Quantitative Assessment of MRI Lesion Load in Cerebral Multiple Sclerosis: A Comparison of Conventional Sequences and Double Inversion Recovery

Abstract Background: It has been established to use FLAIR se-quence in detection of MS lesions in central nervous system. In this study, we introduced a Double Inversion Recovery (DIR) pulse sequence at 1.5 T, which allows a sufficient attenuation of the CSF and the NAWM (Normal Appearing White Matter) of 34 patients with MS, and compared it to the conventional (T2, FLAIR) sequences. MS lesions were clas-sified anatomically into supratentorial lesions and infratentorial lesions. The supratentorial lesions were further categorized into cortical, juxta-cortical and subcortical and deep white matter (DWM). Aim of Study: To assess the diagnostic value of DIR sequence in the detection of MS lesions by comparing DIR with FLAIR and T2-weighted pulse sequences in the brain. Patients and Methods: This Cross Sectional Study was carried out in Radio-diagnosis Department Faculty of Medicine Ain Shams University during the period from January 2021 till August 2021. The study was approved by Ethical Committee of Faculty of Medicine, Ain Shams University. It included 34 known MS patient. Results: A total of 34 patients were enrolled in this study. There were 26 (76.5%) female and 8 (23.5%) male patients, with age ranges from 19 to 43 years with a median of 31.5 years and a mean (±  standard deviation) of 30.47 years (±6.7). Regarding the total lesion load, DIR was found to be signifi-cantly superior to the T2 sequence in 85.3% of cases and superior to FLAIR sequence in 82.4% of cases. Regarding cortical lesions, DIR was found to be significantly superior to T2 and FLAIR sequences in 97% and 93.9% of the cases with cortical affection respectively. Regarding juxta and subcortical lesions, DIR was found to be significantly superior to T2 and FLAIR sequences in 64.5% and 54.8% respectively in cases with juxta and subcortical affection. Regarding DWM lesions, DIR was found to be superior to T2 and FLAIR sequences in 47.1% and 35.3% of cases respectively and equal to T2 and FLAIR sequences in 17.6% of cases. Regarding the infratentorial lesions, DIR was found to be significantly superior to T2 and FLAIR sequences in 65.2% of cases with infratentorial affection.
Conclusion: We found DIR brain imaging had the highest sensitivity in the detection of cortical, juxtacortical and infratentorial lesions compared with FLAIR and T2 sequences. DIR showed better delineation between the WM, GM, and the MS lesions due to its high image contrast measurements. DIR sequence should be included in the routine MR protocols of MS patients especially to answer the question about cortical and infratentorial lesions for better prognostic values to the patients.