Skip to main content
Advertisement

Main menu

  • Home
  • Content
    • Current Issue
    • Accepted Manuscripts
    • Article Preview
    • Past Issue Archive
    • Video Articles
    • AJNR Case Collection
    • Case of the Week Archive
    • Case of the Month Archive
    • Classic Case Archive
  • Special Collections
    • AJNR Awards
    • ASNR Foundation Special Collection
    • Most Impactful AJNR Articles
    • Photon-Counting CT
    • Spinal CSF Leak Articles (Jan 2020-June 2024)
  • Multimedia
    • AJNR Podcasts
    • AJNR SCANtastic
    • Trainee Corner
    • MRI Safety Corner
    • Imaging Protocols
  • For Authors
    • Submit a Manuscript
    • Submit a Video Article
    • Submit an eLetter to the Editor/Response
    • Manuscript Submission Guidelines
    • Statistical Tips
    • Fast Publishing of Accepted Manuscripts
    • Graphical Abstract Preparation
    • Imaging Protocol Submission
    • Author Policies
  • About Us
    • About AJNR
    • Editorial Board
    • Editorial Board Alumni
  • More
    • Become a Reviewer/Academy of Reviewers
    • Subscribers
    • Permissions
    • Alerts
    • Feedback
    • Advertisers
    • ASNR Home

User menu

  • Alerts
  • Log in

Search

  • Advanced search
American Journal of Neuroradiology
American Journal of Neuroradiology

American Journal of Neuroradiology

ASHNR American Society of Functional Neuroradiology ASHNR American Society of Pediatric Neuroradiology ASSR
  • Alerts
  • Log in

Advanced Search

  • Home
  • Content
    • Current Issue
    • Accepted Manuscripts
    • Article Preview
    • Past Issue Archive
    • Video Articles
    • AJNR Case Collection
    • Case of the Week Archive
    • Case of the Month Archive
    • Classic Case Archive
  • Special Collections
    • AJNR Awards
    • ASNR Foundation Special Collection
    • Most Impactful AJNR Articles
    • Photon-Counting CT
    • Spinal CSF Leak Articles (Jan 2020-June 2024)
  • Multimedia
    • AJNR Podcasts
    • AJNR SCANtastic
    • Trainee Corner
    • MRI Safety Corner
    • Imaging Protocols
  • For Authors
    • Submit a Manuscript
    • Submit a Video Article
    • Submit an eLetter to the Editor/Response
    • Manuscript Submission Guidelines
    • Statistical Tips
    • Fast Publishing of Accepted Manuscripts
    • Graphical Abstract Preparation
    • Imaging Protocol Submission
    • Author Policies
  • About Us
    • About AJNR
    • Editorial Board
    • Editorial Board Alumni
  • More
    • Become a Reviewer/Academy of Reviewers
    • Subscribers
    • Permissions
    • Alerts
    • Feedback
    • Advertisers
    • ASNR Home
  • Follow AJNR on Twitter
  • Visit AJNR on Facebook
  • Follow AJNR on Instagram
  • Join AJNR on LinkedIn
  • RSS Feeds

AJNR is seeking candidates for the AJNR Podcast Editor. Read the position description.

Research ArticleBrain

3D Turbo Spin-Echo Sequence with Motion-Sensitized Driven-Equilibrium Preparation for Detection of Brain Metastases on 3T MR Imaging

E. Nagao, T. Yoshiura, A. Hiwatashi, M. Obara, K. Yamashita, H. Kamano, Y. Takayama, K. Kobayashi and H. Honda
American Journal of Neuroradiology April 2011, 32 (4) 664-670; DOI: https://doi.org/10.3174/ajnr.A2343
E. Nagao
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
T. Yoshiura
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
A. Hiwatashi
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
M. Obara
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
K. Yamashita
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
H. Kamano
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Y. Takayama
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
K. Kobayashi
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
H. Honda
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Data
  • Info & Metrics
  • Responses
  • References
  • PDF
Loading

Abstract

BACKGROUND AND PURPOSE: MSDE preparation is a technique for black-blood imaging. Our purpose was to evaluate the usefulness of a 3D TSE sequence with MSDE preparation in detecting brain metastases by comparing it with conventional sequences.

MATERIALS AND METHODS: Postcontrast images of 227 patients who were suspected of having brain metastasis were prospectively obtained by using 3 T1-weighted 3D sequences: a gradient-echo sequence (MPRAGE), TSE-noMSDE, and TSE-MSDE. The number of visualized blood vessels and the lesion-to-normal CNR were compared among the 3 sequences. An observer test involving 9 radiologists was performed, and their diagnostic performance by using TSE-MSDE, MPRAGE, and combined TSE-MSDE and MPRAGE was compared by means of an FOM as an index of diagnostic performance derived by the JAFROC analysis, sensitivity, FP/case, and reading time.

RESULTS: TSE-MSDE resulted in significantly better vessel suppression than the other 2 methods. TSE with and without MSDE resulted in significantly higher CNRs than MPRAGE. In the observer test, significantly higher sensitivity and FOM as well as significantly shorter reading time were achieved by TSE-MSDE compared with MPRAGE, but FP/case was significantly higher with TSE-MSDE. Combined TSE-MSDE/MPRAGE resulted in significantly higher sensitivity and FOM and similar FP/case and reading time compared with MPRAGE alone.

CONCLUSIONS: With blood vessel suppression and increased CNR, TSE-MSDE improves radiologists' performances in detecting brain metastases compared with MPRAGE, but it may increase FP results. Combined with MPRAGE, TSE-MSDE achieves high diagnostic performance while maintaining a low FP rate.

Abbreviations

ANOVA
analysis of variance
CNR
contrast-to-noise ratio
FA
flip angle
FOM
figure of merit
FP
false-positive
FP/case
false-positive results per case
G
gradient
GRE
gradient-recalled echo
JAFROC
Jackknife Free-Response Receiver Operating Characteristic
LCD
liquid crystal display
LSMeans
least square means
MPRAGE
magnetization-prepared rapid acquisition of gradient echo
MSDE
motion-sensitized driven-equilibrium
NS
not significant
RF
radio-frequency
TSE
turbo spin-echo
TSE-MSDE
TSE with MSDE preparation
TSE-noMSDE
TSE without MSDE preparation
VENC
velocity-encoding

Brain metastases are the most common intracranial tumors in adults, affecting ≤20% of patients with cancer.1,2 They represent one of the most frequent neurologic complications of systemic cancer as a major cause of morbidity and mortality. Not only the presence or absence but also the number of brain metastases critically affects therapeutic strategies.3,4 For example, in the management of patients with multiple brain metastases, stereotactic radiosurgery along with whole-brain radiation therapy has been recommended when the number of lesions is ≤4.4,5 Thus, accurate pretreatment diagnosis by MR imaging is crucial.

Postcontrast 3D T1-weighted GRE imaging is widely used to detect brain metastases.6,7 In these images, a high signal intensity of enhancing blood vessels is a disturbing factor because it can be mistaken for enhancing metastases. The suppression of blood vessel signals may simplify radiologists' reading processes and, in turn, improve their performance. In this study, we introduced an MR image with MSDE preparation,8,9 aiming for blood vessel suppression. MSDE preparation is a technique for black-blood imaging and was first optimized to efficiently suppress signals from blood in imaging of the arterial wall.8–10 With MSDE preparation, the flow-sensitizing gradient pair introduces the phase dispersion among moving spins, as opposed to the stationary spins, resulting in selective suppression of signals from flowing blood. We implemented an MSDE preparation with a T1-weighted 3D TSE sequence because it has recently been shown that 3D TSE imaging can increase the CNR for brain metastases compared with a conventional GRE sequence.11,12 Therefore, our purpose was to evaluate the usefulness of TSE-MSDE in detecting brain metastases by comparison with conventional GRE imaging.

Materials and Methods

This study was approved by the institutional review board of our hospital. Written informed consent was obtained from volunteers and patients.

This study consisted of 3 parts. First, we performed a volunteer study to determine an appropriate VENC setting for TSE-MSDE. Next, we evaluated the image quality of the MSDE-TSE sequence by comparing it with conventional sequences. Specifically, the number of visualized vessels and lesion-to-normal CNR was compared. Finally, we conducted an observer test. For the latter 2 parts, we constructed a data base of patients' images from which appropriate cases were selected for the respective purposes.

Volunteer Study

With MSDE preparation, the degree of blood signal-intensity suppression depends on the VENC setting because lower VENC values result in the suppression of blood with a slower flow. 3D TSE-MSDE images of the brains of 2 healthy men (33 and 45 years old) were obtained by using a 3T MR imaging scanner (Achieva Quasar Dual; Philips Electronics, Best, the Netherlands) and an 8-channel array head coil after administration of a contrast agent (gadoteridol, ProHance; Eisai, Tokyo, Japan; 0.2 mmol/Kg). Figure 1 shows our TSE-MSDE sequence.13 Imaging parameters were as follows: TR/TE, 345/20 ms; FA, 90°; echo-train length, 11; refocus angle, 130°; sensitivity-encoding factors, 2.4 (phase) and 1.8 (section); FOV, 240 mm; voxel size, 1.0 × 1.0 × 1.0 mm3. Images were sequentially obtained at 6 VENC values: 7.2, 9.2, 10.8, 20.8, 39.6, and 55.0 mm/s. In our MSDE sequences, motion-sensitized gradients were inserted in all 3 directions. Therefore, the VENC values are indicated as resultant values. The first scan was started at 5 minutes after the contrast injection. To evaluate the possible effect of imaging order on the results, we reversed the order of the 6 scans in the second subject. The images were obtained in a sagittal plane, reconstructed into 2-mm-thick contiguous transverse sections, and displayed on an LCD monitor of a PACS (Rapideye; Toshiba Medical, Tokyo, Japan). For each VENC setting, blood vessels were visually counted by a board-certified radiologist (E.N.) in a single section at the level of the centrum semiovale.

Fig 1.
  • Download figure
  • Open in new tab
  • Download powerpoint
Fig 1.

Diagram of a TSE-MSDE used in this study. The MSDE preparation consists of a 90° excitation pulse, two 180° Malcolm Levitt refocusing pulses with each pulse sandwiched by bipolar motion-sensitizing gradients, and a −90° flip back pulse. The motion-sensitized gradients are inserted in all 3 (x, y, and z) directions. All refocusing pulses are implemented as composite pulses (90x-180y-90x). Bipolar gradients are used to reduce eddy current effects. An additional bipolar gradient is inserted in front of the sequence for further eddy current compensation.

Data Base of Patient Images

We constructed a data base of patient images by prospectively imaging consecutive patients who were referred for MR evaluation for possible brain metastasis. A total of 259 head MR imaging examinations from 227 patients were included in the data base. The MR imaging hardware and the contrast agent were the same as those used for the volunteer study. For each patient, we obtained 3 types of 3D postcontrast T1-weighted images sequentially: GRE (MPRAGE), TSE-noMSDE, and TSE-MSDE sequences. The parameters of the TSE-MSDE sequence are shown in the previous section. VENC was set at an appropriate value determined in the volunteer study, and the resultant shortest preparation duration was 14.7 ms. The parameters for MPRAGE were TR/TE, 8.2/3.8 ms; TI, 1028 ms; FA, 8°; sensitivity-encoding factors, 1 (phase) and 2.5 (section). The parameters for TSE-noMSDE were exactly the same as those for TSE-MSDE except for the absence of MSDE preparation. Imaging times for MPRAGE, TSE-noMSDE, and TSE-MSDE were 5 minutes 20 seconds, 7 minutes, and 7 minutes, respectively. All 3 sequences were obtained in a sagittal plane with the same FOV (240 mm) and voxel size (1.0 × 1.0 × 1.0 mm3) and were reconstructed in 2-mm-thick contiguous transverse images. The first postcontrast scan was started at 5 minutes after the contrast injection. The imaging order was MPRAGE, TSE-noMSDE, and TSE-MSDE (order 1 hereafter) in the first 62 examinations. The reverse order (order 2) was used for the remaining 197 examinations.

Determination of Metastatic Lesions

From the image data base, patients with a history of pathologically proved cancer and with at least 1 follow-up MR imaging examination were selected. There were 132 such patients. Two board-certified radiologists (E.N., T.Y.) reviewed all images of these patients in a consensus reading and selected intraparenchymal enhancing lesions that were visualized in both MPRAGE and TSE-MSDE. We excluded lesions visualized on only 1 of the 2 sequences, to stay conservative in determining the criterion standard. An effort was made to exclude artifacts and enhancing vessels, by carefully comparing the 2 images. Among the selected lesions, those satisfying any of the following conditions were determined to be metastases: 1) the size of the lesion increased in the follow-up period, 2) the lesion newly appeared during the follow-up period, and 3) the lesion received a treatment (either systemic chemotherapy or brain radiation therapy). Four hundred eighty-five lesions of 31 patients were recognized as metastases. During the same review, 174 patients were found to have no enhancing lesions.

Evaluation of Image Quality

Fifty patients with no enhancing lesion (35 men, 15 women; age, 26–87 years), including 25 imaged in order 1 and 25 in order 2, were randomly selected from the image data base. The images of these patients were further evaluated on the PACS by 1 board-certified radiologist (E.N.). For each of the 3 imaging methods, the degree of blood vessel suppression was evaluated by counting the visualized blood vessels in a single section at the level of the centrum semiovale. In addition, the lesion-to-normal CNR was compared. For the CNR evaluation, we selected lesions with a diameter ≥ 5 mm and homogeneous solid enhancement. As a result, 29 metastatic lesions, including 11 imaged in order 1 (1 man, 2 women; age, 46–74 years; 2 patients with lung cancer and 1 with thyroid cancer) and 18 in order 2 (8 male patients with lung cancer; age, 47–77 years) were selected. The CNR was calculated as follows: Embedded Image where SIlesion and SIbackground represent the mean signal intensities of the lesion and normal-appearing white matter in the same section, respectively, and SDlesion and SDbackground are the corresponding SDs.14 These parameters were obtained by defining circular regions of interest of 5 mm in each location.

Observer Study

Cases with 1–9 metastases were selected from the image data base, and as a result, 17 cases (12 men, 5 women; age, 37–87 years; 14 patients with lung cancer, 1 with oral floor carcinoma, 1 with breast cancer, and 1 with pancreatic cancer) with 50 lesions were chosen. Among the 17 cases, 1 case was imaged in order 1 and 16 in order 2. Figure 2 shows the distribution of lesion size. In addition, 17 cases without any enhancing lesions (12 men, 5 women; age, 48–84 years; 15 patients with lung cancer, 1 with gastric cancer, and 1 with renal cell carcinoma) were selected, among which 2 cases were scanned in order 1 and the other 15 in order 2. These 34 cases were used for the observer tests. We included only MPRAGE and TSE-MSDE for the observer test because an evaluation of image quality revealed that TSE-MSDE showed better blood vessel suppression than TSE-noMSDE and similar CNR.

Fig 2.
  • Download figure
  • Open in new tab
  • Download powerpoint
Fig 2.

The distribution of the 50 metastatic lesions used in the observer study according to lesion diameter, which ranged from 2 to 36 mm, with an average of 6.8 mm.

Nine radiologists who were blinded to the patients' clinical information, including 4 first-year radiology residents who each had 6 months of experience in radiology practice and 5 board-certified radiologists who had 16, 13, 10, 9, and 7 years of experience, respectively, participated in the observer test. None of the 9 radiologists participated in the case selection. Each radiologist took part in 3 reading sessions, which were each at least 1 month apart. They read TSE-MSDE, MPRAGE, and both of these, in the first, second, and third reading sessions, respectively. All images were displayed on a 20.8-inch LCD monitor. The radiologists were allowed to freely increment the sections by using a mouse with a wheel. In each reading session, the 34 cases were presented in a randomized order. For a training session before the test, 3 training cases, each of which had 10–12 metastases, were provided to the radiologists to familiarize them with the operation of the PACS and the rating system. The radiologists were asked to place an arrow electronically in each location where they found a metastasis, to record the results of the readings. In the third reading session, in which both TSE-MSDE and MPRAGE were read, the observers were instructed to use TSE-MSDE to pick up high-signal-intensity areas as candidates for metastases and MPRAGE as a second opinion to reject FPs such as enhancing vessels and artifacts, taking advantage of the synchronized section increment capability of the PACS. The radiologists were asked to report their level of confidence in the presence of metastasis at each location by using a rating bar scale, on which the right and left ends corresponded to the highest (100) and lowest (0) confidence levels, respectively. The reading time for each case was recorded.

Statistical Analyses

The number of blood vessels and CNR was compared by using LSMeans Student t test when 2-way ANOVA was significant.

To evaluate the radiologists' performances in the observer test, we used JAFROC analysis.15,16 This analysis has been proposed to statistically estimate the differences in diagnostic performance between different modalities when location issues are relevant. We applied JAFROC analysis with method 1 of Chakraborty and Berbaum15 to estimate an FOM value as an index of each radiologist's performance in each session. A free software package (JAFROC1, http://www.devchakraborty.com) was available. We also obtained the sensitivity and the number of FPs/case. Imaging findings related to the FP results judged by the consensus of the 2 board-certified radiologists (E.N., T.Y.) were reported. Additionally, sensitivities were compared among the 3 sessions according to lesion size: small (≤5 mm in shorter diameter) and large (>5 mm).

The sensitivity, FP/case, and reading time among the 3 reading sessions were compared by using a LSMeans Student t test when 2-way ANOVA was significant. The difference in sensitivity between small and large lesions was analyzed by using the t test. For all analyses, P < .05 was considered statistically significant.

Results

Volunteer Study

The number of vessels in TSE-MSDE decreased with decreasing VENC values until reaching a plateau at 10.8 mm/s and below (Figs 3 and 4). Similar results were reproduced in the 2 subjects independent of the imaging order. On the basis of these results, we decided to use a VENC value of 10.8 mm/s for the following studies.

Fig 3.
  • Download figure
  • Open in new tab
  • Download powerpoint
Fig 3.

Number of blood vessels visualized in a single section of a postcontrast image obtained by using TSE-MSDE sequences at different VENC settings in 2 healthy volunteers. Lower VENC settings were used in earlier scans for volunteer 1, whereas the imaging order was reversed for volunteer 2.

Fig 4.
  • Download figure
  • Open in new tab
  • Download powerpoint
Fig 4.

Postcontrast TSE-MSDE images for a volunteer (volunteer 1) obtained at 6 different VENC settings that are indicated in millimeters per second. Note that fewer blood vessels are visualized at lower VENC settings.

Evaluation of Image Quality

Figure 5 shows the number of vessels counted in imaged orders 1 and 2. In both imaging orders, significantly fewer blood vessels were visualized in TSE-MSDE than in either MPRAGE or TSE-noMSDE (P < .001, respectively), and significantly fewer blood vessels were visualized in TSE-noMSDE than in MPRAGE (P < .001). In each imaging order, both TSE-noMSDE and TSE-MSDE showed significantly higher CNRs compared with MPRAGE (P < .05, respectively), whereas no significant difference was seen between TSE-noMSDE and TSE-MSDE (Fig 6).

Fig 5.
  • Download figure
  • Open in new tab
  • Download powerpoint
Fig 5.

Comparison of blood vessel numbers in the MPRAGE, TSE-noMSDE, and TSE-MSDE. A, The results for cases in which postcontrast images were obtained in the order of MPRAGE, TSE-noMSDE, and then TSE-MSDE (order 1, n = 25). B, The results for the reverse order (order 2, n = 25). Significant differences are found among the 3 imaging methods for both orders (P < .001, respectively).

Fig 6.
  • Download figure
  • Open in new tab
  • Download powerpoint
Fig 6.

Comparison of CNRs for metastatic lesions for MPRAGE, TSE-noMSDE, and TSE-MSDE. A and B, Results for order 1 (n = 25) and order 2 (n = 25), respectively. Significant differences are found between MPRAGE and TSE-noMSDE and between MPRAGE and TSE-MSDE for both orders (P < .05, respectively), whereas no significant difference is found between TSE-noMSDE and TSE-MSDE for either imaging order.

Observer Study

Figure 7 shows an example of a metastasis imaged with TSE-MSDE and MPRAGE.

Fig 7.
  • Download figure
  • Open in new tab
  • Download powerpoint
Fig 7.

A brain metastasis imaged with TSE-MSDE (A) and MPRAGE (B). Note that the lesion is clearly visualized in TSE-MSDE (arrow), whereas it is poorly visualized in MPRAGE (arrow). Also note the well-suppressed blood vessels in TSE-MSDE. In the observer study, this lesion was overlooked by all 4 residents and by 2 of the 5 board-certified radiologists on MPRAGE, while it was correctly detected by 2 residents and all 5 board-certified radiologists on TSE-MSDE.

The On-line Table summarizes the results of the observer study. Sensitivity with TSE-MSDE was higher than that with MPRAGE for all radiologists (P < .001). On the other hand, FP/case increased with the use of TSE-MSDE compared with MPRAGE among residents (P < .001) and all 9 radiologists (P = .002), whereas no significant difference was found among board-certified radiologists. The FOM with TSE-MSDE was significantly higher than that with MPRAGE for all radiologists (P < .05).

The combined use of TSE-MSDE and MPRAGE resulted in significantly higher overall sensitivity than the use of MPRAGE alone (P < .001), whereas it did not significantly differ in sensitivity from TSE-MSDE alone. FP/case with the combined TSE-MSDE/MPRAGE was significantly lower than that with TSE-MSDE alone (P = .004), whereas it did not significantly differ from that with MPRAGE alone. FOM with combined TSE-MSDE/MPRAGE was significantly higher than that with MPRAGE alone among residents (P < .05) and among all 9 radiologists (P < .05), whereas FOMs with these 2 methods did not significantly differ among board-certified radiologists. Only among residents, FOM with combined TSE-MSDE/MPRAGE was significantly higher than that with TSE-MSDE alone (P < .05).

The average reading time with TSE-MSDE was significantly shorter than that with MPRAGE for all radiologists (P < .001) (Table 1). Among the residents, the reading time with combined TSE-MSDE/MPRAGE was significantly shorter than that with MPRAGE alone (P < .001), whereas the reading times with the 2 methods did not significantly differ among board-certified radiologists or among all 9 radiologists (Table 1). The reading time with combined TSE-MSDE/MPRAGE was significantly longer than that with TSE-MSDE alone (P < .001) (Table 2).

View this table:
  • View inline
  • View popup
Table 1:

Average reading time per case for each observer for each reading sessiona

View this table:
  • View inline
  • View popup
Table 2:

Comparison of the sensitivity for 3 reading sessions according to the lesion sizea

Sensitivities with both TSE-MSDE and combined TSE-MSDE/MPRAGE were significantly higher than that with MPRAGE in detecting small (≤ 5 mm) lesions (P < .001, respectively), whereas no significant difference was found in sensitivity in detecting large (>5 mm) lesions among the 3 methods (Table 2).

For each reading session, vessels were the most common imaging finding resulting in FPs, followed by artifacts (Table 3).

View this table:
  • View inline
  • View popup
Table 3:

Summary of imaging findings related to false-positive results for 3 reading sessionsa

Discussion

Our volunteer study confirmed that MSDE preparation at lower VENC settings effectively suppresses blood vessel signals in postcontrast T1-weighted images (Figs 3 and 4). However, a certain number of blood vessels remained visualized even at the lowest VENC setting (7.2 mm/s), suggesting that they had very slow blood flow.

Our vessel-counting results demonstrated that TSE-MSDE achieves better blood vessel suppression than both MPRAGE and TSE-noMSDE (Fig 5). They also showed that blood vessel suppression occurred in TSE even without MSDE (Fig 5), which is consistent with a previous report11 in which the variable FA echo-train technique was used, though that is not directly comparable with our result because we did not use such a technique in our TSE sequences. The better suppression of vessels by TSE-MSDE than by TSE-noMSDE suggests that MSDE preparation effectively suppressed vessels with slower blood flow, such as small veins.

Comparisons of CNRs showed that both TSE-noMSDE and TSE-MSDE improved CNR compared with MPRAGE (Fig 6); these results are consistent with previous reports.11,12

Our observer test revealed that TSE-MSDE significantly improved sensitivity compared with MPRAGE (On-line Table), especially for small lesions (Table 2). This high sensitivity of TSE-MSDE is likely due to the blood vessel suppression and high CNR, which was found in our evaluation of image quality (Figs 5 and 6). Because 16 of 17 cases with metastases used in the observer study were imaged in order 2 (TSE-MSDE, TSE-noMSDE, and then MPRAGE), a possible effect of delayed enhancement17 would have favored MPRAGE rather than TSE-MSDE, though such an effect should be minimized over a postinjection period of 5–20 minutes.18 In careful reading, high signal intensities of enhancing vessels can be distinguished from metastases on the basis of the curvilinear shapes of the former. However, they might have distracted the radiologists, possibly causing the real metastases to be overlooked.

The mean FOM value for TSE-MSDE was significantly higher than that for MPRAGE, not only among the residents but also among the board-certified radiologists (On-line Table). Moreover, the reading time for TSE-MSDE was significantly shorter than that for MPRAGE (Table 1), suggesting that radiologists' reading processes were simplified with TSE-MSDE. Nevertheless, TSE-MSDE was associated with significantly higher FPs/case compared with MPRAGE among the residents and all 9 radiologists (On-line Table). Analyses of FP results revealed that enhancing vessels were the most common mimickers of metastasis, even in TSE-MSDE (Table 3). As shown in our results (Figs 3 and 5), a fraction of the vessels remained visible in TSE-MSDE, presumably due to their lower flow velocity. We consider that vessels can closely mimic small enhancing nodules, especially when they are partially faded by the MSDE preparation (Fig 8). Although TSE-MSDE proved to have a higher FOM than MPRAGE, its higher risk for producing FP results should not be ignored.

Fig 8.
  • Download figure
  • Open in new tab
  • Download powerpoint
Fig 8.

An enhancing blood vessel mimicking a metastatic tumor. TSE-MSDE shows a nodulelike enhancement (arrow) in the right frontal lobe (A), which is not visualized in the next section at 2 mm below (arrow) (B). C and D, In MPRAGE, an enhancing blood vessel (arrows) running across the 2 contiguous sections is visualized in the corresponding area, revealing that the nodulelike enhancement in TSE-MSDE is a partially faded blood vessel.

When TSE-MSDE and MPRAGE were used in combination, sensitivity was comparable with that with TSE-MSDE alone and was significantly higher than that with MPRAGE alone (On-line Table). Moreover, there was no significant difference in FP/case between combined TSE-MSDE/MPRAGE and MPRAGE alone (On-line Table). We assume that the better vessel visualization on the MPRAGE allowed the observers to eliminate the vessels as FPs on the concomitantly used TSE-MSDE sequence. FOM was significantly higher with combined TSE-MSDE/MPRAGE than with MPRAGE alone among residents and all 9 radiologists (On-line Table). FOM was higher with combined TSE-MSDE/MPRAGE than with MPRAGE alone among 4 of 5 board-certified radiologists, though the difference did not reach statistical significance. Furthermore, the reading time with combined TSE-MSDE/MPRAGE was not longer than that with MPRAGE alone (Table 1). We speculate that the observers were successful in combining 2 images as instructed, taking advantage of the synchronized section-increment function of PACS. Taken together, our results suggested that combined TSE-MSDE/MPRAGE was superior to either TSE-MSDE or MPRAGE alone, though this combined method would require an extended imaging time.

The limitations of this study include a lack of pathologic confirmation of the diagnosis of metastasis. Instead, we used clinical criteria customized for this study, which may have been too generous. Contamination of other pathologies with enhancement, such as subacute infarction, cannot be completely eliminated from imaging findings alone. In addition, because we included only lesions that were visualized on both MPRAGE and TSE-MSDE, true metastatic lesions that were seen only in 1 of the 2 sequences might have been excluded. Nevertheless, we believe that our performance comparisons among the different imaging/reading methods are convincing enough. Among the 17 cases with metastasis used in our observer study, only 1 was obtained in order 1 while the other 16 cases were imaged in order 2. This unevenness was partly due to the inequality in the number of examinations performed with these 2 orders (see “Materials and Methods”). Inclusion of a similar number of cases scanned in orders 1 and 2 would have simplified the interpretation of the results of our observer study, though we believe that this unevenness has not distorted our conclusion. Another possible limitation is the relatively small number of cases included for the observer test. However, tests with more cases would have been exceedingly exhausting. Although our results suggest the usefulness of TSE-MSDE in detecting brain metastases, this does not necessarily indicate the superiority of the TSE-MSDE over the conventional sequences for general purposes. For example, we noticed that the contrast between the gray matter and white matter is reduced in TSE-MSDE compared with MPRAGE as seen in Figs 7 and 8. This may hamper accurate anatomic localization of certain brain lesions. Moreover, a longer imaging time (7 minutes) for TSE-MSDE compared with MPRAGE (5 minutes 20 seconds) may lead to higher risk for motion-related artifacts.

Conclusions

Our results showed that compared with conventional MPRAGE, TSE-MSDE improved the radiologists' performances in detecting brain metastases through the suppression of blood vessels and increased lesion-to-normal CNR, but it increased the risk of FP results. Combined with MPRAGE, TSE-MSDE achieves high diagnostic performance while maintaining a low FP rate.

Footnotes

  • Indicates article with supplemental on-line table.

References

  1. 1.↵
    1. Posner JB,
    2. Chernic NL
    . Intracranial metastases from systemic cancer. Adv Neurol 1978;19:579–52
    PubMed
  2. 2.↵
    1. Walker MD
    1. Cairncross JG,
    2. Posner JB
    . The management of brain metastases. In: Walker MD ed. Oncology of the Nervous System. Boston:Martinus Nijhoff;1983:341–77
  3. 3.↵
    1. Sills AK
    . Current treatment approaches to surgery for brain metastases. Neurosurgery 2005;57:24–32
  4. 4.↵
    1. Linskey ME,
    2. Andrews DW,
    3. Asher AL,
    4. et al
    . The role of stereotactic radiosurgery in the management of patients with newly diagnosed brain metastases: a systematic review and evidence-based clinical practice guideline. J Neurooncol 2009;96:45–68
    PubMed
  5. 5.↵
    1. Kondziolka D,
    2. Patel A,
    3. Lunsford LD,
    4. et al
    . Stereotactic radiosurgery plus whole brain radiotherapy versus radiotherapy alone for patients with multiple brain metastases. Int J Radiat Oncol Biol Phys 1999;45:427–34
    PubMed
  6. 6.↵
    1. Kakeda S,
    2. Korogi Y,
    3. Hiai Y,
    4. et al
    . Detection of brain metastasis at 3T: comparison among SE, IR-FSE and 3D-GRE sequences. Eur Radiol 2007;17:2345–51
    CrossRefPubMed
  7. 7.↵
    1. Furutani K,
    2. Harada M,
    3. Mawlan M,
    4. et al
    . Difference in enhancement between spin echo and 3-dimensional fast spoiled gradient recalled acquisition in steady state magnetic resonance imaging of brain metastasis at 3-T magnetic resonance imaging. J Comput Assist Tomogr 2008;32:313–19
    CrossRefPubMed
  8. 8.↵
    1. Koktzoglou I,
    2. Li D
    . Diffusion-prepared segmented steady-state free precession: application to 3D black-blood cardiovascular magnetic resonance of the thoracic aorta and carotid artery walls. J Cardiovasc Magn Reson 2007;9:33–42
    CrossRefPubMed
  9. 9.↵
    1. Wang J,
    2. Yarnykh VL,
    3. Hatsukami T,
    4. et al
    . Improved suppression of plaque-mimicking artifacts in black-blood carotid atherosclerosis imaging using a multislice motion-sensitized driven-equilibrium (MSDE) turbo spin-echo (TSE) sequence. Magn Reson Med 2007;58:973–81
    CrossRefPubMed
  10. 10.↵
    1. Wang J,
    2. Yarnykh VL,
    3. Yuan C
    . Enhanced image quality in black-blood MRI using the improved motion-sensitized driven-equilibrium (iMSDE) sequence. J Magn Reson Imaging 2010;31:1256–63
    CrossRefPubMed
  11. 11.↵
    1. Komada T,
    2. Naganawa S,
    3. Ogawa S,
    4. et al
    . Contrast-enhanced MR imaging of metastatic brain tumor at 3 Tesla: utility of T1-weighted SPACE compared with 2D spin echo and 3D gradient echo sequence. Magn Reson Med Sci 2008;7:13–21
    CrossRefPubMed
  12. 12.↵
    1. Kato Y,
    2. Higano S,
    3. Tamura H,
    4. et al
    . Usefulness of contrast-enhanced T1-weighted sampling perfection with application-optimized contrasts by using different flip angle evolutions in detection of small brain metastasis at 3T MR imaging: comparison with magnetization-prepared rapid acquisition of gradient echo imaging. AJNR Am J Neuroradiol 2009;30:923–29
    Abstract/FREE Full Text
  13. 13.↵
    1. Obara M,
    2. Honda M,
    3. Imai Y,
    4. et al
    . Assessment of motion sensitized driven equilibrium (MSDE) improvement for whole brain application. In: Proceedings of the International Society for Magnetic Resonance in Medicine, Honolulu, Hawaii. April 18–24, 2009:4547
  14. 14.↵
    1. Nezafat R,
    2. Stuber M,
    3. Ouwerkerk R,
    4. et al
    . B1-insensitive T2 preparation for improved coronary magnetic resonance angiography at 3T. Magn Reson Med 2006;55:858–64
    CrossRefPubMed
  15. 15.↵
    1. Chakraborty DP,
    2. Berbaum KS
    . Observer studies involving detection and localization: modeling, analysis, and validation. Med Phys 2004;31:2313–30
    CrossRefPubMed
  16. 16.↵
    1. Chakraborty DP
    . Analysis of location specific observer performance data: validated extensions of the jackknife free-response (JAFROC) method. Acad Radiol 2006;13:1187–93
    CrossRefPubMed
  17. 17.↵
    1. Graif M,
    2. Bydder GM,
    3. Steiner RE,
    4. et al
    . Contrast-enhanced MR imaging of malignant brain tumors. AJNR Am J Neuroradiol 1985;6:855–62
    Abstract/FREE Full Text
  18. 18.↵
    1. Yuh WT,
    2. Engelken JD,
    3. Muhonen MG,
    4. et al
    . Experience with high-dose gadolinium MR imaging in the evaluation of brain metastases. AJNR Am J Neuroradiol 1992;13:335–45
    Abstract/FREE Full Text
  • Received July 5, 2010.
  • Accepted after revision August 18, 2010.
  • Copyright © American Society of Neuroradiology
View Abstract
PreviousNext
Back to top

In this issue

American Journal of Neuroradiology: 32 (4)
American Journal of Neuroradiology
Vol. 32, Issue 4
1 Apr 2011
  • Table of Contents
  • Index by author
Advertisement
Print
Download PDF
Email Article

Thank you for your interest in spreading the word on American Journal of Neuroradiology.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
3D Turbo Spin-Echo Sequence with Motion-Sensitized Driven-Equilibrium Preparation for Detection of Brain Metastases on 3T MR Imaging
(Your Name) has sent you a message from American Journal of Neuroradiology
(Your Name) thought you would like to see the American Journal of Neuroradiology web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Cite this article
E. Nagao, T. Yoshiura, A. Hiwatashi, M. Obara, K. Yamashita, H. Kamano, Y. Takayama, K. Kobayashi, H. Honda
3D Turbo Spin-Echo Sequence with Motion-Sensitized Driven-Equilibrium Preparation for Detection of Brain Metastases on 3T MR Imaging
American Journal of Neuroradiology Apr 2011, 32 (4) 664-670; DOI: 10.3174/ajnr.A2343

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
0 Responses
Respond to this article
Share
Bookmark this article
3D Turbo Spin-Echo Sequence with Motion-Sensitized Driven-Equilibrium Preparation for Detection of Brain Metastases on 3T MR Imaging
E. Nagao, T. Yoshiura, A. Hiwatashi, M. Obara, K. Yamashita, H. Kamano, Y. Takayama, K. Kobayashi, H. Honda
American Journal of Neuroradiology Apr 2011, 32 (4) 664-670; DOI: 10.3174/ajnr.A2343
del.icio.us logo Twitter logo Facebook logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One
Purchase

Jump to section

  • Article
    • Abstract
    • Abbreviations
    • Materials and Methods
    • Results
    • Discussion
    • Conclusions
    • Footnotes
    • References
  • Figures & Data
  • Info & Metrics
  • Responses
  • References
  • PDF

Related Articles

  • No related articles found.
  • PubMed
  • Google Scholar

Cited By...

  • Prospective Comparison of T1-SPACE and MPRAGE for the Identification of Intrinsic T1 Hyperintensity in Patients with Intracranial Melanoma Metastases
  • Improved Blood Suppression of Motion-Sensitized Driven Equilibrium in High-Resolution Whole-Brain Vessel Wall Imaging: Comparison of Contrast-Enhanced 3D T1-Weighted FSE with Motion-Sensitized Driven Equilibrium and Delay Alternating with Nutation for Tailored Excitation
  • Usefulness of the Delay Alternating with Nutation for Tailored Excitation Pulse with T1-Weighted Sampling Perfection with Application-Optimized Contrasts Using Different Flip Angle Evolution in the Detection of Cerebral Metastases: Comparison with MPRAGE Imaging
  • Evaluation of Diffusivity in the Anterior Lobe of the Pituitary Gland: 3D Turbo Field Echo with Diffusion-Sensitized Driven-Equilibrium Preparation
  • Visualization of the Trochlear Nerve in the Cistern with Use of High-Resolution Turbo Spin-Echo Multisection Motion-Sensitized Driven Equilibrium
  • Crossref (85)
  • Google Scholar

This article has been cited by the following articles in journals that are participating in Crossref Cited-by Linking.

  • EANO–ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up of patients with brain metastasis from solid tumours
    E. Le Rhun, M. Guckenberger, M. Smits, R. Dummer, T. Bachelot, F. Sahm, N. Galldiks, E. de Azambuja, A.S. Berghoff, P. Metellus, S. Peters, Y.-K. Hong, F. Winkler, D. Schadendorf, M. van den Bent, J. Seoane, R. Stahel, G. Minniti, P. Wesseling, M. Weller, M. Preusser
    Annals of Oncology 2021 32 11
  • Consensus recommendations for a standardized brain tumor imaging protocol for clinical trials in brain metastases
    Timothy J Kaufmann, Marion Smits, Jerrold Boxerman, Raymond Huang, Daniel P Barboriak, Michael Weller, Caroline Chung, Christina Tsien, Paul D Brown, Lalitha Shankar, Evanthia Galanis, Elizabeth Gerstner, Martin J van den Bent, Terry C Burns, Ian F Parney, Gavin Dunn, Priscilla K Brastianos, Nancy U Lin, Patrick Y Wen, Benjamin M Ellingson
    Neuro-Oncology 2020 22 6
  • Wall Enhancement of the Intracranial Aneurysms Revealed by Magnetic Resonance Vessel Wall Imaging Using Three-Dimensional Turbo Spin-Echo Sequence with Motion-Sensitized Driven-Equilibrium: A Sign of Ruptured Aneurysm?
    S. Nagahata, M. Nagahata, M. Obara, R. Kondo, N. Minagawa, S. Sato, S. Sato, W. Mouri, S. Saito, T. Kayama
    Clinical Neuroradiology 2016 26 3
  • Different spatial distributions of brain metastases from lung cancer by histological subtype and mutation status of epidermal growth factor receptor
    Koji Takano, Manabu Kinoshita, Masatoshi Takagaki, Mio Sakai, Souichirou Tateishi, Takamune Achiha, Ryuichi Hirayama, Kazumi Nishino, Junji Uchida, Toru Kumagai, Jiro Okami, Atsushi Kawaguchi, Naoya Hashimoto, Katsuyuki Nakanishi, Fumio Imamura, Masahiko Higashiyama, Toshiki Yoshimine
    Neuro-Oncology 2016 18 5
  • The detectability of brain metastases using contrast-enhanced spin-echo or gradient-echo images: a systematic review and meta-analysis
    Chong Hyun Suh, Seung Chai Jung, Kyung Won Kim, Junhee Pyo
    Journal of Neuro-Oncology 2016 129 2
  • Spatial brain distribution of intra-axial metastatic lesions in breast and lung cancer patients
    Carlo Cosimo Quattrocchi, Yuri Errante, Chiara Gaudino, Carlo Augusto Mallio, Alessandro Giona, Daniele Santini, Giuseppe Tonini, Bruno Beomonte Zobel
    Journal of Neuro-Oncology 2012 110 1
  • Detection of Small Metastatic Brain Tumors
    Jaeseok Park, Jinna Kim, Eunhye Yoo, Hyunyeol Lee, Jong-Hee Chang, Eung Yeop Kim
    Investigative Radiology 2012 47 2
  • Computer-Aided Detection of Metastatic Brain Tumors Using Magnetic Resonance Black-Blood Imaging
    Seungwook Yang, Yoonho Nam, Min-Oh Kim, Eung Yeop Kim, Jaeseok Park, Dong-Hyun Kim
    Investigative Radiology 2013 48 2
  • Subtypes of breast cancer show different spatial distributions of brain metastases
    Sunghyon Kyeong, Yoon Jin Cha, Sung Gwe Ahn, Sang Hyun Suh, Eun Ju Son, Sung Jun Ahn, William B. Coleman
    PLOS ONE 2017 12 11
  • Magnetic Resonance Imaging Technique for Visualization of Irregular Cerebrospinal Fluid Motion in the Ventricular System and Subarachnoid Space
    Tomohiko Horie, Nao Kajihara, Mitsunori Matsumae, Makoto Obara, Naokazu Hayashi, Akihiro Hirayama, Ken Takizawa, Taro Takahara, Satoshi Yatsushiro, Kagayaki Kuroda
    World Neurosurgery 2017 97

More in this TOC Section

  • SWI or T2*: Which MRI Sequence to Use in the Detection of Cerebral Microbleeds? The Karolinska Imaging Dementia Study
  • Progression of Microstructural Damage in Spinocerebellar Ataxia Type 2: A Longitudinal DTI Study
  • Statin Therapy Does Not Affect the Radiographic and Clinical Profile of Patients with TIA and Minor Stroke
Show more BRAIN

Similar Articles

Advertisement

Indexed Content

  • Current Issue
  • Accepted Manuscripts
  • Article Preview
  • Past Issues
  • Editorials
  • Editor's Choice
  • Fellows' Journal Club
  • Letters to the Editor
  • Video Articles

Cases

  • Case Collection
  • Archive - Case of the Week
  • Archive - Case of the Month
  • Archive - Classic Case

Special Collections

  • AJNR Awards
  • ASNR Foundation Special Collection
  • Most Impactful AJNR Articles
  • Photon-Counting CT
  • Spinal CSF Leak Articles (Jan 2020-June 2024)

More from AJNR

  • Trainee Corner
  • Imaging Protocols
  • MRI Safety Corner

Multimedia

  • AJNR Podcasts
  • AJNR Scantastics

Resources

  • Turnaround Time
  • Submit a Manuscript
  • Submit a Video Article
  • Submit an eLetter to the Editor/Response
  • Manuscript Submission Guidelines
  • Statistical Tips
  • Fast Publishing of Accepted Manuscripts
  • Graphical Abstract Preparation
  • Imaging Protocol Submission
  • Evidence-Based Medicine Level Guide
  • Publishing Checklists
  • Author Policies
  • Become a Reviewer/Academy of Reviewers
  • News and Updates

About Us

  • About AJNR
  • Editorial Board
  • Editorial Board Alumni
  • Alerts
  • Permissions
  • Not an AJNR Subscriber? Join Now
  • Advertise with Us
  • Librarian Resources
  • Feedback
  • Terms and Conditions
  • AJNR Editorial Board Alumni

American Society of Neuroradiology

  • Not an ASNR Member? Join Now

© 2025 by the American Society of Neuroradiology All rights, including for text and data mining, AI training, and similar technologies, are reserved.
Print ISSN: 0195-6108 Online ISSN: 1936-959X

Powered by HighWire