Investig Magn Reson Imaging.  2022 Mar;26(1):32-42. 10.13104/imri.2022.26.1.32.

Benefit of Using Early ContrastEnhanced 2D T2-Weighted Fluid-Attenuated Inversion Recovery Image to Detect Leptomeningeal Metastasis in Lung-Cancer Staging

• Kim HJ
• Lee J
• Lee AL
• Lee JW
• Kim CK
• Kim JY
• Park ST
• Chang KH

• KMID: 2533869
• DOI: http://doi.org/10.13104/imri.2022.26.1.32

Abstract

Purpose
To evaluate the clinical benefit of 2D contrast-enhanced T2 fluidattenuated inversion recovery (CE-T2 FLAIR) image for detecting leptomeningeal metastasis (LM) in the brain metastasis work-up for lung cancer.
Materials and Methods
From June 2017 to July 2019, we collected all consecutive patients with lung cancer who underwent brain magnetic resonance image (MRI), including contrast-enhanced 3D fast spin echo T1 black-blood image (CE-T1WI) and CE-T2 FLAIR; we recruited clinico-radiologically suspected LM cases. Two independent readers analyzed the images for LM in three sessions: CE-T1WI, CE-T2 FLAIR, and their combination.
Results
We recruited 526 patients with suspected lung cancer who underwent brain MRI; of these, we excluded 77 (insufficient image protocol, unclear pathology, different contrast media, poor image quality). Of the 449 patients, 34 were clinicoradiologically suspected to have LM; among them, 23 were diagnosed with true LM. The calculated detection performance of CE-T1WI, CE-T2 FLAIR, and combined analysis obtained from the 34 suspected LM were highest in the combined analysis (AUC: 0.80, 0.82, and 0.89, respectively). The inter-observer agreement was also the highest in the combined analysis (0.68, 0.72, and 0.86, respectively). In quantitative analyses, CNR of CE-T2 FLAIR was significantly higher than that of CE-T1WI (Wilcoxon signed rank test, P < 0.05).
Conclusion
Adding CE-T2 FLAIR might provide better detection for LM in the brainmetastasis screening for lung cancer.

Keyword

Meningeal carcinomatosis; Lung neoplasms; Magnetic resonance imaging; Contrast media; Diagnosis