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

Objective 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). Methods 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. Results 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). Conclusion 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.