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Reply: tomeningeal enhancement than with a single application of black- e appreciate Dr. Nabavizadeh’s interest and comments on blood imaging, which also needs further study. Wour article, “Application of 3D Fast Spin-Echo T1 Black- Blood Imaging in the Diagnosis and Prognostic Prediction of REFERENCES Patients with Leptomeningeal Carcinomatosis.” We agree that 1. Oh J, Choi SH, Lee E, et al. Application of 3D fast spin-echo T1 black- poorly suppressed blood vessels often mimic leptomeningeal en- blood imaging in the diagnosis and prognostic prediction of patients hancement on the black-blood imaging; in particular, slow-flow- with leptomeningeal carcinomatosis. AJNR Am J Neuroradiol 2018; ing blood in leptomeningeal veins, dilated arteries, or leptomen- 39:1453–59 CrossRef Medline ingeal collaterals can be incompletely suppressed using a variable 2. Kato Y, Higano S, Tamura H, et al. Usefulness of contrast-enhanced flip angle refocusing pulse sequence. However, we evaluated the T1-weighted sampling perfection with application-optimized con- trasts by using different flip angle evolutions in detection of small consecutive sections of the images rather than the 1 image section, brain metastasis at 3T MR imaging: comparison with magnetiza- allowing anatomic differentiation between leptomeningeal ves- tion-prepared rapid acquisition of gradient echo imaging. AJNR sels and leptomeningeal enhancement because the floating curvi- Am J Neuroradiol 2009;30:923–29 CrossRef Medline linear enhancement pattern of leptomeningeal vessels is some- 3. Mandell D, Mossa-Basha M, Qiao Y, et al; Vessel Wall Imaging Study what different from that in leptomeningeal carcinomatosis. The Group of the American Society of Neuroradiology. Intracranial vessel wall MRI: principles and expert consensus recommendations of the use of multiplanar reconstruction images may also be helpful in American Society of Neuroradiology. AJNR Am J Neuroradiol 2017; avoiding this kind of misinterpretation. 38:218–29 CrossRef Medline As Dr. Nabavizadeh has mentioned, among the various tech- 4. Park J, Kim EY. Contrast-enhanced, three-dimensional, whole- niques for blood suppression on T1-weighted imaging, other brain, black-blood imaging: application to small brain metastases. methods such as the double inversion recovery technique may be Magn Reson Med 2010;63:553–61 CrossRef CrossRef X J. Oh an alternative to avoid this pitfall. However, the double inversion Department of Radiology recovery technique requires longer acquisition times because of Seoul National University Hospital 3,4 the time needed for spins to reach the null point. This disad- Seoul, Korea X S.H. Choi vantage becomes more problematic as spatial coverage increases, Department of Radiology and it can be difficult to use routinely in clinical practice. How- Seoul National University Hospital ever, we agree that further investigation is warranted to determine Seoul, Korea Department of Radiology the best technique for blood suppression to avoid the above-men- Seoul National University College of Medicine tioned pitfall. Seoul, Korea Our alternative suggestion is that 3D gradient-echo T1- Institute of Radiation Medicine Seoul National University Medical Research Center weighted MPRAGE images can be used with black-blood imaging Seoul, Korea for better differentiation between leptomeningeal vessels and lep- Center for Nanoparticle Research Institute for Basic Science http://dx.doi.org/10.3174/ajnr.A5850 Seoul, Korea E126 Letters Dec 2018 www.ajnr.org http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png American Journal of Neuroradiology American Journal of Neuroradiology

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Publisher
American Journal of Neuroradiology
ISSN
0195-6108
eISSN
1936-959X
DOI
10.3174/ajnr.A5850
Publisher site
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Abstract

tomeningeal enhancement than with a single application of black- e appreciate Dr. Nabavizadeh’s interest and comments on blood imaging, which also needs further study. Wour article, “Application of 3D Fast Spin-Echo T1 Black- Blood Imaging in the Diagnosis and Prognostic Prediction of REFERENCES Patients with Leptomeningeal Carcinomatosis.” We agree that 1. Oh J, Choi SH, Lee E, et al. Application of 3D fast spin-echo T1 black- poorly suppressed blood vessels often mimic leptomeningeal en- blood imaging in the diagnosis and prognostic prediction of patients hancement on the black-blood imaging; in particular, slow-flow- with leptomeningeal carcinomatosis. AJNR Am J Neuroradiol 2018; ing blood in leptomeningeal veins, dilated arteries, or leptomen- 39:1453–59 CrossRef Medline ingeal collaterals can be incompletely suppressed using a variable 2. Kato Y, Higano S, Tamura H, et al. Usefulness of contrast-enhanced flip angle refocusing pulse sequence. However, we evaluated the T1-weighted sampling perfection with application-optimized con- trasts by using different flip angle evolutions in detection of small consecutive sections of the images rather than the 1 image section, brain metastasis at 3T MR imaging: comparison with magnetiza- allowing anatomic differentiation between leptomeningeal ves- tion-prepared rapid acquisition of gradient echo imaging. AJNR sels and leptomeningeal enhancement because the floating curvi- Am J Neuroradiol 2009;30:923–29 CrossRef Medline linear enhancement pattern of leptomeningeal vessels is some- 3. Mandell D, Mossa-Basha M, Qiao Y, et al; Vessel Wall Imaging Study what different from that in leptomeningeal carcinomatosis. The Group of the American Society of Neuroradiology. Intracranial vessel wall MRI: principles and expert consensus recommendations of the use of multiplanar reconstruction images may also be helpful in American Society of Neuroradiology. AJNR Am J Neuroradiol 2017; avoiding this kind of misinterpretation. 38:218–29 CrossRef Medline As Dr. Nabavizadeh has mentioned, among the various tech- 4. Park J, Kim EY. Contrast-enhanced, three-dimensional, whole- niques for blood suppression on T1-weighted imaging, other brain, black-blood imaging: application to small brain metastases. methods such as the double inversion recovery technique may be Magn Reson Med 2010;63:553–61 CrossRef CrossRef X J. Oh an alternative to avoid this pitfall. However, the double inversion Department of Radiology recovery technique requires longer acquisition times because of Seoul National University Hospital 3,4 the time needed for spins to reach the null point. This disad- Seoul, Korea X S.H. Choi vantage becomes more problematic as spatial coverage increases, Department of Radiology and it can be difficult to use routinely in clinical practice. How- Seoul National University Hospital ever, we agree that further investigation is warranted to determine Seoul, Korea Department of Radiology the best technique for blood suppression to avoid the above-men- Seoul National University College of Medicine tioned pitfall. Seoul, Korea Our alternative suggestion is that 3D gradient-echo T1- Institute of Radiation Medicine Seoul National University Medical Research Center weighted MPRAGE images can be used with black-blood imaging Seoul, Korea for better differentiation between leptomeningeal vessels and lep- Center for Nanoparticle Research Institute for Basic Science http://dx.doi.org/10.3174/ajnr.A5850 Seoul, Korea E126 Letters Dec 2018 www.ajnr.org

Journal

American Journal of NeuroradiologyAmerican Journal of Neuroradiology

Published: Dec 1, 2018

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