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AJNR Awards, New Junior Editors, and more. Read the latest AJNR updates

Research ArticleSpine Imaging and Spine Image-Guided Interventions

Proton Density MRI Increases Detection of Cervical Spinal Cord Multiple Sclerosis Lesions Compared with T2-Weighted Fast Spin-Echo

A.L. Chong, R.V. Chandra, K.C. Chuah, E.L. Roberts and S.L. Stuckey
American Journal of Neuroradiology January 2016, 37 (1) 180-184; DOI: https://doi.org/10.3174/ajnr.A4476
A.L. Chong
aFrom Monash Imaging (A.L.C., R.V.C., K.C.C., E.L.R., S.L.S.), Monash Health, Melbourne, Victoria, Australia
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R.V. Chandra
aFrom Monash Imaging (A.L.C., R.V.C., K.C.C., E.L.R., S.L.S.), Monash Health, Melbourne, Victoria, Australia
bDepartments of Medicine (R.V.C., S.L.S.)
cSurgery (R.V.C.)
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K.C. Chuah
aFrom Monash Imaging (A.L.C., R.V.C., K.C.C., E.L.R., S.L.S.), Monash Health, Melbourne, Victoria, Australia
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E.L. Roberts
aFrom Monash Imaging (A.L.C., R.V.C., K.C.C., E.L.R., S.L.S.), Monash Health, Melbourne, Victoria, Australia
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S.L. Stuckey
aFrom Monash Imaging (A.L.C., R.V.C., K.C.C., E.L.R., S.L.S.), Monash Health, Melbourne, Victoria, Australia
bDepartments of Medicine (R.V.C., S.L.S.)
dImaging (S.L.S.), Monash University, Melbourne, Victoria, Australia.
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Abstract

BACKGROUND AND PURPOSE: There is a paucity of literature that supports the Consortium of Multiple Sclerosis Centers guideline that proton density MR imaging is a core spinal cord sequence. We hypothesized that proton density fast spin-echo imaging is superior to T2 fast spin-echo MR imaging for the detection of cervical cord MS lesions. This study compared the detection rate and conspicuity of cervical cord MS lesions on sagittal 1.5T proton density fast spin-echo and T2 fast spin-echo MR imaging.

MATERIALS AND METHODS: One hundred consecutive patients with MS imaged with 1.5T sagittal proton density fast spin-echo and T2 fast spin-echo cervical cord MR imaging between September 2012 and October 2013 were retrospectively included. The number of MS lesions detected on each sequence was recorded; conspicuity was assessed quantitatively with the lesion-to-cord contrast ratio and lesion-contrast-to-noise ratio. Statistical analysis was performed by using the Wilcoxon signed rank test.

RESULTS: Seventy-eight patients had MS cord lesions detected. Proton density fast spin-echo imaging detected a greater number of lesions (n = 181) compared with T2 fast spin-echo imaging (n = 137, P < .001). Fifteen patients (19%) with abnormal findings on proton density fast spin-echo imaging had normal findings on T2 fast spin-echo imaging; no patient with abnormal T2 fast spin-echo imaging findings had normal proton density fast spin-echo imaging findings. Although proton density fast spin-echo and T2 fast spin-echo imaging had similar lesion-to-cord contrast ratios (proton density fast spin-echo, 0.32 ± 0.01, versus T2 fast spin-echo, 0.33 ± 0.01; P = .43), proton density fast spin-echo had greater lesion-contrast-to-noise ratio (proton density fast spin-echo, 82 ± 3.0, versus T2 fast spin-echo, 64 ± 2.6; P < .001).

CONCLUSIONS: Proton density fast spin-echo imaging is superior to T2 fast spin-echo MR imaging for the detection of cervical cord MS lesions. Proton density fast spin-echo detects cord lesions in patients in whom T2 fast spin-echo findings appear normal. This study forms the evidentiary base for the current Consortium of Multiple Sclerosis Centers guideline that proton density imaging is a core spinal cord sequence.

ABBREVIATIONS:

CMSC
Consortium of Multiple Sclerosis Centers
FSE
fast spin-echo
GRE
gradient recalled-echo
LCCR
lesion-to-cord contrast ratio
LCNR
lesion-contrast-to-noise ratio
PD
proton density
SE
spin-echo
  • © 2016 by American Journal of Neuroradiology
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American Journal of Neuroradiology: 37 (1)
American Journal of Neuroradiology
Vol. 37, Issue 1
1 Jan 2016
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Cite this article
A.L. Chong, R.V. Chandra, K.C. Chuah, E.L. Roberts, S.L. Stuckey
Proton Density MRI Increases Detection of Cervical Spinal Cord Multiple Sclerosis Lesions Compared with T2-Weighted Fast Spin-Echo
American Journal of Neuroradiology Jan 2016, 37 (1) 180-184; DOI: 10.3174/ajnr.A4476

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Proton Density MRI Increases Detection of Cervical Spinal Cord Multiple Sclerosis Lesions Compared with T2-Weighted Fast Spin-Echo
A.L. Chong, R.V. Chandra, K.C. Chuah, E.L. Roberts, S.L. Stuckey
American Journal of Neuroradiology Jan 2016, 37 (1) 180-184; DOI: 10.3174/ajnr.A4476
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