title: Altered signal intensity of active enhancing inflammatory lesions using post-contrast double inversion recovery MR sequence.
abstract: OBJECTIVE
  We aimed at establishing the impact upon gadolinium administration on the conspicuity of active enhancing multiple sclerosis (MS) lesions using double inversion recovery (DIR) at 3T.
  
  
  METHODS
  15 consecutive patients with MS (n=8) or a clinically isolated syndrome (n=7) underwent pre and post-contrast DIR in addition to T2-weighted, FLAIR, pre and post-contrast T1-weighted sequences. First, two neuroradiologists located and marked all the enhancing MS lesions visible in consensus. Second, two other neuroradiologists, blinded to other sequences than DIR, independently assessed the SI changes from pre to post-contrast DIR images for each enhancing lesion, according to a 4-point-scale: increased SI (grade 1), absence of change (grade 2), lesion being partially (grade 3) or completely masked on post-contrast DIR images (grade 4).
  
  
  RESULTS
  246 MS lesions were detected including 26 enhancing on post-contrast T1-weighted images in 9 patients. The two blinded readers concluded to a decreased signal-intensity on post-contrast DIR images for all the 26 enhancing MS lesions (14 of grade 3 and 12 of grade 4). Inter-observer agreement was excellent, Kappa=0.85 (0.75 - 0.94). Using DIR post-contrast leads to altered signal-intensity of enhancing active MS lesions, ranging from partial to complete signal-loss.
  
  
  CONCLUSIONS
  Our study strongly suggests the use of DIR before gadolinium administration.
  
  
  CONCLUSIONS
  • DIR has gained widespread use in MS. • MRI protocols for MS patients usually contain several post-contrast sequences. • Signal-intensity of enhancing MS lesions is altered using DIR post-contrast. • Our study strongly suggests the use of DIR before gadolinium administration.
authors.affiliation: Departments of Neuroradiology, AP-HP, Hôpitaux Universitaires Henri Mondor, Créteil, France. jerome.hodel@gmail.com.|Faculty of Medicine, Université Paris Est Créteil, Créteil, France. jerome.hodel@gmail.com.|CHU Lille, Department of Neuroradiology, F-59000, Lille, France. jerome.hodel@gmail.com.
authors.forename: Jérôme
authors.initials: J
authors.lastname: Hodel
authors.affiliation: CHU Lille, Department of Neuroradiology, F-59000, Lille, France.
authors.forename: Sammy
authors.initials: S
authors.lastname: Badr
authors.affiliation: Uniersity of Lille, CHU Lille, LIRIC - INSERM U995, FHU Imminent, F-59000, Lille, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Outteryck
authors.affiliation: CHU Lille, Department of Neuroradiology, F-59000, Lille, France.
authors.forename: Paul
authors.initials: P
authors.lastname: Lebert
authors.affiliation: Philips, Suresnes, France.
authors.forename: David
authors.initials: D
authors.lastname: Chechin
authors.affiliation: Inserm, U1018, Radiation Epidemiology Team, Villejuif, France.
authors.forename: Mohamed Amine
authors.initials: MA
authors.lastname: Benadjaoud
authors.affiliation: University of Lille, CHU Lille, INSERM U1171, FHU VasCog, F-59000, Lille, France.
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Pruvo
authors.affiliation: Uniersity of Lille, CHU Lille, LIRIC - INSERM U995, FHU Imminent, F-59000, Lille, France.
authors.forename: Patrick
authors.initials: P
authors.lastname: Vermersch
authors.affiliation: University of Lille, CHU Lille, INSERM U1171, FHU VasCog, F-59000, Lille, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Leclerc
mesh_terms: D000328:Adult; D001921:Brain / Q000000981:diagnostic imaging* / Q000473:pathology; D003287:Contrast Media; D005260:Female; D005682:Gadolinium; D006801:Humans; D007089:Image Enhancement; D007091:Image Processing, Computer-Assisted / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D009103:Multiple Sclerosis / Q000000981:diagnostic imaging* / Q000473:pathology; D015588:Observer Variation; D055815:Young Adult
chemical_list: D003287:Contrast Media; D005682:Gadolinium
keywords: Active enhancing inflammatory lesions; Clinically isolated syndrome; Double inversion recovery MR sequence; Gadolinium-based contrast agent; Multiple sclerosis