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Updated: Nov 7, 2025
Magnetic Resonance Imaging of Multiple Sclerosis at 7.0 Tesla
Published on: February 19, 2021
MRI to detect and localize the area postrema in multiple sclerosis: The role of 3D-DIR and 3D-FLAIR
Valentine Farges1, Salem Hannoun2, Théo Benini1
1Faculty of Medicine, Claude Bernard Lyon 1 University, Lyon, France.
Background And Purpose:
Area postrema (AP) is a highly vascularized paired 2 mm-long anatomical structure, localized on the dorsal inferior surface of the medulla oblongata, at the caudal end of the fourth-ventricle. AP is principally affected in AP syndrome, which is commonly associated with autoimmune inflammatory diseases, including essentially neuromyelitis optica spectrum disorder (NMOSD). The aim of this study is to assess the best cerebral MRI sequences and planes for AP detection in order to assist or aid in the diagnosis of difficult NMOSD cases.
Methods:
3DT1, 2DT2, 3D-fluid-attenuated inversion recovery (3DFLAIR), and 3D-double inversion recuperation (3DDIR), routinely used in inflammatory diseases, were analyzed and scored based on quality (0-2), and ability to detect AP in each plane (0 = no detection, 1 = probable detection, 2 = obvious detection). Based on image availability, subjects were divided into three groups: Group-1, including 100 randomly selected subjects with 3DT1 and 3DFLAIR, Group-2, including 30 multiple sclerosis (MS) patients from the "Observatoire Français de la Sclérose En Plaques" (OFSEP) with 3DT1, 3DFLAIR, and 3DDIR, and Group-3, including 164 OFSEP MS patients with 3DFLAIR and 2DT2.
Results:
AP was undetectable on 3DT1 and 2DT2. AP was detected in 87% of 3DFLAIR in Group-1, 90% in Group-2, and 90% in Group-3. AP was also detected in 100% of 3DDIR images in the axial plane.
Conclusions:
As evidenced, AP was easily assessed on 3DDIR and 3DFLAIR emphasizing the importance of adding these sequences to NMOSD MRI-protocols. Moreover, the most effective imaging plane in identifying AP was the axial plane.
Insights
Detecting the area postrema (AP) is crucial for diagnosing neuromyelitis optica spectrum disorder (NMOSD). 3D-double inversion recovery (3DDIR) and 3D-fluid-attenuated inversion recovery (3DFLAIR) MRI sequences, particularly in the axial plane, are most effective for AP visualization.
Area of Science:
- Neuroimaging
- Radiology
- Neurology
Background:
- The area postrema (AP) is a key structure affected in AP syndrome, often linked to autoimmune diseases like neuromyelitis optica spectrum disorder (NMOSD).
- Accurate AP detection is vital for diagnosing challenging NMOSD cases.
Purpose of the Study:
- To determine the optimal cerebral MRI sequences and imaging planes for detecting the area postrema (AP).
- To improve the diagnostic accuracy of neuromyelitis optica spectrum disorder (NMOSD) by enhancing AP visualization.
Main Methods:
- Analysis of 3DT1, 2DT2, 3D-fluid-attenuated inversion recovery (3DFLAIR), and 3D-double inversion recuperation (3DDIR) MRI sequences.
- Scoring of image quality and AP detection ability across different planes.
- Evaluation in three patient groups with varying MRI sequence availability.
Main Results:
- The area postrema (AP) was undetectable on 3DT1 and 2DT2 sequences.
- AP detection rates were 87% for 3DFLAIR and 100% for 3DDIR in the axial plane.
- 3DDIR and 3DFLAIR sequences demonstrated high efficacy in AP visualization.
Conclusions:
- 3DDIR and 3DFLAIR MRI sequences are essential additions to NMOSD diagnostic protocols for AP assessment.
- The axial plane is the most effective for identifying the area postrema (AP).
- Optimized MRI protocols can aid in the diagnosis of difficult NMOSD cases.
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