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Comparative Study
. 2025 Jun 1;60(6):387-396.
doi: 10.1097/RLI.0000000000001140. Epub 2024 Nov 28.

Improved MR Detection of Optic Nerve Demyelination With MP2RAGE-FLAWS Compared With T 2 -Weighted Fat-Saturated Sequences

Randa Aichour  1 , Thibaut Emorine, Nadia Oubaya, Imen Megdiche, Alain Créange, Augustin Lecler, Tobias Kober, Aurélien Massire, Blanche Bapst
Affiliations
Comparative Study

Improved MR Detection of Optic Nerve Demyelination With MP2RAGE-FLAWS Compared With T 2 -Weighted Fat-Saturated Sequences

Randa Aichour et al. Invest Radiol. .

Abstract

Objectives: Nonenhanced T 1 -w sequences such as magnetization-prepared 2 rapid acquisition gradient echo (MP2RAGE) and derived fluid and white matter suppression (FLAWS) have demonstrated high performance for detecting brain parenchymal and cervical spine demyelinating lesions in multiple sclerosis. However, their potential for identifying optic nerve (ON) demyelination remains unexplored. The aim of this study was to evaluate the performance of compressed sensing-accelerated (CS) MP2RAGE-FLAWS imaging for detection of ON demyelination lesions compared with T2-w fat-saturated (FS) TSE imaging in a clinical setting.

Materials and methods: We conducted a retrospective study of magnetic resonance scans acquired on patients with central nervous system demyelinating disorders between January and December 2022. Inclusion criteria were the acquisition in the same session of a brain CS-MP2RAGE-FLAWS imaging and a combination of axial + coronal T2-w FS orbital sequences. A 4-step radiological analysis-including blinded and consensus readings-assessed ON lesion detection. The reference standard was the final reading session of radiologists using the entire patient file. Sensitivities and specificities of both sequences were computed and compared using McNemar χ 2 tests.

Results: Thirty-nine patients (mean age: 43 ± 14 years; 25 women) were analyzed, including 34 with multiple sclerosis, 2 with MOGAD (myelin oligodendrocyte glycoprotein antibody-associated disease), 1 with NMOSD (neuromyelitis optica spectrum disorder), and 2 with indeterminate demyelinating disease. Among the 78 ONs analyzed, 64 lesions were detected with CS-MP2RAGE-FLAWS as opposed to 37 with 2D T2-w FS imaging, corresponding to a total of 41 and 27 affected nerves, respectively. CS-MP2RAGE-FLAWS exhibited higher sensitivity for overall detection of ON lesions compared with 2D T2-w FS imaging (97.5% vs 67.5%, P = 0.001) without reducing the specificity. Improved lesion detectability with CS-MP2RAGE-FLAWS was significant compared with 2D T2-w FS in intraorbital and intracanalicular segments (respectively, 92.3% vs 50% and 96.3% vs 66.7%; P < 0.05). There was no difference in sensitivity ( P = 0.69) or specificity ( P = 0.99) regarding the intracranial segment analysis.

Conclusions: CS-MP2RAGE-FLAWS sequence improves ON lesion detection compared with conventional 2D T2-w FS, especially in the intraorbital segment, while simultaneously providing whole-brain and cervical spinal cord imaging at no additional time cost.

Keywords: 3 T; FLAWS; MP2RAGE; MRI; demyelination; multiple sclerosis; optic nerve; optic neuritis.

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Conflict of interest statement

Conflicts of interest and sources of funding: A.M. is an employee of Siemens Healthcare SAS. T.K. is an employee and shareholder of Siemens Healthineers International AG and holds patents filed by Siemens Healthineers. None of them was involved in the analysis and control of the data. For the remaining authors, no conflicts of interest were declared. The authors received no financial support for the research, authorship, or publication of this article.

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