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Contrast-enhanced fluid-attenuated inversion recovery imaging for leptomeningeal disease in children
Paul D Griffiths1, Stuart C Coley, Charles A J Romanowski
1Unit of Academic Radiology, University of Sheffield, England.
Insights
Contrast-enhanced FLAIR MR imaging improves detection of leptomeningeal disease by suppressing normal brain vasculature, offering better visualization than T1-weighted imaging for various conditions and ages.
Area of Science:
- Medical Imaging
- Neurology
- Pediatric Oncology
Background:
- Leptomeningeal disease (LMD) diagnosis relies on imaging.
- Current standard is contrast-enhanced T1-weighted MRI.
- Improved detection methods are needed, especially in high-risk pediatric patients.
Purpose of the Study:
- To develop and evaluate an MR imaging technique for enhanced LMD detection.
- Compare a novel contrast-enhanced FLAIR sequence against standard contrast-enhanced T1-weighted imaging.
Main Methods:
- Investigated 10 high-risk pediatric cases (Sturge-Weber syndrome, medulloblastoma).
- Acquired contrast-enhanced FLAIR images alongside routine sequences.
- Optimized FLAIR parameters to maximize T1 signal intensity for LMD detection.
Main Results:
- FLAIR showed comparable or more extensive LMD than T1-weighted imaging in Sturge-Weber syndrome.
- FLAIR revealed more extensive leptomeningeal enhancement in 2 of 6 medulloblastoma cases.
- Unexpected bilateral disease was noted in one Sturge-Weber case via FLAIR.
Conclusions:
- Contrast-enhanced FLAIR MRI enhances LMD detection compared to T1-weighted imaging.
- FLAIR's suppression of normal vascular signal aids leptomeningeal visualization.
- Findings are potentially applicable to LMD detection across all ages and etiologies.
Background And Purpose:
To develop an MR imaging method that improves detection of leptomeningeal disease when compared with the current reference standard, contrast-enhanced T1-weighted imaging.
Methods:
We investigated the cases of 10 children who were at high risk of intracranial leptomeningeal disease (Sturge-Weber syndrome and medulloblastoma). The cases of Sturge-Weber syndrome were investigated by using one MR imaging examination, and the cases of medulloblastoma were investigated by using four MR imaging examinations performed over 18 months. In all cases, contrast-enhanced fluid-attenuated inversion recovery (FLAIR) images were acquired in addition to the routine sequences. The parameters of the FLAIR sequence were chosen to maximize the T1 component of the signal intensity, to maximize detection of leptomeningeal enhancement. We made subjective and objective assessments of the presence and extent of leptomeningeal disease as shown on contrast-enhanced T1-weighted images and contrast-enhanced FLAIR images.
Results:
In three of the four cases of Sturge-Weber syndrome, the T1 and FLAIR sequences showed comparable extent of leptomeningeal enhancement. For one child, FLAIR images showed unexpected bilateral disease and more extensive leptomeningeal enhancement on the clinically suspected side. In four of six cases of medulloblastoma, no leptomeningeal enhancement was shown on any examinations during the 18-month period. In two cases, FLAIR images showed more extensive leptomeningeal enhancement when compared with T1-weighted images.
Conclusion:
Contrast-enhanced FLAIR imaging seems to improve detection of leptomeningeal disease when compared with routine contrast-enhanced T1-weighted imaging. This seems to be partly because of suppression of signal intensity from normal vascular structures on the surface of the brain by FLAIR, which allows easier visualization of abnormal leptomeninges. We think that these findings can be extrapolated to the investigation of leptomeningeal disease of all causes and at all ages.
