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Intracortical Lesions in Multiple Sclerosis: Improved Detection with 3D Double Inversion-Recovery MR Imaging¹

¹ From the Departments of Radiology (J.J.G.G., F.B., J.A.C.), Neurology (B.M.J.U., C.H.P.), and Physics and Medical Technology (P.J.W.P.), MR Center for MS Research, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands. Received March 10, 2004; revision requested May 21; final revision received September 2; accepted September 29. J.J.G.G. supported by grant 00-427 from the Stichting MS Research, Voorschoten, the Netherlands. Address correspondence to J.J.G.G. (e-mail: j.geurts{at}vumc.nl).

View larger version (128K): [in a new window]   Figure 1. Transverse 3D DIR images selectively depict cortical and deep gray matter in a control subject. Note the high level of contrast between gray matter and white matter and between gray matter and CSF. Artifacts such as transependymal effusion around the ventricles (arrow) and high signal intensity in the choroid plexus (arrowhead) are evident. No contrast agent was used.

View larger version (100K): [in a new window]   Figure 2. Transverse intermediate-weighted (IW), T2-weighted (T2), 3D FLAIR, and 3D DIR images of intracortical lesions. Top row: lesion (arrowhead) in the cortical gray matter, with a possible juxtacortical component; the intracortical lesion is particularly poorly visible on intermediate- and T2-weighted images, as well as on the FLAIR image, whereas it is depicted clearly on the DIR image. Bottom row (different patient): DIR image shows very good delineation of the intracortical lesion (arrowhead), which may be mistaken for a juxtacortical lesion or a partial volume artifact on the T2-weighted image and may even be missed on the FLAIR image. No contrast agent was used.

View larger version (84K): [in a new window]   Figure 3. Transverse intermediate-weighted (IW), T2-weighted (T2), 3D FLAIR, and 3D DIR images of mixed white matter–gray matter lesions (top and bottom rows represent two different patients). Whereas it may be hard to determine whether the lesion (arrowhead) in each patient is juxtacortical or mixed white matter and gray matter on T2-weighted and FLAIR images, DIR images show in more detail that these lesions also involve the cortical gray matter. No contrast agent was used.