Quantitative contrast ratio comparison between T1 (TSE at 1.5T, FLAIR at 3T), magnetization prepared rapid gradient echo and subtraction imaging at 1.5T and 3T

Introduction: Creating contrast between normal anatomy and pathology is the main goal of imaging. Here we compare contrast ratios of enhancing brain lesions at 1.5T between T1 TSE, magnetization prepared rapid gradient echo (MPRAGE) and subtraction and at 3T between T1 FLAIR, MPRAGE and subtraction. Methods: Contrast ratio between enhancing lesions and normal contralateral brain was measured for above mentioned sequences during the same imaging session. A total of 27 exams on 25 patients were evaluated. Results: A total of 90 enhancing brain lesions were utilized. Of these 46 were <5 mm diameter. Taking all lesions into account there was a small but statistically significant improvement in contrast ratio at 1.5T with MPRAGE compared to T1 TSE and at 3T for T1 FLAIR compared to MPRAGE. However, there was no statistically significant difference between these sequences for lesions 5 mm or less in diameter. However, subtraction provided a marked and statistically significant improvement in contrast ratio for both all lesions and including only lesions 5 mm or less in diameter. Conclusions: Our data indicate that for small lesions at 1.5T there is no significant difference in contrast ratio (CR) between T1 TSE and MPRAGE or at 3T between T1 FLAIR and MPRAGE despite the MPRAGE having the advantage of much thinner slices and a higher matrix. However, subtraction provided a markedly improved CR for all lesions at 1.5T and 3T regardless of lesion size. Subtraction should be considered for clinical use to improve detection of small or subtle enhancing lesions.