Added value of delayed post-contrast FLAIR in diagnosis of metastatic brain lesions

Abstract

Abstract Background One of the drawbacks in contrast-enhanced T1-weighted imaging (CE-T1WI) is the enhancing cortical vessels which can be confused with meningeal enhancement. Previous studies reported that post-contrast FLAIR could be better for diagnosing the superficial brain abnormalities. So the purpose of this study was to evaluate the role of delayed post-contrast FLAIR, in comparison with post-contrast T1, in the detection and evaluation of brain metastases. Results The study was conducted on 40 patients with suspected/known brain metastases scanned in order to detect and evaluate brain metastases. All patients were subjected to the following: full history taking, review of clinical examination reports, and other imaging modalities whenever available, followed by brain MRI examination using 1.5 T closed magnet including pre-contrast series, axial and sagittal T1-weighted spin echo (SE), axial and coronal T2-weighted turbo spin echo (TSE) and axial FLAIR, while post-contrast series included axial, coronal and sagittal T1-weighted spin echo (SE) and lastly DPC-FLAIR sequence 10 min after contrast administration. This study included 18 males and 22 females, ranging in age from 26 to 75 years. Six out of a total of 40 patients had brain metastases of unknown origin, while 34 of them were presented with different types of known primary tumors. The detected lesions were subdivided into five groups according to their detectability by DPC-FLAIR and contrast-enhanced T1WI: Group (I): lesions detected only by DPC-FLAIR: 16 lesions; Group (II): lesions detected only by CE-T1WI: 1 lesion; Group (III): lesions detected by both DPC-FLAIR and CE-T1WI with equal conspicuity by both: 28 lesions; Group (IV): lesions detected by both, showing more obvious enhancement with DPC-FLAIR: 43 lesions; and Group (V): lesions detected by both, showing more obvious enhancement with CE-T1WI: 11 lesions. DPC-FLAIR had a sensitivity of 98.98% and a specificity of 100% for the detection of metastatic brain lesions and for CE-T1WI; sensitivity of 83.83%; and a specificity of 50%. Conclusions Delayed post-contrast FLAIR is a reliable sequence for the detection of metastatic brain lesions as it can detect more metastatic brain lesions compared to contrast-enhanced T1WI.

Keywords

• Brain metastasis
• Post-contrast T1WI
• Delayed post-contrast FLAIR
• Leptomeningeal metastasis