Improved Lesion Detection by Using Axial T2-Weighted MRI with Full Spinal Cord Coverage in Multiple Sclerosis.

Area of Science:

• Radiology
• Neurology
• Medical Imaging

Background:

• Accurate identification of lesion location is crucial for multiple sclerosis (MS) diagnostic criteria.
• Current clinical practice often relies on axial scans for cervical cord imaging and sagittal scans for lesion confirmation.
• The diagnostic utility of axial T2-weighted imaging (T2WI) for MS lesions needs further evaluation.

Purpose of the Study:

• To compare the lesion detection rate of axial T2WI with full spinal cord coverage against sagittal scans in patients with MS.
• To assess the impact of lesion size and location on detection rates between imaging planes.

Main Methods:

• 115 patients with definite or suspected MS underwent MRI with 3-mm sagittal and 3.5-mm axial T2WI, covering the full spinal cord.
• Two independent raters identified T2WI lesions on both axial and sagittal scans.
• Analysis included lesion count, axial diameter, craniocaudal extension, intensity, and location.

Main Results:

• Axial scans detected 449/509 (88.2%) lesions, while sagittal scans detected 337/509 (66.2%).
• Only 61.7% of lesions identified on axial scans were also visible on sagittal scans.
• Lesion detection rates were significantly dependent on axial lesion diameter (P < .001).

Conclusions:

• Axial T2WI with full spinal cord coverage identified 22% more MS lesions compared to sagittal scans.
• This improved detection was particularly notable for lesions with smaller axial diameters.
• Biplanar spinal MRI including both axial and sagittal views with full spinal cord coverage is recommended for routine MS lesion detection.