Clinical Neuroradiology

, Volume 25, Issue 3, pp 233–239 | Cite as

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

  • J. P. McNulty
  • R. Lonergan
  • P. C. Brennan
  • M. G. Evanoff
  • R. O’Laoide
  • J. T. Ryan
  • N. Tubridy
Original Article



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.


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.


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 < 0.05). Non-significant differences were also evident between T2 and FLAIR (p = 0.0511). The specificity analysis revealed an overall difference (p = 0.0005), with specific inter-sequence differences shown between T2 and PD (p < 0.05) and PD and FLAIR (p < 0.001) with the PD values being lower than those provided with the other two sequences.


T2-weighted axial imaging through the MLF region resulted in the greatest overall diagnostic efficacy when viewing a combination of mean AUC, sensitivity, and specificity, in terms of the identification of INO-causing lesions.


Magnetic resonance imaging Sequences Internuclear ophthalmoplegia Medial longitudinal fasciculus Multiple sclerosis 



We express our thanks and gratitude to the staff and examiners from the American Board of Radiology for their assistance and participation in this study. We would also like to thank Dr. Mark McEntee (University of Sydney) and Dr. Rachel Toomey (University College Dublin) for their help with data acquisition and data analysis.

Conflict of Interest

The authors have no conflict of interest related to the present study.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • J. P. McNulty
    • 1
  • R. Lonergan
    • 2
  • P. C. Brennan
    • 3
  • M. G. Evanoff
    • 4
  • R. O’Laoide
    • 2
  • J. T. Ryan
    • 1
  • N. Tubridy
    • 2
  1. 1.School of Medicine and Medical ScienceUniversity College DublinBelfieldIreland
  2. 2.St. Vincent’s University HospitalDublin 4Ireland
  3. 3.Faculty of Health SciencesUniversity of SydneyLidcombeAustralia
  4. 4.The American Board of RadiologyTucsonUSA

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