Comparison Between Proton Density And T2 Weighted Sequences For Detection Of Cervical Cord Lesions In Multiple Sclerosis

Abstract

Introduction:<br /> Magnetic resonance imaging (MRI) is the gold standard imaging technique for identification of demyelinating lesions such as Multiple Sclerosis (MS). The Consortium of MS Centers Consensus (CMSC) Guidelines has recommended 2D proton density/T2 weighted sequences in standard MS spinal cord imaging protocol. The present study is conducted to compare two major CMSC standard spinal cord sequences, proton density (PD) and T2 weighted images, in the detection of cervical spinal cord lesions of patients with MS.<br /> Material and Methods:<br /> 130 patients with clinically definite MS were imaged during a period from February 2014 to June 2015. 100 of these patients, who had cervical spinal cord lesions were included in this study. An institutional protocol for MS lesion detection consistent with the CMSC clinical guidelines which include sagittal T2-fast spin echo, sagittal T1-fast spin echo, sagittal PD-fast spin echo and axial T2WI through cervical cord from C1/2 to T1 vertebrae, were performed for all included patients. The data were analyzed in order to assess lesion-to-cord contrast ratio (LCR) and lesion-contrast-to-noise ratio (LNR).<br /> Results:<br /> LCR was significantly higher in T2 weighted images (35.3), in comparison to PD images (24.2). No statistically significant difference was detected between LNR of T2 and PD weighted images (P= 0.2). PDWI could not detect the black hole plaques of MS due to more water content of such lesions.<br /> Conclusin:<br /> Sagittal T2 weighted imaging appears to be superior in comparison to PD sequence for detection of cervical cord MS lesions. Our study questions CMSC guideline in using the PD as a core spinal cord imaging sequence.