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Research ArticleBRAIN

MR Imaging of Leptomeningeal Metastases: Comparison of Three Sequences

Sanjay K. Singh, Norman E. Leeds and Lawrence E. Ginsberg
American Journal of Neuroradiology May 2002, 23 (5) 817-821;
Sanjay K. Singh
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Norman E. Leeds
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Lawrence E. Ginsberg
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Abstract

BACKGROUND AND PURPOSE: Recent work has shown that fluid-attenuated inversion recovery (FLAIR) imaging with contrast enhancement is highly sensitive for detecting subarachnoid space disease. We hypothesized that contrast-enhanced FLAIR imaging has superior sensitivity to contrast-enhanced T1-weighted MR imaging in detecting leptomeningeal metastases.

METHODS: Sixty-eight patients referred for suspected leptomeningeal metastases underwent 74 MR imaging studies. The patients had either temporally related cytologic proof of leptomeningeal metastases or negative results of clinical follow-up confirming absence of leptomeningeal metastases. The MR imaging examinations included unenhanced and contrast-enhanced FLAIR images and contrast-enhanced T1-weighted MR images that were independently reviewed by two neuroradiologists blinded to the results of cytology. Each of the three sequences was reviewed individually and separately and was assigned a score of positive or negative for leptomeningeal metastases. Discrepancies were settled by consensus.

RESULTS: Of the 17 studies of patients with cytology-proven leptomeningeal metastases, two were positive based on unenhanced FLAIR images, seven were positive based on contrast-enhanced FLAIR images, and 10 were positive based on contrast-enhanced T1-weighted MR images. Of the 57 studies of patients without leptomeningeal metastases, 53 were negative based on unenhanced FLAIR images, 50 were negative based on contrast-enhanced FLAIR images, and 53 were negative based on contrast-enhanced T1-weighted MR images. The sensitivity and specificity of unenhanced FLAIR images for detecting leptomeningeal metastases were 12% (two of 17) and 93% (53 of 57), respectively. The sensitivity and specificity for contrast-enhanced FLAIR images for detecting leptomeningeal metastases were 41% (seven of 17) and 88% (50 of 57), respectively. The sensitivity and specificity of contrast-enhanced T1-weighted MR images for detecting leptomeningeal metastases were 59% (10 of 17) and 93% (53 of 57), respectively.

CONCLUSION: Contrast-enhanced fast FLAIR sequences are less sensitive than standard contrast-enhanced T1-weighted MR sequences in detecting intracranial neoplastic leptomeningeal disease.

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American Journal of Neuroradiology: 23 (5)
American Journal of Neuroradiology
Vol. 23, Issue 5
1 May 2002
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MR Imaging of Leptomeningeal Metastases: Comparison of Three Sequences
Sanjay K. Singh, Norman E. Leeds, Lawrence E. Ginsberg
American Journal of Neuroradiology May 2002, 23 (5) 817-821;

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MR Imaging of Leptomeningeal Metastases: Comparison of Three Sequences
Sanjay K. Singh, Norman E. Leeds, Lawrence E. Ginsberg
American Journal of Neuroradiology May 2002, 23 (5) 817-821;
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