Abstract Purpose Accurate MRI-based detection of brain metastases (BM) is essential for planning stereotactic radiosurgery (SRS). Although spin-echo (SE) sequences such as T1-SPACE have shown superior lesion detectability compared with gradient-recalled echo (GRE)–based T1-MPRAGE, direct dosimetric comparisons and evaluations of clinical impact are lacking. This study aimed to quantitatively and qualitatively compare T1-SPACE and T1-MPRAGE sequences for SRS planning, focusing on lesion detectability, target volume delineation, dosimetric effects, and oncological outcomes. Methods Quantitative, qualitative, and dosimetric analyses were performed in 51 patients who underwent MRI with T1-SPACE and T1-MPRAGE sequences prior to SRS (SPACE group). An experienced neuroradiologist identified BM on both sequences as the reference standard. For outcome evaluation, distant brain metastasis-free survival (DBMFS) and overall survival (OS) were compared between the SPACE group and a matched control group ( n = 51) planned exclusively on the T1-MPRAGE sequence. Results A senior resident identified significantly more BM on T1-SPACE (94.7%) than on T1-MPRAGE (82.4%). T1-SPACE also demonstrated significantly higher contrast and contrast-to-noise ratios ( p < 0.001). Dosimetrically, T1-SPACE–based plans showed smaller planning target volumes ( p = 0.008) and modest but significant reductions in irradiated brain volumes (V12Gy and V10Gy, both p < 0.05). Patients planned with T1-SPACE had longer DBMFS (10.4 vs. 5.2 months, p = 0.024) and better OS ( p = 0.049) compared with the control group. Conclusion The T1-SPACE sequence offers superior lesion detectability, more accurate target delineation, and favorable dosimetric and clinical outcomes in patients with BM. These findings support the implementation of T1-SPACE as a standard imaging sequence for SRS planning in patients with BM. Clinical trial number Not applicable.
Uysal et al. (Thu,) studied this question.
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