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Estler A, Hauser TK, Mengel A, Brunnée M, Zerweck L, Richter V, Zuena M, Schuhholz M, Ernemann U, Gohla G. Deep Learning Accelerated Image Reconstruction of Fluid-Attenuated Inversion Recovery Sequence in Brain Imaging: Reduction of Acquisition Time and Improvement of Image Quality. Acad Radiol 2024; 31:180-186. [PMID: 37280126 DOI: 10.1016/j.acra.2023.05.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/08/2023] [Accepted: 05/08/2023] [Indexed: 06/08/2023]
Abstract
RATIONALE AND OBJECTIVES Fluid-attenuated inversion recovery (FLAIR) imaging is playing an increasingly significant role in the detection of brain metastases with a concomitant increase in the number of magnetic resonance imaging (MRI) examinations. Therefore, the purpose of this study was to investigate the impact on image quality and diagnostic confidence of an innovative deep learning-based accelerated FLAIR (FLAIRDLR) sequence of the brain compared to conventional (standard) FLAIR (FLAIRS) imaging. MATERIALS AND METHODS Seventy consecutive patients with staging cerebral MRIs were retrospectively enrolled in this single-center study. The FLAIRDLR was conducted using the same MRI acquisition parameters as the FLAIRS sequence, except for a higher acceleration factor for parallel imaging (from 2 to 4), which resulted in a shorter acquisition time of 1:39 minute instead of 2:40 minutes (-38%). Two specialized neuroradiologists evaluated the imaging datasets using a Likert scale that ranged from 1 to 4, with 4 indicating the best score for the following parameters: sharpness, lesion demarcation, artifacts, overall image quality, and diagnostic confidence. Additionally, the image preference of the readers and the interreader agreement were assessed. RESULTS The average age of the patients was 63 ± 11years. FLAIRDLR exhibited significantly less image noise than FLAIRS, with P-values of< .001 and< .05, respectively. The sharpness of the images and the ability to detect lesions were rated higher in FLAIRDLR, with a median score of 4 compared to a median score of 3 in FLAIRS (P-values of<.001 for both readers). In terms of overall image quality, FLAIRDLR was rated superior to FLAIRS, with a median score of 4 vs 3 (P-values of<.001 for both readers). Both readers preferred FLAIRDLR in 68/70 cases. CONCLUSION The feasibility of deep learning FLAIR brain imaging was shown with additional 38% reduction in examination time compared to standard FLAIR imaging. Furthermore, this technique has shown improvement in image quality, noise reduction, and lesion demarcation.
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Affiliation(s)
- Arne Estler
- Diagnostic and Interventional Neuroradiology, Department of Radiology, University Hospital Tuebingen, Hoppe-Seyler-Str. 3, 72076 Tübingen, Baden-Württemberg, Germany (A.E., T.-K.H., L.Z., V.R., M.Z., U.E., G.G.).
| | - Till-Karsten Hauser
- Diagnostic and Interventional Neuroradiology, Department of Radiology, University Hospital Tuebingen, Hoppe-Seyler-Str. 3, 72076 Tübingen, Baden-Württemberg, Germany (A.E., T.-K.H., L.Z., V.R., M.Z., U.E., G.G.)
| | - Annerose Mengel
- Department of Neurology & Stroke, Eberhard-Karls University of Tübingen, Tuebingen, Germany (A.M.)
| | - Merle Brunnée
- Department of Neuroradiology, Neurological University Clinic, Heidelberg University Hospital, Heidelberg, Germany (M.B.)
| | - Leonie Zerweck
- Diagnostic and Interventional Neuroradiology, Department of Radiology, University Hospital Tuebingen, Hoppe-Seyler-Str. 3, 72076 Tübingen, Baden-Württemberg, Germany (A.E., T.-K.H., L.Z., V.R., M.Z., U.E., G.G.)
| | - Vivien Richter
- Diagnostic and Interventional Neuroradiology, Department of Radiology, University Hospital Tuebingen, Hoppe-Seyler-Str. 3, 72076 Tübingen, Baden-Württemberg, Germany (A.E., T.-K.H., L.Z., V.R., M.Z., U.E., G.G.)
| | - Mario Zuena
- Diagnostic and Interventional Neuroradiology, Department of Radiology, University Hospital Tuebingen, Hoppe-Seyler-Str. 3, 72076 Tübingen, Baden-Württemberg, Germany (A.E., T.-K.H., L.Z., V.R., M.Z., U.E., G.G.)
| | - Martin Schuhholz
- Faculty of Medicine, University of Tuebingen, Tübingen, Germany (M.S.)
| | - Ulrike Ernemann
- Diagnostic and Interventional Neuroradiology, Department of Radiology, University Hospital Tuebingen, Hoppe-Seyler-Str. 3, 72076 Tübingen, Baden-Württemberg, Germany (A.E., T.-K.H., L.Z., V.R., M.Z., U.E., G.G.)
| | - Georg Gohla
- Diagnostic and Interventional Neuroradiology, Department of Radiology, University Hospital Tuebingen, Hoppe-Seyler-Str. 3, 72076 Tübingen, Baden-Württemberg, Germany (A.E., T.-K.H., L.Z., V.R., M.Z., U.E., G.G.)
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Jaju A, Li Y, Dahmoush H, Gottardo NG, Laughlin S, Mirsky D, Panigrahy A, Sabin ND, Shaw D, Storm PB, Poussaint TY, Patay Z, Bhatia A. Imaging of pediatric brain tumors: A COG Diagnostic Imaging Committee/SPR Oncology Committee/ASPNR White Paper. Pediatr Blood Cancer 2023; 70 Suppl 4:e30147. [PMID: 36519599 PMCID: PMC10466217 DOI: 10.1002/pbc.30147] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 11/23/2022] [Indexed: 12/16/2022]
Abstract
Tumors of the central nervous system are the most common solid malignancies in children and the most common cause of pediatric cancer-related mortality. Imaging plays a central role in diagnosis, staging, treatment planning, and response assessment of pediatric brain tumors. However, the substantial variability in brain tumor imaging protocols across institutions leads to variability in patient risk stratification and treatment decisions, and complicates comparisons of clinical trial results. This White Paper provides consensus-based imaging recommendations for evaluating pediatric patients with primary brain tumors. The proposed brain magnetic resonance imaging protocol recommendations balance advancements in imaging techniques with the practicality of deployment across most imaging centers.
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Affiliation(s)
- Alok Jaju
- Department of Medical Imaging, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Yi Li
- UCSF Department of Radiology and Biomedical Imaging, San Francisco, California, USA
| | - Hisham Dahmoush
- Department of Radiology, Lucile Packard Children's Hospital at Stanford, Palo Alto, California, USA
| | - Nicholas G Gottardo
- Department of Paediatric and Adolescent Oncology and Haematology, Perth Children's Hospital, Brain Tumour Research Programme, Telethon Kids Institute, Perth, Western Australia, Australia
| | - Suzanne Laughlin
- Department of Diagnostic Imaging, The Hospital for Sick Children and Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - David Mirsky
- Department of Radiology, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Ashok Panigrahy
- Department of Radiology, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Noah D Sabin
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Dennis Shaw
- Department of Radiology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Phillip B Storm
- Division of Neurosurgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Tina Young Poussaint
- Department of Radiology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Zoltan Patay
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Aashim Bhatia
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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Added value of delayed post-contrast FLAIR in diagnosis of metastatic brain lesions. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2022. [DOI: 10.1186/s43055-022-00844-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
One of the drawbacks in contrast-enhanced T1-weighted imaging (CE-T1WI) is the enhancing cortical vessels which can be confused with meningeal enhancement. Previous studies reported that post-contrast FLAIR could be better for diagnosing the superficial brain abnormalities. So the purpose of this study was to evaluate the role of delayed post-contrast FLAIR, in comparison with post-contrast T1, in the detection and evaluation of brain metastases.
Results
The study was conducted on 40 patients with suspected/known brain metastases scanned in order to detect and evaluate brain metastases. All patients were subjected to the following: full history taking, review of clinical examination reports, and other imaging modalities whenever available, followed by brain MRI examination using 1.5 T closed magnet including pre-contrast series, axial and sagittal T1-weighted spin echo (SE), axial and coronal T2-weighted turbo spin echo (TSE) and axial FLAIR, while post-contrast series included axial, coronal and sagittal T1-weighted spin echo (SE) and lastly DPC-FLAIR sequence 10 min after contrast administration. This study included 18 males and 22 females, ranging in age from 26 to 75 years. Six out of a total of 40 patients had brain metastases of unknown origin, while 34 of them were presented with different types of known primary tumors. The detected lesions were subdivided into five groups according to their detectability by DPC-FLAIR and contrast-enhanced T1WI: Group (I): lesions detected only by DPC-FLAIR: 16 lesions; Group (II): lesions detected only by CE-T1WI: 1 lesion; Group (III): lesions detected by both DPC-FLAIR and CE-T1WI with equal conspicuity by both: 28 lesions; Group (IV): lesions detected by both, showing more obvious enhancement with DPC-FLAIR: 43 lesions; and Group (V): lesions detected by both, showing more obvious enhancement with CE-T1WI: 11 lesions. DPC-FLAIR had a sensitivity of 98.98% and a specificity of 100% for the detection of metastatic brain lesions and for CE-T1WI; sensitivity of 83.83%; and a specificity of 50%.
Conclusions
Delayed post-contrast FLAIR is a reliable sequence for the detection of metastatic brain lesions as it can detect more metastatic brain lesions compared to contrast-enhanced T1WI.
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Jin T, Ge M, Huang R, Yang Y, Liu T, Zhan Q, Yao Z, Zhang H. Utility of Contrast-Enhanced T2 FLAIR for Imaging Brain Metastases Using a Half-dose High-Relaxivity Contrast Agent. AJNR Am J Neuroradiol 2021; 42:457-463. [PMID: 33361381 DOI: 10.3174/ajnr.a6931] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 10/04/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Efficient detection of metastases is important for patient' treatment. This prospective study was to explore the clinical value of contrast-enhanced T2 FLAIR in imaging brain metastases using half-dose gadobenate dimeglumine. MATERIALS AND METHODS In vitro signal intensity of various gadolinium concentrations was explored by spin-echo T1-weighted imaging and T2 FLAIR. Then, 46 patients with lung cancer underwent nonenhanced T2 FLAIR before administration of half-dose gadobenate dimeglumine and 3 consecutive contrast-enhanced T2 FLAIR sequences followed by 1 spin-echo T1WI after administration of half-dose gadobenate dimeglumine. After an additional dose of 0.05 mmol/kg, 3D brain volume imaging was performed. All brain metastases were classified as follows: solid-enhancing, ≥ 5 mm (group A); ring-enhancing, ≥ 5 mm (group B); and lesion diameter of <5 mm (group C). The contrast ratio of the lesions on 3 consecutive phases of contrast-enhanced T2 FLAIR was measured, and the percentage increase of contrast-enhanced T2 FLAIR among the 3 groups was compared. RESULTS In vitro, the maximal signal intensity was achieved in T2 FLAIR at one-eighth to one-half of the contrast concentration needed for maximal signal intensity in T1WI. In vivo, the mean contrast ratio values of metastases on contrast-enhanced T2 FLAIR for the 3 consecutive phases ranged from 63.64% to 83.05%. The percentage increase (PI) values of contrast-enhanced T2 FLAIR were as follows: PIA < PIB (P = .001) and PIA < PIC (P < .001). The degree of enhancement of brain metastases on contrast-enhanced T2 FLAIR was lower than on 3D brain volume imaging (P < .001) in group A, and higher than on 3D brain volume imaging (P < .001) in group C. CONCLUSIONS Small or ring-enhancing metastases can be better visualized on delayed contrast-enhanced T2 FLAIR using a half-dose high-relaxivity contrast agent.
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Affiliation(s)
- T Jin
- From the Department of Radiology (T.J.), Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - M Ge
- Department of Oncology (M.G., R.H., T.L., Q.Z.)
| | - R Huang
- Department of Oncology (M.G., R.H., T.L., Q.Z.)
| | - Y Yang
- Department of Oncology (Y.Y.), Huashan North Hospital, Fudan University, Shanghai, China
| | - T Liu
- Department of Oncology (M.G., R.H., T.L., Q.Z.)
| | - Q Zhan
- Department of Oncology (M.G., R.H., T.L., Q.Z.)
| | - Z Yao
- Radiology (Z.Y.), Huashan Hospital, Fudan University, Shanghai, China
| | - H Zhang
- Department of Radiology (H.Z.), The Affiliated Hospital of Qingdao University, Qingdao, China
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Optimization of Contrast Agent Dosage on Contrast-Enhanced T2 Fluid-Attenuated Inversion Recovery: An In Vitro and In Vivo Study. J Comput Assist Tomogr 2021; 45:121-127. [PMID: 32976269 DOI: 10.1097/rct.0000000000001055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aimed to ascertain the minimum gadolinium dosage on contrast-enhanced (CE) T2 fluid-attenuated inversion recovery (FLAIR) at appropriate imaging time. METHODS Different dosages of gadodiamide were imaged with a 3.0-T magnetic resonance scanner for T2-FLAIR and T1WI. Twenty glioma-induced rat models were randomly assigned into 4 groups (1/2, 1/4, 1/6, 1/8 of routine dosage) and imaged for T2-FLAIR and T1WI preinjection and postinjection of gadodiamide. Contrast-enhanced T2-FLAIR was acquired for 8 repetitions postinjection. Enhancement effects were assessed by calculating contrast-noise ratio and contrast ratio using Kruskal-Wallis and Mann-Whitney rank sum test. RESULTS The in vitro experiment showed that gadodiamide at 1/4 of the T1WI dosage presented the best contrast on CE-T2-FLAIR. For in vivo study, the best enhancement effect on CE-T2-FLAIR was achieved at 1/2 of the routine dosage at 8 to 12 minutes of delayed scanning. Compared with CE-T1WI at routine dosage, CE-T2-FLAIR at 1/2 gadodiamide dosage presented similar enhancement effects with no statistical difference (P = 0.244 and 0.090 for contrast-noise ratio and contrast ratio, respectively). CONCLUSIONS Contrast-enhanced T2-FLAIR imaging with half of T1WI routine gadodiamide dosage can produce similar enhancement effects to CE-T1WI when characterizing brain gliomas. The cut-down of contrast agent dosage may help reduce gadolinium accumulation in certain tissues.
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Hendriks LEL, Subramaniam DS, Dingemans AMC. Editorial: Central Nervous System Metastases in Lung Cancer Patients: From Prevention to Diagnosis and Treatment. Front Oncol 2018; 8:511. [PMID: 30460200 PMCID: PMC6232302 DOI: 10.3389/fonc.2018.00511] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Accepted: 10/19/2018] [Indexed: 12/27/2022] Open
Affiliation(s)
- Lizza E L Hendriks
- Department of Pulmonary Diseases, GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, Netherlands
| | - Deepa S Subramaniam
- Division of Hematology-Oncology, Georgetown University, Washington, DC, United States
| | - Anne-Marie C Dingemans
- Department of Pulmonary Diseases, GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, Netherlands
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Park YW, Ahn SJ. Comparison of Contrast-Enhanced T2 FLAIR and 3D T1 Black-Blood Fast Spin-Echo for Detection of Leptomeningeal Metastases. ACTA ACUST UNITED AC 2018. [DOI: 10.13104/imri.2018.22.2.86] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Yae Won Park
- Department of Radiology, Ewha Womans University College of Medicine, Seoul, Korea
| | - Sung Jun Ahn
- Department of Radiology, Yonsei University, College of Medicine, Seoul, Korea
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Screening for Brain Metastases in Resectable Non-Small Cell Lung Cancer. J Thorac Oncol 2017; 12:e21. [PMID: 28215722 DOI: 10.1016/j.jtho.2016.11.2220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 11/15/2016] [Indexed: 11/23/2022]
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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; 17:127-41. [PMID: 26798225 PMCID: PMC4720800 DOI: 10.3348/kjr.2016.17.1.127] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Accepted: 10/29/2015] [Indexed: 11/30/2022] Open
Abstract
Intracranial lesions may show contrast enhancement through various mechanisms that are closely associated with the disease process. The preferred magnetic resonance sequence in contrast imaging is T1-weighted imaging (T1WI) at most institutions. However, lesion enhancement is occasionally inconspicuous on T1WI. Although fluid-attenuated inversion recovery (FLAIR) sequences are commonly considered as T2-weighted imaging with dark cerebrospinal fluid, they also show mild T1-weighted contrast, which is responsible for the contrast enhancement. For several years, FLAIR imaging has been successfully incorporated as a routine sequence at our institution for contrast-enhanced (CE) brain imaging in detecting various intracranial diseases. In this pictorial essay, we describe and illustrate the diagnostic importance of CE-FLAIR imaging in various intracranial pathologic conditions.
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Affiliation(s)
- Eun Kyoung Lee
- Department of Radiology, Dongguk University Ilsan Hospital, Goyang 10326, Korea.; Department of Radiology, College of Medicine, Kangwon National University, Chuncheon 24289, Korea
| | - Eun Ja Lee
- Department of Radiology, Dongguk University Ilsan Hospital, Goyang 10326, Korea
| | - Sungwon Kim
- Department of Radiology, Dongguk University Ilsan Hospital, Goyang 10326, Korea
| | - Yong Seok Lee
- Department of Radiology, Dongguk University Ilsan Hospital, Goyang 10326, Korea
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Kwak HS, Hwang S, Chung GH, Song JS, Choi EJ. Detection of small brain metastases at 3 T: comparing the diagnostic performances of contrast-enhanced T1-weighted SPACE, MPRAGE, and 2D FLASH imaging. Clin Imaging 2015; 39:571-5. [PMID: 25770904 DOI: 10.1016/j.clinimag.2015.02.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Revised: 01/30/2015] [Accepted: 02/17/2015] [Indexed: 10/23/2022]
Abstract
The aim of this study was to compare the diagnostic performance of contrast-enhanced T1-weighted sampling perfection with application-optimized contrasts using different flip angle evolutions (SPACE), magnetization-prepared rapid gradient-echo (MPRAGE), and two-dimensional (2D) fast low angle shot (FLASH) for the detection of small brain metastases. Twelve patients who had brain metastases less than 10 mm in diameter were enrolled. The diagnostic performance was evaluated using alternative free-response receiver operating characteristic analysis. Sensitivity and positive predictive value were also calculated. The mean Az and sensitivities of SPACE for all observers were significantly higher than those of MPRAGE and 2D FLASH.
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Affiliation(s)
- Hyo-Sung Kwak
- Department of Radiology, Chonbuk National University Medical School and Hospital, 20 Geonji-ro, Deokjin-gu, Jeonju-si, Jeollabuk-do 561-712, Korea; Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital
| | - Seungbae Hwang
- Department of Radiology, Chonbuk National University Medical School and Hospital, 20 Geonji-ro, Deokjin-gu, Jeonju-si, Jeollabuk-do 561-712, Korea; Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital.
| | - Gyung-Ho Chung
- Department of Radiology, Chonbuk National University Medical School and Hospital, 20 Geonji-ro, Deokjin-gu, Jeonju-si, Jeollabuk-do 561-712, Korea; Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital
| | - Ji-Soo Song
- Department of Radiology, Chonbuk National University Hospital, 20 Geonji-ro, Deokjin-gu, Jeonju-si, Jeollabuk-do 561-712, Korea
| | - Eun-Jung Choi
- Department of Radiology, Chonbuk National University Hospital, 20 Geonji-ro, Deokjin-gu, Jeonju-si, Jeollabuk-do 561-712, Korea
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Garcia M, Gloor M, Bieri O, Radue EW, Lieb JM, Cordier D, Stippich C. Imaging of Primary Brain Tumors and Metastases with Fast Quantitative 3-Dimensional Magnetization Transfer. J Neuroimaging 2015; 25:1007-14. [PMID: 25702714 DOI: 10.1111/jon.12222] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Revised: 12/04/2014] [Accepted: 12/10/2014] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND AND PURPOSE This study assesses whether magnetization transfer (MT) imaging provides additive information to conventional MRI in brain tumors. METHODS MT data of 26 patients with neoplastic and metastatic brain tumors were analyzed at 1.5 T. For the 3 largest tumor groups investigated in this study--glioblastoma multiforme (GBM), meningiomas, and metastases-statistical comparisons were performed. Analyzed MT parameters included the magnetization transfer ratio (MTR) and 4 quantitative MT parameters (qMT): Relaxation times (T1, T2), exchange rate (kf), and macromolecular content (F). Total imaging time of high-resolution whole brain MTR and qMT imaging with balanced steady-state free precession required 9 minutes. Five ROIs were chosen: Contrast-enhancing (T1W-CE), noncontrast-enhancing (T1W-non-CE), proximal hyperintensity (T2W-pSI), distal hyperintensity (T2W-dSI), and a reference (ref). RESULTS Pathologies showed significant (P < .05) MT changes (MTR and qMT) compared to the reference. The T1W-CE, T1W-non-CE, and T2W-pSI ROIs of GBMs, meningiomas, and metastases showed significant differences in MTR and qMT estimates. Similar MTR with significant different qMT values were observed in several ROIs among different lesions. MT maps (MTR and qMT) indicated changes in tissue appearing unaffected on MRI in most glial tumors. CONCLUSIONS MTR and qMT imaging enables a better differentiation between brain tumors and provides additive information to MRI.
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Affiliation(s)
- Meritxell Garcia
- Division of Diagnostic & Interventional Neuroradiology, Department of Radiology, Clinic for Radiology & Nuclear Medicine, University of Basel Hospital, Basel, Switzerland
| | - Monika Gloor
- Division of Radiological Physics, Department of Radiology, Clinic for Radiology & Nuclear Medicine, University of Basel Hospital, Basel, Switzerland
| | - Oliver Bieri
- Division of Radiological Physics, Department of Radiology, Clinic for Radiology & Nuclear Medicine, University of Basel Hospital, Basel, Switzerland
| | - Ernst-Wilhelm Radue
- Medical Imaging Analysis Center, University of Basel Hospital, Basel, Switzerland
| | - Johanna M Lieb
- Division of Diagnostic & Interventional Neuroradiology, Department of Radiology, Clinic for Radiology & Nuclear Medicine, University of Basel Hospital, Basel, Switzerland
| | - Dominik Cordier
- Department of Neurosurgery, University of Basel Hospital, Basel, Switzerland
| | - Christoph Stippich
- Division of Diagnostic & Interventional Neuroradiology, Department of Radiology, Clinic for Radiology & Nuclear Medicine, University of Basel Hospital, Basel, Switzerland
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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; 55:1231-7. [PMID: 25048479 PMCID: PMC4108806 DOI: 10.3349/ymj.2014.55.5.1231] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Single dose gadolinium (Gd) enhanced fluid-attenuated inversion recovery (FLAIR) is helpful for visualizing superficial parenchymal metastases. However, the usefulness of FLAIR with a higher dose of Gd is uncertain. The aim of our study was two-folds: first, to prove that the signal to noise ratio (SNR) of small brain metastases is higher than large brain metastases on double-dose (DD) enhanced FLAIR and, second, to explore the added value of DD Gd enhanced FLAIR in relation to T1 GRE for evaluating small brain metastases. MATERIALS AND METHODS For the first purpose, 50 pairs of small (2 mm<diameter≤5 mm) and large brain metastases (diameter>5 mm) were included. The difference in the SNR and contrast ratio (CR) between small and large metastases on DD Gd-enhanced 3D T2 FLAIR was compared by Wilcoxon signed-rank tests. For the second purpose, a total of 404 small metastases were included. The diagnostic sensitivities between 3D T1 gradient echo (GRE) alone and combined results of 3D T1 GRE and 3D T2 FLAIR were compared with McNemar test. RESULTS The SNR and CR of small brain metastases were significantly higher than those of large brain metastases (p<0.001). In qualitative analysis, the diagnostic sensitivities for small brain metastases were significantly higher for 3D T1 GRE plus 3D T2 FLAIR than 3D T1 GRE alone regardless of scan time (p<0.001). CONCLUSION Small brain metastases showed higher signal intensity than large brain metastases on the DD Gd enhanced 3D T2 FLAIR images. DD Gd enhanced 3D T2 FLAIR imaging may have a complementary role to 3D T1 GRE for evaluating small brain metastases.
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Affiliation(s)
- Sung Jun Ahn
- Department of Radiology, Yonsei University College of Medicine, Seoul, Korea
| | - Tae-Sub Chung
- Department of Radiology, Yonsei University College of Medicine, Seoul, Korea
| | - Jong-Hee Chang
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea
| | - Seung-Koo Lee
- Department of Radiology, Yonsei University College of Medicine, Seoul, Korea.
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Hendriks LE, Bootsma GP, de Ruysscher DK, Scheppers NA, Hofman PA, Brans BT, Dingemans AMC. Screening for brain metastases in patients with stage III non-small cell lung cancer: Is there additive value of magnetic resonance imaging above a contrast-enhanced computed tomography of the brain? Lung Cancer 2013; 80:293-7. [DOI: 10.1016/j.lungcan.2013.02.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Revised: 01/22/2013] [Accepted: 02/05/2013] [Indexed: 10/27/2022]
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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. [PMID: 23321838 DOI: 10.1097/rct.0b013e318271f216] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE This study aimed to compare the diagnostic performance in the detection of brain metastases between contrast-enhanced T1-weighted volume isotropic turbo spin echo acquisition (T1-VISTA) and 3-dimensional T1-weighted fluid-attenuated inversion recovery (3D-T1-FLAIR) imaging at 3 T. METHODS Two neuroradiologists selected 129 true (metastases) and 70 false (vessels and artifacts) lesions on the contrast-enhanced T1-VISTA and 3D-T1-FLAIR images of 14 cancer patients with hyperintense brain lesions. Four blinded neuroradiologists distinguished between the true and false lesions, using a 5-point confidence rating scale. The receiver operating characteristic analysis was performed to compare the diagnostic performance. Contrast-to-noise ratio of the true lesions was also compared between the 2 sequences by using paired t tests. RESULTS For lesions less than 3 mm, the area under curve and sensitivity achieved by T1-VISTA imaging were significantly greater than 3D-T1-FLAIR imaging. The contrast-to-noise ratio was also significantly greater with T1-VISTA imaging. CONCLUSIONS The contrast-enhanced T1-VISTA imaging is better suited than 3D-T1-FLAIR imaging, for detection of small metastases.
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Abstract
MR imaging without and with gadolinium-based contrast agents (GBCAs) is an important imaging tool for defining normal anatomy and characteristics of lesions. GBCAs have been used in contrast-enhanced MR imaging in defining and characterizing lesions of the central nervous system for more than 20 years. The combination of unenhanced and GBCA-enhanced MR imaging is the clinical gold standard for the noninvasive detection and delineation of most intracranial and spinal lesions. MR imaging has a high predictive value that rules out neoplasm and most inflammatory and demyelinating processes of the central nervous system.
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Affiliation(s)
- Bum-soo Kim
- Department of Radiology, The Catholic University of Korea, Seoul, Korea
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Ribeiro MM, Farinha S, Costa J, Mauricio JC, O' Neill JG. The magnetization transfer effect in brain studies by 1.5 T magnetic resonance system. When the radiographer should apply it? Radiography (Lond) 2011. [DOI: 10.1016/j.radi.2010.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Differential diagnosis by unenhanced FLAIR T2-weighted magnetic resonance images between solitary high grade gliomas and cerebral metastases appearing as contrast-enhancing cortico-subcortical lesions. J Neurooncol 2010; 103:713-7. [DOI: 10.1007/s11060-010-0454-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2010] [Accepted: 10/25/2010] [Indexed: 10/18/2022]
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Feldman SC, Chu D, Schulder M, Pawar R, Barry M, Cho ES, Liu WC. The blood oxygen level-dependent functional MR imaging signal can be used to identify brain tumors and distinguish them from normal tissue. AJNR Am J Neuroradiol 2009; 30:389-95. [PMID: 19208905 DOI: 10.3174/ajnr.a1326] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE In neuro-oncology, a major problem is clear identification of tumor from the surrounding normal tissue. We hypothesized that we could use the blood oxygen level-dependent functional MR imaging (BOLD fMRI) signals from tumors and normal brain to identify the tumors and distinguish them from the surrounding brain. MATERIALS AND METHODS Fourteen patients with meningiomas, gliomas, and metastatic tumors were scanned before surgery. All subjects performed a motor task; 2 subjects were also scanned while in a resting state. The BOLD signals were taken from selected points within the tumor and from the surrounding normal brain and were analyzed by using correlation analysis to determine how closely they were related. RESULTS The BOLD signals from all of the tumors were significantly different from those in the surrounding normal tissue. In meningiomas and gliomas, selection of a voxel in the tumor for signal-intensity analysis highlighted the entire tumor mass while excluding the normal tissue. The BOLD signal intensity was the same whether the subjects were motionless or finger tapping. CONCLUSIONS Analysis of the BOLD signal intensity provides a relatively simple and straightforward method for identifying brain tumors and distinguishing them from normal tissue. This approach may be of use in neurosurgery.
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Affiliation(s)
- S C Feldman
- Department of Radiology, University of Medicine and Dentistry of New Jersey, New Jersey Medical School, Newark, NJ 07103, USA.
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Grunwald IQ, Veith C, Backens M, Roth C, Papanagiotou P, Reith W. Infratentorielle Tumoren. Radiologe 2007; 47:486-91. [PMID: 17534591 DOI: 10.1007/s00117-007-1515-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This article gives an overview concerning the typical infratentorial tumors of adults.
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Affiliation(s)
- I Q Grunwald
- Klinik für Diagnostische und Interventionelle Neuroradiologie, Universitätsklinikum des Saarlandes, Homburg
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