-----Comparison of T1-Post and FLAIR-Post MRI for identification of traumatic meningeal enhancement in traumatic brain injury patients

PLoS One. 2020 Jul 2;15(7):e0234881. doi: 10.1371/journal.pone.0234881. eCollection 2020.

Abstract

Traumatic meningeal enhancement (TME) is a novel biomarker observed on post-contrast fluid-attenuated inversion recovery (FLAIR) in patients who undergo contrast-enhanced magnetic resonance imaging (MRI) after suspected traumatic brain injury (TBI). TME may be seen on acute MRI despite the absence of other trauma-related intracranial findings. In this study we compare conspicuity of TME on FLAIR post-contrast and T1 weighted imaging (T1WI) post-contrast, and investigate if TME is best detected by FLAIR post-contrast or T1WI post-contrast sequences. Subjects selected for analysis enrolled in the parent study (NCT01132937) in 2016 and underwent contrast-enhanced MRI within 48 hours of suspected TBI. Two blinded readers reviewed pairs of pre- and post-contrast T1WI and FLAIR images for presence or absence of TME. Discordant pairs between the two blinded readers were reviewed by a third reader. Cohen's kappa coefficient was used to calculate agreement. Twenty-five subjects (15 males, 10 females; median age 48 (Q1:35-Q3:62; IQR: 27)) were included. The blinded readers had high agreement for presence of TME on FLAIR (Kappa of 0.90), but had no agreement for presence of TME on T1WI (Kappa of -0.24). The FLAIR and T1WI scans were compared among all three readers and 62% of the cases positive on FLAIR could be seen on T1WI. However, 38% of the cases who were read positive on FLAIR for TME were read negative for TME on T1WI. Conspicuity of TME is higher on post-contrast FLAIR MRI than on post-contrast T1WI. TME as seen on post-contrast FLAIR MRI can aid in the identification of patients with TBI.

Publication types

  • Comparative Study
  • Observational Study
  • Research Support, N.I.H., Intramural
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adult
  • Brain Injuries, Traumatic / pathology*
  • Contrast Media
  • Female
  • Glasgow Coma Scale
  • Humans
  • Magnetic Resonance Imaging / methods*
  • Male
  • Meglumine / analogs & derivatives
  • Meninges / injuries
  • Meninges / pathology*
  • Middle Aged
  • Neuroimaging / methods*
  • Organometallic Compounds
  • Single-Blind Method
  • Subtraction Technique

Substances

  • Contrast Media
  • Organometallic Compounds
  • gadobenic acid
  • Meglumine

Associated data

  • ClinicalTrials.gov/NCT01132937

Grants and funding

This study was supported by funding from the National Institutes of Health Intramural Research Program (https://irp.nih.gov/) (LLL) and the U.S. Department of Defense via the Center for Neuroscience and Regenerative Medicine, Uniformed Services University of the Health Sciences (https://www.usuhs.edu/cnrm) (LLL). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.