Background: In young adults, multiple sclerosis is a prevalent chronic inflammatory demyelinating condition. It is characterized by white matter affection, but many individuals also have significant gray matter involvement. A double inversion recovery pulse pattern was recently proposed to improve the detectability of multiple sclerosis lesions.

Objectives: To evaluate the diagnostic value of double inversion recovery sequence in the detection of cortical and white matter multiple sclerosis plaques in different brain anatomical locations.

Subjects and methods: A total of 37 patients with an established diagnosis of multiple sclerosis were included in this cross-sectional study. Brain MRI was done using double inversion recovery, T2 and FLAIR sequences. The number of lesions was counted and compared in the three sequences.

Results: Dual Inversion Recovery sequence was highly significant and superior to both T2 and FLAIR sequences (P < 0.001) in depicting the lesions regardless of anatomical distribution. Dual Inversion Recovery was significantly superior to T2 (P =<0.001) and FLAIR (P =<0.001) in detecting lesions in cortical and juxtacortical. However, Dual Inversion Recovery shows less periventricular and deep white matter lesions in comparison to T2 and FLAIR sequences.

Conclusion: The Dual Inversion Recovery sequence detected more multiple sclerosis lesions in cortical, subcortical and infratentorial than the traditional T2W and FLAIR sequences. It also demonstrated greater delineation between the white matter, grey matter, and multiple sclerosis lesions, which became more easily visualized.