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Comparison of Dynamic Susceptibility-weighted Contrast-enhanced MR Methods: Recommendations for Measuring Relative Cerebral Blood Volume in Brain Tumors¹

¹ From the Department of Biophysics (E.S.P., K.M.S.) and Radiology (K.M.S.), Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI 53226. Received September 20, 2007; revision requested December 21; revision received April 9, 2008; accepted April 21; final version accepted June 9. Supported by National Institutes of Health/National Cancer Institute grant RO1 CA082500 and National Institutes of Health grant M01-RR00058. Address correspondence to K.M.S. (e-mail: kathleen{at}mcw.edu).

Purpose: To investigate whether estimates of relative cerebral blood volume (rCBV) in brain tumors, obtained by using dynamic susceptibility-weighted contrast material–enhanced magnetic resonance (MR) imaging vary with choice of data acquisition and postprocessing methods.

Materials and Methods: Four acquisition methods were used to collect data in 22 high-grade glioma patients, with informed written consent under HIPAA-compliant guidelines approved by the institutional review board. During bolus administration of a standard single dose of gadolinium-based contrast agent (0.1 mmol per kilogram of body weight), one of three acquisition methods was used: gradient-echo (GRE) echo-planar imaging (echo time [TE], 30 msec; flip angle, 90°; n = 10), small-flip-angle GRE echo-planar imaging (TE, 54 msec; flip angle, 35°; n = 7), or dual-echo GRE spiral-out imaging (TE, 3.3 and 30 msec; flip angle, 72°; n = 5). Next, GRE echo-planar imaging (TE, 30 msec; flip angle, 90°; n = 22) was used to collect data during administration of a second dose of contrast agent (0.2 mmol/kg). Subsequently, six methods of analysis were used to calculate rCBV. Mean rCBV values from whole tumor, tumor hot spots, and contralateral brain were normalized to mean rCBV in normal-appearing white matter.

Results: Friedman two-way analysis of variance and Kruskal-Wallis one-way analysis of variance results indicated that qualitative rCBV values were dependent on acquisition and postprocessing methods for both tumor and contralateral brain. By using the nonparametric Mann-Whitney test, a consistently positive (greater than zero) tumor–contralateral brain rCBV ratio resulted when either the preload-postprocessing correction approach or dual-echo acquisition approach (P < .008 for both methods) was used.

Conclusion: The dependence of tumor rCBV on the choice of acquisition and postprocessing methods is caused by their varying sensitivities to T1 and T2 and/or T2* leakage effects. The preload-correction approach and dual-echo acquisition approach are the most robust choices for the evaluation of brain tumors when the possibility of contrast agent extravasation exists.

Supplemental material: http://radiology.rsnajnls.org/cgi/content/full/2492071659/DC1
http://radiology.rsnajnls.org/cgi/content/full/2492071659/DC2
http://radiology.rsnajnls.org/cgi/content/full/2492071659/DC3

© RSNA, 2008

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