{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T23:36:48Z","timestamp":1790897808793,"version":"4.1.0"},"reference-count":35,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2025,1,30]],"date-time":"2025-01-30T00:00:00Z","timestamp":1738195200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Fred Lewis Enterprise Foundation"},{"name":"Hugh Green Foundation"},{"name":"Manaaki Moves"},{"name":"NZ P Pull"},{"name":"JN &amp; HB Williams Foundation"},{"name":"Mangatawa Beale Williams Memorial Trust"},{"name":"Multiple Sclerosis Society of New Zealand"},{"name":"Neurological Foundation (New Zealand)"},{"name":"Trust Tair\u0101whiti; Friends of M\u0101tai Blue Sky Fund"},{"name":"GE Healthcare; M\u0101tai Ng\u0101 M\u0101ngai Maori and K\u0101noa\u2014Regional Economic Development &amp; Investment Unit of New Zealand"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>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.<\/jats:p>","DOI":"10.3390\/diagnostics15030329","type":"journal-article","created":{"date-parts":[[2025,1,30]],"date-time":"2025-01-30T11:08:23Z","timestamp":1738235303000},"page":"329","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["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"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5427-0634","authenticated-orcid":false,"given":"Paul","family":"Condron","sequence":"first","affiliation":[{"name":"M\u0101tai Medical Research Institute, Gisborne-Tair\u0101whiti 4010, New Zealand"},{"name":"Department of Anatomy and Medical Imaging and Centre for Brain Research, Faculty of Medical and Health Sciences, University of Auckland, Auckland 1010, New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7488-7834","authenticated-orcid":false,"given":"Daniel M.","family":"Cornfeld","sequence":"additional","affiliation":[{"name":"M\u0101tai Medical Research Institute, Gisborne-Tair\u0101whiti 4010, New Zealand"},{"name":"Department of Anatomy and Medical Imaging and Centre for Brain Research, Faculty of Medical and Health Sciences, University of Auckland, Auckland 1010, New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Bydder","sequence":"additional","affiliation":[{"name":"M\u0101tai Medical Research Institute, Gisborne-Tair\u0101whiti 4010, New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eryn E.","family":"Kwon","sequence":"additional","affiliation":[{"name":"M\u0101tai Medical Research Institute, Gisborne-Tair\u0101whiti 4010, New Zealand"},{"name":"Auckland Bioengineering Institute, Private Bag 92019, Auckland 1142, New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen","family":"Whitehead","sequence":"additional","affiliation":[{"name":"Multiple Sclerosis Society, Gisborne-Tair\u0101whiti 4010, New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5225-2993","authenticated-orcid":false,"given":"Emanuele","family":"Pravat\u00e0","sequence":"additional","affiliation":[{"name":"Department of Neuroradiology, Neurocenter of Southern Switzerland, 6903 Lugano, Switzerland"},{"name":"Faculty of Biomedical Sciences, Universita della Svizzera Italiana, 6900 Lugano, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helen","family":"Danesh-Meyer","sequence":"additional","affiliation":[{"name":"M\u0101tai Medical Research Institute, Gisborne-Tair\u0101whiti 4010, New Zealand"},{"name":"Department of Anatomy and Medical Imaging and Centre for Brain Research, Faculty of Medical and Health Sciences, University of Auckland, Auckland 1010, New Zealand"},{"name":"Department of Ophthalmology, University of Auckland, Auckland 1010, New Zealand"},{"name":"Eye Institute, Auckland 1050, New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine","family":"Shi","sequence":"additional","affiliation":[{"name":"M\u0101tai Medical Research Institute, Gisborne-Tair\u0101whiti 4010, New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-8026-2889","authenticated-orcid":false,"given":"Taylor C.","family":"Emsden","sequence":"additional","affiliation":[{"name":"M\u0101tai Medical Research Institute, Gisborne-Tair\u0101whiti 4010, New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gil","family":"Newburn","sequence":"additional","affiliation":[{"name":"M\u0101tai Medical Research Institute, Gisborne-Tair\u0101whiti 4010, New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9593-2956","authenticated-orcid":false,"given":"Miriam","family":"Scadeng","sequence":"additional","affiliation":[{"name":"M\u0101tai Medical Research Institute, Gisborne-Tair\u0101whiti 4010, New Zealand"},{"name":"Department of Anatomy and Medical Imaging and Centre for Brain Research, Faculty of Medical and Health Sciences, University of Auckland, Auckland 1010, New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2929-1169","authenticated-orcid":false,"given":"Samantha J.","family":"Holdsworth","sequence":"additional","affiliation":[{"name":"M\u0101tai Medical Research Institute, Gisborne-Tair\u0101whiti 4010, New Zealand"},{"name":"Department of Anatomy and Medical Imaging and Centre for Brain Research, Faculty of Medical and Health Sciences, University of Auckland, Auckland 1010, New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Graeme M.","family":"Bydder","sequence":"additional","affiliation":[{"name":"M\u0101tai Medical Research Institute, Gisborne-Tair\u0101whiti 4010, New Zealand"},{"name":"Department of Radiology, University of California San Diego (UCSD), San Diego, CA 92093, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,1,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"4658","DOI":"10.21037\/qims-22-394","article-title":"Improving the understanding and performance of clinical MRI using tissue property filters and the central contrast theorem, MASDIR pulse sequences and synergistic contrast MRI","volume":"12","author":"Ma","year":"2022","journal-title":"Quant. 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