Skip to main content
Top
Published in: Journal of Neuro-Oncology 3/2011

01-07-2011 | Clinical Study – Patient Study

Differential diagnosis by unenhanced FLAIR T2-weighted magnetic resonance images between solitary high grade gliomas and cerebral metastases appearing as contrast-enhancing cortico-subcortical lesions

Authors: Carmine Franco Muccio, Annachiara Tarantino, Gennaro Esposito, Alfonso Cerase

Published in: Journal of Neuro-Oncology | Issue 3/2011

Login to get access

Abstract

The aim was to assess the value of unenhanced fluid-attenuated inversion recovery T2-weighted sequences (FLAIR-T2) in the differential diagnosis between solitary high-grade gliomas (HGG) and cerebral metastases (CM) appearing as contrast-enhancing cortico-subcortical lesions of the brain. In 69 patients with a contrast-enhancing cortico-subcortical brain lesion (43 HGG, and 26 CM), unenhanced FLAIR-T2 and gadolinium-enhanced FLAIR T1-weighted (Gd-FLAIR-T1) axial images have been reviewed for the involvement of the cortex adjacent to the contrast-enhancing lesion. In 27 (62.79%) out of 43 HGG, and 3 (11.53%) out of 26 CM, the cortex adjacent to the contrast-enhancing lesion showed high signal intensity on unenhanced FLAIR-T2 without enhancement at Gd-FLAIR-T1. Fischer’s exact probability test was P = 0.0003 when applied to HGG versus CM categories, indicating a significant difference. The high signal intensity on unenhanced FLAIR-T2 without gadolinium-enhancement of the cortex adjacent to the enhancing lesion is more frequently associated with HGG than CM.
Literature
1.
go back to reference Barnard RO, Geddes JF (1987) The incidence of multifocal gliomas: a histologic study of large hemisphere section. Cancer 60:1519–1531PubMedCrossRef Barnard RO, Geddes JF (1987) The incidence of multifocal gliomas: a histologic study of large hemisphere section. Cancer 60:1519–1531PubMedCrossRef
3.
go back to reference Sze G, Milano E, Johnson C, Heier L (1990) Detection of brain metastases: comparison of contrast-enhanced MR with unenhanced MR and enhanced CT. AJNR Am J Neuroradiol 11:785–791PubMed Sze G, Milano E, Johnson C, Heier L (1990) Detection of brain metastases: comparison of contrast-enhanced MR with unenhanced MR and enhanced CT. AJNR Am J Neuroradiol 11:785–791PubMed
4.
go back to reference Hutter A, Schwetye KE, Bierhals AJ, McKinstry RC (2003) Brain neoplasms: epidemiology, diagnosis, and prospects for cost-effective imaging. Neuroimaging Clin N Am 13:237–250PubMedCrossRef Hutter A, Schwetye KE, Bierhals AJ, McKinstry RC (2003) Brain neoplasms: epidemiology, diagnosis, and prospects for cost-effective imaging. Neuroimaging Clin N Am 13:237–250PubMedCrossRef
6.
go back to reference Law M, Cha S, Knopp EA, Johnson G, Arnett J, Litt AW (2002) High-grade gliomas and solitary metastases: differentiation by using perfusion and proton spectroscopic MR imaging. Radiology 222:715–721PubMedCrossRef Law M, Cha S, Knopp EA, Johnson G, Arnett J, Litt AW (2002) High-grade gliomas and solitary metastases: differentiation by using perfusion and proton spectroscopic MR imaging. Radiology 222:715–721PubMedCrossRef
7.
go back to reference Chiang IC, Kuo YT, Lu CY, Yeung KW, Lin WC, Sheu FO, Liu GC (2004) Distinction between high-grade gliomas and solitary metastases using peritumoral 3-T magnetic resonance spectroscopy, diffusion, and perfusion imaging. Neuroradiology 46:619–627PubMedCrossRef Chiang IC, Kuo YT, Lu CY, Yeung KW, Lin WC, Sheu FO, Liu GC (2004) Distinction between high-grade gliomas and solitary metastases using peritumoral 3-T magnetic resonance spectroscopy, diffusion, and perfusion imaging. Neuroradiology 46:619–627PubMedCrossRef
8.
go back to reference Opstad KS, Murphy MM, Wilkins PR, Bell BA, Griffiths JR, Howe FA (2004) Differentiation of metastases from high-grade gliomas using short echo time 1H spectroscopy. J Magn Reson Imaging 20:187–192PubMedCrossRef Opstad KS, Murphy MM, Wilkins PR, Bell BA, Griffiths JR, Howe FA (2004) Differentiation of metastases from high-grade gliomas using short echo time 1H spectroscopy. J Magn Reson Imaging 20:187–192PubMedCrossRef
9.
go back to reference Bulakbasi N, Kocaoglu M, Farzaliyev A, Tayfun C, Ucoz T, Somuncu I (2005) Assessment of diagnostic accuracy of perfusion mr imaging in primary and metastatic solitary malignant brain tumors. AJNR Am J Neuroradiol 26:2187–2199PubMed Bulakbasi N, Kocaoglu M, Farzaliyev A, Tayfun C, Ucoz T, Somuncu I (2005) Assessment of diagnostic accuracy of perfusion mr imaging in primary and metastatic solitary malignant brain tumors. AJNR Am J Neuroradiol 26:2187–2199PubMed
10.
go back to reference Cha S, Lupo JM, Chen MH, Lamborn KR, McDermott MW, Berger MS, Nelson SJ, Dillon WP (2007) Differentiation of glioblastoma multiforme and single brain metastasis by peak height and percentage of signal intensity recovery derived from dynamic susceptibility-weighted contrast-enhanced perfusion mr imaging. AJNR Am J Neuroradiol 28:1078–1084PubMedCrossRef Cha S, Lupo JM, Chen MH, Lamborn KR, McDermott MW, Berger MS, Nelson SJ, Dillon WP (2007) Differentiation of glioblastoma multiforme and single brain metastasis by peak height and percentage of signal intensity recovery derived from dynamic susceptibility-weighted contrast-enhanced perfusion mr imaging. AJNR Am J Neuroradiol 28:1078–1084PubMedCrossRef
11.
go back to reference Young GS, Setayesh K (2009) Spin-eco echo-planar perfusion mr imaging in the differential diagnosis of solitary enhancing brain lesions: distinguishing solitary metastases from primary glioma. AJNR Am J Neuroradiol 29:1805–2000 Young GS, Setayesh K (2009) Spin-eco echo-planar perfusion mr imaging in the differential diagnosis of solitary enhancing brain lesions: distinguishing solitary metastases from primary glioma. AJNR Am J Neuroradiol 29:1805–2000
12.
go back to reference Scarabino T, Popolizio T, Trojsi F, Giannatempo G, Pollice S, Maggialetti N, Carriero A, Di Costanzo A, Tedeschi G, Salvolini U (2009) Role of advanced MR imaging modalities in diagnosing cerebral gliomas. Radiol Med 114:448–460PubMedCrossRef Scarabino T, Popolizio T, Trojsi F, Giannatempo G, Pollice S, Maggialetti N, Carriero A, Di Costanzo A, Tedeschi G, Salvolini U (2009) Role of advanced MR imaging modalities in diagnosing cerebral gliomas. Radiol Med 114:448–460PubMedCrossRef
13.
go back to reference Wang S, Kim S, Chawla S, Wolf RL, Zhang WG, O’Rourke DM, Judy KD, Melhem ER, Poptani H (2009) Differentiation between glioblastomas and solitary brain metastases using diffusion tensor imaging. Neuroimage 44:653–660PubMedCrossRef Wang S, Kim S, Chawla S, Wolf RL, Zhang WG, O’Rourke DM, Judy KD, Melhem ER, Poptani H (2009) Differentiation between glioblastomas and solitary brain metastases using diffusion tensor imaging. Neuroimage 44:653–660PubMedCrossRef
14.
go back to reference De Coene B, Hajnal JV, Gatehouse P, Longmore DB, White SJ, Oatridge A, Pennock JM, Young IR, Bydder GM (1992) MR of the brain using fluid-attenuated inversion recovery (FLAIR) pulse sequences. AJNR Am J Neuroradiol 13:1555–1564PubMed De Coene B, Hajnal JV, Gatehouse P, Longmore DB, White SJ, Oatridge A, Pennock JM, Young IR, Bydder GM (1992) MR of the brain using fluid-attenuated inversion recovery (FLAIR) pulse sequences. AJNR Am J Neuroradiol 13:1555–1564PubMed
15.
go back to reference Essig M, Hawighorst H, Schoenberg SO, Engenhart-Cabillic R, Fuss M, Debus J, Zuna I, Knopp MV, van Kaick G (1998) Fast fluid-attenuated inversion-recovery (FLAIR) MRI in the assessment of intraaxial brain tumors. J Magn Reson Imaging 8:789–798PubMedCrossRef Essig M, Hawighorst H, Schoenberg SO, Engenhart-Cabillic R, Fuss M, Debus J, Zuna I, Knopp MV, van Kaick G (1998) Fast fluid-attenuated inversion-recovery (FLAIR) MRI in the assessment of intraaxial brain tumors. J Magn Reson Imaging 8:789–798PubMedCrossRef
16.
go back to reference Okubo T, Hayashi N, Shirouzu I, Abe O, Aoki S, Wada A, Ohtomo K, Sasaki Y (1998) Detection of brain metastasis: comparison of Turbo-FLAIR imaging, T2-weighted imaging and double-dose gadolinium-enhanced MR imaging. Radiat Med 16:273–281PubMed Okubo T, Hayashi N, Shirouzu I, Abe O, Aoki S, Wada A, Ohtomo K, Sasaki Y (1998) Detection of brain metastasis: comparison of Turbo-FLAIR imaging, T2-weighted imaging and double-dose gadolinium-enhanced MR imaging. Radiat Med 16:273–281PubMed
17.
go back to reference Okuda T, Korogi Y, Shigematsu Y, Sugahara T, Hirai T, Ikushima I, Liang L, Takahashi M (1999) Brain lesions: when should fluid-attenuated inversion-recovery sequences be used in MR evaluation? Radiology 212:793–798PubMed Okuda T, Korogi Y, Shigematsu Y, Sugahara T, Hirai T, Ikushima I, Liang L, Takahashi M (1999) Brain lesions: when should fluid-attenuated inversion-recovery sequences be used in MR evaluation? Radiology 212:793–798PubMed
18.
go back to reference Husstedt HW, Sickert M, Köstler H, Haubitz B, Becker H (2000) Diagnostic value of the fast-FLAIR sequence in MR imaging of intracranial tumors. Eur Radiol 10:745–752PubMedCrossRef Husstedt HW, Sickert M, Köstler H, Haubitz B, Becker H (2000) Diagnostic value of the fast-FLAIR sequence in MR imaging of intracranial tumors. Eur Radiol 10:745–752PubMedCrossRef
19.
go back to reference Singh SK, Agris JM, Leeds NE, Ginsberg LE (2000) Intracranial leptomeningeal metastases: comparison of depiction at FLAIR and contrast-enhanced MR imaging. Radiology 217:50–53PubMed Singh SK, Agris JM, Leeds NE, Ginsberg LE (2000) Intracranial leptomeningeal metastases: comparison of depiction at FLAIR and contrast-enhanced MR imaging. Radiology 217:50–53PubMed
20.
go back to reference Aprile I, Guiducci A, Italiani M et al (2001) Caratterizzazione con RM delle pseudocisti necrotiche dei glioblastomi multiformi per mezzo delle sequenze FLAIR post contrasto. Risultati preliminari. Riv Neuroradiol 14(Sup. 3):15–18 Aprile I, Guiducci A, Italiani M et al (2001) Caratterizzazione con RM delle pseudocisti necrotiche dei glioblastomi multiformi per mezzo delle sequenze FLAIR post contrasto. Risultati preliminari. Riv Neuroradiol 14(Sup. 3):15–18
21.
go back to reference Bynevelt M, Britton J, Seymour H, MacSweeney E, Thomas N, Sandhu K (2001) FLAIR imaging in the follow-up of low-grade gliomas: time to dispense with the dual-echo? Neuroradiology 43:129–133PubMedCrossRef Bynevelt M, Britton J, Seymour H, MacSweeney E, Thomas N, Sandhu K (2001) FLAIR imaging in the follow-up of low-grade gliomas: time to dispense with the dual-echo? Neuroradiology 43:129–133PubMedCrossRef
22.
go back to reference Essig M, Metzner R, Bonsanto M, Hawighorst H, Debus J, Tronnier V, Knopp MV, van Kaick G (2001) Postoperative fluid-attenuated inversion recovery MR imaging of cerebral gliomas: initial results. Eur Radiol 11:2004–2010PubMedCrossRef Essig M, Metzner R, Bonsanto M, Hawighorst H, Debus J, Tronnier V, Knopp MV, van Kaick G (2001) Postoperative fluid-attenuated inversion recovery MR imaging of cerebral gliomas: initial results. Eur Radiol 11:2004–2010PubMedCrossRef
23.
go back to reference Mascott CR, Summers LE (2007) Image fusion of fluid-attenuated inversion recovery magnetic resonance imaging sequences for surgical image guidance. Surg Neurol 67:589–603 discussion 603PubMedCrossRef Mascott CR, Summers LE (2007) Image fusion of fluid-attenuated inversion recovery magnetic resonance imaging sequences for surgical image guidance. Surg Neurol 67:589–603 discussion 603PubMedCrossRef
24.
go back to reference Essig M, Knopp MV, Schoenberg SO, Hawighorst H, Wenz F, Debus J, van Kaick G (1999) Cerebral gliomas and metastases: assessment with contrast-enhanced fast fluid-attenuated inversion-recovery MR imaging. Radiology 210:551–557PubMed Essig M, Knopp MV, Schoenberg SO, Hawighorst H, Wenz F, Debus J, van Kaick G (1999) Cerebral gliomas and metastases: assessment with contrast-enhanced fast fluid-attenuated inversion-recovery MR imaging. Radiology 210:551–557PubMed
25.
go back to reference Ercan N, Gultekin S, Celik H, Tali TE, Oner YA, Erbas G (2004) Diagnostic value of contrast-enhanced fluid-attenuated inversion recovery MR imaging of intracranial metastases. AJNR Am J Neuroradiol 25:761–765PubMed Ercan N, Gultekin S, Celik H, Tali TE, Oner YA, Erbas G (2004) Diagnostic value of contrast-enhanced fluid-attenuated inversion recovery MR imaging of intracranial metastases. AJNR Am J Neuroradiol 25:761–765PubMed
26.
go back to reference Kremer S, Abu Eid M, Bierry G, Bogorin A, Koob M, Dietemann JL, Fruehlich S (2006) Accuracy of delayed post-contrast FLAIR MR imaging for the diagnosis of leptomeningeal infectious or tumoral diseases. J Neuroradiol 33:285–291PubMedCrossRef Kremer S, Abu Eid M, Bierry G, Bogorin A, Koob M, Dietemann JL, Fruehlich S (2006) Accuracy of delayed post-contrast FLAIR MR imaging for the diagnosis of leptomeningeal infectious or tumoral diseases. J Neuroradiol 33:285–291PubMedCrossRef
27.
go back to reference Zhou ZR, Shen TZ, Chen XR, Peng WJ (2006) Diagnostic value of contrast-enhanced fluid-attenuated inversion-recovery MRI for intracranial tumors in comparison with post-contrast T1W spin-echo MRI. Chin Med J (Engl) 119:467–473 Zhou ZR, Shen TZ, Chen XR, Peng WJ (2006) Diagnostic value of contrast-enhanced fluid-attenuated inversion-recovery MRI for intracranial tumors in comparison with post-contrast T1W spin-echo MRI. Chin Med J (Engl) 119:467–473
28.
go back to reference Terae S, Yoshida D, Kudo K, Tha KK, Fujino M, Miyasaka K (2007) Contrast-enhanced FLAIR imaging in combination with pre- and postcontrast magnetization transfer T1-weighted imaging: usefulness in the evaluation of brain metastases. J Magn Reson Imaging 25:479–487PubMedCrossRef Terae S, Yoshida D, Kudo K, Tha KK, Fujino M, Miyasaka K (2007) Contrast-enhanced FLAIR imaging in combination with pre- and postcontrast magnetization transfer T1-weighted imaging: usefulness in the evaluation of brain metastases. J Magn Reson Imaging 25:479–487PubMedCrossRef
29.
go back to reference Aprile I, Giorgi C, Guiducci A et al (2008) Characterization of glioblastoma by contrast-enhanced Flair sequence. The Neuroradiol J 21:196–203 Aprile I, Giorgi C, Guiducci A et al (2008) Characterization of glioblastoma by contrast-enhanced Flair sequence. The Neuroradiol J 21:196–203
30.
go back to reference Tang YM, Ngai S, Stuckey S (2006) The solitary enhancing cerebral lesion: can FLAIR aid the differentiation between gliomi and metastasis? AJNR Am J Neuroradiol 27:609–611PubMed Tang YM, Ngai S, Stuckey S (2006) The solitary enhancing cerebral lesion: can FLAIR aid the differentiation between gliomi and metastasis? AJNR Am J Neuroradiol 27:609–611PubMed
31.
go back to reference Stuckey SL, Wijedeera R (2008) Multicentric/multifocal cerebral lesions: can fluid-attenuated inversion recovery aid the differentiation between glioma and metastases? J Med Imaging Radiat Oncol 52:134–139PubMedCrossRef Stuckey SL, Wijedeera R (2008) Multicentric/multifocal cerebral lesions: can fluid-attenuated inversion recovery aid the differentiation between glioma and metastases? J Med Imaging Radiat Oncol 52:134–139PubMedCrossRef
32.
go back to reference Kleihues P, Cavenee WK (2000) Pathology and genetics of tumours of the nervous system. IARC, Lyon Kleihues P, Cavenee WK (2000) Pathology and genetics of tumours of the nervous system. IARC, Lyon
33.
go back to reference Bakshi R, Ariyaratana S, Benedict RH, Jacobs L (2001) Fluid-attenuated inversion recovery magnetic resonance imaging detects cortical and juxtacortical multiple sclerosis lesions. Arch Neurol 58:742–748PubMedCrossRef Bakshi R, Ariyaratana S, Benedict RH, Jacobs L (2001) Fluid-attenuated inversion recovery magnetic resonance imaging detects cortical and juxtacortical multiple sclerosis lesions. Arch Neurol 58:742–748PubMedCrossRef
34.
go back to reference Toyoda K, Ida M, Fukuda K (2001) Fluid-attenuated inversion recovery intraarterial signal: an early sign of hyperacute cerebral ischemia. AJNR Am J Neuroradiol 22:1021–1029PubMed Toyoda K, Ida M, Fukuda K (2001) Fluid-attenuated inversion recovery intraarterial signal: an early sign of hyperacute cerebral ischemia. AJNR Am J Neuroradiol 22:1021–1029PubMed
35.
go back to reference Essig M, Schoenberg SO, Debus J, van Kaick G (2000) Disappearance of tumor contrast on contrast-enhanced FLAIR imaging of cerebral gliomas. Magn Reson Imaging 18:513–518PubMedCrossRef Essig M, Schoenberg SO, Debus J, van Kaick G (2000) Disappearance of tumor contrast on contrast-enhanced FLAIR imaging of cerebral gliomas. Magn Reson Imaging 18:513–518PubMedCrossRef
36.
go back to reference Kelly PJ, Daumas-Duport C, Kispert DB, Kall BA, Scheithauer BW, Illig JJ (1987) Imaging-based stereotaxic serial biopsies in untreated intracranial glial neoplasm. J Neurosurg 66:865–874PubMedCrossRef Kelly PJ, Daumas-Duport C, Kispert DB, Kall BA, Scheithauer BW, Illig JJ (1987) Imaging-based stereotaxic serial biopsies in untreated intracranial glial neoplasm. J Neurosurg 66:865–874PubMedCrossRef
37.
go back to reference Zhang M, Olsson Y (1997) Hematogenous metastases of the human brain-characteristics of peritumoral brain changes: a review. J Neurooncol 35:81–89PubMedCrossRef Zhang M, Olsson Y (1997) Hematogenous metastases of the human brain-characteristics of peritumoral brain changes: a review. J Neurooncol 35:81–89PubMedCrossRef
38.
go back to reference Baumert BG, Rutten I, Dehing-Oberije C, Twijnstra A, Dirx MJ, Debougnoux-Huppertz RM, Lambin P, Kubat B (2006) A pathology-based substrate for target definition in radiosurgery of brain metastases. Int J Radiat Oncol Biol Phys 66:187–194PubMedCrossRef Baumert BG, Rutten I, Dehing-Oberije C, Twijnstra A, Dirx MJ, Debougnoux-Huppertz RM, Lambin P, Kubat B (2006) A pathology-based substrate for target definition in radiosurgery of brain metastases. Int J Radiat Oncol Biol Phys 66:187–194PubMedCrossRef
Metadata
Title
Differential diagnosis by unenhanced FLAIR T2-weighted magnetic resonance images between solitary high grade gliomas and cerebral metastases appearing as contrast-enhancing cortico-subcortical lesions
Authors
Carmine Franco Muccio
Annachiara Tarantino
Gennaro Esposito
Alfonso Cerase
Publication date
01-07-2011
Publisher
Springer US
Published in
Journal of Neuro-Oncology / Issue 3/2011
Print ISSN: 0167-594X
Electronic ISSN: 1573-7373
DOI
https://doi.org/10.1007/s11060-010-0454-8

Other articles of this Issue 3/2011

Journal of Neuro-Oncology 3/2011 Go to the issue