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Updated: Mar 28, 2026
Magnetic Resonance Imaging of Multiple Sclerosis at 7.0 Tesla
Published on: February 19, 2021
An optimized MP2RAGE protocol for spinal cord imaging in multiple sclerosis
Nico Papinutto1, William A Stern2, Simone Sacco2
1From the Weill Institute for Neurosciences (N.P., W.A.S., S.S., I.P., B.A.C.C., S.L.H., R.G.H.), Department of Neurology, University of California, San Francisco, California, USA and Department of Brain and Behavioral Sciences (I.P.), University of Pavia, Pavia, Italy nico.papinutto@ucsf.edu.
Background And Purpose:
MRI methods for assessing spinal cord atrophy remain underutilized in MS research and clinical practice, because even the current advanced acquisition approaches to gray matter and total cord atrophy are hampered by the presence of lesions and inefficiencies in scan time. However, improved acquisition strategies and quantitative assessment methods have the potential to provide atrophy estimates sufficiently precise to be used as outcomes in clinical trials, as well as for patient care, while simultaneously providing excellent lesion identification. We developed and optimized a novel acquisition strategy for the MP2RAGE sequence at 3T to achieve a short acquisition-time protocol suitable for simultaneous estimation of gray and white matter spinal cord areas and lesion detection.
Materials And Methods:
After MP2RAGE protocol optimization using T1 mapping in a pilot cohort of 23 MS participants with upper cord lesions, we applied the optimized protocol to a cohort of 35 MS participants with varying extent of spinal cord involvement. Two neuroradiologists independently detected lesions using the MP2RAGE UNI image and an axial MEDIC sequence routinely used clinically. Inter-rater reliability of the reads was assessed, and generalized mixed models and Bowker's/McNemar's tests were used to compare the lesion-detection efficacy of the two protocols. SNR and CNR of the MP2RAGE images were computed at three representative cervical levels.
Results:
The proposed protocol provides multiple contrasts that enable clear differentiation of gray matter/white matter and cord/cerebrospinal fluid, even in the presence of lesions - features essential for reliable atrophy measurements. The lesion-detection efficacy of the MP2RAGE was statistically significantly superior to the MEDIC, for both number of detected lesioned levels and reader's confidence. At all three representative levels, the CNR of the optimized protocol was comparable to what was measured for established protocols in a previous study.
Conclusions:
We present a 3T spinal cord-optimized MP2RAGE protocol capable of covering the entire cervical spinal cord in approximately 5 minutes. This protocol offers high tissue CNR-fundamental for area quantification-, as well as lesion-detection efficacy comparable to that of established methods. Therefore, such a single MRI protocol could be an efficient approach for conducting clinical research.
Insights
A new 3T MRI protocol using MP2RAGE imaging allows for rapid, precise assessment of spinal cord atrophy and lesion detection in multiple sclerosis (MS) patients. This efficient method aids in both clinical trials and patient care.
Area of Science:
- Neuroimaging
- Quantitative MRI
- Spinal Cord Imaging
Background:
- Spinal cord atrophy assessment in MS is limited by lesions and scan time.
- Current MRI methods struggle with accuracy due to these limitations.
- Advanced techniques are needed for reliable atrophy estimation and lesion detection.
Purpose of the Study:
- To develop and optimize a novel MP2RAGE MRI protocol for 3T scanners.
- To achieve a fast acquisition suitable for simultaneous gray and white matter atrophy estimation.
- To enable accurate lesion detection alongside atrophy measurements.
Main Methods:
- Optimized MP2RAGE protocol using T1 mapping in MS patients.
- Applied protocol to a cohort of 35 MS participants.
- Compared lesion detection with MP2RAGE versus standard axial MEDIC sequence.
- Assessed signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR).
Main Results:
- The MP2RAGE protocol provides clear gray/white matter and cord/CSF differentiation, even with lesions.
- MP2RAGE demonstrated statistically superior lesion detection compared to MEDIC.
- CNR was comparable to established protocols, crucial for atrophy quantification.
Conclusions:
- A 3T spinal cord-optimized MP2RAGE protocol covers the cervical cord in ~5 minutes.
- Offers high tissue CNR for accurate quantification and effective lesion detection.
- Presents an efficient single MRI protocol for clinical research in MS.
