Abstract
ObjectiveClinical relevance of dynamic glucose enhanced (DGE) chemical exchange saturation transfer (CEST) imaging has mostly been demonstrated at ultra-high field (UHF) due to low effect size. Results of a cohort study at clinical field strength are shown herein.Materials and methodsMotion and field inhomogeneity corrected T1ρ‐based DGE (DGE⍴) images were acquired before, during and after a d-glucose injection with 6.3 s temporal resolution to detect accumulation in the brain. Six glioma patients with clear blood–brain barrier (BBB) leakage, two glioma patients with suspected BBB leakage, and three glioma patients without BBB leakage were scanned at 3 T.ResultsIn high-grade gliomas with BBB leakage, d-glucose uptake could be detected in the gadolinium (Gd) enhancing region as well as in the tumor necrosis with a maximum increase of ∆DGE⍴ around 0.25%, whereas unaffected white matter did not show any significant DGE⍴ increase. Glioma patients without Gd enhancement showed no detectable DGE⍴ effect within the tumor.ConclusionFirst application of DGE⍴ in a patient cohort shows an association between BBB leakage and DGE signal irrespective of the tumor grade. This indicates that glucoCEST corresponds more to the disruptions of BBB with Gd uptake than to the molecular tumor profile or tumor grading.
Highlights
Chemical exchange saturation transfer (CEST) has become a promising tool, for the depiction of micro-environmental and metabolic information within the human brain by utilizing the chemical exchange between protons of protein/ metabolites and the abundant water proton pool
We examined the effects associated with blood–brain barrier breakdown and molecular tumor type and grade
No increase in DGEρ signal was seen in patients with no signs of a blood–brain barrier breakdown
Summary
Chemical exchange saturation transfer (CEST) has become a promising tool, for the depiction of micro-environmental and metabolic information within the human brain by utilizing the chemical exchange between protons of protein/ metabolites and the abundant water proton pool. After the first successful application in the animal brain tumor model [3], the method was quickly applied in humans at ultrahigh field strengths [4,5,6,7,8,9]. At ultra-high field strengths of 7 T and above the CEST effect is stronger than at 3 T [10], and the frequency separation between resonances of the exchangeable groups and the water peak is larger, leading to an improvement in signal detection. While subject motion can cause a pseudoCEST-effect [11], successful implementations of chemical exchange saturation transfer sequences at 3 T have been recently reported [12, 13]
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