# Improved detection of spinal cord lesions using an axial T2-weighted TSE sequence with full spinal cord coverage compared to sagittal T2-weighted TSE and STIR sequences in multiple sclerosis: a prospective study

## TL;DR

A new MRI technique detects more spinal cord lesions in multiple sclerosis patients compared to traditional methods.

## Contribution

The axial T2w-TSE sequence with full spinal cord coverage shows superior lesion detection and inter-rater reliability in MS.

## Key findings

- Axial T2w-TSE detected significantly more lesions than sagittal T2w-TSE and STIR sequences.
- Axial T2w-TSE showed high inter-rater reliability (κ = 0.71) comparable to sagittal T2w-TSE.
- Lesions detected in axial T2w-TSE were often not visible in other sequences upon re-evaluation.

## Abstract

This study aimed to compare the detection rates and inter-rater agreements of the sagittal T2w-TSE and sagittal short tau inversion recovery (STIR) sequence versus the axial T2w-TSE sequence with full spinal cord coverage in identifying spinal cord lesions in patients with suspected demyelinating diseases and diagnosed multiple sclerosis (MS).

104 patients were prospectively enrolled in this study and underwent MRI, including a sagittal T2w-TSE and STIR sequence, as well as an axial T2w-TSE sequence with full spinal cord coverage. Two experienced neuroradiologists, blinded to clinical parameters, independently evaluated the scans in separate sessions. After blinded readings, raters re-evaluated all sequences to assess if lesions could be retrospectively identified in other sequences.

Spinal cord lesions were found in 81 patients. The highest inter-rater reliability was observed for the sagittal T2w-TSE sequence (κ = 0.73, 95%-CI 0.66–0.79), followed by the axial T2w-TSE (κ = 0.71, 95%-CI 0.63–0.79) and the sagittal STIR sequence (κ = 0.65, 95%-CI 0.58–0.73). The axial T2w-TSE sequence demonstrated superior lesion detection rates, identifying significantly more lesions (n = 361) compared to the STIR (n = 293) and T2w-TSE sagittal (n = 224) sequence (p < 0.001).

Axial T2w-TSE sequences with full spinal cord coverage provide superior lesion detection compared to sagittal sequences and should be included in standard MRI protocols for MS patients. They may accelerate meeting MRI criteria for MS, improve monitoring of disease progression, and enhance prediction of future disability.