Contrast-enhanced modified 3D T1-weighted TSE black-blood imaging can improve detection of infectious and neoplastic meningitis

  • Nora Navina SommerEmail author
  • Romina Pons Lucas
  • Eva Coppenrath
  • Hendrik Kooijman
  • Franziska Galiè
  • Nina Hesse
  • Wieland H. Sommer
  • Karla M. Treitl
  • Tobias Saam
  • Matthias F. Froelich



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.

Key Points

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.


Magnetic resonance imaging Meningeal carcinomatosis Meningitis Meninges 







Contrast-to-noise ratio


Cerebrospinal fluid


Fluid-attenuated inversion recovery


Gradient echo


Magnetic resonance imaging


Spin echo


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


Funding information

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.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.


• retrospective

• case-control study

• performed at one institution

Supplementary material

330_2019_6475_MOESM1_ESM.docx (27 kb)
ESM 1 (DOCX 26 kb)


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Copyright information

© European Society of Radiology 2019

Authors and Affiliations

  • Nora Navina Sommer
    • 1
    Email author
  • Romina Pons Lucas
    • 1
  • Eva Coppenrath
    • 1
  • Hendrik Kooijman
    • 2
  • Franziska Galiè
    • 1
  • Nina Hesse
    • 1
  • Wieland H. Sommer
    • 1
  • Karla M. Treitl
    • 1
    • 3
  • Tobias Saam
    • 4
  • Matthias F. Froelich
    • 5
  1. 1.Department of RadiologyLudwig-Maximilians-University HospitalMunichGermany
  2. 2.Philips HealthcareHamburgGermany
  3. 3.German Center for Cardiovascular Disease Research (DZHK e. V.)MunichGermany
  4. 4.Radiologisches Zentrum RosenheimRosenheimGermany
  5. 5.Institute of Clinical Radiology and Nuclear MedicineUniversity Medical Center MannheimMannheimGermany

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