Comparative study between double inversion recovery (DIR) and fluid attenuated inversion recovery (FLAIR) MRI sequences for detection of cerebral lesions in multiple sclerosis
- Citation:
- Elkholy, S. F., M. A. Sabet, M. E. Mohammad, and R. E. I. Asaad, "Comparative study between double inversion recovery (DIR) and fluid attenuated inversion recovery (FLAIR) MRI sequences for detection of cerebral lesions in multiple sclerosis", Egyptian Journal of Radiology and Nuclear Medicine, vol. 51, issue 188, 2020.
Abstract:
Background: Multiple sclerosis (MS) is a common chronic inflammatory demyelinating disorder more common in
young adults. MS is characterized mainly with white matter (WM) affection; however, considerable gray matter (GM)
involvement is also noted in many patients. MRI is used for diagnosis and follow up of the disease using different pulse
sequences; FLAIR imaging provides the highest sensitivity in the detection of supratentorial, juxtacortical, and the
periventricular lesions but is less sensitive in the posterior fossa. A double inversion recovery (DIR) pulse sequence was
recently introduced to improve the visibility of GM lesions and especially cortical lesions. The aim of this study is to
assess the role of DIR sequence in the detection of brain lesions in patients with MS compared to FLAIR sequence.
Results: DIR showed a significantly higher number of MS lesions in infratentorial region (2.9 ± 0.4 compared to 2.25 ±
0.3 in FLAIR) with a statistically significant difference (p = 0.002) and also in supratentorial periventricular regions (11.84
± 8.07 in DIR and 11.31 ± 8.07 in FLAIR, p < 0.001). DIR imaging also demonstrated significantly more intracortical
lesions (7.12 ± 1.2 compared to 1.4 ± 0.9 in FLAIR imaging) with a statistically significant difference
(p < 0.001). On the other hand, corpus callosum lesions were significantly higher on FLAIR (0.84 ± 0.1) with respect to
DIR imaging (0.68 ± 0.1) with a statistically significant difference in between (p = 0.025).
Conclusion: DIR is a powerful conventional MRI sequence for visualization of brain lesions in patients with MS and is
superior to FLAIR sequence in detecting lesions in different locations, namely cortical, periventricular, and infratentorial
regions; hence, DIR can be added to the MRI protocol of MS patients or even can replace FLAIR which would be of a
good diagnostic value with only 80 s added to the scan time.
Keywords: Multiple sclerosis, MRI, FLAIR, DIR, Cortical lesions, White matter
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