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Double inversion recovery to detect cervical spinal cord multiple sclerosis lesions
Shivam Patel1,2, Ian Dimaandal2, Tyler Kuhns2
1Comprehensive MS Center, UConn Health, Farmington, Connecticut, USA.
Background And Purpose:
Magnetic resonance imaging (MRI) plays a key role in diagnosing and monitoring multiple sclerosis (MS). Double inversion recovery (DIR) is a pulse sequence that has proven highly effective at detecting cortical lesions but is understudied in the spinal cord. We hypothesize that DIR images obtained during brain MRI can be of value in assessing the upper spinal cord of MS patients.
Methods:
We retrospectively examined brain MRI exams of 64 patients with established MS, who had also undergone cervical spine MRI. Two blinded MS expert readers, who assessed the scans for lesion numbers and rated lesion visibility and overall image quality, reviewed brain 3-dimensional DIR sagittal and coronal images. Standardized mean contrast-to-noise ratios (C/N) and standard deviation (SD) were calculated in representative lesions for each patient and compared to those of 3-dimensional FLAIR images.
Results:
For the analysis of lesions categorized as "definite lesions," the sensitivity was 87%, specificity was 61%, and negative predictive value was 80%. On the other hand, for "definite" plus "probable" lesions, the sensitivity was 91%, the specificity was 54%, and negative predictive value was 86%. DIR demonstrated lesions with an average C/N of 7.56 with an SD of 1.77. FLAIR sequence demonstrated lesions with an average C/N of 0.67 and SD of 1.27.
Conclusions:
Sagittally acquired brain DIR can provide useful information on upper spinal cord lesions, with high C/N. In theory, this should facilitate the attainment of McDonald's or the Magnetic Resonance Imaging in MS (MAGNIMS) criteria in some cases, without a dedicated cervical spine MRI exam.
Insights
Double inversion recovery (DIR) magnetic resonance imaging (MRI) of the brain can effectively detect upper spinal cord lesions in multiple sclerosis (MS) patients. This technique offers high contrast-to-noise ratios, potentially aiding diagnosis without a separate spinal MRI.
Area of Science:
- Neuroimaging
- Radiology
- Medical Diagnostics
Background:
- Magnetic resonance imaging (MRI) is crucial for multiple sclerosis (MS) diagnosis and monitoring.
- Double inversion recovery (DIR) is effective for brain cortical lesions but understudied in the spinal cord.
- Assessing the upper spinal cord in MS patients is vital for comprehensive disease evaluation.
Purpose of the Study:
- To investigate the utility of brain DIR MRI sequences for evaluating upper spinal cord lesions in MS patients.
- To compare the lesion detection capabilities of DIR with standard FLAIR sequences in the cervical spinal cord.
- To assess the diagnostic performance of DIR in identifying MS spinal cord lesions.
Main Methods:
- Retrospective analysis of brain MRI exams from 64 MS patients with existing cervical spine MRI.
- Two expert readers assessed brain 3D DIR sagittal and coronal images for lesion detection and quality.
- Contrast-to-noise ratios (C/N) and standard deviations (SD) were calculated for lesions and compared between DIR and FLAIR sequences.
Main Results:
- DIR demonstrated significantly higher C/N ratios (7.56) compared to FLAIR (0.67) for MS lesions.
- Sensitivity for definite lesions was 87%, with a negative predictive value of 80%.
- For definite plus probable lesions, sensitivity reached 91%, with a negative predictive value of 86%.
Conclusions:
- Sagittally acquired brain DIR MRI provides valuable information on upper spinal cord lesions in MS.
- The high C/N of DIR facilitates lesion visualization and characterization.
- Brain DIR MRI may potentially aid in meeting diagnostic criteria (e.g., McDonald's, MAGNIMS) without dedicated spinal MRI.
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