Axial 3D gradient-echo imaging for improved multiple sclerosis lesion detection in the cervical spinal cord at 3T

Abstract

Introduction In multiple sclerosis (MS), spinal cord imaging can help in diagnosis and follow-up evaluation. However, spinal cord magnetic resonance imaging (MRI) is technically challenging, and image quality, particularly in the axial plane, is typically poor compared to brain MRI. Because gradient-recalled echo (GRE) images might offer improved contrast resolution within the spinal cord at high magnetic field strength, both without and with a magnetization transfer prepulse, we compared them to T2-weighted fast-spin-echo (T2-FSE) images for the detection of MS lesions in the cervical cord at 3T. Methods On a clinical 3T MRI scanner, we studied 62 MS cases and 19 healthy volunteers. Axial 3D GRE sequences were performed without and with off-resonance radiofrequency irradiation. To mimic clinical practice, all images were evaluated in conjunction with linked images from a sagittal short tau inversion recovery scan, which is considered the gold standard for lesion detection in MS. Two experienced observers recorded image quality, location and size of focal lesions, atrophy, swelling, and diffuse signal abnormality independently at first and then in consensus. Results The number and volume of lesions detected with high confidence was more than three times as high on both GRE sequences compared to T2-FSE (p<0.0001). Approximately 5 % of GRE scans were affected by artifacts that interfered with image interpretation, not significantly different from T2W-FSE. Conclusions Axial 3D GRE sequences are useful for MS lesion detection when compared to 2D T2-FSE sequences in the cervical spinal cord at 3T and should be considered when examining intramedullary spinal cord lesions.

MRI of the cervical spine with 3D gradient echo sequence at 3 T: initial experience

“…Considering the advantages, the 3D FFE sequence could be incorporated into the cervical spine imaging protocol. A previous study 31 showed that gradient echo sequences are useful in the detection of cervical cord MS lesions at 3 T, which is concordant with the results of the present study.…”

The central vein sign and its clinical evaluation for the diagnosis of multiple sclerosis: a consensus statement from the North American Imaging in Multiple Sclerosis Cooperative

“…T2*-based imaging of the spinal cord is much more challenging, owing to factors such as the small physical dimensions of the spinal cord, strong magnetic field inhomogeneity caused by surrounding tissues (bones, soft tissues and air), and physiological motion (pulsation of cerebrospinal fluid flow, and cardiac and respiratory movement). Nonetheless, recent studies have demonstrated that high-quality, high-resolution T2*-weighted imaging of the cervical 65,66 and thoracic 67 cord is possible in patients with MS. However, no central vein findings have yet been reported.…”

Double Inversion Recovery Sequence of the Cervical Spinal Cord in Multiple Sclerosis and Related Inflammatory Diseases

“…Numerous studies have compared different sequences, such as STIR, which provides high lesion contrast, with this standard protocol in MS. [5][6][7] Other studies compared T2*-weighted gradient recalled-echo sequences with and without a magnetization transfer prepulse with axial T2 FSE and sagittal STIR images. 8 In inflammatory spine diseases with a diffuse pattern, such as neuromyelitis optica, diffusion tensor imaging has recently been used to measure fractional anisotropy with great success. 9,10 The double inversion recovery (DIR) sequence was first described by Redpath and Smith in 1994.…”