Evaluation of CE-MATRIX-Enhanced FLAIR imaging in the detection of leptomeningeal metastasis.

Abstract

Objective: To investigate the diagnostic value of CE-MATRIX-T1FLAIR and 3D CE-T2FLAIR sequences based on Contrast Enhancement Modulated flip Angle Technique in Refocused Imaging with eXtended echo train (CE-MATRIX) technology for detecting Leptomeningeal Metastasis (LM) using Fluid Attenuated Inversion Recovery (FLAIR) imaging.

Methods: This prospective study included 563 hospitalized patients with clinically suspected LM, diagnosed with malignant tumors between January 2022 and October 2023 at Henan Cancer Hospital. Both CE-MATRIX-T1FLAIR and 3D CE-T2FLAIR sequences were used for imaging. Two radiologists independently evaluated image quality, diagnostic confidence, and objective measurements, diagnosing LM as positive or negative, with disagreements resolved by consultation. Subjective and objective scores were compared using the Wilcoxon signed-rank test. The diagnostic performance of the sequences was compared using ROC curve analysis, with cerebrospinal fluid (CSF) cytology as the gold standard. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, and area under the curve (AUC) values were calculated and compared using Z-tests.

Results: LM was confirmed in 321 patients. CE-MATRIX-T1FLAIR showed superior subjective scores in image quality and diagnostic confidence (p < 0.001). Though CE-MATRIX-T1FLAIR had a lower SNR (p = 0.013), it demonstrated higher sensitivity, specificity, PPV, NPV, accuracy, and AUC than 3D CE-T2FLAIR (p < 0.001). Both sequences provided effective diagnosis and differentiation of LM.

Conclusion: CE-MATRIX-T1FLAIR offers superior diagnostic performance compared to 3D CE-T2FLAIR for LM, with slightly better subjective ratings despite a lower SNR. Both sequences are effective for diagnosing LM.