الفهرس 
RADIOLOGICAL ANATOMY OF THE BRAIN ON MRIOnly 14 pages are availabe for public view
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Abstract
M
S is the most common chronic inflammatory demyelinating disease of the CNS, resulting in both physical and neurocognitive disability. Typically, MS affects the WM, but recent studies have revealed GM involvement in the earliest clinical stages of MS, suggesting correlations between the lesions and degree of physical and cognitive dysfunction.
Since MRI plays an important role in the early diagnosis of MS, several attempts have been carried out using different MRI pulse sequences, to increase the sensitivity to detect more MS lesions in different anatomical regions.
The importance of GM damage in MS patients and the potential of the DIR sequence to detect cortical lesions excited the introduction of the DIR in many imaging centers as DIR images display great delineation of GM.
Herein, we aimed to assess the role of the DIR sequence in the detection of brain lesions with the delineation of different cortical subtypes in MS patients compared to FLAIR & its impact in evaluating the degree of patient disability.
This was a cross-sectional retrospective study conducted at the Radiology Department at Ain-Shams University and the Ministry of Health Hospitals on 30 patients already diagnosed with MS according to the 2017 revised McDonald criteria who were attended for regular follow-up.
The patients’ ages ranged from 21 to 54 years with a mean ± SD of 31.20 ± 7.81 years. Females were more predominant than males (63.3% vs. 36.7%, respectively) with a female-to-male ratio of about 1.7:1.
The patients’ ages when diagnosed with MS ranged from 18 to 54 years with a mean ± SD 26.07 ± 6.31 years. The disease duration ranged from 2 to 11 years with a mean ± SD of 4.80 ± 2.17 years. The EDSS ranged from 0 to 6.5 with a mean of 2.30 ± 1.33. As regards MS type, the majority of MS patients (96.7%) had RRMS and only one patient (3.3%) had PPMS.
DIR significantly improved the detection of juxtacortical lesions by 53% (p<0.001), cortical lesions by 72% (p<0.001), and infratentorial lesions by 66% (p= 0.012) compared to FLAIR. Whereas, FLAIR significantly improved the detection of periventricular lesions by 33% (p= 0.004) and corpus callosum lesions by 45% (p<0.001) than the DIR. The detection of deep white matter lesions and craniocervical junction lesions was comparable in both DIR and FLAIR sequences. Overall, the DIR sequence was superior to FLAIR in the detection of all MS and significantly improved the detection of MS lesions by 8% (p<0.001).
As regards the detection of cortical lesions type I, type II, type III, and type IV, we reported a significantly higher number of lesions in the DIR sequence compared to FLAIR (p<0.001).
Highly significant positive correlations were found between the number of cortical lesions detected by DIR with both the MS duration (r= 0.670; p <0.001) and the EDSS (r= 0.579; p <0.001). Also, there were significant positive correlations between the EDSS with the number of periventricular lesions (r= 0.428; p= 0.018,), deep white matter lesions (r= 0.471; p= 0.009), infratentorial lesions (r= 0.395; p= 0.031), and corpus callosum lesions (r= 0.468; p= 0.009) that were detected by DIR.
Also, there were highly significant positive correlations between the number of cortical lesions detected by FLAIR with both the MS duration (r= 0.665; p <0.001) and the Expanded Disability Status Scale (EDSS) (r= 0.466; p= 0.009). Also, there were significant positive correlations between the EDSS with the number of periventricular lesions (r= 0.417; p= 0.022,), deep WM lesions (r= 0.404; p= 0.027), juxtacortical lesions (r= 0.388; p= 0.034), infratentorial lesions (r= 0.407; p= 0.026), and corpus callosum lesions (r= 0.436; p= 0.016) that were detected by FLAIR.
CONCLUSION
U
sing both FLAIR and DIR imaging can fill a niche in neuroimaging by enabling visualization of most MS lesions.
Our data suggested that DIR is more supreme for the detection of overall lesions, particularly cortical and juxtacortical lesions in MS patients compared to FLAIR. Owing to the significance of GM damage in MS patients and its impact on the patient’s disability, using DIR in the routine scan as a supplementary tool to standard FLAIR and T2 sequences to visualize and quantify the cortical lesions in MS patients is a top priority.
RECOMMENDATIONS
The current study recommended the following:
1. Further prospective studies with larger sample sizes to authorize our findings.
2. The introduction of DIR as a part of the routine scan as a supplementary tool to standard FLAIR and T2 sequences.
3. Further prospective studies focus on MS patients in the early stages and incorporate a thorough analysis of the lesion distribution and number to increase our knowledge of the early disease.
4. More prospective works to explain the cognitive deficits due to GM involvement in MS.