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Clinical Neuroradiology
Published in: Clinical Neuroradiology 3/2015

01-09-2015 | Original Article

Diagnostic Efficacy of Conventional MRI Pulse Sequences in the Detection of Lesions Causing Internuclear Ophthalmoplegia in Multiple Sclerosis Patients

Authors: J. P. McNulty, R. Lonergan, P. C. Brennan, M. G. Evanoff, R. O’Laoide, J. T. Ryan, N. Tubridy

Published in: Clinical Neuroradiology | Issue 3/2015

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Abstract

Purpose

The purpose of this study was to investigate the diagnostic efficacy of a range of conventional magnetic resonance imaging (MRI) pulse sequences in the identification of internuclear ophthalmoplegia (INO) caused by medial longitudinal fasciculus (MLF) lesions in multiple sclerosis patients using a receiver-operating characteristic (ROC) methodology.

Methods

A total of 15 clinically confirmed INO and 15 control subjects underwent conventional MRI at 1.5 T consisting of T2-weighted, proton density (PD)-weighted, and fluid-attenuated inversion recovery (FLAIR) sequences, following full institutional approval. A free-response, multiple-reader multiple-case design ROC study was used to evaluate the diagnostic efficacy of each sequence. All imaging sequences were evaluated by 10 board-certified neuroradiologists. Area under the curve (AUC), sensitivity, and specificity were analysed statistically for all three pulse sequences using repeated-measures analyses of variance and post-test analysis using Bonferroni’s multiple comparison test of differences.

Results

No significant AUC differences were found between the three sequences (p = 0.0697), with T2 recording the highest AUC (0.8346). Sensitivity differences between PD (0.7927) and FLAIR (0.6329) were significant (p < 0.05). Non-significant differences were also evident between T2 and FLAIR (p = 0.0511). The specificity analysis revealed an overall difference (p = 0.0005), with specific inter-sequence differences shown between T2 and PD (p < 0.05) and PD and FLAIR (p < 0.001) with the PD values being lower than those provided with the other two sequences.

Conclusion

T2-weighted axial imaging through the MLF region resulted in the greatest overall diagnostic efficacy when viewing a combination of mean AUC, sensitivity, and specificity, in terms of the identification of INO-causing lesions.
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Metadata
Title
Diagnostic Efficacy of Conventional MRI Pulse Sequences in the Detection of Lesions Causing Internuclear Ophthalmoplegia in Multiple Sclerosis Patients
Authors
J. P. McNulty
R. Lonergan
P. C. Brennan
M. G. Evanoff
R. O’Laoide
J. T. Ryan
N. Tubridy
Publication date
01-09-2015
Publisher
Springer Berlin Heidelberg
Published in
Clinical Neuroradiology / Issue 3/2015
Print ISSN: 1869-1439
Electronic ISSN: 1869-1447
DOI
https://doi.org/10.1007/s00062-014-0295-5

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