Usefulness of Post-enhanced Delayed FLAIR Imaging for Making the Diagnosis of Leptomeningitis

ABSTRACT

PURPOSE: To evaluate the usefulness of post-enhanced delayed FLAIR (fluid-attenuated inversion-recovery) images in the diagnosis of leptomeningitis. MATERIALS AND METHODS: We obtained the pre- and post-enhanced FLAIR images of 7 rabbits every hour after infusing triple doses of contrast, and we measured the signal intensities of the CSF (cerebrospinal fluid) and the brain parenchyma. Five leptomeningitis patients and 5 volunteers were enrolled to obtain the pre-enhanced FLAIR images, the early post-enhanced FLAIR images and the delayed post-enhanced FLAIR images, with using a standard dose of contrast, and to measure the signal intensities of the CSF and brain parenchyma. The statistical significances were determined by a mixed procedure and the Wilcoxon rank-sum test (p<0.05). RESULTS: In the rabbits, the signal intensities of the CSF began to increase after an hour of contrast infusion, but those of the parenchyma did not increase. The time of maximum CSF enhancement was 2 hours after contrast infusion (p<0.001; standard estimate=750.43) and we obtained the post-enhanced delayed FLAIR images for clinical studies according to this result. The signal intensities of the CSF in the subarachnoid space were higher in the patient group compared with those of the normal control group on both the early post-enhanced FLAIR images and the delayed post-enhanced FLAIR images (p=0.0096) (p=0.0391). In the patient group, changes of signal intensities of the CSF in the subarachnoid space were more conspicuous on the delayed post-enhanced FLAIR images than on the early post-enhanced FLAIR images (p=0.0042). However, those of the parenchyma were not different in either group. CONCLUSION: The post-enhanced delayed FLAIR images obtained at 2 hours after contrast infusion are more useful for making the the diagnosis of leptomeningitis than are the post-enhanced early FLAIR images.