title: Double inversion recovery sequence of the cervical spinal cord in multiple sclerosis and related inflammatory diseases.
abstract: OBJECTIVE
  MR imaging plays an important role in diagnosing MS and other related inflammatory diseases; however, imaging of the spinal cord is still challenging. We hypothesized that a 3D double inversion recovery sequence for cervical spinal cord imaging would be more sensitive in detecting inflammatory lesions than a conventional 2D T2-weighted TSE sequence at 3T.
  
  
  METHODS
  On a 3T MR imaging scanner, we examined 30 patients with suspected or established MS (MS, n = 16; clinically isolated syndrome, n = 12; isolated myelitis, n = 2) and 10 healthy controls. Newly developed 3D double inversion recovery and conventional 2D axial and sagittal T2-weighted TSE images of the cervical spinal cord were acquired. Two blinded neuroradiologists independently assessed the scans in pseudorandomized order for lesion numbers and rated lesion visibility and overall image quality on 5-point scales. A subsequent consensus reading delivered definite lesion counts. Standardized contrast-to-noise ratios were calculated in representative lesions of each patient.
  
  
  RESULTS
  Overall, 28% more lesions could be detected with 3D double inversion recovery than with conventional T2WI (119 versus 93, P < .002). On average, the standardized contrast-to-noise ratio was significantly higher (P < .001) in double inversion recovery than in T2WI. Lesion visibility was rated significantly higher (P < .001) in double inversion recovery compared with T2WI despite lower image quality.
  
  
  CONCLUSIONS
  The novel 3D double inversion recovery sequence allowed better detection of lesions in MS and related inflammatory diseases of the cervical spinal cord, compared with conventional 2D T2WI.
authors.affiliation: From the Departments of Diagnostic and Interventional Neuroradiology (I.R., C.P., J.S.B., J.F.K., C.Z.) Isabelle.riederer@tum.de.
authors.forename: I
authors.initials: I
authors.lastname: Riederer
authors.affiliation: Diagnostic and Interventional Radiology (D.C.K., M.S.).
authors.forename: D C
authors.initials: DC
authors.lastname: Karampinos
authors.affiliation: Diagnostic and Interventional Radiology (D.C.K., M.S.).
authors.forename: M
authors.initials: M
authors.lastname: Settles
authors.affiliation: From the Departments of Diagnostic and Interventional Neuroradiology (I.R., C.P., J.S.B., J.F.K., C.Z.) Neuroimaging Center at the Technische Universität München (C.P., M.M.).
authors.forename: C
authors.initials: C
authors.lastname: Preibisch
authors.affiliation: From the Departments of Diagnostic and Interventional Neuroradiology (I.R., C.P., J.S.B., J.F.K., C.Z.).
authors.forename: J S
authors.initials: JS
authors.lastname: Bauer
authors.affiliation: From the Departments of Diagnostic and Interventional Neuroradiology (I.R., C.P., J.S.B., J.F.K., C.Z.).
authors.forename: J F
authors.initials: JF
authors.lastname: Kleine
authors.affiliation: Neuroimaging Center at the Technische Universität München (C.P., M.M.) Department of Neurology (M.M.), Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Mühlau
authors.affiliation: From the Departments of Diagnostic and Interventional Neuroradiology (I.R., C.P., J.S.B., J.F.K., C.Z.).
authors.forename: C
authors.initials: C
authors.lastname: Zimmer
mesh_terms: D000328:Adult; D002574:Cervical Vertebrae / Q000473:pathology; D003711:Demyelinating Diseases / Q000175:diagnosis; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods; D021621:Imaging, Three-Dimensional / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000175:diagnosis*; D009187:Myelitis / Q000175:diagnosis; D059906:Neuroimaging / Q000379:methods*