Comparison Study between 3D FLAIR Sequence and 3D Double Inversion Recovery compared in the Detection of Juxtacortical/cortical Lesions in MS Patients

Multiple sclerosis (MS) is a chronic inflammatory and neurodegenerative disorder of the central nervous system, characterized by demyelination, axonal injury, and progressive neuronal loss. This study sought to evaluate and compare the ability of double inversion recovery 3D (DIR) and 3D FLAIR sequences to identify cortical and juxtacortical lesions in individuals with multiple sclerosis.

Participants were recruited in this cross-sectional study at Yarmouk Teaching Hospital between June 2025 and January 2026. Forty-nine consecutive patients with multiple sclerosis (all clinical phenotypes) were included. Each subject underwent evaluation using the two imaging modalities as part of routine clinical assessment.
MRI examinations were performed on a 3-Tesla Philips Achieva scanner (Philips Healthcare, Best, the Netherlands) using a 16-channel head coil. The imaging protocol included 3D DIR and 3D FLAIR sequences acquired as part of the routine evaluation of patients with multiple sclerosis. For study purposes, lesion detection using the two sequences was compared.

There were 31 females, accounting for 63.3%, and 18 males. The mean age was 36.6 Añ 6.97 years. Mixed-effects negative binomial regression demonstrated that 3D DIR detected significantly more lesions than 3D FLAIR. The detection rate was approximately 55% higher with 3D DIR (IRR 1.55, 95% CI 1.2-1.99, p <0.001). Age and gender were not independently associated with lesion counts. Adjusted marginal estimates showed mean detections of 3.10 lesions with 3D DIR compared with 2.01 using 3D FLAIR.

This study has several important strengths. First, the paired design, in which each patient underwent both imaging modalities, reduced between-subject variability and allowed direct within-patient comparison. Second, the consistency of findings across patients-with most showing higher lesion detection using 3D DIR-strengthens the credibility and clinical relevance of the results. Several limitations should be acknowledged. The study was conducted in a single center, which may limit generalizability. Additionally, relevant clinical or imaging factors such as lesion characteristics or location were not included in the model, and the analysis focused on lesion counts rather than diagnostic accuracy or long-term clinical outcomes.

3D DIR significantly improved lesion detection, identifying approximately 55% more lesions than 3D FLAIR independent of age and gender.