Proton Density MRI Increases Detection of Cervical Spinal Cord Multiple Sclerosis Lesions Compared with T2-Weighted Fast Spin-Echo

Abstract

BACKGROUND AND PURPOSE:There is a paucity of literature that supports the Consortium of Multiple Sclerosis Centers guideline that proton density MR imaging is a core spinal cord sequence. We hypothesized that proton density fast spin-echo imaging is superior to T2 fast spin-echo MR imaging for the detection of cervical cord MS lesions. This study compared the detection rate and conspicuity of cervical cord MS lesions on sagittal 1.5T proton density fast spin-echo and T2 fast spin-echo MR imaging.

A 3T Phase-Sensitive Inversion Recovery MRI Sequence Improves Detection of Cervical Spinal Cord Lesions and Shows Active Lesions in Patients with Multiple Sclerosis

“…17 We reported significantly higher detection of spinal cord lesions with 3D-PSIR, with 65% of overall lesions not visible on the conventional set, which is consistent with the 28%-72% increased detection rate using the optimized spinal cord sequences in the literature. 10,12,14,16,23,24 Eleven (11%) patients without any lesions detected with the conventional set had at least 1 lesion captured using 3D-PSIR, which is similar to the 3%-24% previously reported. 10,12,16 One unreported-yet-major interest of 3D-PSIR was its ability to detect enhancement of active spinal cord lesions with similar detection rates compared with postcontrast T1 sequences.…”

“…To overcome challenges with spine imaging and increase both the sensitivity and specificity to detect inflammatory medullary lesions, the literature indicates a few other reliable MR imaging sequences, such as proton-density imaging, 10 STIR, 11,12 phasesensitive T1-weighted inversion-recovery MR imaging (PST1-IR), 13 Multi-Echo Recombined Gradient Echo (MERGE; GE Healthcare, Milwaukee, Wisconsin), 14 white matter-suppressed T1 inversion recovery, 15 double inversion recovery, 16 and MPRAGE. 17 Recent studies have shown that the phase-sensitive inversion recovery (PSIR) sequence, consisting of a heavily T1weighted inversion recovery combined with phase-sensitive reconstruction, 13,18 had the highest lesion-to-cord contrast and lesion-limit definition.…”

g-Ratio weighted imaging of the human spinal cord in vivo

“…Note that qMT has been used to measure myelin content in different g-ratio applications (Stikov et al, 2015b, 2011). The sensitivity of MTV to myelin is also confirmed by (i) lower values in the grey matter (see figure 6), (ii) its sensitivity to demyelination in the spinal cord (Bot et al, 2004; Chong et al, 2016), (iii) its high correlation with myelin stained histology (r 2 = 0.52) in multiple sclerosis (Mottershead et al, 2003), and (iv) its relation with brain development (Saito et al, 2012). …”

Evaluation of Focal Cervical Spinal Cord Lesions in Multiple Sclerosis: Comparison of White Matter-Suppressed T1 Inversion Recovery Sequence versus Conventional STIR and Proton Density-Weighted Turbo Spin-Echo Sequences

“…5,6 STIR has intrinsic sensitivity to T1 shortening effects in addition to T2 prolongation effects and improves the lesion contrast compared with T2-weighted sequences, translating to a better interreader agreement in the assessment of the extent of disease. 7 Nevertheless, artifacts and lower lesion conspicuity prevalent on these sequences may cause variability in the clinical evaluation of lesion burden, which is difficult to resolve in the absence of a true reference standard.…”