nuclear layer (INL) of patients with RRMS (19.55 ± 5.65 vs 13.84 ± 2.57, p < 0.001) and associated with INL volume (β: 1.21, p < 0.001). GM lesion volume significantly correlated with the INL HRF count (p = 0.008). Survival analysis revealed a significant association between INL HRF and both cNEDA (p = 0.017) and rNEDA (p = 0.002).DiscussionWe found a strong association between retinal microglial proliferation and cortical pathology in RRMS, a finding suggesting a possible underlying common immunopathologic mechanism. Furthermore, microglial activation at baseline was observed to predict subsequent inflammatory events, indicating that HRF might be a candidate prognostic biomarker worthy of further investigation.Classification of EvidenceThis study provides Class II evidence that in patients with early RRMS but without ON, the number of HRF on OCT of the retinal inner nuclear layer is associated with cNEDA and rNEDA.

Contrast-enhanced double inversion recovery sequence for patients with multiple sclerosis: feasibility of subtraction images between pre- and post-contrast images.

Few reports have examined the feasibility of a post-contrast double inversion recovery (DIR) magnetic resonance (MR) sequence in patients with multiple sclerosis (MS) because of partial or complete signal loss of enhancing MS lesions. To compare subtracted images of DIR (pre-contrast - post-contrast DIR images) with contrast enhanced T1-weighted (CE-T1W) images in the depiction of contrast enhancement of MS lesions. In total, 27 patients were included. Two neuroradiologists interpreted both images of CE-T1W imaging and subtracted DIR, and interpretation of the images was classified into a score of 1-5 (from 5, definitely superior contrast of lesions on DIR subtraction compared to conventional CE-T1W imaging, to 1, definitely superior contrast of lesions on CE-T1W imaging. The interrater agreement (κ coefficient) was measured. The signal-to-noise ratio (SNR) and contrast-noise-ratio (CNR) of the lesion were compared. A significant difference (P < 0.001) in scoring was seen between conventional CE-T1W imaging (2.1 ± 1.5 with one reviewer and 2.4 ± 1.5 with the other) and DIR subtraction (4.4 ± 1.0 with one reviewer and 4.7 ± 0.8 with the other). SNR from conventional CE-T1W imaging (24.8 ± 14.7) was significantly superior to that from DIR subtraction (4.0 ± 1.0; P < 0.001). CNR in DIR subtraction (326.4 ± 250.0) was significantly superior to that in conventional CE-T1W imaging (0.8 ± 5.5; P < 0.001). For interrater agreement in the evaluation of contrast enhancement of the lesions, κ coefficients were 0.84 for conventional CE-T1W imaging and 0.72 for DIR subtraction. Subtracted DIR image enables more obvious contrast enhancement of the MS lesions compared with conventional CE-T1W imaging.

Diagnostic accuracy of double inversion recovery (DIR) in detection of cortical gray matter lesions in patients with MS

BackgroundConventional imaging techniques have a low sensitivity for detection of cortical and deep grey matter lesions in MS which hinder accurate assessment of the total lesion burden. Aim of this work was to assess the diagnostic accuracy of double inversion recovery (DIR) sequence in the detection of cortical grey matter lesions in MS patients.ResultsForty MS patients were prospectively included in this study. Imaging was performed using Philips Ingenia 1.5 T device. The sensitivity, specificity, PPV, NPV and accuracy of DIR sequence in detection of cortical grey matter lesions were 60%, 100%, 100%, 55.6% and 73.3%, respectively. The sensitivity, specificity, positive and negative predictive values as well as accuracy of Flair sequence were 50%, 100%, 100%, 50% and 66.7%, respectively. The sensitivity, specificity, positive and negative predictive values as well as accuracy of T2 sequence in the detection of cortical grey matter lesions were 22.5%, 100%, 100%, 39.2% and 48.3%, respectively.ConclusionsDetection rate of cortical gray matter lesions was significantly higher on DIR sequence than on T2 and Flair sequences.

Comparative between Double Inversion Recovery and Fluid-Attenuated Inversion Recovery Sequences for Detection of Brain Multiple Sclerosis

Multiple sclerosis (MS) is the most common chronic inflammatory demyelinating disease of the central nervous system (CNS). MS diagnosis and disease monitoring are mostly based on Magnetic Resonance Imaging (MRI). This study aims to compare a double inversion recovery MRI sequence with a fluid-attenuated inversion recovery sequence in Multiple Sclerosis (MS) in the brain. A study was conducted on 75 patients whose aged between 10 and 70 years who were having MS in the brain to compare a double in

Utility of 3D Double Inversion Recovery Sequence in Paediatric Epilepsy and its Comparison to 3D Fluid Attenuation Inversion Recovery Sequence and T1 Inversion Recovery Sequence : A Cross-sectional Study

Introduction: Epilepsy is a disease with predisposition to generate epileptic seizures, associated with neurobiological, cognitive, psychological, and social consequences. Nearly 30% of children undergoing medical treatment for epilepsy become refractive to the treatment. For those children, the ability to find the epileptogenic area is higher with Magnetic Resonance Imaging (MRI) of the brain. The traditional 2D spin-echo sequences used in epilepsy protocol for adults cannot be used alone in paediatric structural neuroimaging. Additional sequences are needed to identify epileptogenic areas due to differences in myelination. Here, present study compared the role of three volumetric sequences 3D-Fluid Attenuated Inversion Recovery (FLAIR) , 3D-T1 weighted Inversion Recovery (T1-IR) and 3D-Double Inversion Recovery (DIR) for paediatric epilepsy as part of structural neuroimaging. Aim: To assess the utility of 3D-DIR in paediatric epilepsy disorders and localisation of epileptogenic foci in brain, congenital malformations of brain and compare its findings with 3D-FLAIR and 3D-T1-IR. Materials and Methods: The present study was a cross-sectional study of children diagnosed with paediatric epilepsy, who were evaluated with MRI brain at Stanley Medical College, Chennai, Tamil Nadu, India, between April 2020 to April 2021 with three sequences, 3D-DIR, 3D-T1-IR and 3D-FLAIR. Lesions of atleast 3 mm in diameter were identified as foci of high signal intensity and counted in each of the three sequences separately and classified according to their location. Then, average signal intensities of the lesions were calculated manually on each of sequences using Region of Interest (ROI) analysis which had a mean size of 3 mm2 . Then the Signal-to-Noise Ratio (SNR), Contrast to-Noise Ratio (CNR), Contrast Ratio (CR), and Asymmetry Signal Ratio (ASR) were calculated. Results: Evaluation was done on 51 paediatric epilepsy patients and showed the total number of lesions detected (208 lesions) and measured contrast parameters (CR, CNR and ASR) which were found to be significantly higher in 3D-DIR, showed higher detection of the intracortical and white matter lesions than 3DFLAIR and 3D-T1-IR. SNR was higher in 3D-FLAIR. Conclusion: Present study concluded that the greatest value of the DIR sequence has a higher ability in detecting epileptogenic foci and congenital malformations of the lesions in comparison with FLAIR and T1-IR.

Glymphatic system impairment in multiple sclerosis: relation with brain damage and disability.

Recent evidence has shown the existence of a CNS 'waste clearance' system, defined as the glymphatic system. Glymphatic abnormalities have been described in several neurodegenerative conditions, including Alzheimer's and Parkinson's disease. Glymphatic function has not been thoroughly explored in multiple sclerosis, where neurodegenerative processes are intermingled with inflammatory processes. We aimed to investigate glymphatic system function in multiple sclerosis and to evaluate its association with clinical disability, disease course, demyelination and neurodegeneration, quantified using different MRI techniques. In this retrospective study, we enrolled 71 multiple sclerosis patients (49 relapsing-remitting and 22 progressive multiple sclerosis) and 32 age- and sex-matched healthy control subjects. All subjects underwent neurological and MRI assessment including high-resolution T1, T2 and double inversion recovery sequences, diffusion and susceptibility weighted imaging. We calculated the diffusion along perivascular space index, a proxy for glymphatic function, cortical and deep grey matter volume, white and cortical grey matter lesion volume and normal-appearing white matter microstructural damage. Multiple sclerosis patients showed an overall lower diffusion along perivascular space index versus healthy controls (estimated mean difference: -0.09, P = 0.01). Both relapsing-remitting and progressive multiple sclerosis patients had lower diffusion along perivascular space index versus healthy controls (estimated mean difference: -0.06, P = 0.04 for relapsing-remitting and -0.19, P = 0.001 for progressive multiple sclerosis patients). Progressive multiple sclerosis patients showed lower diffusion along perivascular space index versus relapsing-remitting multiple sclerosis patients (estimated mean difference: -0.09, P = 0.03). In multiple sclerosis patients, lower diffusion along perivascular space index was associated with more severe clinical disability (r = -0.45, P = 0.001) and longer disease duration (r = -0.37, P = 0.002). Interestingly, we detected a negative association between diffusion along perivascular space index and disease duration in the first 4.13 years of the disease course (r = -0.38, P = 0.04) without any association thereafter (up to 34 years of disease duration). Lower diffusion along perivascular space index was associated with higher white (r = -0.36, P = 0.003) and cortical (r = -0.41, P = 0.001) lesion volume, more severe cortical (r = 0.30, P = 0.007) and deep (r = 0.42, P = 0.001) grey matter atrophy, reduced fractional anisotropy (r = 0.42, P = 0.001) and increased mean diffusivity (r = -0.45, P = 0.001) in the normal-appearing white matter. Our results suggest that the glymphatic system is impaired in multiple sclerosis, especially in progressive stages. Impaired glymphatic function was associated with measures of both demyelination and neurodegeneration and reflects a more severe clinical disability. These findings suggest that glymphatic impairment may be a pathological mechanism underpinning multiple sclerosis. The dynamic interplay with other pathological substrates of the disease deserves further investigation.

In vivo detection of damage in multiple sclerosis cortex and cortical lesions using NODDI

ObjectiveTo characterise in vivo the microstructural abnormalities of multiple sclerosis (MS) normal-appearing (NA) cortex and cortical lesions (CLs) and their relations with clinical phenotypes and disability using neurite orientation dispersion...

The value of double inversion recovery MRI sequence in assessment of epilepsy patients

BackgroundThe 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.ResultsIn mesial temporal sclerosis, the measured contrast parameters (SNR, CR, CNR and AI) were found to be significantly higher in DIR than in FLAIR and T2 sequences. In cases of focal cortical dysplasia, significantly higher CNR and AI in DIR than in 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.ConclusionsOur 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.

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.