Comparison of a conventional cardiac-triggered dual spin-echo and a fast STIR sequence in detection of spinal cord lesions in multiple sclerosis

The current optimal imaging protocol in spinal cord MR imaging in patients with multiple sclerosis includes a long TR conventional spin-echo (CSE) seq uence, requiring long aquisition times. Using short tau inversion recovery fast spin-echo (fast STIR) sequences both acquisition time can be shortened and sensitivity in the detection of multiple sclerosis (MS) abnormalities can be increased. This study compares both sequences for the potential to d etect bot focal and diffuse spinal abnormalities. Spinal cords of 5 volunte ers and 20 MS patients were studies at 1.0 T. Magnetic resonance imaging in cluded cardiac-gated sagittal dual-echo CSE and a cardiac-gated fast fast S TIR sequence. Images were scored regarding number, size, and location of fo cal lesions, diffuse abnormalities and presence/hindrance of artifacts by t wo experienced radiologists. Examinations were scored as being definitely n ormal, indeterminate, or definitely abnormal. Interobserver agreement regar ding focal lesions was higher regarding focal lesions was higher for CSE (x = 0.67) than for fast STIR (x = 0.57) but did not differ significantly. Of all focal lesions scored in consensus. 47% were scored on both sequences. 31% were only detected by fast STIR, and 22% only by dual-echo CSE (n.s). I nterobserver agreement for diffuse abnormalities and dual-echo CSE in 3. Af ter consensus, fast STIR showed in 10 patients diffuse abnormalities and du al-echo CSE scans were considered as definitely abnormal compared with 17 f or fast STIR. The fast STIR sequence is a useful adjunct to dual-echo CSE i n detecting focal abnormalities and is helpful in detecting diffuse MS abno rmalities in the spinal cord. Due to frequent occurrence of artifacts and t he lower observer concordance, fast STIR cannot be used alone.