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Diagnostic Confidence of Contrast-Enhanced T1-Weighted MRI for the Detection of Brain Metastases: 3D FSE versus 3D
Maria Gule-Monroe1, Nathan Chasen1, James P Long2
1From the Department of Neuroradiology (M.G.-M., N.C., V.A.K., K.S., M.C., M.W.), The University of Texas MD Anderson Cancer Center, Houston, Texas.
Background And Purpose:
This retrospective study evaluated the utility of contrast-enhanced T1-weighted 3D fast spin-echo-based sampling perfection with application-optimized contrasts by using different flip angle evolutions (SPACE) sequences for brain metastasis detection on 3T MRI compared with a gradient-recalled echo-based 3D FLASH sequence.
Materials And Methods:
We identified all patients at a single institution who underwent SPACE and 3D FLASH sequences as part of a practice quality-improvement project. Their medical records were retrospectively reviewed. Five certified neuroradiologists reviewed the images, with at least 2 weeks' separation between scoring sequences for the same patient. We evaluated the following parameters: number of metastatic lesions, number of indeterminate lesions, lesion margin, contrast-to-noise ratio (CNR), extent of image artifacts, and overall image quality. The CNR was also quantified for solidly enhancing lesions of >1 cm.
Results:
We identified 220 patients who underwent SPACE and 3D FLASH sequences (the order of the sequences was equally distributed). Of these, 79 had brain metastases on imaging, and 7 were excluded; thus, 72 patients were included in the study. Twenty patients were scored by 2 radiologists. Of the 92 evaluations, SPACE detected more lesions than 3D FLASH in 35, while 3D FLASH detected more lesions in 10. More indeterminate lesions were seen on 3D FLASH (n = 27) than on SPACE (n = 9). For the lesion margin, CNR, and overall image quality on a Likert scale, SPACE performed significantly better than 3D FLASH, with fewer image artifacts (P < .00001). Higher quantitative CNRs were found on SPACE than on 3D FLASH images, though this result was not statistically significant (median = 22.9 versus 15.5, respectively, P = .134). There was a high interreader lesion detection concordance with the Krippendorf α ordinals at 0.962 for SPACE, 0.870 for 3D FLASH, and 0.918 for the 2 sequences combined.
Conclusions:
Compared with 3D FLASH, the SPACE sequence detected more metastatic lesions and was rated higher for image quality, lesion margin, and CNR, with fewer artifacts. Importantly, the SPACE sequence resulted in increased reader confidence, with fewer indeterminate lesions detected.
Insights
The Sampling Perfection with Application-Optimized Contrasts by using different flip angle evolutions (SPACE) sequence detects more brain metastases and offers superior image quality compared to the 3D FLASH sequence. This leads to increased radiologist confidence in diagnosing brain lesions.
Area of Science:
- Radiology
- Neuroimaging
- Oncology
Background:
- Brain metastases detection is crucial for patient management.
- 3T MRI is a standard imaging modality.
- Optimizing MRI sequences can improve diagnostic accuracy.
Purpose of the Study:
- To compare the utility of 3D fast spin-echo SPACE sequences with 3D FLASH sequences for detecting brain metastases on 3T MRI.
- To evaluate image quality, lesion detection, and artifact levels between the two sequences.
Main Methods:
- Retrospective review of 72 patients who underwent both SPACE and 3D FLASH sequences at 3T MRI.
- Five neuroradiologists assessed lesion number, margin, artifacts, and image quality.
- Quantitative contrast-to-noise ratio (CNR) was measured for lesions >1 cm.
Main Results:
- SPACE detected significantly more metastatic lesions and fewer indeterminate lesions than 3D FLASH.
- SPACE demonstrated superior lesion margin, CNR, and overall image quality with fewer artifacts (P < .00001).
- High interreader concordance was observed for SPACE (0.962).
Conclusions:
- The SPACE sequence is more effective than 3D FLASH for detecting brain metastases on 3T MRI.
- SPACE offers improved image quality and reduced artifacts, enhancing diagnostic confidence.
- SPACE is a valuable tool for improving the detection of brain metastases.
