Application of 3D Fast Spin-Echo T1 Black-Blood Imaging in the Diagnosis and Prognostic Prediction of Patients with Leptomeningeal Carcinomatosis

Abstract

Background and purpose: Contrast-enhanced 3D fast spin-echo T1 black-blood imaging selectively suppresses the signal of blood flow and could provide a higher contrast-to-noise ratio compared with contrast-enhanced 3D ultrafast gradient recalled echo (contrast-enhanced gradient recalled echo) and 2D spin-echo T1WI (contrast-enhanced spin-echo). The purpose of our study was to evaluate whether black-blood imaging can improve the diagnostic accuracy for leptomeningeal carcinomatosis compared with contrast-enhanced gradient recalled-echo and contrast-enhanced spin-echo and, furthermore, to determine whether the grade of leptomeningeal carcinomatosis evaluated on black-blood imaging is a significant predictor of progression-free survival.

Materials and methods: Leptomeningeal carcinomatosis (n = 78) and healthy (n = 31) groups were enrolled. Contrast-enhanced gradient recalled-echo, contrast-enhanced spin-echo, and black-blood imaging were separately reviewed, and a diagnostic rating (positive, indeterminate, or negative) and grading of leptomeningeal carcinomatosis were assigned. The diagnostic accuracies of the 3 imaging sequences were compared in terms of leptomeningeal carcinomatosis detection. The Kaplan-Meier and the Cox proportional hazards model analyses were performed to determine the relationship between the leptomeningeal carcinomatosis grade evaluated on black-blood imaging and progression-free survival.

Results: Black-blood imaging showed a significantly higher sensitivity (97.43%) than contrast-enhanced gradient recalled-echo (64.1%) and contrast-enhanced spin-echo (66.67%) (P < .05). In terms of specificities, we did not find any significant differences among contrast-enhanced gradient recalled-echo (90.32%), contrast-enhanced spin-echo (90.32%), and black-blood imaging (96.77%) (P > .05). A Cox proportional hazards model identified the time to metastasis, Karnofsky Performance Scale status, and a combination of the leptomeningeal carcinomatosis grade with a linear pattern as independent predictors of progression-free survival (P < .05).

Conclusions: Black-blood imaging can improve the diagnostic accuracy and predict progression-free survival in patients with leptomeningeal carcinomatosis.

Fig 1.

MR images of a 60-year-old female patient with lung cancer. On all contrast-enhanced 3D ultrafast GRE (A and D), SE T1WI (B and E), and black-blood imaging (C and F), leptomeningeal enhancement along the sulci of the bilateral cerebral hemispheres and cerebellar surface was observed (arrows).

Fig 2.

MR images of a 60-year-old female patient with lung cancer. The contrast-enhanced 3D ultrafast GRE (A and D) and SE T1WI (B and E) were negatively interpreted by all raters. On only the black-blood imaging (C and F) scans was leptomeningeal enhancement along the interpeduncular cistern (C, arrow) and bilateral cerebellar surface observed (F, arrows).

Fig 3.

Kaplan-Meier curves showing a significant difference in the progression-free survival for the time to metastasis (A), Karnofsky Performance Scale (B), and a combination of the LC grade and pattern (C) with P values of .036, .036, and .009, respectively. When we compared the patients according to the cutoff values, the median PFS times were as follows: 12.27 months (95% CI, 3.37–15.00 months) versus 3.50 months (95% CI, 2.53–4.73 months; P = .036) in time to metastasis; 11.63 months (95% CI, 3.67–13.57 months) versus 3.37 months (95% CI, 1.37–4.73 months; P = .036) in KPS; and 4.87 months (95% CI, 3.47–1.27 months) versus 1.77 months (95% CI, 1.07–3.50 months; P = .009) in a combination of the LC grade and pattern, respectively.