Comparative evaluation of lesion conspicuity in white matter disease using double inversion recovery and T2 fluid-attenuated inversion recovery magnetic resonance imaging sequences: A cross-sectional observational study
TL;DR
DIR showed a modest, though not statistically significant, advantage in lesion conspicuity over T2 FLAIR, particularly for cortical and juxtacortical lesions, and both sequences performed consistently across lobes.
Abstract
To compare lesion visibility between DIR and T2 FLAIR MRI sequences, with additional focus on whether conspicuity varies across brain lobes. A cross-sectional observational study was conducted on 84 patients undergoing MRI for suspected white matter disease. Inclusion criteria required complete datasets including T2W, T2 FLAIR, DWI/ADC, and DIR sequences. Lesion conspicuity was graded on a 5-point Likert scale by two experienced radiologists. Lesions were classified by location into frontal, temporal, parietal, and occipital lobes. Statistical analyses included Wilcoxon Signed-Rank Test, Kruskal-Wallis Test, and chi-square tests, with significance set at p <0.05. DIR sequences demonstrated a slightly higher mean conspicuity score (2.95 ± 1.34) compared to T2 FLAIR (2.77 ± 1.25). While DIR received more high scores (14.3% rated 5) relative to FLAIR (10.7% rated 5), the differences were not statistically significant ( p >0.05). Conspicuity did not significantly vary across lobes for either sequence (DIR: p =0.809; FLAIR: p =0.379). DTI analysis supported microstructural disruption in affected tracts, with significant FA -MD correlation (r=0.250, p =0.022). DIR showed a modest, though not statistically significant, advantage in lesion conspicuity over T2 FLAIR, particularly for cortical and juxtacortical lesions. Both sequences performed consistently across lobes. Findings suggest DIR may serve as a valuable complementary tool in clinical MRI protocols, enhancing detection of subtle white matter pathology.