Contrast-enhanced modified 3D T1-weighted TSE black-blood imaging can improve detection of infectious and neoplastic meningitis
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To evaluate the diagnostic value of a contrast-enhanced 3D T1-weighted-modified volumetric isotropic turbo spin-echo acquisition sequence (T1-mVISTA) in comparison with a conventional 3D T1-weighted magnetization-prepared rapid gradient-echo (T1-MP-RAGE) sequence for the detection of meningeal enhancement in patients with meningitis.
Thirty patients (infectious meningitis, n = 12; neoplastic meningitis, n = 18) and 45 matched controls were enrolled in this retrospective case-control study. Sets of randomly selected T1-mVISTA and T1-MP-RAGE images (both with 0.8-mm isotropic resolution) were read separately 4 weeks apart. Image quality, leptomeningeal and dural enhancement, grading of visual contrast enhancement, and diagnostic confidence were compared using the Kruskal-Wallis rank sum test.
Image quality was rated to be good to excellent in 75 out of 75 cases (100%) for T1-mVISTA and 74 out of 75 cases (98.7%) for T1-MP-RAGE. T1-mVISTA detected significantly more patients with leptomeningeal enhancement (p = 0.006) compared with T1-MP-RAGE (86.7 vs. 50.0%, p < 0.001), each with specificity of 100%. Similarly, sensitivity of T1-mVISTA for the detection of dural and/or leptomeningeal enhancement was also significantly higher compared with that of T1-MP-RAGE (96.7 vs. 80.0%, p = 0.025) without significant differences regarding specificity (97.8 vs. 95.6%, p = 0.317). No significant differences were found for dural enhancement alone. Diagnostic confidence in T1-mVISTA was significantly higher (p = 0.01). Visual contrast enhancement was tendentially higher in T1-mVISTA.
T1-mVISTA may be an adequate and probably better alternative to T1-MP-RAGE for detection of leptomeningeal diseases.
• Black-blood T1-mVISTA showed a significant higher sensitivity for the detection of leptomeningeal enhancement compared with MP-RAGE without losses regarding specificity.
• Diagnostic confidence was assessed significantly higher in T1-mVISTA.
• T1-mVISTA should be considered a supplement or an alternative to T1-MP-RAGE in patients with suspected leptomeningeal diseases.
KeywordsMagnetic resonance imaging Meningeal carcinomatosis Meningitis Meninges
Fluid-attenuated inversion recovery
Magnetic resonance imaging
T1-weighted magnetization-prepared rapid gradient echo
T1-weighted-modified volumetric isotropic turbo spin-echo acquisition
T1 sampling perfection with application-optimized contrasts by using different flip angle evolutions
Turbo spin echo
The authors state that this work has not received any funding.
Compliance with ethical standards
The scientific guarantor of this publication is Nora Navina Sommer.
Conflict of interest
Dr. Hendrik Kooijman is an employee of Philips Healthcare.
For the remaining authors, no conflicts of interests were declared.
Statistics and biometry
No complex statistical methods were necessary for this paper.
Written informed consent was waived by the Institutional Review Board.
Institutional Review Board approval was obtained.
• case-control study
• performed at one institution
- 1.GBD 2017 Disease and Injury Incidence and Prevalence Collaborators (2018) Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 392:1789–1858Google Scholar
- 30.Fukuoka H, Hirai T, Okuda T et al (2010) Comparison of the added value of contrast-enhanced 3D fluid-attenuated inversion recovery and magnetization-prepared rapid acquisition of gradient echo sequences in relation to conventional postcontrast T1-weighted images for the evaluation of leptomening. AJNR Am J Neuroradiol 31:868–873CrossRefGoogle Scholar
- 34.Kato Y, Higano S, Tamura H et al (2009) 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. AJNR Am J Neuroradiol 30:923–929CrossRefGoogle Scholar
- 39.Eikendal ALM, Blomberg BA, Haaring C et al (2016) 3D black blood VISTA vessel wall cardiovascular magnetic resonance of the thoracic aorta wall in young, healthy adults: reproducibility and implications for efficacy trial sample sizes: a cross-sectional study. J Cardiovasc Magn Reson 18:20. https://doi.org/10.1186/s12968-016-0237-2 CrossRefPubMedPubMedCentralGoogle Scholar
- 40.Mittl RL Jr, Yousem DM (1994) Frequency of unexplained meningeal enhancement in the brain after lumbar puncture. AJNR Am J Neuroradiol 15:633–638Google Scholar