3D Fast Spin-Echo T1 Black-Blood Imaging for the Preoperative Detection of Venous Sinus Invasion by Meningioma : Comparison with Contrast-Enhanced MRV.

OBJECTIVES

To prospectively evaluate the diagnostic value of 3D fast spin-echo (FSE) T1 black-blood magnetic resonance (MR) imaging (3D CUBE T1WI) in comparison with contrast-enhanced MR venography (CE-MRV) in the detection of sinus invasion by meningiomas.

METHODS

In this study forty consecutive patients with suspected meningiomas adjacent to venous sinus underwent conventional MR imaging, CE-MRV and 3D CUBE T1WI scans. Images obtained by each technique were assessed independently by two neuroradiologists for (1) wall invasion and (2) lumen occlusion of the target venous sinus.

RESULTS

The use of 3D CUBE T1W imaging was found to provide an easy way to detect the venous wall invasion by para-sinus lesions. The interobserver agreement was excellent (κ = 0.843; 95% confidence interval CI 0.757-0.929) and the result was highly consistent with the surgical findings (sensitivity 90.48%, specificity 94.12%). In the analysis of the lumen occlusion, the interobserver agreement obtained by 3D CUBE T1WI sequence was excellent (κ = 0.956; 95% CI, 0.913-0.999) with a diagnostic accuracy of 94.74%, which surpassed CE-MRV not only in interobserver agreement (κ = 0.736; 95% CI, 0.639-0.833) but also in diagnostic value (accuracy = 68.42%). Among 38 patients with meningiomas, the existence and extent of peritumoral edema did not correlate with the invasion of adjacent venous sinus.

CONCLUSION

Currently, 3D CUBE T1WI sequence is a reliable technique to provide accurate assessment about the venous sinus invasion by meningioma. Meanwhile, CE-MRV is more suitable in the evaluation of the bypass draining veins around the tumor.