Detection of multiple sclerosis lesions in the cervical cord: which of the MAGNIMS ‘mandatory’ non-gadolinium enhanced sagittal sequences is optimal at 3T?

Abstract

Background and purpose 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. Methods 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. Results 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. Conclusions 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.

Improved detection of multiple sclerosis lesions with T2‐prepared double inversion recovery at 3T

“…In the study of spinal cord MS lesions, DIR is not commonly included in MR protocols, 40–42 even though the current guidelines 28 underline the importance of spinal cord examination at disease onset and during monitoring. While, on the one hand, it has been shown that DIR allows better detection of lesions of the cervical segment in comparison with conventional turbo spin echo sequences, 43 on the other hand, proton density‐weighted fast spin echo and short tau inversion recovery can detect more lesions compared to DIR 44 . Our results, despite being obtained only in the cervical segment of the spine, demonstrated a clearly better detection of MS lesions by using T2P, which encourages further studies to assess whether T2PDIR, either with or without ID, may be considered for future inclusion in MRI protocols addressing spinal cord lesions in MS.…”

Double inversion recovery to detect cervical spinal cord multiple sclerosis lesions

“…The current criteria from the MAGNIMS network recommends the use of sagittal noncontrast T2, proton density, and short tau inversion recovery (STIR) for the evaluation of MS lesions in the spinal cord. 7 Despite this, spinal cord evaluation has remained a challenge due to multiple factors, including the small size of the cord and artifacts caused by movements such as respiration, swallowing, and cardiac pulsations. 8 Double inversion recovery (DIR) is a MRI sequence wherein signal from the cerebrospinal fluid is suppressed (as with FLAIR).…”

“…DIR has been shown to be sensitive and specific, particularly in evaluation of cerebral cortical/juxtacortical demyelinating lesions 11 . However, based on current studies, there has been mixed data with studies supporting either superiority or inferiority of DIR in detecting demyelinating lesions in the cervical cord, with recent studies available having limited sample size 7,8,11 . The aim of the study was to explore the possibility of using volumetric DIR from brain MRI to study MS lesions of the upper cervical cord.…”