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Application of 3D T1 Black-Blood Imaging in the Diagnosis of Leptomeningeal Carcinomatosis: Potential Pitfall of Slow-Flowing Blood

Application of 3D T1 Black-Blood Imaging in the Diagnosis of Leptomeningeal Carcinomatosis:... LETTERS Application of 3D T1 Black-Blood Imaging in the Diagnosis of Leptomeningeal Carcinomatosis: Potential Pitfall of Slow-Flowing Blood read the publication “Application of 3D Fast Spin-Echo T1 and T1 properties of blood to suppress its signal. This technique I Black-Blood Imaging in the Diagnosis and Prognostic Predic- requires a longer acquisition time, which is a limitation in high- tion of Patients with Leptomeningeal Carcinomatosis” by Oh et resolution intracranial vessel wall MR imaging, given the need for al with a great interest. The authors concluded that black-blood very high spatial resolution; however, this should be less of a prob- imaging showed a significantly higher sensitivity than contrast- lem in the context of metastatic disease. enhanced gradient recalled-echo and contrast-enhanced spin- In conclusion, I agree with the authors that postcontrast T1 echo imaging for detecting leptomeningeal carcinomatosis. black-blood imaging is a promising technique for the detection of A variety of techniques can be used to achieve blood suppres- leptomeningeal carcinomatosis; however, it will require further sion on T1-weighted imaging. The most commonly used tech- investigation to determine the best technique for blood suppres- nique, which was also used by Oh et al, is a variable flip angle sion to avoid the above-mentioned pitfall. refocusing pulse sequence in which the protons in the vessel lu- men experience the slice-selective radiofrequency pulse but flow REFERENCES out of the imaging section before the refocusing pulse, resulting in 1. Oh J, Choi SH, Lee E, et al. Application of 3D fast spin-echo T1 black- blood-signal suppression. This technique is widely used in high- blood imaging in the diagnosis and prognostic prediction of patients with leptomeningeal carcinomatosis. AJNR Am J Neuroradiol 2018; resolution intracranial vessel wall MR imaging; however, an im- 39:1453–59 CrossRef Medline portant pitfall with this technique is that slow-flowing blood in 2. Mandell DM, Mossa-Basha M, Qiao Y, et al; Vessel Wall Imaging Study leptomeningeal veins, dilated arteries, or leptomeningeal collat- Group of the American Society of Neuroradiology. Intracranial vessel 2,3 4 erals can cause incomplete or lack of suppression. Kato et al wall MRI: principles and expert consensus recommendations of the compared 3D fast spin-echo (sampling perfection with applica- American Society of Neuroradiology. AJNR Am J Neuroradiol 2017; 38:218–29 CrossRef Medline tion-optimized contrasts by using different flip angle evolutions 3. Lindenholz A, van der Kolk AG, Zwanenburg JJ, et al. The use and [SPACE; Siemens, Erlangen, Germany]) and 3D gradient-echo pitfalls of intracranial vessel wall imaging: how we do it. Radiology T1-weighted MPRAGE images in patients with small parenchy- 2018;286:12–28 CrossRef Medline mal brain metastasis. Lesion detectability was significantly higher 4. Kato Y, Higano S, Tamura H, et al. Usefulness of contrast-enhanced on SPACE than on MPRAGE; however, vessels were falsely re- T1-weighted sampling perfection with application-optimized con- trasts by using different flip angle evolutions in detection of small ported as metastasis using both techniques. I can only imagine brain metastasis at 3T MR imaging: comparison with magnetiza- that this pitfall will be aggravated when assessing leptomeningeal tion-prepared rapid acquisition of gradient echo imaging. AJNR metastasis. One way to avoid these artifacts would be to use a Am J Neuroradiol 2009;30:923–29 CrossRef Medline double inversion recovery technique, which exploits both the flow X S.A. Nabavizadeh Department of Neuroradiology Hospital of the University of Pennsylvania http://dx.doi.org/10.3174/ajnr.A5832 Philadelphia, Pennsylvania AJNR Am J Neuroradiol 39:E125 Dec 2018 www.ajnr.org E125 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png American Journal of Neuroradiology American Journal of Neuroradiology

Application of 3D T1 Black-Blood Imaging in the Diagnosis of Leptomeningeal Carcinomatosis: Potential Pitfall of Slow-Flowing Blood

American Journal of Neuroradiology , Volume 39 (12) – Dec 1, 2018

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Publisher
American Journal of Neuroradiology
ISSN
0195-6108
eISSN
1936-959X
DOI
10.3174/ajnr.A5832
Publisher site
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Abstract

LETTERS Application of 3D T1 Black-Blood Imaging in the Diagnosis of Leptomeningeal Carcinomatosis: Potential Pitfall of Slow-Flowing Blood read the publication “Application of 3D Fast Spin-Echo T1 and T1 properties of blood to suppress its signal. This technique I Black-Blood Imaging in the Diagnosis and Prognostic Predic- requires a longer acquisition time, which is a limitation in high- tion of Patients with Leptomeningeal Carcinomatosis” by Oh et resolution intracranial vessel wall MR imaging, given the need for al with a great interest. The authors concluded that black-blood very high spatial resolution; however, this should be less of a prob- imaging showed a significantly higher sensitivity than contrast- lem in the context of metastatic disease. enhanced gradient recalled-echo and contrast-enhanced spin- In conclusion, I agree with the authors that postcontrast T1 echo imaging for detecting leptomeningeal carcinomatosis. black-blood imaging is a promising technique for the detection of A variety of techniques can be used to achieve blood suppres- leptomeningeal carcinomatosis; however, it will require further sion on T1-weighted imaging. The most commonly used tech- investigation to determine the best technique for blood suppres- nique, which was also used by Oh et al, is a variable flip angle sion to avoid the above-mentioned pitfall. refocusing pulse sequence in which the protons in the vessel lu- men experience the slice-selective radiofrequency pulse but flow REFERENCES out of the imaging section before the refocusing pulse, resulting in 1. Oh J, Choi SH, Lee E, et al. Application of 3D fast spin-echo T1 black- blood-signal suppression. This technique is widely used in high- blood imaging in the diagnosis and prognostic prediction of patients with leptomeningeal carcinomatosis. AJNR Am J Neuroradiol 2018; resolution intracranial vessel wall MR imaging; however, an im- 39:1453–59 CrossRef Medline portant pitfall with this technique is that slow-flowing blood in 2. Mandell DM, Mossa-Basha M, Qiao Y, et al; Vessel Wall Imaging Study leptomeningeal veins, dilated arteries, or leptomeningeal collat- Group of the American Society of Neuroradiology. Intracranial vessel 2,3 4 erals can cause incomplete or lack of suppression. Kato et al wall MRI: principles and expert consensus recommendations of the compared 3D fast spin-echo (sampling perfection with applica- American Society of Neuroradiology. AJNR Am J Neuroradiol 2017; 38:218–29 CrossRef Medline tion-optimized contrasts by using different flip angle evolutions 3. Lindenholz A, van der Kolk AG, Zwanenburg JJ, et al. The use and [SPACE; Siemens, Erlangen, Germany]) and 3D gradient-echo pitfalls of intracranial vessel wall imaging: how we do it. Radiology T1-weighted MPRAGE images in patients with small parenchy- 2018;286:12–28 CrossRef Medline mal brain metastasis. Lesion detectability was significantly higher 4. Kato Y, Higano S, Tamura H, et al. Usefulness of contrast-enhanced on SPACE than on MPRAGE; however, vessels were falsely re- T1-weighted sampling perfection with application-optimized con- trasts by using different flip angle evolutions in detection of small ported as metastasis using both techniques. I can only imagine brain metastasis at 3T MR imaging: comparison with magnetiza- that this pitfall will be aggravated when assessing leptomeningeal tion-prepared rapid acquisition of gradient echo imaging. AJNR metastasis. One way to avoid these artifacts would be to use a Am J Neuroradiol 2009;30:923–29 CrossRef Medline double inversion recovery technique, which exploits both the flow X S.A. Nabavizadeh Department of Neuroradiology Hospital of the University of Pennsylvania http://dx.doi.org/10.3174/ajnr.A5832 Philadelphia, Pennsylvania AJNR Am J Neuroradiol 39:E125 Dec 2018 www.ajnr.org E125

Journal

American Journal of NeuroradiologyAmerican Journal of Neuroradiology

Published: Dec 1, 2018

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