Recognition of Brain Metastases Using Gadolinium-Enhanced SWI MRI: Proof-of-Concept Study.

Background and purpose: SWI MRI, a T2*-dominant MRI sequence with T1 shine-through effect, uses intrinsic structural susceptibility to create enhancement among brain structures. We evaluated whether gadolinium-enhanced SWI (SWI-Gd) improves brain metastasis detection in combination with other MRI sequences. Materials and methods: MRI images of 24 patients (46 studies) were prospectively acquired using a 1.5-T scanner. T1-weighted, unenhanced SWI (SWI-U) and SWI-Gd were evaluated blindly to clinical features by two board-certified radiologists. Results: SWI-Gd revealed more significant metastatic lesions than either T1-Gd or SWI-U (p = 0.0004 for either comparator sequence). Moreover, SWI-Gd revealed more lesions only for those patients with ≤5 lesions on T1-Gd (n = 30 studies from 16 patients; p = 0.046). Performing SWI-Gd added <5 min of scanning time with no further additional risk. Conclusions: Our findings suggest that, when added to T1-Gd and other common sequences, SWI-Gd may improve the diagnostic yield of brain metastases with only a few extra minutes of scanning time and no further risk than that of a regular gadolinium-enhanced MRI.

Cerebral changes in SLE with or without antiphospholipid syndrome. a case-control MRI study.

BACKGROUND: To determine and characterize the prevalence of cerebral changes on MRI in patients with antiphospholipid syndrome (APLS) within systemic lupus erythematosus (SLE). METHODS: Seventy-one patients with SLE were prospectively studied with brain MRI: 32 with definite APLS and 39 without. Atrophy, ventricular enlargement, leukoaraiosis, interuncal distance, Evans' index, infarcts, and white matter hyperintensities (WMH) were analyzed. Demographic data, treatment, and SLE activity were analyzed. RESULTS: Groups were similar in age (32.4 vs. 32.8 years old; P= non-significant [NS]), and gender. Duration of disease was longer in patients with APLS (87.3 vs. 55.4 months; P= .064). Cortical atrophy was common in both groups (68.7% vs. 89.7%; P= NS). Leukoaraiosis was present in only 3 patients (9.4%; P= .08), all in the APLS group. WMH were found in more than 40% of the patients from both groups. Infarcts (21.9% vs. 2.6%; P= .019) and infarcts plus WHM (12.5% vs. 0; P= .037) were more common in patients with APLS. CONCLUSIONS: Although a higher prevalence of neurological involvement in SLE has been reported in APLS patients, we found gross brain changes to be similar between groups. Strokes and leukoaraiosis were more common in the APLS group, consistent with the idea of an APLS-induced prothrombotic state.