title: Double inversion recovery brain imaging at 3T: diagnostic value in the detection of multiple sclerosis lesions.
abstract: OBJECTIVE
  To prospectively determine the sensitivity in the detection of multiple sclerosis (MS) lesions by using double inversion recovery (DIR), fluid-attenuated inversion recovery (FLAIR), and T2-weighted turbo spin-echo (T2 TSE) MR imaging at 3T.
  
  
  METHODS
  Seventeen patients presenting with a clinically isolated syndrome (CIS) suggestive of MS, 9 patients with definite MS, and 6 healthy control subjects were included. Imaging was performed on a 3T MR system using DIR, FLAIR, and T2 TSE sequences. Lesions were counted and classified according to 5 anatomic regions: infratentorial, periventricular, deep white matter, juxtacortical, and mixed white matter-gray matter. The sensitivity at DIR was compared with the corresponding sensitivity at FLAIR and T2 TSE sequence. The contrast between lesions and normal-appearing gray matter, normal-appearing white matter, and CSF was determined for all sequences.
  
  
  RESULTS
  Because of higher lesion-white matter contrast, the DIR showed a higher number of lesions compared with the FLAIR (7% gain, P = 0.04) and the T2 TSE (15% gain, P = 0.01). The higher sensitivity was also significant for the infratentorial region compared with the FLAIR (56% gain, P = 0.02) and the T2 TSE (44% gain, P = 0.02). Compared with the FLAIR, no significant changes of the lesion load measurements were observed in the supratentorial brain: slightly higher numbers of periventricular and mixed gray matter-white matter lesions on the DIR were counterbalanced by a slightly reduced sensitivity regarding juxtacortical lesions.
  
  
  CONCLUSIONS
  DIR brain imaging at 3T provides the highest sensitivity in the detection of MS lesions especially in the infratentorial region.
authors.affiliation: Department of Radiology, University of Bonn, Bonn, Germany. mike.wattjes@ukb.uni-bonn.de
authors.forename: M P
authors.initials: MP
authors.lastname: Wattjes
authors.forename: G G
authors.initials: GG
authors.lastname: Lutterbey
authors.forename: J
authors.initials: J
authors.lastname: Gieseke
authors.forename: F
authors.initials: F
authors.lastname: Träber
authors.forename: L
authors.initials: L
authors.lastname: Klotz
authors.forename: S
authors.initials: S
authors.lastname: Schmidt
authors.forename: H H
authors.initials: HH
authors.lastname: Schild
mesh_terms: D000328:Adult; D001921:Brain / Q000473:pathology*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D020644:Midline Thalamic Nuclei / Q000473:pathology; D009103:Multiple Sclerosis / Q000175:diagnosis*; D009413:Nerve Fibers, Myelinated / Q000473:pathology; D010487:Periaqueductal Gray / Q000473:pathology; D011446:Prospective Studies; D012680:Sensitivity and Specificity