The Effect of Sagittal STIR and FLAIR Sequences Compared to Sagittal T2-W for Characterizing MS Lesions in Cervical Spine MRI
-
Karim Sharifi
,
Daem Roshani
,
Bakhtiar Moradi
,
Shadi Parvizpour
,
Somayeh Moloudi
,
Neda Charekhah
,
Jamil Abdolmohammadi
,
Mozaffar Mahmoodi
Abstract
Purpose: Multiple Sclerosis (MS) is an acute, autoimmune, and inflammatory disease in the central nervous system. This study investigated the effect of sagittal Short Tau Inversion Recovery (STIR) and T2-W Fluid Attenuated Inversion Recovery (FLAIR) sequences rather than sagittal T2-W as complementary sequences in patients with cervical spinal cord lesions and suspected MS.
Materials and Methods: This cross-sectional study was performed on all individuals referred to the Shahid Ghazi MRI center in Sanandaj for six months. Sixty patients with a cervical spine MRI request that were suspected of having MS were examined. The number of MS plaques in the sagittal T2-W FSE, sagittal STIR, and sagittal T2-W FLAIR were recorded separately. A comparison between routine sequences and sequence supplementation has been made for characterizing MS plaque in the spine.
Results: Results showed that the greatest agreement was related to sagittal STIR, and sagittal FLAIR (Cohen’s kappa = 0.56). Whereas the least agreement values were from sagittal T2-W and sagittal FLAIR, STIR and FLAIR, T2-W and FLAIR, T2-W and STIR (Cohen’s kappa = 0.20, 0.33, 0.48, 0.55), respectively. Sagittal STIR and sagittal FLAIR were excellent predictors for MS plaques diagnosis due to the area under the ROC curve = 0.56; sensitivity (95% CI) = [0.85 (0.73426 to 0.929044)] and specificity (95% CI) = [0.46 (0.336699 to 0.600035)].
Conclusion: Results show that FLAIR T2-W images in sagittal sequence are appropriate for detecting lesions around spinal cord lesions. Furthermore, using thresholds obtained via statistical analysis, plaques in the cervical spinal cord can be identified in sagittal STIR images.
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9- J Nieves, F Cosman, J Herbert, V Shen, and R Lindsay, "High prevalence of vitamin D deficiency and reduced bone mass in multiple sclerosis." Neurology, Vol. 44 (No. 9), pp. 1687-87, (1994).
10- Mohaddeseh Azadvari, Omid Mirmosayyeb, Maryam Hosseini, Saeed Vaheb, and Seyede Zahra Emami Razavi, "The prevalence of osteoporosis/osteopenia in patients with multiple sclerosis (MS): a systematic review and meta-analysis." Neurological Sciences, pp. 1-14, (2022).
11- Ruth Ann Marrie et al., "Effect of comorbidity on mortality in multiple sclerosis." Neurology, Vol. 85 (No. 3), pp. 240-47, (2015).
12- W Ian McDonald et al., "Recommended diagnostic criteria for multiple sclerosis: guidelines from the International Panel on the diagnosis of multiple sclerosis." Annals of Neurology: Official Journal of the American Neurological Association and the Child Neurology Society, Vol. 50 (No. 1), pp. 121-27, (2001).
13- Paula Wildner, Mariusz Stasiołek, and Mariola Matysiak, "Differential diagnosis of multiple sclerosis and other inflammatory CNS diseases." Multiple Sclerosis and Related Disorders, Vol. 37p. 101452, (2020).
14- Brett S Travers, Benjamin KT Tsang, and Joshua L Barton, "Multiple sclerosis: Diagnosis, disease-modifying therapy and prognosis." Australian Journal of General Practice, Vol. 51 (No. 4), pp. 199-206, (2022).
15- DH Miller, RI Grossman, SC Reingold, and HF McFarland, "The role of magnetic resonance techniques in understanding and managing multiple sclerosis." Brain: a journal of neurology, Vol. 121 (No. 1), pp. 3-24, (1998).
16- Yang Ma et al., "Multiple sclerosis lesion analysis in brain magnetic resonance images: techniques and clinical applications." IEEE Journal of Biomedical and Health Informatics, (2022).
17- Ke-Ru Li et al., "The Key Role of Magnetic Resonance Imaging in the Detection of Neurodegenerative Diseases-Associated Biomarkers: A Review." Molecular Neurobiology, pp. 1-20, (2022).
18- Seraj Mohaghegh, Ali Tarighatnia, Yadollah Omidi, Jaleh Barar, Ayuob Aghanejad, and Khosro Adibkia, "Multifunctional Magnetic Nanoparticles for MRI-guided Co-delivery of Erlotinib and L-Asparaginase to Ovarian Cancer." Journal of Microencapsulation, (No. just-accepted), pp. 1-31, (2022).
19- Stefan Weidauer, Peter Raab, and Elke Hattingen, "Diagnostic approach in multiple sclerosis with MRI: an update." Clinical Imaging, Vol. 78pp. 276-85, (2021).
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21- Ali Tarighatnia, Gurkaran Johal, Ayuob Aghanejad, Hossein Ghadiri, and Nader D Nader, "Tips and Tricks in Molecular Imaging." Frontiers in Biomedical Technologies, Vol. 8 (No. 3), pp. 226-35, (2021).
22- Laura Emilia Toader et al., "Cerebrolysin increases motor recovery and decreases inflammation in a mouse model of autoimmune encephalitis." Romanian journal of morphology and embryology, Vol. 59 (No. 3), pp. 755-62, (2018).
23- Dragan A Stojanov, Aleksandra Aracki-Trenkic, Slobodan Vojinovic, Daniela Benedeto-Stojanov, and Srdjan Ljubisavljevic, "Increasing signal intensity within the dentate nucleus and globus pallidus on unenhanced T1W magnetic resonance images in patients with relapsing-remitting multiple sclerosis: correlation with cumulative dose of a macrocyclic gadolinium-based contrast agent, gadobutrol." European radiology, Vol. 26 (No. 3), pp. 807-15, (2016).
24- A Traboulsee et al., "Revised recommendations of the consortium of MS centers task force for a standardized MRI protocol and clinical guidelines for the diagnosis and follow-up of multiple sclerosis." American Journal of Neuroradiology, Vol. 37 (No. 3), pp. 394-401, (2016).
25- Wolfgang Krauss, Martin Gunnarsson, Margareta Nilsson, and Per Thunberg, "Conventional and synthetic MRI in multiple sclerosis: a comparative study." European radiology, Vol. 28 (No. 4), pp. 1692-700, (2018).
26- NB Nayak, R Salah, JC Huang, and GM Hathout, "A comparison of sagittal short T1 inversion recovery and T2‐weighted FSE sequences for detection of multiple sclerosis spinal cord lesions." Acta Neurologica Scandinavica, Vol. 129 (No. 3), pp. 198-203, (2014).
27- Paula Alcaide-Leon et al., "Comparison of sagittal FSE T2, STIR, and T1-weighted phase-sensitive inversion recovery in the detection of spinal cord lesions in MS at 3T." American Journal of Neuroradiology, Vol. 37 (No. 5), pp. 970-75, (2016).
28- Govind Nair, Martina Absinta, and Daniel S Reich, "Optimized T1-MPRAGE sequence for better visualization of spinal cord multiple sclerosis lesions at 3T." American Journal of Neuroradiology, Vol. 34 (No. 11), pp. 2215-22, (2013).
29- Cristina Philpott and Peter Brotchie, "Comparison of MRI sequences for evaluation of multiple sclerosis of the cervical spinal cord at 3 T." European journal of radiology, Vol. 80 (No. 3), pp. 780-85, (2011).
30- Amin Abolhasani Foroughi, Mahdi Saeedi-Moghadam, Banafsheh Zeinali-Rafsanjani, and Masoume Nazeri, "Comparison between T2, STIR and PSIR sequences, for detection of cervical cord MS plaques." Iranian Journal of Radiology, Vol. 16 (No. 3), (2019).
2- Massimo Ralli et al., "Otolaryngologic symptoms in multiple sclerosis: a review." The International Tinnitus Journal, Vol. 22 (No. 2), pp. 160-69, (2018).
3- Marisa P McGinley, Carolyn H Goldschmidt, and Alexander D Rae-Grant, "Diagnosis and treatment of multiple sclerosis: a review." Jama, Vol. 325 (No. 8), pp. 765-79, (2021).
4- Ramya Talanki Manjunatha, Salma Habib, Sai Lahari Sangaraju, Daniela Yepez, and Xavier A Grandes, "Multiple Sclerosis: Therapeutic Strategies on the Horizon." Cureus, Vol. 14 (No. 5), (2022).
5- Hyun-Yoon Ko, "Nontraumatic Spinal Cord Injuries/Lesions." in Management and Rehabilitation of Spinal Cord Injuries: Springer, (2022), pp. 317-51.
6- Naila Makhani and Helen Tremlett, "The multiple sclerosis prodrome." Nature Reviews Neurology, Vol. 17 (No. 8), pp. 515-21, (2021).
7- Ron Milo and Esther Kahana, "Multiple sclerosis: geoepidemiology, genetics and the environment." Autoimmunity reviews, Vol. 9 (No. 5), pp. A387-A94, (2010).
8- Ane CE Moor, Helga E de Vries, Albertus G de Boer, and Douwe D Breimer, "The blood-brain barrier and multiple sclerosis." Biochemical pharmacology, Vol. 47 (No. 10), pp. 1717-24, (1994).
9- J Nieves, F Cosman, J Herbert, V Shen, and R Lindsay, "High prevalence of vitamin D deficiency and reduced bone mass in multiple sclerosis." Neurology, Vol. 44 (No. 9), pp. 1687-87, (1994).
10- Mohaddeseh Azadvari, Omid Mirmosayyeb, Maryam Hosseini, Saeed Vaheb, and Seyede Zahra Emami Razavi, "The prevalence of osteoporosis/osteopenia in patients with multiple sclerosis (MS): a systematic review and meta-analysis." Neurological Sciences, pp. 1-14, (2022).
11- Ruth Ann Marrie et al., "Effect of comorbidity on mortality in multiple sclerosis." Neurology, Vol. 85 (No. 3), pp. 240-47, (2015).
12- W Ian McDonald et al., "Recommended diagnostic criteria for multiple sclerosis: guidelines from the International Panel on the diagnosis of multiple sclerosis." Annals of Neurology: Official Journal of the American Neurological Association and the Child Neurology Society, Vol. 50 (No. 1), pp. 121-27, (2001).
13- Paula Wildner, Mariusz Stasiołek, and Mariola Matysiak, "Differential diagnosis of multiple sclerosis and other inflammatory CNS diseases." Multiple Sclerosis and Related Disorders, Vol. 37p. 101452, (2020).
14- Brett S Travers, Benjamin KT Tsang, and Joshua L Barton, "Multiple sclerosis: Diagnosis, disease-modifying therapy and prognosis." Australian Journal of General Practice, Vol. 51 (No. 4), pp. 199-206, (2022).
15- DH Miller, RI Grossman, SC Reingold, and HF McFarland, "The role of magnetic resonance techniques in understanding and managing multiple sclerosis." Brain: a journal of neurology, Vol. 121 (No. 1), pp. 3-24, (1998).
16- Yang Ma et al., "Multiple sclerosis lesion analysis in brain magnetic resonance images: techniques and clinical applications." IEEE Journal of Biomedical and Health Informatics, (2022).
17- Ke-Ru Li et al., "The Key Role of Magnetic Resonance Imaging in the Detection of Neurodegenerative Diseases-Associated Biomarkers: A Review." Molecular Neurobiology, pp. 1-20, (2022).
18- Seraj Mohaghegh, Ali Tarighatnia, Yadollah Omidi, Jaleh Barar, Ayuob Aghanejad, and Khosro Adibkia, "Multifunctional Magnetic Nanoparticles for MRI-guided Co-delivery of Erlotinib and L-Asparaginase to Ovarian Cancer." Journal of Microencapsulation, (No. just-accepted), pp. 1-31, (2022).
19- Stefan Weidauer, Peter Raab, and Elke Hattingen, "Diagnostic approach in multiple sclerosis with MRI: an update." Clinical Imaging, Vol. 78pp. 276-85, (2021).
20- Karim Sharifi et al., "Investigation of the frequency of meniscal ligament injuries and other abnormal knee injuries in the patients referring to MRI Center of Shahid Ghazi Clinic in Sanandaj." Scientific Journal of Kurdistan University of Medical Sciences, Vol. 21 (No. 6), (2017).
21- Ali Tarighatnia, Gurkaran Johal, Ayuob Aghanejad, Hossein Ghadiri, and Nader D Nader, "Tips and Tricks in Molecular Imaging." Frontiers in Biomedical Technologies, Vol. 8 (No. 3), pp. 226-35, (2021).
22- Laura Emilia Toader et al., "Cerebrolysin increases motor recovery and decreases inflammation in a mouse model of autoimmune encephalitis." Romanian journal of morphology and embryology, Vol. 59 (No. 3), pp. 755-62, (2018).
23- Dragan A Stojanov, Aleksandra Aracki-Trenkic, Slobodan Vojinovic, Daniela Benedeto-Stojanov, and Srdjan Ljubisavljevic, "Increasing signal intensity within the dentate nucleus and globus pallidus on unenhanced T1W magnetic resonance images in patients with relapsing-remitting multiple sclerosis: correlation with cumulative dose of a macrocyclic gadolinium-based contrast agent, gadobutrol." European radiology, Vol. 26 (No. 3), pp. 807-15, (2016).
24- A Traboulsee et al., "Revised recommendations of the consortium of MS centers task force for a standardized MRI protocol and clinical guidelines for the diagnosis and follow-up of multiple sclerosis." American Journal of Neuroradiology, Vol. 37 (No. 3), pp. 394-401, (2016).
25- Wolfgang Krauss, Martin Gunnarsson, Margareta Nilsson, and Per Thunberg, "Conventional and synthetic MRI in multiple sclerosis: a comparative study." European radiology, Vol. 28 (No. 4), pp. 1692-700, (2018).
26- NB Nayak, R Salah, JC Huang, and GM Hathout, "A comparison of sagittal short T1 inversion recovery and T2‐weighted FSE sequences for detection of multiple sclerosis spinal cord lesions." Acta Neurologica Scandinavica, Vol. 129 (No. 3), pp. 198-203, (2014).
27- Paula Alcaide-Leon et al., "Comparison of sagittal FSE T2, STIR, and T1-weighted phase-sensitive inversion recovery in the detection of spinal cord lesions in MS at 3T." American Journal of Neuroradiology, Vol. 37 (No. 5), pp. 970-75, (2016).
28- Govind Nair, Martina Absinta, and Daniel S Reich, "Optimized T1-MPRAGE sequence for better visualization of spinal cord multiple sclerosis lesions at 3T." American Journal of Neuroradiology, Vol. 34 (No. 11), pp. 2215-22, (2013).
29- Cristina Philpott and Peter Brotchie, "Comparison of MRI sequences for evaluation of multiple sclerosis of the cervical spinal cord at 3 T." European journal of radiology, Vol. 80 (No. 3), pp. 780-85, (2011).
30- Amin Abolhasani Foroughi, Mahdi Saeedi-Moghadam, Banafsheh Zeinali-Rafsanjani, and Masoume Nazeri, "Comparison between T2, STIR and PSIR sequences, for detection of cervical cord MS plaques." Iranian Journal of Radiology, Vol. 16 (No. 3), (2019).
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| Issue | Vol 10 No 3 (2023) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/fbt.v10i3.13157 | |
| Keywords | ||
| Magnetic Resonance Imaging Multiple Sclerosis Cervical Spinal Cord Lesion Short Tau Inversion Recovery and Fluid Attenuated Inversion Recovery Sequences | ||
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How to Cite
1.
Sharifi K, Roshani D, Moradi B, Parvizpour S, Moloudi S, Charekhah N, Abdolmohammadi J, Mahmoodi M. The Effect of Sagittal STIR and FLAIR Sequences Compared to Sagittal T2-W for Characterizing MS Lesions in Cervical Spine MRI. Frontiers Biomed Technol. 2023;10(3):277-286.
