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Modeling Brain Metastases Through Intracranial Injection and Magnetic Resonance Imaging
Published on: June 7, 2020
Non-Contrast MR T2-Weighted Imaging Is as Accurate as Contrast-Enhanced T1-Weighted Imaging in the Detection of
Bianca M Dijkstra1, Guillaume A Padmos2, Martijn P G Broen3
1Department of Neurosurgery, Maastricht University Medical Center, 6229 HX Maastricht, The Netherlands.
Abstract:
Background/Objectives: Asymptomatic meningiomas require frequent follow-up using MR imaging, with the standard of care being contrast-enhanced T1-weighted imaging (CE-T1WI) with Gadolinium-Based Contrast Agents (GBCAs). Limiting GBCA exposure reduces the environmental impact and limits possible gadolinium deposition in the brain. Therefore, the research objective was investigating the diagnostic accuracy of T2WI for evaluating significant meningioma growth (≥10% per year), using the CE-T1WI as reference standard. Methods: A total of 99 asymptomatic patients with the radiological diagnosis of meningioma and a minimum follow-up period of 11 months were retrospectively identified. Patients were scanned with various scanners in multiple hospitals. The maximum tumor diameter was measured in the transverse plane. Tumor growth was calculated in changes in millimeters and converted to percentages in the longest tumor diameter in the transverse plane. A paired-sample t-test was used to compare tumor growth on T2WI to CE-T1WI. The diagnostic accuracy of T2WI was determined by calculation of sensitivity, specificity, and positive and negative predictive values. Results: Mean follow-up time was 1.9 years. Significant tumor growth was found in 16 patients using T2WI, compared to 10 patients using CE-T1WI, which was not statistically significant. T2WI had a sensitivity of 80%, specificity of 90%, a positive predictive value of 47%, and negative predictive value of 98% for prediction of significant meningioma growth. Conclusions: T2WI was not inferior to CE-T1WI in the detection of significant tumor growth in asymptomatic meningioma and therefore can be used in follow-up to reduce gadolinium exposure.
Insights
T2-weighted imaging (T2WI) can effectively monitor asymptomatic meningioma growth, matching contrast-enhanced T1-weighted imaging (CE-T1WI) performance. This allows for reduced gadolinium-based contrast agent exposure during follow-up MRI scans.
Area of Science:
- Neurology
- Radiology
- Oncology
Background:
- Asymptomatic meningiomas necessitate regular MRI follow-up, typically using contrast-enhanced T1-weighted imaging (CE-T1WI) with Gadolinium-Based Contrast Agents (GBCAs).
- Reducing GBCA administration is desirable to minimize environmental impact and potential gadolinium deposition in the brain.
- Investigating alternative imaging techniques for meningioma surveillance is crucial.
Purpose of the Study:
- To assess the diagnostic accuracy of T2-weighted imaging (T2WI) in detecting significant meningioma growth (≥10% per year).
- To compare the efficacy of T2WI against the reference standard of CE-T1WI for monitoring tumor progression.
- To evaluate T2WI as a potential method to reduce GBCA exposure in meningioma follow-up.
Main Methods:
- Retrospective analysis of 99 asymptomatic meningioma patients with a minimum 11-month follow-up.
- Tumor growth calculated based on the maximum diameter change in the transverse plane.
- Paired-sample t-test used to compare growth measurements between T2WI and CE-T1WI; diagnostic accuracy metrics (sensitivity, specificity, PPV, NPV) calculated for T2WI.
Main Results:
- Mean follow-up duration was 1.9 years.
- Significant tumor growth was identified in 16 patients via T2WI and 10 patients via CE-T1WI (not statistically significant difference).
- T2WI demonstrated 80% sensitivity, 90% specificity, 47% positive predictive value, and 98% negative predictive value for significant growth.
Conclusions:
- T2WI is non-inferior to CE-T1WI for detecting significant tumor growth in asymptomatic meningiomas.
- T2WI can be utilized as a viable alternative in follow-up protocols.
- Adoption of T2WI can lead to reduced exposure to gadolinium-based contrast agents.
