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Differences in dynamic susceptibility contrast MR perfusion maps generated by different methods implemented in commercial software. J Comput Assist Tomogr 2014; 38:647-54. [PMID: 24879459 DOI: 10.1097/rct.0000000000000115] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE There are several potential sources of difference that can influence the reproducibility of magnetic resonance (MR) perfusion values. We aimed to investigate the reproducibility and variability of dynamic susceptibility contrast (DSC) MR imaging (MRI) parameters obtained from identical source data by using 2 commercially available software applications with different postprocessing algorithms. METHODS AND MATERIALS We retrospectively evaluated DSC-MRI data sets of 24 consecutive patients with glioblastoma multiforme. Perfusion data were postprocessed with 2 commercial software packages, NordicICE (NordicNeuroLab, Bergen, Norway) and GE Brainstat (GE Healthcare, Milwaukee, Wis), each of which offers the possibility of different algorithms. We focused the comparison on their main analysis issues, that is, the gamma-variate fitting function (GVF) and the arterial input function (AIF). Two regions of interest were placed on maps of perfusion parameters (cerebral blood volume [CBV], cerebral blood flow [CBF], mean transit time [MTT]): one around tumor hot spot and one in the contralateral normal brain. A one-way repeated-measures analysis of variance was conducted to determine whether there was a significant difference in the calculated MTT, CBV, and CBF values. RESULTS As regards NordicICE software application, the use of AIF is significant (P = 0.048) but not the use of GVF (P = 0.803) for CBV values. Additionally, in GE, the calculation method discloses a statistical effect on data. Comparing similar GE-NordicICE algorithms, both method (P = 0.005) and software (P < 0.0001) have a statistical effect in the difference. Leakage-corrected and uncorrected normalized CBV (nCBV) values are statistically equal. No statistical differences have been found in nMTT values when directly calculated. Values of nCBF are affected by the use of GVF. CONCLUSION The use of a different software application determines different results, even if the algorithms seem to be the same. The introduction of AIF in the data postprocessing determines a higher estimates variability that can make interhospital and intrahospital examinations not completely comparable. A simpler approach based on raw curve analysis produces more stable results.
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Abstract
Brain tumors are one of the most challenging disorders encountered, and early and accurate diagnosis is essential for the management and treatment of these tumors. In this article, diagnostic modalities including single-photon emission computed tomography, positron emission tomography, magnetic resonance imaging, and optical imaging are reviewed. We mainly focus on the newly emerging, specific imaging probes, and their potential use in animal models and clinical settings.
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Affiliation(s)
- Huile Gao
- Key Laboratory of Smart Drug Delivery, Ministry of Education & PLA, School of Pharmacy, Fudan University, 826 Zhangheng Road, Shanghai 201203, China
| | - Xinguo Jiang
- Key Laboratory of Smart Drug Delivery, Ministry of Education & PLA, School of Pharmacy, Fudan University, 826 Zhangheng Road, Shanghai 201203, China
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Friedman SN, Bambrough PJ, Kotsarini C, Khandanpour N, Hoggard N. Semi-automated and automated glioma grading using dynamic susceptibility-weighted contrast-enhanced perfusion MRI relative cerebral blood volume measurements. Br J Radiol 2013; 85:e1204-11. [PMID: 23175486 DOI: 10.1259/bjr/13908936] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE Despite the established role of MRI in the diagnosis of brain tumours, histopathological assessment remains the clinically used technique, especially for the glioma group. Relative cerebral blood volume (rCBV) is a dynamic susceptibility-weighted contrast-enhanced perfusion MRI parameter that has been shown to correlate to tumour grade, but assessment requires a specialist and is time consuming. We developed analysis software to determine glioma gradings from perfusion rCBV scans in a manner that is quick, easy and does not require a specialist operator. METHODS MRI perfusion data from 47 patients with different histopathological grades of glioma were analysed with custom-designed software. Semi-automated analysis was performed with a specialist and non-specialist operator separately determining the maximum rCBV value corresponding to the tumour. Automated histogram analysis was performed by calculating the mean, standard deviation, median, mode, skewness and kurtosis of rCBV values. All values were compared with the histopathologically assessed tumour grade. RESULTS A strong correlation between specialist and non-specialist observer measurements was found. Significantly different values were obtained between tumour grades using both semi-automated and automated techniques, consistent with previous results. The raw (unnormalised) data single-pixel maximum rCBV semi-automated analysis value had the strongest correlation with glioma grade. Standard deviation of the raw data had the strongest correlation of the automated analysis. CONCLUSION Semi-automated calculation of raw maximum rCBV value was the best indicator of tumour grade and does not require a specialist operator. ADVANCES IN KNOWLEDGE Both semi-automated and automated MRI perfusion techniques provide viable non-invasive alternatives to biopsy for glioma tumour grading.
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Affiliation(s)
- S N Friedman
- Sackler School of Medicine, Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
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Abstract
MR imaging without and with gadolinium-based contrast agents (GBCAs) is an important imaging tool for defining normal anatomy and characteristics of lesions. GBCAs have been used in contrast-enhanced MR imaging in defining and characterizing lesions of the central nervous system for more than 20 years. The combination of unenhanced and GBCA-enhanced MR imaging is the clinical gold standard for the noninvasive detection and delineation of most intracranial and spinal lesions. MR imaging has a high predictive value that rules out neoplasm and most inflammatory and demyelinating processes of the central nervous system.
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Affiliation(s)
- Bum-soo Kim
- Department of Radiology, The Catholic University of Korea, Seoul, Korea
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Willowson K, Bailey D, Schembri G, Baldock C. CT-based quantitative SPECT for the radionuclide ²⁰¹Tl: experimental validation and a standardized uptake value for brain tumour patients. Cancer Imaging 2012; 12:31-40. [PMID: 22375306 PMCID: PMC3335331 DOI: 10.1102/1470-7330.2012.0005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We have previously reported on a method for reconstructing quantitative data from 99mTc single photon emission computed tomography (SPECT) images based on corrections derived from X-ray computed tomography, producing accurate results in both experimental and clinical studies. This has been extended for use with the radionuclide ²⁰¹Tl. Accuracy was evaluated with experimental phantom studies, including corrections for partial volume effects where necessary. The quantitative technique was used to derive standardized uptake values (SUVs) for ²⁰¹Tl evaluation of brain tumours. A preliminary study was performed on 26 patients using ²⁰¹Tl SPECT scans to assess residual tumor after surgery and then to monitor response to treatment, with a follow-up time of 18 months. Measures of SUVmax were made following quantitative processing of the data and using a threshold grown volume of interest around the tumour. Phantom studies resulted in the calculation of concentration values consistently within 4% of true values. No continuous relation was found between SUVmax (post-resection) and patient survival. Choosing an SUVmax cut-off of 1.5 demonstrated a difference in survival between the 2 groups of patients after surgery. Patients with an SUVmax<1.5 had a 70% survival rate over the first 10 months, compared with a 47% survival rate for those with SUVmax>1.5. This difference did not achieve significance, most likely due to the small study numbers. By 18 months follow-up this difference had reduced, with corresponding survival rates of 40% and 27%, respectively. Although this study involves only a small cohort, it has succeeded in demonstrating the possibility of an SUV measure for SPECT to help monitor response to treatment of brain tumours and predict survival.
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Affiliation(s)
- Kathy Willowson
- Institute of Medical Physics, School of Physics, University of Sydney, Camperdown, NSW 2006, Australia.
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Mills SJ, Soh C, O'Connor JPB, Rose CJ, Buonaccorsi G, Cheung S, Zhao S, Parker GJM, Jackson A. Enhancing fraction in glioma and its relationship to the tumoral vascular microenvironment: A dynamic contrast-enhanced MR imaging study. AJNR Am J Neuroradiol 2009; 31:726-31. [PMID: 20019100 DOI: 10.3174/ajnr.a1925] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE EnF is a newly described measure of proportional tumor enhancement derived from DCE-MR imaging. The aim of this study was to assess the relationship between EnF and the more established DCE-MR imaging parameters: K(trans), v(e), and v(p). MATERIALS AND METHODS Forty-two patients with 43 gliomas (16 grade II, 3 grade III, and 24 grade IV) were studied. Imaging included pre- and postcontrast T1-weighted sequences through the lesion and T1-weighted DCE-MR imaging. Parametric maps of EnF, K(trans), v(e), and v(p) were generated. Voxels were classified as enhancing if the IAUC was positive (EnF(IAUC)(60>0)). A threshold of IAUC > 2.5 mmol.s was used to generate EnF(IAUC)(60>2.5). Both measures of EnF were compared with the DCE-MR imaging parameters (K(trans), v(e), and v(p)). RESULTS In grade II gliomas, EnF(IAUC60>0) and EnF(IAUC60>2.5) correlated with v(p) (R(2) = 0.6245, P < .0005; and R(2) = 0.4727, P = .003) but not with K(trans) or v(e). In grade IV tumors, both EnF(IAUC60>0) and EnF(IAUC60>2.5) correlated with K(trans) (R(2) = 0.3501, P = .001; and R(2) = 0.4699, P < .0005) and v(p) (R(2) = 0.1564, P = .01; and R(2) = 0.2429, P = .007), but not with v(e). Multiple regression analysis showed K(trans) as the only independent correlate of both EnF(IAUC60>0) and EnF(IAUC60>2.5) for grade IV tumors. CONCLUSIONS This study suggests that in grade II tumors, EnF reflects v(p) and varies due to changes in vascular density. In grade IV gliomas, EnF is affected by K(trans) with secondary associated changes in v(p).
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Affiliation(s)
- S J Mills
- University of Manchester, United Kingdom.
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Jackson A, O'Connor J, Thompson G, Mills S. Magnetic resonance perfusion imaging in neuro-oncology. Cancer Imaging 2008; 8:186-99. [PMID: 18980870 PMCID: PMC2590875 DOI: 10.1102/1470-7330.2008.0019] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Recent advances in magnetic resonance imaging (MRI) have seen the development of techniques that allow quantitative imaging of a number of anatomical and physiological descriptors. These techniques have been increasingly applied to cancer imaging where they can provide some insight into tumour microvascular structure and physiology. This review details technical approaches and application of quantitative MRI, focusing particularly on perfusion imaging and its role in neuro-oncology.
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Affiliation(s)
- Alan Jackson
- Division of Imaging Science, University of Manchester, Wolfson Molecular Imaging Centre, 27 Palatine Road, Manchester M203LJ, UK.
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Aprile I, Giorgi C, Guiducci A, Conti G, Ottaviano I, Ottaviano P. Characterization of Glioblastoma by Contrast-Enhanced Flair Sequences. Neuroradiol J 2008; 21:196-203. [DOI: 10.1177/197140090802100207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2007] [Accepted: 11/24/2007] [Indexed: 11/16/2022] Open
Abstract
The tissues placed on the edge of a glioblastoma's necrotic cavities are more vascularized than other pseudocystic central nervous system (CNS) tumours, both benign and malignant. The post-contrast enhancement is greater in Fluid-Attenuated Inversion-Recovery (FLAIR) images than in Spin Echo T1-weighted (SE T1w) sequences above all in the CNS tissues with a low concentration of gadolinium. The purpose of this study was to distinguish pseudocystic glioblastomas from other cystic CNS tumors by comparing post-contrast pseudocystic rim enhancement in FLAIR and SE T1-w magnetic resonance (MR) images. We investigated 32 extensive sets of MR images relating to histologically diagnosed pseudocystic CNS tumors; 14/32 were glioblastoma. Fast Spin Echo (FSE) T2-weighted and Proton Density, SE T1w and FSE FLAIR sequences were acquired in all the studies. After contrast media administration SE T1w and FLAIR sequences were acquired. In post-contrast T1w SE and T2w FLAIR acquisitions, pseudocyst rim enhancement was evaluated assigning scores: 4 = rim enhancement completely surrounds perimeter; 3 = rim enhancement in ≥50% of perimeter; 2 ? rim in < 50% of perimeter; 1 = rim enhancement absent. Mean scores were calculated and the results were compared with statistical methods (Student's t test) for glioblastomas and all other tumors. Moreover differences between FLAIR and SE scores was assessed in each patient. If the difference was 0 glioblastoma was assumed, if the difference was ≥ 1 another tumor was assumed; the sensitivity and specificity of this diagnosis compared to the histological diagnosis were assessed. Mean Tl-weighted SE scores did not differ in glioblastomas and other tumors. FLAIR scores in glioblastomas were less than half those of other tumors (p < 0.005). Glioblastoma diagnosis based on score difference identified 13 true positives (glioblastomas), 16 true negatives (non glioblastomas), two false positives and two false negatives. The sensitivity for glioblastoma was 86.7% and the specificity was 94.1%. Comparison of post-contrast rim enhancement in T1w SE and FLAIR sequences distinguishes glioblastomas from other pseudocystic CNS tumors, assisting the differential diagnosis of glioblastomas, that in many cases are not distinguishable from metastases even with advanced MR techniques.
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Affiliation(s)
- I. Aprile
- Diagnostica Immagini, Neuroradiologia; Terni, Italy
| | - C. Giorgi
- Diagnostica Immagini, Neuroradiologia; Terni, Italy
| | - A. Guiducci
- Diagnostica Immagini, Neuroradiologia; Terni, Italy
| | - G. Conti
- Diagnostica Immagini, Neuroradiologia; Terni, Italy
| | - I. Ottaviano
- Diagnostica Immagini, Neuroradiologia; Terni, Italy
| | - P. Ottaviano
- Diagnostica Immagini, Neuroradiologia; Terni, Italy
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Hammoud DA, Pomper MG. Central Nervous System Imaging. Oncology 2007. [DOI: 10.1007/0-387-31056-8_27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Hakyemez B, Erdogan C, Bolca N, Yildirim N, Gokalp G, Parlak M. Evaluation of different cerebral mass lesions by perfusion-weighted MR imaging. J Magn Reson Imaging 2007; 24:817-24. [PMID: 16958061 DOI: 10.1002/jmri.20707] [Citation(s) in RCA: 143] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE To investigate the contribution of perfusion-weighted MR imaging (PWI) by using the relative cerebral blood volume (rCBV) ratio in the differential diagnosis of various intracranial space-occupying lesions. MATERIALS AND METHODS This study involved 105 patients with lesions (high-grade glioma (N=26), low-grade glioma (N=11), meningioma (N=23), metastasis (N=25), hemangioblastoma (N=6), pyogenic abscess (N=4), schwannoma (N=5), and lymphoma (N=5)). The patients were examined with a T2*-weighted (T2*W) gradient-echo single-shot EPI sequence. The rCBV ratios of the lesions were obtained by dividing the values obtained from the normal white matter. Statistical analysis was performed with the Mann-Whitney U-test. A P-value less than 0.05 was considered statistically significant. RESULTS The rCBV ratio was 5.76+/-3.35 in high-grade gliomas, 1.69+/-0.51 in low-grade gliomas, 8.02+/-3.89 in meningiomas, 5.27+/-3.22 in metastases, 11.36+/-4.41 in hemangioblastomas, 0.76+/-0.12 in abscesses, 1.10+/-0.32 in lymphomas, and 3.23+/-0.81 in schwannomas. The rCBV ratios were used to discriminate between 1) high- and low-grade gliomas (P<0.001), 2) hemangioblastomas and metastases (P<0.05), 3) abscesses from high-grade gliomas and metastases (P<0.001), 4) schwannomas and meningiomas (P<0.001), 5) lymphomas from high-grade gliomas and metastases (P<0.001), and 6) typical meningiomas and atypical meningiomas (P<0.01). CONCLUSION rCBV ratios can help discriminate intracranial space-occupying lesions by demonstrating lesion vascularity. It is possible to discriminate between 1) high- and low-grade gliomas, 2) hemangioblastomas and other intracranial posterior fossa masses, 3) abscesses from high-grade gliomas and metastases, 4) schwannomas and meningiomas, 5) lymphomas and high-grade gliomas and metastases, and 6) typical and atypical meningiomas.
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Affiliation(s)
- Bahattin Hakyemez
- Department of Radiology, Uludag University Medical School, and Bursa State Hospital, Bursa, Turkey.
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Di Costanzo A, Scarabino T, Trojsi F, Giannatempo GM, Popolizio T, Catapano D, Bonavita S, Maggialetti N, Tosetti M, Salvolini U, d'Angelo VA, Tedeschi G. Multiparametric 3T MR approach to the assessment of cerebral gliomas: tumor extent and malignancy. Neuroradiology 2006; 48:622-31. [PMID: 16752135 DOI: 10.1007/s00234-006-0102-3] [Citation(s) in RCA: 108] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2005] [Accepted: 04/12/2006] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Contrast-enhanced MR imaging is the method of choice for routine assessment of brain tumors, but it has limited sensitivity and specificity. We verified if the addition of metabolic, diffusion and hemodynamic information improved the definition of glioma extent and grade. METHODS Thirty-one patients with cerebral gliomas (21 high- and 10 low-grade) underwent conventional MR imaging, proton MR spectroscopic imaging ((1)H-MRSI), diffusion weighted imaging (DWI) and perfusion weighted imaging (PWI) at 3 Tesla, before undergoing surgery and histological confirmation. Normalized metabolite signals, including choline (Cho), N-acetylaspartate (NAA), creatine and lactate/lipids, were obtained by (1)H-MRSI; apparent diffusion coefficient (ADC) by DWI; and relative cerebral blood volume (rCBV) by PWI. RESULTS Perienhancing areas with abnormal MR signal showed 3 multiparametric patterns: "tumor", with abnormal Cho/NAA ratio, lower ADC and higher rCBV; "edema", with normal Cho/NAA ratio, higher ADC and lower rCBV; and "tumor/edema", with abnormal Cho/NAA ratio and intermediate ADC and rCBV. Perienhancing areas with normal MR signal showed 2 multiparametric patterns: "infiltrated", with high Cho and/or abnormal Cho/NAA ratio; and "normal", with normal spectra. Stepwise discriminant analysis showed that the better classification accuracy of perienhancing areas was achieved when regarding all MR variables, while (1)H-MRSI variables and rCBV better differentiated high- from low-grade gliomas. CONCLUSION Multiparametric MR assessment of gliomas, based on (1)H-MRSI, PWI and DWI, discriminates infiltrating tumor from surrounding vasogenic edema or normal tissues, and high- from low-grade gliomas. This approach may provide useful information for guiding stereotactic biopsies, surgical resection and radiation treatment.
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Affiliation(s)
- Alfonso Di Costanzo
- Department of Health Sciences, University of Molise, Via de Sanctis 2, 86100, Campobasso, Italy.
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Comte F, Bauchet L, Rigau V, Hauet JR, Fabbro M, Coubes P, Chevalier J, Mariano-Goulart D, Rossi M, Zanca M. Correlation of preoperative thallium SPECT with histological grading and overall survival in adult gliomas. Nucl Med Commun 2006; 27:137-42. [PMID: 16404226 DOI: 10.1097/01.mnm.0000191855.19327.af] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The management and prognosis of a glioma depend on the tumour's histological grade. Thus, preoperative prediction of the grade is routinely needed to indicate whether surgery or biopsies are required. It has been proposed that thallium single photon emission computed tomography (SPECT), in a relative short series, will aid this prediction. AIM To confirm the correlation between the results of preoperative thallium SPECT and grade of tumour as well as patient survival, and to define the cut-off value of the optimal thallium index for the detection of high grade gliomas in a large series of patients. METHODS One hundred and eighteen patients treated for glioma were retrospectively included in this study. All patients underwent preoperative 201Tl SPECT upon initial presentation and were referred for neurosurgery. Initial scintigraphic findings were correlated with the histological grade of the tumour and overall patient survival. RESULTS Thallium uptake was highly correlated with histological grade; the mean thallium indices for low grade and high grade gliomas were 1.8 and 4.9, respectively. On the basis of receiver operating characteristic analysis, the optimal cut-off value of the thallium index for the detection of high grade glioma was determined. By using 2.2 as the value for the threshold thallium index, the sensitivity and specificity were 93% and 72%, respectively. Kaplan-Meier estimates of the overall survival curves, as a function of the thallium index, indicated that it was correlated with the overall survival (P<0.001). CONCLUSION Thallium SPECT provides useful information about the histological grade of the tumour and overall patient survival. Additionally, in spite of its relatively weak resolution, it appears to be a powerful routine clinical tool for the management of gliomas.
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Batra A, Tripathi RP, Singh AK. Perfusion magnetic resonance imaging and magnetic resonance spectroscopy of cerebral gliomas showing imperceptible contrast enhancement on conventional magnetic resonance imaging. ACTA ACUST UNITED AC 2005; 48:324-32. [PMID: 15344981 DOI: 10.1111/j.0004-8461.2004.01315.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The purpose of the present paper was to evaluate the utility of perfusion MRI in cerebral gliomas showing imperceptible contrast enhancement on conventional MRI, and to evaluate the relationships of perfusion MRI and magnetic resonance (MR) spectroscopic results in these tumours. Twenty-two patients with histopathologically proven cerebral gliomas and showing insignificant contrast enhancement on conventional MR were included in the present study. All patients underwent perfusion MRI and MR spectroscopy on a 1.5-T MR system. Significant differences of the relative cerebral blood volume (rCBV) values and the choline : creatine ratios were noted between low-grade and anaplastic gliomas (P < 0.01). Good correlation was found between the rCBV values and the choline : creatine values (y = 0. 532x + 1.5643; r = 0.67). Perfusion MRI can be a useful tool in assessing the histopathological grade of non-contrast-enhancing cerebral gliomas. Along with MR spectroscopic imaging it can serve as an important technique for preoperative characterization of such gliomas, so that accurate targeting by stereotactic biopsies is possible.
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Affiliation(s)
- A Batra
- NMR Research Centre, Institute Of Nuclear Medicine and Allied Sciences, Defence Research and Development Organization, SK Mazumdar Road, Timarpur, Delhi-110054, India
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Maia ACM, Malheiros SMF, da Rocha AJ, Stávale JN, Guimarães IF, Borges LRR, Santos AJ, da Silva CJ, de Melo JGSP, Lanzoni OP, Gabbai AA, Ferraz FAP. Stereotactic biopsy guidance in adults with supratentorial nonenhancing gliomas: role of perfusion-weighted magnetic resonance imaging. J Neurosurg 2005; 101:970-6. [PMID: 15597757 DOI: 10.3171/jns.2004.101.6.0970] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The. diagnosis of low-grade glioma (LGG) cannot be based exclusively on conventional magnetic resonance (MR) imaging studies, and target selection for stereotactic biopsy is a crucial issue given the high risk of sampling errors. The authors hypothesized that perfusion-weighted imaging could provide information on the microcirculation in presumed supratentorial LGGs. METHODS All adult patients with suspected (nonenhancing) supratentorial LGGs on conventional MR imaging between February 2001 and February 2004 were included in this study. Preoperative MR imaging was performed using a dynamic first-pass gadopentate dimeglumine-enhanced spin echo-echo planar perfusion-weighted sequence, and the tumors' relative cerebral blood volume (rCBV) measurements were expressed in relation to the values observed in contralateral white matter. In patients with heterogeneous tumors a stereotactic biopsy was performed in the higher perfusion areas before resection. Among 21 patients (16 men and five women with a mean age of 36 years, range 23-60 years), 10 had diffuse astrocytomas (World Health Organization Grade II) and 11 had other LGGs and anaplastic gliomas. On perfusion-weighted images demonstrating heterogeneous tumors, areas of higher rCBV focus were found to be oligodendrogliomas or anaplastic astrocytomas on stereotactic biopsy; during tumor resection, however, specimens were characterized predominantly as astrocytomas. Diffuse astrocytomas were associated with significantly lower mean rCBV values compared with those in the other two lesion groups (p < 0.01). The rCBV ratio cutoff value that permitted better discrimination between diffuse astrocytomas and the other lesion groups was 1.2 (80% sensitivity and 100% specificity). CONCLUSIONS Perfusion-weighted imaging is a feasible method of reducing the sampling error in the histopathological diagnosis of a presumed LGG, particularly by improving the selection of targets for stereotactic biopsy.
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Abstract
Dynamic susceptibility contrast imaging has proven to be useful in brain tumor studies, and it provides additional information on tumor characteristics based on the microvascular structure of gliomas. The cerebral blood volume maps can be used to noninvasively grade gliomas, to determine optimal biopsy sites, to separate radiation necrosis from tumor regrowth, and to plan and follow irradiation, chemo- and antiangiogenic therapy. Besides of cerebral blood volume mapping, dynamic susceptibility contrast imaging sets also contain information about the flow and permeability properties of the tumor microvascular system. When combined with the conventional MRI, dynamic susceptibility contrast techniques offer important functional information about the biology of gliomas in a cost-effective way.
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Affiliation(s)
- Hannu J Aronen
- Department of Clinical Radiology, Kuopio University Hospital, P.O. Box 1777, FIN-70211 Kuopio, Finland.
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