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<meta name="DC.Title" content="FLAIR2: A Combination of FLAIR and T2 for Improved MS Lesion Detection" />
<meta name="DC.Identifier" content="10.3174/ajnr.A4514" />
<meta name="DC.Date" content="2015-10-15" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
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<meta name="DC.Description" content="BACKGROUND AND PURPOSE: FLAIR and double inversion recovery are important MR imaging scans for MS. The suppression of signal from CSF in FLAIR and the additional suppression of WM signal in double inversion recovery improve contrast between lesions, WM and GM, albeit at a reduced SNR. However, whether the acquisition of double inversion recovery is necessary is still debated. Here, we present an approach that allows obtaining CSF-suppressed images with improved contrast between lesions, WM and GM without strongly penalizing SNR.

MATERIALS AND METHODS: 3D T2-weighted and 3D-FLAIR data acquired from September 2014 to April 2015 in healthy volunteers (23.4 ± 2.4 years of age; female/male ratio, 3:2) and patients (44.1 ± 14.0 years of age; female/male ratio, 4:5) with MS were coregistered and multiplied (FLAIR2). SNR and contrast-to-noise measurements were performed for focal lesions and GM and WM. Furthermore, data from 24 subjects with relapsing-remitting and progressive MS were analyzed retrospectively (52.7 ± 8.1 years of age; female/male ratio, 14:10).

RESULTS: The GM-WM contrast-to-noise ratio was by 133% higher in FLAIR2 than in FLAIR and improved between lesions and WM by 31%, 93%, and 158% compared with T2, DIR, and FLAIR, respectively. Cortical and juxtacortical lesions were more conspicuous in FLAIR2. Furthermore, the 3D nature of FLAIR2 allowed reliable visualization of callosal and infratentorial lesions.

CONCLUSIONS: We present a simple approach for obtaining CSF suppression with an improved contrast-to-noise ratio compared with conventional FLAIR and double inversion recovery without the acquisition of additional data. FLAIR2 can be computed retrospectively if T2 and FLAIR scans are available.

### Abbreviations

CNR
:   contrast-to-noise ratio
DIR
:   double inversion recovery" />
<meta name="DC.Contributor" content="V. Wiggermann" />
<meta name="DC.Contributor" content="E. Hernández-Torres" />
<meta name="DC.Contributor" content="A. Traboulsee" />
<meta name="DC.Contributor" content="D.K.B. Li" />
<meta name="DC.Contributor" content="A. Rauscher" />
<meta name="article:published_time" content="2015-10-08" />
<meta name="article:section" content="ADULT BRAIN" />
<meta name="citation_title" content="FLAIR2: A Combination of FLAIR and T2 for Improved MS Lesion Detection" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;FLAIR and double inversion recovery are important MR imaging scans for MS. The suppression of signal from CSF in FLAIR and the additional suppression of WM signal in double inversion recovery improve contrast between lesions, WM and GM, albeit at a reduced SNR. However, whether the acquisition of double inversion recovery is necessary is still debated. Here, we present an approach that allows obtaining CSF-suppressed images with improved contrast between lesions, WM and GM without strongly penalizing SNR.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;3D T2-weighted and 3D-FLAIR data acquired from September 2014 to April 2015 in healthy volunteers (23.4 ± 2.4 years of age; female/male ratio, 3:2) and patients (44.1 ± 14.0 years of age; female/male ratio, 4:5) with MS were coregistered and multiplied (FLAIR&lt;sup&gt;2&lt;/sup&gt;). SNR and contrast-to-noise measurements were performed for focal lesions and GM and WM. Furthermore, data from 24 subjects with relapsing-remitting and progressive MS were analyzed retrospectively (52.7 ± 8.1 years of age; female/male ratio, 14:10).&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;The GM-WM contrast-to-noise ratio was by 133% higher in FLAIR&lt;sup&gt;2&lt;/sup&gt; than in FLAIR and improved between lesions and WM by 31%, 93%, and 158% compared with T2, DIR, and FLAIR, respectively. Cortical and juxtacortical lesions were more conspicuous in FLAIR&lt;sup&gt;2&lt;/sup&gt;. Furthermore, the 3D nature of FLAIR&lt;sup&gt;2&lt;/sup&gt; allowed reliable visualization of callosal and infratentorial lesions.&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;We present a simple approach for obtaining CSF suppression with an improved contrast-to-noise ratio compared with conventional FLAIR and double inversion recovery without the acquisition of additional data. FLAIR&lt;sup&gt;2&lt;/sup&gt; can be computed retrospectively if T2 and FLAIR scans are available.&lt;/p&gt;" />
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<meta name="citation_author" content="V. Wiggermann" />
<meta name="citation_author_institution" content="From the Departments of Physics and Astronomy (V.W.), Pediatrics (V.W., E.H.T., A.R.), Medicine (Neurology) (A.T., D.K.B.L.), and Radiology (D.K.B.L.); and University of British Columbia MRI Research Centre (V.W., E.H.T., A.R.); Centre for Brain Health (D.K.B.L., A.R.); and Child and Family Research Institute (A.R.), University of British Columbia, Vancouver, British Columbia, Canada." />
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<meta name="citation_author" content="E. Hernández-Torres" />
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<meta name="citation_author" content="A. Traboulsee" />
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<meta name="citation_author_orcid" content="http://orcid.org/0000-0002-0351-9639" />
<meta name="citation_author" content="D.K.B. Li" />
<meta name="citation_author_institution" content="From the Departments of Physics and Astronomy (V.W.), Pediatrics (V.W., E.H.T., A.R.), Medicine (Neurology) (A.T., D.K.B.L.), and Radiology (D.K.B.L.); and University of British Columbia MRI Research Centre (V.W., E.H.T., A.R.); Centre for Brain Health (D.K.B.L., A.R.); and Child and Family Research Institute (A.R.), University of British Columbia, Vancouver, British Columbia, Canada." />
<meta name="citation_author_orcid" content="http://orcid.org/0000-0002-1121-5571" />
<meta name="citation_author" content="A. Rauscher" />
<meta name="citation_author_institution" content="From the Departments of Physics and Astronomy (V.W.), Pediatrics (V.W., E.H.T., A.R.), Medicine (Neurology) (A.T., D.K.B.L.), and Radiology (D.K.B.L.); and University of British Columbia MRI Research Centre (V.W., E.H.T., A.R.); Centre for Brain Health (D.K.B.L., A.R.); and Child and Family Research Institute (A.R.), University of British Columbia, Vancouver, British Columbia, Canada." />
<meta name="citation_author_orcid" content="http://orcid.org/0000-0002-1961-8252" />
<meta name="citation_fulltext_world_readable" content="" />
<meta name="twitter:title" content="FLAIR2: A Combination of FLAIR and T2 for Improved MS Lesion Detection" />
<meta name="twitter:card" content="summary" />
<meta name="twitter:description" content="BACKGROUND AND PURPOSE: FLAIR and double inversion recovery are important MR imaging scans for MS. The suppression of signal from CSF in FLAIR and the additional suppression of WM signal in double inversion recovery improve contrast between lesions, WM and GM, albeit at a reduced SNR. However, whether the acquisition of double inversion recovery is necessary is still debated. Here, we present an approach that allows obtaining CSF-suppressed images with improved contrast between lesions, WM and GM without strongly penalizing SNR.

MATERIALS AND METHODS: 3D T2-weighted and 3D-FLAIR data acquired from September 2014 to April 2015 in healthy volunteers (23.4 ± 2.4 years of age; female/male ratio, 3:2) and patients (44.1 ± 14.0 years of age; female/male ratio, 4:5) with MS were coregistered and multiplied (FLAIR2). SNR and contrast-to-noise measurements were performed for focal lesions and GM and WM. Furthermore, data from 24 subjects with relapsing-remitting and progressive MS were analyzed retrospectively (52.7 ± 8.1 years of age; female/male ratio, 14:10).

RESULTS: The GM-WM contrast-to-noise ratio was by 133% higher in FLAIR2 than in FLAIR and improved between lesions and WM by 31%, 93%, and 158% compared with T2, DIR, and FLAIR, respectively. Cortical and juxtacortical lesions were more conspicuous in FLAIR2. Furthermore, the 3D nature of FLAIR2 allowed reliable visualization of callosal and infratentorial lesions.

CONCLUSIONS: We present a simple approach for obtaining CSF suppression with an improved contrast-to-noise ratio compared with conventional FLAIR and double inversion recovery without the acquisition of additional data. FLAIR2 can be computed retrospectively if T2 and FLAIR scans are available.

### Abbreviations

CNR
:   contrast-to-noise ratio
DIR
:   double inversion recovery" />
<meta name="og-title" property="og:title" content="FLAIR2: A Combination of FLAIR and T2 for Improved MS Lesion Detection" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/early/2015/10/15/ajnr.A4514" />
<meta name="og-site-name" property="og:site_name" content="American Journal of Neuroradiology" />
<meta name="og-description" property="og:description" content="BACKGROUND AND PURPOSE: FLAIR and double inversion recovery are important MR imaging scans for MS. The suppression of signal from CSF in FLAIR and the additional suppression of WM signal in double inversion recovery improve contrast between lesions, WM and GM, albeit at a reduced SNR. However, whether the acquisition of double inversion recovery is necessary is still debated. Here, we present an approach that allows obtaining CSF-suppressed images with improved contrast between lesions, WM and GM without strongly penalizing SNR.

MATERIALS AND METHODS: 3D T2-weighted and 3D-FLAIR data acquired from September 2014 to April 2015 in healthy volunteers (23.4 ± 2.4 years of age; female/male ratio, 3:2) and patients (44.1 ± 14.0 years of age; female/male ratio, 4:5) with MS were coregistered and multiplied (FLAIR2). SNR and contrast-to-noise measurements were performed for focal lesions and GM and WM. Furthermore, data from 24 subjects with relapsing-remitting and progressive MS were analyzed retrospectively (52.7 ± 8.1 years of age; female/male ratio, 14:10).

RESULTS: The GM-WM contrast-to-noise ratio was by 133% higher in FLAIR2 than in FLAIR and improved between lesions and WM by 31%, 93%, and 158% compared with T2, DIR, and FLAIR, respectively. Cortical and juxtacortical lesions were more conspicuous in FLAIR2. Furthermore, the 3D nature of FLAIR2 allowed reliable visualization of callosal and infratentorial lesions.

CONCLUSIONS: We present a simple approach for obtaining CSF suppression with an improved contrast-to-noise ratio compared with conventional FLAIR and double inversion recovery without the acquisition of additional data. FLAIR2 can be computed retrospectively if T2 and FLAIR scans are available.

### Abbreviations

CNR
:   contrast-to-noise ratio
DIR
:   double inversion recovery" />
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    <div class="highwire-article-citation highwire-citation-type-highwire-article node51374--5" data-node-nid="51374" id="top-node-51374--62049904772" data-pisa="ajnr;ajnr.A4514v2" data-pisa-master="ajnr;ajnr.A4514" data-apath="/ajnr/early/2015/10/15/ajnr.A4514.atom" data-hw-author-tooltip-instance="highwire_author_tooltip"><div class="highwire-cite highwire-cite-highwire-article highwire-citation-jcore-article-title-complete clearfix has-author-tooltip highwire-citation-highwire-article-top-a">
  
  
      <div class="highwire-cite-overline"><span  class="highwire-cite-metadata-article-type highwire-cite-metadata">Research Article</span><span class="separator-pipe"></span><span  class="highwire-cite-metadata-art-cat highwire-cite-metadata"><span class="wrapper">ADULT BRAIN</span></span></div>
  
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      <h1 class="highwire-cite-title" id="page-title">FLAIR<sup>2</sup>: A Combination of FLAIR and T2 for Improved MS Lesion Detection</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">V. Wiggermann</span>, <span class="highwire-citation-author" data-delta="1">E. Hernández-Torres</span>, <span class="highwire-citation-author" data-delta="2">A. Traboulsee</span>, <span class="highwire-citation-author" data-delta="3">D.K.B. Li</span> and <span class="highwire-citation-author" data-delta="4">A. Rauscher</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">October 2015,  </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A4514 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-51374--62049904772" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">V. Wiggermann </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Departments of Physics and Astronomy (V.W.), Pediatrics (V.W., E.H.T., A.R.), Medicine (Neurology) (A.T., D.K.B.L.), and Radiology (D.K.B.L.); and University of British Columbia MRI Research Centre (V.W., E.H.T., A.R.); Centre for Brain Health (D.K.B.L., A.R.); and Child and Family Research Institute (A.R.), University of British Columbia, Vancouver, British Columbia, Canada.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=V.%2BWiggermann%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Wiggermann%20V&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AV.%2BWiggermann%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0001-5236-3039" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for V. Wiggermann</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">E. Hernández-Torres </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Departments of Physics and Astronomy (V.W.), Pediatrics (V.W., E.H.T., A.R.), Medicine (Neurology) (A.T., D.K.B.L.), and Radiology (D.K.B.L.); and University of British Columbia MRI Research Centre (V.W., E.H.T., A.R.); Centre for Brain Health (D.K.B.L., A.R.); and Child and Family Research Institute (A.R.), University of British Columbia, Vancouver, British Columbia, Canada.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=E.%2BHern%C3%A1ndez-Torres%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Hern%C3%A1ndez-Torres%20E&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AE.%2BHern%25C3%25A1ndez-Torres%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0003-2873-5693" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for E. Hernández-Torres</a></li></ul></div><div class="author-tooltip-2"><div class="author-tooltip-name">A. Traboulsee </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Departments of Physics and Astronomy (V.W.), Pediatrics (V.W., E.H.T., A.R.), Medicine (Neurology) (A.T., D.K.B.L.), and Radiology (D.K.B.L.); and University of British Columbia MRI Research Centre (V.W., E.H.T., A.R.); Centre for Brain Health (D.K.B.L., A.R.); and Child and Family Research Institute (A.R.), University of British Columbia, Vancouver, British Columbia, Canada.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=A.%2BTraboulsee%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Traboulsee%20A&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AA.%2BTraboulsee%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0002-0351-9639" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for A. Traboulsee</a></li></ul></div><div class="author-tooltip-3"><div class="author-tooltip-name">D.K.B. Li </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Departments of Physics and Astronomy (V.W.), Pediatrics (V.W., E.H.T., A.R.), Medicine (Neurology) (A.T., D.K.B.L.), and Radiology (D.K.B.L.); and University of British Columbia MRI Research Centre (V.W., E.H.T., A.R.); Centre for Brain Health (D.K.B.L., A.R.); and Child and Family Research Institute (A.R.), University of British Columbia, Vancouver, British Columbia, Canada.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=D.K.B.%2BLi%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Li%20D&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AD.K.B.%2BLi%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0002-1121-5571" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for D.K.B. Li</a></li></ul></div><div class="author-tooltip-4"><div class="author-tooltip-name">A. Rauscher </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Departments of Physics and Astronomy (V.W.), Pediatrics (V.W., E.H.T., A.R.), Medicine (Neurology) (A.T., D.K.B.L.), and Radiology (D.K.B.L.); and University of British Columbia MRI Research Centre (V.W., E.H.T., A.R.); Centre for Brain Health (D.K.B.L., A.R.); and Child and Family Research Institute (A.R.), University of British Columbia, Vancouver, British Columbia, Canada.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=A.%2BRauscher%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Rauscher%20A&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AA.%2BRauscher%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0002-1961-8252" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for A. Rauscher</a></li></ul></div></div></div>  </div>

  
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      <div class="highwire-cite-title">FLAIR<sup>2</sup>: A Combination of FLAIR and T2 for Improved MS Lesion Detection</div>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">V.</span> <span class="nlm-surname">Wiggermann</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">E.</span> <span class="nlm-surname">Hernández-Torres</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">A.</span> <span class="nlm-surname">Traboulsee</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">D.K.B.</span> <span class="nlm-surname">Li</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">A.</span> <span class="nlm-surname">Rauscher</span></span></span></div>
  
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      <div class="highwire-cite-title">FLAIR<sup>2</sup>: A Combination of FLAIR and T2 for Improved MS Lesion Detection</div>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">V.</span> <span class="nlm-surname">Wiggermann</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">E.</span> <span class="nlm-surname">Hernández-Torres</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">A.</span> <span class="nlm-surname">Traboulsee</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">D.K.B.</span> <span class="nlm-surname">Li</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">A.</span> <span class="nlm-surname">Rauscher</span></span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-oa-ind highwire-cite-metadata"><i class="highwire-oa-indicator"></i> </span><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Oct 2015, </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A4514 </span></div>
  
  
  
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