Usefulness of Phase Sensitive Inversion Recovery MRI Sequence in the Detection of Cortical Lesions in Multiple Sclerosis

Background: The presence of cerebral cortical lesions in multiple sclerosis has an important clinical impact on the prognosis of the disease and associated disability. However, the accurate detection of cortical lesions using conventional magnetic resonance imaging sequences remains challenging. The study aims to assess the value of phase-sensitive inversion recovery sequence in the detection of cortical lesions in multiple sclerosis patients and to evaluate their relation with clinical subtypes, duration, and clinical disability of the disease. Patients and Methods: Seventy cases, 51 females and 19 males, of multiple sclerosis, confirmed by McDonald criteria, were enrolled in this cross-sectional study and phase-sensitive inversion recovery images, axial and coronal sections, were obtained for each patient in every MRI session. Cortical lesions were subclassified into intracortical, leukocortical, and juxtacortical. Clinical disability was assessed using the extended disability status scale. The number of detected cortical lesions on phase-sensitive inversion recovery images was calculated and compared with that detected on conventional T2-weighted and fluid-attenuated inversion recovery images. Results: The number of cortical lesions detected on phase-sensitive inversion recovery was lesser compared to the T2-weighted sequence, a total of 1151 versus 1258 lesions respectively. The T2-weighted sequence was significantly better in the detection of leukocortical and juxtacortical. On the other hand, phase-sensitive inversion recovery was better than fluid-attenuated inversion recovery in detecting intracortical, while fluid-attenuated inversion recovery was better in detecting juxtacortical, and both sequences detected the same number of leukocortical lesions. The overall number of detected cortical lesions showed a statistically significant correlation only with the extended disability status scale and not with the clinical subtype or duration of multiple sclerosis. Conclusion: phase-sensitive inversion recovery detected more intracortical lesions and fewer juxtacortical lesions than fluid-attenuated inversion recovery, cortical lesions were significantly correlated with the degree of clinical disability of multiple sclerosis.