Cross-Sectional Evaluation of Conventional (T2W, T2 FLAIR, DWI/ADC) Versus Advanced MRI Sequences (DTI, DIR) for Detecting White Matter Disease and Assessing Microstructural Integrity: A Pilot Study

Background: White matter diseases (WMDs) are a group of neurological conditions with structural and functional impairments of the white matter in the brain. Standard MRI sequences (T2W, T2 FLAIR, DWI/ADC) are still the gold standard for WMD evaluation, but can be insensitive to early microstructural alterations. Advanced MRI methods, like diffusion tensor imaging (DTI) and double inversion recovery (DIR), provide better lesion visualization and microstructure assessment. Nevertheless, their clinical utility and diagnostic yield against standard sequences are still under investigation. Aim: To assess the diagnostic performance of DTI and DIR sequences against standard MRI to identify white matter lesions and measure microstructural integrity. Methodology: A cross-sectional study was conducted at the Department of Radiodiagnosis, Teerthanker Mahaveer University, Hospital, Moradabad in Uttar Pradesh, India, over a period of 6 months. A total of 22 patients clinically suspected or diagnosed with white matter diseases (WMDs) underwent MRI brain imaging on a 1.5T scanner. Both conventional sequences (T2W, T2 FLAIR, DWI/ADC) and advanced sequences (DTI, DIR) were utilized. Lesion characteristics such as size and conspicuity, along with DTI-derived microstructural parameters fractional anisotropy (FA) and mean diffusivity (MD) were assessed. Statistical analysis included paired t-tests, correlation analyses, and Friedman’s ANOVA to compare differences across sequences and evaluate diagnostic performance. Results: DIR imaging demonstrated significantly higher lesion conspicuity (mean score: 4.64) compared to T2 FLAIR (mean score: 2.14; p < 0.001). DTI revealed significant differences in FA and MD values between patients with and without tract disruptions (p < 0.001), indicating its sensitivity to microstructural alterations. However, no significant association were found between lesion size on conventional MRI and DTI parameters, suggesting that macrostructural and microstructural findings provide complementary diagnostic insights. Additionally, chi-square analysis revealed no association between tract disruption and acute lesions seen on DWI/ADC (p = 1.000). Conclusion: This study highlights the superior lesion detection ability of DIR and the microstructural sensitivity of DTI in evaluating white matter diseases. These findings advocate for the integration of advanced MRI sequences into standard imaging protocols to improve early detection and diagnostic accuracy in clinical practice.