Ali Batouli1 Dennis Monks1 Sobia Mirza1 Michael Goldberg1

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Presentation transcript:

Parenchyma Nulling T1 Weighted Inversion Recovery: Improving the Detection of Brain Tumors Ali Batouli1 Dennis Monks1 Sobia Mirza1 Michael Goldberg1 Emanuel Kanal2 Michael Spearman1 1Allegheny Health Network 2University of Pittsburgh eP-103

Disclosures The authors have no disclosures

Purpose Compare the effectiveness of a novel parenchyma nulling T1 weighted inversion recovery sequence (PNIR) to that of spin echo magnetization transfer (SEMT) in detecting enhancing brain tumors.

Materials and Methods PNIR sequence parameters were developed to reduce signal from gray matter (GM), white matter (WM) and CSF in a healthy adult volunteer.

Sequence Parameters PNIR (test) SEMT (standard) TR (ms) 700 445 TE (ms) 11 17 Excitations 2 1 Concatenations 5 Flip Angle 150 Acquisition time (mins) 04:38 02:35 Sections 23 Matrix 256 x 192 Field of View (mm) 230 Slice thickness (mm) Gap (mm) 1.5

Sample and Design 41 patients with known or suspected brain tumors underwent PNIR (test) and SEMT (standard of care) imaging after the administration of intravenous gadobenate dimeglumine. Patients ranged from 21 to 74 years old (mean 51) 14 of the patients had enhancing brain tumors, with a total of 23 tumors analyzed Tumor pathology included GBM, meningoma, grade 3 astrocytoma, ganglioglioma and metastases

Outcomes Tested In patients with tumors, the following comparisons were made: Tumor-to-WM, Tumor-to-GM, Tumor-to-CSF contrast ratios (CR) Contrast Ratio = (Tumor Signal – Background Tissue Signal)/ Background Tissue Signal Calculations were done for the maximum and average values found within the tumor

Outcomes Tested In patients with tumors, comparisons were made in regards to Radiologist rated subjective conspicuity Two neuroradiologists independently reviewed each tumor on both sequences

Results: Normal Patients PNIR SEMT

Signal of Tissues Comparison of absolute signal by tissue type PNIR (95% CI) SEMT (95% CI) Ratio PNIR/SEMT GM 85 (77-93) 329 (309-349) 0.26 WM 169 (157-181) 380 (356-404) 0.44 CSF 22 (19-25) 165 (151-179) 0.13 Tumor Maximum 440 (350-530) 709 (627-791) 0.62 Tumor Average 299 (232-366) 577 (500-654) 0.52

Improved Contrast Ratio Contrast Ratio (CR) improved in PNIR sequence in all background tissue types and all tumor types The greatest improvement in CR was seen with tumor-to-CSF, followed by tumor-to-GM and then tumor-to-WM.

Improved Contrast Ratio Comparison of CR by background tissue   Contrat Ratio PNIR SEMT PNIR / SEMT P-Value Average Signal Tumor-to-GM 2.63 0.73 3.60 0.0001 Tumor-to-WM 0.76 0.58 1.31 0.0435 Tumor-to-CSF 13.03 3.45 3.78 <0.0001 Maximum Signal 4.37 1.16 3.77 1.56 0.88 1.77 0.0007 20.55 3.32 6.19

Improved Contrast Example: Improved conspicuity of occipital lobe metastasis on PNIR SEMT PNIR

Unanticipated PNIR Effects PNIR decreased signal from subacute T1 hyperintense hemorrhage Pre contrast Fast Spin Echo SEMT + contrast PNIR + contrast

Unanticipated PNIR Effects Reduced signal in non-enhancing portions of tumors SEMT PNIR

Shortcomings of PNIR Detection of lesions in posterior fossa on PNIR somewhat limited by pulsation artifact, which is accentuated by inversion recovery technique SEMT PNIR

Subjective Conspicuity Subjective conspicuity was not consistently improved by PNIR   PNIR More Conspicuous PNIR Less Conspicuous Equal Conspicuity PNIR More Artifacts Radiologist 1 26% (6) 61% (14) 13% (3) 100% Radiologist 2 48% (11) 43% (10) 9% (2)

Subjective Conspicuity Possible reasons for lack of improvement in subjective conspicuity Radiologists not accustomed to appearance of PNIR Increased Artifacts on PNIR Decreased signal of nonenhancing portions of tumor

Conclusions PNIR provides superior contrast ratio of enhancing tumors to background WM, GM and CSF. PNIR does not consistently improve radiologist determined lesion conspicuity when compared to SEMT. PNIR can potentially help differentiate between hemorrhage and enhancement by reducing signal from T1 hyperintense hemorrhage

Future Research Improve PNIR through artifact reduction techniques Improve resolution Directly test ability of PNIR to help differentiate enhancement from T1 hyperintense hemorrhage

References Yoneyama M, Nakamura M, Tabuchi T, et al. Whole-brain black-blood imaging with magnetization-transfer prepared spin echo-like contrast: a novel sequence for contrast-enhanced brain metastasis screening at 3T. Radiol Phys Technol. 2013;6(2):431-6. Qian YF, Yu CL, Zhang C, Yu YQ. MR T1-weighted inversion recovery imaging in detecting brain metastases: could it replace T1-weighted spin-echo imaging?. AJNR Am J Neuroradiol 2008;29:701–704. Wattjes MP, Lutterbey GG, Gieseke J, et al. Double inversion recovery brain imaging at 3T: Diagnostic value in the detection of multiple sclerosis lesions. AJNR Am J Neuroradiol 2007;28:54-59. Hori M, Okubo T, Uozumi K, et al. T1-weighted fluid-attenuated inversion recovery at low field strength: a viable alternative for T1-weighted intracranial imaging. AJNR Am J Neuroradiol 2003;24:648–51. Hou P, Hasan KM, Sitton CW, et al. Phase-Sensitive T1 inversion recovery imaging: A time-efficient interleaved technique for improved tissue contrast in neuroimaging. AJNR Am J Neuroradiol 2005 26: 1432-1438

Thank You