Contrast-enhanced FLAIR Versus Contrast-enhanced T1-Weighted Sequence of Magnetic Resonance Imaging for the Evaluation of Leptomeningeal Disease: Which one is Better?

Objectives: The purpose of this study was to compare the sensitivity of gadolinium-enhanced T1-weighted magnetic resonance imaging (MRI) and gadolinium-enhanced FLAIR (fluid attenuated inversion recovery) MRI in detecting leptomeningeal carcinomatosis. Method: In all patients, all routine brain imaging sequences were performed, including T1- and T2-weighted axial and coronal unenhanced spin-echo sequences, FLAIR axial unenhanced sequence, as well as contrast-enhanced FLAIR, and T1-weighted sequences. These sequences were used in the study group consisted of 12 patients (5 male, 7 female, age range: 51-82; 4 breast carcinoma, 4 lung carcinoma, 2 melanoma, 2 lymphoma) with proven leptomeningeal carcinomatosis disease. Comparisons were made particularly between enhanced T1- and FLAIR- enhanced images.Results: In all 12 patients with clinically proven leptomeningeal disease (10 metastatic carcinoma, 2 lymphoma), contrast-enhanced FLAIR sequence demonstrated better and more extensive and conspicuous enhancement when compared to contrast-enhanced T1 sequence. Discussion: Gadolinium-enhanced FLAIR images were superior to gadolinium-enhanced T1 sequences for detecting pathologic leptomeninges. (Arc-hi-ves of Neu-ropsy-chi-atry 2012;49: 108-113)