@article{3122456,
    title = "Proton Density Fat Suppressed MRI in 3T Increases the Sensitivity of Multiple Sclerosis Lesion Detection in the Cervical Spinal Cord",
    author = "Karavasilis, E. and Velonakis, G. and Argiropoulos, G. and Athanasakos, A. and Poulou, L.S. and Toulas, P. and Kelekis, N.L. and Efstathopoulos, E.P.",
    journal = "Clinical Neuroradiology",
    year = "2019",
    volume = "29",
    number = "1",
    pages = "45-50",
    publisher = "Urban und Vogel GmbH",
    issn = "1869-1439",
    doi = "10.1007/s00062-017-0626-4",
    keywords = "Article;  cervical spinal cord injury;  clinical article;  contrast to noise ratio;  human;  image quality;  lesion to cord contrast ratio;  multiple sclerosis;  nuclear magnetic resonance imaging;  proton density fat suppressed nuclear magnetic resonance imaging;  qualitative analysis;  quantitative analysis;  adult;  comparative study;  diagnostic imaging;  evaluation study;  female;  male;  multiple sclerosis;  myelin sheath;  nonparametric test;  nuclear magnetic resonance imaging;  procedures;  sensitivity and specificity;  signal noise ratio;  spinal cord;  spinal cord disease, Adult;  Female;  Humans;  Magnetic Resonance Imaging;  Male;  Multiple Sclerosis;  Myelin Sheath;  Sensitivity and Specificity;  Signal-To-Noise Ratio;  Spinal Cord;  Spinal Cord Diseases;  Statistics, Nonparametric",
    abstract = "Purpose: Considering the number of multiple sclerosis (MS) patients referred for clinical spinal cord imaging, the optimization of imaging protocols plays a crucial role. We aimed to evaluate the use of proton density (PD) turbo spin-echo (TSE) with spectral attenuated inversion recovery (SPAIR) fat suppression and compare it with the currently recommended T2-TSE-SPAIR in sagittal plane in cervical spinal cord imaging. Methods: In this study 35 MS patients with clinically suspected or known spinal cord lesions were scanned on a 3.0T magnetic resonance imaging (MRI) system. In addition to the routine protocol, PD-TSE-SPAIR sequences were obtained to quantitatively and qualitatively evaluate lesion detectability and image quality compared to T2-TSE-SPAIR sequences. Quantitative analysis was based on measurements of lesion-to-cord contrast ratio (LCCR), lesion contrast-to-noise ratio (LCNR) and lesion dimensions and the qualitative analysis on ranking with a predetermined score scale. The presence of lesions in these sequences was verified in axial T2 multi-echo gradient echo images. Results: In quantitative analysis, the lesions on PD-TSE-SPAIR had statistically significantly higher contrast (p < 0.05), according to the statistical test of LCCR, LCNR calculated contrast and measured lesion dimensions. Qualitative analyses were congruent with quantitative results; the median rank of PD-TSE-SPAIR was significantly higher than T2-TSE-SPAIR (p < 0.05). Of the 34 detected lesions 9 (26%) were not visualized in T2-TSE-SPAIR sequence. Conclusion: Considering its superiority in contrast ratios and lesion dimensions when compared to T2-TSE-SPAIR in both qualitative and quantitative analyses, we therefore recommend PD-TSE-SPAIR as a pivotal sequence to evaluate demyelinating spinal cord lesions at 3T. © 2017, Springer-Verlag GmbH Germany."
}