Comparison of single- and triple-dose contrast material in the MR screening of brain metastases

• Published in: American journal of neuroradiology : AJNR Vol. 19; no. 5; pp. 821 - 828
• Main Authors: Sze, G, Johnson, C, Kawamura, Y, Goldberg, SN, Lange, R, Friedland, RJ, Wolf, RJ
• Format: Journal Article
• Language: English
• Published: Oak Brook, IL Am Soc Neuroradiology 01.05.1998; American Society of Neuroradiology
• Subjects: Biological and medical sciences; Brain - pathology; Brain Neoplasms - diagnosis; Brain Neoplasms - secondary; Comparative Study; Contrast Media - administration & dosage; Dose-Response Relationship, Drug; False Positive Reactions; Humans; Magnetic Resonance Imaging; Medical sciences; Neurology; Prospective Studies; Single-Blind Method; Tumors of the nervous system. Phacomatoses; Performance evaluation; Human; Intracranial; Nervous system diseases; Malignant tumor; Metastasis; Nuclear magnetic resonance imaging; Posology; Cerebral disorder; Central nervous system disease; Medical imagery; Diagnosis; Contrast media
• ISSN: 0195-6108; 1936-959X

Although studies obtained with triple-dose contrast administration can show more brain metastases than those obtained with single-dose contrast material in patients with multiple metastases, such studies are costly and of limited clinical benefit. Since most patients who undergo screening have negative findings or a single metastasis, this study was performed to compare the clinical utility of single-dose versus triple-dose contrast administration in this large group of patients who could benefit from the possible increased sensitivity in lesion detection. Ninety-two consecutive patients with negative or equivocal findings or a solitary metastasis on single-dose contrast-enhanced MR images underwent triple-dose studies. Findings were compared with a standard of reference composed of panel review and long-term follow-up. Further analysis was performed by comparing results with those obtained by two blinded readers. In all 70 negative single-dose studies, the triple-dose studies depicted no additional metastases in terms of the standard of reference. No statistically significant difference was seen between the results of the single- and triple-dose studies. For 10 equivocal single-dose studies, the triple-dose study helped clarify the presence or absence of metastases in 50% of the cases. In 12 patients with a solitary metastasis seen on the single-dose study, the triple-dose study depicted additional metastases in 25% of the cases. In the results of one of the two blinded readers, use of triple-dose contrast led to a statistical difference by decreasing the number of equivocal readings but at the expense of increasing the number of false-positive readings. Routine triple-dose contrast administration in all cases of suspected brain metastasis is not helpful. On the basis of our investigation, we conclude that the use of triple-dose contrast material is beneficial in selected cases with equivocal findings or solitary metastasis, although with the disadvantage of increasing the number of false-positive results.