The use of DIR and SWI sequences in 1.5 Tesla MRI for the diagnosis of multiple sclerosis

The use of DIR and SWI sequences in 1.5 Tesla MRI for the diagnosis of multiple sclerosis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The use of DIR and SWI sequences in 1.5 Tesla MRI for the diagnosis of multiple sclerosis Mojtaba Akbari, Peyman Famili, Mohammad Reza Babaei, Mostafa Almasi-Dooghaee, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5768815/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Multiple sclerosis (MS) is a chronic autoimmune disease affecting the central nervous system, characterized by demyelination and neurodegeneration. Accurate diagnosis, especially in atypical cases, relies heavily on imaging techniques. This study evaluates the sensitivity of DIR (double inversion recovery) and SWI (susceptibility-weighted imaging) sequences in detecting MS plaques and central venous signs (CVS) using 1.5 Tesla MRI. Methods Seventeen patients with confirmed MS were enrolled after excluding other comorbidities. Brain MRI was performed using T2, FLAIR, SWI, and DIR sequences. Plaques were counted in cortical/juxtacortical, subcortical, periventricular, and infratentorial regions. The presence of CVS was assessed in SWI and FLAIR sequences. Statistical analyses were conducted using SPSS26. Results A total of 1022 plaques were identified, with DIR showing the highest sensitivity (321 plaques), followed by FLAIR (278), SWI (219), and T2 (204). The periventricular and subcortical regions were the most common sites of plaque detection across all sequences. DIR showed a 13%, 32%, and 36% higher sensitivity than FLAIR, SWI, and T2, respectively. CVS was most prominent in the SWI sequence (52.5% of plaques) compared to FLAIR (6%). DIR and T2 sequences showed negligible sensitivity for CVS detection. A significant association was found between age and the prevalence of CVS in the infratentorial region. Conclusion DIR is the most sensitive sequence for detecting MS plaques, particularly in the periventricular and infratentorial regions. SWI at 1.5 Tesla MRI demonstrates a high prevalence of CVS and can differentiate MS from other pathologies. Further studies are warranted to confirm these findings in larger populations. Figures Figure 1 Figure 2 Figure 3 Introduction Multiple sclerosis (MS) is a chronic, autoimmune and inflammatory disease of the central nervous system that causes demyelination, gliosis and loss of neurons( 1 ). The disease usually involves the white matter of the brain and spinal cord, but gray matter involvement has also been reported in many studies( 2 ). Multiple sclerosis usually affects young and middle-aged adults, with a female predilection( 3 ). This disease can usually be diagnosed by a set of clinical symptoms; however, in patients who do not have typical clinical symptoms, imaging methods play a significant role because delays in the diagnosis of the disease can cause severe and irreversible damage to the patient( 4 ). MRI is a common method for diagnosing multiple sclerosis lesions and is also used in known patients to evaluate disease activity( 5 ). The most important feature of multiple sclerosis on MRI is the temporal and spatial distribution of disease-related lesions in the brain and spinal cord( 6 ). Over time, atypical cases of multiple sclerosis with different imaging findings have been reported; however, various diseases can mimic radiological findings similar to those of multiple sclerosis with white matter involvement, such that approximately 20% of patients are initially considered to have multiple sclerosis on the basis of imaging findings, ultimately turning out not to have the disease ( 7 ). Therefore, the usual MRI sequences are not helpful in some patients, so various MRI protocols have been presented to diagnose this disease and differentiate it from other similar diseases ( 6 ). Considering the pathogenesis of multiple sclerosis, infiltration of immune cells from the veins and inflammation around these veins, MS plaques form around the veins. These veins are in the center of the lesion and usually have a diameter of less than 2 mm, and in the T2 and FLAIR sequences, they have a hypointense signal with respect to the surrounding lesion and are called the central venous sign( 8 )( 9 ). Susceptibility-weighted MRI is a new type of MRI sequence that is capable of mapping brain veins and can therefore be used to find central venous signs( 10 ) ( 11 ). Double inversion recovery (DIR) is another newly used MRI sequence that detects brain lesions with increased sensitivity. Several recent studies have shown that the use of susceptibility-weighted MRI and double inversion recovery in the diagnosis of MS plaques is more sensitive than conventional MRI procedures( 12 ). Most of the previous studies have evaluated these new methods on 3- or 7-Tesla MR images, and very few of them focused on 1.5-Tesla MR images. In this study, we evaluated SWI and DIR sequences via 1.5 Tesla MRI. Materials and methods This study focused on patients diagnosed with multiple sclerosis who had a previous hospitalization or outpatient visit to Firuzgar Hospital, where their definitive diagnosis was established through clinical follow-up and imaging. The exclusion criteria for the study included the presence of cerebrovascular disease other than this condition, cardiovascular disease, diabetes, a history of malignancy, and age over 55 years. Twenty patients were enrolled in the study, and MRI was performed. The goal was to perform brain MRI with T2, FLAIR, SWI, and DIR sequences on these patients. Unfortunately, three patients were excluded because of incomplete sequences provided by MRI technologists. We counted the number of lesions and central venous signs in 4 different anatomical spaces (cortical/juxtacortical, subcortical, periventricular and infratentorial) on each of the 4 MRI sequences for every 17 patients. Other necessary information, such as age, sex, and duration of the disease, was extracted from the patients' previous records, which were available in the hospital's information system. All the statistical analyses were performed via SPSS26 software, including descriptive analyses related to the prevalence of lesions in different regions and comparative analyses (t tests) between different sequences. A P value of < 0.05 was considered to indicate statistical significance. Results In the present study, 17 patients were studied. Of these, 12 (70.6%) were female, and 5 (29.4%) were male. The mean age of the participants was 38 years. A total of 1022 lesions were detected, 321 of which were observed in the DIR sequence, 278 in FLAIR, 219 in SWI and 204 in T2. The most sensitive sequence among these four sequences was DIR (321 plaques), in which the most anatomical locations of the lesions were the periventricular and subcortical regions (Table 1 , Fig. 1 ). Table 1 Plaques counted on the DIR sequence Factor n Total Prevalence DIR Cortical/juxtacortical 52 321 0.16 DIR subcortical 118 321 0.37 DIR periventricular 141 321 0.44 DIR infratentorial 10 321 0.03 After the DIR sequence, the FLAIR sequence has the highest sensitivity. This sequence has approximately 13% less sensitivity in showing multiple sclerosis plaques than does the DIR sequence. In this sequence, the most common anatomical sites were the periventricular and subcortical regions (Table 2 ). Table 2 Plaques counted on FLAIR sequences Factor n Total Prevalence Flair Cortical/juxtacortical 50 278 0.18 Flair subcortical 108 278 0.39 Flair periventricular 112 278 0.40 Flair infratentorial 8 278 0.03 Compared with the DIR sequence, the SWI and T2 sequences had 32% and 36% lower sensitivities, respectively, in showing MS plaques. In these two sequences, as in the previous two sequences, the most common locations of the plaques were the periventricular and subcortical areas (Tables 3 and 4 ). Table 3 Plaques counted on the SWI sequence Factor n Total Prevalence Swi Cortical/juxtacortical 33 219 0.15 Swi subcortical 83 219 0.38 Swi periventricular 98 219 0.45 Swi infratentorial 5 219 0.02 Table 4 Plaques counted on the T2 sequence Factor n Total Prevalence T2 Cortical/juxtacortical 33 204 0.17 T2 subcortical 83 204 0.40 T2 periventricular 84 204 0.41 T2 infratentorial 4 204 0.02 The central venous sign (CVS) was not visible in the DIR and T2 sequences, and only 6% of the plaques observed in the FLAIR sequence contained CVS. The highest prevalence of this sign was in the SWI sequence, with a rate of 52.5% (Figs. 2 , 3 ). The prevalence of this sign was greater in the periventricular and subcortical regions than in other regions. In the FLAIR sequence, this sign was only visible in the periventricular and subcortical areas (Table 5 ). Table 5 Prevalence of CVS at SWI and FLAIR in different anatomical regions Factor n Total Prevalence Flair CVS Cortical/juxtacortical 0 50 0 CVS subcortical 8 108 0.07 CVS periventricular 10 112 0.09 CVS infratentorial 0 8 0 SWI CVS Cortical/juxtacortical 10 33 0.30 CVS subcortical 48 83 0.58 CVS periventricular 56 98 0.57 CVS infratentorial 1 5 0.20 The relationships between MRI findings and sex, age and mean duration of the disease were evaluated; The only statistically significant relationship observed was between age and the presence of CVS in the infratentorial region on the SWI sequence. Discussion Multiple sclerosis is an autoimmune disease with central nervous system involvement. The diagnosis of this disease can be challenging, as various diseases may present similar clinical and imaging manifestations( 13 )( 14 ). To date, no single, high-precision diagnostic test has been reported for this disease; therefore, the diagnosis is based on a set of clinical, laboratory, and imaging findings( 15 ). The development of new imaging methods may be able to differentiate MS from other diseases. One of these methods is the evaluation of the central venous sign (CVS) via MRI with high magnetic field strength ( 16 ). Various histological studies at autopsy have shown that most MS plaques form around veins ( 17 ). 7T MRI has also confirmed this finding in several studies ( 18 )( 19 ). Some studies have concluded that the presence of the central venous sign in more than 40% of plaques is diagnostic for MS ( 20 ). A small number of studies have also assessed the sensitivity of 3T MRI for this purpose ( 21 )( 22 )( 23 ). In one of these studies, the sensitivity of 3T MRI for identifying multiple sclerosis plaques and showing CVS was significantly lower than that of 7T MRI. Few studies have investigated the prevalence of this sign on 1.5T MRI.( 20 ) The present study was performed by 1.5T MRI with SWI, DIR, T2, and FLAIR sequences on 17 known MS patients with a female-to-male ratio of 2.4, which is close to the prevalence ratio in the community (F/M = 2) ( 24 ). The mean age of the patients was 38.2 years, which is almost identical to that reported in previous studies, with a peak prevalence of 35 years ( 24 ). In this study, the most common sites of MS plaques were the periventricular and subcortical areas, which have also been reported in previous studies ( 11 )( 25 ). However, in different studies, there are slight differences between the prevalence rates in these two regions; thus, in the study of Elkholy et al., the subcortical region and deep white matter are the most common sites and are significantly different from the prevalence in the periventricular region ( 25 ). However, in Anan et al.'s study, the periventricular region was more common than the subcortical region and deep white matter, although there was no significant difference between the two regions ( 11 ). In our study, the periventricular region was more common than the subcortical region, but there was no significant difference between them. However, the prevalence in the cortical/juxtacortical and infratentorial regions is significantly lower than that in the subcortical and periventricular regions. In this study, the DIR sequence was the most sensitive sequence for finding MS plaques, and this higher sensitivity was more pronounced in the periventricular and infratentorial regions, which has also been reported in previous studies ( 25 ). The sensitivity of the FLAIR sequence was 13%, the sensitivity of SWI was 32%, and the sensitivity of T2 was 36% lower than that of DIR in showing MS plaques, which was statistically significant (p value = 0.01). In the present study, the central venous sign was visible in 52.5% of the plaques in the SWI sequence and in 6% of the plaques in the FLAIR sequence. In the conventional T2 and DIR sequences, there was negligible sensitivity, at zero percent, in this study for observing the CVS. Previous studies have focused on the SWI sequence, and even in MRIs with very high magnetic fields of up to 7 Tesla, only the SWI sequences and, to a lesser extent, the FLAIR sequences have been of interest ( 26 ). Other studies have also indicated the inability of conventional T2 and FLAIR sequences to demonstrate CVS ( 22 ). The prevalence of this sign varies considerably across studies. Studies have also reported various prevalence thresholds for distinguishing multiple sclerosis from other diseases, including 30%, 40%, 47.5%, 50%, and 54% thresholds ( 27 )( 28 )( 29 )( 30 ). In a meta-analysis conducted by A. Bhandari and colleagues, a threshold of 46.4% was reported for differentiation from other diseases ( 26 ). In our study, the prevalence of this sign in MS plaques was higher than the threshold reported in most studies. In the present study, there was no significant relationship between sex or disease duration and the prevalence of plaques in anatomical sites or various sequences. Similar results were obtained in the study by Elkholy et al. ( 25 ). There was a direct and significant relationship between age and the prevalence of CVS only in the infratentorial region in the SWI sequence, such that with increasing age, the prevalence of this sign in the infratentorial region significantly increased. A comprehensive study reporting the relationship between age and the prevalence of CVS in various brain regions has not been reported; however, a study conducted by Al Zandi and colleagues reported a general decrease in the prevalence of this sign with increasing age ( 29 ). This finding in our study is somewhat different from that of Al Zandi and colleagues, and further studies are necessary for a more detailed investigation of this issue. Conclusion The most important findings of this study are the significantly greater number of plaques found in the DIR sequence than in the other sequences, the significantly greater prevalence of plaques in the periventricular and subcortical regions, the significantly greater prevalence of CVS in the SWI sequence, and the significant increase in the prevalence of CVS in the infratentorial region with increasing age. Additionally, we can conclude that the SWI sequence at 1.5T MRI can be used to determine the CVS and distinguish MS from similar lesions. Declarations Consent to Participate Declaration This study involved human participants, and all procedures performed were in accordance with the ethical standards of the Declaration of Helsinki and approved by the Ethics Committee of Iran University of Medical Sciences (Approval Code: IR.IUMS.FMD.REC.1402.148). Verbal informed consent was obtained from all participants after they were provided with a comprehensive explanation of the study’s objectives, procedures, potential risks, and benefits. Participants were informed of their right to withdraw from the study at any time without any consequences. The process of obtaining verbal consent was documented and approved by the Ethics Committee. Confidentiality and privacy of all participants were strictly maintained throughout the research process. Funding Declaration This study did not receive any financial support from external organizations or funding agencies. All expenses related to the research were fully covered by the researchers themselves. Additionally, no financial burden was imposed on the participants, and all procedures were conducted without any cost to them. Author Contribution declaration Mojtaba Akbari and Manizhe Ataee Kachuee had role in study design, data gathering, analysing, writing and revising of the study. Peyman Family and Mostafa Almasi-Dooghaee had role in study design, data gathering, interpretation and revision of the study. Mohammad Reza Babaei had role in study design, Analysing, writing and revising the study. Consent to Publish declaration Informed consent for publication of the details/images/videos in this manuscript was obtained from all participants (or their legal guardians in the case of minors) in accordance with the guidelines provided by the journal. The presented images and data have been processed to ensure that no identifying information of the individuals is disclosed. Consent includes agreement to publish the details under the relevant Creative Commons license, making them freely available on the internet. Data Availability declaration We are prepared to provide the Excel file containing the study data to the journal reviewers. Additionally, if required, we can share links to the MRI scans of a subset of patients to allow the reviewers to examine the images. Ethics declaration This study involved human participants, and all procedures performed were in accordance with the ethical standards of the Declaration of Helsinki and approved by the Ethics Committee of Iran University of Medical Sciences (Approval Code: IR.IUMS.FMD.REC.1402.148). Verbal informed consent was obtained from all participants after they were provided with a comprehensive explanation of the study’s objectives, procedures, potential risks, and benefits. Participants were informed of their right to withdraw from the study at any time without any consequences. 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Available from: https://doi.org/10.1016/j.ejrnm.2017.09.003 Mistry N, Abdel-Fahim R, Samaraweera A, Mougin O, Tallantyre E, Tench C, et al. Imaging central veins in brain lesions with 3-T T2*-weighted magnetic resonance imaging differentiates multiple sclerosis from microangiopathic brain lesions. Mult Scler J [Internet]. 2015 Dec 10;22(10):1289–96. Available from: https://doi.org/10.1177/1352458515616700 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5768815","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":401509736,"identity":"016f4201-9c7f-4ace-8a20-8a16c52a8d39","order_by":0,"name":"Mojtaba Akbari","email":"","orcid":"","institution":"Department of Radiology, School of Medicine, Iran University of Medical Sciences, Tehran","correspondingAuthor":false,"prefix":"","firstName":"Mojtaba","middleName":"","lastName":"Akbari","suffix":""},{"id":401509737,"identity":"132be541-4b67-4597-a093-56525b491c29","order_by":1,"name":"Peyman 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Tehran","correspondingAuthor":true,"prefix":"","firstName":"Manizhe","middleName":"Ataee","lastName":"Kachuee","suffix":""}],"badges":[],"createdAt":"2025-01-05 16:53:06","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5768815/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5768815/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":73865906,"identity":"0531e3d5-a1e9-4755-8216-8d28fdea73a5","added_by":"auto","created_at":"2025-01-15 11:52:09","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":116102,"visible":true,"origin":"","legend":"\u003cp\u003eAn MS plaque perpendicular to the corpus callosum on the DIR sequence.\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-5768815/v1/80e11b3ddee38c01412bd3bf.png"},{"id":73865905,"identity":"bd9859db-336c-4493-82c9-eabc6e4af2e9","added_by":"auto","created_at":"2025-01-15 11:52:09","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":124164,"visible":true,"origin":"","legend":"\u003cp\u003eAn MS plaque adjacent to the posterior horn of the right lateral ventricle with a central venous sign on SWI.\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-5768815/v1/1be887d4e742ef8220eec396.png"},{"id":73867676,"identity":"90c2898c-f225-4930-a5cb-a9796861b069","added_by":"auto","created_at":"2025-01-15 12:00:09","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":94240,"visible":true,"origin":"","legend":"\u003cp\u003eAn MS plaque adjacent to the posterior horn of the left lateral ventricle with a central venous sign on SWI in another patient.\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-5768815/v1/1d8e15079dc0ee340fa15809.png"},{"id":74580209,"identity":"3e6dff85-1ac5-4acf-89f5-3b1707e6cbf2","added_by":"auto","created_at":"2025-01-23 15:47:02","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1121443,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5768815/v1/4ba1de29-3b7e-413e-9ad9-f3a0133491d6.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The use of DIR and SWI sequences in 1.5 Tesla MRI for the diagnosis of multiple sclerosis","fulltext":[{"header":"Introduction","content":"\u003cp\u003eMultiple sclerosis (MS) is a chronic, autoimmune and inflammatory disease of the central nervous system that causes demyelination, gliosis and loss of neurons(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). The disease usually involves the white matter of the brain and spinal cord, but gray matter involvement has also been reported in many studies(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eMultiple sclerosis usually affects young and middle-aged adults, with a female predilection(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). This disease can usually be diagnosed by a set of clinical symptoms; however, in patients who do not have typical clinical symptoms, imaging methods play a significant role because delays in the diagnosis of the disease can cause severe and irreversible damage to the patient(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). MRI is a common method for diagnosing multiple sclerosis lesions and is also used in known patients to evaluate disease activity(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). The most important feature of multiple sclerosis on MRI is the temporal and spatial distribution of disease-related lesions in the brain and spinal cord(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Over time, atypical cases of multiple sclerosis with different imaging findings have been reported; however, various diseases can mimic radiological findings similar to those of multiple sclerosis with white matter involvement, such that approximately 20% of patients are initially considered to have multiple sclerosis on the basis of imaging findings, ultimately turning out not to have the disease (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Therefore, the usual MRI sequences are not helpful in some patients, so various MRI protocols have been presented to diagnose this disease and differentiate it from other similar diseases (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eConsidering the pathogenesis of multiple sclerosis, infiltration of immune cells from the veins and inflammation around these veins, MS plaques form around the veins. These veins are in the center of the lesion and usually have a diameter of less than 2 mm, and in the T2 and FLAIR sequences, they have a hypointense signal with respect to the surrounding lesion and are called the central venous sign(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e)(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSusceptibility-weighted MRI is a new type of MRI sequence that is capable of mapping brain veins and can therefore be used to find central venous signs(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e) (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eDouble inversion recovery (DIR) is another newly used MRI sequence that detects brain lesions with increased sensitivity. Several recent studies have shown that the use of susceptibility-weighted MRI and double inversion recovery in the diagnosis of MS plaques is more sensitive than conventional MRI procedures(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Most of the previous studies have evaluated these new methods on 3- or 7-Tesla MR images, and very few of them focused on 1.5-Tesla MR images. In this study, we evaluated SWI and DIR sequences via 1.5 Tesla MRI.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cp\u003eThis study focused on patients diagnosed with multiple sclerosis who had a previous hospitalization or outpatient visit to Firuzgar Hospital, where their definitive diagnosis was established through clinical follow-up and imaging. The exclusion criteria for the study included the presence of cerebrovascular disease other than this condition, cardiovascular disease, diabetes, a history of malignancy, and age over 55 years. Twenty patients were enrolled in the study, and MRI was performed. The goal was to perform brain MRI with T2, FLAIR, SWI, and DIR sequences on these patients. Unfortunately, three patients were excluded because of incomplete sequences provided by MRI technologists.\u003c/p\u003e \u003cp\u003eWe counted the number of lesions and central venous signs in 4 different anatomical spaces (cortical/juxtacortical, subcortical, periventricular and infratentorial) on each of the 4 MRI sequences for every 17 patients.\u003c/p\u003e \u003cp\u003eOther necessary information, such as age, sex, and duration of the disease, was extracted from the patients' previous records, which were available in the hospital's information system.\u003c/p\u003e \u003cp\u003eAll the statistical analyses were performed via SPSS26 software, including descriptive analyses related to the prevalence of lesions in different regions and comparative analyses (t tests) between different sequences. A P value of \u0026lt;\u0026thinsp;0.05 was considered to indicate statistical significance.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eIn the present study, 17 patients were studied. Of these, 12 (70.6%) were female, and 5 (29.4%) were male. The mean age of the participants was 38 years.\u003c/p\u003e \u003cp\u003eA total of 1022 lesions were detected, 321 of which were observed in the DIR sequence, 278 in FLAIR, 219 in SWI and 204 in T2.\u003c/p\u003e \u003cp\u003eThe most sensitive sequence among these four sequences was DIR (321 plaques), in which the most anatomical locations of the lesions were the periventricular and subcortical regions (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePlaques counted on the DIR sequence\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFactor\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePrevalence\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDIR Cortical/juxtacortical\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e321\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.16\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDIR subcortical\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e118\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e321\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.37\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDIR periventricular\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e141\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e321\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.44\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDIR infratentorial\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e321\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.03\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eAfter the DIR sequence, the FLAIR sequence has the highest sensitivity. This sequence has approximately 13% less sensitivity in showing multiple sclerosis plaques than does the DIR sequence. In this sequence, the most common anatomical sites were the periventricular and subcortical regions (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePlaques counted on FLAIR sequences\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFactor\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePrevalence\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFlair Cortical/juxtacortical\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e278\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.18\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFlair subcortical\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e108\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e278\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.39\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFlair periventricular\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e112\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e278\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.40\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFlair infratentorial\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e278\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.03\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eCompared with the DIR sequence, the SWI and T2 sequences had 32% and 36% lower sensitivities, respectively, in showing MS plaques. In these two sequences, as in the previous two sequences, the most common locations of the plaques were the periventricular and subcortical areas (Tables\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e and \u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePlaques counted on the SWI sequence\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFactor\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePrevalence\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSwi Cortical/juxtacortical\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e219\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.15\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSwi subcortical\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e219\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.38\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSwi periventricular\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e219\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.45\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSwi infratentorial\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e219\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePlaques counted on the T2 sequence\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFactor\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePrevalence\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eT2 Cortical/juxtacortical\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e204\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.17\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eT2 subcortical\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e204\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.40\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eT2 periventricular\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e204\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.41\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eT2 infratentorial\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e204\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe central venous sign (CVS) was not visible in the DIR and T2 sequences, and only 6% of the plaques observed in the FLAIR sequence contained CVS. The highest prevalence of this sign was in the SWI sequence, with a rate of 52.5% (Figs.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e,\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). The prevalence of this sign was greater in the periventricular and subcortical regions than in other regions. In the FLAIR sequence, this sign was only visible in the periventricular and subcortical areas (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePrevalence of CVS at SWI and FLAIR in different anatomical regions\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFactor\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePrevalence\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFlair\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCVS Cortical/juxtacortical\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCVS subcortical\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e108\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.07\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCVS periventricular\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e112\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.09\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCVS infratentorial\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSWI\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCVS Cortical/juxtacortical\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.30\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCVS subcortical\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.58\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCVS periventricular\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.57\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCVS infratentorial\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe relationships between MRI findings and sex, age and mean duration of the disease were evaluated; The only statistically significant relationship observed was between age and the presence of CVS in the infratentorial region on the SWI sequence.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eMultiple sclerosis is an autoimmune disease with central nervous system involvement. The diagnosis of this disease can be challenging, as various diseases may present similar clinical and imaging manifestations(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e)(\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). To date, no single, high-precision diagnostic test has been reported for this disease; therefore, the diagnosis is based on a set of clinical, laboratory, and imaging findings(\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). The development of new imaging methods may be able to differentiate MS from other diseases. One of these methods is the evaluation of the central venous sign (CVS) via MRI with high magnetic field strength (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). Various histological studies at autopsy have shown that most MS plaques form around veins (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). 7T MRI has also confirmed this finding in several studies (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e)(\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). Some studies have concluded that the presence of the central venous sign in more than 40% of plaques is diagnostic for MS (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). A small number of studies have also assessed the sensitivity of 3T MRI for this purpose (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e)(\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e)(\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). In one of these studies, the sensitivity of 3T MRI for identifying multiple sclerosis plaques and showing CVS was significantly lower than that of 7T MRI. Few studies have investigated the prevalence of this sign on 1.5T MRI.(\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eThe present study was performed by 1.5T MRI with SWI, DIR, T2, and FLAIR sequences on 17 known MS patients with a female-to-male ratio of 2.4, which is close to the prevalence ratio in the community (F/M\u0026thinsp;=\u0026thinsp;2) (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). The mean age of the patients was 38.2 years, which is almost identical to that reported in previous studies, with a peak prevalence of 35 years (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn this study, the most common sites of MS plaques were the periventricular and subcortical areas, which have also been reported in previous studies (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e)(\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). However, in different studies, there are slight differences between the prevalence rates in these two regions; thus, in the study of Elkholy et al., the subcortical region and deep white matter are the most common sites and are significantly different from the prevalence in the periventricular region (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). However, in Anan et al.'s study, the periventricular region was more common than the subcortical region and deep white matter, although there was no significant difference between the two regions (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). In our study, the periventricular region was more common than the subcortical region, but there was no significant difference between them. However, the prevalence in the cortical/juxtacortical and infratentorial regions is significantly lower than that in the subcortical and periventricular regions.\u003c/p\u003e \u003cp\u003eIn this study, the DIR sequence was the most sensitive sequence for finding MS plaques, and this higher sensitivity was more pronounced in the periventricular and infratentorial regions, which has also been reported in previous studies (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). The sensitivity of the FLAIR sequence was 13%, the sensitivity of SWI was 32%, and the sensitivity of T2 was 36% lower than that of DIR in showing MS plaques, which was statistically significant (p value\u0026thinsp;=\u0026thinsp;0.01).\u003c/p\u003e \u003cp\u003eIn the present study, the central venous sign was visible in 52.5% of the plaques in the SWI sequence and in 6% of the plaques in the FLAIR sequence. In the conventional T2 and DIR sequences, there was negligible sensitivity, at zero percent, in this study for observing the CVS. Previous studies have focused on the SWI sequence, and even in MRIs with very high magnetic fields of up to 7 Tesla, only the SWI sequences and, to a lesser extent, the FLAIR sequences have been of interest (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). Other studies have also indicated the inability of conventional T2 and FLAIR sequences to demonstrate CVS (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). The prevalence of this sign varies considerably across studies. Studies have also reported various prevalence thresholds for distinguishing multiple sclerosis from other diseases, including 30%, 40%, 47.5%, 50%, and 54% \u003csup\u003ethresholds\u003c/sup\u003e (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e)(\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e)(\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e)(\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). In a meta-analysis conducted by A. Bhandari and colleagues, a threshold of 46.4% was reported for differentiation from other diseases (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). In our study, the prevalence of this sign in MS plaques was higher than the threshold reported in most studies.\u003c/p\u003e \u003cp\u003eIn the present study, there was no significant relationship between sex or disease duration and the prevalence of plaques in anatomical sites or various sequences. Similar results were obtained in the study by Elkholy et al. (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). There was a direct and significant relationship between age and the prevalence of CVS only in the infratentorial region in the SWI sequence, such that with increasing age, the prevalence of this sign in the infratentorial region significantly increased. A comprehensive study reporting the relationship between age and the prevalence of CVS in various brain regions has not been reported; however, a study conducted by Al Zandi and colleagues reported a general decrease in the prevalence of this sign with increasing age (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). This finding in our study is somewhat different from that of Al Zandi and colleagues, and further studies are necessary for a more detailed investigation of this issue.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe most important findings of this study are the significantly greater number of plaques found in the DIR sequence than in the other sequences, the significantly greater prevalence of plaques in the periventricular and subcortical regions, the significantly greater prevalence of CVS in the SWI sequence, and the significant increase in the prevalence of CVS in the infratentorial region with increasing age.\u003c/p\u003e \u003cp\u003eAdditionally, we can conclude that the SWI sequence at 1.5T MRI can be used to determine the CVS and distinguish MS from similar lesions.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eConsent to Participate Declaration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study involved human participants, and all procedures performed were in accordance with the ethical standards of the Declaration of Helsinki and approved by the Ethics Committee of Iran University of Medical Sciences (Approval Code: IR.IUMS.FMD.REC.1402.148). Verbal informed consent was obtained from all participants after they were provided with a comprehensive explanation of the study\u0026rsquo;s objectives, procedures, potential risks, and benefits. Participants were informed of their right to withdraw from the study at any time without any consequences. The process of obtaining verbal consent was documented and approved by the Ethics Committee. Confidentiality and privacy of all participants were strictly maintained throughout the research process.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding Declaration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study did not receive any financial support from external organizations or funding agencies. All expenses related to the research were fully covered by the researchers themselves. Additionally, no financial burden was imposed on the participants, and all procedures were conducted without any cost to them.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contribution declaration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMojtaba Akbari and Manizhe Ataee Kachuee had role in study design, data gathering, analysing, writing and revising of the study.\u003c/p\u003e\n\u003cp\u003ePeyman Family and Mostafa Almasi-Dooghaee had role in study design, data gathering, interpretation and revision of the study.\u003c/p\u003e\n\u003cp\u003eMohammad Reza Babaei had role in study design, Analysing, writing and revising the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Publish declaration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInformed consent for publication of the details/images/videos in this manuscript was obtained from all participants (or their legal guardians in the case of minors) in accordance with the guidelines provided by the journal. The presented images and data have been processed to ensure that no identifying information of the individuals is disclosed. Consent includes agreement to publish the details under the relevant Creative Commons license, making them freely available on the internet.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eData Availability declaration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe are prepared to provide the Excel file containing the study data to the journal reviewers. Additionally, if required, we can share links to the MRI scans of a subset of patients to allow the reviewers to examine the images.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics declaration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study involved human participants, and all procedures performed were in accordance with the ethical standards of the Declaration of Helsinki and approved by the Ethics Committee of Iran University of Medical Sciences (Approval Code: IR.IUMS.FMD.REC.1402.148). Verbal informed consent was obtained from all participants after they were provided with a comprehensive explanation of the study\u0026rsquo;s objectives, procedures, potential risks, and benefits. Participants were informed of their right to withdraw from the study at any time without any consequences. The process of obtaining verbal consent was documented and approved by the Ethics Committee. Confidentiality and privacy of all participants were strictly maintained throughout the research process.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eSheng H, Zhao B, Ge Y. Blood perfusion and cellular microstructural changes associated with iron deposition in multiple sclerosis lesions. Front Neurol. 2019;10(JUL):1\u0026ndash;10.\u003c/li\u003e\n\u003cli\u003eZivadinov R, Weinstock-Guttman B, Hashmi K, Abdelrahman N, Stosic M, Dwyer M, et al. Smoking is associated with increased lesion volumes and brain atrophy in multiple sclerosis. Neurology. 2009;73(7):504\u0026ndash;10.\u003c/li\u003e\n\u003cli\u003eGiovannoni G, Butzkueven H, Dhib-Jalbut S, Hobart J, Kobelt G, Pepper G, et al. Brain health: time matters in multiple sclerosis. Mult Scler Relat Disord [Internet]. 2016;9:S5\u0026ndash;48. 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The central vein sign and its clinical evaluation for the diagnosis of multiple sclerosis: A consensus statement from the North American Imaging in Multiple Sclerosis Cooperative. Nat Rev Neurol [Internet]. 2016;12(12):714\u0026ndash;22. Available from: http://dx.doi.org/10.1038/nrneurol.2016.166\u003c/li\u003e\n\u003cli\u003eAnan RA, El-Adalany MA, Belal TMI, Elmogy SAED. Detection of central veins using susceptibility weighted imaging (SWI) for discrimination between lesions in multiple sclerosis (MS) and cerebral small vessel disease (CSVD). Egypt J Radiol Nucl Med. 2020;51(1).\u003c/li\u003e\n\u003cli\u003eSparacia G, Agnello F, Gambino A, Sciortino M, Midiri M. Multiple sclerosis: High prevalence of the \u0026lsquo;central vein\u0026rsquo; sign in white matter lesions on susceptibility-weighted images. Neuroradiol J. 2018;31(4):356\u0026ndash;61.\u003c/li\u003e\n\u003cli\u003eCharil A, Yousry TA, Rovaris M, Barkhof F, De Stefano N, Fazekas F, et al. MRI and the diagnosis of multiple sclerosis: expanding the concept of \u0026ldquo;no better explanation\u0026rdquo;. Lancet Neurol. 2006 Oct;5(10):841\u0026ndash;52.\u003c/li\u003e\n\u003cli\u003eMiller DH, Weinshenker BG, Filippi M, Banwell BL, Cohen JA, Freedman MS, et al. Differential diagnosis of suspected multiple sclerosis: a consensus approach. Mult Scler. 2008 Nov;14(9):1157\u0026ndash;74.\u003c/li\u003e\n\u003cli\u003ePolman CH, Reingold SC, Banwell B, Clanet M, Cohen JA, Filippi M, et al. Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria. Ann Neurol. 2011 Feb;69(2):292\u0026ndash;302.\u003c/li\u003e\n\u003cli\u003eKollia K, Maderwald S, Putzki N, Schlamann M, Theysohn JM, Kraff O, et al. First clinical study on ultrahigh-field MR imaging in patients with multiple sclerosis: Comparison of 1.5T and 7T. Am J Neuroradiol. 2009;30(4):699\u0026ndash;702.\u003c/li\u003e\n\u003cli\u003eFOG T. ON THE VESSEL-PLAQUE RELATIONSHIPS IN THE BRAIN IN MULTIPLE SCLEROSIS. Acta Neurol Scand Suppl. 1964;40:SUPPL 10:9-15.\u003c/li\u003e\n\u003cli\u003eMistry N, Dixon J, Tallantyre E, Tench C, Abdel-Fahim R, Jaspan T, et al. Central veins in brain lesions visualized with high-field magnetic resonance imaging: a pathologically specific diagnostic biomarker for inflammatory demyelination in the brain. JAMA Neurol. 2013 May;70(5):623\u0026ndash;8.\u003c/li\u003e\n\u003cli\u003eTallantyre EC, Dixon JE, Donaldson I, Owens T, Morgan PS, Morris PG, et al. Ultrahigh-field imaging distinguishes MS lesions from asymptomatic white matter lesions. Neurology. 2011 Feb;76(6):534\u0026ndash;9.\u003c/li\u003e\n\u003cli\u003eTallantyre EC, Morgan PS, Dixon JE, Al-Radaideh A, Brookes MJ, Evangelou N, et al. A comparison of 3T and 7T in the detection of small parenchymal veins within MS lesions. Invest Radiol. 2009;44(9):491\u0026ndash;4.\u003c/li\u003e\n\u003cli\u003eGait\u0026aacute;n MI, Maggi P, Wohler J, Leibovitch E, Sati P, Calandri IL, et al. Perivenular brain lesions in a primate multiple sclerosis model at 7-tesla magnetic resonance imaging. Mult Scler. 2014 Jan;20(1):64\u0026ndash;71.\u003c/li\u003e\n\u003cli\u003eSati P, George IC, Shea CD, Gait\u0026aacute;n MI, Reich DS. FLAIR*: a combined MR contrast technique for visualizing white matter lesions and parenchymal veins. Radiology. 2012 Dec;265(3):926\u0026ndash;32.\u003c/li\u003e\n\u003cli\u003eLuo J, Yablonskiy DA, Hildebolt CF, Lancia S, Cross AH. Gradient echo magnetic resonance imaging correlates with clinical measures and allows visualization of veins within multiple sclerosis lesions. Mult Scler. 2014 Mar;20(3):349\u0026ndash;55.\u003c/li\u003e\n\u003cli\u003eSarbu N, Shih RY, Jones R V, Horkayne-Szakaly I, Oleaga L, Smirniotopoulos JG. White Matter Diseases with Radiologic-Pathologic Correlation. RadioGraphics [Internet]. 2016;36(5):1426\u0026ndash;47. Available from: https://doi.org/10.1148/rg.2016160031\u003c/li\u003e\n\u003cli\u003eElkholy SF, Sabet MA, Mohammad ME, Asaad REI. Comparative study between double inversion recovery (DIR) and fluid-attenuated inversion recovery (FLAIR) MRI sequences for detection of cerebral lesions in multiple sclerosis. Egypt J Radiol Nucl Med. 2020;51(1).\u003c/li\u003e\n\u003cli\u003eBhandari A, Xiang H, Lechner-Scott J, Agzarian M. Central vein sign for multiple sclerosis: A systematic review and meta-analysis. Clin Radiol [Internet]. 2020;75(6):479.e9-479.e15. Available from: https://doi.org/10.1016/j.crad.2020.01.011\u003c/li\u003e\n\u003cli\u003eMaggi P, Absinta M, Sati P, Perrotta G, Massacesi L, Dachy B, et al. The \u0026ldquo;central vein sign\u0026rdquo; in patients with diagnostic \u0026ldquo;red flags\u0026rdquo; for multiple sclerosis: A prospective multicenter 3T study. Mult Scler J [Internet]. 2019 Sep 19;26(4):421\u0026ndash;32. Available from: https://doi.org/10.1177/1352458519876031\u003c/li\u003e\n\u003cli\u003eCortese R, Magnollay L, Tur C, Abdel-Aziz K, Jacob A, De Angelis F, et al. Value of the central vein sign at 3T to differentiate MS from seropositive NMOSD. Neurology. 2018 Apr;90(14):e1183\u0026ndash;90.\u003c/li\u003e\n\u003cli\u003eAl-Zandi SH, Fayadh NAH, Al-Waely NKN. Central vein sign detected by SWI at 3 T MRI as a discriminator between multiple sclerosis and leukoaraiosis. Egypt J Radiol Nucl Med [Internet]. 2018;49(1):158\u0026ndash;64. Available from: https://doi.org/10.1016/j.ejrnm.2017.09.003\u003c/li\u003e\n\u003cli\u003eMistry N, Abdel-Fahim R, Samaraweera A, Mougin O, Tallantyre E, Tench C, et al. Imaging central veins in brain lesions with 3-T T2*-weighted magnetic resonance imaging differentiates multiple sclerosis from microangiopathic brain lesions. Mult Scler J [Internet]. 2015 Dec 10;22(10):1289\u0026ndash;96. Available from: https://doi.org/10.1177/1352458515616700\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-5768815/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5768815/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eMultiple sclerosis (MS) is a chronic autoimmune disease affecting the central nervous system, characterized by demyelination and neurodegeneration. Accurate diagnosis, especially in atypical cases, relies heavily on imaging techniques. This study evaluates the sensitivity of DIR (double inversion recovery) and SWI (susceptibility-weighted imaging) sequences in detecting MS plaques and central venous signs (CVS) using 1.5 Tesla MRI.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eSeventeen patients with confirmed MS were enrolled after excluding other comorbidities. Brain MRI was performed using T2, FLAIR, SWI, and DIR sequences. Plaques were counted in cortical/juxtacortical, subcortical, periventricular, and infratentorial regions. The presence of CVS was assessed in SWI and FLAIR sequences. Statistical analyses were conducted using SPSS26.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eA total of 1022 plaques were identified, with DIR showing the highest sensitivity (321 plaques), followed by FLAIR (278), SWI (219), and T2 (204). The periventricular and subcortical regions were the most common sites of plaque detection across all sequences. DIR showed a 13%, 32%, and 36% higher sensitivity than FLAIR, SWI, and T2, respectively. CVS was most prominent in the SWI sequence (52.5% of plaques) compared to FLAIR (6%). DIR and T2 sequences showed negligible sensitivity for CVS detection. A significant association was found between age and the prevalence of CVS in the infratentorial region.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eDIR is the most sensitive sequence for detecting MS plaques, particularly in the periventricular and infratentorial regions. SWI at 1.5 Tesla MRI demonstrates a high prevalence of CVS and can differentiate MS from other pathologies. Further studies are warranted to confirm these findings in larger populations.\u003c/p\u003e","manuscriptTitle":"The use of DIR and SWI sequences in 1.5 Tesla MRI for the diagnosis of multiple sclerosis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-01-15 11:52:04","doi":"10.21203/rs.3.rs-5768815/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"2a89a533-51c9-415f-bbde-caa3fbe9ca50","owner":[],"postedDate":"January 15th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-03-07T00:38:17+00:00","versionOfRecord":[],"versionCreatedAt":"2025-01-15 11:52:04","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5768815","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5768815","identity":"rs-5768815","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}