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Updated: Apr 14, 2026
Modeling Brain Metastases Through Intracranial Injection and Magnetic Resonance Imaging
Published on: June 7, 2020
Improving small brain metastasis detection with composite and augmented T1-weighted imaging in contrast-enhanced
Xue Liang1,2, Zhengyang Zhu1, Chuanshuai Tian1
1Department of Radiology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China.
Background:
Contrast-enhanced T1-weighted (T1W) imaging has limited sensitivity for detecting small brain metastases less than 5 mm in diameter. A recently-developed MULTI-parametric magnetic resonance imaging (MRI) with fLEXible design (MULTIPLEX) has shown promise in the detection of various neurological disorders. In the current study, we compared the performance of MULTIPLEX-derived composite T1-weighted (cT1W) and augmented T1-weighted (aT1W) imaging with that of magnetization-prepared rapid gradient-echo T1-weighted (MPRAGE-T1W) imaging for the detection of small brain metastases.
Methods:
This prospective study recruited patients with suspected intracranial metastases who underwent contrast-enhanced MRI with both MULTIPLEX and MPRAGE-T1W imaging. Two radiologists independently assessed the total number of enhanced lesions, visual image quality, and their level of diagnostic confidence. Additionally, sensitivity, the average false-negative rate, the average false- positive rate, and the mean discrepancy were evaluated for small metastases. Image quality was also assessed objectively using signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) measurements. Qualitative and quantitative imaging characteristics were compared using the Friedman test and analysis of variance, respectively. The P values were adjusted for multiple comparison correction using the Bonferroni method. A P value < 0.05 was considered statistically significant.
Results:
A total of 47 patients (55±7 years; 22 males) were included in the study, 20 of whom were diagnosed with brain metastases by two radiologists. Compared with MPRAGE-T1W imaging {2 [interquartile range (IQR), 0-5.25]}, a greater number of small metastases was detected by MULTIPLEX-derived cT1W [2.5 (IQR, 1-7.5), P=0.002] and aT1W imaging [2.5 (IQR, 1-7.5), P=0.044], with higher detection sensitivity (94.95% and 84.15% vs. 60.65%). MULTIPLEX-cT1W imaging had significantly higher SNRs in both metastatic lesions (P=0.027) and grey matter (GM; P<0.001), while MULTIPLEX-aT1W imaging selectively enhanced lesion-to-GM contrast (P<0.001) compared with MPRAGE-T1W. Despite comparable subjective image quality (P=0.22), MULTIPLEX-derived imaging yielded higher diagnostic confidence (P=0.031).
Conclusions:
MULTIPLEX-derived cT1W and aT1W imaging improved the detection of small brain metastases, with enhanced lesion conspicuity and diagnostic confidence, compared with MPRAGE-T1W imaging.
Insights
New MULTIPLEX magnetic resonance imaging (MRI) techniques, including composite T1-weighted (cT1W) and augmented T1-weighted (aT1W) imaging, significantly improve the detection of small brain metastases compared to standard MPRAGE-T1W imaging.
Area of Science:
- Radiology
- Medical Imaging
- Oncology
Background:
- Contrast-enhanced T1-weighted (T1W) imaging struggles to detect small brain metastases (<5 mm).
- MULTIPLEX (MULTI-parametric MRI with fLEXible design) is a novel MRI technique showing potential for neurological disorder detection.
Purpose of the Study:
- To compare the efficacy of MULTIPLEX-derived cT1W and aT1W imaging against MPRAGE-T1W imaging for detecting small brain metastases.
Main Methods:
- Prospective study involving patients with suspected intracranial metastases.
- Comparison of MULTIPLEX and MPRAGE-T1W contrast-enhanced MRI scans.
- Independent radiologist assessment of lesion counts, image quality, and diagnostic confidence.
- Objective image quality assessment using SNR and CNR.
Main Results:
- MULTIPLEX-derived cT1W and aT1W imaging detected significantly more small metastases than MPRAGE-T1W.
- Detection sensitivity was higher for MULTIPLEX techniques (94.95% for cT1W, 84.15% for aT1W) versus MPRAGE-T1W (60.65%).
- MULTIPLEX imaging demonstrated superior signal-to-noise ratios and contrast-to-noise ratios, leading to higher diagnostic confidence.
Conclusions:
- MULTIPLEX-derived cT1W and aT1W imaging enhance the detection of small brain metastases.
- These advanced MRI techniques improve lesion conspicuity and increase diagnostic confidence compared to conventional MPRAGE-T1W imaging.
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