KMID : 1144720220260010032
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Investigative Magnetic Resonance Imaging 2022 Volume.26 No. 1 p.32 ~ p.42
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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
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Kim Han-Joon
Lee Jung-Bin Lee A-Leum Lee Jae-Wook Kim Chan-Kyu Kim Jung-Youn Park Sung-Tae Chang Kee-Hyun
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Abstract
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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.
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KEYWORD
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Meningeal carcinomatosis, Lung neoplasms, Magnetic resonance imaging, Contrast media, Diagnosis
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