Contrast-Enhanced MRI with Magnetization Transfer Effect in the Imaging of Brain Metastatic Lesions

Purpose: to investigate the diagnostic opportunities of contrast  magnetic resonance imaging with the effect of magnetization transfer effect in the diagnosis of focal metastatic lesions in the brain.

Materials and methods. Images of contrast MRI of the brain of 16  patients (mean age 49 ± 18.5 years) were analysed. Diagnosis of  the direction is focal brain lesion. All MRI studies were carried out  using the Toshiba Titan Octave with magnetic field of 1.5 T. The  contrast agent is “Magnevist” at concentration of 0.2 ml/kg was  used. After contrasting process two T1-weighted studies were  performed: without T1-SE magnetization transfer with parameters of pulse: TR = 540 ms, TE = 12 ms, DFOV = 24 sm, MX = 320 × 224  and with magnetization transfer – T1-SE-MTC with parameters of pulse: ΔF = −210 Hz, FA(МТС) = 600°, TR = 700 ms, TE = 10 ms,  DFOV = 23.9 sm, MX = 320 x 224. For each detected metastatic  lesion, a contrast-to-brain ratio (CBR) was calculated. Comparative  analysis of CBR values was carried out using a non-parametric  Wilcoxon test at a significance level p < 0.05. To evaluate the  sensitivity and specificity of the techniques in the detection of  metastatic foci (T1-SE and T1-SE-MTC), ROC analysis was used. The sample is divided into groups: 1 group is foci ≤5 mm in size, 2  group is foci from 6 to 10 mm, and 3 group is foci >10 mm. 

Results. Comparative analysis of CBR using non-parametric Wilcoxon test showed that the values of the CBR on T1-weighted  images with magnetization transfer are significantly higher (p  <0.001) that on T1-weighted images without magnetization transfer. According to the results of the ROC analysis, sensitivity in detecting  metastases (n = 90) in the brain on T1-SE-MTC and T1-SE was  91.7% and 81.6%, specificity was 100% and 97.6%, respectively.  The accuracy of the T1-SE-MTC is 10% higher in comparison with  the technique without magnetization transfer. Significant differences (p < 0.01) between the size of the foci detected in post-contrast T1- weighted images with magnetization transfer and in post-contrast  T1-weighted images without magnetization transfer, in particular for  foci ≤5 mm in size, were found.

Conclusions
1. Comparative analysis of CBR showed significant (p < 0.001)  increase of contrast between metastatic lesion and white matter on  T1-SE-MTC in comparison with T1-SE.
2. The sensitivity, specificity and accuracy of the magnetization transfer program (T1-SE-MTC) in detecting foci of  metastatic lesions in the brain is significantly higher (p < 0.01), relative to T1-SE.
3. The T1-SE-MTC program allows detecting more foci in comparison with T1-SE, in particular foci of ≤5 mm (96% and 86%, respectively, with p < 0.05).

1. Mehta M.P., Tsao M.N., Whelan T.J. The American Society for Therapeutic Radiology and Oncology (ASTRO) evidence-based review of the role of radiosurgery for brain metastases. Int. J. Radiat. Oncol. Biol. Phys. 2005; 63: 37–46. DOI:10.1016/j.ijrobp.2005.05.023.

2. Fink K., Fink J. Imaging of brain metastases. Surg. Neurol. Int. 2013; 4: 209. DOI: 10.4103/2152-7806.111298.

3. Eichler A.F., Chung E., Kodack D.P., Loeffler J.S., Fukumura D., Jain R.K. The biology of brain metastases – translation to new therapies. Nature reviews. Clin. Oncol. 2011; 8 (6): 344–356. DOI: 10.1038/nrclinonc.2011.58.

4. Ludemann L., Hamm B., Zimmer C. Pharmacokinetic analysis of glioma compartments with dynamic Gd-DTPAenhanced magnetic resonance imaging. Magn. Reson. Imaging. 2000; 18: 1201–1214.

5. Makary M., Chiocca E.A., Erminy N., Antor M., Bergese S.D., Abdel-Rasoul M., Fernandez S., Dzwonczyk R. Clinical and economic outcomes of lowfield intraoperative MRI-guided tumor resection neurosurgery. J. Magn. Reson. Imaging. 2011; 34: 1022–1030. DOI: 10.1002/jmri.22739.

6. Petrirena G.J., Goldman S., Delattre J.Y. Advances in PET imaging of brain tumors: a referring physician's perspective. Curr. Opin. Oncol. 2011; 23: 617–623.

7. Fink J.R., Muzi M., Peck M., Krohn K.A. Multimodality brain tumor imaging: MR imaging, PET, and PET/MR imaging. J. Nucl. Med. 2015; 56 (10): 1554–1561. DOI: 10.1097/CCO.0b013e32834aa752.

8. Desprechins B., Stadnik T., Koerts G., Shabana W., Breucq C., Osteaux M. Use of diffusion- weighted MR imaging in the differential diagnosis between intracerebral necrotic tumors and cerebral abscesses. Am. J. Neuroradiol. 1999; 20: 1252–1257.

9. Schellinger P.D., Meinck H.M., Thron A. Diagnostic accuracy of MRI compared to CCT in patients with brain metastases. J. Neuro-oncol. 1999; 44 (3): 275–281.

10. Bhangoo S.S., Linskey M.E., Kalkanis S.N. Evidencebased guidelines for the management of brain metastases. Neurosurg. Clin. N. Am. 2011; 22 (1): 97–104i. DOI: 10.1016/j.nec.2010.09.001.

11. Zabel A., Milker-Zabel S., Thilmann C., Zuna I., Rhein B., Wannenmacher M., Debus J. Treatment of brain metastasis in patients with non-small cell lung cancer (NSCLC) by stereotactic linac-based radiosurgery: prognostic factors. Lung Cancer. 2002; 37: 87–94.

12. Lury K.M., Smith J.K., Matheus M.G., Castillo M. Neurosarcoidosis–review of imaging findings. Seminars in roentgenology. Elsevier. 2004; 39 (4): 495–504.

13. Fink K., Fink J. Imaging of brain metastases. Surg. Neurol. Int. 2013; 4: 209–219. DOI: 10.4103/2152-7806.111298.

14. Корниенко В.Н., Пронин И.Н. Диагностическая нейрорадиология. В 4-х томах. Т. 1. М.: Антидор, 2008. 455 с. Kornienko V.N., Pronin I.N. Diagnostic Neuroradiology. In 4 vol. V. 1. M.: Antidor, 2008. 455 p. (In Russian)

15. Akeson P., Larsson E.M, Kristoffersen D.T., Jonsson E., Holtas S. Brain metastases – comparison of gadodiamide injection-enhanced MR imaging at standard and high dose, contrast-enhanced CT and non-contrast-enhanced MR imaging. Actaradiologica. 1995; 36 (3): 300–306.

16. Lignelli A., Khandji A.G. Review of imaging techniques in the diagnosis and management of brain metastases. Neurosurg. Clin. N. Am. 2011; 22 (1): 15–25. DOI: 10.1016/j.nec.2010.09.002.

17. Haba D., Pasco Papon A., Tanguy J.Y., Burtin P., Aube C., Caron-Poitreau C. Use of half- dose gadolinium-enhanced MRI and magnetization transfer saturation in brain tumors. Eur. Radiol. 2001; 11: 117–122.

18. Wolff S.D., Balaban R.S. Magnetization transfer contrast (MTC) and tissue water proton relaxation in vivo. Magn. Reson. Med. 1989; 10 (1): 135–144.

19. Bal riaux D., Colosimo C., Ruscalleda J., Korves M., Schneider G., Bohndorf K., Bongartz G., van Buchem M.A., Reiser M., Sartor K., Bourne M.W., Parizel P.M., Cherryman G.R., Salerio I., La Noce A., Pirovano G., Kirchin M.A., Spinazzi A. Magnetic resonance imaging of metastatic disease to the brain with gado benatedimeglumine. Neuroradiology. 2002; 44 (3): 191–203.

20. Fan B., Li M., Wang X., Xu Y., Li F., Zhang L., Jiang J., Jiang Y. Diagnostic value of gadobutrol versus gadopentetate dimeglumine in enhanced MRI of brain metastases. J. Magn. Reson. Imaging. 2017; 45 (6): 1827–1834. DOI: 10.1002/jmri.25491.

21. Takei H., Rouah E., Ishida Y. Brain metastasis: clinical characteristics, pathological findings and molecular subtyping for therapeutic implications. Brain Tumor Pathol. 2016; 33 (1): 1–12. DOI: 10.1007/s10014-015-0235-3.

22. Kato Y., Higano S., Tamura H., Mugikura S., Umetsu A., Murata T., Takahashi S. Usefulness of contrast-enhanced T1-weighted sampling perfection with applicationoptimized contrasts by using different flip angle evolutions in detection of small brain metastasis at 3T MR imaging: comparison with magnetization-prepared rapid acquisition of gradient echo imaging. Am. J. Neuroradiol. 2009; 30 (5): 923–929. DOI: 10.3174/ajnr.A1506.

23. Zheng L., Sun P., Zheng S., Han Y., Zhang, G. Functional dynamic contrast-enhanced magnetic resonance imaging in an animal model of brain metastases: a pilot study. PloS one. 2014; 9 (10): e109308. DOI: 10.1371/journal.pone.0109308.

24. Yuh W.T., Tali E.T., Nguyen H.D., Simonson T.M., Mayr N.A., Fisher D.J. The effect of contrast dose, imaging time, and lesion size in the MRdetection of intracerebral metastasis. Am. J. Neuroradiol. 1995; 16: 373–380.

25. Thompson G., Mills S.J., Coope D.J., O'Connor J.P., Jackson A. Imaging biomarkers of angiogenesis and the microvascular environment in cerebral tumours. Br. J. Radiol. 2011; 84 (2): 127–144. DOI: 10.1259/bjr/66316279.

26. Грязов А. Б., Чувашова О. Ю. Возможности радиохирургического лечения метастазов рака в головном мозге. Український нейрохірургічний журнал. 2012; 3: 37– 42. Gryazov A.B., Chuvashova O.Yu. Possibilities of radiosurgical treatment of metastases of cancer in the brain. Ukrainskiy neirokhirurgicheskiy zhurnal. 2012; 3: 37–42. (In Russian)

27. Aoyama H., Shirato H., Tago M., Nakagawa K., Toyoda T., Hatano K., Kenjyo M., Oya N., Hirota S., Shioura H., Kunieda E., Inomata T., Hayakawa K., Katoh N., Kobashi G. Stereotactic radiosurgery plus whole-brain radiation therapy vs stereotactic radiosurgery alone for treatment of brain metastases: a randomized controlled trial. JAMA. 2006; 295 (21): 2483– 2491.

28. Михина З.П., Ткачев С.И., Трофимова О.П., Иванов С.M., Медведев С.В., Захаров С.Н., Крат В.Б., Коргунов С.В. Эффективность лечения одиночных метастазов в головном мозге в зависимости от групп прогноза (Оценка по RPARTOG). Вопросы онкологии. 2009; 55 (2): 205–209. Mikhina Z.P., Tkachev S.I., Trofimova O.P., Ivanov S.M., Medvedev S.V., Zakharov S.N., Krat V.B., Korgunov S.V. Dependenceofsingle cerebral metastasis treatment on RPA RTOG prognosis. Voprosi onkologii. 2009; 55 (2): 205–209. (In Russian)

29. Kurki T.J., Niemi P.T., Lundbom N. Gadolinium-enhanced magnetization transfer contrast imaging of intracranial tumors. J. Magn. Reson. Imaging. 1992; 2 (4): 401–406.

30. Terae S., Yoshida D., Kudo K., Tha K.K., Fujino M., Miyasaka K. 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. 2007; 25 (3): 479–487. DOI: 10.1002/jmri.20847.