Multiple sclerosis lesion detection in the brain: A comparison of fast fluid-attenuated inversion recovery and conventional T2-weighted dual spin echo

We performed fast fluid-attenuated inversion recovery (fFLAIR) and conventional spin echo (CSE) brain MRI in 32 multiple sclerosis (MS) patients(eight each benign, relapsing-remitting, primary progressive, and secondary progressive). We compared number and site of lesions detected on each sequence. With initial separate assessment, we identified a total of 3,668 lesions-2,892 by CSE and 2,943 by fFLAIR. Following simultaneous review of the sequences, we identified an additional 217 lesions on fFLAIR and 229 on CSE. fFLAIR detected fewer lesions in the posterior fossa (66 versus 138, p = 0.001), fewer small (<5 mm) discrete cerebral white matter lesions (671 versus 829, p = 0.0002), more subcortical lesions(542 versus 306, p < 0.0001), and more large discrete lesions(419 versus 385, p = 0.0006). Its relatively poor detection of posterior fossa lesions makes it premature for fFLAIR to replace CSE as the primary sequence for detecting MS lesions in clinical trials.

[1]  D. Paty.  Multiple Sclerosis: Assessment of Disease Progression and Effects of Treatment , 1987, Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques.

[2]  D. Silberberg,et al.  New diagnostic criteria for multiple sclerosis: Guidelines for research protocols , 1983, Annals of neurology.

[3]  W G Bradley,et al.  Suspected multiple sclerosis: MR imaging with a thin-section fast FLAIR pulse sequence. , 1995, Radiology.

[4]  Joseph V. Hajnal,et al.  High Signal Regions in Normal White Matter Shown by Heavily T2‐Weighted CSF Nulled IR Sequences , 1992, Journal of computer assisted tomography.

[5]  A. Thompson,et al.  Imaging of the spinal cord and brain in multiple sclerosis: a comparative study between fast flair and fast spin echo , 1997, Journal of Neurology.

[6]  J. Martín,et al.  Patterns of disease activity in multiple sclerosis. , 1990, BMJ.

[7]  H Lechner,et al.  Criteria for an increased specificity of MRI interpretation in elderly subjects with suspected multiple sclerosis , 1988, Neurology.

[8]  R. Sobel.  The pathology of multiple sclerosis. , 1995, Neurologic clinics.

[9]  M. Osbakken,et al.  Spin‐lattice relaxation (T1) times of cerebral white matter in multiple sclerosis , 1986, Magnetic resonance in medicine.

[10]  J C Gore,et al.  The Loss of Small Objects in Variable TE Imaging: Implications for FSE, RARE, and EPI , 1992, Magnetic resonance in medicine.

[11]  J Hennig,et al.  RARE imaging: A fast imaging method for clinical MR , 1986, Magnetic resonance in medicine.

[12]  M. Raichle.  The pathophysiology of brain ischemia , 1983, Annals of neurology.

[13]  J. Ebersole,et al.  An evaluation of ambulatory, cassette EEG monitoring , 1983, Neurology.

[14]  I. Moseley,et al.  Fast FLAIR of the brain: the range of appearances in normal subjects and its application to quantification of white-matter disease , 1997, Neuroradiology.

[15]  F. Barkhof,et al.  Guidelines for the use of magnetic resonance techniques in monitoring the treatment of multiple sclerosis , 1996, Annals of neurology.

[16]  J. Charboneau,et al.  CT and sonographically guided needle biopsy: current techniques and new innovations. , 1990, AJR. American journal of roentgenology.

[17]  D. Li,et al.  Magnetic resonance imaging in the evaluation of clinical trials in multiple sclerosis , 1994, Annals of neurology.

[18]  D. Paty,et al.  Scales for rating impairment in multiple sclerosis , 1988, Neurology.

[19]  R. Rosenberg.  Autosomal dominant cerebellar phenotypes , 1990, Neurology.

[20]  J C Gore,et al.  Factors influencing contrast in fast spin-echo MR imaging. , 1992, Magnetic resonance imaging.

[21]  J. Gilbert,et al.  Duchenne muscular dystrophy , 1988, Neurology.

[22]  W. Yuh,et al.  MRI in neuro-Behçet's disease , 1997, Neuroradiology.

[23]  G. Barker,et al.  Detection of multiple sclerosis by magnetic resonance imaging , 1994, The Lancet.

[24]  J. Kurtzke.  Rating neurologic impairment in multiple sclerosis , 1983, Neurology.

[25]  B. Weinshenker,et al.  Natural history of multiple sclerosis. , 2005, Neurologic clinics.

[26]  Interferon beta‐lb in the treatment of multiple sclerosis , 1995, Neurology.

[27]  J. Olesen,et al.  In vivo determination of T1 and T2 in the brain of patients with severe but stable multiple sclerosis , 1988, Magnetic resonance in medicine.

[28]  R C Grimm,et al.  Initial clinical experience in MR imaging of the brain with a fast fluid-attenuated inversion-recovery pulse sequence. , 1994, Radiology.

[29]  B C Bowen,et al.  MR signal abnormalities in memory disorder and dementia. , 1990, AJNR. American journal of neuroradiology.

[30]  C. Jack,et al.  Contrast optimization of fluid‐attenuated inversion recovery (flair) imaging , 1995, Magnetic resonance in medicine.

[31]  R. Grossman,et al.  Magnetic resonance imaging and degree of disability in multiple sclerosis. , 1988, Archives of physical medicine and rehabilitation.

[32]  S. Atlas.  MR angiography in neurologic disease. , 1994, Radiology.

[33]  K. Syndulko,et al.  Quantitative multiple sclerosis plaque assessment with magnetic resonance imaging. Its correlation with clinical parameters, evoked potentials, and intra-blood-brain barrier IgG synthesis. , 1990, Archives of neurology.