Comparative evaluation of lesion conspicuity in white matter disease using double inversion recovery and T2 fluid-attenuated inversion recovery magnetic resonance imaging sequences: A cross-sectional observational study

Objectives: To compare lesion visibility between DIR and T2 FLAIR MRI sequences, with additional focus on whether conspicuity varies across brain lobes. Materials and Methods: A cross-sectional observational study was conducted on 84 patients undergoing MRI for suspected white matter disease. Inclusion criteria required complete datasets including T2W, T2 FLAIR, DWI/ADC, and DIR sequences. Lesion conspicuity was graded on a 5-point Likert scale by two experienced radiologists. Lesions were classified by location into frontal, temporal, parietal, and occipital lobes. Statistical analyses included Wilcoxon Signed-Rank Test, Kruskal-Wallis Test, and chi-square tests, with significance set at p <0.05. Results: DIR sequences demonstrated a slightly higher mean conspicuity score (2.95 ± 1.34) compared to T2 FLAIR (2.77 ± 1.25). While DIR received more high scores (14.3% rated 5) relative to FLAIR (10.7% rated 5), the differences were not statistically significant ( p >0.05). Conspicuity did not significantly vary across lobes for either sequence (DIR: p =0.809; FLAIR: p =0.379). DTI analysis supported microstructural disruption in affected tracts, with significant FA -MD correlation (r=0.250, p =0.022). Conclusion: DIR showed a modest, though not statistically significant, advantage in lesion conspicuity over T2 FLAIR, particularly for cortical and juxtacortical lesions. Both sequences performed consistently across lobes. Findings suggest DIR may serve as a valuable complementary tool in clinical MRI protocols, enhancing detection of subtle white matter pathology.