Diagnostic accuracy of MR imaging of patients with leptomeningeal seeding from lung adenocarcinoma based on 2017 RANO proposal: added value of contrast-enhanced 2D axial T2 FLAIR

Seong, Minjung; Park, Sehhoon; Kim, Sung Tae; Park, Sung Goo; Kim, Yi Kyung; Kim, Hyung Jin; Ahn, Myung Ju

doi:10.1007/s11060-020-03617-2

Cited by 13 publications

(13 citation statements)

References 11 publications

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“…In our previous study that evaluated the initial MRI at the diagnosis of LM, CE 2D FLAIR had a higher diagnostic performance than CE 3D T1WI [15]. In this study, both sensitivity and speci city were lower in CE 2D FLAIR than in CE 3D T1WI in the follow-up imaging; however, the differences are statistically insigni cant (p = 0.765 and 0.729, respectively).…”

Section: Discussioncontrasting

confidence: 51%

“…We retrospectively reviewed data of thirty-ve NSCLC patients registered to NCT03257124 from May 2017 to December 2018, who had progressed disease despite the chemotherapy using tyrosine kinase inhibitor (TKI) [10]. The patients are the same cohort who participated in the previous study [15]. In the previous study, the initial images of the patients were analyzed, and in contrast in this study, follow-up MRI was analyzed so the analyzed images did not overlap.…”

Section: Methodsmentioning

confidence: 99%

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Diagnostic Accuracy of MR Imaging of Patients with Leptomeningeal Seeding from Lung Adenocarcinoma after Chemotherapy using a Tyrosine Kinase Inhibitor

Seong

Park

Kim

et al. 2022

Preprint

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PurposeTo assess the diagnostic accuracy of contrast-enhanced(CE) MRI in evaluation of leptomeningeal metastasis(LM) on the MRI after chemotherapy with tyrosine kinase inhibitor(TKI). MethodsWe retrospectively reviewed data of 35 non-small cell lung cancer(NSCLC) patients registered to NCT03257124 from May 2017 to December 2018, who had progressed disease despite the chemotherapy using TKI and had CSF cytology result positive for malignant cells at the time of registration. 29 patients whose MRI exhibited LM at the time of registration were enrolled. After chemotherapy, MRI scans and following CSF exams were performed in every two months. Each patient underwent MRI scans from once to nine times. Total 113 MRI scans were evaluated. For each CE MRI scan, positivity for LM was evaluated in 3D T1-weighted image(T1WI) and 2D FLAIR, respectively. The diagnostic performance was calculated using CSF cytology result as a reference standard.ResultsCSF results were positive in 69 exams and negative in 44. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of CE 3D T1WI were 0.51, 0.55, 0.63, 0.41, and 0.52; and those of CE 2D FLAIR were 0.45, 0.49, 0.58, 0.36, and 0.46. After chemotherapy, discrepancy of CSF and MRI results tended to increase over time. Diagnostic accuracy of MRI after chemotherapy were 0.66, 0.58, 0.62, and 0.47 at the first, second, third, and fourth follow-up, respectively.ConclusionMRI is not satisfactory enough in evaluation of LM in NSCLC patients after treatment using TKI. CSF study may be inevitable for the evaluation of treatment response.

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Section: Discussioncontrasting

confidence: 51%

Section: Methodsmentioning

confidence: 99%

Diagnostic Accuracy of MR Imaging of Patients with Leptomeningeal Seeding from Lung Adenocarcinoma after Chemotherapy using a Tyrosine Kinase Inhibitor

Seong

Park

Kim

et al. 2022

Preprint

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“…Each patient was scanned by 3-T MRI using the brain tumor MRI protocol in our institution, including pre- and post-contrast 5-mm-thick T1-weighted imaging, 5-mm-thick fat-suppressed echo T2-weighted imaging, 5-mm-thick FLAIR imaging, diffusion weighted imaging (DWI), which was performed with spin echo using a b-value of 0 and 1000 s/mm 2 and dynamic susceptibility contrast (DSC)-perfusion-weighted imaging (PWI) (Dotarem; Guerbet, Aulnay-sous-Bois, France). T2*-perfusion data were processed for the maximum regional cerebral blood volume (rCBV) ratio of non-enhanced (NE) and contrast-enhanced (CE) portions, and rCBV maps were computed using the software provided by the MR vendor (Intellispace Portal 9.0; Philips Health Tech, Best, the Netherlands) 38 , 39 .…”

Section: Methodsmentioning

confidence: 99%

Histopathology and surgical outcome of symptomatic treatment-related changes after gamma knife radiosurgery in patients with brain metastases

Kim

Choi

Kong

et al. 2022

Sci Rep

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A late-onset treatment-related changes (TRCs), which represent radiographic radiation necrosis (RN), frequently occur after stereotactic radiosurgery (SRS) for brain metastases and often need surgical treatment. This study aimed to validate the true pathology and investigate clinical implication of surgically resected TRCs on advanced magnetic resonance imaging (MRI). Retrospective analyses of 86 patients who underwent surgical resection after radiosurgery of brain metastases were performed. Fifty-four patients displayed TRCs on preoperative MRI, comprising pure RN in 19 patients (TRC-RN group) and mixed viable tumor cells in 35 patients (TRC-PD group). Thirty-two patients revealed the consistent diagnosis of progressive disease in both MRI and histopathology (PD–PD group). The TRC-PD group showed larger prescription isodose volume (9.4 cm3) than the TRC-RN (4.06 cm3, p = 0.014) group and a shorter time interval from SRS to preoperative MRI diagnosis (median 4.07 months) than the PD–PD group (median 8.77 months, p = 0.004). Progression-free survival was significantly different among the three groups (p < 0.001), but not between TRC-RN and TRC-PD (post hoc test, p = 1.00), while no difference was observed in overall survival (p = 0.067). Brain metastases featured as TRCs after SRS frequently contained viable tumor cells. However, this histologic heterogeneity had a minor impact on benign local prognosis of TRCs after surgical resection.

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“…3). 6,13,20 This phenomenon can be explained by the following: first, Gd from damaged leptomeningeal vessels may leak into adjacent CSF, becoming diluted and consequently being present in low concentration. Second, FLAIR effectively suppresses the normal vasculature of the leptomeninges, which can be confused with abnormal enhancement in a variant of T1-weighted gradient echo sequences.…”

Section: Leptomeningeal Enhancementmentioning

confidence: 99%

Contrast‐Enhanced Fluid‐Attenuated Inversion Recovery in Neuroimaging: A Narrative Review on Clinical Applications and Technical Advances

Ahn

Taoka

Moon

et al. 2022

Magnetic Resonance Imaging

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While contrast‐enhanced fluid‐attenuated inversion recovery (FLAIR) has long been regarded as an adjunct sequence to evaluate leptomeningeal disease in addition to contrast‐enhanced T1‐weighted imaging, it is gradually being used for more diverse pathologies beyond leptomeningeal disease. Contrast‐enhanced FLAIR is known to be highly sensitive to low concentrations of gadolinium within the fluid. Accordingly, recent research has suggested the potential utility of contrast‐enhanced FLAIR in various kinds of disease, such as Meniere's disease, seizure, stroke, traumatic brain injury, and brain metastasis, in addition to being used for visualizing glymphatic dysfunction. However, its potential applications have been reported sporadically in an unorganized manner. Furthermore, the exact mechanism for its superior sensitivity to low concentrations of gadolinium has not been fully understood. Rapidly developing magnetic resonance technology and unoptimized parameters for FLAIR may challenge its accurate application in clinical practice. This review provides the fundamental mechanism of contrast‐enhanced FLAIR, systematically describes its current and potential clinical application, and elaborates on technical considerations for its optimization.Level of Evidence3Technical Efficacy Stage5

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Diagnostic accuracy of MR imaging of patients with leptomeningeal seeding from lung adenocarcinoma based on 2017 RANO proposal: added value of contrast-enhanced 2D axial T2 FLAIR

Cited by 13 publications

References 11 publications

Diagnostic Accuracy of MR Imaging of Patients with Leptomeningeal Seeding from Lung Adenocarcinoma after Chemotherapy using a Tyrosine Kinase Inhibitor

Diagnostic Accuracy of MR Imaging of Patients with Leptomeningeal Seeding from Lung Adenocarcinoma after Chemotherapy using a Tyrosine Kinase Inhibitor

Histopathology and surgical outcome of symptomatic treatment-related changes after gamma knife radiosurgery in patients with brain metastases

Contrast‐Enhanced Fluid‐Attenuated Inversion Recovery in Neuroimaging: A Narrative Review on Clinical Applications and Technical Advances

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