J Korean Soc Radiol.  2018 Mar;78(3):179-189. 10.3348/jksr.2018.78.3.179.

Does Multiphasic Contrast Enhanced Fluid Attenuated Inversion Recovery Magnetic Resonance Imaging Enhance the Detectability of Small Intracerebral Metastases?

• Kim JH
• Yi KS
• Choi CH
• Woo ST
• Cha SH

• KMID: 2405720
• DOI: http://doi.org/10.3348/jksr.2018.78.3.179

Abstract

PURPOSE
To determine adequate timing of acquisition of contrast-enhanced fluid attenuated inversion recovery (FLAIR) by using multiphasic contrast-enhanced FLAIR magnetic resonance imaging (MRI) and to evaluate added value in detecting small intracerebral metastases 5 mm or less.
MATERIALS AND METHODS
Twenty-nine patients, that underwent multiphasic contrast-enhanced FLAIR MRI and contrast-enhanced T1 weighted image (T1WI) were included and total number of small intracerebral metastases was 131. Sensitivity, specificity and accuracy of lesion detection were evaluated. Contrast ratio (CR) and enhancement ratio of each lesion were compared and analyzed among each imaging sequence.
RESULTS
Sensitivity, specificity and accuracy of lesion detection were increased when contrast-enhanced FLAIR was added to contrast-enhanced T1WI. Area of under receiver operating characteristic curve significantly increased by addition of contrast-enhanced FLAIR than using contrast-enhanced T1WI alone (p < 0.05). CR was significantly higher in contrast-enhanced T1WI than FLAIR (p < 0.001). All of the above results were not different according to time of acquisition of contrastenhanced FLAIR.
CONCLUSION
There was advantage of conducting contrast-enhanced FLAIR MRI, but multiphasic contrast-enhanced FLAIR did not provide additional information for detection of small intracerebral metastases compared with single-phase FLAIR MRI.

MeSH Terms

Brain
Contrast Media
Humans
Image Enhancement
Magnetic Resonance Imaging*
Neoplasm Metastasis*
ROC Curve
Sensitivity and Specificity
Contrast Media

Figure

• 

  Fig. 1. 53-year-old female with brain metastases from non-small cell lung cancer. On axial image of postcontrast T1 weighted image (A), there is a suspicious enhancing nodular lesion in left frontal area confused with cortical vessels (arrow). And axial image of precontrast fluid attenuated inversion recovery (B) shows perilesional edema around the lesion (arrow). Therefore the lesion was assessed as metastasis, not a cortical vessel.

• 

  Fig. 2. 57-year-old male with brain metastases from non-small cell lung cancer. Axial image of postcontrast T1 weighted image (A) shows suspicious enhancing nodular lesion in left cerebellar hemisphere (arrow). But axial images of precontrast FLAIR (B), 1st postcontrast FLAIR (C), and 2nd postcontrast FLAIR (D) do not show abnormal enhancement at the same location. Therefore the lesion was assessed as pulsating artifact, not a metastasis. FLAIR = fluid attenuated inversion recovery

• 

  Fig. 3. 78-year-old male with brain metastases from colon cancer. Axial image of postcontrast T1 weighted image (A) shows a subtle enhancing nodule in right frontal cortex (arrow). And axial images of 1st postcontrast FLAIR (B) and 2nd postcontrast FLAIR (C) also show strong rim-enhancing nodule at the same location (arrows). Therefore the lesion was assessed as metastasis. FLAIR = fluid attenuated inversion recovery

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  Fig. 4. ROC curves for detectability of small brain metastases of three readers. The area of under ROC curve is significantly greater in T1WI + pre/ postcontrast FLAIR as compared to that in pre/postcontrast T1WI or T1WI + precontrast FLAIR. FLAIR = fluid attenuated inversion recovery, ROC = receiver operating characteristic, T1WI = T1 weighted image

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  Fig. 5. Comparison of CRs and ERs on multiphase contrast enhanced FLAIR MRI. In 3-phase MRI (A, B), CRs of small brain metastases in post-contrast T1WI are significantly lower than those in postcontrast FLAIR (p < 0.001) and ERs in pre/postcontrast T1WI are significantly greater than those in pre/postcontrast FLAIR (p < 0.001). In 2-phase MRI (C, D), the result is not different from the above. And there is no significant difference between CRs and ERs with time delays in both 2-phase and 3-phase contrast enhanced FLAIR MRI. CR = contrast ratio, ER = enhancement ratio, FLAIR = fluid attenuated inversion recovery, MRI = magnetic resonance imaging, T1WI = T1 weighted image

• 

  Fig. 6. Comparison of CRs and ERs for contrast media on 2 phase contrast enhanced FLAIR magnetic resonance imaging. When gadobutrol is used (A, B), CRs of small brain metastases in postcontrast T1WI are significantly lower than those in postcontrast FLAIR (p < 0.001) and ERs in pre/postcontrast T1WI are significantly greater than those in pre/postcontrast FLAIR (p < 0.001). When gadoteridol is used (C, D), the result is not different from the above. When gadobutrol and gadoteridol are used, there is no difference in CRs and ERs according to time delays. CR = contrast ratio, ER = enhancement ratio, FLAIR = fluid attenuated inversion recovery, T1WI = T1 weighted image

Reference

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