Investigative Magnetic Resonance Imaging

Korean Society of Magnetic Resonance in Medicine (대한자기공명의과학회)
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Benefit of Using Early Contrast-Enhanced 2D T2-Weighted Fluid-Attenuated Inversion Recovery Image to Detect Leptomeningeal Metastasis in Lung-Cancer Staging

  • Kim, Han Joon (Department of Radiology, Soonchunhyang University Bucheon Hospital) ;
  • Lee, Jungbin (Department of Radiology, Soonchunhyang University Bucheon Hospital) ;
  • Lee, A Leum (Department of Radiology, Soonchunhyang University Bucheon Hospital) ;
  • Lee, Jae-Wook (Department of Radiology, Soonchunhyang University Bucheon Hospital) ;
  • Kim, Chan-Kyu (Department of Internal Medicine, Soonchunhyang University Bucheon Hospital) ;
  • Kim, Jung Youn (Department of Radiology, Kangbuk Samsung Medical Center) ;
  • Park, Sung-Tae (Department of Radiology, Soonchunhyang University Seoul Hospital) ;
  • Chang, Kee-Hyun (Department of Radiology, Human Medical Imaging and Intervention Center)
  • Received : 2021.08.03
  • Accepted : 2021.10.08
  • Published : 2022.03.30
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Abstract

Purpose: To evaluate the clinical benefit of 2D contrast-enhanced T2 fluid-attenuated inversion recovery (CE-T2 FLAIR) image for detecting leptomeningeal metastasis (LM) in the brain metastasis work-up for lung cancer. Materials and Methods: From June 2017 to July 2019, we collected all consecutive patients with lung cancer who underwent brain magnetic resonance image (MRI), including contrast-enhanced 3D fast spin echo T1 black-blood image (CE-T1WI) and CE-T2 FLAIR; we recruited clinico-radiologically suspected LM cases. Two independent readers analyzed the images for LM in three sessions: CE-T1WI, CE-T2 FLAIR, and their combination. Results: We recruited 526 patients with suspected lung cancer who underwent brain MRI; of these, we excluded 77 (insufficient image protocol, unclear pathology, different contrast media, poor image quality). Of the 449 patients, 34 were clinico-radiologically suspected to have LM; among them, 23 were diagnosed with true LM. The calculated detection performance of CE-T1WI, CE-T2 FLAIR, and combined analysis obtained from the 34 suspected LM were highest in the combined analysis (AUC: 0.80, 0.82, and 0.89, respectively). The inter-observer agreement was also the highest in the combined analysis (0.68, 0.72, and 0.86, respectively). In quantitative analyses, CNR of CE-T2 FLAIR was significantly higher than that of CE-T1WI (Wilcoxon signed rank test, P < 0.05). Conclusion: Adding CE-T2 FLAIR might provide better detection for LM in the brain-metastasis screening for lung cancer.

Keywords

References

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