Comparison of proton density MRI and T2-Weighted Fast Echo for The Detection of Cervical Spinal Cord Multiple Sclerosis Lesions

  • Iman Emad Ahmed M.B.Ch.B. , permanent Radiology, Imamein Kadhimein Medical City
  • Hayder Kareem Al-Jaberi F.I.B.M.S.(Rad), head of radiology department, Imamein Kadhimein Medical City
  • Mohammed M. Jawad Alkahlissi Consultant radiology, Imamein Kadhimein Medical city
Keywords: Cervical Multiple Sclerosis, Proton density MRI, T2-Weighted Fast Echo MRI


Background: The prevalence of spinal cord lesions is high in multiple sclerosis particularly in the cervical cord, and their detection can assist in both the diagnosis and follow-up of the patients. For spinal multiple sclerosis, MRI is considered the first line investigation.

Objective: To evaluate the value of sagittal 1.5 Tesla proton density-fast spin echo (PD-FSE) MRI in the detecting and increasing conspicuity of multiple sclerosis lesions in cervical cord in comparison with sagittal T2 fast spin-echo (T2-FSE) MRI.

Patients and Methods: A cross sectional study carried out from 3rd of January 2017 to 1st of January 2018 in the MRI department of Al-Imamein Al-Kadhimein Medical City, and included 60 selected patients with a known diagnosis of multiple sclerosis. All patients were examined with 1.5 T sagittal PD-FSE, T2-FSE and axial gradient recalled-echo (GRE) MRI.

Results: Sixty patients with cervical multiple sclerosis were enrolled in the study, 146 (100%) lesions were detected by PD-FSE imaging, while T2 detected 105 (71.9%), 41 more lesions (28%) were detected by PD-FSE imaging, (P-value <0.001). All extra lesions were confirmed on axial imaging. In 13 patients (21.6%) one lesion or more had been detected on sagittal PD-FSE imaging while on sagittal T2-FSE imaging, no lesion were detected. On PD-FSE imaging, 17 long lesions were detected in 16 patients (26.7%) while 7 long lesions in 7 patients (11.7%) were detected by T2-FSE imaging. So, in 9 patients (16.7%) 10 lesions were detected as long in PD-FSE while short lesion in T2– FSE, the detection of long lesions by PD-FSE was significantly higher than in T2– FSE (100% vs 71.9% with p- value of 0.002). The mean lesion contrast to cord ratio was significantly higher in PD-FSE as compared to T2-FSE (PD-FSE, 79±2.0, against T2-FSE, 61± 2.6; P-value <0.001).

Conclusion: Sagittal proton density was more efficient and more accurate in the detection of cervical cord lesions than sagittal T2-FSE sequence, when used in conjunction with sagittal T2-FSE; it can raise the diagnostic assurance via improving the visualization of the lesions. 


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Ahmed I, Al-Jaberi H, Jawad Alkahlissi M. Comparison of proton density MRI and T2-Weighted Fast Echo for The Detection of Cervical Spinal Cord Multiple Sclerosis Lesions. JFacMedBagdad [Internet]. 12May2019 [cited 7May2021];60(4):195-01. Available from: