Quantifizierung morphologischer Veränderungen meningealer Strukturen in magnetresonanztomographischen Untersuchungen
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Philipps-Universität Marburg
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Abstract
Abnormal contrast enhancement of the cerebral meninges in magnetic resonance imaging (mri) can be observed in several diseases of various aetiology. The introduction of three-dimensional contrast enhanced (CE) „magnetization-prepared rapid-acquisition-gradient-echo“(mp-rage) sequences into routine MR-imaging resulted in a more prominent appearance of the meninges. However, it remained unclear if the visual assessment of meningeal thickening by a radiologist is reproducible by imaging software-based measurement. Furthermore, the suitability of this radiological parameter to determine significant differences in meningeal diameter and enhancement patterns was still questionable. This study analysed contrast-enhanced meninges in the largest comparable patient collective to date. The main goal of this analysis was to investigate the clinical conditions and diseases affecting the meninges, especially with regard to neoplastic meningitis (NM).
To start out, the reports on approximately 41,500 MRI examinations from 2011 to 2016 were scanned by keyword search. 197 cases could be included in the study, of which 108 could be fully analysed with routine radiological analysis software. CE T1 sequences of the brain were compared with CE mp-rage-sequences against a control group of 121 patients whose meninges had a regular appearance. Additionally, native T2-FLAIR sequences were used for the analysis of morphology and signal intensity.
The analysis by measurements of the meningeal diameter confirmed the visual assessment: meninges were significantly larger in the observation group (mean thickness 2.16mm) as compared to the control group with normal appearing meninges (mean thickness 1.47mm) (p<0.001). The CE mp-rage sequence proved to be the best method for assessing the meninges, even better than conventional CE T1 images. Furthermore, it can be inferred from the data that native T2-FLAIR sequences are not suitable for diagnosis based on morphology and signal intensity. The causes of meningeal thickening were in 56.5% mechanical, in 23.1% neoplastic, of which 14.8% account for neoplastic meningitis, and in 17.6% inflammatory. The remaining 2,8% accounted for ischemic alterations or stayed unclear.
These results reveal that a large number of pathologies result in thickening of the meninges. Additionally, the measurements indicate that experienced neuroradiologists are capable of diagnosing pathological contrast enhancement based on subjective assessment alone. Consequently, a contrast enhancement of the meninges should not prematurely lead to the diagnosis of neoplastic meningitis. Adjustments to the method of measurement for future studies could further strengthen the herein attained results.
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Created: 2020Issued: 2021-01-21Updated: 2021-01-21
Faculty
Medizin
Publisher
Philipps-Universität Marburg
Language
ger
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DoctoralThesis
Keywords
MRT SequenzSequenzmp-rageMeningenenhancementmagnetic resonance imagingflaiMP-RAGEneoplasticmeningesmeningitisMRTMagnetresonanztomographieMeningeosis,neoplastic meningitismeningealT1MRImeningeal enhancementKontrastmittelMeningitisFLAIRMeningeose3DHirnhaut
DFG-subjects
HirnhautGehirnKontrastmittelSchädelMagnetische ResonanzHirnhautentzündungGadoliniumTrepanationKernspintomografieWasserkopf
DDC-Numbers
610
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Homberg, Marcel: Quantifizierung morphologischer Veränderungen meningealer Strukturen in magnetresonanztomographischen Untersuchungen. : Philipps-Universität Marburg 2021-01-21. DOI: https://doi.org/10.17192/z2021.0014.