Initial Evaluation of Conventional (T2W, T2 FLAIR, DWI/ADC) and New MRI Sequences (DTI, DIR) for White Matter Disease Detection and Microstructural Integrity Assessment..

Abstract

Introduction: White matter diseases (WMDs) refer to a variety of neurological conditions involving white matter integrity of the brain. Conventional MRI sequences such as T2-weighted (T2W), T2 fluid-attenuated inversion recovery (T2 FLAIR), and diffusion-weighted imaging/apparent diffusion coefficient (DWI/ADC) are commonly applied for WMD identification but might not be sensitive enough for minute microstructural alterations. New sequences such as diffusion tensor imaging (DTI) and double inversion recovery (DIR) provide improved lesion detection and quantitative measurement of white matter integrity. This pilot study compares the feasibility, image quality, and diagnostic value of these new sequences with conventional MRI.

Aim: To compare the feasibility and initial diagnostic performance of DTI and DIR with standard MRI sequences for WMD detection and microstructural analysis.

Material and Method: A pilot study was performed prospectively on 56 patients with suspected or proven WMDs on a 1.5T SIEMENS MAGNETOM Avanto MRI scanner. Standard MRI (T2W, T2 FLAIR, DWI/ADC) and advanced imaging sequences (DTI, DIR) were obtained. Statistical tests such as ANOVA, Chi-square, and correlation analysis were used to analyze lesion conspicuity, size, and microstructural integrity.

Results: DIR enhanced lesion visibility in high CSF areas, whereas DTI yielded FA and MD values indicating microstructural integrity. Lesion conspicuity between sequences did not differ significantly (T2W, T2 FLAIR, DWI/ADC and DTI, DIR) (ANOVA, p > 0.05). Inter-rater agreement was moderate (Kappa: 0.41–0.60). DTI-sourced FA and MD values demonstrated significant correlations with lesion conspicuity (p < 0.001).

Conclusion: DIR increases lesion visibility, and DTI provides microstructural information but does not have a clinically important advantage over standard MRI in lesion visibility. Large-scale studies are required to maximize clinical utility.