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MR imaging of leptomeningeal metastases: comparison of three sequences
Sanjay K Singh1, Norman E Leeds, Lawrence E Ginsberg
1Department of Diagnostic Radiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA.
Background And Purpose:
Recent work has shown that fluid-attenuated inversion recovery (FLAIR) imaging with contrast enhancement is highly sensitive for detecting subarachnoid space disease. We hypothesized that contrast-enhanced FLAIR imaging has superior sensitivity to contrast-enhanced T1-weighted MR imaging in detecting leptomeningeal metastases.
Methods:
Sixty-eight patients referred for suspected leptomeningeal metastases underwent 74 MR imaging studies. The patients had either temporally related cytologic proof of leptomeningeal metastases or negative results of clinical follow-up confirming absence of leptomeningeal metastases. The MR imaging examinations included unenhanced and contrast-enhanced FLAIR images and contrast-enhanced T1-weighted MR images that were independently reviewed by two neuroradiologists blinded to the results of cytology. Each of the three sequences was reviewed individually and separately and was assigned a score of positive or negative for leptomeningeal metastases. Discrepancies were settled by consensus.
Results:
Of the 17 studies of patients with cytology-proven leptomeningeal metastases, two were positive based on unenhanced FLAIR images, seven were positive based on contrast-enhanced FLAIR images, and 10 were positive based on contrast-enhanced T1-weighted MR images. Of the 57 studies of patients without leptomeningeal metastases, 53 were negative based on unenhanced FLAIR images, 50 were negative based on contrast-enhanced FLAIR images, and 53 were negative based on contrast-enhanced T1-weighted MR images. The sensitivity and specificity of unenhanced FLAIR images for detecting leptomeningeal metastases were 12% (two of 17) and 93% (53 of 57), respectively. The sensitivity and specificity for contrast-enhanced FLAIR images for detecting leptomeningeal metastases were 41% (seven of 17) and 88% (50 of 57), respectively. The sensitivity and specificity of contrast-enhanced T1-weighted MR images for detecting leptomeningeal metastases were 59% (10 of 17) and 93% (53 of 57), respectively.
Conclusion:
Contrast-enhanced fast FLAIR sequences are less sensitive than standard contrast-enhanced T1-weighted MR sequences in detecting intracranial neoplastic leptomeningeal disease.
Insights
Contrast-enhanced T1-weighted MRI is more sensitive than contrast-enhanced FLAIR MRI for detecting leptomeningeal metastases. This finding is crucial for accurate diagnosis of neoplastic leptomeningeal disease.
Area of Science:
- Neuroradiology
- Medical Imaging
- Oncology
Background:
- Fluid-attenuated inversion recovery (FLAIR) imaging with contrast enhancement shows high sensitivity for subarachnoid space disease.
- Leptomeningeal metastases detection remains a diagnostic challenge.
Purpose of the Study:
- To compare the sensitivity of contrast-enhanced FLAIR imaging versus contrast-enhanced T1-weighted MR imaging in detecting leptomeningeal metastases.
- To evaluate the diagnostic performance of different MRI sequences for leptomeningeal disease.
Main Methods:
- Seventy-four MRI studies from 68 patients with suspected leptomeningeal metastases were analyzed.
- Unenhanced and contrast-enhanced FLAIR images, along with contrast-enhanced T1-weighted MR images, were independently reviewed by two neuroradiologists.
- Diagnostic performance was assessed by comparing imaging findings with cytologic proof or clinical follow-up.
Main Results:
- Contrast-enhanced T1-weighted MR imaging detected 10 of 17 cases (59% sensitivity), while contrast-enhanced FLAIR detected 7 of 17 cases (41% sensitivity).
- Specificity for contrast-enhanced T1-weighted MR imaging was 93%, and for contrast-enhanced FLAIR was 88%.
- Unenhanced FLAIR had the lowest sensitivity (12%) but high specificity (93%).
Conclusions:
- Contrast-enhanced T1-weighted MR imaging demonstrates superior sensitivity compared to contrast-enhanced FLAIR sequences for detecting intracranial neoplastic leptomeningeal disease.
- Standard contrast-enhanced T1-weighted MR imaging remains the preferred sequence for evaluating leptomeningeal metastases.