PT  - JOURNAL ARTICLE
AU  - Singh, Sanjay K.
AU  - Leeds, Norman E.
AU  - Ginsberg, Lawrence E.
TI  - MR Imaging of Leptomeningeal Metastases: Comparison of Three Sequences
DP  - 2002 May 01
TA  - American Journal of Neuroradiology
PG  - 817--821
VI  - 23
IP  - 5
4099  - http://www.ajnr.org/content/23/5/817.short
4100  - http://www.ajnr.org/content/23/5/817.full
SO  - Am. J. Neuroradiol.2002 May 01; 23
AB  - 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.