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

• Published in: Clinical neuroradiology (Munich) 2015-09, Vol.25 (3), p.233-239
• Main Authors: McNulty, J. P., Lonergan, R., Brennan, P. C., Evanoff, M. G., O’Laoide, R., Ryan, J. T., Tubridy, N.
• Format: Article
• Language: English
• Subjects: Adult; Communications equipment; Diagnostic Techniques, Ophthalmological; Diffusion Tensor Imaging - methods; Eye; Female; Humans; Image Enhancement - methods; Magnetic resonance imaging; Male; Medical colleges; Medicine; Medicine & Public Health; Middle Aged; Multiple sclerosis; Multiple Sclerosis - complications; Multiple Sclerosis - pathology; Neurology; Neuroradiology; Neurosurgery; NMR; Nuclear magnetic resonance; Observer Variation; Ocular Motility Disorders - etiology; Ocular Motility Disorders - pathology; Oculomotor Nerve - pathology; Oculomotor paralysis; Original Article; Paralysis; Reproducibility of Results; Sensitivity and Specificity; Signal Processing, Computer-Assisted; Validation studies
• ISSN: 1869-1439; 1869-1447
• DOI: 10.1007/s00062-014-0295-5

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