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Updated: Jan 20, 2026
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Comprehensive Autopsy Program for Individuals with Multiple Sclerosis
Published on: July 19, 2019
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Comparison of Unenhanced and Gadolinium-Enhanced Imaging in Multiple Sclerosis: Is Contrast Needed for Routine
G Sadigh1, A M Saindane2, A D Waldman2
1From the Departments of Radiology and Imaging Sciences (G.S., A.M.S., A.D.W., R.H.) gsadigh@emory.edu.
AJNR. American Journal of Neuroradiology
|August 24, 2019
Summary
Unenhanced MRI sequences, double inversion recovery (DIR) and FLAIR, can detect most gadolinium-enhancing lesions in multiple sclerosis (MS) patients. However, small or periventricular enhancing lesions may be missed, potentially impacting disease progression monitoring.
Area of Science:
- Radiology
- Neurology
- Medical Imaging
Background:
- Gadolinium-enhanced MRI is standard for multiple sclerosis (MS) follow-up.
- Assessing disease progression relies on detecting new or active lesions.
Purpose of the Study:
- To determine if unenhanced MRI sequences can identify gadolinium-enhancing MS lesions.
- To evaluate the utility of double inversion recovery (DIR) and FLAIR sequences for detecting MS lesion activity.
Main Methods:
- Reviewed 252 MRIs from 172 adult MS patients.
- Neuroradiologists assessed signal abnormality in DIR and FLAIR sequences corresponding to enhancing lesions.
- Assessed lesion progression in a subset of patients with prior imaging.
Main Results:
- 52 of 55 (95%) enhancing lesions showed corresponding hyperintensity on DIR and FLAIR.
- All enhancing lesions were concordant between DIR and FLAIR.
- Three small enhancing lesions were not visible on unenhanced sequences.
Conclusions:
- High concordance exists between gadolinium-enhancing lesions and DIR/FLAIR hyperintensity.
- Unenhanced DIR or FLAIR sequences can capture most MS imaging progression.
- Isolated enhancing lesions in confluent white matter lesions may be missed with unenhanced sequences alone.
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