Abstract
PurposeRelative cerebral blood volume (rCBV) is the most widely used parameter derived from DSC perfusion MR imaging for predicting brain tumor aggressiveness. However, accurate rCBV estimation is challenging in enhancing glioma, because of contrast agent extravasation through a disrupted blood-brain barrier (BBB), and even for nonenhancing glioma with an intact BBB, due to an elevated steady-state contrast agent concentration in the vasculature after first passage. In this study a thorough investigation of the effects of two different leakage correction algorithms on rCBV estimation for enhancing and nonenhancing tumors was conducted.MethodsTwo datasets were used retrospectively in this study: 1. A publicly available TCIA dataset (49 patients with 35 enhancing and 14 nonenhancing glioma); 2. A dataset acquired clinically at Erasmus MC (EMC, Rotterdam, NL) (47 patients with 20 enhancing and 27 nonenhancing glial brain lesions). The leakage correction algorithms investigated in this study were: a unidirectional model-based algorithm with flux of contrast agent from the intra- to the extravascular extracellular space (EES); and a bidirectional model-based algorithm additionally including flow from EES to the intravascular space.ResultsIn enhancing glioma, the estimated average contrast-enhanced tumor rCBV significantly (Bonferroni corrected Wilcoxon Signed Rank Test, p < 0.05) decreased across the patients when applying unidirectional and bidirectional correction: 4.00 ± 2.11 (uncorrected), 3.19 ± 1.65 (unidirectional), and 2.91 ± 1.55 (bidirectional) in TCIA dataset and 2.51 ± 1.3 (uncorrected), 1.72 ± 0.84 (unidirectional), and 1.59 ± 0.9 (bidirectional) in EMC dataset. In nonenhancing glioma, a significant but smaller difference in observed rCBV was found after application of both correction methods used in this study: 1.42 ± 0.60 (uncorrected), 1.28 ± 0.46 (unidirectional), and 1.24 ± 0.37 (bidirectional) in TCIA dataset and 0.91 ± 0.49 (uncorrected), 0.77 ± 0.37 (unidirectional), and 0.67 ± 0.34 (bidirectional) in EMC dataset.ConclusionBoth leakage correction algorithms were found to change rCBV estimation with BBB disruption in enhancing glioma, and to a lesser degree in nonenhancing glioma. Stronger effects were found for bidirectional leakage correction than for unidirectional leakage correction.
Highlights
Dynamic susceptibility contrast (DSC)-MRI is a technique that uses rapid measurements of MRI signal change following the injection of a gadolinium-based contrast agent (GBCA) (1)
This study investigated the effect of two known leakage correction algorithms on relative cerebral blood volume (rCBV) measurements in both enhancing and nonenhancing glioma in two independent datasets
The result of this study showed that in enhancing glioma, when the blood-brain barrier (BBB) is disrupted, application of either of these two leakage correction methods decreased rCBV measurements
Summary
Dynamic susceptibility contrast (DSC)-MRI is a technique that uses rapid measurements of MRI signal change following the injection of a gadolinium-based contrast agent (GBCA) (1). Perfusion parameters derived from DSC-MRI are increasingly utilized as image-based biomarkers for management of patients with brain cancer. Of particular interest is relative cerebral blood volume (rCBV) It is the most widely used parameter derived from DSC-MRI for predicting brain tumor aggressiveness (2, 3). A particular challenge in using DSC-MRI for the determination of rCBV in brain tumors is that the presence of a leaky blood-brain barrier (BBB) may confound measurements (6). In T∗2-weighted DSC-MRI acquisition, the shortening of T∗2 results in signal loss induced by the passage of the paramagnetic contrast agent. This forms the basis of rCBV estimation. A disrupted BBB is present in enhancing glioma, defined as a glial tumor in which a signal increase is clearly seen on T1-weighted imaging after injection of a GBCA
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