Bae Yun Jung, Choi Byung Se, Lee Kyung Mi, Yoon Yeon Hong, Sunwoo Leonard, Jung Cheolkyu, Kim Jae Hyoung
Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea.
Department of Radiology, Kyung Hee University College of Medicine, Kyung Hee University Hospital, Seoul 02447, Korea.
Korean J Radiol. 2017 Jul-Aug;18(4):699-709. doi: 10.3348/kjr.2017.18.4.699. Epub 2017 May 19.
To evaluate the diagnostic benefits of 5-mm maximum intensity projection of improved motion-sensitized driven-equilibrium prepared contrast-enhanced 3D T1-weighted turbo-spin echo imaging (MIP iMSDE-TSE) in the detection of brain metastases. The imaging technique was compared with 1-mm images of iMSDE-TSE (non-MIP iMSDE-TSE), 1-mm contrast-enhanced 3D T1-weighted gradient-echo imaging (non-MIP 3D-GRE), and 5-mm MIP 3D-GRE.
From October 2014 to July 2015, 30 patients with 460 enhancing brain metastases (size > 3 mm, n = 150; size ≤ 3 mm, n = 310) were scanned with non-MIP iMSDE-TSE and non-MIP 3D-GRE. We then performed 5-mm MIP reconstruction of these images. Two independent neuroradiologists reviewed these four sequences. Their diagnostic performance was compared using the following parameters: sensitivity, reading time, and figure of merit (FOM) derived by jackknife alternative free-response receiver operating characteristic analysis. Interobserver agreement was also tested.
The mean FOM (all lesions, 0.984; lesions ≤ 3 mm, 0.980) and sensitivity ([reader 1: all lesions, 97.3%; lesions ≤ 3 mm, 96.2%], [reader 2: all lesions, 97.0%; lesions ≤ 3 mm, 95.8%]) of MIP iMSDE-TSE was comparable to the mean FOM (0.985, 0.977) and sensitivity ([reader 1: 96.7, 99.0%], [reader 2: 97, 95.3%]) of non-MIP iMSDE-TSE, but they were superior to those of non-MIP and MIP 3D-GREs (all, < 0.001). The reading time of MIP iMSDE-TSE (reader 1: 47.7 ± 35.9 seconds; reader 2: 44.7 ± 23.6 seconds) was significantly shorter than that of non-MIP iMSDE-TSE (reader 1: 78.8 ± 43.7 seconds, = 0.01; reader 2: 82.9 ± 39.9 seconds, < 0.001). Interobserver agreement was excellent (κ > 0.75) for all lesions in both sequences.
MIP iMSDE-TSE showed high detectability of brain metastases. Its detectability was comparable to that of non-MIP iMSDE-TSE, but it was superior to the detectability of non-MIP/MIP 3D-GREs. With a shorter reading time, the false-positive results of MIP iMSDE-TSE were greater. We suggest that MIP iMSDE-TSE can provide high diagnostic performance and low false-positive rates when combined with 1-mm sequences.
评估改良的运动敏感驱动平衡预饱和对比增强三维T1加权快速自旋回波成像（MIP iMSDE-TSE）的5毫米最大强度投影在脑转移瘤检测中的诊断价值。将该成像技术与iMSDE-TSE的1毫米图像（非MIP iMSDE-TSE）、1毫米对比增强三维T1加权梯度回波成像（非MIP 3D-GRE）以及5毫米MIP 3D-GRE进行比较。
2014年10月至2015年7月，对30例患有460个强化脑转移瘤（大小>3毫米，n = 150；大小≤3毫米，n = 310）的患者进行非MIP iMSDE-TSE和非MIP 3D-GRE扫描。然后对这些图像进行5毫米MIP重建。两位独立的神经放射科医生对这四个序列进行评估。使用以下参数比较它们的诊断性能：灵敏度、阅片时间以及通过留一法交替自由响应接收器操作特征分析得出的品质因数（FOM）。还测试了观察者间的一致性。
MIP iMSDE-TSE的平均FOM（所有病灶，0.984；病灶≤3毫米，0.980）和灵敏度（[阅片者1：所有病灶，97.3%；病灶≤3毫米，96.2%]，[阅片者2：所有病灶，97.0%；病灶≤3毫米，95.8%]）与非MIP iMSDE-TSE的平均FOM（0.985，0.977）和灵敏度（[阅片者1：96.7，99.0%]，[阅片者2：97，95.3%]）相当，但优于非MIP和MIP 3D-GRE（所有，<0.001）。MIP iMSDE-TSE的阅片时间（阅片者1：47.7±35.9秒；阅片者2：44.7±23.6秒）明显短于非MIP iMSDE-TSE（阅片者1：78.8±43.7秒，P = 0.01；阅片者2：82.9±39.9秒，P<0.001）。两个序列中所有病灶的观察者间一致性均极佳（κ>0.75）。
MIP iMSDE-TSE对脑转移瘤具有较高的检测能力。其检测能力与非MIP iMSDE-TSE相当，但优于非MIP/MIP 3D-GRE。由于阅片时间较短，MIP iMSDE-TSE的假阳性结果更多。我们建议MIP iMSDE-TSE与1毫米序列联合使用时可提供高诊断性能和低假阳性率。
