Initial experience with double inversion recovery in the detection of multiple sclerosis lesions in the cervical cord: A comparison with proton density weighted and T2 weighted sequences at 1.5 tesla.

PURPOSE Double inversion recovery (DIR) has been shown to be more sensitive than T2 turbo spin echo (TSE) and FLAIR for detection of multiple sclerosis (MS) lesions in the brain. However DIR sensitivity in the cervical cord remains unexplored. The cervical cord to C6 is routinely included as part of brain DIR imaging. We hypothesised that detection of cervical cord lesions on brain DIR may mitigate the need for dedicated cervical cord T2/PD imaging. The aim of the study was to compare cervical cord MS lesion detection and conspicuity on sagittal 1.5 T DIR brain to PD TSE and T2 TSE cervical cord imaging. METHODS 40 patients being treated or investigated for MS over a six-month period with brain and cervical cord MRI were included in this retrospective analysis. Sagittal DIR, PD TSE and T2 TSE images were acquired on a 1.5 T Siemens Magnetom Avanto MRI scanner. A head and neck matrix coil combination was utilised for brain DIR, which included the cervical cord to C6. A 4-channel neck matrix coil was employed for PD TSE and T2 TSE sequences. Two neuroradiologists identified MS lesions, with consensus agreement for single viewer lesions. Regions of interest were obtained within lesions using Osirix v3.0.2. Quantitative analysis comparing the normalised lesion-to-cord contrast ratio (LCCR) and the signal-to-noise ratio (SNR) for each sequence was performed using sample T-tests, where P>0.05 was considered statistically significant. RESULTS 81 cervical cord lesions were detected in 19 patients - 25 on DIR, 25 on T2 TSE and 31 on PD TSE. Five patients with positive T2 TSE scans had negative DIR imaging. Compared to PD and T2, DIR had greater LCCR (DIR 1.51+/-0.09 vs. PD TSE 0.26+/-0.02, P<0.0001; DIR vs. T2 TSE 0.30+/-0.03, P<0.0001), and higher SNR (DIR 126.90+/-5.94 vs. PD TSE 52.63+/-4.00, P<0.0001; DIR vs. T2 TSE 53.02+/-4.99, P<0.0001). CONCLUSIONS DIR detected lesions demonstrate superior contrast resolution and SNR compared to T2 TSE and PD TSE imaging. However mul