Use of MRI-double inversion recovery sequence for early diagnosis of multiple sclerosis: case series

Abstract

The choice of additional Double Inversion Recovery (DIR) Magnetic Resonance Imaging (MRI) sequences may affect the judgment of the presence and nature of lesions. Herein, we reported three cases initially presenting with non-typical multiple sclerosis (MS) symptoms, in which the final diagnosis of MS was confirmed after incorporating spinal cord and brain DIR MRI sequence. The sequence revealed more conspicuous lesions compared to conventional T2-weighted imaging or T2-weighted fluid-attenuated inversion recovery (T2WI/FLAIR) sequences. Consequently, the patients received an earlier definitive diagnosis and timely treatment. Our cases demonstrated the additional DIR sequences for the patients with non-typical MS symptoms were reasonable and may be helpful.

Keywords: Double inversion recovery sequence; Magnetic resonance imaging; Multiple sclerosis.

Fig. 1

(A.a-A.c) Lumbar T2WI of the 33-year-old male. (A.a-A.b) lumbar MRI before the intervertebral disc surgery. The T2WI detected the herniated disc. But there existed two suspicious short-segment lesions with high T2 signal intensity (arrow). (A.c) lumbar MRI with metal artifacts (square bracket) scanned after intervertebral disc surgery; (B.a-B.b) The cervical cord T2-weighted and DIR sequence MRI scanned within three months after the intervertebral disc surgery. Both T2WI and DIR images showed a short-segment lesion in the cervical spine 4–5 (arrow). The signal of lesion on the DIR image was uniform, well-circumscribed and high signal (right arrow); (C.a-C.c) The additional brain DIR images showed multiple lesions in periventricular area (C.a-C.b, arrow) and subcortical white matter in the right temporal lobe (C.c, arrow). (D.a-D.c) The Flair sequence at the matched imaging position

Fig. 2

The MRI of the 16-year-old female who initially complained of numbness in both hands. (A-B) the cervical and thoracic spinal cord MRI images on T1WI, T2WI, DIR and T1 + C sequences. (Fig. 2A, red arrow) A short-segment lesion without enhancement was detected in the cervical spinal cord. (Fig. 2B) A short-segment lesion without enhancement was detected in the thoracic spinal cord, the DIR image showed sharp brim and signal intensity; (Fig. 2C) The brain MRI images on T1WI, T2WI, FLAIR and DIR sequences. Multiple small periventricular lesions were detected in the brain, clearer on DIR than T2/FLAIR (red arrow). The DIR detected the lesion of the corpus callosum (yellow arrow) which was poor displayed on regular sequences

Fig. 3

The brain MRI on T2WI, DIR and T1 + C sequences of the 33-year-old male. (First row) The images showed multiple lesions in the parietal level of the lateral ventricle. The images detected the roundish lesion without enhancement within the white matter of the right frontal lobe (yellow arrow) and multiple small lesions in the periventricular area (red arrow), which both were more conspicuously showed on DIR scan than T2WI. (Second row) The images showed lesions (blue arrow) in semi-ovale region, clearer on DIR scan. (Third row) Only the DIR sequence detected the small lesion in left brain stem (red arrow). (Fourth row) The DIR sequence of cervical and thoracic spinal cord detected a short-segment high signal lesion on cervical spinal cord (red arrow)