Fat-saturated post gadolinium T1 imaging of the brain in multiple sclerosis

Background: Magnetic resonance imaging (MRI) is of vital importance in the diagnosis and follow-up of patients with multiple sclerosis (MS). Imaging sequences better demonstrating enhancing lesions can help in detecting active MS plaques. Purpose: To evaluate the role of fat-saturated gadolinium-enhanced T1-weighted (T1W) images of the brain in MS and to assess the benefit of performing this additional sequence in the detection of enhancing lesions. Material and Methods: In a prospective study over a six-month period, 70 consecutive patients with clinically diagnosed MS were enrolled. These constituted 14 male and 56 female patients between the ages of 21 and 44 years. All the patients underwent brain MRIs on a 1.5 Tesla Magnet. Gadolinium-enhanced T1 images with and without fat saturation were compared and results were recorded and analyzed using a conspicuity score and McNemar test. Results: There were a total of 157 lesions detected in 70 patients on post-contrast T1W fat-saturated images compared with 139 lesions seen on the post-contrast T1W fast spin-echo (FSE) images. This was because 18 of the lesions (11.5%) were only seen on the fat-saturated images. In addition, 15 lesions were more conspicuous on the fat saturation sequence (9.5%). The total conspicuity score obtained, including all the lesions, was 2.24 +/-0.60 (SD). Using the two-tailed McNemar test for quantitative analysis, the P value obtained was <0.0001. Conclusion: T1W fat-saturated gadolinium-enhanced images show better lesion enhancement than T1W images without fat saturation.