<![CDATA[Introduction: Multiple sclerosis (MS) lesions may involve cortical and white matter regions and can be challenging to characterize using conventional magnetic resonance imaging (MRI). Three-dimensional T2 Fluid-Attenuated Inversion Recovery (3D T2-FLAIR) and Double Inversion Recovery (3D DIR) provide different tissue suppression characteristics; however, their relative image quality in MS patients with epileptic manifestations requires further evaluation. To compare the image quality of 3D T2-FLAIR and 3D DIR sequences for detecting MS lesions on 3 Tesla brain MRI using Signal-to-Noise Ratio (SNR) and Contrast-to-Noise Ratio (CNR). Research Methodology: This quantitative comparative retrospective study included 10 non-contrast 3 Tesla brain MRI examinations of patients with MS and epileptic manifestations. SNR and CNR were measured using regions of interest placed in white matter, gray matter, and MS lesions. Differences between 3D T2-FLAIR and 3D DIR were analyzed using the Wilcoxon signed-rank test with α=0.05. Results: T2-FLAIR demonstrated significantly higher white matter SNR than DIR (111.47 vs. 16.08; p=0.002). No significant differences were observed for gray matter SNR (156.17 vs. 182.71; p=0.275) or lesion SNR (170.61 vs. 229.78; p=0.105). DIR produced significantly higher lesion-to-white matter CNR than T2-FLAIR (577.51 vs. 398.25; p=0.049), while gray matter-to-white matter and lesion-to-gray matter CNR differences were not significant. Conclusion: 3D T2-FLAIR provides superior white matter SNR, whereas 3D DIR improves lesion-to-white matter contrast. Their complementary characteristics support combined use for more comprehensive evaluation of MS lesions on 3 Tesla MRI.]]>
