Ultra-High Contrast (UHC) MRI of the Brain, Spinal Cord, and Optic Nerves in Multiple Sclerosis Using Directly Acquired and Synthetic Bipolar Filter (BLAIR) Images

Condron, Paul; Cornfeld, Daniel M.; Bydder, Mark; Kwon, Eryn E.; Whitehead, Karen; Pravatà, Emanuele; Danesh-Meyer, Helen; Shi, Catherine; Emsden, Taylor C.; Newburn, Gil; Scadeng, Miriam; Holdsworth, Samantha J.; Bydder, Graeme M.

doi:10.3390/diagnostics15030329

This is an early access version, the complete PDF, HTML, and XML versions will be available soon.

Open AccessReview

Ultra-High Contrast (UHC) MRI of the Brain, Spinal Cord, and Optic Nerves in Multiple Sclerosis Using Directly Acquired and Synthetic Bipolar Filter (BLAIR) Images

by

Paul Condron

^1,2

,

Daniel M. Cornfeld

^1,2

,

Mark Bydder

¹,

Eryn E. Kwon

^1,3,

Karen Whitehead

⁴,

Emanuele Pravatà

^5,6

,

Helen Danesh-Meyer

^1,2,7,8,

Catherine Shi

¹,

Taylor C. Emsden

¹

,

Gil Newburn

¹,

Miriam Scadeng

^1,2

,

Samantha J. Holdsworth

^1,2

and

Graeme M. Bydder

^1,9,*

¹

Mātai Medical Research Institute, Gisborne-Tairāwhiti 4010, New Zealand

²

Department of Anatomy and Medical Imaging and Centre for Brain Research, Faculty of Medical and Health Sciences, University of Auckland, Auckland 1010, New Zealand

³

Auckland Bioengineering Institute, Private Bag 92019, Auckland 1142, New Zealand

⁴

Multiple Sclerosis Society, Gisborne-Tairāwhiti 4010, New Zealand

⁵

Department of Neuroradiology, Neurocenter of Southern Switzerland, 6903 Lugano, Switzerland

⁶

Faculty of Biomedical Sciences, Universita della Svizzera Italiana, 6900 Lugano, Switzerland

⁷

Department of Ophthalmology, University of Auckland, Auckland 1010, New Zealand

⁸

Eye Institute, Auckland 1050, New Zealand

⁹

Department of Radiology, University of California San Diego (UCSD), San Diego, CA 92093, USA

^*

Author to whom correspondence should be addressed.

Diagnostics 2025, 15(3), 329; https://doi.org/10.3390/diagnostics15030329

Submission received: 10 January 2025 / Revised: 22 January 2025 / Accepted: 24 January 2025 / Published: 30 January 2025

(This article belongs to the Special Issue Recent Advances in MRI of Multiple Sclerosis)

Download Review Reports Versions Notes

Abstract

In this educational review, the basic physics underlying the use of ultra-high contrast (UHC) bipolar filter (BLAIR) sequences, including divided subtracted inversion recovery (dSIR), is explained. These sequences can increase the contrast produced by small changes in T₁ by a factor of ten or more compared with conventional IR sequences. In illustrative cases, the sequences were used in multiple sclerosis (MS) patients during relapse and remission and were compared with positionally matched conventional (T₂-weighted spin echo, T₂-FLAIR) images. Well-defined focal lesions were seen with dSIR sequences in areas where little or no change was seen with conventional sequences. In addition, widespread abnormalities affecting almost all of the white matter of the brain were seen during relapses when there were no corresponding abnormalities seen on conventional sequences (the whiteout sign). Grayout signs, in which there is a loss of contrast in gray matter or between gray matter and CSF, were also seen, as well as high signal boundaries around lesions. Disruption of the usual high signal boundary between white and gray matter was seen in leucocortical lesions. Lesions in the spinal cord were better seen or only seen with dSIR sequences. Generalized change was observed in the optic nerve with the dSIR sequence in a case of optic neuritis. UHC BLAIR sequences may be of considerable value for recognition of abnormalities in clinical practice and in research studies on MS.

Keywords: ultra-high contrast MRI; divided subtracted inversion recovery (dSIR) sequence; logarithmic then subtracted inversion recovery (lSIR) sequence; bipolar filter (BLAIR); multiple sclerosis; whiteout sign; grayout sign; white matter disease of the brain

Share and Cite

MDPI and ACS Style

Condron, P.; Cornfeld, D.M.; Bydder, M.; Kwon, E.E.; Whitehead, K.; Pravatà, E.; Danesh-Meyer, H.; Shi, C.; Emsden, T.C.; Newburn, G.; et al. Ultra-High Contrast (UHC) MRI of the Brain, Spinal Cord, and Optic Nerves in Multiple Sclerosis Using Directly Acquired and Synthetic Bipolar Filter (BLAIR) Images. Diagnostics 2025, 15, 329. https://doi.org/10.3390/diagnostics15030329

AMA Style

Condron P, Cornfeld DM, Bydder M, Kwon EE, Whitehead K, Pravatà E, Danesh-Meyer H, Shi C, Emsden TC, Newburn G, et al. Ultra-High Contrast (UHC) MRI of the Brain, Spinal Cord, and Optic Nerves in Multiple Sclerosis Using Directly Acquired and Synthetic Bipolar Filter (BLAIR) Images. Diagnostics. 2025; 15(3):329. https://doi.org/10.3390/diagnostics15030329

Chicago/Turabian Style

Condron, Paul, Daniel M. Cornfeld, Mark Bydder, Eryn E. Kwon, Karen Whitehead, Emanuele Pravatà, Helen Danesh-Meyer, Catherine Shi, Taylor C. Emsden, Gil Newburn, and et al. 2025. "Ultra-High Contrast (UHC) MRI of the Brain, Spinal Cord, and Optic Nerves in Multiple Sclerosis Using Directly Acquired and Synthetic Bipolar Filter (BLAIR) Images" Diagnostics 15, no. 3: 329. https://doi.org/10.3390/diagnostics15030329

APA Style

Condron, P., Cornfeld, D. M., Bydder, M., Kwon, E. E., Whitehead, K., Pravatà, E., Danesh-Meyer, H., Shi, C., Emsden, T. C., Newburn, G., Scadeng, M., Holdsworth, S. J., & Bydder, G. M. (2025). Ultra-High Contrast (UHC) MRI of the Brain, Spinal Cord, and Optic Nerves in Multiple Sclerosis Using Directly Acquired and Synthetic Bipolar Filter (BLAIR) Images. Diagnostics, 15(3), 329. https://doi.org/10.3390/diagnostics15030329

Note that from the first issue of 2016, this journal uses article numbers instead of page numbers. See further details here.

Article Menu

Ultra-High Contrast (UHC) MRI of the Brain, Spinal Cord, and Optic Nerves in Multiple Sclerosis Using Directly Acquired and Synthetic Bipolar Filter (BLAIR) Images

Abstract

Share and Cite

Article Metrics

Article Access Statistics

Further Information

Guidelines

MDPI Initiatives

Follow MDPI