Abstract / Summary
Abstract Background Spinal cord MRI is challenging due to small anatomy, motion artifacts, and complex lesions [1, 2], complicating lesion detection and assessment. While T2-weighted imaging (T2WI) is standard, Short Tau Inversion Recovery (STIR) improves lesion contrast [3]. Double Inversion Recovery (DIR) MRI offers enhanced visualization of cervical cord lesions in multiple sclerosis (MS). Objectives To evaluate the comparative lesion detection performance of DIR for detecting and characterizing cervical cord lesions in MS, and to explore associations between DIR findings and clinical disability measures. Methods This cross-sectional study included 100 MS patients with brain and cervical cord involvement, diagnosed per 2017 McDonald criteria and MAGNIMS 2021. Patients presented with motor, sensory, and/or autonomic dysfunction. All underwent MRI with T2WI, STIR, and DIR sequences. Lesions were identified, quantified, and visually graded by two independent experienced neuroradiologists with excellent interobserver agreement ( κ = 0.89; ICC = 0.92, 95% CI: 0.88–0.95). Results DIR outperformed STIR and T2WI. In this pre-selected cohort of patients with confirmed lesions, DIR achieved a lesion detection rate of 100% (mean 5.02 ± 2.89 lesions/patient; total 389 lesions), compared to STIR (99%; mean 4.58 ± 2.86; total 361) and T2WI (96%; mean 3.67 ± 2.44; total 290; p < 0.001). DIR demonstrated a predominance of marked lesion intensity (65%), compared to STIR (predominantly moderate 58%) and T2WI (predominantly mild 81%) ( p < 0.001). DIR lesion count showed a modest positive correlation with EDSS score ( r = 0.215, p = 0.041) and with disease progression ( r = 0.369, p < 0.001). Conclusions In this cross-sectional study, 3 T DIR MRI demonstrated superior lesion detection and conspicuity compared to STIR and T2WI for cervical cord assessment in MS patients with pre-confirmed spinal cord involvement. These findings suggest potential value of DIR as an adjunctive imaging sequence; however, prospective longitudinal studies are needed to confirm clinical utility.