Evaluating Triple-Dose Gadolinium T1 and Enhanced Fast-Flair MR Studies in Neurologically Symptomatic HIV-Positive Patients

Abstract

We compared delayed triple-dose gadolinium (Gd) (0.3 mmol/kg) T1-weighted (D3x-T1), triple-dose fluid-attenuated inversion-recovery fast spin-echo (fast-FLAIR) (3x-FF) and routine single-dose Gd (0.1 mmol/kg) T1-weighted (1x-T1) images in the detection of central nervous system (CNS) abnormalities in patients with human immunodeficiency virus (HIV) infection. Thirty-three brain MRI scans performed on 29 patients were reviewed by a panel of three neuroradiologists for lesion conspicuity, comparing D3x-T1 with 1x-T1 and D3x-T1 with 3x-FF For each pair of comparisons, the panel reached a consensus about which technique was superior in terms of the number of lesions revealed or lesion conspicuity. Note was made of cases in which a particular technique was judged to alter the radiologic diagnosis. Compared to 1x-T1, D3x-T1 improved lesion detection in 14/29 patients (48%). In three patients (10%), the improvement changed the radiologic diagnosis. Compared to D3x-T1, lesion detection on 3x-FF improved in 19/29 patients (66%), including 11 patients whose lesions were not visible on D3x-T1. However, 3x-FF was inferior to D3x-T1 in four patients. 3x-T1 and 3x-FF images are complementary in the assessment of CNS pathology in symptomatic HIV-positive patients and are especially helpful in the diagnosis of meningeal and white matter abnormalities.

Keywords

triple-dose gadolinium fast-flair MR HIV positive patients neurological symptoms

Get full access to this article

View all access options for this article.

References

Yuh

WTC

Tali

: The effect of contrast dose, imaging time, and lesion size in the MR detection of intracerebral metastasis. Am J Neuroradiol 16: 373–380, 1995.

Yuh

WTC

Fisher

: Phase III multicenter trial of high-dose gadoteridol in MR evaluation of brain metastases. Am J Neuroradiol 15: 1037–1051, 1994.

Runge

Wells

: MR imaging detection of cerebral metastases with a single injection of high-dose gadoteridol. J Magn Reson Imaging 4: 669–673, 1994.

Runge

Wells

Williams

: Magnetic resonance imaging of an experimental model of intracranial metastatic disease. A study of lesion detectability. Invest Radiol 29(12): 1050–1056, 1994.

Akeson

Larsson

: Brain metastases—comparison of gadodiamide injection-enhanced MR imaging at standard and high dose, contrast-enhanced CT and non-contrast-enhanced MR imaging. Acta Radiol 36: 300–306, 1995.

Kuhn

Hammer

: MRI evaluation of “solitary” brain metastases with triple-dose gadoteridol: Comparison with contrast-enhanced CT and conventional-dose gadopentetate dimeglumine MRI studies in the same patients. Comput Med Imaging Graph 18(5): 391–399, 1994.

Andreula

Recchia-Luciana

: Rationale for the use of contrast media in MR imaging. Neuroimaging Clin N Am 7(3): 461–498, 1997.

Thurnher

: Comparison of T2-weighted and fluid-attenuated inversion-recovery fast spin-echo MR sequences in intracerebral AIDS-associated disease. Am J Neuroradiol 18: 1601–1609, 1997.

Tsuchiya

Inaoka

: Fast fluid-attenuated inversion-recovery MR of intracranial infections. Am J Neuroradio 18: 909–913, 1997.

10.

Melhem

Jara

Eustace

: Fluid-attenuated inversion recovery MR imaging: Identification of protein concentration thresholds for CSF hyperintensity. Am J Roentgenol 169: 859–862, 1997.

11.

Mathews

Alo

: AIDS-related CNS cryptococcosis: Radiologic-pathologic correlation. Am J Neuroradiol 13: 1477–1486, 1992.

12.

Arnder

Castillo

: Unusual pattern of enhancement in cryptococcal meningitis: In vivo findings with postmortem correlation. J Comput Assist Tomogr 20(6): 1023–1026, 1996.