What question did this study set out to answer?

This research aims to compare the diagnostic performance of T1 Turbo Spin-Echo and Gradient-Recalled Echo MRI sequences in detecting brain metastases.

March 14, 2026Open Access

Volumetric Postcontrast T1 Turbo Spin-Echo versus Gradient-Recalled Echo MR sequences for Detecting Brain Metastases: a Systematic Review and Meta-analysis

Key Points

This research aims to compare the diagnostic performance of T1 Turbo Spin-Echo and Gradient-Recalled Echo MRI sequences in detecting brain metastases.
Conducted a systematic review and meta-analysis of studies on diagnostic performance of MRI sequences.
Searched databases like MEDLINE and EMBASE from inception to April 2025.
Included 15 studies encompassing 544 patients and analyzed diagnostic accuracy parameters.
Pooled sensitivity for TSE was 97.4% compared to 76.1% for GRE.
TSE showed better detection of small lesions (<5 mm) at 96.1% vs. 58.4% for GRE.
Both techniques were similar in detecting larger lesions (≥5 mm).

Abstract

BACKGROUND: Contrast-enhanced 3D T1-weighted MRI is the imaging reference for detection and follow-up of brain metastases. Volumetric GRE-based sequences, such as MPRAGE, are widely used but remain prone to susceptibility and lower lesion conspicuity. 3D black-blood TSE-based sequences, such as Sampling Perfection with Application-Optimized Contrasts by using different flip angle Evolutions (SPACE), have been increasingly embedded into routine workflow and are thought to improve lesion detection in part through vessel signal suppression. PURPOSE: We aimed to investigate the comparative diagnostic performance of 3D T1 TSE versus GRE sequences for the detection of brain metastases. DATA SOURCES: Studies comparing the diagnostic performance of postcontrast 3D T1 SE and GRE sequences in adults with brain metastases were searched on MEDLINE, EMBASE, Cochrane Central, Google Scholar, and PROSPERO, from inception through April 2025. STUDY SELECTION: Fifteen studies encompassing 544 patients with 4338 metastases were included. DATA ANALYSIS: Data on diagnostic accuracy parameters, image quality, and inter-rater agreement were extracted. Random-effects models were applied to compute pooled sensitivity and comparative OR for lesion detection. Risk of bias was assessed using QUADAS-2 and QUADAS-C tools. DATA SYNTHESIS: Pooled sensitivities for detection of brain metastases were 97.4% (95%CI, 93.2%-99.0%) for TSE and 76.1% (95%CI, 69.3-81.9) for GRE-based sequences, with a comparative OR of 12.0 (95%CI, 5.45-26.6, P LIMITATIONS: Our meta-analysis is limited by high heterogeneity, case-only studies, possible small-study effects, and high risk of bias for the reference standard domain. CONCLUSIONS: Postcontrast 3D T1 TSE sequences provide higher sensitivity and improved lesion conspicuity compared with GRE sequence, particularly for small metastases, though at the cost of slightly higher false positives.

Volumetric Postcontrast T1 Turbo Spin-Echo versus Gradient-Recalled Echo MR sequences for Detecting Brain Metastases: a Systematic Review and Meta-analysis

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Abstract

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