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AJNR - American Journal of Neuroradiology

Published ahead of print on September 20, 2007
doi: 10.3174/ajnr.A0645

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Improved Identification of Intracortical Lesions in Multiple Sclerosis with Phase-Sensitive Inversion Recovery in Combination with Fast Double Inversion Recovery MR Imaging

F. Nelson^a, A.H. Poonawalla^b, P. Hou^b, F. Huang^a, J.S. Wolinsky^a and P.A. Narayana^b

^a Department of Neurology, University of Texas Health Science Center at Houston, Houston, Tex
^b Departments of Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston, Houston, Tex

View larger version (38K): [in this window] [in a new window]   Fig 1. DIR (A), PSIR (B), and FLAIR (C) images from a single patient with MS at the same section location. An intracortical lesion is evident in the left parietal area. Also note the excellent overall delineation of the gray-white matter border on PSIR.

View larger version (56K): [in this window] [in a new window]   Fig 2. Examples of cortical lesions on PSIR (left), DIR (center), and FLAIR (right). Lesions shown are (A) purely intracortical, (B) mixed, and (C) juxtacortical.

View larger version (40K): [in this window] [in a new window]   Fig 3. Example of flow artifact. On the DIR image (A), apparent cortical lesions (arrows) are visible. However, on the PSIR image (B), there are no corresponding hypointense signals. On PSIR, a flow artifact is seen more clearly (arrows), which is the likely source of the false-positive.

View larger version (29K): [in this window] [in a new window]   Fig 4. Example of RF inhomogeneity artifact. On the DIR image (A), an apparent cortical lesion is visible (white arrow). On the PSIR image (B), there is again no corresponding hypointensity. On DIR, the signal intensity is 38% higher for the apparent lesion than the contralateral area, compared with 14% for PSIR. The relative insensitivity of PSIR to the RF artifact allows rejection of the lesion on DIR as a false-positive.