Comparison of 3D double inversion recovery and 2D STIR FLAIR MR sequences for the imaging of optic neuritis: pilot study

Abstract

3D DIR is increasingly used in neuroradiology. Compared with STIR FLAIR, 3D DIR improves detection of optic neuritis. Multiplanar analysis had the best diagnostic performance for optic nerve signal abnormalities. Sensitivity was 95% and specificity 94%. Findings support the use of 3D DIR instead of 2D sequences.

How Common Is Signal-Intensity Increase in Optic Nerve Segments on 3D Double Inversion Recovery Sequences in Visually Asymptomatic Patients with Multiple Sclerosis?

“…Differences in the signal-intensity rating between the student group and the expert reader could be explained by 2 possibilities: First, hyperintense susceptibility artifacts at the skull base common on 3D DIR were present in 57% of all examinations (in both the comparison group and the group of patients with MS) in various intensities and obscured the correct identification of 12 prechiasmatic nerve segments and 1 chiasm for the student readers and prevented accurate signal-intensity analysis of these nerve segments on 3D DIR for the unexperienced readers. 10 No artifacts were observed along the retrobulbar and the canalicular nerve segments on 3D DIR.…”

“…Acute optic neuritis is easily diagnosed by contrast enhancement on T1-weighted fat-suppressed images and T2-weighted hyperintensity on fat-suppressed T2-weighted FSE images and FLAIR images 10,[24][25][26][30][31]34,35 or by hypersignal on 3D DIR, 10 for the 3D DIR sequence suppresses fat, white matter, and fluid and gives optimal contrast between a pathologic hyperintense lesion and the surrounding suppressed background. 10 The diagnosis of subclinical optic nerve demyelination, however, is challenging on MR imaging. Contrast enhancement of the optic nerve segments on T1-weighted MR images is absent.…”

“…[14][15][16][17] Acute optic neuritis is easily diagnosed on MR imaging by focal nerve swelling and segmental T2-weighted hyperintensity, especially on STIR images or on fat-suppressed T2-weighted images and by segmental gadolinium enhancement on T1-weighted fat-suppressed images. 10,[18][19][20][21][22] The enhancement is present for a mean of 30 days after the onset of visual symptoms. 21,[23][24][25][26][27][28][29][30][31] Subclinical optic nerve demyelination, however, is not easily visible on MR imaging.…”

“…23,32,33 The highly diagnostic value of fat-suppressed FLAIR images and fat-suppressed 3D DIR images in the detection of any pathologic signal intensity in the optic nerve has been evaluated in acute optic nerve demyelination. 10,34,35 In a few patients with subclinical optic nerve demyelination, signal-intensity abnormalities have been reported on 3D FLAIR. 34 However, there are few data about the use of the 3D DIR sequence in the evaluation of subclinical optic nerve demyelination.…”

3D-DIR for early differential diagnostic and prognostic evaluation of NMO

“…In the acute period, the spinal cord showed swelling, necrosis and cavity lesions, lesions were enhanced after enhanced scanning, involving primarily gray matters and partial white matters of the central part, transversely, with the average length of the lesion being 4.7±0.6 centrum (Fig. 4), mostly located in neck and thoracic cord, and the lesions of cervical segment can extend up to the lower part of the medulla, and during recovery, the spinal cord in lesion site was able to shrink (19,20). The results of the present study show that the signal intensity of T2W, FLAIR and DIR of NMO patients were significantly higher than those of the MS patients, the average of sites involved were significantly more than those of the MS patients.…”