Regional Cerebral Blood Volume Maps Research Articles

Fractional tumor burden maps increase the confidence of reading brain MR perfusion

Rationale and objectivesVarious methods exist to perform and post-process perfusion weighted MR imaging in the post-treatment imaging of glioma patients to differentiate tumor progression from tumor-related abnormalities. One of these post-processing methods produces ‘fractional tumor burden’ maps. This multi-reader study investigated the clinical feasibility of fractional tumor burden maps on real world data from radiological follow-up of high-grade astrocytoma patients. MethodsFive readers with background in radiology and varying levels of experience were tasked with assessing 30 astrocytoma and glioblastoma patients during one reader session. First, they were provided with a dataset of conventional MRI sequences, including perfusion MRI with regional cerebral blood volume maps. Then the dataset was expanded with a corresponding fractional tumor burden maps. Diagnostic accuracy, duration of post-processing, duration of the assessment of the fractional tumor burden maps, the diagnostic confidence reported by the readers and their diagnoses were recorded. Final diagnosis was determined by clinical and radiological follow-up and/or histopathological data used as gold standard. ResultsA mean sensitivity of 83.3 % and mean specificity of 55.1 % was obtained without the use of fractional tumor burden maps, whereas their additional of fractional tumor burden maps resulted in a mean sensitivity and specificity of 79.5 % and 54.2 %, respectively. Diagnostic accuracies with and without fractional tumor burden maps were not significantly different (Z = 0.76, p = 0.450). The median time spent post-processing was 313 s, while the median duration of the assessment of the FTB maps was 19 s. Interestingly, reader confidence increased significantly after adding the fractional tumor burden-maps to the assessment (Z = 454, p < 0.01). ConclusionsWhile the use of fractional tumor burden maps does not carry additional value in the radiological follow-up of post-operative high-grade astrocytoma and glioblastoma patients, it does give readers more confidence in their diagnosis.

BIOM-51. IDENTIFICATION OF A LOW-FLIP ANGLE BASED CBV THRESHOLD FOR FRACTIONAL TUMOR BURDEN (FTB) MAPPING IN RECURRENT GLIOBLASTOMA

Abstract INTRODUCTION Differentiation of glioblastoma recurrence from post treatment radiation effects (PTRE) would improve patient management. Dynamic susceptibility contrast (DSC) MRI can be used to generate fractional tumor burden (FTB) maps, via application of regional cerebral blood volume (RCBV) thresholds, to spatially differentiate recurrence from PTRE. FTB maps derived from a DSC-MRI protocol that includes a contrast agent preload in addition to the bolus injection and a moderate-flip angle (MFA) been histologically validated. Recently, a single-dose, low-flip angle (LFA) protocol was shown to provide RCBV measurements consistent with the MFA protocol and has been recommended as a consensus protocol. This study aims to identify the RCBV thresholds for the single-dose, LFA protocol that generates FTB maps, concordant with those obtained from the reference double-dose, MFA protocol. METHODS Two sets of DSC-MRI data were collected sequentially from 52 patients using a single-dose, low-flip angle (30o) protocol and a double-dose, moderate flip angle (60o) protocol using TR = 1.5s and TE = 30ms. Standardized RCBV maps (sRCBV) were obtained and co-registered with the post-contrast T1-weighted images using the FDA-approved clinical software, IB Neuro™ and IB Delta Suite™, respectively. The ground truth MFA-based FTB maps were computed using multiple sRCBV thresholds (1.0 and 1.75). An ROC analysis was conducted to identify the optimal, voxel-wise LFA sRCBV thresholds to produce FTB maps that best match the reference maps. RESULTS/ CONCLUSIONS The ROC analysis identified a lower LFA threshold of 1.0 to accurately distinguish PTRE from tumor recurrence and an upper threshold of 1.55 to differentiate aggressive tumor regions. The single-dose, LFA protocol eliminates variations in the contrast agent incubation time between the preload and bolus injection. This study provides motivation for the use of the single-dose LFA protocol in the management of patients with glioblastoma and is a reliable method for distinguishing tumor from PTRE.

Minute changes of cerebral parenchymal non-contrast computed tomography attenuation reflect cerebral volume alterations of blood.

Non-infarcted acute cerebral ischaemic areas appear hypo-attenuated on non-contrast narrow-window computed tomography images. We aimed to determine the mechanism underlying minute computed tomography hypo-attenuation and visualise these attenuation changes on non-contrast computed tomography images. The cerebral parenchyma was defined by pixels with attenuation of 20-50 Hounsfield units. We calculated the mean cerebral parenchymal attenuation in non-contrast computed tomography images. We analysed the correlation of complete blood counts with corresponding mean cerebral parenchymal attenuation values using linear regression analysis. Moreover, we developed an image processing method that involved pixel colorisation based on the noise-reduced attenuation value for minute cerebral parenchymal attenuation visualisation. Haemoglobin, haematocrit and red blood cell counts positively correlated with mean cerebral parenchymal attenuation values. The cerebral haematocrit is correlated with the blood haematocrit; therefore, cerebral parenchymal attenuation correlated linearly with cerebral haemoglobin concentration. Haemoglobin contents in a pixel partially determine the X-ray absorption dose and attenuation value. Pixel haemoglobin contents are determined by the cerebral volume of blood in a pixel. Image processed computed tomography images reflected cerebral volume of blood and showed the same alterations with regional cerebral blood volume maps of perfusion computed tomography. Cerebral parenchymal attenuation correlated with cerebral haemoglobin concentration and cerebral volume of blood. Infarcted cerebral parenchyma shows about 5 Hounsfield units gray matter attenuation decrease. Attenuation decrease by less than 5 Hounsfield units means decreased cerebral volume of blood, indicating a reversible functional change. One cannot recognise minute hypo-attenuation (<5 Hounsfield units) in routine computed tomography images. However, it can be visualised through an image processing method on non-contrast computed tomography images. It may detect pre-infarction cerebral volume of blood and regional cerebral blood volume alterations.

P.1.e.008 High -resolution regional cerebral blood volume mapping by using pharmacological high-field magnetic resonance imaging

P.1.e.008 High -resolution regional cerebral blood volume mapping by using pharmacological high-field magnetic resonance imaging

Discrimination of an infected brain tumor from a cerebral abscess by combined MR perfusion and diffusion imaging

The aim of this study was to investigate the signal characteristics of the abscess wall and tumor wall on diffusion-weighted and perfusion-weighted images and thus to evaluate the feasibility of using combined MR diffusion and perfusion imaging to differentiate pyogenic cerebral abscess from infected brain tumor. The tumor wall of various types of cystic or necrotic brain tumor was significantly hyperintense relative to that of cerebral abscess wall on both diffusion-weighted images and regional cerebral blood volume maps. Sixteen patients who had cerebral masses with large cystic or necrotic cavities were imaged to generate diffusion-weighted images and regional cerebral blood volume maps using single-shot echoplanar imaging (EPI) pulse sequences. Apart from qualitative analysis, apparent diffusion coefficients (ADC) as well as regional cerebral blood volume (rCBV) ratios were calculated from the abscess wall and peripheral tumor wall and comparison was made by using Student's t-test. The tumor wall of various types of cystic or necrotic brain tumor had significantly lower ADCs relative to those of the abscess wall ( P<0.005) and thus appeared relatively hyperintense on diffusion-weighted images. The mean rCBV ratio relative to normal white matter (2.90±0.62) of the peripheral tumor wall of various types of cystic or necrotic brain tumor were significantly larger than the mean rCBV ratio (0.45±0.11) of the pyogenic cerebral abscess wall ( P<0.001) by Student's t-test. It is concluded that the combined MR diffusion and perfusion imaging might be capable of differentiating an infected brain tumor from a pyogenic cerebral abscess.

Regional Cerebral Blood Volume Mapping after Ischemic Lesions

The possible persistence of a microvascular deficit at long time intervals after cerebral ischemia induction is not well established. In rats, we have generated in vivo maps of the regional cerebral blood volume (rCBV) at different time intervals after middle cerebral artery occlusion (MCAo) with the aim to evaluate the persistence of a rCBV deficit in the damaged area or in the surrounding regions. The rats were examined by magnetic resonance imaging (MRI) at different time intervals, starting from the first day until three months after ischemia and postmortem histological and ultrastructural correlation was obtained. All MRI experiments were carried out using an imager-spectrometer equipped with a 4.7 Tesla magnet. To produce the susceptibility-weighted rCBV images, a suspension of superparamagnetic iron oxide nanoparticles (AMI-25) was injected to the rat. In a control group (nonoperated or sham-operated rats), a symmetrical distribution of rCBV values was found between the two hemispheres (differences between left and right cortex below 8%). In the rats with MCAo an evident vascular asymmetry was found 24 h after ischemia (differences between left and right ranging from 22 and 77%) and reduced rCBV values were evident in the ischemic areas. In a time range following the 15th day most of the rats showed a complete recovery of the lesion while only four animals still had a small residual lesion, as probed by T2-weighted (T2W) images. In three of these four cases, the reduction of rCBV in the ipsilateral cortex with respect to the contralateral was greater than 20%. Correlation was found (Y > 0.8) between late rCBV measurement and the initial volume of the lesion (hyperintense region in T2W images). The postmortem measurements correlate much better with the rCBV data than with the T2W ones. In conclusion, the present work demonstrates that cortical lesions may result in a deficit of rCBV for long periods and that a mismatch between T2w and rCBV data can be present during the repair process.

An efficient and robust PC program to calculate MR based regional cerebral blood volume maps

In addition to morphological and anatomical information, functional information is increasingly used in clinical routine to assess pathological alterations of the brain. In addition to nuclear-medical methods there is a growing interest in using magnetic resonance imaging (MRI) to investigate tissue perfusion of the brain. The method employed is based on the indicator-dilution method after bolus injection of a contrast agent. In this paper we present the implementation of an efficient algorithm to calculate quantitatively the regional cerebral blood volume (rCBV). Computation requires about 1 min on a Macintosh Quadra 660AV. The results are represented as parameter images that allow global overall visual inspection as well as quantitative local evaluation by means of user-defined regions of interest.

Regional cerebral blood volume of intracranial tumors determined by MRI

The aim of this study was to characterize intracranial tumors based on MR measurements of regional cerebral blood volume. In 8 patients without intracranial pathology and 42 patients with intracranial tumors a T2*-weighted image series was acquired during bolus injection of gadolinium-DTPA, and regional cerebral blood volume maps were calculated. The regional cerebral blood volume index (rCBVi) of vital tumor was expressed in percent of the value measured in contralateral gray matter. In extra-axial tumors (meningiomas) rCBVi was higher (124 ± 110%), and in low-grade intra axial tumors rCBVi was lower (79 ± 65%), than in contralateral cortex. In malignant intra-axial tumors the distribution of rCBV was heterogenous: high in vital tumor (glioblastomas: rCBVi = 165 ± 85%; metastases: rCBVi = 106 ± 79%), but low in necrosis (rCBVi = 33% of contralateral white matter) and edema (rCBVi = 53% of contralateral white matter). rCBVi was highest in arteriovenous malformations (1053 ± 584% of contralateral gray matter). We conclude that the regional cerebral blood volume distribution is useful to characterize intracranial tumors, although the large biological variability of individual tumor entities indicates limitations.

20 Use of the functional imaging modalities, f MRI r CBV and PET FDG, alters radiation therapy 3-D treatment planning in patients with malignant gliomas

Malignant gliomas present one of the most difficult challenges to definitive radiation therapy, not only with respect to local control, but also with respect to clinical functional status. While tumor target volume definitions for malignant gliomas are often based on CT and conventional MRI, the functional imaging modalities, echo planar rCBV (regional cerebral blood volume mapping) and 18F-fluorodeoxyglucose PET, are more sensitive modalities for the detection of neovascularization, perhaps one of the earliest signs of glial tumor initiation and progression. In order to address the clinical utility of functional imaging in radiation therapy 3-D treatment planning, we compared tumor target volume definitions and overall dosimetry in patients either undergoing co-registration of conventional Gadolinium-enhanced MRI, or co-registration of functional imaging modalities, prior to radiation therapy 3-D treatment planning.