UTILITY OF 3D DOUBLE INVERSION RECOVERY SEQUENCES IN DETECTING SMALL GRAY AND WHITE MATTER LESIONS IN PATIENTS WITH MULTIPLE SCLEROSIS.

Amarnath C; Sathyan G; Gnana soundari K S; Lakshminarasimhan R; Periakarupan A; Gopinathan K

Volume : VIII, Issue : II, February - 2019

UTILITY OF 3D DOUBLE INVERSION RECOVERY SEQUENCES IN DETECTING SMALL GRAY AND WHITE MATTER LESIONS IN PATIENTS WITH MULTIPLE SCLEROSIS.

Amarnath C, Sathyan G, Gnana Soundari K S, Lakshminarasimhan R, Periakarupan A, Gopinathan K

Abstract :

AIM: The aim of this study was to compare the sensitivity of 3D sequences of double inversion recovery (DIR) with fluid attenuated inversion recovery(FLAIR) & T2 weighted imaging in early detection of small cortical and white matter lesions in patients with multiple sclerosis. MATERIALS AND METHODS: Seven patients of multiple sclerosis (MS) with 364 supratentorial lesions were included in this study. Imaging was done with a 1.5T MR system (MagnetomAera, Siemens, Germany) using 3D sequences of DIR (Double inversion recovery), fluid-attenuated inversion-recovery (FLAIR), and T2-weighted image (T2WI) sequences. The sensitivity of DIR was compared with the sensitivity of FLAIR and T2WI sequences. RESULTS: Double inversion recovery imaging technique by using a combination of two inversion pulses provides a sufficient attenuation of both CSF and the white matter (WM) and significantly detected more overall load of lesions compared to the T2W and FLAIR sequences. Double inversion recovery (DIR) sequence similarly detected more supratentorial white matter (WM) lesions in the juxta cortical regions compared to the FLAIR sequence which was considered the gold standard in this region. Due to better contrast between lesions and the surrounding GM in the DIR images DIR sequences revealed more intra cortical lesions(ICLs) . CONCLUSION: DIR showed better delineation between the white matter, grey matter, and the lesions of multiple sclerosis due to its image contrast in all anatomical locations. DIR sequence is valuable in the imaging workup of MS as it can detect more MS lesions compared to the T2W and FLAIR sequences DIR helps to plan Disease Modifying drugs (DMDs) early and to detect the progression of disease after initiating DMDs. Hence DIR sequence should be included in the routine MR protocols of MS patients especially to answer the question about intra-cortical and juxta-cortical MS lesions.