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Evaluation of dynamic contrast-enhanced T1-weighted perfusion MRI in the differentiation of tumor recurrence from radiation necrosis

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Abstract

Introduction

To investigate if perfusion measured with dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) can be used to differentiate radiation necrosis from tumor recurrence in patients with high-grade glioma.

Methods

The study was approved by the institutional review board and informed consent was obtained from all subjects. 19 patients were recruited following surgery and radiation therapy for glioma. Patients had contrast enhancing lesions, which during the standard MRI examination could not be exclusively determined as recurrence or radiation necrosis. DCE-MRI was used to measure cerebral blood volume (CBV), blood–brain barrier (BBB) permeability and cerebral blood flow (CBF). Subjects also underwent FDG-PET and lesions were classified as either metabolically active or inactive. Follow-up clinical MRI and lesion histology in case of additional tissue resection was used to determine whether lesions were regressing or progressing.

Results

Fourteen enhancing lesions could be classified as progressing (11) or regressing (three). An empirical threshold of 2.0 ml/100 g for CBV allowed detection of regressing lesions with a sensitivity of 100 % and specificity of 100 %. FDG-PET and DCE-MRI agreed in classification of tumor status in 13 out of the 16 cases where an FDG-PET classification was obtained. In two of the remaining three patients, MRI follow-up and histology was available and both indicated that the DCE-MRI answer was correct.

Conclusion

CBV measurements using DCE-MRI may predict the status of contrast enhancing lesions and give results very similar to FDG-PET with regards to differentiation between tumor recurrence and radiation necrosis.

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Abbreviations

AIF:

Arterial input function

BBB:

Blood–brain barrier

CBF:

Cerebral blood flow

CBV:

Cerebral blood volume

DCE-MRI:

Dynamic contrast enhanced magnetic resonance imaging

DSC-MRI:

Dynamic susceptibility contrast magnetic resonance imaging

FDG-PET:

18F-fluorodeoxyglucose positron emission tomography

ICA:

Internal carotid artery

K trans :

Transfer constant

rCBV:

Relative CBV

ROI:

Region of interest

SD:

Standard deviation

TE:

Echo time

WM:

White matter

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Conflict of interest

We declare that we have no conflict of interest.

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Authors and Affiliations

  1. Department of Radiology, Glostrup University Hospital, 57 Nordre Ringvej, 2600, Glostrup, Denmark

    Vibeke A. Larsen & Adam E. Hansen

  2. Functional Imaging Unit, Glostrup University Hospital, 57 Nordre Ringvej, 2600, Glostrup, Denmark

    Helle J. Simonsen, Henrik B. W. Larsson & Adam E. Hansen

  3. Department of Clinical Physiology, Glostrup University Hospital, 57 Nordre Ringvej, 2600, Glostrup, Denmark

    Helle J. Simonsen & Henrik B. W. Larsson

  4. Department of Clinical Physiology, Nuclear Medicine & PET, section 3982, Rigshospitalet, 9 Blegdamsvej, 2100, Copenhagen Ø, Denmark

    Ian Law

  5. Department of Radiology, Glostrup University Hospital, Section 3023, Rigshospitalet, 9 Blegdamsvej, 2100, Copenhagen Ø, Denmark

    Vibeke A. Larsen

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  1. Vibeke A. Larsen
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Correspondence to Vibeke A. Larsen.

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Larsen, V.A., Simonsen, H.J., Law, I. et al. Evaluation of dynamic contrast-enhanced T1-weighted perfusion MRI in the differentiation of tumor recurrence from radiation necrosis. Neuroradiology 55, 361–369 (2013). https://doi.org/10.1007/s00234-012-1127-4

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  • DOI: https://doi.org/10.1007/s00234-012-1127-4

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