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Contrast-enhanced modified 3D T1-weighted TSE black-blood imaging can improve detection of infectious and neoplastic meningitis

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Abstract

Objectives

To evaluate the diagnostic value of a contrast-enhanced 3D T1-weighted-modified volumetric isotropic turbo spin-echo acquisition sequence (T1-mVISTA) in comparison with a conventional 3D T1-weighted magnetization-prepared rapid gradient-echo (T1-MP-RAGE) sequence for the detection of meningeal enhancement in patients with meningitis.

Methods

Thirty patients (infectious meningitis, n = 12; neoplastic meningitis, n = 18) and 45 matched controls were enrolled in this retrospective case-control study. Sets of randomly selected T1-mVISTA and T1-MP-RAGE images (both with 0.8-mm isotropic resolution) were read separately 4 weeks apart. Image quality, leptomeningeal and dural enhancement, grading of visual contrast enhancement, and diagnostic confidence were compared using the Kruskal-Wallis rank sum test.

Results

Image quality was rated to be good to excellent in 75 out of 75 cases (100%) for T1-mVISTA and 74 out of 75 cases (98.7%) for T1-MP-RAGE. T1-mVISTA detected significantly more patients with leptomeningeal enhancement (p = 0.006) compared with T1-MP-RAGE (86.7 vs. 50.0%, p < 0.001), each with specificity of 100%. Similarly, sensitivity of T1-mVISTA for the detection of dural and/or leptomeningeal enhancement was also significantly higher compared with that of T1-MP-RAGE (96.7 vs. 80.0%, p = 0.025) without significant differences regarding specificity (97.8 vs. 95.6%, p = 0.317). No significant differences were found for dural enhancement alone. Diagnostic confidence in T1-mVISTA was significantly higher (p = 0.01). Visual contrast enhancement was tendentially higher in T1-mVISTA.

Conclusions

T1-mVISTA may be an adequate and probably better alternative to T1-MP-RAGE for detection of leptomeningeal diseases.

Key Points

• Black-blood T1-mVISTA showed a significant higher sensitivity for the detection of leptomeningeal enhancement compared with MP-RAGE without losses regarding specificity.

• Diagnostic confidence was assessed significantly higher in T1-mVISTA.

• T1-mVISTA should be considered a supplement or an alternative to T1-MP-RAGE in patients with suspected leptomeningeal diseases.

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Abbreviations

3D:

Three-dimensional

CE:

Contrast-enhanced

CNR:

Contrast-to-noise ratio

CSF:

Cerebrospinal fluid

FLAIR:

Fluid-attenuated inversion recovery

GRE:

Gradient echo

MRI:

Magnetic resonance imaging

SE:

Spin echo

T1-MP-RAGE:

T1-weighted magnetization-prepared rapid gradient echo

T1-mVISTA:

T1-weighted-modified volumetric isotropic turbo spin-echo acquisition

T1-SPACE:

T1 sampling perfection with application-optimized contrasts by using different flip angle evolutions

T1:

T1-weighted

T2:

T2-weighted

TSE:

Turbo spin echo

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The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Department of Radiology, Ludwig-Maximilians-University Hospital, Ziemssenstr. 1, 80336, Munich, Germany

    Nora Navina Sommer, Romina Pons Lucas, Eva Coppenrath, Franziska Galiè, Nina Hesse, Wieland H. Sommer & Karla M. Treitl

  2. Philips Healthcare, Roentgenstrasse 22, 22335, Hamburg, Germany

    Hendrik Kooijman

  3. German Center for Cardiovascular Disease Research (DZHK e. V.), Pettenkoferstr. 8a, 80336, Munich, Germany

    Karla M. Treitl

  4. Radiologisches Zentrum Rosenheim, Stollstr. 6, 83022, Rosenheim, Germany

    Tobias Saam

  5. Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany

    Matthias F. Froelich

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  1. Nora Navina Sommer
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Correspondence to Nora Navina Sommer.

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The scientific guarantor of this publication is Nora Navina Sommer.

Conflict of interest

Dr. Hendrik Kooijman is an employee of Philips Healthcare.

For the remaining authors, no conflicts of interests were declared.

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Sommer, N.N., Pons Lucas, R., Coppenrath, E. et al. Contrast-enhanced modified 3D T1-weighted TSE black-blood imaging can improve detection of infectious and neoplastic meningitis. Eur Radiol 30, 866–876 (2020). https://doi.org/10.1007/s00330-019-06475-3

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  • DOI: https://doi.org/10.1007/s00330-019-06475-3

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