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Optimisation of unenhanced MRI for detection of lesions in multiple sclerosis: a comparison of five pulse sequences
N Tubridy1, G J Barker, D G MacManus
1NMR Unit, Institute of Neurology, London, UK.
Abstract:
We used five MRI sequences in six patients with multiple sclerosis (MS): conventional spin-echo (CSE) with 5-mm slices; 2D fast spin-echo (FSE) with 2-mm slices; multishot T2*-weighted echo-planar imaging (EPI) with 5-mm slices; fast fluid-attenuated inversion recovery (fFLAIR) with 2-mm slices; and 3D fast spin-echo with 1.5-mm-thick slices. A total of 225 lesions were detected on CSE, 274 on 2D FSE, 137 on EPI, 385 on fFLAIR and 320 on 3D FSE. The EPI sequence was clearly the least sensitive and susceptibility artefact was a problem, particularly in the brain stem and temporal lobes. Fast FLAIR displayed a much higher number of supratentorial lesions (380) than 3D FSE (297), 2D FSE (264) or CSE (211). However, in the posterior cranial fossa 3D FSE was the most sensitive sequence (23 lesions), followed by CSE (14) and 2D FSE (10), while fFLAIR (5) was extremely insensitive.
Insights
Comparing MRI sequences for multiple sclerosis (MS) lesion detection, fast FLAIR excels in supratentorial regions, while 3D fast spin-echo is superior in the posterior cranial fossa. Echo-planar imaging showed the lowest sensitivity.
Area of Science:
- Radiology
- Neuroimaging
- Medical Physics
Background:
- Multiple sclerosis (MS) diagnosis and monitoring rely heavily on Magnetic Resonance Imaging (MRI) for lesion detection.
- Optimizing MRI sequences is crucial for accurate lesion characterization and patient management.
Purpose of the Study:
- To compare the sensitivity and lesion detection capabilities of five different MRI sequences in patients with multiple sclerosis.
- To identify the most effective MRI sequences for detecting lesions in different brain regions.
Main Methods:
- Five MRI sequences were evaluated in six multiple sclerosis patients: conventional spin-echo (CSE), 2D fast spin-echo (FSE), multishot T2*-weighted echo-planar imaging (EPI), fast fluid-attenuated inversion recovery (fFLAIR), and 3D fast spin-echo.
- Lesion counts were systematically recorded for each sequence.
Main Results:
- Fast FLAIR detected the highest number of supratentorial lesions (385), significantly outperforming other sequences.
- 3D fast spin-echo demonstrated the highest sensitivity for detecting lesions in the posterior cranial fossa (23 lesions).
- Echo-planar imaging (EPI) exhibited the lowest sensitivity and was prone to susceptibility artifacts, particularly in the brain stem and temporal lobes.
Conclusions:
- Fast FLAIR and 3D fast spin-echo are highly effective for detecting multiple sclerosis lesions, with regional strengths.
- The choice of MRI sequence should be tailored to the specific brain region of interest for optimal lesion detection in MS.
- EPI is not recommended for sensitive MS lesion detection due to low sensitivity and artifact issues.