Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, 1095 Jiefang Ave, Wuhan 430030, China.
AJR Am J Roentgenol. 2012 Jan;198(1):27-32. doi: 10.2214/AJR.11.7030.
The purpose of this study was to evaluate the sensitivities and specificities of four single-slab 3D MRI sequences in the detection of cranial metastases: double inversion recovery (IR), T2 FLAIR, contrast-enhanced T2 FLAIR, and contrast-enhanced IR-prepared fast spoiled gradient-echo (FSPGR) sequences.
Eighty-four patients underwent double IR and T2 FLAIR imaging using 3-T MRI. Then, 49 of 84 patients were randomly selected to undergo contrast-enhanced IR-prepared FSPGR before contrast-enhanced T2 FLAIR, and the other 35 patients underwent contrast-enhanced T2 FLAIR before contrast-enhanced IR-prepared FSPGR. Two experienced neuroradiologists reviewed the images by consensus on a workstation. Metastases were scored a negative, equivocal, or positive. For each metastasis, we recorded the anatomic area and size, and checked whether edema was present.
A total of 210 cranial metastases in 56 of 84 patients were revealed. The sensitivities of double IR, T2 FLAIR, contrast-enhanced IR-prepared FSPGR, and contrast-enhanced T2 FLAIR sequences were 66.2%, 56.7%, 80.5%, and 99%, respectively. The specificities were 68.3%, 73%, 75.7%, and 82.4%. The areas under the receiver operating characteristic curve were 0.763, 0.709, 0.865, and 0.993. Contrast-enhanced T2 FLAIR imaging was found to have the highest sensitivity especially for detecting lesions in meninges (98.2%; p<0.0001) and gray matter (GM) (100%; p<0.0001). The double IR sequence was superior to the T2 FLAIR sequence for imaging metastases located in ependyma (81.8% vs 36.4%) and GM (66.7% vs 48.1%). Delayed enhancement did not affect the sensitivities of the contrast-enhanced T2 FLAIR and contrast-enhanced IR-prepared FSPGR sequences.
Contrast-enhanced T2 FLAIR is the most sensitive sequence of the four MR sequences evaluated for the detection of cranial metastases despite its delay time after contrast enhancement.
本研究旨在评估四种单层面 3D MRI 序列在检测颅转移瘤中的敏感性和特异性：双反转恢复（IR）、T2 液体衰减反转恢复（FLAIR）、对比增强 T2 FLAIR 和对比增强 IR 预处理快速梯度回波（FSPGR）序列。
84 例患者接受 3T MRI 双 IR 和 T2 FLAIR 成像。然后，随机选择 84 例患者中的 49 例进行对比增强 IR 预处理 FSPGR 前的对比增强 T2 FLAIR，另外 35 例患者进行对比增强 T2 FLAIR 前的对比增强 IR 预处理 FSPGR。两位有经验的神经放射科医生在工作站上通过共识对图像进行审查。转移灶被评为阴性、可疑或阳性。对于每个转移灶，我们记录了解剖区域和大小，并检查了是否存在水肿。
在 84 例患者中的 56 例中发现了 210 个颅转移灶。双 IR、T2 FLAIR、对比增强 IR 预处理 FSPGR 和对比增强 T2 FLAIR 序列的敏感性分别为 66.2%、56.7%、80.5%和 99%。特异性分别为 68.3%、73%、75.7%和 82.4%。受试者工作特征曲线下面积分别为 0.763、0.709、0.865 和 0.993。对比增强 T2 FLAIR 成像具有最高的敏感性，特别是用于检测脑膜（98.2%；p<0.0001）和灰质（GM）（100%；p<0.0001）中的病变。双 IR 序列在成像位于室管膜（81.8%比 36.4%）和 GM（66.7%比 48.1%）的转移灶方面优于 T2 FLAIR 序列。延迟增强不影响对比增强 T2 FLAIR 和对比增强 IR 预处理 FSPGR 序列的敏感性。
尽管对比增强 T2 FLAIR 的对比增强后延迟时间较长，但在检测颅转移瘤方面，它是四种评估的 MRI 序列中最敏感的序列。
