Kazufumi Kikuchi MD, Presenter: Nothing to Disclose

Takashi Yoshiura MD, PhD, Abstract Co-Author: Nothing to Disclose

Akio Hiwatashi MD, Abstract Co-Author: Nothing to Disclose

Osamu Togao MD, PhD, Abstract Co-Author: Nothing to Disclose

Koji Yamashita MD,PhD, Abstract Co-Author: Nothing to Disclose

Hiroshi Honda MD, Abstract Co-Author: Nothing to Disclose

Masami Yoneyama, Abstract Co-Author: Nothing to Disclose

Makoto Obara, Abstract Co-Author: Nothing to Disclose

Post-contrast 3D gradient-echo is the standard for brain metastases, but enhancing blood vessel can be a disturbing factor. Recent studies have shown that blood vessel suppression techniques help detect metastases more efficiently. However, incompletely suppressed vessels may closely mimic metastases, hence can result in false positive results. To solve this issue, we developed a novel 3D sequence named volume isotropic simultaneous interleaved bright- and black-blood examination (VISIBLE), which allows for simultaneous acquisitions of images with blood vessel suppression (Black images) and those without (Bright images) in 5 minutes. Our purpose was to evaluate usefulness of VISIBE through an observer study.

In VISIBLE, two sequential phases of TFE acquisition are implemented following a motion-sensitized driven-equilibrium preparation for black-blood imaging. Patients with suspected brain metastasis were prospectively imaged using both VISIBLE and conventional MPRAGE. 34 patients including consecutive 17 patients with 1 to 6 metastases and 17 with no metastasis were selected and used for the observer study. 3 radiologists read VISBLE and MPRAGE of the 34 patients in the first and second reading session. In reading VISIBLE, each observer was instructed to use Black images to pick up high signal intensity areas as candidates for metastases and Bright images as a second opinion to reject false positives such as incompletely suppressed enhancing vessels. The observers’ diagnostic performance was evaluated by means of the figure-of-merit (FOM) as an index of diagnostic performance derived from the JAFROC analysis, sensitivity, false-positive per case (FP/case), and reading time.

Compared to MPRAGE, VISIBLE was associated with significantly higher sensitivity (91.7±4.2% for VISBLE vs. 70.8±11.1% for MPRAGE, P<.05), significantly higher FOM (0.94±0.02 vs. 0.82±0.05, P<.05), and significantly shorter reading time (108.4±57.8 sec vs. 149.5±74.7 sec, P<.05). FP/case was fewer with VISIBLE (0.13±0.12 vs. 0.23±0.22), although it did not reach statistical significance.

VISIBLE can improve radiologists’ diagnostic performance in detecting brain metastases.

VISIBLE is capable of simultaneous acquisitions with and without blood vessel suppression and can improve radiologists’ diagnostic performance in detecting brain metastases.

Kikuchi, K, Yoshiura, T, Hiwatashi, A, Togao, O, Yamashita, K, Honda, H, Yoneyama, M, Obara, M, A Novel 3D MR Sequence Capable of Simultaneous Image Acquisitions with and without Blood Vessel Suppression: Observe Test for Efficacy in Detecting Brain Metastases.  Radiological Society of North America 2013 Scientific Assembly and Annual Meeting, December 1 - December 6, 2013 ,Chicago IL. http://archive.rsna.org/2013/13018563.html