Detection of Leptomeningeal Metastasis by Contrast-Enhanced 3D T1-SPACE: Comparison with 2D FLAIR and Contrast-Enhanced 2D T1-Weighted Images.
BACKGROUND
To compare the diagnostic accuracy of contrast-enhanced 3D(dimensional) T1-weighted sampling perfection with application-optimized contrasts by using different flip angle evolutions (T1-SPACE), 2D fluid attenuated inversion recovery (FLAIR) images and 2D contrast-enhanced T1-weighted image in detection of leptomeningeal metastasis except for invasive procedures such as a CSF tapping.


METHODS
Three groups of patients were included retrospectively for 9 months (from 2013-04-01 to 2013-12-31). Group 1 patients with positive malignant cells in CSF cytology (n = 22); group 2, stroke patients with steno-occlusion in ICA or MCA (n = 16); and group 3, patients with negative results on MRI, whose symptom were dizziness or headache (n = 25). A total of 63 sets of MR images are separately collected and randomly arranged: (1) CE 3D T1-SPACE; (2) 2D FLAIR; and (3) CE T1-GRE using a 3-Tesla MR system. A faculty neuroradiologist with 8-year-experience and another 2nd grade trainee in radiology reviewed each MR image- blinded by the results of CSF cytology and coded their observations as positives or negatives of leptomeningeal metastasis. The CSF cytology result was considered as a gold standard. Sensitivity and specificity of each MR images were calculated. Diagnostic accuracy was compared using a McNemar's test. A Cohen's kappa analysis was performed to assess inter-observer agreements.


RESULTS
Diagnostic accuracy was not different between 3D T1-SPACE and CSF cytology by both raters. However, the accuracy test of 2D FLAIR and 2D contrast-enhanced T1-weighted GRE was inconsistent by the two raters. The Kappa statistic results were 0.657 (3D T1-SPACE), 0.420 (2D FLAIR), and 0.160 (2D contrast-enhanced T1-weighted GRE). The 3D T1-SPACE images showed the highest inter-observer agreements between the raters.


CONCLUSIONS
Compared to 2D FLAIR and 2D contrast-enhanced T1-weighted GRE, contrast-enhanced 3D T1 SPACE showed a better detection rate of leptomeningeal metastasis.
Departments of Radiology Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
Bomi
B
Gil
Departments of Radiology Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
Eo-Jin
EJ
Hwang
Departments of Radiology Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
Song
S
Lee
Departments of Radiology Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
Jinhee
J
Jang
Departments of Radiology Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
Hyun Seok
http://orcid.org/0000-0003-4999-8513
HS
Choi
Departments of Radiology Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
So-Lyung
SL
Jung
Departments of Radiology Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
Kook-Jin
KJ
Ahn
Departments of Radiology Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
Bum-Soo
BS
Kim
D000368:Aged; D003287:Contrast Media / Q000008:administration & dosage; D003581:Cytodiagnosis / Q000379:methods; D004244:Dizziness / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology; D055088:Early Detection of Cancer / Q000379:methods; D005260:Female; D006261:Headache / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008577:Meningeal Neoplasms / Q000134:cerebrospinal fluid / Q000175:diagnosis* / Q000000981:diagnostic imaging* / Q000556:secondary; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009369:Neoplasms / Q000134:cerebrospinal fluid / Q000175:diagnosis* / Q000000981:diagnostic imaging*; D020521:Stroke / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology
D003287:Contrast Media
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