Saleh A, Wenserski F, Cohnen M, Fürst G, Godehardt E, Mödder U
Institute of Diagnostic Radiology, Clinic of Thoracic and Cardiovascular Surgery, University Hospital Düsseldorf, Germany.
Br J Radiol. 2004 Mar;77(915):183-8. doi: 10.1259/bjr/62546157.
We hypothesized that in patients with negative fluid-attenuated inversion recovery (FLAIR) images T(2) weighted fast spin-echo (FSE) images and T(1) weighted spin-echo (SE) images before and after intravenous administration of gadolinium-based contrast medium display no pathology either. Thus, we assessed the negative predictive value of FLAIR images to rule out MR-detectable brain lesions. 1026 consecutive cranial MR examinations were reviewed. Routine MRI of the brain included T(1) weighted coronal imaging before and after administration of gadopentetate dimeglumine, axial T(2) weighted FSE and fast-FLAIR imaging. The FLAIR images were rated by two radiologists into categories of 0 (without pathologic changes) and 1 (with pathologic changes). Two other radiologists analysed the complete examination. In 284 MR examinations of the brain no abnormalities were found (28%). FLAIR-ratings were false-negative in four cases and false-positive in 30 cases. Sensitivity and specificity of the FLAIR sequence for MR-detectable brain lesions were 99.5% and 89.4%. The unselective application of gadolinium avoided one false-negative MR-reading and improved the sensitivity of the MR-examination from 99.5% to 99.6%. Positive and negative predictive values were 96.1% and 98.4%, respectively. The interobserver reliability was kappa=0.93 for the FLAIR-readers and 0.89 for the readers who rated the complete examination. In conclusion, negative FLAIR images provide a high negative predictive value for MR-detectable brain lesions. Thus, in patients with negative FLAIR images the unselective application of gadolinium seems to be unnecessary.
我们假设，对于液体衰减反转恢复（FLAIR）图像呈阴性的患者，静脉注射钆基造影剂前后的T（2）加权快速自旋回波（FSE）图像和T（1）加权自旋回波（SE）图像也未显示出病变。因此，我们评估了FLAIR图像排除磁共振（MR）可检测脑病变的阴性预测价值。回顾了1026例连续的头颅MR检查。脑部常规MRI包括静脉注射钆喷酸葡胺前后的T（1）加权冠状位成像、轴位T（2）加权FSE成像和快速FLAIR成像。两名放射科医生将FLAIR图像分为0类（无病理改变）和1类（有病理改变）。另外两名放射科医生分析了完整的检查结果。在284例脑部MR检查中未发现异常（28%）。FLAIR评级在4例中为假阴性，在30例中为假阳性。FLAIR序列对MR可检测脑病变的敏感性和特异性分别为99.5%和89.4%。钆的非选择性应用避免了一次假阴性MR读片，并将MR检查的敏感性从99.5%提高到99.6%。阳性和阴性预测值分别为96.1%和98.4%。FLAIR图像阅片者之间的观察者间可靠性kappa值为0.93，对完整检查结果进行评级的阅片者之间的kappa值为0.89。总之，FLAIR图像阴性对MR可检测脑病变具有较高的阴性预测价值。因此，对于FLAIR图像阴性的患者，钆的非选择性应用似乎没有必要。
