Abstract
ObjectivesTo investigate the value of contrast-enhanced (CE) turbo spin echo black blood (BB) sequences for imaging of therapy-naive high-grade gliomas (HGGs).MethodsConsecutive patients with histopathologically confirmed World Health Organization (WHO) grade III or IV gliomas and no oncological treatment prior to index imaging (March 2019 to January 2020) were retrospectively included. Magnetic resonance imaging (MRI) at 3 Tesla comprised CE BB and CE turbo field echo (TFE) sequences. The lack/presence of tumor-related contrast enhancement and satellite lesions were evaluated by two readers. Sharper delineation of tumor boundaries (1, bad; 2, intermediate; 3, good delineation) and vaster expansion of HGGs into the adjacent brain parenchyma on CE BB imaging were the endpoints. Furthermore, contrast-to-noise ratios (CNRs) were calculated and compared between sequences.ResultsFifty-four patients were included (mean age: 61.2 ± 15.9 years, 64% male). The vast majority of HGGs (51/54) showed contrast enhancement in both sequences, while two HGGs as well as one of six detected satellite lesions were depicted in CE BB imaging only. Tumor boundaries were significantly sharper (R1: 2.43 ± 0.71 vs. 2.73 ± 0.62, p < 0.001; R2: 2.44 ± 0.74 vs. 2.77 ± 0.60, p = 0.001), while the spread of HGGs into the adjacent parenchyma was larger when considering CE BB sequences according to both readers (larger spread in CE BB sequences: R1: 23 patients; R2: 20 patients). The CNR for CE BB sequences significantly exceeded that of CE TFE sequences (43.4 ± 27.1 vs. 32.5 ± 25.0, p = 0.0028).ConclusionsOur findings suggest that BB imaging may considerably improve delineation of therapy-naive HGGs when compared with established TFE imaging. Thus, CE BB sequences might supplement MRI protocols for brain tumors.Key Points• This study investigated contrast-enhanced (CE) T1-weighted black blood (BB) sequences for improved MRI in patients with therapy-naive high-grade gliomas (HGGs).• Compared with conventionally used turbo field echo (TFE) sequences, CE BB sequences depicted tumor boundaries and spread of HGGs into adjacent parenchyma considerably better, which also showed higher CNRs.• Two enhancing tumor masses and one satellite lesion were exclusively identified in CE BB sequences, but remained undetected in conventionally used CE TFE sequences.
Highlights
Over 300,000 patients are affected by malignant primary brain tumors each year [1, 2]
Histopathology reports of the surgical probes revealed glioma grade IV in 44 patients and glioma grade III in 10 patients according to the grading of the World Health Organization (WHO)
In an effort to improve neuro-oncological imaging, we evaluated whether the previously reported increased sensitivity of CE black blood (BB) compared with that of conventional CE T1-weighted sequences in depicting metastatic brain lesions could be replicated for therapy-naive high-grade gliomas (HGGs)
Summary
Over 300,000 patients are affected by malignant primary brain tumors each year [1, 2]. While therapy relies on factors such as tumor grade and functional eloquence of the affected brain region, the most commonly used scheme for treatment of HGGs includes debulking surgery and extended focal irradiation, as well as adjuvant chemotherapy [5,6,7,8]. This aggressive regime is routinely used in the clinical setting, prognosis of affected patients has remained largely stagnant for the last decades. In spite of the overall poor prognosis, factors that impair (i.e., higher grade of the tumor) or favor outcomes (i.e., complete surgical resection) have been identified and are of considerable clinical relevance [8,9,10,11]
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