title: Evaluation of Focal Cervical Spinal Cord Lesions in Multiple Sclerosis: Comparison of White Matter-Suppressed T1 Inversion Recovery Sequence versus Conventional STIR and Proton Density-Weighted Turbo Spin-Echo Sequences.
abstract: Conventional MR imaging of the cervical spinal cord in MS is challenged by numerous artifacts and interreader variability in lesion counts. This study compares the relatively novel WM-suppressed T1 inversion recovery sequence with STIR and proton density-weighted TSE sequences in the evaluation of cervical cord lesions in patients with MS.
  
  
  
  Retrospective blinded analysis of cervical cord MR imaging examinations of 50 patients with MS was performed by 2 neuroradiologists. In each patient, the number of focal lesions and overall lesion conspicuity were measured in the STIR/proton density-weighted TSE and WM-suppressed T1 inversion recovery sequence groups. Independent side-by-side comparison was performed to categorize the discrepant lesions as either "definite" or "spurious." Lesion contrast ratio and edge sharpness were independently calculated in each sequence.
  
  
  
  Substantial interreader agreement was noted on the WM-suppressed T1 inversion recovery sequence (κ = 0.82) compared with STIR/proton density-weighted TSE (κ = 0.52). Average lesion conspicuity was better on the WM-suppressed T1 inversion recovery sequence (conspicuity of 3.1/5.0 versus 3.7/5.0, P < .01, in the WM-suppressed T1 inversion recovery sequence versus STIR/proton density-weighted TSE, respectively). Spurious lesions were more common on STIR/proton density-weighted TSE than on the WM-suppressed T1 inversion recovery sequence (23 and 30 versus 3 and 4 by readers 1 and 2, respectively; P < .01). More "definite" lesions were missed on STIR/proton density-weighted TSE compared with the WM-suppressed T1 inversion recovery sequence (37 and 38 versus 3 and 6 by readers 1 and 2, respectively). Lesion contrast ratio and edge sharpness were highest on the WM-suppressed T1 inversion recovery sequence.
  
  
  
  There is better interreader consistency in the lesion count on the WM-suppressed T1 inversion recovery sequence compared with STIR/proton density-weighted TSE sequences. The focal cord lesions are visualized with better conspicuity due to better contrast ratio and edge sharpness. There are fewer spurious lesions on the WM-suppressed T1 inversion recovery sequence compared with STIR/proton density-weighted TSE. The WM-suppressed T1 inversion recovery sequence could potentially be substituted for either STIR or proton density-weighted TSE sequences in routine clinical protocols.
authors.affiliation: From the Department of Radiology, University of Washington, Seattle, Washington. dineshs@uw.edu.
authors.forename: D K
authors.identifier: 0000-0003-2261-8971
authors.initials: DK
authors.lastname: Sundarakumar
authors.affiliation: From the Department of Radiology, University of Washington, Seattle, Washington.
authors.forename: C M
authors.identifier: 0000-0002-8863-1020
authors.initials: CM
authors.lastname: Smith
authors.affiliation: From the Department of Radiology, University of Washington, Seattle, Washington.
authors.forename: W D
authors.identifier: 0000-0003-0525-4512
authors.initials: WD
authors.lastname: Hwang
authors.affiliation: From the Department of Radiology, University of Washington, Seattle, Washington.
authors.forename: M
authors.identifier: 0000-0001-7798-8158
authors.initials: M
authors.lastname: Mossa-Basha
authors.affiliation: From the Department of Radiology, University of Washington, Seattle, Washington.
authors.forename: K R
authors.identifier: 0000-0001-9188-5374
authors.initials: KR
authors.lastname: Maravilla
mesh_terms: D000328:Adult; D000368:Aged; D016477:Artifacts; D066193:Cervical Cord / Q000000981:diagnostic imaging* / Q000473:pathology; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000000981:diagnostic imaging* / Q000473:pathology; D059906:Neuroimaging / Q000379:methods*; D012189:Retrospective Studies; D066127:White Matter / Q000000981:diagnostic imaging / Q000473:pathology