Cervical Spinal Cord Lesions in Multiple Sclerosis: Comparison among Different Magnetic Resonance Imaging (MRI) Sequences
Iraqi Postgraduate Medical Journal,
2018, Volume 17, Issue 3, Pages 271-277
Multiple sclerosis (MS) is a chronic inflammatory, demyelinating and neurodegenerative disease of the brain and spinal cord. The cervical spinal cord is commonly affected in multiple sclerosis ,as many as 90% of MS patients which is often associated with an increase in clinical disability. Though rarely seen in other diseases, asymptomatic lesions of the spinal cord can be present in MS and may help lead to the correct diagnosis. Since the integration of MR imaging into the International Panel (McDonald) criteria in 2001,there is increasing international effort to standardize MR imaging protocols.
To evaluate MRI imaging protocols for detection of cervical spinal cord multiple sclerosis lesions using 1.5 T MRI scanner.
PATIENTS AND METHODS:
A cross sectional analytical study was conducted at Al-Yarmouk Teaching hospital in Baghdad city. Thirty-one known as MS Patients were examined. from October 2016 till December 2017 by Phillips Achieva Nova Dual 1.5T using a SENSE Neurovascular coil .All patients. underwent sagitta1 T2-turbo spin echo(T2-TSE), Sagittal proton density-turbo spin echo(PD-TSE), sagittal short tau inversion recovery-turbo-spin echo(STIR-TSE )and axial T2-fast field echo(T2-FFE).Comparison was done between the sequences in the means of detectability, conspicuity and number of lesions.
Total patients were (31),22 were females and 9 were males .The female to male ratio was (2.4:1). The patient ages ranges between 20-61 years with a mean of age of about 38 years.
Mean Lesion to Cord Contrast Ratio (mean LCCR) of STIR and T2WI MR imaging was lower than PD imaging [p value < 0.01].Despite of STIR and T2WI had comparable LCCR (mean= 0.39), STIR imaging had expressively better Lesion Contrast to Noise Ratio (LCNR) [P value < 0.01]. PD had better LCNR (mean=48.8) as compared to T2 and STIR [p value<0.001].
PD-TSE sequence detected a large number of spinal cord lesions as compared to T2-TSE and STIR-TSE sequences [110 vs. 76 , 76; respectively . P value < 0.001].
PD-TSE improves overall lesion detection ,delineation, conspicuity and edge definition, however it cannot give precise cord morphological data, but it prove to be the sequence of choice in cervical MS plaque detection as it has the higher lesion contrast ,and it is beneficial in overcoming artifacts seen in both STIR and T2-TSE.
STIR-TSE have good signal to noise ratio, although have higher CSF flow artifacts.
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