Assessment of cerebral gliomas by a new dark fluid sequence, high intensity REduction (HIRE): A preliminary study

• Published in: Journal of magnetic resonance imaging 2000-05, Vol.11 (5), p.506-517
• Main Authors: Essig, Marco, Deimling, Michael, Hawighorst, H., Debus, J., van Kaick, G.
• Format: Article
• Language: English
• Subjects: Adult; Brain - pathology; Brain Neoplasms - diagnosis; Cerebral gliomas; Contrast Media; Female; FLAIR; Gadolinium DTPA; Glioma - diagnosis; HIRE; Humans; Image Processing, Computer-Assisted; Magnetic Resonance Imaging - methods; Male; Middle Aged; Subtraction Technique
• ISSN: 1053-1807; 1522-2586
• DOI: 10.1002/(SICI)1522-2586(200005)11:5<506::AID-JMRI6>3.0.CO;2-D

The purpose of this study was to assess the diagnostic potential of a new dark fluid sequence, high intensity reduction (HIRE) in the diagnostic workup of patients with cerebral gliomas. The HIRE sequence utilizes a very long T2 value of the cerebrospinal fluid (CSF) to suppress its high signal contribution in T2‐weighted imaging by a image subtraction technique. Fifteen patients with histologically confirmed cerebral gliomas were examined with T2‐weighted fast spin‐echo (FSE), T1‐weighted SE, fast fluid‐attenuated inversion recovery (FLAIR), and HIRE imaging using identical scan parameters. In patients with enhancing lesions, fast FLAIR and HIRE were added to the contrast‐enhanced T1‐weighted SE images. Images were analyzed in a qualitative and quantitative evaluation. In the qualitative analysis, lesion detection, lesion delineation, and differentiation between enhancing and non‐enhancing tumor tissue were assessed in a two‐reader study. For the quantitative analysis, lesion‐to‐background and lesion‐to‐CSF contrast and contrast‐to‐noise ratios were determined in a region of interest analysis. HIRE achieved a significant reduction of the CSF signal without losing the high gray‐to‐white matter contrast of T2‐weighted sequences. In the quantitative analysis, the contrast ratios of the HIRE images were lower compared with the FLAIR images due to a relatively high background and CSF signal. After administration of contrast media, HIRE images presented a significant signal increase in enhancing lesions, which subsequently increased the contrast and contrast‐to‐noise ratios. In the qualitative analysis, both readers found all tumors clearly delineated on HIRE imaging. Compared with T2‐weighted FSE, the tumor delineation with HIRE was better in nine patients, equal in four patients, and less in one patient. Compared with the FLAIR images, HIRE was rated superior in three patients, equal in nine patients, and inferior in another three patients. Delineation of the enhancing tumor parts was possible with HIRE in all patients. HIRE images had significantly fewer image artifacts than FLAIR images due to reduced inflow effects. The T2‐based HIRE sequence presented is an alternative to the T1‐based FLAIR sequence, with the advantage of better gray‐to‐white matter contrast and shorter measurement time. Due to the subtraction technique, signal intensities from tissues with relaxation times in the range T2 WM < < T2 < T2 CSF are also gradually affected, corresponding to t