title: A comparison of MR imaging with fast-FLAIR, HASTE-FLAIR, and EPI-FLAIR sequences in the assessment of patients with multiple sclerosis.
abstract: OBJECTIVE
  Fast fluid-attenuated inversion-recovery (FLAIR) sequences are sensitive for detecting lesions in patients with multiple sclerosis (MS). More rapid fast-FLAIR imaging of the brain can be achieved by the concomitant use of half-Fourier acquisition single-shot turbo spin-echo (HASTE-FLAIR) and echo-planar imaging (EPI-FLAIR). The present study was performed in a large cohort of subjects to assess and compare the number and volume of brain lesions detected by the fast-FLAIR, HASTE-FLAIR, and EPI-FLAIR sequences in patients with MS.
  
  
  METHODS
  Fast-FLAIR, HASTE-FLAIR, and EPI-FLAIR sequences were obtained from 46 consecutive MS patients. Lesions seen on each type of sequence were counted and classified by consensus by two observers. Lesion volumes were measured using a semiautomated segmentation technique based on local thresholding.
  
  
  RESULTS
  The quality of the fast-FLAIR images was significantly better than that of HASTE-FLAIR and EPI-FLAIR images. Fast-FLAIR revealed significantly more lesions and higher lesion volumes than did HASTE-FLAIR and EPI-FLAIR. A similar number of large lesions was detected by the three sequences, but HASTE-FLAIR and EPI-FLAIR showed significantly fewer small and intermediate lesions than did fast-FLAIR. The number of lesions seen on HASTE-FLAIR and EPI-FLAIR images was similar.
  
  
  CONCLUSIONS
  HASTE-FLAIR and EPI-FLAIR sequences revealed as many large MS lesions as fast-FLAIR. Because their acquisition times are only a fraction of that needed for fast-FLAIR sequences, they may be useful for making a rapid diagnosis of MS in uncooperative patients. Their reduced ability to detect smaller lesions indicates that they should not be used as a routine approach to imaging patients with MS.
authors.affiliation: Department of Neuroscience, Scientific Institute Ospedale San Raffaele, University of Milan, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Filippi
authors.forename: M A
authors.initials: MA
authors.lastname: Rocca
authors.forename: M
authors.initials: M
authors.lastname: Wiessmann
authors.forename: S
authors.initials: S
authors.lastname: Mennea
authors.forename: M
authors.initials: M
authors.lastname: Cercignani
authors.forename: T A
authors.initials: TA
authors.lastname: Yousry
authors.forename: M P
authors.initials: MP
authors.lastname: Sormani
authors.forename: G
authors.initials: G
authors.lastname: Comi
mesh_terms: D000328:Adult; D001921:Brain / Q000473:pathology; D017352:Echo-Planar Imaging; D005260:Female; D005583:Fourier Analysis; D006801:Humans; D007089:Image Enhancement; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000175:diagnosis*; D012680:Sensitivity and Specificity