The study was conducted in the department of Radiology, at the time period from December 2017 to February 2020. All patients were diagnosed in neuropsychiatry department, and they were referred to our department of radio-diagnosis for MRI examination.

Demographics and clinical data

Demographic and clinical variables in 40 multiple sclerosis (MS) patients and 20 controls who were included in the study are shown in the following Tables and Figs. 1, 2, 3, 4 and 5.

Fig. 1
figure1

ROC curve analysis for the prediction of cortical grey matter lesions using different MRI sequences (DIR, Flair and T2) (control group is the reference group)

Fig. 2
figure2

Female 30-years-old with history of RRMS since 6 months presented by numbness and headache, EDSS = 2. AC (Axial DIR, Flair and T2 sequences, respectively) show multiple MS plaques more obvious with more localization on DIR sequence. (1 = intracortical, 2 = juxtacortical and 3 = WM lesion)

Fig. 3
figure3

Female patient 30-years-old with history of RRMS since 4 years presented by weakness, headache and visual disorder, EDSS = 4.5. AC (Axial DIR, Flair and T2 sequences, respectively) show MS plaques noted at different anatomical locations more obvious on DIR sequence. (1 = leukocortical lesion, 2 = WM lesion and 3 = intra-cortical lesion)

Fig. 4
figure4

Female patient 32-years-old with history of RRMS since 3 years presented by weakness, headache and visual disorder, EDSS = 4. AC (Axial DIR, Flair and T2 sequences, respectively) show MS plaques (1 = juxtacortical lesion, 2 = WM lesion, 3 = lesions at deep grey matter (involving both thalami), 4 = confluent lesion, 5 = WM Lesion)

Fig. 5
figure5

Female patient 27-years-old with history of RRMS since 1 year presented by headache, EDSS = 2. AC (Axial DIR, Flair and T2 sequences, respectively) show the arrow points to an abnormal high signal intensity intra-cortical lesion visualized at the right posterior high parietal level seen at DIR sequence and not visualized at other sequences

The included 40 patients were (87.5% female and 12.5% were male) diagnosed as MS according to Mc-Donald criteria 2017. Range of the age was (20–47) years and mean age of all patients was (29.2 ± 7.1) years (Table 1).

Table 1 Socio-demographic data among 40 MS patients:

For the control group 20 healthy volunteers were examined in the analysis for comparison. All were female, age range was (24–48) years and mean age was (32.75 ± 9.23) years (Table 2).

Table 2 Socio-demographic data among 20 controls:

Conventional MRI criteria

As regarding distribution of MS plaques in different anatomical locations of the brain among 40 patients revealed that 22 patients (55%) had leukocortical plaques while 10 patients (25%) had intra-cortical plaques (Table 3).

Table 3 Percentage of the distribution of multiple sclerosis plaques in different anatomical locations of the brain among studied MS patients

A statistically significant difference was found between different MRI sequences (DIR, T2 and Flair) as regarding number of cortical grey mater lesions among studied MS patients (P < 0.001). In the present study, 254 cortical lesions were detected with DIR sequence and 214 lesions with Flair sequence while only 72 lesions were detected with T2 sequence.

DIR sequence demonstrated significantly more cortical grey matter lesions compared to Flair and T2 sequences (Table 4).

Table 4 Comparison between different MRI pulse sequences (T2, Flair and DIR) as regarding detection rate and number of cortical grey matter lesions among studied 40 MS patients:

As regarding cortical grey matter lesions, there was statistically significant strong agreement between DIR and Flair (K = 0.8, P < 0.001) and fair significant agreement between DIR and T2 (K = 0.32, P = 0.005) as well as moderate significant agreement between Flair and T2 (K = 0.52, P < 0.001) (Table 5).

Table 5 Agreement between DIR, T2 and Flair results as regarding diagnostic accuracy parameters among studied 40 MS patients

It was found that there was statistically significant strong positive correlation between number of cortical grey matter lesions in different MRI pulse sequences (T2, Flair and DIR) versus EDSS. However, DIR sequence showed the highest significant positive correlation (Tables 6, 7).

Table 6 Spearmen correlation between number of cortical grey matter lesions in DIR, T2 and Flair sequences versus EDSS score among studied 40 MS patients
Table 7 Comparison between different MRI sequences (T2, Flair and DIR) among studied 40 MS patients versus controls as regarding detection rate of cortical grey matter lesions

ROC curve analysis shows significant diagnostic performance for detection of cortical grey matter lesions with DIR sequence (AUC = 0.8) and fair significant diagnostic performance with Flair sequence (AUC = 0.75) while poor insignificant diagnostic performance was observed by T2 sequence (AUC = 0.61). So diagnostic performance of DIR sequence in prediction of cortical grey matter lesions was more than Flair and T2 sequences. The sensitivity, specificity, PPV, NPV and accuracy of DIR sequence in detection of cortical grey matter lesions were 60%, 100%, 100%, 55.6% and 73.3%, respectively. The sensitivity, specificity, positive and negative predictive values as well as accuracy of Flair sequence were 50%, 100%, 100%, 50% and 66.7%, respectively. The sensitivity, specificity, positive and negative predictive values as well as accuracy of T2 sequence in the detection of cortical grey matter lesions were 22.5%, 100%, 100%, 39.2% and 48.3%, respectively (Table 8).

Table 8 ROC curve analysis for the prediction of cortical grey matter lesions using different MRI pulse sequences (DIR, Flair and T2) among studied 40 MS patients (control group is the reference group)

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