Evaluation of an Ultra-Short MRI Protocol for Cerebral Staging Examinations in Melanoma Patients

Abstract

Purpose Due to its high sensitivity and lack of radiation, MRI is often used to stage cerebral tumors in patients. In contrast, the relatively long examination times and the limited availability of MRI slots at the clinic might delay these examinations. The aim of this study was to compare an ultra-short MRI protocol with the routinely used standard protocol.

Materials and Methods Cerebral MRI of 147 patients with malignant melanoma were evaluated retrospectively, whereby only two sequences (FLAIR images and contrast-enhanced T1 MPR images) were evaluated in one group and images from the whole examination were available for the second group, including five sequences (DWI, T2 TSE, FLAIR, native and contrast-enhanced T1 TSE, and contrast-enhanced T1 MPR). The results of the two groups were compared and tested to determine whether the ultra-short approach was inferior to the full examination.

Results 13.6 % of the patients had cerebral metastases. Overall, 73 metastases were detected: 60 were located supratentorially and 13 infratentorially. Concerning the detection of cerebral metastases, the ultra-short MRI examination, involving only a FLAIR and a contrast-enhanced T1 MPR sequence, was not inferior to the full MRI protocol in general (p = 0.017) and separated by location for supratentorial (p = 0.026) and infratentorial (p = 0.001) metastases.

Conclusion For staging purposes, a focused, ultra-short MRI protocol is not inferior to a standard MRI examination. This might open up opportunities for faster staging processes and a more efficient use of the often-restricted MRI capacities.

Key Points 

• Short MRI protocols for cerebral staging are not inferior to standard examinations.

• Contrast-enhanced images represent the centerpiece of an ultra-short MRI protocol.

• Short MRI protocols might enable a more efficient use of restricted resources.

Citation Format

• Peters S, Gärtner F, Austein F et al. Evaluation of an Ultra-Short MRI Protocol for Cerebral Staging Examinations in Melanoma Patients. Fortschr Röntgenstr 2022; 194: 409 – 415

Zusammenfassung

Ziel Aufgrund der hohen Sensitivität ist das MRT die erste Wahl für Staginguntersuchungen des Gehirns bei Tumorpatienten. Die Untersuchungen dauern jedoch relativ lange, was zu einer Limitation der Kapazitäten beiträgt und so den Stagingprozess verzögern kann. Ziel dieser Studie ist es, ein ultrakurzes MRT-Protokoll mit einem ausführlichen Routine-Protokoll zu vergleichen.

Material und Methoden Es wurden 147 zerebrale MRT von Melanom-Patienten ausgewertet. Von einer Gruppe wurden nur 2 Sequenzen bezüglich zerebraler Metastasen beurteilt (Flair und kontrastverstärkte T1 MPR). Die andere Gruppe hatte die gesamte MRT-Untersuchung mit 5 Sequenzen (DWI, T2 TSE, Flair, native und kontrastverstärkte T1 TSE, kontrastverstärkte T1 MPR) zur Verfügung. Die Ergebnisse beider Gruppen wurden bezüglich einer Nichtunterlegenheit des ultrakurzen Protokolls statistisch getestet.

Ergebnisse 13.6 % der Melanom-Patienten hatten insgesamt 73 zerebrale Metastasen. Hiervon waren 60 Metastasen supratentoriell und 13 Metastasen infratentoriell gelegen. Das ultrakurze MRT-Protokoll, bestehend aus einer Flair und einer kontrastverstärkten T1 MPR, war dem ausführlichen Protokoll bezüglich der Metastasendetektion generell (p = 0,017) sowie für die Lokalisationen supratentoriell (p = 0,026) und infratentoriell (p = 0,001) statistisch nicht unterlegen.

Schlussfolgerung Zum zerebralen Staging ist ein fokussiertes, ultrakurzes MRT-Protokoll einem ausführlichen Routine-Protokoll nicht unterlegen. Fokussierte und kurze MRT-Protokolle könnten somit einen effizienten Einsatz der oftmals eingeschränkten MRT-Kapazitäten und einen schnellen Stagingprozess ermöglichen.

Kernaussagen: 

• Zum zerebralen Staging ist ein kurzes MRT-Protokoll einem Routineprotokoll nicht unterlegen

• Kontrastmittelverstärkte Aufnahmen sind das Kernstück eines ultrakurzen Staging-Protokolls

• Kurze MRT-Protokolle könnten bei einem effizienteren Einsatz der häufig limitierten MRT-Kapazitäten helfen

Key words

MR imaging - melanoma - metastases - CNS - brain neoplasms - brain - radiologists - staging

Publication History

Received: 29 June 2021

Accepted: 03 October 2021

Article published online:
18 November 2021

• References

• 1 Pope WB. Brain metastases: neuroimaging. Handb Clin Neurol 2018; 149: 89-112
• 2 Nathoo N, Toms SA, Barnett GH. Metastases to the brain: current management perspectives. Expert Rev Neurother 2004; 4: 633-640
• 3 Patel SH, Robbins JR, Gore EM. et al. ACR Appropriateness Criteria^® follow-up and retreatment of brain metastases. Am J Clin Oncol 2012; 35: 302-306
• 4 Leitlinienprogramm Onkologie (Deutsche Krebsgesellschaft, Deutsche Krebshilfe, AWMF): Diagnostik, Therapie und Nachsorge des MLeitlinienprogramm Onkologie (Deutsche Krebsgesellschaft, Deutsche Krebshilfe, AWMF): Diagnostik, Therapie und Nachsorge des Melanoms, Langversion 3.2, 2019, AWMF Registernummer: 032/024OL. http://www.leitlinienprogramm-onkologie.de/leit-linien/melanomelanoms , Langversion 3.2.
• 5 Leitlinienprogramm Onkologie (Deutsche Krebsgesellschaft, Deutsche Krebshilfe, AWMF): Prävention, Diagnostik, Therapie und Nachsorge des Lungenkarzinoms, Lang-version 1.0, 2018, AWMF-Registernummer: 020/007OL. 2018 http://leitlinienprogramm-on-kologie.de/Lungenkarzinom.98.0.html
• 6 Michielin O, van Akkooi ACJ, Ascierto PA. ESMO Guidelines Committee. et al. Electronic address: [e-mail]. Cutaneous melanoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up†. Ann Oncol Off J Eur Soc Med Oncol 2019; 30: 1884-1901
• 7 Schellinger PD, Meinck HM, Thron A. Diagnostic accurancy of MRI compared to CCT in patients with brain metastases. J Neurooncol 1999; 44: 275-281
• 8 Ryu KH, Choi DS, Baek HJ. et al. Clinical feasibility of 1-min ultrafast brain MRI compared with routine brain MRI using synthetic MRI: a single center pilot study. J Neurol 2019; 266: 431-439
• 9 Heidemann RM, Ozsarlak O, Parizel PM. et al. A brief review of parallel magnetic resonance imaging. Eur Radiol 2003; 13: 2323-2337
• 10 Fagundes J, Longo MG, Huang SY. et al. Diagnostic Performance of a 10-Minute Gadolinium-Enhanced Brain MRI Protocol Compared with the Standard Clinical Protocol for Detection of Intracranial Enhancing Lesions. AJNR Am J Neuroradiol 2017; 38: 1689-1694
• 11 Greenwood HI. Abbreviated protocol breast MRI: The past, present, and future. Clin Imaging 2019; 53: 169-173
• 12 Nael K, Khan R, Choudhary G. et al. Six-Minute Magnetic Resonance Imaging Protocol for Evaluation of Acute Ischemic Stroke: Pushing the Boundaries. Stroke 2014; 45: 1985-1991
• 13 Chan MV, McDonald SJ, Ong YY. et al. HCC screening: assessment of an abbreviated non-contrast MRI protocol. Eur Radiol Exp 2019; 3: 49
• 14 Sartoretti T, van Smoorenburg L, Sartoretti E. et al Ultrafast Intracranial Vessel Imaging With Non-Cartesian Spiral 3-Dimensional Time-of-Flight Magnetic Resonance Angiography at 1.5 T: An In Vitro and Clinical Study in Healthy Volunteers. Invest Radiol 2020; 55: 293-303 . PMID: 31895223.
• 15 Lo SS-M, Gore EM, Bradley JD. Expert Panel on Radiation Oncology-Brain Metastases. et al. ACR Appropriateness Criteria® pre-irradiation evaluation and management of brain metastases. J Palliat Med 2014; 17: 880-886
• 16 Kaufmann TJ, Smits M, Boxerman J. et al Consensus recommendations for a standardized brain tumor imaging protocol for clinical trials in brain metastases (BTIP-BM). Neuro-Oncol 2020; 22: 757-772 . PMID: 32048719; PMCID: PMC7283031.
• 17 Ellingson BM, Bendszus M, Boxerman J. et al. Consensus recommendations for a standardized Brain Tumor Imaging Protocol in clinical trials. Neuro-Oncol 2015; 17: 1188-1198
• 18 Deike-Hofmann K, Thünemann D, Breckwoldt MO. et al. Sensitivity of different MRI sequences in the early detection of melanoma brain metastases. PloS One 2018; 13: e0193946
• 19 Downs RK, Bashir MH, Ng CK. et al. Quantitative contrast ratio comparison between T1 (TSE at 1.5T, FLAIR at 3T), magnetization prepared rapid gradient echo and subtraction imaging at 1.5T and 3T. Quant Imaging Med Surg 2013; 3: 141-146
• 20 Mirowitz SA. Intracranial lesion enhancement with gadolinium: T1-weighted spin-echo versus three-dimensional Fourier transform gradient-echo MR imaging. Radiology 1992; 185: 529-534
• 21 Li D, Haacke EM, Tarr RW. et al. Magnetic resonance imaging of the brain with gadopentetate dimeglumine-DTPA: comparison of T1-weighted spin-echo and 3D gradient-echo sequences. J Magn Reson Imaging JMRI 1996; 6: 415-424
• 22 Ercan N, Gultekin S, Celik H. et al. Diagnostic value of contrast-enhanced fluid-attenuated inversion recovery MR imaging of intracranial metastases. AJNR Am J Neuroradiol 2004; 25: 761-765
• 23 Vaswani AK, Nizamani WM, Ali M. et al. Diagnostic Accuracy of Contrast-Enhanced FLAIR Magnetic Resonance Imaging in Diagnosis of Meningitis Correlated with CSF Analysis. ISRN Radiol 2014; 2014: 1-7
• 24 Kazmierczak PM, Dührsen M, Forbrig R. et al. Ultrafast Brain Magnetic Resonance Imaging in Acute Neurological Emergencies: Diagnostic Accuracy and Impact on Patient Management. Invest Radiol 2020; 55: 181-189
• 25 Fogarty GB, Tartaguia C. The utility of magnetic resonance imaging in the detection of brain metastases in the staging of cutaneous melanoma. Clin Oncol R Coll Radiol G B 2006; 18: 360-362
• 26 Barnholtz-Sloan JS, Sloan AE, Davis FG. et al. Incidence proportions of brain metastases in patients diagnosed (1973 to 2001) in the Metropolitan Detroit Cancer Surveillance System. J Clin Oncol Off J Am Soc Clin Oncol 2004; 22: 2865-2872
• 27 Schlamann M, Loquai C, Goericke S. et al. [Cerebral MRI in neurological asymptomatic patients with malignant melanoma]. ROFO Fortschr Geb Rontgenstr Nuklearmed 2008; 180: 143-147
• 28 Fitzmaurice C, Allen C, Barber RM. Global Burden of Disease Cancer Collaboration. et al. Global, Regional, and National Cancer Incidence, Mortality, Years of Life Lost, Years Lived With Disability, and Disability-Adjusted Life-years for 32 Cancer Groups, 1990 to 2015: A Systematic Analysis for the Global Burden of Disease Study. JAMA Oncol 2017; 3: 524-548
• 29 Kim SY, Kim JS, Park HS. et al. Screening of brain metastasis with limited magnetic resonance imaging (MRI): clinical implications of using limited brain MRI during initial staging for non-small cell lung cancer patients. J Korean Med Sci 2005; 20: 121-126