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AJNR Am J Neuroradiol. 2018 Aug;39(8):1453-1459. doi: 10.3174/ajnr.A5721. Epub 2018 Jul 12.

Application of 3D Fast Spin-Echo T1 Black-Blood Imaging in the Diagnosis and Prognostic Prediction of Patients with Leptomeningeal Carcinomatosis.

Oh J1,2, Choi SH3,2,4,5, Lee E1, Shin DJ1, Jo SW1, Yoo RE1,2, Kang KM1,2, Yun TJ1,2, Kim JH1,2, Sohn CH1,2.

Author information

1
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.
2
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.
3
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 verocay@snuh.org.
4
Institute of Radiation Medicine (S.H.C.), Seoul National University Medical Research Center, Seoul, Korea.
5
Center for Nanoparticle Research (S.H.C.), Institute for Basic Science, Seoul, Republic of Korea.

Abstract

BACKGROUND AND PURPOSE:

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.

MATERIALS AND METHODS:

Leptomeningeal carcinomatosis (n = 78) and healthy (n = 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.

RESULTS:

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%) (P < .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%) (P > .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 (P < .05).

CONCLUSIONS:

Black-blood imaging can improve the diagnostic accuracy and predict progression-free survival in patients with leptomeningeal carcinomatosis.

PMID:
30002052
DOI:
10.3174/ajnr.A5721

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