The value of qualitative and quantitative assessment of lesion to cerebral cortex signal ratio on double inversion recovery sequence in the differentiation of demyelinating plaques from non-specific T2 hyperintensities.
OBJECTIVE
To assess the usefulness of the visual assessment and to determine diagnostic value of the lesion-to-cerebral cortex signal ratio (LCSR) measurement in the differentiation of demyelinating plaques and non-specific T2 hyperintensities on double inversion recovery (DIR) sequence.


METHODS
DIR and fluid-attenuated inversion recovery (FLAIR) sequences of 25 clinically diagnosed multiple sclerosis (MS) patients and 25 non-MS patients with non-specific T2-hyperintense lesions were evaluated visually and LCSRs were measured by two observers independently.


RESULTS
On DIR sequence, the calculated mean LCSR ± SD for demyelinating plaques and non-specific T2-hyperintense lesions were 1.60 ± 0.26 and 0.75 ± 0.19 for observer1, and 1.61 ± 0.27 and 0.74 ± 0.19 for observer2. LCSRs of demyelinating plaques were significantly higher than other non-specific T2-hyperintense lesions on DIR sequence. By using the visual assessment demyelinating plaques were differentiated from non-specific T2-hyperintensities with 92.8 % sensitivity, 97.5 % specificity and 95.1 % accuracy for observer1 and 92.8 % sensitivity, 95 % specificity and 93.9 % accuracy for observer2.


CONCLUSIONS
Visual assessment and LCSR measurement on DIR sequence seems to be useful for differentiating demyelinating MS plaques from supratentorial non-specific T2 hyperintensities. This feature can be used for diagnosis of MS particularly in patients with only supratentorial T2-hyperintense lesions who are categorized as radiologically possible MS.


CONCLUSIONS
• Demyelinating plaques and non-specific T2-hyperintensities have different SI on DIR images. • These differences can be assessed by LCSR measurement or visual assessment. • There is an excellent inter-observer agreement for both methods. • This feature can be used in radiologically possible MS cases.
Department of Radiology, Gulhane Military Medical School, 06018, Etlik, Ankara, Turkey.
Salih
S
Hamcan
Department of Radiology, Gulhane Military Medical School, 06018, Etlik, Ankara, Turkey. bilbat_23@yahoo.com.
Bilal
B
Battal
Department of Radiology, Gulhane Military Medical School, 06018, Etlik, Ankara, Turkey.
Veysel
V
Akgun
Department of Neurology, Gulhane Military Medical School, Ankara, Turkey.
Oguzhan
O
Oz
Department of Radiology, Golcuk Military Hospital, Kocaeli, Turkey.
Yalcin
Y
Bozkurt
Department of Neurology, Gulhane Military Medical School, Ankara, Turkey.
Serdar
S
Tasdemir
Department of Radiology, Gulhane Military Medical School, 06018, Etlik, Ankara, Turkey.
Sebahattin
S
Sari
Department of Radiology, Gulhane Military Medical School, 06018, Etlik, Ankara, Turkey.
Mustafa
M
Tasar
D000328:Adult; D016022:Case-Control Studies; D002540:Cerebral Cortex / Q000000981:diagnostic imaging*; D059345:Cerebral Small Vessel Diseases / Q000000981:diagnostic imaging; D003711:Demyelinating Diseases / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D006973:Hypertension / Q000000981:diagnostic imaging; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000000981:diagnostic imaging; D009103:Multiple Sclerosis / Q000000981:diagnostic imaging*; D015588:Observer Variation; D011871:Radiology; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014657:Vasculitis / Q000000981:diagnostic imaging; D055815:Young Adult
DIR; Demyelinating plaque; MRI; Multiple sclerosis; Signal intensity