Double Inversion Recovery Brain Imaging at 3T: Diagnostic Value in the Detection of Multiple Sclerosis Lesions
M.P. Wattjesa,
G.G. Lutterbeya,
J. Giesekea,c,
F. Träbera,
L. Klotzb,
S. Schmidtb and
H.H. Schilda
a Departments of Radiology/Neuroradiology, University of Bonn, Bonn, Germany
b Department of Neurology, University of Bonn, Bonn, Germany
C Philips Medical Systems, Best, the Netherlands
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Fig 1. Transverse T2-weighted TSE, FLAIR, and DIR image examples documenting the higher sensitivity of DIR in the detection of inflammatory brain lesion in the infratentorial brain.
Top row (A–C), A 36-year-old woman presenting with a polysymptomatic CIS. A sharp delineated inflammatory lesion in the left pedunculus cerebelli (arrow) can be clearly identified on the DIR image but not on the corresponding sections of the T2 TSE and FLAIR sequences.
Bottom row (D–F), A 23-year-old man presenting with optic neuritis of the left eye. Compared with the T2 TSE and FLAIR images, more lesions in both hemispheres of the cerebellum (arrows) can be identified on the DIR image. Moreover, those lesions identified on all 3 sequences were better delineated on DIR compared with the corresponding T2 TSE and FLAIR images.
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Fig 2. Transverse FLAIR (bottom row) and DIR (top row) sections of the supratentorial brain. The inflammatory lesions have a more sharp delineated appearance on the DIR compared with the corresponding FLAIR images. Despite a minor contrast between lesions and the normal-appearing gray matter, DIR showed a high sensitivity in the detection of juxtacortical and mixed white matter-gray matter lesions (arrows). A differentiation between juxtacortical and mixed white matter-gray matter lesions is much easier on the DIR than on the FLAIR images. Regarding the periventricular white matter, the lesions are easier to identify on the DIR compared with the FLAIR images (open arrows).
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Fig 3. Image examples of the improved detection of mixed white matter-gray matter lesions on the DIR pulse sequence. These images were obtained from a 40-year-old woman with a relapsing-remitting course of MS (disease duration, 165 months; EDSS, 6) presenting with a high lesion load on the MR imaging, including mixed white matter-gray matter lesions. Top row, an example of different classifications of a lesion using different pulse sequences. A lesion (arrow) was prospectively classified as a juxtacortical lesion on the T2 TSE and FLAIR images. Because of the better delineation of the white and gray matter on the DIR image, this lesion had to reclassified into a mixed white matter-gray matter lesion. Bottom row, an example of the higher conspicuity of a cortical lesion (arrow) on the DIR image that was not prospectively identified on the corresponding T2 TSE and FLAIR images. Another lesion (open arrow) could be easily identified and categorized on the DIR image as a pure juxtacortical lesion without touching the cortex.
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