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Updated: Mar 20, 2026
Magnetic Resonance Imaging of Multiple Sclerosis at 7.0 Tesla
Published on: February 19, 2021
Altered signal intensity of active enhancing inflammatory lesions using post-contrast double inversion recovery MR
Jérôme Hodel1,2,3, Sammy Badr4, Olivier Outteryck5
1Departments of Neuroradiology, AP-HP, Hôpitaux Universitaires Henri Mondor, Créteil, France. jerome.hodel@gmail.com.
Objectives:
We aimed at establishing the impact upon gadolinium administration on the conspicuity of active enhancing multiple sclerosis (MS) lesions using double inversion recovery (DIR) at 3T.
Methods:
15 consecutive patients with MS (n=8) or a clinically isolated syndrome (n=7) underwent pre and post-contrast DIR in addition to T2-weighted, FLAIR, pre and post-contrast T1-weighted sequences. First, two neuroradiologists located and marked all the enhancing MS lesions visible in consensus. Second, two other neuroradiologists, blinded to other sequences than DIR, independently assessed the SI changes from pre to post-contrast DIR images for each enhancing lesion, according to a 4-point-scale: increased SI (grade 1), absence of change (grade 2), lesion being partially (grade 3) or completely masked on post-contrast DIR images (grade 4).
Results:
246 MS lesions were detected including 26 enhancing on post-contrast T1-weighted images in 9 patients. The two blinded readers concluded to a decreased signal-intensity on post-contrast DIR images for all the 26 enhancing MS lesions (14 of grade 3 and 12 of grade 4). Inter-observer agreement was excellent, Kappa=0.85 (0.75 - 0.94). Using DIR post-contrast leads to altered signal-intensity of enhancing active MS lesions, ranging from partial to complete signal-loss.
Conclusion:
Our study strongly suggests the use of DIR before gadolinium administration.
Key Points:
• DIR has gained widespread use in MS. • MRI protocols for MS patients usually contain several post-contrast sequences. • Signal-intensity of enhancing MS lesions is altered using DIR post-contrast. • Our study strongly suggests the use of DIR before gadolinium administration.
Insights
Gadolinium administration alters the conspicuity of active multiple sclerosis (MS) lesions on double inversion recovery (DIR) MRI scans. Performing DIR before gadolinium contrast injection is strongly suggested to avoid signal loss in enhancing MS lesions.
Area of Science:
- Radiology
- Neuroimaging
- Magnetic Resonance Imaging
Background:
- Double inversion recovery (DIR) is widely used in multiple sclerosis (MS) imaging.
- MRI protocols for MS patients often include post-contrast sequences.
Purpose of the Study:
- To evaluate the impact of gadolinium administration on the conspicuity of active, enhancing MS lesions using 3T DIR imaging.
Main Methods:
- 15 patients with MS or clinically isolated syndrome underwent pre- and post-contrast DIR and other MRI sequences.
- Two blinded neuroradiologists assessed signal intensity changes in enhancing lesions on post-contrast DIR images using a 4-point scale.
Main Results:
- All 26 enhancing MS lesions showed decreased signal intensity on post-contrast DIR images (14 partially masked, 12 completely masked).
- Inter-observer agreement for lesion masking was excellent (Kappa=0.85).
- Post-contrast DIR alters signal intensity of enhancing active MS lesions, causing partial to complete signal loss.
Conclusions:
- Gadolinium administration significantly impacts the visibility of enhancing MS lesions on DIR sequences.
- The findings strongly suggest performing DIR imaging prior to gadolinium administration in MS patients.
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