Dark Rims: Novel Sequence Enhances Diagnostic Specificity in Multiple Sclerosis

Area of Science:

• Neurology
• Radiology
• Medical Imaging

Background:

• The 2010 McDonald criteria for multiple sclerosis (MS) diagnosis offer high sensitivity but can lack specificity, potentially leading to misdiagnosis.
• Distinguishing MS from other white matter lesions is a diagnostic challenge.

Purpose of the Study:

• To evaluate a novel double inversion recovery magnetic resonance (MR) imaging technique for enhancing the specificity of MS diagnostic criteria.
• To assess the potential of GM-double inversion recovery MR imaging in differentiating MS from non-MS white matter lesions.

Main Methods:

• A cross-sectional observational study comparing MR imaging data from patients with MS and control subjects with white matter lesions.
• Utilized a novel GM-double inversion recovery sequence to suppress cerebrospinal fluid (CSF) and gray matter (GM) signals.
• Analyzed lesion characteristics, including the presence of a rim on GM-double inversion recovery images, in conjunction with McDonald criteria.

Main Results:

• Analysis included 107 patients with relapsing-remitting MS and 36 control subjects.
• A rim on GM-double inversion recovery MR imaging was observed in 35% of MS lesions versus 1% of control lesions.
• Combining 2010 McDonald criteria with the presence of rim lesions achieved 78% and 97% specificity for MS diagnosis with ≥1 and ≥2 rim lesions, respectively.

Conclusions:

• The novel GM-double inversion recovery MR imaging technique significantly enhances diagnostic specificity for MS.
• This technique offers a valuable addition to established MR imaging criteria for more accurate MS diagnosis.