Raja Sekaran Kattumannarkudi Ramalingam MBBS, Presenter: Nothing to Disclose

Sravanthi Mantripragada MBBS, Abstract Co-Author: Nothing to Disclose

yvette kirubha MBBS, MD, Abstract Co-Author: Nothing to Disclose

Meera krishnakumar, Abstract Co-Author: Nothing to Disclose

Chidambaranathan Natesan MD, PhD, Abstract Co-Author: Nothing to Disclose

To evaluate the utility of Double inversion recovery(DIR) imaging of brain in comparision to Fluid attenuated inversion recovery (FLAIR) in patients with seizures by analysing the lesion detection, lesion conspicuity and additional diagnostic informations

This prospective study was conducted with institional review board approval and informed consent was obtained. The study protocol ( Routine epilepsy protocol+ DIR sequence) was performed with a 1.5 Tesla MRI in 123 consecutive seizure patients (mean age 18.2 years; range, 3 months-72 years) and 34 control population. Two radiologists independently assessed three criteria: lesion detection, conspicuity and additional diagnostic informations by using three point grading system, and compared FLAIR and DIR images. Interobserver agreement of each criteria were compared using kappa statistics.

On DIR images lesions were more conspicuous than FLAIR (p< 0.0001 & kappa 0.85 -Perfect agreement). Overall ability for the presence of lesions and detectability(p<0.0001 & kappa 0.71 -sustantial agreement), although similar among two sequences, was highest with DIR sequence. However, compared with FLAIR, significant additional diagnostic information(p<0.0001 & kappa 0.62 -substantial agreement) was observed on DIR sequence, especially additonal diagnostic information scores for malformations of cortical development (p<0.0001 & kappa 0.89 -perfect agreement) and hippocampal sclerosis which were highest on DIR images.

DIR overcame the disadvantages of FLAIR in malformations of cortical development and hippocampal sclerosis.DIR images significantly improved the conspicuity of the lesions when compared to FLAIR especially lesions with low contrast on FLAIR images, lesions along the ependymal lining, cortical volume loss, abnormal cortical morphology,ectopic grey matter, pattern of abnormal gyri and sulci.DIR sequence can provide useful additional diagnostic information when evaluating cortical dysplasias, hippocampal sclerosis, lesions with perilesional edema, cortical atrophy.

DIR sequence should be used as an adjunctive to FLAIR sequence in evaluation of epileptogenic lesions but need not replace it and it is recommended to implement DIR sequence in routine practice.

Kattumannarkudi Ramalingam, R, Mantripragada, S, kirubha, y, krishnakumar, M, Natesan, C, Double Inversion Recovery Imaging of the Brain in Seizures.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14045583.html