Detection of Leptomeningeal Metastasis by Contrast-Enhanced 3D T1-SPACE: Comparison with 2D FLAIR and Contrast-Enhanced 2D T1-Weighted Images

Abstract

IntroductionTo compare the diagnostic accuracy of contrast-enhanced 3D(dimensional) T1-weighted sampling perfection with application-optimized contrasts by using different flip angle evolutions (T1-SPACE), 2D fluid attenuated inversion recovery (FLAIR) images and 2D contrast-enhanced T1-weighted image in detection of leptomeningeal metastasis except for invasive procedures such as a CSF tapping.Materials and MethodsThree groups of patients were included retrospectively for 9 months (from 2013-04-01 to 2013-12-31). Group 1 patients with positive malignant cells in CSF cytology (n = 22); group 2, stroke patients with steno-occlusion in ICA or MCA (n = 16); and group 3, patients with negative results on MRI, whose symptom were dizziness or headache (n = 25). A total of 63 sets of MR images are separately collected and randomly arranged: (1) CE 3D T1-SPACE; (2) 2D FLAIR; and (3) CE T1-GRE using a 3-Tesla MR system. A faculty neuroradiologist with 8-year-experience and another 2nd grade trainee in radiology reviewed each MR image- blinded by the results of CSF cytology and coded their observations as positives or negatives of leptomeningeal metastasis. The CSF cytology result was considered as a gold standard. Sensitivity and specificity of each MR images were calculated. Diagnostic accuracy was compared using a McNemar’s test. A Cohen's kappa analysis was performed to assess inter-observer agreements.ResultsDiagnostic accuracy was not different between 3D T1-SPACE and CSF cytology by both raters. However, the accuracy test of 2D FLAIR and 2D contrast-enhanced T1-weighted GRE was inconsistent by the two raters. The Kappa statistic results were 0.657 (3D T1-SPACE), 0.420 (2D FLAIR), and 0.160 (2D contrast-enhanced T1-weighted GRE). The 3D T1-SPACE images showed the highest inter-observer agreements between the raters.ConclusionsCompared to 2D FLAIR and 2D contrast-enhanced T1-weighted GRE, contrast-enhanced 3D T1 SPACE showed a better detection rate of leptomeningeal metastasis.

Application of 3D Fast Spin-Echo T1 Black-Blood Imaging in the Diagnosis and Prognostic Prediction of Patients with Leptomeningeal Carcinomatosis

“…11,25 In addition, a recent study comparing 2D-FLAIR, 2D-CE T1-weighted GRE, and black-blood imaging in the diagnosis of LC demonstrated that black-blood imaging showed a better detection rate of LC, regardless of the degree of the rater's experience. 26 Our study results were in good agreement with previous clinical studies, but our study differs from the previously published studies in some respects. First, we used clear inclusion criteria for those with LC and healthy patients.…”

Brain metastases: neuroimaging

“…For instance, postcontrast FLAIR images may improve the detection of leptomeningeal metastases (Singh et al, 2000; Ercan et al, 2004; Hatzoglou et al, 2016). But in most cases volumetric contrast-enhanced sequences provide better sensitivity for leptomeningeal disease than two-dimensional T1-weighted or FLAIR images (Gil et al, 2016). …”

Lateral Ventrikül Görünür Difüzyon Katsayısı Leptomeningeal Karsinomatozis Tanısında Yararlı Olabilir mi?

“…The examination of CSF has critical value for the diagnosis of LMC (12). When cytologic analysis does not reveal LMC, LMC can be noninvasively diagnosed by neuroimaging alone in the appropriate clinical setting (4,6). The MR abnormalities included pial-arachnoid metastatic disease, metastatic disease coating the nerves, hydrocephalus, subependymal metastasis.…”

“…In addition, as an invasive examination, CSF cytology is not proposed as a common examination (3,5). When cytologic analysis does not reveal LMC, LMC can be diagnosed by contrastenhanced (CE) magnetic resonance (MR) imaging alone (4,6). Leptomeningeal enhancement appears as a streakly pattern on MRI.…”