Double inversion recovery cervical cord imaging at 3T: Is it better for multiple sclerosis lesion detection?.

PURPOSE: Double inversion recovery (DIR) brain imaging at 3T has greater diagnostic value in detection of multiple sclerosis (MS) lesions compared to T2-weighted turbo spin-echo (T2-TSE) imaging. Our aim was to compare cervical cord MS lesion detection using 3T sagittal DIR imaging to the sagittal T2-TSE, proton density (PD) and short-tau inversion recovery (STIR) magnetic resonance (MR) sequences recommended by the Consortium of MS Centers. MATERIALS AND METHODS: We prospectively enrolled patients with MS and imaged the cervical cord with 3T sagittal DIR, sagittal and axial T2-TSE, sagittal PD, sagittal STIR and axial multi-echo recombined gradient echo (MERGE) MRI sequences. Two neuroradiologists blinded to clinical and demographic data reviewed the MR images. A definite MS lesion was defined by either detection on 2 sagittal sequences, or if seen on 1 sagittal sequence alone, then by detection of the same lesion by axial T2-TSE or axial MERGE MR imaging. The cervical cord was divided into 13 segments - C1, C1/2, C2, C2/3, C3, C3/4, C4, C4/5, C5, C5/6, C6, C6/7, and C7. For each MR sequence, we analysed the total number of involved cord segments and compared the normalised lesion-to-cord contrast ratio (LCCR) and the contrast-to-noise ratio (CNR). The Wilcoxon signed-rank test was used for statistical correlation. RESULT(S): Nineteen patients (13 females) with mean age of 47 years (range 23-74 years) were included. Eighty percent had definite cervical cord MS lesions. DIR cervical cord imaging detected definite MS lesions in 48 cervical cord segments. PD detected the greatest number of involved cord segments (n=75), significantly greater than DIR (p=0.0005) and T2-TSE (p=0.01), but similar to STIR (p=0.17). STIR and T2-TSE also detected a significantly greater number of involved cord segments than DIR (STIR, n=67;p=0.01 and T2, n=61;p=0.01). The LCCR was highest for STIR; significantly greater than DIR (p=0.0009). The CNR was highest for PD; significantly greater