From the Department of Radiology (J.O., S.H.C., E.L., D.J.S., S.W.J., R.-E.Y., K.M.K., T.J.Y., J.-h.K., C.-H.S.), Seoul National University Hospital, Seoul, Korea.
Department of Radiology (J.O., S.H.C., R.-E.Y., K.M.K., T.J.Y., J.-h.K., C.-H.S.), Seoul National University College of Medicine, Seoul, Korea.
AJNR Am J Neuroradiol. 2018 Aug;39(8):1453-1459. doi: 10.3174/ajnr.A5721. Epub 2018 Jul 12.
Contrast-enhanced 3D fast spin-echo T1 black-blood imaging selectively suppresses the signal of blood flow and could provide a higher contrast-to-noise ratio compared with contrast-enhanced 3D ultrafast gradient recalled echo (contrast-enhanced gradient recalled echo) and 2D spin-echo T1WI (contrast-enhanced spin-echo). The purpose of our study was to evaluate whether black-blood imaging can improve the diagnostic accuracy for leptomeningeal carcinomatosis compared with contrast-enhanced gradient recalled-echo and contrast-enhanced spin-echo and, furthermore, to determine whether the grade of leptomeningeal carcinomatosis evaluated on black-blood imaging is a significant predictor of progression-free survival.
Leptomeningeal carcinomatosis ( = 78) and healthy ( = 31) groups were enrolled. Contrast-enhanced gradient recalled-echo, contrast-enhanced spin-echo, and black-blood imaging were separately reviewed, and a diagnostic rating (positive, indeterminate, or negative) and grading of leptomeningeal carcinomatosis were assigned. The diagnostic accuracies of the 3 imaging sequences were compared in terms of leptomeningeal carcinomatosis detection. The Kaplan-Meier and the Cox proportional hazards model analyses were performed to determine the relationship between the leptomeningeal carcinomatosis grade evaluated on black-blood imaging and progression-free survival.
Black-blood imaging showed a significantly higher sensitivity (97.43%) than contrast-enhanced gradient recalled-echo (64.1%) and contrast-enhanced spin-echo (66.67%) ( < .05). In terms of specificities, we did not find any significant differences among contrast-enhanced gradient recalled-echo (90.32%), contrast-enhanced spin-echo (90.32%), and black-blood imaging (96.77%) ( > .05). A Cox proportional hazards model identified the time to metastasis, Karnofsky Performance Scale status, and a combination of the leptomeningeal carcinomatosis grade with a linear pattern as independent predictors of progression-free survival ( < .05).
Black-blood imaging can improve the diagnostic accuracy and predict progression-free survival in patients with leptomeningeal carcinomatosis.
对比增强 3D 快速自旋回波 T1 黑血成像选择性地抑制血流信号，与对比增强 3D 超快梯度回波（对比增强梯度回波）和 2D 自旋回波 T1WI（对比增强自旋回波）相比，可提供更高的对比噪声比。本研究的目的是评估黑血成像是否可以提高脑膜癌病的诊断准确性，与对比增强梯度回波和对比增强自旋回波相比，并且，进一步确定黑血成像上评估的脑膜癌病分级是否是无进展生存期的显著预测因子。
脑膜癌病组（n=78）和健康对照组（n=31）入组。分别对对比增强梯度回波、对比增强自旋回波和黑血成像进行了评估，并给出了诊断评分（阳性、不确定或阴性）和脑膜癌病分级。比较了 3 种成像序列在脑膜癌病检测方面的诊断准确性。通过 Kaplan-Meier 和 Cox 比例风险模型分析，确定黑血成像上评估的脑膜癌病分级与无进展生存期之间的关系。
黑血成像的灵敏度（97.43%）显著高于对比增强梯度回波（64.1%）和对比增强自旋回波（66.67%）（<0.05）。在特异性方面，我们没有发现对比增强梯度回波（90.32%）、对比增强自旋回波（90.32%）和黑血成像（96.77%）之间有任何显著差异（>0.05）。Cox 比例风险模型确定转移时间、Karnofsky 表现量表状态以及脑膜癌病分级与线性模式的组合是无进展生存期的独立预测因子（<0.05）。
黑血成像可以提高脑膜癌病患者的诊断准确性和预测无进展生存期。
