Korean J Radiol.  2017 ;18(4):699-709. 10.3348/kjr.2017.18.4.699.

Efficacy of Maximum Intensity Projection of Contrast-Enhanced 3D Turbo-Spin Echo Imaging with Improved Motion-Sensitized Driven-Equilibrium Preparation in the Detection of Brain Metastases

• Bae YJ
• Choi BS
• Lee KM
• Yoon YH
• Sunwoo L
• Jung C
• Kim JH

• KMID: 2427239
• DOI: http://doi.org/10.3348/kjr.2017.18.4.699

Abstract

OBJECTIVE
To evaluate the diagnostic benefits of 5-mm maximum intensity projection of improved motion-sensitized driven-equilibrium prepared contrast-enhanced 3D T1-weighted turbo-spin echo imaging (MIP iMSDE-TSE) in the detection of brain metastases. The imaging technique was compared with 1-mm images of iMSDE-TSE (non-MIP iMSDE-TSE), 1-mm contrast-enhanced 3D T1-weighted gradient-echo imaging (non-MIP 3D-GRE), and 5-mm MIP 3D-GRE.
MATERIALS AND METHODS
From October 2014 to July 2015, 30 patients with 460 enhancing brain metastases (size > 3 mm, n = 150; size ≤ 3 mm, n = 310) were scanned with non-MIP iMSDE-TSE and non-MIP 3D-GRE. We then performed 5-mm MIP reconstruction of these images. Two independent neuroradiologists reviewed these four sequences. Their diagnostic performance was compared using the following parameters: sensitivity, reading time, and figure of merit (FOM) derived by jackknife alternative free-response receiver operating characteristic analysis. Interobserver agreement was also tested.
RESULTS
The mean FOM (all lesions, 0.984; lesions ≤ 3 mm, 0.980) and sensitivity ([reader 1: all lesions, 97.3%; lesions ≤ 3 mm, 96.2%], [reader 2: all lesions, 97.0%; lesions ≤ 3 mm, 95.8%]) of MIP iMSDE-TSE was comparable to the mean FOM (0.985, 0.977) and sensitivity ([reader 1: 96.7, 99.0%], [reader 2: 97, 95.3%]) of non-MIP iMSDE-TSE, but they were superior to those of non-MIP and MIP 3D-GREs (all, p < 0.001). The reading time of MIP iMSDE-TSE (reader 1: 47.7 ± 35.9 seconds; reader 2: 44.7 ± 23.6 seconds) was significantly shorter than that of non-MIP iMSDE-TSE (reader 1: 78.8 ± 43.7 seconds, p = 0.01; reader 2: 82.9 ± 39.9 seconds, p < 0.001). Interobserver agreement was excellent (κ> 0.75) for all lesions in both sequences.
CONCLUSION
MIP iMSDE-TSE showed high detectability of brain metastases. Its detectability was comparable to that of non-MIP iMSDE-TSE, but it was superior to the detectability of non-MIP/MIP 3D-GREs. With a shorter reading time, the false-positive results of MIP iMSDE-TSE were greater. We suggest that MIP iMSDE-TSE can provide high diagnostic performance and low false-positive rates when combined with 1-mm sequences.

Keyword

Brain; Neoplasm metastasis; Magnetic resonance imaging; 3 tesla

MeSH Terms

Adolescent
Adult
Aged
Aged, 80 and over
Area Under Curve
Brain Neoplasms/diagnosis/*diagnostic imaging
Contrast Media/chemistry
Female
Humans
Imaging, Three-Dimensional
Magnetic Resonance Imaging/*methods
Male
Middle Aged
ROC Curve
Sensitivity and Specificity
Young Adult
Contrast Media

Figure

• 

  Fig. 1 Results of JAFROC analyses.In first analysis, all lesions (A) were included, while second analysis included only small lesions ≤ 3 mm (B). In both analyses, area under AFROC1 curve (Az) was significantly greater in non-MIP and MIP iMSDE-TSE as compared to that in non-MIP and MIP iMSDE-TSE (all, p < 0.001). However, there is no significant difference in Az for non-MIP and MIP iMSDE-TSEs, and Az is also not significantly different in non-MIP and MIP 3D-GREs. AFROC1 = alternative free-response receiver operating characteristic 1, JAFROC = jackknife alternative free-response receiver operating characteristic, MIP iMSDE-TSE = maximum intensity projection of improved motion-sensitized driven-equilibrium prepared contrast-enhanced 3D T1-weighted turbo-spin echo imaging, MIP 3D-GRE = maximum intensity projection of contrast-enhanced 3D T1-weighted gradient-echo imaging, non-MIP iMSDE-TSE = 1-mm images of improved motion-sensitized driven-equilibrium prepared contrast-enhanced 3D T1-weighted turbo-spin echo imaging, non-MIP 3D-GRE = 1-mm images of contrast-enhanced 3D T1-weighted gradient-echo imaging

• 

  Fig. 2 64-year-old male with brain metastases from lung cancer.Axial image of non-MIP 3D-GRE (A), non-MIP iMSDE-TSE (B), MIP 3D-GRE (C), and MIP iMSDE-TSE (D) shows enhancing metastasis (arrows) of less than 3 mm in left posterior insula. Lesion is evidently visualized in non-MIP and MIP iMSDE-TSE. However, in non-MIP and MIP 3D-GRE, it is difficult to discriminate lesion from adjacent vessel. MIP iMSDE-TSE = maximum intensity projection of improved motion-sensitized driven-equilibrium prepared contrast-enhanced 3D T1-weighted turbo-spin echo imaging, MIP 3D-GRE = maximum intensity projection of contrast-enhanced 3D T1-weighted gradient-echo imaging, non-MIP iMSDE-TSE = 1-mm images of improved motion-sensitized driven-equilibrium prepared contrast-enhanced 3D T1-weighted turbo-spin echo imaging, non-MIP 3D-GRE = 1-mm images of contrast-enhanced 3D T1-weighted gradient-echo imaging

• 

  Fig. 3 Representative false-positive cases.A. Axial image of MIP 3D-GRE shows nodular enhancing lesion (arrow) in right cerebellum of 62-year-old man. In non-MIP 3D-GRE, enhancing vessel was confirmed (not shown). B. Axial image of MIP iMSDE-TSE shows tiny nodular enhancement (arrow) in right temporo-occipital lobe of 64-year-old woman. It was unsuppressed vascular signal. C. Axial image of MIP 3D-GRE shows focal dural enhancement in form of nodular enhancing lesion (arrow) in right frontal lobe of 60-year-old man. D. Axial image of MIP 3D-GRE probably shows two nodular enhancing lesions (arrows) in left occipital lobe of 26-year-old man. They were confirmed as artifacts in non-MIP 3D-GRE. E. In axial image of MIP iMSDE-TSE, artifactual enhancement is presented as nodular enhancing lesion (arrow) of 75-year-old female. MIP iMSDE-TSE = maximum intensity projection of improved motion-sensitized driven-equilibrium prepared contrast-enhanced 3D T1-weighted turbo-spin echo imaging, MIP 3D-GRE = maximum intensity projection of contrast-enhanced 3D T1-weighted gradient-echo imaging, non-MIP 3D-GRE = 1-mm images of contrast-enhanced 3D T1-weighted gradient-echo imaging

• 

  Fig. 4 73-year-old male with brain metastases from lung cancer.Axial image of non-MIP 3D-GRE (A), non-MIP iMSDE-TSE (B), MIP 3D-GRE (C), and MIP iMSDE-TSE (D) shows enhancing metastasis (arrows) of less than 3 mm in left occipital lobe. Lesion is clearly seen in non-MIP and MIP iMSDE-TSE, and it can be distinguished in non-MIP 3D-GRE. On other hand, lesion is masked by summation of vascular enhancement in MIP 3D-GRE. MIP iMSDE-TSE = maximum intensity projection of improved motion-sensitized driven-equilibrium prepared contrast-enhanced 3D T1-weighted turbo-spin echo imaging, MIP 3D-GRE = maximum intensity projection of contrast-enhanced 3D T1-weighted gradient-echo imaging, non-MIP iMSDE-TSE = 1-mm images of improved motion-sensitized driven-equilibrium prepared contrast-enhanced 3D T1-weighted turbo-spin echo imaging, non-MIP 3D-GRE = 1-mm images of contrast-enhanced 3D T1-weighted gradient-echo imaging

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