Journal of the Korean Society of Radiology (대한영상의학회지)

The Korean Society of Radiology (대한영상의학회)
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Does Multiphasic Contrast Enhanced Fluid Attenuated Inversion Recovery Magnetic Resonance Imaging Enhance the Detectability of Small Intracerebral Metastases?

다중시기 조영증강 액체감쇠역전회복 자기공명영상은 작은 뇌전이의 발견에 도움이 되는가?

  • Kim, Jung Hwan (Department of Radiology, Chungbuk National University Hospital) ;
  • Yi, Kyung Sik (Department of Radiology, Chungbuk National University Hospital) ;
  • Choi, Chi-Hoon (Department of Radiology, Chungbuk National University Hospital) ;
  • Woo, Seung Tae (Radiology, Bayer Healthcare Medical Care) ;
  • Cha, Sang-Hoon (Department of Radiology, Chungbuk National University Hospital)
  • 김정환 (충북대학교병원 영상의학과) ;
  • 이경식 (충북대학교병원 영상의학과) ;
  • 최치훈 (충북대학교병원 영상의학과) ;
  • 우승태 (바이엘 코리아 영상의학사업부) ;
  • 차상훈 (충북대학교병원 영상의학과)
  • Received : 2017.07.06
  • Accepted : 2017.09.07
  • Published : 2018.03.01
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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.

목적: 다중시기 조영증강 액체감쇠역전회복(fluid attenuated inversion recovery; 이하 FLAIR) 자기공명영상을 이용하여 5 mm 이하의 작은 뇌전이를 발견하는 데 가장 적절한 영상 획득 시기를 규명하고 부가적인 가치가 있는지 평가하고자 하였다. 대상과 방법: 조영증강 T1강조영상과 더불어 이중시기 혹은 삼중시기 조영증강 FLAIR영상을 시행한 환자 중 5 mm 이하의 뇌전이가 발견된 29명의 환자에게서 발견된 총 131개의 병변을 대상으로 뇌전이의 발견율, 명암비와 조영증강비를 구하여 각 영상 검사별 차이를 분석하였다. 결과: 조영증강 T1강조영상만을 단독으로 시행했을 때보다 조영증강 FLAIR영상을 추가로 시행했을 때 뇌실질 전이 발견의 민감도, 특이도, 정확도가 증가하는 경향을 보였으나 조영증강 FLAIR영상의 획득 시기별 차이는 없었다. Receiver operating characteristic 커브의 커브아래면적도 조영증강 FLAIR영상을 추가로 시행했을 때 그 값이 유의하게 증가하였다(p < 0.05). 뇌전이 병변의 명암비는 조영 후 FLAIR영상에서 유의하게 높았고(p < 0.001), 조영증강비는 조영증강 T1 강조영상에서 유의하게 높았으나(p < 0.001) 조영증강 FLAIR영상의 획득 시기별 병변의 명암비와 조영증강비에는 차이가 없었다. 결론: 조영증강 FLAIR영상은 작은 뇌전이 발견에 부가적인 가치가 있지만 다중시기 조영증강 FLAIR영상별 차이는 없었다.

Keywords

References

  1. Barnholtz-Sloan JS, Sloan AE, Davis FG, Vigneau FD, Lai P, Sawaya RE. Incidence proportions of brain metastases in patients diagnosed (1973 to 2001) in the Metropolitan Detroit Cancer Surveillance System. J Clin Oncol 2004;22:2865-2872 https://doi.org/10.1200/JCO.2004.12.149
  2. Patchell RA. The management of brain metastases. Cancer Treat Rev 2003;29:533-540 https://doi.org/10.1016/S0305-7372(03)00105-1
  3. Ranjan T, Abrey LE. Current management of metastatic brain disease. Neurotherapeutics 2009;6:598-603 https://doi.org/10.1016/j.nurt.2009.04.012
  4. Hall WA, Djalilian HR, Nussbaum ES, Cho KH. Long-term survival with metastatic cancer to the brain. Med Oncol 2000;17:279-286 https://doi.org/10.1007/BF02782192
  5. Stelzer KJ. Epidemiology and prognosis of brain metastases. Surg Neurol Int 2013;4(Suppl 4):S192-S202 https://doi.org/10.4103/2152-7806.111296
  6. Chang EL, Hassenbusch SJ 3rd, Shiu AS, Lang FF, Allen PK, Sawaya R, et al. The role of tumor size in the radiosurgical management of patients with ambiguous brain metastases. Neurosurgery 2003;53:272-280; discussion 280-281 https://doi.org/10.1227/01.NEU.0000073546.61154.9A
  7. Lin J, Jandial R, Nesbit A, Badie B, Chen M. Current and emerging treatments for brain metastases. Oncology (Williston Park) 2015;29:250-257
  8. Ahn SJ, Chung TS, Chang JH, Lee SK. The added value of double dose gadolinium enhanced 3D T2 fluid-attenuated inversion recovery for evaluating small brain metastases. Yonsei Med J 2014;55:1231-1237 https://doi.org/10.3349/ymj.2014.55.5.1231
  9. Ercan N, Gultekin S, Celik H, Tali TE, Oner YA, Erbas G. Diagnostic value of contrast-enhanced fluid-attenuated inversion recovery MR imaging of intracranial metastases. AJNR Am J Neuroradiol 2004;25:761-765
  10. Fukuoka H, Hirai T, Okuda T, Shigematsu Y, Sasao A, Kimura E, et al. Comparison of the added value of contrast-enhanced 3D fluid-attenuated inversion recovery and magnetizationprepared rapid acquisition of gradient echo sequences in relation to conventional postcontrast T1-weighted images for the evaluation of leptomeningeal diseases at 3T. AJNR Am J Neuroradiol 2010;31:868-873 https://doi.org/10.3174/ajnr.A1937
  11. Tomura N, Narita K, Takahashi S, Otani T, Sakuma I, Yasuda K, et al. Contrast-enhanced multi-shot echo-planar FLAIR in the depiction of metastatic tumors of the brain: comparison with contrast-enhanced spin-echo T1-weighted imaging. Acta Radiol 2007;48:1032-1037 https://doi.org/10.1080/02841850701499425
  12. Lee EK, Lee EJ, Kim S, Lee YS. Importance of contrast-enhanced fluid-attenuated inversion recovery magnetic resonance imaging in various intracranial pathologic conditions. Korean J Radiol 2016;17:127-141 https://doi.org/10.3348/kjr.2016.17.1.127
  13. Terae S, Yoshida D, Kudo K, Tha KK, Fujino M, Miyasaka K. Contrast-enhanced FLAIR imaging in combination with preand postcontrast magnetization transfer T1-weighted imaging: usefulness in the evaluation of brain metastases. J Magn Reson Imaging 2007;25:479-487 https://doi.org/10.1002/jmri.20847
  14. Essig M, Knopp MV, Schoenberg SO, Hawighorst H, Wenz F, Debus J, et al. Cerebral gliomas and metastases: assessment with contrast-enhanced fast fluid-attenuated inversion-recovery MR imaging. Radiology 1999;210:551-557 https://doi.org/10.1148/radiology.210.2.r99ja22551
  15. Mathews VP, Caldemeyer KS, Lowe MJ, Greenspan SL, Weber DM, Ulmer JL. Brain: gadolinium-enhanced fast fluid-attenuated inversion-recovery MR imaging. Radiology 1999;211:257-263 https://doi.org/10.1148/radiology.211.1.r99mr25257
  16. Mathews VP, Caldemeyer KS, Ulmer JL, Nguyen H, Yuh WT. Effects of contrast dose, delayed imaging, and magnetization transfer saturation on gadolinium-enhanced MR imaging of brain lesions. J Magn Reson Imaging 1997;7:14-22 https://doi.org/10.1002/jmri.1880070104
  17. Melhem ER, Bert RJ, Walker RE. Usefulness of optimized gadolinium-enhanced fast fluid-attenuated inversion recovery MR imaging in revealing lesions of the brain. AJR Am J Roentgenol 1998;171:803-807 https://doi.org/10.2214/ajr.171.3.9725320
  18. Yuh WT, Tali ET, Nguyen HD, Simonson TM, Mayr NA, Fisher DJ. The effect of contrast dose, imaging time, and lesion size in the MR detection of intracerebral metastasis. AJNR Am J Neuroradiol 1995;16:373-380
  19. Jeon JY, Choi JW, Roh HG, Moon WJ. Effect of imaging time in the magnetic resonance detection of intracerebral metastases using single dose gadobutrol. Korean J Radiol 2014;15:145-150 https://doi.org/10.3348/kjr.2014.15.1.145
  20. Cohen-Inbar O, Xu Z, Dodson B, Rizvi T, Durst CR, Mukherjee S, et al. Time-delayed contrast-enhanced MRI improves detection of brain metastases: a prospective validation of diagnostic yield. J Neurooncol 2016;130:485-494 https://doi.org/10.1007/s11060-016-2242-6
  21. Kushnirsky M, Nguyen V, Katz JS, Steinklein J, Rosen L, Warshall C, et al. Time-delayed contrast-enhanced MRI improves detection of brain metastases and apparent treatment volumes. J Neurosurg 2016;124:489-495 https://doi.org/10.3171/2015.2.JNS141993
  22. Kremer S, Abu Eid M, Bierry G, Bogorin A, Koob M, Dietemann JL, et al. Accuracy of delayed post-contrast FLAIR MR imaging for the diagnosis of leptomeningeal infectious or tumoral diseases. J Neuroradiol 2006;33:285-291 https://doi.org/10.1016/S0150-9861(06)77286-8
  23. Hirota T, Ishihara K, Akazawa K, Kubota T, Yamada K, Nishimura T. Case report: delayed post-contrast fluid-attenuated inversion recovery image for depicting meningeal carcinomatosis. Br J Radiol 2004;77:528-531 https://doi.org/10.1259/bjr/51430802
  24. Kazi AZ, Joshi PC, Kelkar AB, Mahajan MS, Ghawate AS. MRI evaluation of pathologies affecting the corpus callosum: a pictorial essay. Indian J Radiol Imaging 2013;23:321-332 https://doi.org/10.4103/0971-3026.125604
  25. Yoshida A, Tha KK, Fujima N, Zaitsu Y, Yoshida D, Tsukahara A, et al. Detection of brain metastases by 3-dimensional magnetic resonance imaging at 3 T: comparison between T1-weighted volume isotropic turbo spin echo acquisition and 3-dimensional T1-weighted fluid-attenuated inversion recovery imaging. J Comput Assist Tomogr 2013;37:84-90 https://doi.org/10.1097/RCT.0b013e318271f216
  26. Kato Y, Higano S, Tamura H, Mugikura S, Umetsu A, Murata T, et al. Usefulness of contrast-enhanced T1-weighted sampling perfection with application-optimized contrasts by using different flip angle evolutions in detection of small brain metastasis at 3T MR imaging: comparison with magnetization-prepared rapid acquisition of gradient echo imaging. AJNR Am J Neuroradiol 2009;30:923-929 https://doi.org/10.3174/ajnr.A1506