Comparison of Contrast-Enhanced T2 FLAIR and 3D T1 Black-Blood Fast Spin-Echo for Detection of Leptomeningeal Metastases

Yae Won Park; Sung Jun Ahn

doi:10.13104/imri.2018.22.2.86

Journal List > Investig Magn Reson Imaging > v.22(2) > 1098682

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Park and Ahn: Comparison of Contrast-Enhanced T2 FLAIR and 3D T1 Black-Blood Fast Spin-Echo for Detection of Leptomeningeal Metastases

Original Article

iMRI 2018;22(2):86-93.

Published online: 12 January 2018

DOI: https://doi.org/10.13104/imri.2018.22.2.86

Comparison of Contrast-Enhanced T2 FLAIR and 3D T1 Black-Blood Fast Spin-Echo for Detection of Leptomeningeal Metastases

Yae Won Park¹, Sung Jun Ahn²

^¹Department of Radiology, Ewha Womans University College of Medicine, Seoul, Korea

^²Department of Radiology, Yonsei University, College of Medicine, Seoul, Korea

Correspondence to: Yae Won Park, M.D. Department of Radiology, Ewha Womans University Mokdong Hospital, 1071 Anyangchen-ro, Yangcheon-gu, Seoul 07985, Korea. Tel. +82-2-2650-5114 Fax. +82-2-2650-5302 E-mail: aahng77@yuhs.ac

Received 5 March 2018 Revised 11 April 2018 Accepted 15 May 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

Imaging plays a significant role in diagnosing leptomeningeal metastases. However, the most appropriate sequence for the detection of leptomeningeal metastases has yet to be determined. This study compares the efficacies of contrast-enhanced T2 fluid attenuated inversion recovery (FLAIR) and contrast-enhanced 3D T1 black-blood fast spin echo (FSE) imaging for the detection of leptomeningeal metastases.

Materials and Methods

Tube phantoms containing varying concentrations of gadobutrol solution were scanned using T2 FLAIR and 3D T1 black-blood FSE. Additionally, 30 patients with leptomeningeal metastases were retrospectively evaluated to compare conspicuous lesions and the extent of leptomeningeal metastases detected by T2 FLAIR and 3D T1 black-blood FSE.

Results

The signal intensities of low-concentration gadobutrol solutions (< 0.5 mmol/L) on T2 FLAIR images were higher than in 3D T1 black-blood FSE. The T2 FLAIR sequences exhibited significantly greater visual conspicuity scores than the 3D T1 black-blood sequence in leptomeningeal metastases of the pial membrane of cistern (P = 0.014). T2 FLAIR images exhibited a greater or equal extent (96.7%) of leptomeningeal metastases than 3D T1 black-blood FSE images.

Conclusion

Because of its high sensitivity even at low gadolinium concentrations, contrast-enhanced T2 FLAIR images delineated leptomeningeal metastases in a wider territory than 3D T1 black-blood FSE.

Keywords: Leptomeningeal metastases, Black-blood, Contrast-enhanced T2 FLAIR

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Fig. 1.

Relative signal intensities of gadolinium solution based on gadolinium concentration at various pulse sequences: The signal intensities of low-concentration gadobutrol solutions (< 0.5 mmol/ L) relative to normal saline on T2 FLAIR images are higher than in 3D T1 BB FSE images. 3D = three dimensional; BB = black blood; FLAIR = fluid attenuated inversion recovery; FSE = fast spin echo; FSPGR = fast spoiled gradient echo

Fig. 2.

Images of phantom tubes containing low concentrations of gadobutrol solution (0.0125–0.9 mmol/L) acquired by T2 FLAIR and 3D T1 BB FSE MRI. 3D = three-dimensional; BB = black blood; FLAIR = fluid attenuated inversion recovery; FSE = fast spin echo; FSPGR = fast spoiled gradient echo

Fig. 3.

Images of a 73-year-old female patient with primary lung cancer acquired using the contrast-enhanced T2 FLAIR (a-c) and T1 BB-FSE (d-f) sequences. In T2 FLAIR images, leptomeningeal enhancement is clearly visualized in the pial membrane of the cistern and the cranial nerve (arrows; visual conspicuity score: 2). In 3D T1 BB-FSE images, leptomeningeal enhancement is not clearly demarcated in the pial membrane of the cistern (arrow; visual conspicuity score: 0) but suspected in the cranial nerve (conspicuity score: 1). 3D = three-dimensional; BB = black blood; FLAIR = fluid attenuated inversion recovery; FSE = fast spin echo

Fig. 4.

Images of a 50-year-old female patient acquired using the T2 FLAIR (a) and 3D T1 BB-FSE (b) sequences. The extent of leptomeningeal seeding in the T2 FLAIR image is greater than in the 3D T1 BB-FSE image (white arrows). 3D = three-dimensional; BB = black blood; FLAIR = fluid attenuated inversion recovery; FSE = fast spin echo

Table 1.

Imaging Parameters for the T2 FLAIR and 3D T1 BB FSE Sequences

	T2 FLAIR	3D BB T1 FSE
FOV (mm)	210	220
TR (ms)	12000	500
TE (ms)	144.46	24.511
Inversion time (ms)	2517
Matrix (RO/PE)	352 × 224	256 × 224
Slice thickness (mm)	4	1
ETL	30	24
Flip angle	111	Variable
Scan FOV (cm)	21	22
Scan time (min)	3 min 12 sec	4 min 54 sec

3D = three dimensional; BB = black blood; ETL = echo train length; FLAIR = fluid attenuated inversion recovery; FOV = field of view; FSE = fast spin echo; FSPGR = fast spoiled gradient-echo; PE = phase encoding; RO = readout; TE = echo time;

Table 2.

Visual Conspicuity Scores of Each Sequence for Detection of Leptomeningeal Metastases

		T2 FLAIR	T1 BB FSE	P value
Sulci of cerebral hemisphere or folia of cerebellum (n = 29)	R 1	1.90 ± 0.41	1.69 ± 0.60	0.124
	R 2	1.86 ± 0.52	1.72 ± 0.59	0.056
Cranial nerve (n = 16)	R 1	1.56 ± 0.63	1.13 ± 0.89	0.068
	R 2	1.63 ± 0.62	1.19 ± 0.91	0.053
Subependymal line (n = 1)	R 1	2	2	NA
	R 2	1	2	NA
Pial membrane in cistern (n = 10)	R 1	1.60 ± 0.70	0.70 ± 0.82	0.014*
	R 2	1.50 ± 0.85	0.70 ± 0.82	0.023*

Visual conspicuity scores for leptomeningeal metastases: 0, negative; 1, suspicious of leptomeningeal metastases, but not clearly distinguished from adjacent structures; and 2, certain leptomeningeal metastases, clearly distinguished from adjacent structures. *P < 0.05 BB = black blood; FLAIR = fluid attenuated inversion recovery; FSE = fast spin echo; NA = not applicable; R1 = Reviewer 1; R2 = Reviewer 2

Table 3.

Extent of Leptomeningeal Seeding

	Reviewer 1	Reviewer 2
T2 FLAIR > 3D T1 BB FSE	13/30 (43.3)	10/30 (33.3)
T2 FLAIR = 3D T1 BB FSE	16/30 (53.3)	19/30 (63.4)
T2 FLAIR < 3D T1 BB FSE	1/30 (3.3)	1/30 (3.3)

Data are presented as numbers of patients/total patients (%). BB = black blood; FLAIR = fluid attenuated inversion recovery; FSE = fast spin echo

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