Abstract
Background and purpose: SWI MRI, a T2*-dominant MRI sequence with T1 shine-through effect, uses intrinsic structural susceptibility to create enhancement among brain structures. We evaluated whether gadolinium-enhanced SWI (SWI-Gd) improves brain metastasis detection in combination with other MRI sequences.Materials and methods: MRI images of 24 patients (46 studies) were prospectively acquired using a 1.5-T scanner. T1-weighted, unenhanced SWI (SWI-U) and SWI-Gd were evaluated blindly to clinical features by two board-certified radiologists.Results: SWI-Gd revealed more significant metastatic lesions than either T1-Gd or SWI-U (p = 0.0004 for either comparator sequence). Moreover, SWI-Gd revealed more lesions only for those patients with ≤5 lesions on T1-Gd (n = 30 studies from 16 patients; p = 0.046). Performing SWI-Gd added <5 min of scanning time with no further additional risk.Conclusions: Our findings suggest that, when added to T1-Gd and other common sequences, SWI-Gd may improve the diagnostic yield of brain metastases with only a few extra minutes of scanning time and no further risk than that of a regular gadolinium-enhanced MRI.
Highlights
Cerebral metastases are the most common form of brain tumors in adults [1, 2], are a significant source of morbidity and mortality, and have direct implications on the treatment and prognosis of the primary tumor [3, 4].Contrast-enhanced magnetic resonance imaging (MRI) is the standard for diagnosing brain metastases [5]; there is no one-size-fits-all MRI protocol for their evaluation [6]
Susceptibility-weighted imaging (SWI) is routinely performed without the use of gadolinium contrast enhancement and is used clinically to evaluate a number of neurological conditions [10, 11]
Our final sample included 24 patients (19 female, 5 male), with a total of 58 MRI studies, of which 12 studies were excluded from the analysis due to movement artifacts, leaving us with 46 MRI studies that were considered of good quality for analysis
Summary
SWI-Gd revealed more significant metastatic lesions than either T1-Gd or SWI-U (p = 0.0004 for either comparator sequence). SWI-Gd revealed more lesions only for those patients with ≤5 lesions on T1-Gd (n = 30 studies from 16 patients; p = 0.046). Performing SWI-Gd added
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