Cerebral staging of lung cancer: is one single contrast-enhanced T1-weighted three-dimensional gradient-echo sequence sufficient?
Fiche publication
Date publication
août 2014
Auteurs
Membres identifiés du Cancéropôle Est :
Pr ROY Catherine
Tous les auteurs :
Ohana M, Jeung MY, Bazille G, Roy C
Lien Pubmed
Résumé
INTRODUCTION: Gadolinium-enhanced magnetic resonance imaging (MRI) is the gold standard for cerebral staging in thoracic oncology. We hypothesize that a minimalist examination, consisting of a single contrast-enhanced T1-weighted three-dimensional gradient-echo sequence (CE 3D-GRE), would be sufficient for the cerebral staging of nonsymptomatic lung cancer patients. METHODS: Seventy nonsymptomatic patients (50 % men; 62 years +/- 10.2) referred for cerebral staging of a lung cancer were retrospectively included. All underwent a standard 3 T MRI examination with T1, FLAIR, T2* GRE, diffusion, and CE 3D-GRE sequences, for a total examination time of 20 min. The sole CE 3D-GRE (acquisition time: 6 min) was extracted and blindly interpreted by two radiologists in search of brain metastases. Hemorrhagic features of potential lesions and relevant incidental findings were also noted. Discrepant cases were reviewed by a third reader. The full MRI examination and follow-up studies were used as a reference to calculate sensitivity and specificity of the sole CE 3D-GRE. RESULTS: Thirty-eight point six percent (27 out of 70) of the patients had brain metastases. Performances and reader's agreement with the sole CE 3D-GRE sequence were excellent for the diagnosis of brain metastases (sensitivity=96.3 %, specificity=100 %, kappa=0.91) and incidental findings (sensitivity=85.7 %, specificity=100 %, kappa=0.62) but insufficient for the identification of hemorrhages within the metastases (sensitivity=33.3 %, specificity=85.7 %, kappa=0.47). CONCLUSIONS: In the specific case of lung cancer, cerebral staging in nonsymptomatic patients can be efficiently achieved with a minimalistic protocol consisting of a single CE 3D-GRE sequence, completed if positive with a T2* sequence for hemorrhagic assessment, thus halving appointment delays.
Référence
Neuroradiology. 2014 Aug;56(8):621-7