Komal Bankim Shah MD, Presenter: Nothing to Disclose

Colleen Mary Costelloe MD, Abstract Co-Author: Nothing to Disclose

Nandita Guha-Thakurta MD, Abstract Co-Author: Nothing to Disclose

John E. Madewell MD, Abstract Co-Author: Nothing to Disclose

Ashok J. Kumar MD, Abstract Co-Author: Nothing to Disclose

Dawid Schellingerhout MD, Abstract Co-Author: Speakers Bureau, ArthroCare Corporation

Cerebrospinal fluid (CSF) surrounding the spinal cord may not appear adequately suppressed on T1 spin echo (SE) sequences at 3T. We tested for differences in diagnostic quality between T1 SE and T1 fluid attenuated inversion recovery (FLAIR) sequences at 3T.

Reviewer 1, a musculoskeletal radiologist, and reviewer 2, a neuroradiologist, reviewed contrast enhanced MRI of the thoracic and lumbar spine at 3T, in 156 patients. All patients had sagittal post-contrast T1 SE and T1 FLAIR sequences. The radiologists compared the 2 sequences in each category of diagnosis, on a scale of 1 to 7 where 1 indicated the finding was much more conspicuous on FLAIR and 7 indicated the finding was much more conspicuous on SE. The categories of diagnosis were bone lesion, disc herniation, other epidural disease, and CSF suppression. The mean values for each category were calculated. The non-parametric signed rank test was used to assess significance.

Both reviewers reported significantly better CSF-cord distinction with T1 FLAIR (mean 2.1 and 1.3, both p<0.0001). Both reviewers reported that bone lesions were slightly more conspicuous on T1 FLAIR (mean 3.6, p<0.0001 and mean 3.9, p=0.04). Both reported that disc herniation was slightly more conspicuous on T1 FLAIR (mean 3.7, p=0.003 and mean 3.6, p=0.0004). Other epidural lesions (mostly metastatic disease) were also judged slightly more conspicuous on T1 FLAIR, (mean 3.6, p=0.04 and mean 3.5, p=0.007).

T1 FLAIR post contrast imaging in the spine results in significantly improved CSF suppression and increases the conspicuity of bone lesions, disc herniations and epidural metastasis.

The increased conspicuity of bone metastases on post-contrast T1 FLAIR should be considered when comparing studies performed with different techniques for treatment effect.

Shah, K, Costelloe, C, Guha-Thakurta, N, Madewell, J, Kumar, A, Schellingerhout, D, Diagnostic Quality of Contrast-enhanced T1 FLAIR vs Contrast-enhanced T1 Spin Echo Sagittal Imaging in the Spine at 3T.  Radiological Society of North America 2009 Scientific Assembly and Annual Meeting, November 29 - December 4, 2009 ,Chicago IL. http://archive.rsna.org/2009/8009113.html