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; Jamil  Abdolmohammadi; Shadi  Parvizpour; Neda  Charekhah; Somaye  Moloudi; Mozaffar  Mahmoodi

doi:10.18502/fbt.v10i3.13157

Karim Sharifi Department of Radiology, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
Daem Roshani Department of Epidemiology and Biostatistics, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
Bakhtiar Moradi Shahid Ghazi MRI Center, Sanandaj, Iran
Jamil Abdolmohammadi Department of Radiology, Faculty of Paramedical, Kurdistan University of Medical Sciences, Sanandaj, Iran
Shadi Parvizpour Department of Radiology, Faculty of Paramedical, Kurdistan University of Medical Sciences, Sanandaj, Iran
Neda Charekhah Department of Radiology, Faculty of Paramedical, Kurdistan University of Medical Sciences, Sanandaj, Iran
Somaye Moloudi Department of Radiology, Faculty of Paramedical, Kurdistan University of Medical Sciences, Sanandaj, Iran
Mozaffar Mahmoodi Department of Molecular Medicine and Medical Biotechnology, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran

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

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.