title: Proton Density MRI Increases Detection of Cervical Spinal Cord Multiple Sclerosis Lesions Compared with T2-Weighted Fast Spin-Echo.
abstract: OBJECTIVE
  There is a paucity of literature that supports the Consortium of Multiple Sclerosis Centers guideline that proton density MR imaging is a core spinal cord sequence. We hypothesized that proton density fast spin-echo imaging is superior to T2 fast spin-echo MR imaging for the detection of cervical cord MS lesions. This study compared the detection rate and conspicuity of cervical cord MS lesions on sagittal 1.5T proton density fast spin-echo and T2 fast spin-echo MR imaging.
  
  
  METHODS
  One hundred consecutive patients with MS imaged with 1.5T sagittal proton density fast spin-echo and T2 fast spin-echo cervical cord MR imaging between September 2012 and October 2013 were retrospectively included. The number of MS lesions detected on each sequence was recorded; conspicuity was assessed quantitatively with the lesion-to-cord contrast ratio and lesion-contrast-to-noise ratio. Statistical analysis was performed by using the Wilcoxon signed rank test.
  
  
  RESULTS
  Seventy-eight patients had MS cord lesions detected. Proton density fast spin-echo imaging detected a greater number of lesions (n = 181) compared with T2 fast spin-echo imaging (n = 137, P < .001). Fifteen patients (19%) with abnormal findings on proton density fast spin-echo imaging had normal findings on T2 fast spin-echo imaging; no patient with abnormal T2 fast spin-echo imaging findings had normal proton density fast spin-echo imaging findings. Although proton density fast spin-echo and T2 fast spin-echo imaging had similar lesion-to-cord contrast ratios (proton density fast spin-echo, 0.32 ± 0.01, versus T2 fast spin-echo, 0.33 ± 0.01; P = .43), proton density fast spin-echo had greater lesion-contrast-to-noise ratio (proton density fast spin-echo, 82 ± 3.0, versus T2 fast spin-echo, 64 ± 2.6; P < .001).
  
  
  CONCLUSIONS
  Proton density fast spin-echo imaging is superior to T2 fast spin-echo MR imaging for the detection of cervical cord MS lesions. Proton density fast spin-echo detects cord lesions in patients in whom T2 fast spin-echo findings appear normal. This study forms the evidentiary base for the current Consortium of Multiple Sclerosis Centers guideline that proton density imaging is a core spinal cord sequence.
authors.affiliation: From Monash Imaging (A.L.C., R.V.C., K.C.C., E.L.R., S.L.S.), Monash Health, Melbourne, Victoria, Australia.
authors.forename: A L
authors.identifier: http://orcid.org/0000-0002-3066-4559
authors.initials: AL
authors.lastname: Chong
authors.affiliation: From Monash Imaging (A.L.C., R.V.C., K.C.C., E.L.R., S.L.S.), Monash Health, Melbourne, Victoria, Australia Departments of Medicine (R.V.C., S.L.S.) Surgery (R.V.C.) ronil.chandra@monashhealth.org ronilvchandra@gmail.com.
authors.forename: R V
authors.identifier: http://orcid.org/0000-0001-7555-2297
authors.initials: RV
authors.lastname: Chandra
authors.affiliation: From Monash Imaging (A.L.C., R.V.C., K.C.C., E.L.R., S.L.S.), Monash Health, Melbourne, Victoria, Australia.
authors.forename: K C
authors.identifier: http://orcid.org/0000-0003-3855-9670
authors.initials: KC
authors.lastname: Chuah
authors.affiliation: From Monash Imaging (A.L.C., R.V.C., K.C.C., E.L.R., S.L.S.), Monash Health, Melbourne, Victoria, Australia.
authors.forename: E L
authors.identifier: http://orcid.org/0000-0002-0969-3099
authors.initials: EL
authors.lastname: Roberts
authors.affiliation: From Monash Imaging (A.L.C., R.V.C., K.C.C., E.L.R., S.L.S.), Monash Health, Melbourne, Victoria, Australia Departments of Medicine (R.V.C., S.L.S.) Imaging (S.L.S.), Monash University, Melbourne, Victoria, Australia.
authors.forename: S L
authors.identifier: http://orcid.org/0000-0001-7181-6443
authors.initials: SL
authors.lastname: Stuckey
mesh_terms: D000328:Adult; D066193:Cervical Cord / Q000473:pathology*; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000175:diagnosis* / Q000473:pathology; D012189:Retrospective Studies; D012680:Sensitivity and Specificity