The added value of double inversion recovery (DIR) sequence compared to fluid attenuation inversion recovery (FLAIR) in identifying multiple sclerosis lesions and different cortical subtypes

Background. There is a rising concern about multiple sclerosis (MS) lesions that occur in the cortical gray matter (GM), owing to its direct relationship with the disability and cognition dysfunction that occur during the MS course. Two magnetic resonance imaging (MRI) sequences that aid in the precise identification of these lesions are the Double Inversion Recovery (DIR) and Fluid Attenuation Inversion Recovery (FLAIR) sequences. Objective. To study the importance of the DIR for brain lesion detection and the various cortical subtypes distinction in MS-diagnosed patients and its correlations to the level of patient disability by comparing it to FLAIR. Patients and Methods: Thirty MS patients participated in this retrospective cross-sectional study, who had been previously diagnosed with MS and were routinely followed up at the Radiology Department at Ain-Shams University. Results. Comparing the DIR sequence to FLAIR, the overall MS lesion detection enhanced by 8% (p<0.001). Regarding the detection of cortical lesion subtypes (I–IV), it was discovered that the DIR sequence revealed significantly more lesions than FLAIR (p<0.001). The cortical lesions detected by DIR or FLAIR were found to have positive, highly significant correlations with both patients’ disability and the MS duration. Conclusion. For lesion identification, DIR is more effective than FLAIR, particularly for cortical and juxtacortical lesions in MS patients.