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
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).
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).
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).
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).
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).
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).
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).
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