Seong Minjung, Park Sehhoon, Kim Sung Tae, Park Sung Goo, Kim Yi Kyung, Kim Hyung-Jin, Ahn Myung-Ju
Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea.
Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
J Neurooncol. 2020 Sep;149(2):367-372. doi: 10.1007/s11060-020-03617-2. Epub 2020 Sep 8.
We purposed to compare diagnostic accuracy of contrast-enhanced (CE) 3D T1-weighted fast field echo (3D T1-WI), CE 2D spin echo T1-weighted image (2D T1-WI), and CE 2D T2 FLAIR on evaluation of leptomeningeal metastasis(LM) using detailed features suggested in RANO proposal in a homogeneous group with cytology-proven LM.
Thirty-five lung adenocarcinoma patients with CSF cytology-proven leptomeningeal metastasis were enrolled in this retrospective analysis, who were enrolled in the prospective study (NCT03257124). MR images including CE 3D T1-WI, CE 2D T1-WI, and CE 2D FLAIR were reviewed. Presence of leptomeningeal nodule, leptomeningeal enhancement, and cranial nerve enhancement was evaluated according to the RANO proposal. Diagnostic accuracy of each sequence was compared and added value of CE 2D FLAIR to CE 3D T1-WI was evaluated.
Two patients had unmeasurable small nodules recognized on 3D T1-WI only. Leptomeningeal enhancement was positive in 60%, 60%, and 77.1%, cranial nerve enhancement was positive in 51.4%, 45.7%, and 68.6% of the patients on 3D T1-WI, 2D T1-WI, and 2D FLAIR, respectively. Overall sensitivity for detection of LM was 71.4%, 71.4%, and 82.9% on 3D T1-WI, 2D T1-WI, and 2D FLAIR. When adding 2D FLAIR to 3D T1-WI, overall sensitivity for detection of LM was 82.9%.
3D T1-WI is the best for identifying leptomeningeal nodules. The sensitivity of 2D FLAIR is the highest for both LNE and CNE. Since both sequences are complementary, it can be helpful to take both sequences. Checking each feature according to the RANO proposal, especially CNE, may help you not to miss LM.
我们旨在比较对比增强（CE）三维T1加权快速场回波成像（3D T1-WI）、CE二维自旋回波T1加权成像（2D T1-WI）和CE二维T2液体衰减反转恢复序列（2D FLAIR）在评估软脑膜转移（LM）方面的诊断准确性，使用RANO提议中提出的详细特征，研究对象为经细胞学证实患有LM的同质组患者。
35例经脑脊液细胞学证实患有软脑膜转移的肺腺癌患者纳入本回顾性分析，这些患者曾参与前瞻性研究（NCT03257124）。回顾包括CE 3D T1-WI、CE 2D T1-WI和CE 2D FLAIR的磁共振成像。根据RANO提议评估软脑膜结节、软脑膜强化和脑神经强化情况。比较各序列的诊断准确性，并评估CE 2D FLAIR对CE 3D T1-WI的附加值。
2例患者仅在3D T1-WI上发现不可测量的小结节。在3D T1-WI、2D T1-WI和2D FLAIR上，分别有60%、60%和77.1%的患者软脑膜强化呈阳性，51.4%、45.7%和68.6%的患者脑神经强化呈阳性。在3D T1-WI、2D T1-WI和2D FLAIR上，检测LM的总体敏感性分别为71.4%、71.4%和82.9%。当将2D FLAIR添加到3D T1-WI时，检测LM的总体敏感性为82.9%。
3D T1-WI在识别软脑膜结节方面最佳。2D FLAIR对软脑膜强化和脑神经强化的敏感性最高。由于这两个序列具有互补性，同时采用这两个序列可能会有帮助。根据RANO提议检查每个特征，尤其是脑神经强化，可能有助于避免漏诊LM。
