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Background <p>Spinal inflammatory demyelinating diseases (IDDs) often exhibit overlapping imaging features across different etiologies. This study aims to compare and analyze the differences in qualitative diagnostic capability (specificity) and lesion detection performance (including lesion count and lesion contrast) between DIR and T2-weighted imaging (T2WI) in spinal cord IDDs, thereby exploring the diagnostic value of the DIR in these conditions.</p> Methods <p>Retrospectively analyzed MRI data of 20 spinal demyelinating disease patients (13 MS, 4 ADEM, 3 NMOSD) from March 2022 to November 2024. Two radiologists independently performed qualitative diagnosis for all patients using DIR and T2WI images. They then counted the lesions on spinal cord DIR and T2WI, and calculated the contrast-to-noise ratio (CNR) and signal intensity ratio (SIR) for all lesions. Lesion contrast differences were compared using CNR and SIR values. Inter-observer agreement was measured by ICC analysis.</p> Results <p>Inter-observer agreement was excellent for DIR (κ = 0.83) and substantial for T2WI (κ = 0.76). Consensus diagnosed 16 cases on DIR versus 6 on T2WI. Lesion count agreement was good (ICC &gt; 0.75) both on T2WI and DIR. DIR detected 77.78% more lesions (<i>p</i> &lt; 0.05). DIR showed higher CNR (8.74 ± 2.04 vs. 2.83 ± 0.74) and SIR (0.98 ± 0.40 vs. 0.37 ± 0.14) than T2WI (both <i>p</i> &lt; 0.01).</p> Conclusions <p>Compared with conventional T2WI, DIR demonstrated significantly improved lesion detection capability, revealing more lesions with higher CNR and SIR values. DIR sequences showed superior diagnostic performance (specificity) for spinal IDDs than T2WI. We recommend DIR sequences as a supplementary MRI protocol for evaluating spinal IDDs.</p>

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The value of double inversion recovery MRI sequences in the diagnosis of inflammatory demyelinating diseases of the spinal cord

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月21日

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  • Yannan Zhang,
  • Qian Xiao,
  • Dan Zhu,
  • Xiaoxia Zhang,
  • Yibin Wang,
  • Genlin Zong,
  • Ailan Cheng,
  • Shuguang Chu

摘要

Background

Spinal inflammatory demyelinating diseases (IDDs) often exhibit overlapping imaging features across different etiologies. This study aims to compare and analyze the differences in qualitative diagnostic capability (specificity) and lesion detection performance (including lesion count and lesion contrast) between DIR and T2-weighted imaging (T2WI) in spinal cord IDDs, thereby exploring the diagnostic value of the DIR in these conditions.

Methods

Retrospectively analyzed MRI data of 20 spinal demyelinating disease patients (13 MS, 4 ADEM, 3 NMOSD) from March 2022 to November 2024. Two radiologists independently performed qualitative diagnosis for all patients using DIR and T2WI images. They then counted the lesions on spinal cord DIR and T2WI, and calculated the contrast-to-noise ratio (CNR) and signal intensity ratio (SIR) for all lesions. Lesion contrast differences were compared using CNR and SIR values. Inter-observer agreement was measured by ICC analysis.

Results

Inter-observer agreement was excellent for DIR (κ = 0.83) and substantial for T2WI (κ = 0.76). Consensus diagnosed 16 cases on DIR versus 6 on T2WI. Lesion count agreement was good (ICC > 0.75) both on T2WI and DIR. DIR detected 77.78% more lesions (p < 0.05). DIR showed higher CNR (8.74 ± 2.04 vs. 2.83 ± 0.74) and SIR (0.98 ± 0.40 vs. 0.37 ± 0.14) than T2WI (both p < 0.01).

Conclusions

Compared with conventional T2WI, DIR demonstrated significantly improved lesion detection capability, revealing more lesions with higher CNR and SIR values. DIR sequences showed superior diagnostic performance (specificity) for spinal IDDs than T2WI. We recommend DIR sequences as a supplementary MRI protocol for evaluating spinal IDDs.