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Noncontrast MRI Surveillance of Craniopharyngiomas Using a Balanced Steady-state Free Precession (bSSFP) Sequence
Kelly Trinh1, Michael Tang2, Claire White-Dzuro3
1From the Texas Tech University Health Sciences Center (K.T.), Lubbock, Texas.
Background And Purpose:
Contrast-enhanced MRI (CEMRI) is a commonly used imaging technique for craniopharyngioma surveillance; however, it carries risks such as allergic reaction and gadolinium deposition. This study evaluates the efficacy of non contrast-enhanced MRI (NCMRI) with a balanced steady-state free precession (bSSFP) sequence compared with CEMRI T1-weighted imaging for craniopharyngioma surveillance.
Materials And Methods:
Twenty-nine patients with craniopharyngioma (16 females/13 males, mean age =21.5 ± 4.3 years) with CEMRIs, including a bSSFP sequence, were evaluated. For each patient, 2 blinded neuroradiologists compared the dimensions of residual craniopharyngioma on non-contrast- and contrast-enhanced sequences. Tumor volume and solid/cystic component measurements were evaluated by using paired t-tests. Diagnostic confidence levels for non-contrast- and contrast-enhanced evaluations were measured by using a 3-point scale (2 = confident, 1 = adequate, 0 = unsure). Analyses of tumor involvement of cranial nerves (CNs) and adjacent vasculature and diagnostic confidence were performed by using Fisher exact and chi-square tests.
Results:
No significant difference was observed between residual tumor volumes in both studies (18.86 ± 21.67 cm3 versus 17.64 ± 23.85 cm3, P = .55) and measurements of dominant solid component volume, number of cystic components, and largest cystic component volume (2.71 ± 3.47 cm3 versus 3.95 ± 5.51 cm3, P = .10; 2.5 ± 1.5 versus 2.9 ± 1.5, P = .10; 7.61 ± 13.41 versus 6.84 ± 13.37 cm3, P = .22, respectively). Tumor involvement of CNs II (P = .64), III (P = .42), and adjacent vasculature (P = .05) showed no significant differences in detection. Diagnostic confidence was comparable in evaluating CN II, vascular structures, and third ventricle (P > .05) involvement. Higher levels of confidence were observed with bSSFP sequences for the detection of CN III involvement (P = .0001) and with contrast-enhanced T1-weighted imaging for cavernous sinus involvement (P = .02).
Conclusions:
NCMRI techniques by using a bSSFP sequence provide similar characterization of craniopharyngiomas as contrast-enhanced techniques.
Insights
Non-contrast MRI (NCMRI) using a balanced steady-state free precession (bSSFP) sequence offers comparable craniopharyngioma characterization to contrast-enhanced MRI (CEMRI). This NCMRI approach provides similar tumor volume and component measurements, reducing risks associated with contrast agents.
Area of Science:
- Neuroradiology
- Oncology Imaging
Background:
- Contrast-enhanced MRI (CEMRI) is standard for craniopharyngioma surveillance but poses risks like allergic reactions and gadolinium deposition.
- Non-contrast MRI (NCMRI) offers a potentially safer alternative for monitoring these tumors.
Purpose of the Study:
- To evaluate the efficacy of NCMRI with a balanced steady-state free precession (bSSFP) sequence compared to CEMRI T1-weighted imaging for craniopharyngioma surveillance.
- To assess if NCMRI can provide similar diagnostic information as CEMRI, minimizing contrast-related risks.
Main Methods:
- Twenty-nine craniopharyngioma patients underwent CEMRI, including a bSSFP sequence.
- Two blinded neuroradiologists compared tumor dimensions, volume, and solid/cystic components between NCMRI and CEMRI.
- Diagnostic confidence for tumor involvement of cranial nerves (CNs) and vasculature was assessed.
Main Results:
- No significant differences were found in residual tumor volumes, solid/cystic component volumes, or number of cysts between NCMRI and CEMRI.
- Detection rates for tumor involvement of CNs II, III, and adjacent vasculature were comparable.
- Diagnostic confidence was similar for CN II and vascular structures, but bSSFP improved confidence for CN III, while CEMRI improved confidence for cavernous sinus involvement.
Conclusions:
- NCMRI techniques utilizing bSSFP sequences provide comparable craniopharyngioma characterization to contrast-enhanced techniques.
- NCMRI with bSSFP is a viable alternative for craniopharyngioma surveillance, potentially reducing risks associated with contrast agents.
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