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  • Time-delayed Contrast-enhanced MRI Improves Detection of Brain Metastases: A Prospective Study for Validation of Diagnostic Yield

    Final Number:

    Jason P. Sheehan MD, PhD, FACS; Or Cohen-Inbar MD, PhD; Zhiyua Xu; Blair Dodson; Tanvir Rizvi; Christopher Durst; Sugoto Mukherjee MD

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2016 Annual Meeting

    Introduction: The radiological detection of BMs is essential for optimizing a patient’s treatment. This statement is even more valid when stereotactic radiosurgery (SRS), a noninvasive image guided treatment that can target BM as small as 1-2mm, is delivered as part of that care. The timing of image acquisition after contrast administration can influence the diagnostic sensitivity of contrast enhanced MRI for BM. We investigated the effect of time delayed acquisition after administration of intravenous Gadavist® (Gadobutrol 1mmol/ml) on the detection of BM.

    Methods: This is a prospective IRB approved study of 50 patients with BM who underwent post-contrast MRI sequences immediately after injection of 0.1 mmol/kg Gadavist® as part of clinical care (defined as t0), followed by axial T1 sequences after a 10 minutes (t1) and 20 minute delay interval (t2). MRI studies were blindly compared by 3 neuro-radiologists.

    Results: Single measure intraclass correlation coefficients were very high (0.914, 0.904 and 0.905 for t0, t1 and t2 respectively), corresponding to a reliable inter-observer correlation. The t2 delayed sequences showed a significant and consistently higher diagnostic sensitivity for BM by every participating neuroradiologist as well as for the entire cohort (p=0.016, p=0.035 and 0.034 respectively). A disproportionately high representation of BM detected on the delayed studies was located within posterior circulation territories (compared to predictions based on tissue volume and blood-flow volumes).

    Conclusions: Considering the safe and potentially high yield nature of the delayed MRI sequences, it should supplement the basic MRI sequences in all patients in need of precise delineation of their intracranial disease.

    Patient Care: The research represents a prospective study of the value of delayed contrast MRI sequencing for detecting brain metastases. This approach will lead to better detection and appropriate and complete treatment of patients with brain metastases.

    Learning Objectives: 1. Prospectively determine the diagnostic yield of delayed contrast MRI for detection of brain metastases 2. Identification of neuro-anatomic areas where additional brain metastases are likely to be detected by delayed contrast MRI sequencing


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