Double inversion recovery to detect cervical spinal cord multiple sclerosis lesions

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.