title: Diagnostic Efficacy of Conventional MRI Pulse Sequences in the Detection of Lesions Causing Internuclear Ophthalmoplegia in Multiple Sclerosis Patients.
abstract: OBJECTIVE
  The purpose of this study was to investigate the diagnostic efficacy of a range of conventional magnetic resonance imaging (MRI) pulse sequences in the identification of internuclear ophthalmoplegia (INO) caused by medial longitudinal fasciculus (MLF) lesions in multiple sclerosis patients using a receiver-operating characteristic (ROC) methodology.
  
  
  METHODS
  A total of 15 clinically confirmed INO and 15 control subjects underwent conventional MRI at 1.5 T consisting of T2-weighted, proton density (PD)-weighted, and fluid-attenuated inversion recovery (FLAIR) sequences, following full institutional approval. A free-response, multiple-reader multiple-case design ROC study was used to evaluate the diagnostic efficacy of each sequence. All imaging sequences were evaluated by 10 board-certified neuroradiologists. Area under the curve (AUC), sensitivity, and specificity were analysed statistically for all three pulse sequences using repeated-measures analyses of variance and post-test analysis using Bonferroni's multiple comparison test of differences.
  
  
  RESULTS
  No significant AUC differences were found between the three sequences (p = 0.0697), with T2 recording the highest AUC (0.8346). Sensitivity differences between PD (0.7927) and FLAIR (0.6329) were significant (p < 0.05). Non-significant differences were also evident between T2 and FLAIR (p = 0.0511). The specificity analysis revealed an overall difference (p = 0.0005), with specific inter-sequence differences shown between T2 and PD (p < 0.05) and PD and FLAIR (p < 0.001) with the PD values being lower than those provided with the other two sequences.
  
  
  CONCLUSIONS
  T2-weighted axial imaging through the MLF region resulted in the greatest overall diagnostic efficacy when viewing a combination of mean AUC, sensitivity, and specificity, in terms of the identification of INO-causing lesions.
authors.affiliation: School of Medicine and Medical Science, University College Dublin, Belfield, Dublin 4, Ireland, Jonathan.mcnulty@ucd.ie.
authors.forename: J P
authors.initials: JP
authors.lastname: McNulty
authors.forename: R
authors.initials: R
authors.lastname: Lonergan
authors.forename: P C
authors.initials: PC
authors.lastname: Brennan
authors.forename: M G
authors.initials: MG
authors.lastname: Evanoff
authors.forename: R
authors.initials: R
authors.lastname: O'Laoide
authors.forename: J T
authors.initials: JT
authors.lastname: Ryan
authors.forename: N
authors.initials: N
authors.lastname: Tubridy
mesh_terms: D000328:Adult; D003941:Diagnostic Techniques, Ophthalmological; D056324:Diffusion Tensor Imaging / Q000379:methods*; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000150:complications / Q000473:pathology*; D015588:Observer Variation; D015835:Ocular Motility Disorders / Q000209:etiology / Q000473:pathology*; D009802:Oculomotor Nerve / Q000473:pathology*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012815:Signal Processing, Computer-Assisted