Diagnostic accuracy of MR imaging of patients with leptomeningeal seeding from lung adenocarcinoma based on 2017 RANO pr
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CLINICAL STUDY
Diagnostic accuracy of MR imaging of patients with leptomeningeal seeding from lung adenocarcinoma based on 2017 RANO proposal: added value of contrast‑enhanced 2D axial T2 FLAIR Minjung Seong1 · Sehhoon Park2 · Sung Tae Kim1 · Sung Goo Park1 · Yi Kyung Kim1 · Hyung‑Jin Kim1 · Myung‑Ju Ahn2 Received: 17 July 2020 / Accepted: 2 September 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose We purposed to compare diagnostic accuracy of contrast-enhanced (CE) 3D T1-weighted fast field echo (3D T1-WI), CE 2D spin echo T1-weighted image (2D T1-WI), and CE 2D T2 FLAIR on evaluation of leptomeningeal metastasis(LM) using detailed features suggested in RANO proposal in a homogeneous group with cytology-proven LM. Methods Thirty-five lung adenocarcinoma patients with CSF cytology-proven leptomeningeal metastasis were enrolled in this retrospective analysis, who were enrolled in the prospective study (NCT03257124). MR images including CE 3D T1-WI, CE 2D T1-WI, and CE 2D FLAIR were reviewed. Presence of leptomeningeal nodule, leptomeningeal enhancement, and cranial nerve enhancement was evaluated according to the RANO proposal. Diagnostic accuracy of each sequence was compared and added value of CE 2D FLAIR to CE 3D T1-WI was evaluated. Results Two patients had unmeasurable small nodules recognized on 3D T1-WI only. Leptomeningeal enhancement was positive in 60%, 60%, and 77.1%, cranial nerve enhancement was positive in 51.4%, 45.7%, and 68.6% of the patients on 3D T1-WI, 2D T1-WI, and 2D FLAIR, respectively. Overall sensitivity for detection of LM was 71.4%, 71.4%, and 82.9% on 3D T1-WI, 2D T1-WI, and 2D FLAIR. When adding 2D FLAIR to 3D T1-WI, overall sensitivity for detection of LM was 82.9%. Conclusion 3D T1-WI is the best for identifying leptomeningeal nodules. The sensitivity of 2D FLAIR is the highest for both LNE and CNE. Since both sequences are complementary, it can be helpful to take both sequences. Checking each feature according to the RANO proposal, especially CNE, may help you not to miss LM. Keywords Lung cancer · Leptomeningeal metastasis · MRI · FLAIR
Introduction Leptomeningeal metastasis (LM) is severe and debilitating endstage complication in advanced cancer. Worldwidely, the most common solid tumor that causes leptomeningeal Minjung Seong and Sehhoon Park contributed equally to this manuscript. * Sung Tae Kim [email protected] 1
Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon‑ro, Gangnam‑gu, Seoul 06351, Korea
Division of Hematology‑Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
2
metastasis (LM) is known to be breast cancer (12–35%), followed by lung cancer (10–26%), melanoma (5–25%), gastrointestinal cancer (4–14%), and cancers of unknown primary (1–7%) [1–3]. Meanwhile, lung cancer is the most common solid tumor of LM in Korea that accounts for 64% of solid tumors, and among the histologic subgroups of
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