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Dickie BR, Ahmed Z, Arvidsson J, Bell LC, Buckley DL, Debus C, Fedorov A, Floca R, Gutmann I, van der Heijden RA, van Houdt PJ, Sourbron S, Thrippleton MJ, Quarles C, Kompan IN. A community-endorsed open-source lexicon for contrast agent-based perfusion MRI: A consensus guidelines report from the ISMRM Open Science Initiative for Perfusion Imaging (OSIPI). Magn Reson Med 2024; 91:1761-1773. [PMID: 37831600 DOI: 10.1002/mrm.29840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 07/25/2023] [Accepted: 08/04/2023] [Indexed: 10/15/2023]
Abstract
This manuscript describes the ISMRM OSIPI (Open Science Initiative for Perfusion Imaging) lexicon for dynamic contrast-enhanced and dynamic susceptibility-contrast MRI. The lexicon was developed by Taskforce 4.2 of OSIPI to provide standardized definitions of commonly used quantities, models, and analysis processes with the aim of reducing reporting variability. The taskforce was established in February 2020 and consists of medical physicists, engineers, clinicians, data and computer scientists, and DICOM (Digital Imaging and Communications in Medicine) standard experts. Members of the taskforce collaborated via a slack channel and quarterly virtual meetings. Members participated by defining lexicon items and reporting formats that were reviewed by at least two other members of the taskforce. Version 1.0.0 of the lexicon was subject to open review from the wider perfusion imaging community between January and March 2022, and endorsed by the Perfusion Study Group of the ISMRM in the summer of 2022. The initial scope of the lexicon was set by the taskforce and defined such that it contained a basic set of quantities, processes, and models to enable users to report an end-to-end analysis pipeline including kinetic model fitting. We also provide guidance on how to easily incorporate lexicon items and definitions into free-text descriptions (e.g., in manuscripts and other documentation) and introduce an XML-based pipeline encoding format to encode analyses using lexicon definitions in standardized and extensible machine-readable code. The lexicon is designed to be open-source and extendable, enabling ongoing expansion of its content. We hope that widespread adoption of lexicon terminology and reporting formats described herein will increase reproducibility within the field.
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Affiliation(s)
- Ben R Dickie
- Division of Informatics, Imaging, and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- Geoffrey Jefferson Brain Research Center, Manchester Academic Health Science Center, The University of Manchester, Manchester, UK
| | - Zaki Ahmed
- Corewell Health William Beaumont University Hospital, Royal Oak, Michigan, USA
| | - Jonathan Arvidsson
- Department of Medical Radiation Sciences, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Laura C Bell
- Clinical Imaging Group, Genentech, Inc., South San Francisco, California, USA
| | | | | | - Andrey Fedorov
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ralf Floca
- National Center for Radiation Research in Oncology, Heidelberg Institute for Radiation Oncology, Heidelberg, Germany
| | - Ingomar Gutmann
- Faculty of Physics, Physics of Functional Materials, University of Vienna, Vienna, Austria
| | - Rianne A van der Heijden
- Department of Radiology & Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Petra J van Houdt
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Steven Sourbron
- Department of Infection, Immunity, and Cardiovascular Diseases, University of Sheffield, Sheffield, UK
| | - Michael J Thrippleton
- Edinburgh Imaging and Center for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Chad Quarles
- Department of Cancer Systems Imaging, UT MD Anderson Cancer Center, Houston, Texas, USA
| | - Ina N Kompan
- Division of Medical Image Computing, German Cancer Research Center, Heidelberg, Germany
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Shalom ES, Khan A, Van Loo S, Sourbron SP. Current status in spatiotemporal analysis of contrast-based perfusion MRI. Magn Reson Med 2024; 91:1136-1148. [PMID: 37929645 PMCID: PMC10962600 DOI: 10.1002/mrm.29906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 10/05/2023] [Accepted: 10/10/2023] [Indexed: 11/07/2023]
Abstract
In perfusion MRI, image voxels form a spatially organized network of systems, all exchanging indicator with their immediate neighbors. Yet the current paradigm for perfusion MRI analysis treats all voxels or regions-of-interest as isolated systems supplied by a single global source. This simplification not only leads to long-recognized systematic errors but also fails to leverage the embedded spatial structure within the data. Since the early 2000s, a variety of models and implementations have been proposed to analyze systems with between-voxel interactions. In general, this leads to large and connected numerical inverse problems that are intractible with conventional computational methods. With recent advances in machine learning, however, these approaches are becoming practically feasible, opening up the way for a paradigm shift in the approach to perfusion MRI. This paper seeks to review the work in spatiotemporal modelling of perfusion MRI using a coherent, harmonized nomenclature and notation, with clear physical definitions and assumptions. The aim is to introduce clarity in the state-of-the-art of this promising new approach to perfusion MRI, and help to identify gaps of knowledge and priorities for future research.
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Affiliation(s)
- Eve S. Shalom
- School of Physics and AstronomyUniversity of LeedsLeedsUK
- Division of Clinical MedicineUniversity of SheffieldSheffieldUK
| | - Amirul Khan
- School of Civil EngineeringUniversity of LeedsLeedsUK
| | - Sven Van Loo
- School of Physics and AstronomyUniversity of LeedsLeedsUK
- Department of Applied PhysicsGhent UniversityGhentBelgium
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Zedde M, Napoli M, Grisendi I, Assenza F, Moratti C, Valzania F, Pascarella R. Perfusion Status in Lacunar Stroke: A Pathophysiological Issue. Diagnostics (Basel) 2023; 13:2003. [PMID: 37370898 DOI: 10.3390/diagnostics13122003] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 06/02/2023] [Accepted: 06/05/2023] [Indexed: 06/29/2023] Open
Abstract
The pathophysiology of lacunar infarction is an evolving and debated field, where relevant information comes from histopathology, old anatomical studies and animal models. Only in the last years, have neuroimaging techniques allowed a sufficient resolution to directly or indirectly assess the dynamic evolution of small vessel occlusion and to formulate hypotheses about the tissue status and the mechanisms of damage. The core-penumbra concept was extensively explored in large vessel occlusions (LVOs) both from the experimental and clinical point of view. Then, the perfusion thresholds on one side and the neuroimaging techniques studying the perfusion of brain tissue were focused and optimized for LVOs. The presence of a perfusion deficit in the territory of a single small perforating artery was negated for years until the recent proposal of the existence of a perfusion defect in a subgroup of lacunar infarcts by using magnetic resonance imaging (MRI). This last finding opens pathophysiological hypotheses and triggers a neurovascular multidisciplinary reasoning about how to image this perfusion deficit in the acute phase in particular. The aim of this review is to summarize the pathophysiological issues and the application of the core-penumbra hypothesis to lacunar stroke.
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Affiliation(s)
- Marialuisa Zedde
- Neurology Unit, Stroke Unit, AUSL-IRCCS di Reggio Emilia, Via Amendola 2, 42122 Reggio Emilia, Italy
| | - Manuela Napoli
- Neuroradiology Unit, AUSL-IRCCS di Reggio Emilia, Via Amendola 2, 42122 Reggio Emilia, Italy
| | - Ilaria Grisendi
- Neurology Unit, Stroke Unit, AUSL-IRCCS di Reggio Emilia, Via Amendola 2, 42122 Reggio Emilia, Italy
| | - Federica Assenza
- Neurology Unit, Stroke Unit, AUSL-IRCCS di Reggio Emilia, Via Amendola 2, 42122 Reggio Emilia, Italy
| | - Claudio Moratti
- Neuroradiology Unit, AUSL-IRCCS di Reggio Emilia, Via Amendola 2, 42122 Reggio Emilia, Italy
| | - Franco Valzania
- Neurology Unit, Stroke Unit, AUSL-IRCCS di Reggio Emilia, Via Amendola 2, 42122 Reggio Emilia, Italy
| | - Rosario Pascarella
- Neuroradiology Unit, AUSL-IRCCS di Reggio Emilia, Via Amendola 2, 42122 Reggio Emilia, Italy
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Elschot EP, Backes WH, de Jong JJA, Drenthen GS, Wong SM, Staals J, Postma AA, Rouhl RPW, van Oostenbrugge RJ, Jansen JFA. Assessment of the clinical feasibility of detecting subtle blood-brain barrier leakage in cerebral small vessel disease using dynamic susceptibility contrast MRI. Magn Reson Imaging 2023; 102:55-61. [PMID: 37137345 DOI: 10.1016/j.mri.2023.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 04/26/2023] [Accepted: 04/26/2023] [Indexed: 05/05/2023]
Abstract
PURPOSE Cerebral small vessel disease (cSVD) involves several pathologies affecting the small vessels, including blood-brain barrier (BBB) impairment. Dynamic susceptibility contrast (DSC) MRI is sensitive to both blood perfusion and BBB leakage, and correction methods may be crucial for obtaining reliable perfusion measures. These methods might also be applicable to detect BBB leakage itself. This study investigated to what extent DSC-MRI can measure subtle BBB leakage in a clinical feasibility setting. METHODS In vivo DCE and DSC data were collected from fifteen cSVD patients (71 (±10) years, 6F/9M) and twelve elderly controls (71 (±10) years, 4F/8M). DSC-derived leakage fractions were obtained using the Boxerman-Schmainda-Weisskoff method (K2). K2 was compared with the DCE-derived leakage rate Ki, obtained from Patlak analysis. Subsequently, differences were assessed between white matter hyperintensities (WMH), cortical gray matter (CGM), and normal-appearing white matter (NAWM). Additionally, computer simulations were performed to assess the sensitivity of DSC-MRI to BBB leakage. RESULTS K2 showed significant differences between tissue regions (P < 0.001 for CGM-NAWM and CGM-WMH, and P = 0.001 for NAWM-WMH). Conversely, according to the computer simulations the DSC sensitivity was insufficient to measure subtle BBB leakage, as the K2 values were below the derived limit of quantification (4∙10-3 min-1). As expected, Ki was elevated in the WMH compared to CGM and NAWM (P < 0.001). CONCLUSIONS Although clinical DSC-MRI seems capable to detect subtle BBB leakage differences between WMH and normal-appearing brain tissue it is not recommended. K2 as a direct measure for subtle BBB leakage remains ambiguous as its signal effects are due to mixed T1- and T2∗-weighting. Further research is warranted to better disentangle perfusion from leakage effects.
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Affiliation(s)
- Elles P Elschot
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, P. Debyelaan 25, Maastricht, the Netherlands; School for Mental Health and Neuroscience (MHeNs), Maastricht University, Minderbroedersberg 4-6, Maastricht, the Netherlands
| | - Walter H Backes
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, P. Debyelaan 25, Maastricht, the Netherlands; School for Mental Health and Neuroscience (MHeNs), Maastricht University, Minderbroedersberg 4-6, Maastricht, the Netherlands; School for Cardiovascular Diseases (CARIM), Maastricht University, Minderbroedersberg 4-6, Maastricht, the Netherlands
| | - Joost J A de Jong
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, P. Debyelaan 25, Maastricht, the Netherlands; School for Mental Health and Neuroscience (MHeNs), Maastricht University, Minderbroedersberg 4-6, Maastricht, the Netherlands
| | - Gerhard S Drenthen
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, P. Debyelaan 25, Maastricht, the Netherlands; School for Mental Health and Neuroscience (MHeNs), Maastricht University, Minderbroedersberg 4-6, Maastricht, the Netherlands
| | - Sau May Wong
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, P. Debyelaan 25, Maastricht, the Netherlands
| | - Julie Staals
- Department of Neurology, Maastricht University Medical Center+, P. Debyelaan 25, Maastricht, the Netherlands; School for Cardiovascular Diseases (CARIM), Maastricht University, Minderbroedersberg 4-6, Maastricht, the Netherlands
| | - Alida A Postma
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, P. Debyelaan 25, Maastricht, the Netherlands; School for Mental Health and Neuroscience (MHeNs), Maastricht University, Minderbroedersberg 4-6, Maastricht, the Netherlands
| | - Rob P W Rouhl
- School for Mental Health and Neuroscience (MHeNs), Maastricht University, Minderbroedersberg 4-6, Maastricht, the Netherlands; Department of Neurology, Maastricht University Medical Center+, P. Debyelaan 25, Maastricht, the Netherlands; Academic Center for Epileptology Kempenhaeghe/MUMC+, Heeze and Maastricht, the Netherlands
| | - Robert J van Oostenbrugge
- School for Mental Health and Neuroscience (MHeNs), Maastricht University, Minderbroedersberg 4-6, Maastricht, the Netherlands; Department of Neurology, Maastricht University Medical Center+, P. Debyelaan 25, Maastricht, the Netherlands; School for Cardiovascular Diseases (CARIM), Maastricht University, Minderbroedersberg 4-6, Maastricht, the Netherlands
| | - Jacobus F A Jansen
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, P. Debyelaan 25, Maastricht, the Netherlands; School for Mental Health and Neuroscience (MHeNs), Maastricht University, Minderbroedersberg 4-6, Maastricht, the Netherlands; Department of Electrical Engineering, Eindhoven University of Technology, De Rondom 70, Eindhoven, the Netherlands; Academic Center for Epileptology Kempenhaeghe/MUMC+, Heeze and Maastricht, the Netherlands.
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Ota Y, Liao E, Zhao R, Capizzano AA, Baba A, Lobo R, Shah G, Srinivasan A. Utility of dynamic susceptibility contrast MRI for differentiation between paragangliomas and meningiomas in the cerebellopontine angle and jugular foramen region. Clin Imaging 2023; 96:49-55. [PMID: 36801537 DOI: 10.1016/j.clinimag.2022.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 12/21/2022] [Accepted: 12/27/2022] [Indexed: 01/15/2023]
Abstract
PURPOSE Differentiation of paragangliomas and meningiomas can be a challenge. This study aimed to assess the utility of dynamic susceptibility contrast perfusion MRI (DSC-MRI) to distinguish paragangliomas from meningiomas. METHODS This retrospective study included 40 patients with paragangliomas and meningiomas in the cerebellopontine angle and jugular foramen region between March 2015 and February 2022 in a single institution. Pretreatment DSC-MRI and conventional MRI were performed in all cases. Normalized relative cerebral blood volume (nrCBV), relative cerebral blood flow (nrCBF), relative mean transit time (nrMTT), and time to peak (nTTP) as well as conventional MRI features were compared between the 2 tumor types and between meningioma subtypes as appropriate. Receiver operating characteristic curve and multivariate logistic regression analysis were performed. RESULTS Twenty-eight meningiomas including 8 WHO grade II meningiomas (12 males, 16 females; median age 55 years) and 12 paragangliomas (5 males, 7 females; median age 35 years) were included in this study. Paragangliomas had a higher rate of cystic/necrotic changes (10/12 vs 10/28; P = 0.014), a higher rate of internal flow voids (9/12 vs 8/28; P = 0.013), higher nrCBV (median 9.78 vs 6.64; P = 0.04), and shorter nTTP (median 0.78 vs 1.06; P < 0.001) than meningiomas. There was no difference in conventional imaging features and DSC-MRI parameters between meningioma subtypes. nTTP was identified as the most significant parameter for the 2 tumor types in the multivariate logistic regression analysis (P = 0.009). CONCLUSIONS In this small retrospective study, DSC-MRI perfusion differences were observed between paragangliomas and meningiomas, but not between grade I and II meningiomas.
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Affiliation(s)
- Yoshiaki Ota
- Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI 48109, USA.
| | - Eric Liao
- Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI 48109, USA
| | - Raymond Zhao
- Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI 48109, USA
| | - Aristides A Capizzano
- Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI 48109, USA
| | - Akira Baba
- Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI 48109, USA
| | - Remy Lobo
- Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI 48109, USA
| | - Gaurang Shah
- Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI 48109, USA
| | - Ashok Srinivasan
- Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI 48109, USA
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Boxerman JL, Snyder BS, Barboriak DP, Schmainda KM. Early post-bevacizumab change in rCBV from DSC-MRI identifies pseudoresponse in recurrent glioblastoma: Results from ACRIN 6677/RTOG 0625. Front Oncol 2023; 13:1061502. [PMID: 36776298 PMCID: PMC9909012 DOI: 10.3389/fonc.2023.1061502] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 01/02/2023] [Indexed: 01/27/2023] Open
Abstract
Background Progressive enhancement predicted poor survival in ACRIN 6677/RTOG 0625, a multi-center trial of bevacizumab with irinotecan or temozolomide in recurrent glioblastoma, but pseudoresponse likely limited enhancement-based survival prognostication in T1 non-progressors. We aimed to determine whether early change in cerebral blood volume from baseline (ΔCBV) could further stratify the T1 non-progressors according to overall (OS) and progression-free (PFS) survival. Methods 37/123 enrolled patients had DSC-MRI, including 13, 15, and 8 patients without 2D-T1 progression at 2, 8, and 16 weeks post-treatment initiation, respectively. Mean CBV normalized to white matter (nRCBV) and mean standardized CBV (sRCBV) were extracted from enhancing tumor. ROC curves were derived for ΔCBV using six-month PFS and one-year OS as reference standards. Kaplan-Meier survival estimates and log-rank test compared PFS and OS for both ΔCBV (increase vs. decrease) and T1 response status (stable vs. decreasing enhancement). Results PFS and OS were significantly worse for increasing CBV at 2 weeks (p=0.003 and p=0.002 for nRCBV, and p=0.03 and p=0.03 for sRCBV, respectively), but not for 2D-T1 patients with stable vs. decreasing enhancement (p=0.44 and p=0.86, respectively). ΔCBV at week 2 was also a good prognostic marker for OS-1 and PFS-6 using ROC analysis. By contrast, 2D-T1 response status at weeks 2, 8, and 16 was not associated with PFS-6. ΔCBV at 16 weeks (p=0.008 for sRCBV) but not 8 weeks (p=0.74 for nRCBV and p=0.56 for sRCBV) was associated with significant difference in median survival, but no difference in survival was observed for 2D-T1 patients with stable vs. decreasing enhancement at 8 weeks (p=0.69) or 16 weeks (p=0.21). At 16 weeks, OS did not differ significantly between 2D-T1 progressors and 2D-T1 non-progressors with increasing CBV (median survival 3.3 months post week 16 scan vs. 9.2 months, respectively; p=0.13), suggesting that 2D-T1 non-progressors with increasing CBV may have a prognosis like that of 2D-T1 progressors. Conclusion After 2 weeks of anti-angiogenic therapy, ΔCBV in 2D-T1 non-progressors significantly prognosticated PFS and OS, whereas 2D-T1 response status did not, identifying a subpopulation that benefits from bevacizumab. Combining 2D-T1 progression and ΔCBV may yield a response assessment paradigm with 3-tiered OS stratification.
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Affiliation(s)
- Jerrold L. Boxerman
- Department of Diagnostic Imaging, Rhode Island Hospital and Alpert Medical School of Brown University, Providence, RI, United States
| | - Bradley S. Snyder
- Center for Statistical Sciences, Brown University School of Public Health, Providence, RI, United States
| | - Daniel P. Barboriak
- Department of Radiology, Duke University Medical Center, Durham, NC, United States
| | - Kathleen M. Schmainda
- Department of Biophysics, Medical College of Wisconsin, Milwaukee, WI, United States
- Department of Radiology, Medical College of Wisconsin, Milwaukee, WI, United States
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Jin S, Cho HJ. Model-free leakage index estimation of the blood-brain barrier using dual dynamic susceptibility contrast MRI acquisition. NMR Biomed 2021; 34:e4570. [PMID: 34132432 DOI: 10.1002/nbm.4570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 04/30/2021] [Accepted: 05/23/2021] [Indexed: 06/12/2023]
Abstract
Pharmacokinetic K2 mapping from dynamic susceptibility contrast (DSC)-MRI can be a sensitive technique for evaluating the vascular permeability of the subtly damaged blood-brain barrier (BBB) in ischemic regions. However, the K2 values of ischemic lesions depend upon the selection of the intact BBB reference region. As previous observations suggest that the ΔR2* curve of pre-loaded DSC-MRI is not significantly affected by the extravasation of contrast agent, dual DSC-MRI acquisitions can be performed to derive the BBB leakage index from the voxel-wise reference input function for ischemic regions. This study aims to demonstrate the robustness of such model-free leakage index estimation in ischemic brains. By configuring the relationship between dual ΔR2* curves of the intact contralateral brain, the deviation of the measured ΔR2* curve from the unloaded DSC-MRI with respect to the non-deviated ΔR2* curve in the pre-loaded DSC-MRI can be quantified as the BBB leakage index. Such model-free leakage index values from rats with transient middle carotid artery occlusion (tMCAO) (n = 17) and normal controls (n = 3) were evaluated and compared with conventional K2 values with multiple reference regions. Inter-subject leakage index values were also compared with the corresponding ΔT1 map. Evans-blue-stained images were used to validate the leakage index. For the tMCAO group, leakage index values correlated well with ΔT1 (Pearson's r = 0.828). The hyperintense area on the leakage index map matched well with the corresponding Evans-blue-stained area (Dice correlation = 0.626). The slopes of the scatter-plot from the leakage index (0.97-1.00) were observed to be more robust against changes in the reference region than those from conventional K2 values (0.94-1.07). In a subtly damaged BBB tMCAO model, model-free evaluation of vascular permeability using dual DSC-MRIs would provide a consistent measure of inter-subject vascular permeability.
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Affiliation(s)
- Seokha Jin
- Department of Biomedical Engineering, Ulsan National Institute of Science and Technology, Ulsan, South Korea
| | - Hyung Joon Cho
- Department of Biomedical Engineering, Ulsan National Institute of Science and Technology, Ulsan, South Korea
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Taxt T, Andersen E, Jiřík R. Single voxel vascular transport functions of arteries, capillaries and veins; and the associated arterial input function in dynamic susceptibility contrast magnetic resonance brain perfusion imaging. Magn Reson Imaging 2021; 84:101-114. [PMID: 34461158 DOI: 10.1016/j.mri.2021.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 07/13/2021] [Accepted: 08/15/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE The composite vascular transport function of a brain voxel consists of one convolutional component for the arteries, one for the capillaries and one for the veins in the voxel of interest. Here, the goal is to find each of these three convolutional components and the associated arterial input function. PHARMACOKINETIC MODELLING The single voxel vascular transport functions for arteries, capillaries and veins were all modelled as causal exponential functions. Each observed multipass tissue contrast function was as a first approximation modelled as the resulting parametric composite vascular transport function convolved with a nonparametric and voxel specific multipass arterial input function. Subsequently, the residue function was used in the true perfusion equation to optimize the three parameters of the exponential functions. DECONVOLUTION METHODS For each voxel, the parameters of the three exponential functions were estimated by successive iterative blind deconvolutions using versions of the Lucy-Richardson algorithm. The final multipass arterial input function was then computed by nonblind deconvolution using the Lucy-Richardson algorithm and the estimated composite vascular transport function. RESULTS Simulations showed that the algorithm worked. The estimated mean transit time of arteries, capillaries and veins of the simulated data agreed with the known input values. For real data, the estimated capillary mean transit times agreed with known values for this parameter. The nonparametric multipass arterial input functions were used to derive the associated map of the arrival time. The arrival time map of a healthy volunteer agreed with known arterial anatomy and physiology. CONCLUSION Clinically important new voxelwise hemodynamic information for arteries, capillaries and veins separately can be estimated using multipass tissue contrast functions and the iterative blind Lucy-Richardson deconvolution algorithm.
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Affiliation(s)
- Torfinn Taxt
- Department of Biomedicine, University of Bergen, Bergen, N-5020, Norway; Department of Radiology, Haukeland University Hospital, Bergen, N-5021, Norway
| | - Erling Andersen
- Department of Clinical Engineering, Haukeland University Hospital, Bergen, N-5021, Norway
| | - Radovan Jiřík
- Institute of Scientific Instruments of the Czech Academy of Sciences, Brno, 61264, Czech Republic.
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Richter V, Klose U, Bender B, Rabehl K, Skardelly M, Schittenhelm J, Tabatabai G, Hempel JM, Ernemann U, Brendle C. Dynamic Susceptibility Perfusion Imaging for Differentiating Progressive Disease from Pseudoprogression in Diffuse Glioma Molecular Subtypes. J Clin Med 2021; 10:598. [PMID: 33562558 DOI: 10.3390/jcm10040598] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 01/31/2021] [Accepted: 02/02/2021] [Indexed: 01/22/2023] Open
Abstract
Rationale and Objectives: Advanced adjuvant therapy of diffuse gliomas can result in equivocal findings in follow-up imaging. We aimed to assess the additional value of dynamic susceptibility perfusion imaging in the differentiation of progressive disease (PD) from pseudoprogression (PsP) in different molecular glioma subtypes. Materials and Methods: 89 patients with treated diffuse glioma with different molecular subtypes (IDH wild type (Astro-IDHwt), IDH mutant astrocytomas (Astro-IDHmut) and oligodendrogliomas), and tumor-suspect lesions on post-treatment follow-up imaging were classified into two outcome groups (PD or PsP) retrospectively by histopathology or clinical follow-up. The relative cerebral blood volume (rCBV) was assessed in the tumor-suspect FLAIR and contrast-enhancing (CE) lesions. We analyzed how a multilevel classification using a molecular subtype, the presence of a CE lesion, and two rCBV histogram parameters performed for PD prediction compared with a decision tree model (DTM) using additional rCBV parameters. Results: The PD rate was 69% in the whole cohort, 86% in Astro-IDHwt, 52% in Astro-IDHmut, and 55% in oligodendrogliomas. In the presence of a CE lesion, the PD rate was higher with 82%, 94%, 59%, and 88%, respectively; if there was no CE lesion, however, the PD rate was only 44%, 60%, 40%, and 33%, respectively. The additional use of the rCBV parameters in the DTM yielded a prediction accuracy for PD of 99%, 100%, 93%, and 95%, respectively. Conclusion: Utilizing combined information about the molecular tumor type, the presence or absence of CE lesions and rCBV parameters increases PD prediction accuracy in diffuse glioma.
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Boxerman JL, Quarles CC, Hu LS, Erickson BJ, Gerstner ER, Smits M, Kaufmann TJ, Barboriak DP, Huang RH, Wick W, Weller M, Galanis E, Kalpathy-Cramer J, Shankar L, Jacobs P, Chung C, van den Bent MJ, Chang S, Al Yung WK, Cloughesy TF, Wen PY, Gilbert MR, Rosen BR, Ellingson BM, Schmainda KM. Consensus recommendations for a dynamic susceptibility contrast MRI protocol for use in high-grade gliomas. Neuro Oncol 2020; 22:1262-1275. [PMID: 32516388 PMCID: PMC7523451 DOI: 10.1093/neuonc/noaa141] [Citation(s) in RCA: 96] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Despite the widespread clinical use of dynamic susceptibility contrast (DSC) MRI, DSC-MRI methodology has not been standardized, hindering its utilization for response assessment in multicenter trials. Recently, the DSC-MRI Standardization Subcommittee of the Jumpstarting Brain Tumor Drug Development Coalition issued an updated consensus DSC-MRI protocol compatible with the standardized brain tumor imaging protocol (BTIP) for high-grade gliomas that is increasingly used in the clinical setting and is the default MRI protocol for the National Clinical Trials Network. After reviewing the basis for controversy over DSC-MRI protocols, this paper provides evidence-based best practices for clinical DSC-MRI as determined by the Committee, including pulse sequence (gradient echo vs spin echo), BTIP-compliant contrast agent dosing (preload and bolus), flip angle (FA), echo time (TE), and post-processing leakage correction. In summary, full-dose preload, full-dose bolus dosing using intermediate (60°) FA and field strength-dependent TE (40-50 ms at 1.5 T, 20-35 ms at 3 T) provides overall best accuracy and precision for cerebral blood volume estimates. When single-dose contrast agent usage is desired, no-preload, full-dose bolus dosing using low FA (30°) and field strength-dependent TE provides excellent performance, with reduced contrast agent usage and elimination of potential systematic errors introduced by variations in preload dose and incubation time.
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Affiliation(s)
- Jerrold L Boxerman
- Department of Diagnostic Imaging, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
- Representative of the Eastern Cooperative Oncology Group–American College of Radiology Imaging Network (ECOG-ACRIN) Cancer Research Group
- Representative of the American Society of Neuroradiology (ASNR)
- Representative of the American Society of Functional Neuroradiology (ASFNR)
| | - Chad C Quarles
- Department of Neuroimaging Research and Barrow Neuroimaging Innovation Center, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Leland S Hu
- Department of Radiology, Mayo Clinic, Phoenix, Arizona, USA
- Representative of the Alliance for Clinical Trials in Oncology
- Representative of the American Society of Neuroradiology (ASNR)
| | - Bradley J Erickson
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
- Representative of the Alliance for Clinical Trials in Oncology
- Representative of the RSNA Quantitative Imaging Biomarker Alliance (QIBA)
- Representative of the American Society of Neuroradiology (ASNR)
| | - Elizabeth R Gerstner
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Representative of the Adult Brain Tumor Consortium (ABTC)
| | - Marion Smits
- Department of Radiology and Nuclear Medicine, Erasmus MC–University Medical Center Rotterdam, Rotterdam, Netherlands
- Representative of the European Organisation for Research and Treatment of Cancer (EORTC)
| | - Timothy J Kaufmann
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
- Representative of the Alliance for Clinical Trials in Oncology
| | - Daniel P Barboriak
- Department of Radiology, Duke University School of Medicine, Durham, North Carolina, USA
- Representative of the Eastern Cooperative Oncology Group–American College of Radiology Imaging Network (ECOG-ACRIN) Cancer Research Group
- Representative of the RSNA Quantitative Imaging Biomarker Alliance (QIBA)
- Representative of the American Society of Neuroradiology (ASNR)
| | - Raymond H Huang
- Department of Radiology, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Center for Neuro-Oncology, Dana-Farber/Brigham and Women’s Cancer Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Wolfgang Wick
- Department of Neurooncology, National Center of Tumor Disease, University Clinic Heidelberg, Heidelberg, Germany
- Representative of the European Organisation for Research and Treatment of Cancer (EORTC)
| | - Michael Weller
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
- Representative of the European Organisation for Research and Treatment of Cancer (EORTC)
| | - Evanthia Galanis
- Division of Medical Oncology, Department of Oncology, Mayo Clinic, Rochester, Minnesota, USA
- Representative of the Alliance for Clinical Trials in Oncology
| | - Jayashree Kalpathy-Cramer
- Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Lalitha Shankar
- Division of Cancer Treatment and Diagnosis, National Cancer Institute (NCI), Bethesda, Maryland, USA
| | - Paula Jacobs
- Division of Cancer Treatment and Diagnosis, National Cancer Institute (NCI), Bethesda, Maryland, USA
| | - Caroline Chung
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Representative of the Alliance for Clinical Trials in Oncology
| | - Martin J van den Bent
- Department of Neuro-Oncology, Erasmus MC Cancer Institute, Rotterdam, Netherlands
- Representative of the European Organisation for Research and Treatment of Cancer (EORTC)
| | - Susan Chang
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA
| | - W K Al Yung
- Department of Neuro-Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Timothy F Cloughesy
- UCLA Neuro-Oncology Program and UCLA Brain Tumor Imaging Laboratory (BTIL), David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
- Department of Neurology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Patrick Y Wen
- Center for Neuro-Oncology, Dana-Farber/Brigham and Women’s Cancer Center, Harvard Medical School, Boston, Massachusetts, USA
- Representative of the Adult Brain Tumor Consortium (ABTC)
| | - Mark R Gilbert
- Neuro-Oncology Branch, National Cancer Institute (NCI), Bethesda, Maryland, USA
- Representative of the Radiation Therapy Oncology Group (RTOG)
| | - Bruce R Rosen
- Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Benjamin M Ellingson
- UCLA Neuro-Oncology Program and UCLA Brain Tumor Imaging Laboratory (BTIL), David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
- Departments of Radiological Sciences, Psychiatry, and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
- Representative of the Adult Brain Tumor Consortium (ABTC)
- Representative of the Ivy Consortium for Early Phase Clinical Trials
- Representative of the Eastern Cooperative Oncology Group–American College of Radiology Imaging Network (ECOG-ACRIN) Cancer Research Group
- Representative of the RSNA Quantitative Imaging Biomarker Alliance (QIBA)
- Representative of the American Society of Neuroradiology (ASNR)
| | - Kathleen M Schmainda
- Department of Biophysics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Representative of the Eastern Cooperative Oncology Group–American College of Radiology Imaging Network (ECOG-ACRIN) Cancer Research Group
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11
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Cindil E, Sendur HN, Cerit MN, Dag N, Erdogan N, Celebi FE, Oner Y, Tali T. Validation of combined use of DWI and percentage signal recovery-optimized protocol of DSC-MRI in differentiation of high-grade glioma, metastasis, and lymphoma. Neuroradiology 2020; 63:331-342. [PMID: 32821962 DOI: 10.1007/s00234-020-02522-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 08/13/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE With conventional MRI, it is often difficult to effectively differentiate between contrast-enhancing brain tumors, including primary central nervous system lymphoma (PCNSL), high-grade glioma (HGG), and metastasis. This study aimed to assess the discrimination ability of the parameters obtained from DWI and the percentage signal recovery- (PSR-) optimized protocol of DSC-MRI between these three tumor types at an initial step. METHODS DSC-MRI using a PSR-optimized protocol (TR/TE = 1500/30 ms, flip angle = 90°, no preload) and DWI of 99 solitary enhancing tumors (60 HGGs, 24 metastases, 15 PCNSLs) were retrospectively assessed before treatment. rCBV, PSR, ADC in the tumor core and rCBV, and ADC in peritumoral edema were measured. The differences were evaluated using one-way ANOVA, and the diagnostic performance was evaluated using ROC curve analysis. RESULTS PSR in the tumor core showed the best discriminating performance in differentiating these three tumor types with AUC values of 0.979 for PCNSL vs. others and 0.947 for HGG vs. metastasis. The ADC was only helpful in the tumor core and distinguishing PCNSLs from others (AUC = 0.897). CONCLUSION Different from CBV-optimized protocols (preload, intermediate FA), PSR derived from the PSR-optimized protocol seems to be the most important parameter in the differentiation of HGGs, metastases, and PCNSLs at initial diagnosis. This property makes PSR remarkable and carries the need for comprehensive DSC-MRI protocols, which provides PSR sensitivity and CBV accuracy together, such as the preload use of the PSR-optimized protocol before the CBV-optimized protocol.
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Affiliation(s)
- Emetullah Cindil
- School of Medicine, Department of Radiology, Gazi University, Ankara, Turkey.
| | - Halit Nahit Sendur
- School of Medicine, Department of Radiology, Gazi University, Ankara, Turkey
| | - Mahi Nur Cerit
- School of Medicine, Department of Radiology, Gazi University, Ankara, Turkey
| | - Nurullah Dag
- School of Medicine, Department of Radiology, Gazi University, Ankara, Turkey
| | - Nesrin Erdogan
- School of Medicine, Department of Radiology, Gazi University, Ankara, Turkey
| | - Filiz Elbuken Celebi
- School of Medicine, Department of Radiology, Yeditepe University, Istanbul, Turkey
| | - Yusuf Oner
- School of Medicine, Department of Radiology, Gazi University, Ankara, Turkey
| | - Turgut Tali
- School of Medicine, Department of Radiology, Gazi University, Ankara, Turkey
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12
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Bell LC, Semmineh N, An H, Eldeniz C, Wahl R, Schmainda KM, Prah MA, Erickson BJ, Korfiatis P, Wu C, Sorace AG, Yankeelov TE, Rutledge N, Chenevert TL, Malyarenko D, Liu Y, Brenner A, Hu LS, Zhou Y, Boxerman JL, Yen YF, Kalpathy-Cramer J, Beers AL, Muzi M, Madhuranthakam AJ, Pinho M, Johnson B, Quarles CC. Evaluating the Use of rCBV as a Tumor Grade and Treatment Response Classifier Across NCI Quantitative Imaging Network Sites: Part II of the DSC-MRI Digital Reference Object (DRO) Challenge. Tomography 2020; 6:203-208. [PMID: 32548297 PMCID: PMC7289259 DOI: 10.18383/j.tom.2020.00012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
We have previously characterized the reproducibility of brain tumor relative cerebral blood volume (rCBV) using a dynamic susceptibility contrast magnetic resonance imaging digital reference object across 12 sites using a range of imaging protocols and software platforms. As expected, reproducibility was highest when imaging protocols and software were consistent, but decreased when they were variable. Our goal in this study was to determine the impact of rCBV reproducibility for tumor grade and treatment response classification. We found that varying imaging protocols and software platforms produced a range of optimal thresholds for both tumor grading and treatment response, but the performance of these thresholds was similar. These findings further underscore the importance of standardizing acquisition and analysis protocols across sites and software benchmarking.
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Affiliation(s)
- Laura C. Bell
- Division of Neuroimaging Research, Barrow Neurological Institute, Phoenix, AZ
| | - Natenael Semmineh
- Division of Neuroimaging Research, Barrow Neurological Institute, Phoenix, AZ
| | - Hongyu An
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, MO
| | - Cihat Eldeniz
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, MO
| | - Richard Wahl
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, MO
| | - Kathleen M. Schmainda
- Departments of Radiology; and
- Biophysics, Medical College of Wisconsin, Milwaukee, WI
| | | | | | | | - Chengyue Wu
- Oden Institute for Computational Engineering and Sciences, Departments of Biomedical Engineering, Diagnostic Medicine, and Oncology, Livestrong Cancer Institutes, University of Texas at Austin, Austin, TX
| | - Anna G. Sorace
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL
| | - Thomas E. Yankeelov
- Oden Institute for Computational Engineering and Sciences, Departments of Biomedical Engineering, Diagnostic Medicine, and Oncology, Livestrong Cancer Institutes, University of Texas at Austin, Austin, TX
| | - Neal Rutledge
- Oden Institute for Computational Engineering and Sciences, Departments of Biomedical Engineering, Diagnostic Medicine, and Oncology, Livestrong Cancer Institutes, University of Texas at Austin, Austin, TX
| | | | | | - Yichu Liu
- UT Health San Antonio, San Antonio, TX
| | | | - Leland S. Hu
- Department of Radiology, Mayo Clinic, Scottsdale, AZ
| | - Yuxiang Zhou
- Department of Radiology, Mayo Clinic, Scottsdale, AZ
| | - Jerrold L. Boxerman
- Department of Diagnostic Imaging, Rhode Island Hospital and Alpert Medical School of Brown University, Providence, RI
| | - Yi-Fen Yen
- Department of Radiology, MGH—Martinos Center for Biomedical Imaging, Boston, MA
| | | | - Andrew L. Beers
- Department of Radiology, MGH—Martinos Center for Biomedical Imaging, Boston, MA
| | - Mark Muzi
- Radiology, University of Washington, Seattle, WA
| | | | - Marco Pinho
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX; and
| | - Brian Johnson
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX; and
- Philips Healthcare, Gainesville, FL
| | - C. Chad Quarles
- Division of Neuroimaging Research, Barrow Neurological Institute, Phoenix, AZ
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13
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Brendle C, Klose U, Hempel JM, Schittenhelm J, Skardelly M, Tabatabai G, Ernemann U, Bender B. Association of dynamic susceptibility magnetic resonance imaging at initial tumor diagnosis with the prognosis of different molecular glioma subtypes. Neurol Sci 2020; 41:3625-3632. [PMID: 32462389 PMCID: PMC8203510 DOI: 10.1007/s10072-020-04474-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 05/15/2020] [Indexed: 12/17/2022]
Abstract
Purpose The updated 2016 CNS World Health Organization classification differentiates three main groups of diffuse glioma according to their molecular characteristics: astrocytic tumors with and without isocitrate dehydrogenase (IDH) mutation and 1p/19q co-deleted oligodendrogliomas. The present study aimed to determine whether dynamic susceptibility contrast magnetic resonance imaging (DSC-MRI) is an independent prognostic marker within the molecular subgroups of diffuse glioma. Methods Fifty-six patients with treatment-naive gliomas and advanced preoperative MRI examination were assessed retrospectively. The mean and maximal normalized cerebral blood volume values from DSC-MRI within the tumors were measured. Optimal cutoff values for the 1-year progression-free survival (PFS) were defined, and Kaplan-Meier analyses were performed separately for the three glioma subgroups. Results IDH wild-type astrocytic tumors had a higher mean and maximal perfusion than IDH-mutant astrocytic tumors and oligodendrogliomas. Patients with IDH wild-type astrocytic tumors and a low mean or maximal perfusion had a significantly shorter PFS than patients of the same group with high perfusion (p = 0.0159/0.0112). Furthermore, they had a significantly higher risk for early progression (hazard ratio = 5.6/5.1). This finding was independent of the methylation status of O6-methylguanin-DNA-methyltransferase and variations of the therapy. Within the groups of IDH-mutant astrocytic tumors and oligodendrogliomas, the PFS of low and highly perfused tumors did not differ. Conclusion High perfusion upon initial diagnosis is not compellingly associated with worse short-term prognosis within the different molecular subgroups of diffuse glioma. Particularly, the overall highly perfused group of IDH wild-type astrocytic tumors contains tumors with low perfusion but unfavorable prognosis.
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Affiliation(s)
- Cornelia Brendle
- Diagnostic and Interventional Neuroradiology, Department of Radiology, Eberhard Karls University, Hoppe-Seyler-Straße 3, 72076, Tuebingen, Germany.
| | - Uwe Klose
- Diagnostic and Interventional Neuroradiology, Department of Radiology, Eberhard Karls University, Hoppe-Seyler-Straße 3, 72076, Tuebingen, Germany
| | - Johann-Martin Hempel
- Diagnostic and Interventional Neuroradiology, Department of Radiology, Eberhard Karls University, Hoppe-Seyler-Straße 3, 72076, Tuebingen, Germany
| | - Jens Schittenhelm
- Neuropathology, Department of Pathology and Neuropathology, Eberhard Karls University, Calwerstr. 3, 72076, Tuebingen, Germany
| | - Marco Skardelly
- University Hospital for Neurosurgery, Eberhard Karls University, Hoppe-Seyler-Straße 3, 72076, Tuebingen, Germany
| | - Ghazaleh Tabatabai
- Interdisciplinary Section of Neurooncology, Eberhard Karls University, Hoppe-Seyler-Straße 3, 72076, Tuebingen, Germany
| | - Ulrike Ernemann
- Diagnostic and Interventional Neuroradiology, Department of Radiology, Eberhard Karls University, Hoppe-Seyler-Straße 3, 72076, Tuebingen, Germany
| | - Benjamin Bender
- Diagnostic and Interventional Neuroradiology, Department of Radiology, Eberhard Karls University, Hoppe-Seyler-Straße 3, 72076, Tuebingen, Germany
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14
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Cuccarini V, Aquino D, Gioppo A, Anghileri E, Pellegatta S, Schettino C, Mazzi F, Finocchiaro G, Bruzzone MG, Eoli M. Advanced MRI Assessment during Dendritic Cell Immunotherapy Added to Standard Treatment Against Glioblastoma. J Clin Med 2019; 8:jcm8112007. [PMID: 31744235 PMCID: PMC6912338 DOI: 10.3390/jcm8112007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 11/12/2019] [Accepted: 11/13/2019] [Indexed: 01/18/2023] Open
Abstract
Evaluating changes induced by immunotherapies (IT) on conventional magnetic resonance imaging (MRI) is difficult because those treatments may produce inflammatory responses. To explore the potential contribution of advanced MRI to distinguish pseudoprogression (PsP) and true tumor progression (TTP), and to identify patients obtaining therapeutic benefit from IT, we examined aMRI findings in newly diagnosed glioblastoma treated with dendritic cell IT added to standard treatment. We analyzed longitudinal MRIs obtained in 22 patients enrolled in the EUDRACT N° 2008-005035-15 trial. According to RANO criteria, we observed 18 TTP and 8 PsP. Comparing MRI performed at the time of TTP/PsP with the previous exam performed two months before, a difference in cerebral blood volume ΔrCBVmax ≥ 0.47 distinguished TTP from PsP with a sensitivity of 67% and specificity of 75% (p = 0.004). A decrease in minimal apparent diffusion coefficient rADCmin (1.15 vs. 1.01, p = 0.003) was observed after four vaccinations only in patients with a persistent increase of natural killer cells (response effectors during IT) in peripheral blood. Basal rADCmin > 1 was independent predictor of longer progression free (16.1 vs. 9 months, p = 0.0001) and overall survival (32.8 vs. 17.5 months, p = 0.0005). In conclusion, rADC predicted response to immunotherapy and survival; Apparent Diffusion Coefficient (ADC) and Cerebral Blood Volume (CBV) modifications over time help differentiating PsP from TTP at onset.
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Affiliation(s)
- Valeria Cuccarini
- Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy; (V.C.); (D.A.); (A.G.); (F.M.)
| | - Domenico Aquino
- Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy; (V.C.); (D.A.); (A.G.); (F.M.)
| | - Andrea Gioppo
- Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy; (V.C.); (D.A.); (A.G.); (F.M.)
| | - Elena Anghileri
- Neuro-oncology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy; (E.A.); (S.P.); (C.S.); (G.F.); (M.E.)
| | - Serena Pellegatta
- Neuro-oncology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy; (E.A.); (S.P.); (C.S.); (G.F.); (M.E.)
| | - Carla Schettino
- Neuro-oncology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy; (E.A.); (S.P.); (C.S.); (G.F.); (M.E.)
| | - Federica Mazzi
- Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy; (V.C.); (D.A.); (A.G.); (F.M.)
| | - Gaetano Finocchiaro
- Neuro-oncology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy; (E.A.); (S.P.); (C.S.); (G.F.); (M.E.)
| | - Maria Grazia Bruzzone
- Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy; (V.C.); (D.A.); (A.G.); (F.M.)
- Correspondence: ; Tel.: +39-0223942775
| | - Marica Eoli
- Neuro-oncology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy; (E.A.); (S.P.); (C.S.); (G.F.); (M.E.)
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15
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Bell LC, Stokes AM, Quarles CC. Analysis of postprocessing steps for residue function dependent dynamic susceptibility contrast (DSC)-MRI biomarkers and their clinical impact on glioma grading for both 1.5 and 3T. J Magn Reson Imaging 2019; 51:547-553. [PMID: 31206948 DOI: 10.1002/jmri.26837] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 05/30/2019] [Accepted: 05/31/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Dynamic susceptibility contrast (DSC)-MRI analysis pipelines differ across studies and sites, potentially confounding the clinical value and use of the derived biomarkers. PURPOSE/HYPOTHESIS To investigate how postprocessing steps for computation of cerebral blood volume (CBV) and residue function dependent parameters (cerebral blood flow [CBF], mean transit time [MTT], capillary transit heterogeneity [CTH]) impact glioma grading. STUDY TYPE Retrospective study from The Cancer Imaging Archive (TCIA). POPULATION Forty-nine subjects with low- and high-grade gliomas. FIELD STRENGTH/SEQUENCE 1.5 and 3.0T clinical systems using a single-echo echo planar imaging (EPI) acquisition. ASSESSMENT Manual regions of interest (ROIs) were provided by TCIA and automatically segmented ROIs were generated by k-means clustering. CBV was calculated based on conventional equations. Residue function dependent biomarkers (CBF, MTT, CTH) were found by two deconvolution methods: circular discretization followed by a signal-to-noise ratio (SNR)-adapted eigenvalue thresholding (Method 1) and Volterra discretization with L-curve-based Tikhonov regularization (Method 2). STATISTICAL TESTS Analysis of variance, receiver operating characteristics (ROC), and logistic regression tests. RESULTS MTT alone was unable to statistically differentiate glioma grade (P > 0.139). When normalized, tumor CBF, CTH, and CBV did not differ across field strengths (P > 0.141). Biomarkers normalized to automatically segmented regions performed equally (rCTH AUROC is 0.73 compared with 0.74) or better (rCBF AUROC increases from 0.74-0.84; rCBV AUROC increases 0.78-0.86) than manually drawn ROIs. By updating the current deconvolution steps (Method 2), rCTH can act as a classifier for glioma grade (P < 0.007), but not if processed by current conventional DSC methods (Method 1) (P > 0.577). Lastly, higher-order biomarkers (eg, rCBF and rCTH) along with rCBV increases AUROC to 0.92 for differentiating tumor grade as compared with 0.78 and 0.86 (manual and automatic reference regions, respectively) for rCBV alone. DATA CONCLUSION With optimized analysis pipelines, higher-order perfusion biomarkers (rCBF and rCTH) improve glioma grading as compared with CBV alone. Additionally, postprocessing steps impact thresholds needed for glioma grading. LEVEL OF EVIDENCE 3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2020;51:547-553.
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Affiliation(s)
- Laura C Bell
- Division of Neuroimaging Research, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Ashley M Stokes
- Division of Neuroimaging Research, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - C Chad Quarles
- Division of Neuroimaging Research, Barrow Neurological Institute, Phoenix, Arizona, USA
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16
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Bell LC, Semmineh N, An H, Eldeniz C, Wahl R, Schmainda KM, Prah MA, Erickson BJ, Korfiatis P, Wu C, Sorace AG, Yankeelov TE, Rutledge N, Chenevert TL, Malyarenko D, Liu Y, Brenner A, Hu LS, Zhou Y, Boxerman JL, Yen YF, Kalpathy-Cramer J, Beers AL, Muzi M, Madhuranthakam AJ, Pinho M, Johnson B, Quarles CC. Evaluating Multisite rCBV Consistency from DSC-MRI Imaging Protocols and Postprocessing Software Across the NCI Quantitative Imaging Network Sites Using a Digital Reference Object (DRO). Tomography 2019; 5:110-117. [PMID: 30854448 PMCID: PMC6403027 DOI: 10.18383/j.tom.2018.00041] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Relative cerebral blood volume (rCBV) cannot be used as a response metric in clinical trials, in part, because of variations in biomarker consistency and associated interpretation across sites, stemming from differences in image acquisition and postprocessing methods (PMs). This study leveraged a dynamic susceptibility contrast magnetic resonance imaging digital reference object to characterize rCBV consistency across 12 sites participating in the Quantitative Imaging Network (QIN), specifically focusing on differences in site-specific imaging protocols (IPs; n = 17), and PMs (n = 19) and differences due to site-specific IPs and PMs (n = 25). Thus, high agreement across sites occurs when 1 managing center processes rCBV despite slight variations in the IP. This result is most likely supported by current initiatives to standardize IPs. However, marked intersite disagreement was observed when site-specific software was applied for rCBV measurements. This study's results have important implications for comparing rCBV values across sites and trials, where variability in PMs could confound the comparison of therapeutic effectiveness and/or any attempts to establish thresholds for categorical response to therapy. To overcome these challenges and ensure the successful use of rCBV as a clinical trial biomarker, we recommend the establishment of qualifying and validating site- and trial-specific criteria for scanners and acquisition methods (eg, using a validated phantom) and the software tools used for dynamic susceptibility contrast magnetic resonance imaging analysis (eg, using a digital reference object where the ground truth is known).
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Affiliation(s)
- Laura C. Bell
- Division of Neuroimaging Research, Barrow Neurological Institute, Phoenix, AZ
| | - Natenael Semmineh
- Division of Neuroimaging Research, Barrow Neurological Institute, Phoenix, AZ
| | - Hongyu An
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, MO
| | - Cihat Eldeniz
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, MO
| | - Richard Wahl
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, MO
| | - Kathleen M. Schmainda
- Departments of Radiology and Biophysics, Medical College of Wisconsin, Wauwatosa, WI
| | - Melissa A. Prah
- Departments of Radiology and Biophysics, Medical College of Wisconsin, Wauwatosa, WI
| | | | | | - Chengyue Wu
- Department of Diagnostic Medicine, University of Texas at Austin, Austin, TX
| | - Anna G. Sorace
- Department of Diagnostic Medicine, University of Texas at Austin, Austin, TX
| | - Thomas E. Yankeelov
- Department of Diagnostic Medicine, University of Texas at Austin, Austin, TX
| | - Neal Rutledge
- Department of Diagnostic Medicine, University of Texas at Austin, Austin, TX
| | | | | | - Yichu Liu
- UT Health San Antonio, San Antonio, TX
| | | | - Leland S. Hu
- Department of Radiology, Mayo Clinic, Scottsdale, AZ
| | - Yuxiang Zhou
- Department of Radiology, Mayo Clinic, Scottsdale, AZ
| | - Jerrold L. Boxerman
- Department of Diagnostic Imaging, Rhode Island Hospital, Providence, RI;,Alpert Medical School of Brown University, Providence, RI
| | - Yi-Fen Yen
- Department of Radiology, Massachusetts General Hospital, Boston, MA
| | | | - Andrew L. Beers
- Department of Radiology, Massachusetts General Hospital, Boston, MA
| | - Mark Muzi
- Department of Radiology, University of Washington, Seattle, Washington
| | | | - Marco Pinho
- UT Southwestern Medical Center, Dallas, TX; and
| | - Brian Johnson
- UT Southwestern Medical Center, Dallas, TX; and,Philips Healthcare, Gainesville, FL
| | - C. Chad Quarles
- Division of Neuroimaging Research, Barrow Neurological Institute, Phoenix, AZ
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17
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Hedderich D, Kluge A, Pyka T, Zimmer C, Kirschke JS, Wiestler B, Preibisch C. Consistency of normalized cerebral blood volume values in glioblastoma using different leakage correction algorithms on dynamic susceptibility contrast magnetic resonance imaging data without and with preload. J Neuroradiol 2018; 46:44-51. [PMID: 29753641 DOI: 10.1016/j.neurad.2018.04.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 02/27/2018] [Accepted: 04/21/2018] [Indexed: 10/16/2022]
Abstract
BACKGROUND AND PURPOSE Several leakage correction algorithms for dynamic susceptibility contrast (DSC) magnetic resonance imaging (MRI)-based cerebral blood volume (CBV) measurement have been proposed, and combination with a preload of contrast agent is generally recommended. A single bolus application scheme would largely simplify and facilitate standardized clinical applications, while reducing contrast agent (CA) dose. The aim of this study was, therefore, to investigate whether appropriate leakage correction redundantizes prebolus application by comparing normalized DSC-based CBV (nCBV) measures of two consecutive CA boli. MATERIALS AND METHODS Twenty-seven patients with suspected glioblastoma (WHO-grade-IV) underwent DSC-MRI during two consecutive boli of Gd-based CA. Four variants of two post-processing leakage correction techniques were compared with respect to nCBV in contrast enhancing tumor tissue. First, a reference curve approach with first pass and full integration of corrected ΔR2*(t), and second, a deconvolution-based approach using singular value decomposition (SVD) with a standard noise-dependent cutoff or Tikhonov regularization. RESULTS Compared to respective uncorrected values, all leakage correction techniques increased nCBV for data acquired without prebolus, while there was no consistent trend for data acquired with prebolus. The best agreement between corrected nCBV values in contrast enhancing tumor, obtained in the same patients without and with prebolus, respectively, was obtained for the reference curve-based correction approach with either first pass or full integration. CONCLUSION The reference curve-based leakage correction approach with integration-based nCBV calculation yielded a high accordance between nCBV values without and with prebolus, respectively. Thus, it appears possible to obtain valid nCBV in glioblastoma with a single CA injection.
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Affiliation(s)
- Dennis Hedderich
- Department of Diagnostic and Interventional Neuroradiology, Technische Universität München, Ismaningerst. 22, 81675 Munich, Germany
| | - Anne Kluge
- Department of Diagnostic and Interventional Neuroradiology, Technische Universität München, Ismaningerst. 22, 81675 Munich, Germany
| | - Thomas Pyka
- Clinic for Nuclear Medicine, Technische Universität München, Ismaningerst. 22, 81675 Munich, Germany
| | - Claus Zimmer
- Department of Diagnostic and Interventional Neuroradiology, Technische Universität München, Ismaningerst. 22, 81675 Munich, Germany
| | - Jan S Kirschke
- Department of Diagnostic and Interventional Neuroradiology, Technische Universität München, Ismaningerst. 22, 81675 Munich, Germany
| | - Benedikt Wiestler
- Department of Diagnostic and Interventional Neuroradiology, Technische Universität München, Ismaningerst. 22, 81675 Munich, Germany
| | - Christine Preibisch
- Department of Diagnostic and Interventional Neuroradiology, Technische Universität München, Ismaningerst. 22, 81675 Munich, Germany; Clinic for Neurology, Technische Universität München, Ismaningerst. 22, 81675 Munich, Germany.
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18
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Liang J, Liu D, Gao P, Zhang D, Chen H, Shi C, Luo L. Diagnostic Values of DCE-MRI and DSC-MRI for Differentiation Between High-grade and Low-grade Gliomas: A Comprehensive Meta-analysis. Acad Radiol 2018; 25:338-348. [PMID: 29223713 DOI: 10.1016/j.acra.2017.10.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 10/15/2017] [Accepted: 10/16/2017] [Indexed: 12/14/2022]
Abstract
RATIONALE AND OBJECTIVES This study aimed to collect the studies on the role of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and dynamic susceptibility contrast MRI (DSC-MRI) in differentiating the grades of gliomas, and evaluate the diagnostic performances of relevant quantitative parameters in glioma grading. MATERIALS AND METHODS We systematically searched studies on the diagnosis of gliomas with DCE-MRI or DSC-MRI in Medline, PubMed, China National Knowledge Infrastructure database, Cochrane Library, and Embase published between January 2005 and December 2016. Standardized mean differences and 95% confidence intervals were calculated for volume transfer coefficient (Ktrans), volume fraction of extravascular extracellular space (Ve), rate constant of backflux (Kep), relative cerebral blood volume (rCBV), and relative cerebral blood flow (rCBF) using Review Manager 5.2 software. Sensitivity, specificity, area under the curve (AUC), and Begg test were calculated by Stata 12.0. RESULTS Twenty-two studies with available outcome data were included in the analysis. The standardized mean difference of Ktrans values between high-grade glioma and low-grade glioma were 1.18 (0.91, 1.45); Ve values were 1.43 (1.06, 1.80); Kep values were 0.65 (-0.05, 1.36); rCBV values were 1.44 (1.08, 1.81); and rCBF values were 1.17 (0.68, 1.67), respectively. The results were all significant statistically (P < .05) except Kep values (P = .07), and high-grade glioma had higher Ktrans, Ve, rCBV, and rCBF values than low-grade glioma. AUC values of Ktrans, Ve, rCBV, and rCBF were 0.90, 0.88, 0.93, and 0.73, respectively; rCBV had the largest AUC among the four parameters (P < .05). CONCLUSION Both DCE-MRI and DSC-MRI are reliable techniques in differentiating the grades of gliomas, and rCBV was found to be the most sensitive one.
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Affiliation(s)
- Jianye Liang
- Medical Imaging Center, The First Affiliated Hospital of Jinan University, No.613, Huangpu Road West Tianhe District, Guangzhou, 510630, China
| | - Dexiang Liu
- Department of Radiology, Guangzhou Panyu Central Hospital, Guangzhou, Guangdong, China
| | - Peng Gao
- Medical Imaging Center, The First Affiliated Hospital of Jinan University, No.613, Huangpu Road West Tianhe District, Guangzhou, 510630, China
| | - Dong Zhang
- Medical Imaging Center, The First Affiliated Hospital of Jinan University, No.613, Huangpu Road West Tianhe District, Guangzhou, 510630, China
| | - Hanwei Chen
- Department of Radiology, Guangzhou Panyu Central Hospital, Guangzhou, Guangdong, China
| | - Changzheng Shi
- Medical Imaging Center, The First Affiliated Hospital of Jinan University, No.613, Huangpu Road West Tianhe District, Guangzhou, 510630, China.
| | - Liangping Luo
- Medical Imaging Center, The First Affiliated Hospital of Jinan University, No.613, Huangpu Road West Tianhe District, Guangzhou, 510630, China.
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19
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Yan N, Zheng Y, Yang C. Functional and morphological effects of diazepam and midazolam on tumor vasculature in the 9L gliosarcoma brain tumor model using dynamic susceptibility contrast MRI: a comparative study. Drug Des Devel Ther 2017; 11:2931-2936. [PMID: 29042753 PMCID: PMC5634367 DOI: 10.2147/dddt.s143838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Antiangiogenic therapy attenuates tumor growth by reducing vascularization. Diazepam (DZP) and midazolam (MZL) have antiangiogenic properties in human umbilical vein endothelial cells. Thus, we investigated the antiangiogenic activity of DZP and MZL in the rat 9L gliosarcoma brain tumor model. The effect on tumor vasculature was evaluated using dynamic susceptibility contrast magnetic resonance imaging with gradient-echo (GE) and spin-echo (SE) to assess perfusion parameters, including cerebral blood volume (CBV), cerebral blood flow (CBF), mean transit time (MTT), and mean vessel diameter. The GE-normalized CBF (nCBF) in the tumors of untreated controls was significantly lower than that in normal brain tissue, whereas the CBV and MTT were higher. DZP- and MZL-treated rats had higher CBF and lower CBV and MTT values than did untreated controls. The tumor size decreased significantly to 33.5% in DZP-treated rats (P<0.001) and 22.5% in MZL-treated rats (P<0.01) relative to controls. The SE-normalized CBV was lower in DZP-treated (32.9%) and MZL-treated (10.6%) rats compared with controls. The mean vessel diameter decreased significantly by 32.5% in DPZ-treated and by 24.9% in MZL-treated rats compared with controls (P<0.01). The GE and SE nCBF values were higher in DZP-treated (49.9% and 40.1%, respectively) and MZL-treated (41.2% and 32.1%, respectively) rats than in controls. The GE- and SE-normalized MTTs were lower in DZP-treated (48.2% and 59.8%, respectively) and MZL-treated (40.5% and 51.2%, respectively) rats than in controls. Both DZP and MZL had antiangiogenic effects on tumor perfusion and vasculature; however, the antiangiogenic activity of DZP is more promising than that of MZL.
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Affiliation(s)
- Nuo Yan
- Second Department of Anesthesiology, The Affiliated Hospital to Logistics University of PAP, Tianjin
| | - Yuzhen Zheng
- Department of Anesthesiology, Tianjin Huanhu Hospital, Tianjin, China
| | - Cheng Yang
- Second Department of Anesthesiology, The Affiliated Hospital to Logistics University of PAP, Tianjin
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20
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Bell LC, Hu LS, Stokes AM, McGee SC, Baxter LC, Quarles CC. Characterizing the Influence of Preload Dosing on Percent Signal Recovery (PSR) and Cerebral Blood Volume (CBV) Measurements in a Patient Population With High-Grade Glioma Using Dynamic Susceptibility Contrast MRI. ACTA ACUST UNITED AC 2017; 3:89-95. [PMID: 28825039 PMCID: PMC5557059 DOI: 10.18383/j.tom.2017.00004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
With DSC-MRI, contrast agent leakage effects in brain tumors can either be leveraged for percent signal recovery (PSR) measurements or be adequately resolved for accurate relative cerebral blood volume (rCBV) measurements. Leakage effects can be dimished by administration of a preload dose before imaging and/or specific postprocessing steps. This study compares the consistency of both PSR and rCBV measurements as a function of varying preload doses in a retrospective analysis of 14 subjects with high-grade gliomas. The scans consisted of 6 DSC-MRI scans during 6 sequential bolus injections (0.05 mmol/kg). Mean PSR was calculated for tumor and normal-appearing white matter regions of interest. DSC-MRI data were corrected for leakage effects before computing mean tumor rCBV. Statistical differences were seen across varying preloads for tumor PSR (P value = 4.57E-24). Tumor rCBV values did not exhibit statistically significant differences across preloads (P value = .14) and were found to be highly consistent for clinically relevant preloads (intraclass correlation coefficient = 0.93). For a 0.05 mmol/kg injection bolus and pulse sequence parameters used, the highest PSR contrast between normal-appearing white matter and tumor occurs when no preload is used. This suggests that studies using PSR as a biomarker should acquire DSC-MRI data without preload. The finding that leakage-corrected rCBV values do not depend on the presence or dose of preload contradicts that of previous studies with dissimilar acquisition protocols. This further confirms the sensitivity of rCBV to preload dosing schemes and pulse sequence parameters and highlights the importance of standardization efforts for achieving multisite rCBV consistency.
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Affiliation(s)
- Laura C Bell
- Division of Imaging Research, Barrow Neurological Institute, Phoenix, Arizona
| | - Leland S Hu
- Department of Radiology, Mayo Clinic Arizona, Scottsdale, Arizona
| | - Ashley M Stokes
- Division of Imaging Research, Barrow Neurological Institute, Phoenix, Arizona
| | - Samuel C McGee
- Division of Imaging Research, Barrow Neurological Institute, Phoenix, Arizona
| | - Leslie C Baxter
- Division of Imaging Research, Barrow Neurological Institute, Phoenix, Arizona
| | - C Chad Quarles
- Division of Imaging Research, Barrow Neurological Institute, Phoenix, Arizona
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21
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Knutsson L, Xu X, Ståhlberg F, Barker PB, Lind E, Sundgren PC, van Zijl PCM, Wirestam R. Dynamic Susceptibility Contrast MRI at 7 T: Tail-Scaling Analysis and Inferences About Field Strength Dependence. Tomography 2017; 3:74-78. [PMID: 28825038 PMCID: PMC5558863 DOI: 10.18383/j.tom.2017.00001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Dynamic susceptibility contrast magnetic resonance imaging (DSC-MRI) following bolus injection of gadolinium contrast agent (CA) is widely used for the estimation of brain perfusion parameters such as cerebral blood volume (CBV), cerebral blood flow (CBF), and mean transit time (MTT) for both clinical and research purposes. Although it is predicted that DSC-MRI will have superior performance at high magnetic field strengths, to the best of our knowledge, there are no reports of 7 T DSC-MRI in the literature. It is plausible that the transfer of DSC-MRI to 7 T may be accompanied by increased R2* relaxivity in tissue and a larger difference in ΔR2*-versus-concentration relationships between tissue and large vessels. If not accounted for, this will subsequently result in apparent CBV and CBF estimates that are higher than those reported previously at lower field strengths. The aims of this study were therefore to assess the feasibility of 7 T DSC-MRI and to investigate the apparent field-strength dependence of CBV and CBF estimates. In total, 8 healthy volunteers were examined using DSC-MRI at 7 T. A reduced CA dose of 0.05 mmol/kg was administered to decrease susceptibility artifacts. CBV, CBF, and MTT maps were calculated using standard DSC-MRI tracer-kinetic theory. Subject-specific arterial partial volume correction factors were obtained using a tail-scaling approach. Compared with literature values obtained using the tail-scaling approach at 1.5 T and 3 T, the CBV and CBF values of the present study were found to be further overestimated. This observation is potentially related to an inferred field-strength dependence of transverse relaxivities, although issues related to the CA dose must also be considered.
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Affiliation(s)
- Linda Knutsson
- Department of Medical Radiation Physics, Lund University, Lund, Sweden.,Department of Radiology (Adjunct), Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Xiang Xu
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland.,F. M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland
| | - Freddy Ståhlberg
- Department of Medical Radiation Physics, Lund University, Lund, Sweden.,Department of Diagnostic Radiology, Lund University, Lund, Sweden.,Lund University Bioimaging Center, Lund University, Lund, Sweden
| | - Peter B Barker
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland.,F. M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland
| | - Emelie Lind
- Department of Medical Radiation Physics, Lund University, Lund, Sweden
| | - Pia C Sundgren
- Department of Diagnostic Radiology, Lund University, Lund, Sweden
| | - Peter C M van Zijl
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland.,F. M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland
| | - Ronnie Wirestam
- Department of Medical Radiation Physics, Lund University, Lund, Sweden
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22
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Hirai S, Inaji M, Tanaka Y, Hara S, Nariai T, Maehara T. Correlation between Clinical Presentations and Hemodynamic Parameters Measured by Dynamic Susceptibility Contrast Magnetic Resonance Imaging in Adult Patients with Moyamoya Disease. J Stroke Cerebrovasc Dis 2017; 26:2814-2820. [PMID: 28778721 DOI: 10.1016/j.jstrokecerebrovasdis.2017.06.057] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 05/19/2017] [Accepted: 06/30/2017] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The examination of cerebral hemodynamics is indispensable for the clinical management of patients with moyamoya disease (MMD). In this study, we examined the correlation between clinical presentations and hemodynamic parameters measured by dynamic susceptibility contrast magnetic resonance imaging (DSC-MRI) in adult patients with MMD. METHODS One hundred fifty-seven hemispheres in 122 adult patients with MMD were examined by DSC-MRI to measure the regional relative cerebral blood volume (CBV) and relative mean transit time (MTT). The patients were divided into 4 groups based on their clinical presentations: a nonsymptomatic (NS), hemorrhagic (H), infarction (I), and transient ischemic attack (T) group. The regional CBV and MTT values were compared among the 4 groups. RESULTS The relative value of CBV was significantly higher in groups T and I than in the NS group (P < .01). The CBV of group H was higher than that of the NS group only in the frontal lobe cortex. There were no significant statistical differences among the 3 symptomatic groups. Prolongation of the MTT in comparison with the cerebellum (MTT delay) was significantly higher in groups T and I than in the NS group in all regions of the cerebral cortex (P < .05). The MTT delay was significantly lower in group H than in group T in the frontal lobe and the Rolandic area (P < .05). CONCLUSIONS Hemodynamic factors measured by DSC-MRI reflected the variable clinical presentations of patients with MMD. DSC-MRI is a useful modality for evaluating the clinical conditions of individual adult patients with MMD.
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Affiliation(s)
- Sakyo Hirai
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Motoki Inaji
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan.
| | - Yoji Tanaka
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shoko Hara
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tadashi Nariai
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Taketoshi Maehara
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
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23
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Digernes I, Bjørnerud A, Vatnehol SAS, Løvland G, Courivaud F, Vik-Mo E, Meling TR, Emblem KE. A theoretical framework for determining cerebral vascular function and heterogeneity from dynamic susceptibility contrast MRI. J Cereb Blood Flow Metab 2017; 37:2237-2248. [PMID: 28273722 PMCID: PMC5444554 DOI: 10.1177/0271678x17694187] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Mapping the complex heterogeneity of vascular tissue in the brain is important for understanding cerebrovascular disease. In this translational study, we build on previous work using vessel architectural imaging (VAI) and present a theoretical framework for determining cerebral vascular function and heterogeneity from dynamic susceptibility contrast magnetic resonance imaging (MRI). Our tissue model covers realistic structural architectures for vessel branching and orientations, as well as a range of hemodynamic scenarios for blood flow, capillary transit times and oxygenation. In a typical image voxel, our findings show that the apparent MRI relaxation rates are independent of the mean vessel orientation and that the vortex area, a VAI-based parameter, is determined by the relative oxygen saturation level and the vessel branching of the tissue. Finally, in both simulated and patient data, we show that the relative distributions of the vortex area parameter as a function of capillary transit times show unique characteristics in normal-appearing white and gray matter tissue, whereas tumour-voxels in comparison display a heterogeneous distribution. Collectively, our study presents a comprehensive framework that may serve as a roadmap for in vivo and per-voxel determination of vascular status and heterogeneity in cerebral tissue.
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Affiliation(s)
- Ingrid Digernes
- 1 Department of Diagnostic Physics, Oslo University Hospital, Oslo, Norway
| | - Atle Bjørnerud
- 1 Department of Diagnostic Physics, Oslo University Hospital, Oslo, Norway.,2 Department of Physics, University of Oslo, Oslo, Norway
| | | | - Grete Løvland
- 1 Department of Diagnostic Physics, Oslo University Hospital, Oslo, Norway
| | - Frédéric Courivaud
- 1 Department of Diagnostic Physics, Oslo University Hospital, Oslo, Norway
| | - Einar Vik-Mo
- 3 Department of Neurosurgery, Oslo University Hospital, Oslo, Norway
| | - Torstein R Meling
- 3 Department of Neurosurgery, Oslo University Hospital, Oslo, Norway.,4 Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Kyrre E Emblem
- 1 Department of Diagnostic Physics, Oslo University Hospital, Oslo, Norway
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24
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Livne M, Madai VI, Brunecker P, Zaro-Weber O, Moeller-Hartmann W, Heiss WD, Mouridsen K, Sobesky J. A PET-Guided Framework Supports a Multiple Arterial Input Functions Approach in DSC-MRI in Acute Stroke. J Neuroimaging 2017; 27:486-492. [PMID: 28207200 DOI: 10.1111/jon.12428] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Accepted: 01/02/2017] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND PURPOSE In acute stroke, arterial-input-function (AIF) determination is essential for obtaining perfusion estimates with dynamic susceptibility-weighted contrast-enhanced magnetic resonance imaging (DSC-MRI). Standard DSC-MRI postprocessing applies single AIF selection, ie, global AIF. Physiological considerations, however, suggest that a multiple AIFs selection method would improve perfusion estimates to detect penumbral flow. In this study, we developed a framework based on comparable DSC-MRI and positron emission tomography (PET) images to compare the two AIF selection approaches and assess their performance in penumbral flow detection in acute stroke. METHODS In a retrospective analysis of 17 sub(acute) stroke patients with consecutive MRI and PET scans, voxel-wise optimized AIFs were calculated based on the kinetic model as derived from both imaging modalities. Perfusion maps were calculated based on the optimized-AIF using two methodologies: (1) Global AIF and (2) multiple AIFs as identified by cluster analysis. Performance of penumbral-flow detection was tested by receiver-operating characteristics (ROC) curve analysis, ie, the area under the curve (AUC). RESULTS Large variation of optimized AIFs across brain voxels demonstrated that there is no optimal single AIF. Subsequently, the multiple-AIF method (AUC range over all maps: .82-.90) outperformed the global AIF methodology (AUC .72-.85) significantly. CONCLUSIONS We provide PET imaging-based evidence that a multiple AIF methodology is beneficial for penumbral flow detection in comparison with the standard global AIF methodology in acute stroke.
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Affiliation(s)
- Michelle Livne
- Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Vince I Madai
- Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Peter Brunecker
- Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | | | | | - Kim Mouridsen
- Center of Functionally Integrative Neuroscience, Aarhus University, Denmark
| | - Jan Sobesky
- Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin Berlin, Berlin, Germany
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25
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Grøvik E, Redalen KR, Storås TH, Negård A, Holmedal SH, Ree AH, Meltzer S, Bjørnerud A, Gjesdal KI. Dynamic multi-echo DCE- and DSC-MRI in rectal cancer: Low primary tumor K trans and ΔR2* peak are significantly associated with lymph node metastasis. J Magn Reson Imaging 2016; 46:194-206. [PMID: 28001320 DOI: 10.1002/jmri.25566] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 11/08/2016] [Indexed: 12/16/2022] Open
Abstract
PURPOSE To implement a dynamic contrast-based multi-echo MRI sequence in assessment of rectal cancer and evaluate associations between histopathologic data and the acquired dynamic contrast-enhanced (DCE) and dynamic susceptibility contrast (DSC) -MRI parameters. MATERIALS AND METHODS This pilot study reports results from 17 patients with resectable rectal cancer. Dynamic contrast-based multi-echo MRI (1.5T) was acquired using a three-dimensional multi-shot EPI sequence, yielding both DCE- and DSC-data following a single injection of contrast agent. The Institutional Review Board approved the study and all patients provided written informed consent. Quantitative analysis was performed by pharmacokinetic modeling on DCE data and tracer kinetic modeling on DSC data. Mann-Whitney U-test and receiver operating characteristics curve statistics was used to evaluate associations between histopathologic data and the acquired DCE- and DSC-MRI parameters. RESULTS For patients with histologically confirmed nodal metastasis, the primary tumor demonstrated a significantly lower Ktrans and peak change in R2*, R2*-peakenh , than patients without nodal metastasis, showing a P-value of 0.010 and 0.005 for reader 1, and 0.043 and 0.019 for reader 2, respectively. CONCLUSION This study shows the feasibility of acquiring DCE- and DSC-MRI in rectal cancer by dynamic multi-echo MRI. A significant association was found between both Ktrans and R2*-peakenh in the primary tumor and histological nodal status of the surgical specimen, which may improve stratification of patients to intensified multimodal treatment. LEVEL OF EVIDENCE 4 Technical Efficacy: Stage 2 J. MAGN. RESON. IMAGING 2017;46:194-206.
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Affiliation(s)
- Endre Grøvik
- Oslo University Hospital, The Intervention Centre, Oslo, Norway.,University of Oslo, Department of Physics, Blindern, Oslo, Norway
| | | | | | - Anne Negård
- Akershus University Hospital, Department of Radiology, Lørenskog, Norway
| | | | - Anne Hansen Ree
- Akershus University Hospital, Department of Oncology, Lørenskog, Norway.,University of Oslo, Faculty of Medicine, Blindern, Oslo, Norway
| | - Sebastian Meltzer
- Akershus University Hospital, Department of Oncology, Lørenskog, Norway.,University of Oslo, Faculty of Medicine, Blindern, Oslo, Norway
| | - Atle Bjørnerud
- Oslo University Hospital, The Intervention Centre, Oslo, Norway.,University of Oslo, Department of Physics, Blindern, Oslo, Norway
| | - Kjell-Inge Gjesdal
- Akershus University Hospital, Department of Radiology, Lørenskog, Norway.,Sunnmøre MR-klinikk, Ålesund, Norway
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26
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Dibble EH, Boxerman JL, Baird GL, Donahue JE, Rogg JM. Toxoplasmosis versus lymphoma: Cerebral lesion characterization using DSC-MRI revisited. Clin Neurol Neurosurg 2016; 152:84-89. [PMID: 27940418 DOI: 10.1016/j.clineuro.2016.11.023] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Revised: 11/21/2016] [Accepted: 11/30/2016] [Indexed: 11/24/2022]
Abstract
OBJECTIVE CNS toxoplasmosis and lymphoma are often indistinguishable by conventional contrast-enhanced MRI. There is limited literature on the diagnostic efficacy of dynamic susceptibility contrast (DSC) MRI for differentiating these entities. This study assesses the clinical utility of relative cerebral blood volume (rCBV) for making a diagnosis and determines rCBV thresholds for differentiation using contemporary DSC-MRI. PATIENTS AND METHODS Thirteen patients with 25 lesions (13 toxoplasmosis and 12 lymphoma) and pre-treatment DSC-MRI were identified retrospectively. Volumetric regions of interest of segmented enhancement were used to extract mean rCBV normalized to normal-appearing white matter for each lesion. We compared average mean rCBV between all toxoplasmosis and lymphoma lesions using a general mixed model. Three models were also compared for evaluating rCBV-based disease status in each patient: 1) mean rCBV of each lesion using a generalized estimating equation, 2) volume-weighted mean rCBV, and 3) maximum mean rCBV of all lesions using logistic regression. RESULTS The average mean rCBV for all toxoplasmosis lesions was 0.98 (95% CI 0.55-1.41) compared to 2.07 (95% CI 1.71-2.43) for all lymphoma lesions, a significant difference (1.09, 95% CI 0.53-1.65, p=0.0013). For the three models used to evaluate rCBV-based disease status in each patient, a significant relationship was observed, with an optimal rCBV threshold of approximately 1.5 for distinguishing lymphoma from toxoplasmosis in each model. CONCLUSION RCBV derived from contemporary DSC-MRI is helpful for distinguishing between cerebral toxoplasmosis and cerebral lymphoma on an individual patient basis and may facilitate more timely initiation of appropriate directed therapy.
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Affiliation(s)
- Elizabeth H Dibble
- Rhode Island Hospital, Department of Diagnostic Imaging, 593 Eddy Street, Providence, RI, 02903, United States; The Warren Alpert Medical School of Brown University, 222 Richmond Street, Providence, RI, 02903, United States.
| | - Jerrold L Boxerman
- Rhode Island Hospital, Department of Diagnostic Imaging, 593 Eddy Street, Providence, RI, 02903, United States; The Warren Alpert Medical School of Brown University, 222 Richmond Street, Providence, RI, 02903, United States.
| | - Grayson L Baird
- Rhode Island Hospital, Department of Diagnostic Imaging, 593 Eddy Street, Providence, RI, 02903, United States; The Warren Alpert Medical School of Brown University, 222 Richmond Street, Providence, RI, 02903, United States.
| | - John E Donahue
- Rhode Island Hospital, Department of Neuropathology, 593 Eddy Street, Providence, RI, 02903, United States; The Warren Alpert Medical School of Brown University, 222 Richmond Street, Providence, RI, 02903, United States.
| | - Jeffrey M Rogg
- Rhode Island Hospital, Department of Diagnostic Imaging, 593 Eddy Street, Providence, RI, 02903, United States; The Warren Alpert Medical School of Brown University, 222 Richmond Street, Providence, RI, 02903, United States.
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Paulson ES, Prah DE, Schmainda KM. Spiral Perfusion Imaging With Consecutive Echoes (SPICE™) for the Simultaneous Mapping of DSC- and DCE-MRI Parameters in Brain Tumor Patients: Theory and Initial Feasibility. ACTA ACUST UNITED AC 2016; 2:295-307. [PMID: 28090589 PMCID: PMC5226659 DOI: 10.18383/j.tom.2016.00217] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Dynamic contrast-enhanced (DCE) and dynamic susceptibility contrast (DSC) magnetic resonance imaging (MRI) are the perfusion imaging techniques most frequently used to probe the angiogenic character of brain neoplasms. With these methods, T1- and T2/T2*-weighted imaging sequences are used to image the distribution of gadolinium (Gd)-based contrast agents. However, it is well known that Gd exhibits combined T1, T2, and T2* shortening effects in tissue, and therefore, the results of both DCE- and DSC-MRI can be confounded by these opposing effects. In particular, residual susceptibility effects compete with T1 shortening, which can confound DCE-MRI parameters, whereas dipolar T1 and T2 leakage and residual susceptibility effects can confound DSC-MRI parameters. We introduce here a novel perfusion imaging acquisition and postprocessing method termed Spiral Perfusion Imaging with Consecutive Echoes (SPICE) that can be used to simultaneously acquire DCE- and DSC-MRI data, which requires only a single dose of the Gd contrast agent, does not require the collection of a precontrast T1 map for DCE-MRI processing, and eliminates the confounding contrast agent effects due to contrast extravasation. A detailed mathematical description of SPICE is provided here along with a demonstration of its utility in patients with high-grade glioma.
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Affiliation(s)
- Eric S Paulson
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Douglas E Prah
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
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Hansen MB, Tietze A, Kalpathy-Cramer J, Gerstner ER, Batchelor TT, Østergaard L, Mouridsen K. Reliable estimation of microvascular flow patterns in patients with disrupted blood-brain barrier using dynamic susceptibility contrast MRI. J Magn Reson Imaging 2016; 46:537-549. [PMID: 27902858 DOI: 10.1002/jmri.25549] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 10/27/2016] [Indexed: 11/06/2022] Open
Abstract
PURPOSE To present and quantify the performance of a method to compute tissue hemodynamic parameters from dynamic susceptibility contrast (DSC) MRI data in brain tissue with possible nonintact blood-brain barrier. THEORY AND MATERIALS AND METHODS We propose a Bayesian scheme to obtain perfusion metrics, including capillary transit-time heterogeneity (CTH), from DSC-MRI data in the presence of contrast agent extravasation. Initial performance assessment is performed through simulations. Next, we assessed possible over- or under correction for tracer extravasation in two patients receiving contrast agent preloading and two patients not receiving preloading. Perfusion metrics for N = 60 patients diagnosed with either grade III (N = 14) or grade IV gliomas (N = 46) were analyzed across tissue types to evaluate the ability to distinguish regions with different hemodynamic patterns. Finally, N = 4 patient cases undergoing anti-angiogenic treatment are evaluated qualitatively for treatment effects. All patient data were acquired at 3.0 Tesla. RESULTS The simulation studies showed good robustness against low signal-to-noise ratios, exemplified with Pearson correlations of R = 0.833 (mean transit time) and R = 0.738 (CTH) at signal-to-noise ratio = 20. Region-of-interest analysis of the N = 60 glioma patients showed that cerebral blood volume (CBV) significantly separated enhancing core from edema (grade IV: P < 10-8 , grade III: P < 0.05) and enhancing core from normal appearing ipsilateral white matter (NAWM) (grade IV: P < 10-8 , grade III: P < 0.05). The microvascular parameters were particularly good in separating edematous tissue from NAWM tissue in grade IV gliomas (P < 0.001). Finally, CTH separated grade III and grade IV core tissue (P < 0.05). CONCLUSION We have demonstrated robustness of the proposed Bayesian algorithm against experimental noise and demonstrated complementary value in microvascular parameters to the CBV parameter in separating tissue types in gliomas. LEVEL OF EVIDENCE 3 Technical Efficacy: Stage 2 J. MAGN. RESON. IMAGING 2017;46:537-549.
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Affiliation(s)
- Mikkel Bo Hansen
- Center of Functionally Integrative Neuroscience and MINDLab, Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Anna Tietze
- Center of Functionally Integrative Neuroscience and MINDLab, Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Neuroradiology, Aarhus University Hospital, Aarhus, Denmark.,Institute of Neuroradiology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, D-10117, Berlin
| | - Jayashree Kalpathy-Cramer
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Elizabeth R Gerstner
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Tracy T Batchelor
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Leif Østergaard
- Center of Functionally Integrative Neuroscience and MINDLab, Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Neuroradiology, Aarhus University Hospital, Aarhus, Denmark
| | - Kim Mouridsen
- Center of Functionally Integrative Neuroscience and MINDLab, Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Ramb R, Mader I, Jung B, Hennig J, Zaitsev M. High resolution CBV assessment with PEAK-EPI: k-t-undersampling and reconstruction in echo planar imaging. Magn Reson Med 2016; 77:2153-2166. [PMID: 27343201 DOI: 10.1002/mrm.26298] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 04/22/2016] [Accepted: 05/17/2016] [Indexed: 11/10/2022]
Abstract
PURPOSE Achieving higher spatial resolution and improved brain coverage while mitigating in-plane susceptibility artifacts in the assessment of perfusion parameters, such as cerebral blood volume, in echo planar imaging (EPI)-based dynamic susceptibility contrast weighted cerebral perfusion measurements. METHODS PEAK-EPI, an EPI sequence with interleaved readout trajectories and three different strategies for autocalibration-signal acquisition (inplace, dynamic extra and extra) is presented. Performance of each approach is analyzed in vivo based on flip angle variation induced dynamics, assessing temporal fidelity, temporal SNR and g-factors. All approaches are compared with conventional GRAPPA reconstructions. PEAK-EPI with inplace autocalibration-signal at R = 5 is then compared with the standard clinical EPI protocol in six patients, using two half-dose dynamic susceptibility contrast weighted cerebral perfusion measurements per subject. RESULTS PEAK-EPI acquisition facilitates a substantial increase of spatial resolution at a higher number of slices per TR and provides improved SNR compared to conventional GRAPPA. High dependency of the resulting reconstruction quality on the type of autocalibration-signal acquisition is observed. PEAK-EPI with inplace autocalibration-signal achieves high temporal fidelity and initial feasibility is shown. CONCLUSION The obtained high resolution cerebral blood volume maps reveal more detailed information than in corresponding standard EPI measurements and facilitate detailed delineation of tumorous tissue. Magn Reson Med 77:2153-2166, 2017. © 2016 International Society for Magnetic Resonance in Medicine.
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Affiliation(s)
- Rebecca Ramb
- Department of Radiology, Medical Physics, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Irina Mader
- Department of Neuroradiology, University Medical Center, Freiburg, Germany
| | - Bernd Jung
- Institute of Diagnostic, Interventional and Pediatric Radiology, University Hospital Bern, Bern, Switzerland
| | - Jürgen Hennig
- Department of Radiology, Medical Physics, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Maxim Zaitsev
- Department of Radiology, Medical Physics, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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30
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Ahlgren A, Wirestam R, Lind E, Ståhlberg F, Knutsson L. A linear mixed perfusion model for tissue partial volume correction of perfusion estimates in dynamic susceptibility contrast MRI: Impact on absolute quantification, repeatability, and agreement with pseudo-continuous arterial spin labeling. Magn Reson Med 2016; 77:2203-2214. [PMID: 27321696 DOI: 10.1002/mrm.26305] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 05/20/2016] [Accepted: 05/20/2016] [Indexed: 11/07/2022]
Abstract
PURPOSE The partial volume effect (PVE) is an important source of bias in brain perfusion measurements. The impact of tissue PVEs in perfusion measurements with dynamic susceptibility contrast MRI (DSC-MRI) has not yet been well established. The purpose of this study was to suggest a partial volume correction (PVC) approach for DSC-MRI and to study how PVC affects DSC-MRI perfusion results. METHODS A linear mixed perfusion model for DSC-MRI was derived and evaluated by way of simulations. Twenty healthy volunteers were scanned twice, including DSC-MRI, arterial spin labeling (ASL), and partial volume measurements. Two different algorithms for PVC were employed and assessed. RESULTS Simulations showed that the derived model had a tendency to overestimate perfusion values in voxels with high fractions of cerebrospinal fluid. PVC reduced the tissue volume dependence of DSC-MRI perfusion values from 44.4% to 4.2% in gray matter and from 55.3% to 14.2% in white matter. One PVC method significantly improved the voxel-wise repeatability, but PVC did not improve the spatial agreement between DSC-MRI and ASL perfusion maps. CONCLUSION Significant PVEs were found for DSC-MRI perfusion estimates, and PVC successfully reduced those effects. The findings suggest that PVC might be an important consideration for DSC-MRI applications. Magn Reson Med 77:2203-2214, 2017. © 2016 International Society for Magnetic Resonance in Medicine.
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Affiliation(s)
- André Ahlgren
- Department of Medical Radiation Physics, Lund University, Lund, Sweden
| | - Ronnie Wirestam
- Department of Medical Radiation Physics, Lund University, Lund, Sweden
| | - Emelie Lind
- Department of Medical Radiation Physics, Lund University, Lund, Sweden
| | - Freddy Ståhlberg
- Department of Medical Radiation Physics, Lund University, Lund, Sweden.,Department of Diagnostic Radiology, Lund University, Lund, Sweden.,Lund University Bioimaging Center, Lund University, Lund, Sweden
| | - Linda Knutsson
- Department of Medical Radiation Physics, Lund University, Lund, Sweden
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31
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Leu K, Boxerman JL, Lai A, Nghiemphu PL, Pope WB, Cloughesy TF, Ellingson BM. Bidirectional Contrast agent leakage correction of dynamic susceptibility contrast (DSC)-MRI improves cerebral blood volume estimation and survival prediction in recurrent glioblastoma treated with bevacizumab. J Magn Reson Imaging 2016; 44:1229-1237. [PMID: 26971534 DOI: 10.1002/jmri.25227] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 02/24/2016] [Indexed: 11/11/2022] Open
Abstract
PURPOSE To evaluate a leakage correction algorithm for T1 and T2* artifacts arising from contrast agent extravasation in dynamic susceptibility contrast magnetic resonance imaging (DSC-MRI) that accounts for bidirectional contrast agent flux and compare relative cerebral blood volume (CBV) estimates and overall survival (OS) stratification from this model to those made with the unidirectional and uncorrected models in patients with recurrent glioblastoma (GBM). MATERIALS AND METHODS We determined median rCBV within contrast-enhancing tumor before and after bevacizumab treatment in patients (75 scans on 1.5T, 19 scans on 3.0T) with recurrent GBM without leakage correction and with application of the unidirectional and bidirectional leakage correction algorithms to determine whether rCBV stratifies OS. RESULTS Decreased post-bevacizumab rCBV from baseline using the bidirectional leakage correction algorithm significantly correlated with longer OS (Cox, P = 0.01), whereas rCBV change using the unidirectional model (P = 0.43) or the uncorrected rCBV values (P = 0.28) did not. Estimates of rCBV computed with the two leakage correction algorithms differed on average by 14.9%. CONCLUSION Accounting for T1 and T2* leakage contamination in DSC-MRI using a two-compartment, bidirectional rather than unidirectional exchange model might improve post-bevacizumab survival stratification in patients with recurrent GBM. J. Magn. Reson. Imaging 2016;44:1229-1237.
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Affiliation(s)
- Kevin Leu
- UCLA Brain Tumor Imaging Laboratory (BTIL), Center for Computer Vision and Imaging Biomarkers, University of California, Los Angeles, Los Angeles, California, USA.,Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA.,Department of Bioengineering, Henry Samueli School of Engineering and Applied Science, University of California, Los Angeles, Los Angeles, California, USA
| | - Jerrold L Boxerman
- Department of Diagnostic Imaging, Rhode Island Hospital and Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Albert Lai
- UCLA Neuro-Oncology Program, University of California, Los Angeles, Los Angeles, California, USA.,Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - Phioanh L Nghiemphu
- UCLA Neuro-Oncology Program, University of California, Los Angeles, Los Angeles, California, USA.,Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - Whitney B Pope
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - Timothy F Cloughesy
- UCLA Neuro-Oncology Program, University of California, Los Angeles, Los Angeles, California, USA.,Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - Benjamin M Ellingson
- UCLA Brain Tumor Imaging Laboratory (BTIL), Center for Computer Vision and Imaging Biomarkers, University of California, Los Angeles, Los Angeles, California, USA. .,Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA. .,Department of Bioengineering, Henry Samueli School of Engineering and Applied Science, University of California, Los Angeles, Los Angeles, California, USA. .,UCLA Neuro-Oncology Program, University of California, Los Angeles, Los Angeles, California, USA. .,Department of Biomedical Physics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA.
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Talati P, Rane S, Skinner J, Gore J, Heckers S. Increased hippocampal blood volume and normal blood flow in schizophrenia. Psychiatry Res 2015; 232:219-25. [PMID: 25896442 PMCID: PMC4439302 DOI: 10.1016/j.pscychresns.2015.03.007] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Revised: 03/07/2015] [Accepted: 03/27/2015] [Indexed: 11/27/2022]
Abstract
Neuroimaging studies have provided compelling evidence for abnormal hippocampal activity in schizophrenia. Most studies made inferences about baseline hippocampal activity using a single hemodynamic parameter (e.g., blood volume or blood flow). Here we studied several hemodynamic measures in the same cohort to test the hypothesis of increased hippocampal activity in schizophrenia. We used dynamic susceptibility contrast- (DSC-) magnetic resonance imaging (MRI) to assess blood volume, blood flow, and mean transit time in the hippocampus of 15 patients with chronic schizophrenia and 15 healthy controls. Left and right hippocampal measurements were combined for absolute measures of cerebral blood volume (CBV), cerebral blood flow (CBF), and mean transit time (MTT). We found significantly increased hippocampal CBV, but normal CBF and MTT, in schizophrenia. The uncoupling of CBV and CBF could be due to several factors, including antipsychotic medication, loss of cerebral perfusion pressure, or angiogenesis. Further studies need to incorporate several complementary imaging modalities to better characterize hippocampal dysfunction in schizophrenia.
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Affiliation(s)
- Pratik Talati
- Vanderbilt Brain Institute, Department of Psychiatry, Vanderbilt University, Nashville, TN 37212 USA.
| | - Swati Rane
- Institute of Imaging Science, Department of Radiology and Radiological Sciences, Vanderbilt University, Nashville, TN 37232 USA.
| | - Jack Skinner
- Institute of Imaging Science, Department of Radiology and Radiological Sciences, Vanderbilt University, Nashville, TN, 37232 USA
| | - John Gore
- Institute of Imaging Science, Department of Radiology and Radiological Sciences, Vanderbilt University, Nashville, TN, 37232 USA
| | - Stephan Heckers
- Vanderbilt Brain Institute, Department of Psychiatry, Vanderbilt University, Nashville, TN, 37212 USA
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Peng SL, Wang FN, Wang CH, Peng HH, Lu CT, Yeh CK. Using microbubbles as an MRI contrast agent for the measurement of cerebral blood volume. NMR Biomed 2013; 26:1540-1546. [PMID: 23794141 DOI: 10.1002/nbm.2988] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Revised: 05/17/2013] [Accepted: 05/17/2013] [Indexed: 06/02/2023]
Abstract
The susceptibility differences at the gas-liquid interface of microbubbles (MBs) allow their use as an intravascular susceptibility contrast agent for in vivo MRI. However, the characteristics of MBs are very different from those of the standard gadolinium-diethylenetriaminepentaacetic acid (Gd-DPTA) contrast agent, including the size distribution and hemodynamic properties, which could influence MRI outcomes. Here, we investigate quantitatively the correlation between the relative cerebral blood volume (rCBV) derived from Gd-DTPA (rCBV(Gd)) and the MB-induced susceptibility effect (ΔR(2*MB)) by conventional dynamic susceptibility contrast MRI (DSC-MRI). Custom-made MBs had a mean diameter of 0.92 µm and were capable of inducing 4.68 ± 3.02% of the maximum signal change (MSC). The MB-associated ΔR(2*MB) was compared with rCBV(Gd) in 16 rats on 4.7-T MRI. We observed a significant effect of the time to peak (TTP) on the correlation between ΔR(2*MB) and rCBV(Gd), and also found a noticeable dependence between TTP and MSC. Our findings suggest that MBs with longer TTPs can be used for the estimation of rCBV by DSC-MRI, and emphasize the critical effect of TTP on MB-based contrast MRI.
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Affiliation(s)
- Shin-Lei Peng
- Department of Biomedical Engineering and Environmental Sciences, National Tsing Hua University, Hsinchu, Taiwan
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Sourbron SP, Buckley DL. Classic models for dynamic contrast-enhanced MRI. NMR Biomed 2013; 26:1004-1027. [PMID: 23674304 DOI: 10.1002/nbm.2940] [Citation(s) in RCA: 232] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Revised: 02/12/2013] [Accepted: 02/12/2013] [Indexed: 06/02/2023]
Abstract
Dynamic contrast-enhanced MRI (DCE-MRI) is a functional MRI method where T1 -weighted MR images are acquired dynamically after bolus injection of a contrast agent. The data can be interpreted in terms of physiological tissue characteristics by applying the principles of tracer-kinetic modelling. In the brain, DCE-MRI enables measurement of cerebral blood flow (CBF), cerebral blood volume (CBV), blood-brain barrier (BBB) permeability-surface area product (PS) and the volume of the interstitium (ve ). These parameters can be combined to form others such as the volume-transfer constant K(trans) , the extraction fraction E and the contrast-agent mean transit times through the intra- and extravascular spaces. A first generation of tracer-kinetic models for DCE-MRI was developed in the early 1990s and has become a standard in many applications. Subsequent improvements in DCE-MRI data quality have driven the development of a second generation of more complex models. They are increasingly used, but it is not always clear how they relate to the models of the first generation or to the model-free deconvolution methods for tissues with intact BBB. This lack of understanding is leading to increasing confusion on when to use which model and how to interpret the parameters. The purpose of this review is to clarify the relation between models of the first and second generations and between model-based and model-free methods. All quantities are defined using a generic terminology to ensure the widest possible scope and to reveal the link between applications in the brain and in other organs.
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