Comparing lesion detection of infratentorial multiple sclerosis lesions between T2-weighted spin-echo, 2D-FLAIR, and 3D-FLAIR sequences

Wang, Kevin Y.; Uribe, Tomas; Lincoln, Christie M.

doi:10.1016/j.clinimag.2018.05.017

Cited by 13 publications

(14 citation statements)

References 21 publications

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“…Since 3D FLAIR is insensitive to flow artifacts, has thin partitions without gaps, and high isotropic spatial resolution, no additional acquisitions for the corpus callosum or infratentorial regions are needed. 34 3D FLAIR improves upon 2D FLAIR in many aspects relevant to the diagnosis and clinical investigation of MS, such as lesion detection 34 and CNR. Studies at 3 T found that 3D FLAIR revealed 21%–74% more lesions or white matter hyperintensities than 2D FLAIR.…”

Section: Flairmentioning

confidence: 99%

Three-dimensional MRI sequences in MS diagnosis and research

Rajendran

Lapointe

et al. 2019

Mult Scler

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The most recent guidelines for magnetic resonance imaging (MRI) in multiple sclerosis (MS) recommend three-dimensional (3D) MRI sequences over their two-dimensional (2D) counterparts. This development has been made possible by advances in MRI scanner hardware and software. In this article, we review the 3D versions of conventional sequences, including T1-weighted, T2-weighted and fluid-attenuated inversion recovery (FLAIR), as well as more advanced scans, including double inversion recovery (DIR), FLAIR2, FLAIR*, phase-sensitive inversion recovery, and susceptibility weighted imaging (SWI).

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Section: Flairmentioning

confidence: 99%

Three-dimensional MRI sequences in MS diagnosis and research

Rajendran

Lapointe

et al. 2019

Mult Scler

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“…Also, previous studies pointed out non-uniform signal of the magnetic field in the cortex of the limbic region, as well as the cortex of the central salcus. They indicated lower SNR and higher scanning time prevents the high spatial resolution requiring to display the cortex with a thickness of only 2 to 4 mm [23]. However, the CSF nulling was appropriate in our images obtained by DIR sequence even in the worst conditions.…”

Section: Discussionmentioning

confidence: 79%

“…The signal from CSF will be suppressed in FLAIR and DIR pulse sequences while on the contrary, DIR also attenuates the signal from white matter (WM) and the sensitivity of DIR pulse sequence increases to detect brain lesions in WM and gray matter (GM) compared to sequences such as proton density (PD) or T2WI and T1weighted (T1W) MR sequences at 1.5 and 3.0 T [18,22]. DIR has potential advantages over conventional MRI protocols to demonstrate both infratentorial and supratentorial MS lesions and also provides improved appearance of early lesions [20,23]. Various pulse sequences are used recently to enhance the sensitivity of MRI to identify more MS plaques.…”

Section: Discussionmentioning

confidence: 99%

“…It is important to diagnose infratentorial lesions because these findings indicate long-term disability in patients with MS which are along with early detection of the disease [23]. Performing DIR sequence is a beneficial method which may affect the diagnosis and deciding the treatment at the onset of the disease or especially in patients with CIS.…”

Section: Discussionmentioning

confidence: 99%

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Lesion load assessment among multiple sclerosis patient using DIR, FLAIR, and T2WI sequences

Almutairi

Hassan

Suppiah

et al. 2020

Egypt J Radiol Nucl Med

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Background Magnetic resonance imaging (MRI) is one of the diagnostic imaging modalities employing in lesion detection in neurological disorders such as multiple sclerosis (MS). Advances in MRI techniques such as double inversion recovery (DIR) made it more sensitive to distinguish lesions in the brain. To investigate the lesion load on different anatomical regions of the brain with MS using DIR, fluid attenuated inversion recovery (FLAIR) and T2-weighted imaging (T2WI) sequences. A total of 97 MS patients were included in our retrospective study, confirmed by neurologist. The patients were randomly selected from the major hospital in Saudi Arabia. All images were obtained using 3T Scanner (Siemens Skyra). The images from the DIR, FLAIR, and T2WI sequence were compared on axial planes with identical anatomic position and the number of lesions was assigned to their anatomical region. Results Comparing the lesion load measurement at various brain anatomical regions showed a significant difference among those three methods (p < 0.05). Conclusion DIR is a valuable MRI sequence for better delineation, greater contrast measurements and the increasing total number of MS lesions in MRI, compared with FLAIR, and T2WI and DIR revealed more intracortical lesions as well; therefore, in MS patients, it is recommended to add DIR sequence in daily routine imaging sequences.

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“…However, the contrast of infratentorial lesions on T2-FLAIR is suboptimal due to partial T1-weighting and different tissue relaxation properties between supratentorial and infratentorial regions. [3][4][5] 3D T2-FLAIR imaging has shown promise in improving the detection of infratentorial lesions, 6,7 especially with optimized scan parameters. 8 Combining T2-weighted and proton density-weighted images has also shown improved contrast.…”

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confidence: 99%

Sensitive Detection of Infratentorial and Upper Cervical Cord Lesions in Multiple Sclerosis with Combined 3D FLAIR and T2-Weighted (FLAIR3) Imaging

Gabr

Lincoln

Kamali

et al. 2020

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE: Infratentorial and spinal cord lesions are important for diagnosing and monitoring multiple sclerosis, but they are difficult to detect on conventional MR imaging. We sought to improve the detection of infratentorial and upper cervical cord lesions using composite FLAIR3 images. MATERIALS AND METHODS: 3D T2-weighted FLAIR and 3D T2-weighted images were acquired in 30 patients with MS and combined using the FLAIR3 formula. FLAIR3 was assessed against 3D T2-FLAIR by comparing the number of infratentorial and upper cervical cord lesions per subject using the Wilcoxon signed rank test. Intrarater and interrater reliability was evaluated using the intraclass correlation coefficient. The number of patients with and without $1 visible infratentorial/spinal cord lesion on 3D T2-FLAIR versus FLAIR3 was calculated to assess the potential impact on the revised MS diagnostic criteria. RESULTS: Compared with 3D T2-FLAIR, FLAIR3 detected significantly more infratentorial (mean, 4.6 6 3.6 versus 2.0 6 1.8, P , .001) and cervical cord (mean, 1.58 6 0.94 versus 0.46 6 0.45, P , .001) lesions per subject. FLAIR3 demonstrated significantly improved interrater reliability (intraclass correlation coefficient ¼ 0.77 [95% CI, 0.63-0.87] versus 0.60 [95% CI, 0.40-0.76] with 3D T2-FLAIR, P ¼ .019) and a tendency toward a higher intrarater reliability (0.86 [95% CI, 0.73-0.93] versus 0.79 [95% CI, 0.61-0.89], P ¼ .23). In our cohort, 20%-30% (47%-67%) of the subjects with MS had $ 1 infratentorial (cervical cord) lesion visible only on FLAIR3. CONCLUSIONS: FLAIR3 provides higher sensitivity than T2-FLAIR for the detection of MS lesions in infratentorial brain parenchyma and the upper cervical cord.

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Comparing lesion detection of infratentorial multiple sclerosis lesions between T2-weighted spin-echo, 2D-FLAIR, and 3D-FLAIR sequences

Cited by 13 publications

References 21 publications

Three-dimensional MRI sequences in MS diagnosis and research

Three-dimensional MRI sequences in MS diagnosis and research

Lesion load assessment among multiple sclerosis patient using DIR, FLAIR, and T2WI sequences

Sensitive Detection of Infratentorial and Upper Cervical Cord Lesions in Multiple Sclerosis with Combined 3D FLAIR and T2-Weighted (FLAIR3) Imaging

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