Quantitative assessment of MRI lesion load in cerebral Multiple Sclerosis: A comparison of conventional sequences and Double Inversion Recovery

Abstract

Multiple sclerosis (MS) is the most common chronic inflammatory demyelinating disease of the central nervous system (CNS), that is characterized by focal demyelinating plaques and diffuse neurodegeneration, resulting in both physical and neurocognitive disability. It has been established to use FLAIR sequence in detection of MS lesions in central nervous system. In this study, we introduced a 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 classified anatomically into supratentorial lesions and infratentorial lesions. The supratentorial lesions were further categorized into cortical, juxta-cortical and subcortical and deep white matter (DWM). In our study, we compared DIR sequence to the conventional sequences (T2 and FLAIR) as regards their ability to detect demyelinating lesions in different regions of the brain of 34 known MS patients. In 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.