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Year : 2018  |  Volume : 35  |  Issue : 3  |  Page : 386-393

Diagnosis of gray matter lesions in multiple sclerosis using variant sequences of magnetic resonance imaging (T2, fluid-attenuated inversion recovery, and double inversion recovery)

Department of Radiology, Benha University, Benha, Egypt

Correspondence Address:
Dr. Shimaa A El-Sabbagh
Shirbin Central Hospital, Benha University, Cairo
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/bmfj.bmfj_166_18

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Background and aim Gray matter atrophy is significantly correlated with both physical and cognitive disability in patients with multiple sclerosis (MS). Patients and methods The study was conducted on 40 patients with definite relapsing-remitting MS according to McDonald criteria. All patients were subjected to conventional MRI [T2 and fluid-attenuated inversion recovery (FLAIR) sequences] and double inversion recovery (DIR) sequence to assess their sensitivity for detecting gray matter lesions in patients with MS. Results Comparative studies between serial MRI sequences revealed highly significant increase in detected number of white matter lesions in FLAIR and DIR-MRI sequences (P=0.0007). Comparative studies also revealed a nonsignificant difference in detection rate in all 3 MRI sequences (P>0.05). Moreover, there were significant increases in detected number of gray matter lesions in DIR-MRI sequences (P=0.021) and a highly significant increase in detection rate in DIR-MRI sequences compared with T2 and FLAIR-MRI sequences (P<0.001). By using receiver operating characteristic curve analysis, T2-MRI sequences failed to discriminate patients with gray matter lesions from patients without, with failed accuracy, having sensitivity of 17% and specificity of 100% (P=0.051). However, FLAIR-MRI sequences discriminated patients with gray matter lesions from patients without with poor accuracy, having sensitivity of 34% and specificity of 100% (P<0.0001). On the contrary, DIR-MRI sequences discriminated patients with gray matter lesions from patients without, with perfect accuracy, having sensitivity of 100% and specificity of 100% (P<0.0001). Conclusion DIR is a valuable MRI sequence in imaging of MS because of the following: (a) it showed better delineation between the white matter, the gray matter, and the MS lesions owing to its high image contrast measurements; (b) it detected more MS lesions compared with T2WI and FLAIR sequences in all anatomic locations; (c) it revealed more periventricular and juxta-cortical MS lesions, which are characteristic of MS; and (d) it detected more intracortical lesions as well, which should be considered in all patients with MS.

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