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Spectrally fat-suppressed coronal 2D TSE sequences may be more sensitive than 2D STIR for the detection of hyperintense optic nerve lesions

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Abstract

Objectives

The aim of the study is to compare coronal spectrally fat-suppressed 2D turbo spin-echo (TSE) with 2D short-tau inversion-recovery (STIR) sequences for the detection of optic nerve hyperintensities in patients with acute optic nerve neuritis (ON).

Methods

A retrospective review of patients with suspected unilateral ON and pathological visual evoked potentials, who received coronal TSE and STIR sequences with similar fast and clinically feasible acquisition times in addition to our standard imaging protocol. All images were evaluated and compared concerning the presence of optic nerve lesions, lesion lengths, and signal intensities in different anatomical parts of the optic nerves and CNR measures. A summary confidence score (CS) was calculated based on each reader’s subjective confidence regarding the scoring items.

Results

Interobserver agreements regarding the detection of optic nerve lesions were excellent for both sequences (TSE, κ = 0.89 and STIR, κ = 0.80). Greater extensions (17.4 ± 6.3 mm vs. 14.1 ± 5.8 mm), as well as higher numbers of optic nerve lesions in symptomatic nerves, were detected on TSE (49/52) compared with STIR (45/52) sequences (both p < 0.001). Overall CS were significantly (p < 0.001) higher for TSE (2.8) compared with STIR (2.1) sequences regarding the presence or absence of optic nerve lesions. CNR ratios of lesions’ mean signal intensities vs. ipsilateral surrounding orbital fat and vs. signal intensity measurements from contralateral optic nerves were significantly higher on TSE compared with STIR (p < 0.001 for both comparisons).

Conclusion

Spectrally fat-suppressed coronal 2D TSE sequences appear to be more sensitive for the detection of hyperintense optic lesions compared with 2D STIR sequences.

Key Points

• Spectrally fat-suppressed TSE sequences showed higher detection rates of hyperintense optic nerve lesions, as well as a higher reader confidence scores compared with STIR.

• Optic nerve signal abnormalities on TSE sequences were brighter and showed a greater expansion along the optic nerve course.

• CNR measures were significantly higher on TSE compared with STIR, when comparing the ratios of mean signal intensities of optic nerve lesions to ipsilateral orbital fat and to contralateral healthy optic nerves of both sequences.

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Abbreviations

AQP4-IgG:

Aquaporin-4 immunoglobulin G

AU:

Arbitrary unit

CHESS:

Chemical shift selective

CIS:

Clinically isolated syndrome

CS:

Compound confidence score

CSF:

Cerebrospinal fluid

IQR:

Interquartile range

L-CON-Q:

Lesion contralateral optic nerve quotient

MRI:

Magnetic resonance imaging

MS:

Multiple sclerosis

NMOSD:

Neuromyelitis optica spectrum disorder

ON:

Optic neuritis

PACS:

Picture archiving and communication system

ROI:

Region of interest

SE:

Spin-echo

SPIR:

Selective-partial inversion-recovery

STIR:

Short-tau inversion-recovery

TSE:

Turbo spin-echo

VEP:

Visual evoked potentials

WM:

White matter

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Funding

The authors state that this work has not received any funding.

Author information

Authors and Affiliations

  1. Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg-Eppendorf, Germany

    Tobias D. Faizy, Gabriel Broocks, Isabelle Frischmuth, Carina Westermann, Fabian Flottmann, Michael H. Schönfeld, Jawed Nawabi, Hannes Leischner, Daniel Kutzner, Jens Fiehler, Susanne Gellißen & Uta Hanning

  2. Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    Jan-Patrick Stellmann & Christoph Heesen

  3. Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    Jan-Patrick Stellmann & Christoph Heesen

Authors
  1. Tobias D. Faizy
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  2. Gabriel Broocks
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  3. Isabelle Frischmuth
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  4. Carina Westermann
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  14. Uta Hanning
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Corresponding author

Correspondence to Tobias D. Faizy.

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Guarantor

The scientific guarantor of this publication is Professor Dr. med. Jens Fiehler, Hamburg.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Dr. Stellmann reports grants from Alpina, during the conduct of the study; grants and personal fees from Biogen; personal fees from Genzyme; and grants from Novartis, outside the submitted work. These fundings did not compromise or influence the scientific work presented in this manuscript.

Statistics and biometry

Dr. Uta Hanning and Dr. Fabian Flottmann have significant statistical expertise. No complex statistical methods were necessary for this paper.

Informed consent

The study was approved by the local research Ethical Committee Hamburg (Ethik-Komission der Ärztekammer Hamburg), following the guidelines of the Declaration of Helsinki and written informed consent was given from every participant.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• Retrospective

• Diagnostic or prognostic study

• Performed at one institution

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Faizy, T.D., Broocks, G., Frischmuth, I. et al. Spectrally fat-suppressed coronal 2D TSE sequences may be more sensitive than 2D STIR for the detection of hyperintense optic nerve lesions. Eur Radiol 29, 6266–6274 (2019). https://doi.org/10.1007/s00330-019-06255-z

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  • DOI: https://doi.org/10.1007/s00330-019-06255-z

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