Article Figures & Data
Figures
- Fig 1.
Bland-Altman analysis of the lesion counts of reader 1 and 2 for the DIR sequence (upper row) and the T2WI TSE sequence (lower row). There was an almost identical, nonsignificant bias in both techniques, with reader 2 counting on average 0.33 more lesions on DIR images and 0.37 more lesions on T2 images than reader 1 (95% CI, −3.2–2.6; correlation coefficient, r = 0.97; and −2.8–2.1, r = 0.94, respectively).
- Fig 2.
Examples of 2 patients with lesions visible only in the DIR images and not in the T2WI TSE images. Sagittal (A and F) and axial (D and H) T2WI TSE images; sagittal (B and G), coronal (C), and axial (E and I) reconstructions of the 3D DIR sequence of the spinal cord. The group of images on the left (I, A–E) shows the cervical spinal cord of a 52-year-old female patient. Note the lesion in the spinal cord at the C4 vertebral body level, which is only visible in the DIR sequence. This patient indicated pain in her left shoulder, weakness of her left arm, and tingling in her left palm. In T2WI TSE images, 1 lesion was visible in the cervical spinal cord at the C2/C3 level with discrete contrast enhancement (not shown in the image). At first, the differential diagnosis included neoplasm and inflammation. Due to the cervical 3D DIR sequence, another small lesion was detected at the C4 lateral level on the right (arrow), favoring the diagnosis of cervical myelitis. The group of images on the right (II, F–I) shows the spinal cord of a 49-year-old patient with clinically isolated syndrome. Note the lesion in the spinal cord at the C7 vertebral body level, which is only visible in the DIR sequence.
- Fig 3.
The number of lesions per patient according to the consensus reading of both radiologists in the T2WI TSE and DIR sequences. Volunteers are not included. Range, 0–13 (DIR), 0–11 (T2WI TSE); mean, 3.97 ± 3.85 (DIR), 3.10 ± 3.00 (T2WI TSE); P < .01.
- Fig 4.
Sagittal T2WI TSE (A and C) and DIR (B and D) images of the cervical spinal cord of 2 patients. A and B, Two lesions in the spinal cord at the C4 vertebral body level of a 22-year-old female patient with clinically isolated syndrome. C and D, A diffuse myelitis of an 18-year-old female patient with MS. The lesion-to-background contrast sCNR in DIR images is remarkably higher.
- Fig 5.
Sagittal (A), coronal (B), and axial (C) reconstructions of 3D DIR images of the cervical spinal cord of a 42-year-old female patient with primary-progressive MS. Elongated lesions in the lateral spinal cord are visible on both sides (arrow).
- Fig 6.
Sagittal T2WI TSE (A) and DIR (B) sequence of the thoracic spinal cord of a 35-year-old female patient with clinically isolated syndrome. On both sequences, a hyperintense lesion is visible in the spinal cord at the T7 level (arrow).
Tables
MRI acquisition parameters of the 3D DIR and axial and sagittal T2WI TSE sequences
Sequence 3D DIR 2D T2WI TSE Imaging plane Sagittal Sagittal Axial Acquisition matrix 208 × 208 × 300 212 × 233 308 × 207 Acquisition voxel size (mm3) 1.2 × 1.2 × 1.3 0.94 × 1.18 × 2 0.65 × 0.88 × 4 TR (ms) 5500 3071 4238 TE (ms) 287 100 100 TSE factor 173 29 25 IR delays (ms) 2550/450 Flip/refocusing angle T2prep with TE = 125 ms and 4 refocusing pulses 90°/120° 90°/120° Acquisition time 7 min 36 sec 3 min 47 sec 3 min 15 sec Sections 300 15 28 Note:—IR indicates inversion recovery; T2prep, preparation pulse to ensure T2 weighting.
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