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Diffusion-weighted and Perfusion MR Imaging for Brain Tumor Characterization and Assessment of Treatment Response¹

¹ From the Department of Radiology, Box 3808, Duke University Medical Center, Durham, NC 27710. Received December 1, 2004; revision requested January 25, 2005; revision received March 15; accepted April 8; final version accepted April 18; final review by J.M.P. January 2, 2006. Address correspondence to J.M.P.

View larger version (151K): [in a new window]   Figure 1a: Conventional MR images and rCBV map in 37-year-old man with biopsy-proved World Health Organization grade III astrocytoma. (a) Transverse contrast-enhanced T1-weighted image shows inhomogeneous mass in right frontal lobe. Anterior portion of the mass (arrowhead) shows contrast enhancement; posterior half of the mass does not. (b) Baseline transverse echo-planar T2*-weighted image from DSC sequence (precontrast) shows homogeneous hyperintense signal throughout the mass. (c) rCBV map shows that anterior portion of the mass (corresponding to contrast-enhanced portion in a) has high rCBV (red and yellow), and posterior portion has low rCBV (blue).

View larger version (90K): [in a new window]   Figure 1b: Conventional MR images and rCBV map in 37-year-old man with biopsy-proved World Health Organization grade III astrocytoma. (a) Transverse contrast-enhanced T1-weighted image shows inhomogeneous mass in right frontal lobe. Anterior portion of the mass (arrowhead) shows contrast enhancement; posterior half of the mass does not. (b) Baseline transverse echo-planar T2*-weighted image from DSC sequence (precontrast) shows homogeneous hyperintense signal throughout the mass. (c) rCBV map shows that anterior portion of the mass (corresponding to contrast-enhanced portion in a) has high rCBV (red and yellow), and posterior portion has low rCBV (blue).

View larger version (133K): [in a new window]   Figure 1c: Conventional MR images and rCBV map in 37-year-old man with biopsy-proved World Health Organization grade III astrocytoma. (a) Transverse contrast-enhanced T1-weighted image shows inhomogeneous mass in right frontal lobe. Anterior portion of the mass (arrowhead) shows contrast enhancement; posterior half of the mass does not. (b) Baseline transverse echo-planar T2*-weighted image from DSC sequence (precontrast) shows homogeneous hyperintense signal throughout the mass. (c) rCBV map shows that anterior portion of the mass (corresponding to contrast-enhanced portion in a) has high rCBV (red and yellow), and posterior portion has low rCBV (blue).

View larger version (158K): [in a new window]   Figure 2a: Dynamic contrast-enhanced T1-weighted MR to assess permeability in a patient with high-grade glioma who has residual contrast enhancement after previous resection. Three-dimensional spoiled-gradient-echo sequence was performed every 6.45 seconds for 58 seconds after intravenous infusion of 0.1 mmol/kg gadopentetate dimeglumine. Five unenhanced images were first obtained at five different flip angles to derive T1 values of tissue needed for permeability analysis. (a) Transverse anatomic image of surgical site shows large enhancing region around surgical cavity. (b) Quantitative volume transfer constant (Ktrans) map between blood plasma and EES obtained at same location as in a shows marked increase in Ktrans (arrow) surrounding much of the surgical site. (c) Quantitative map of fractional plasma volume (vp) map obtained at same location as in a shows elevated vp (arrow) in only a small portion of the enhancing region (b and c generated with TOPPCAT; www.radweb.duke.edu/dbplab).

View larger version (142K): [in a new window]   Figure 2b: Dynamic contrast-enhanced T1-weighted MR to assess permeability in a patient with high-grade glioma who has residual contrast enhancement after previous resection. Three-dimensional spoiled-gradient-echo sequence was performed every 6.45 seconds for 58 seconds after intravenous infusion of 0.1 mmol/kg gadopentetate dimeglumine. Five unenhanced images were first obtained at five different flip angles to derive T1 values of tissue needed for permeability analysis. (a) Transverse anatomic image of surgical site shows large enhancing region around surgical cavity. (b) Quantitative volume transfer constant (Ktrans) map between blood plasma and EES obtained at same location as in a shows marked increase in Ktrans (arrow) surrounding much of the surgical site. (c) Quantitative map of fractional plasma volume (vp) map obtained at same location as in a shows elevated vp (arrow) in only a small portion of the enhancing region (b and c generated with TOPPCAT; www.radweb.duke.edu/dbplab).

View larger version (146K): [in a new window]   Figure 2c: Dynamic contrast-enhanced T1-weighted MR to assess permeability in a patient with high-grade glioma who has residual contrast enhancement after previous resection. Three-dimensional spoiled-gradient-echo sequence was performed every 6.45 seconds for 58 seconds after intravenous infusion of 0.1 mmol/kg gadopentetate dimeglumine. Five unenhanced images were first obtained at five different flip angles to derive T1 values of tissue needed for permeability analysis. (a) Transverse anatomic image of surgical site shows large enhancing region around surgical cavity. (b) Quantitative volume transfer constant (Ktrans) map between blood plasma and EES obtained at same location as in a shows marked increase in Ktrans (arrow) surrounding much of the surgical site. (c) Quantitative map of fractional plasma volume (vp) map obtained at same location as in a shows elevated vp (arrow) in only a small portion of the enhancing region (b and c generated with TOPPCAT; www.radweb.duke.edu/dbplab).

View larger version (135K): [in a new window]   Figure 3a: Measurement of fractional anisotropy values in various tumor and peritumoral regions in 56-year-old woman with biopsy-proved World Health Organization grade IV glioblastoma multiforme. Normalized fractional anisotropy values in solid enhancing tumor are similar to those in adjacent unenhancing regions (which may represent vasogenic edema or unenhancing tumor). (a) Transverse contrast-enhanced T1-weighted image shows enhancing mass in left parietal lobe. Regions of interest (ROIs) have been placed in solid portion of tumor (1), hypointense region (vasogenic edema or unenhancing tumor) adjacent to tumor (3), normal-appearing WM adjacent to region of hypointense signal near tumor (5), and in corresponding contralateral WM areas (2, 4, 6). (b) Transverse echo-planarMR image from diffusion-tensor sequence before application of diffusion gradients (b = 0 sec/mm2) on which ROIs from a have been superimposed confirms that ROI 1 is located in region of hyperintense signal related to enhancing tumor, 3 is in area of peritumoral edema or unenhancing infiltrating tumor, and 5 is in region of normal signal intensity. (c) Color-coded fractional anisotropy map (yellow and red = high anisotropy, blue = low) shows anisotropy values in enhancing tumor that are 42% of those in corresponding contralateral regions.

View larger version (134K): [in a new window]   Figure 3b: Measurement of fractional anisotropy values in various tumor and peritumoral regions in 56-year-old woman with biopsy-proved World Health Organization grade IV glioblastoma multiforme. Normalized fractional anisotropy values in solid enhancing tumor are similar to those in adjacent unenhancing regions (which may represent vasogenic edema or unenhancing tumor). (a) Transverse contrast-enhanced T1-weighted image shows enhancing mass in left parietal lobe. Regions of interest (ROIs) have been placed in solid portion of tumor (1), hypointense region (vasogenic edema or unenhancing tumor) adjacent to tumor (3), normal-appearing WM adjacent to region of hypointense signal near tumor (5), and in corresponding contralateral WM areas (2, 4, 6). (b) Transverse echo-planarMR image from diffusion-tensor sequence before application of diffusion gradients (b = 0 sec/mm2) on which ROIs from a have been superimposed confirms that ROI 1 is located in region of hyperintense signal related to enhancing tumor, 3 is in area of peritumoral edema or unenhancing infiltrating tumor, and 5 is in region of normal signal intensity. (c) Color-coded fractional anisotropy map (yellow and red = high anisotropy, blue = low) shows anisotropy values in enhancing tumor that are 42% of those in corresponding contralateral regions.

View larger version (131K): [in a new window]   Figure 3c: Measurement of fractional anisotropy values in various tumor and peritumoral regions in 56-year-old woman with biopsy-proved World Health Organization grade IV glioblastoma multiforme. Normalized fractional anisotropy values in solid enhancing tumor are similar to those in adjacent unenhancing regions (which may represent vasogenic edema or unenhancing tumor). (a) Transverse contrast-enhanced T1-weighted image shows enhancing mass in left parietal lobe. Regions of interest (ROIs) have been placed in solid portion of tumor (1), hypointense region (vasogenic edema or unenhancing tumor) adjacent to tumor (3), normal-appearing WM adjacent to region of hypointense signal near tumor (5), and in corresponding contralateral WM areas (2, 4, 6). (b) Transverse echo-planarMR image from diffusion-tensor sequence before application of diffusion gradients (b = 0 sec/mm2) on which ROIs from a have been superimposed confirms that ROI 1 is located in region of hyperintense signal related to enhancing tumor, 3 is in area of peritumoral edema or unenhancing infiltrating tumor, and 5 is in region of normal signal intensity. (c) Color-coded fractional anisotropy map (yellow and red = high anisotropy, blue = low) shows anisotropy values in enhancing tumor that are 42% of those in corresponding contralateral regions.

View larger version (158K): [in a new window]   Figure 4a: High mean ADC in 70-year-old man with partially resected glioblastoma multiforme. (a) Transverse contrast-enhanced T1-weighted MR image shows rim-enhancing mass in left temporal lobe. (b) Transverse T2-weighted MR image shows hyperintense resection cavity in central portion of mass, which is surrounded by hyperintense abnormality consistent with vasogenic edema or unenhancing tumor. Regions of interest in solid portion of mass (1) and contralateral normal white matter (2) indicate sites of ADC measurement for (c) transverse ADC map, which shows ADC in tumor is 183% of that in normal brain, corresponding to low cell density and nuclear-to-cytoplasmic ratio and abundant extracellular matrix seen at histologic analysis. (Reprinted, with permission, from reference 79.)

View larger version (151K): [in a new window]   Figure 4b: High mean ADC in 70-year-old man with partially resected glioblastoma multiforme. (a) Transverse contrast-enhanced T1-weighted MR image shows rim-enhancing mass in left temporal lobe. (b) Transverse T2-weighted MR image shows hyperintense resection cavity in central portion of mass, which is surrounded by hyperintense abnormality consistent with vasogenic edema or unenhancing tumor. Regions of interest in solid portion of mass (1) and contralateral normal white matter (2) indicate sites of ADC measurement for (c) transverse ADC map, which shows ADC in tumor is 183% of that in normal brain, corresponding to low cell density and nuclear-to-cytoplasmic ratio and abundant extracellular matrix seen at histologic analysis. (Reprinted, with permission, from reference 79.)

View larger version (91K): [in a new window]   Figure 4c: High mean ADC in 70-year-old man with partially resected glioblastoma multiforme. (a) Transverse contrast-enhanced T1-weighted MR image shows rim-enhancing mass in left temporal lobe. (b) Transverse T2-weighted MR image shows hyperintense resection cavity in central portion of mass, which is surrounded by hyperintense abnormality consistent with vasogenic edema or unenhancing tumor. Regions of interest in solid portion of mass (1) and contralateral normal white matter (2) indicate sites of ADC measurement for (c) transverse ADC map, which shows ADC in tumor is 183% of that in normal brain, corresponding to low cell density and nuclear-to-cytoplasmic ratio and abundant extracellular matrix seen at histologic analysis. (Reprinted, with permission, from reference 79.)

View larger version (113K): [in a new window]   Figure 5a: Low mean ADC representing metastasis from primary lesion outside the central nervous system in a 62-year-old man with large B-cell lymphoma. (a) Transverse contrast-enhanced T1-weighted MR image shows large right frontal lobe enhancing lesion with mass effect. (b) Transverse T2-weighted MR image shows signal intensity of central portion of mass is only slightly higher than that of gray matter, suggesting high cell density. Signal intensity is lower than that shown for glioblastoma in Figure 4. (c) Transverse ADC map shows mass has lower signal intensity than normal tissue. Mean ADC in the mass region of interest (1) was 65% of that of normal tissue, much lower than that for patient in Figure 4.

View larger version (122K): [in a new window]   Figure 5b: Low mean ADC representing metastasis from primary lesion outside the central nervous system in a 62-year-old man with large B-cell lymphoma. (a) Transverse contrast-enhanced T1-weighted MR image shows large right frontal lobe enhancing lesion with mass effect. (b) Transverse T2-weighted MR image shows signal intensity of central portion of mass is only slightly higher than that of gray matter, suggesting high cell density. Signal intensity is lower than that shown for glioblastoma in Figure 4. (c) Transverse ADC map shows mass has lower signal intensity than normal tissue. Mean ADC in the mass region of interest (1) was 65% of that of normal tissue, much lower than that for patient in Figure 4.

View larger version (85K): [in a new window]   Figure 5c: Low mean ADC representing metastasis from primary lesion outside the central nervous system in a 62-year-old man with large B-cell lymphoma. (a) Transverse contrast-enhanced T1-weighted MR image shows large right frontal lobe enhancing lesion with mass effect. (b) Transverse T2-weighted MR image shows signal intensity of central portion of mass is only slightly higher than that of gray matter, suggesting high cell density. Signal intensity is lower than that shown for glioblastoma in Figure 4. (c) Transverse ADC map shows mass has lower signal intensity than normal tissue. Mean ADC in the mass region of interest (1) was 65% of that of normal tissue, much lower than that for patient in Figure 4.

View larger version (129K): [in a new window]   Figure 6a: Use of rCBV map to determine optimal biopsy site in a 44-year-old woman with seizures who was suspected of having a brain tumor. Subsequent biopsy showed World Health Organization grade III astrocytoma. (a) Transverse T2-weighted MR image shows hyperintense region (arrow) in left frontal lobe. (b) Transverse contrast-enhanced T1-weighted MR image shows no areas of abnormal contrast enhancement, making determination of region of optimal biopsy site difficult. (c) rCBV map obtained with DSC technique (red and yellow = high rCBV, green and blue = low rCBV). A high rCBV area (arrow) corresponds to region of hyperintense abnormality in a. At biopsy, this region was shown to represent high-grade glioma. (Reprinted, with permission, from reference 30.)

View larger version (111K): [in a new window]   Figure 6b: Use of rCBV map to determine optimal biopsy site in a 44-year-old woman with seizures who was suspected of having a brain tumor. Subsequent biopsy showed World Health Organization grade III astrocytoma. (a) Transverse T2-weighted MR image shows hyperintense region (arrow) in left frontal lobe. (b) Transverse contrast-enhanced T1-weighted MR image shows no areas of abnormal contrast enhancement, making determination of region of optimal biopsy site difficult. (c) rCBV map obtained with DSC technique (red and yellow = high rCBV, green and blue = low rCBV). A high rCBV area (arrow) corresponds to region of hyperintense abnormality in a. At biopsy, this region was shown to represent high-grade glioma. (Reprinted, with permission, from reference 30.)

View larger version (124K): [in a new window]   Figure 6c: Use of rCBV map to determine optimal biopsy site in a 44-year-old woman with seizures who was suspected of having a brain tumor. Subsequent biopsy showed World Health Organization grade III astrocytoma. (a) Transverse T2-weighted MR image shows hyperintense region (arrow) in left frontal lobe. (b) Transverse contrast-enhanced T1-weighted MR image shows no areas of abnormal contrast enhancement, making determination of region of optimal biopsy site difficult. (c) rCBV map obtained with DSC technique (red and yellow = high rCBV, green and blue = low rCBV). A high rCBV area (arrow) corresponds to region of hyperintense abnormality in a. At biopsy, this region was shown to represent high-grade glioma. (Reprinted, with permission, from reference 30.)

View larger version (122K): [in a new window]   Figure 7a: Correspondence between increased ADC (increase > 55 x 10–5 mm2/sec) in pineal-region germ cell tumor and decreased tumor size after treatment. (a, c, e) Transverse T2-weighted MR images show color-coded regional spatial distribution of ADC changes on single sections, while (b, d, f) corresponding scatterplots (x-axis = ADC, y-axis = number of pixels) show ADC changes for three-dimensional tumor volume at (a, b) 1, (c, d) 3, and (e, f) 6 weeks after start of therapy. Increased ADC is shown as red pixels (on MR images) or points (on scatterplots); decreased ADC, as blue pixels or points; and unchanged ADC, as green pixels or points. At 1 week (a, b), 15% of pixels had ADC higher than baseline; at 3 weeks (c, d), 54% had ADC higher than baseline; and at 6 weeks (e, f), 63% had ADC higher than baseline. (Images courtesy of Brian Ross, PhD, University of Michigan, Ann Arbor.)

View larger version (33K): [in a new window]   Figure 7b: Correspondence between increased ADC (increase > 55 x 10–5 mm2/sec) in pineal-region germ cell tumor and decreased tumor size after treatment. (a, c, e) Transverse T2-weighted MR images show color-coded regional spatial distribution of ADC changes on single sections, while (b, d, f) corresponding scatterplots (x-axis = ADC, y-axis = number of pixels) show ADC changes for three-dimensional tumor volume at (a, b) 1, (c, d) 3, and (e, f) 6 weeks after start of therapy. Increased ADC is shown as red pixels (on MR images) or points (on scatterplots); decreased ADC, as blue pixels or points; and unchanged ADC, as green pixels or points. At 1 week (a, b), 15% of pixels had ADC higher than baseline; at 3 weeks (c, d), 54% had ADC higher than baseline; and at 6 weeks (e, f), 63% had ADC higher than baseline. (Images courtesy of Brian Ross, PhD, University of Michigan, Ann Arbor.)

View larger version (111K): [in a new window]   Figure 7c: Correspondence between increased ADC (increase > 55 x 10–5 mm2/sec) in pineal-region germ cell tumor and decreased tumor size after treatment. (a, c, e) Transverse T2-weighted MR images show color-coded regional spatial distribution of ADC changes on single sections, while (b, d, f) corresponding scatterplots (x-axis = ADC, y-axis = number of pixels) show ADC changes for three-dimensional tumor volume at (a, b) 1, (c, d) 3, and (e, f) 6 weeks after start of therapy. Increased ADC is shown as red pixels (on MR images) or points (on scatterplots); decreased ADC, as blue pixels or points; and unchanged ADC, as green pixels or points. At 1 week (a, b), 15% of pixels had ADC higher than baseline; at 3 weeks (c, d), 54% had ADC higher than baseline; and at 6 weeks (e, f), 63% had ADC higher than baseline. (Images courtesy of Brian Ross, PhD, University of Michigan, Ann Arbor.)

View larger version (30K): [in a new window]   Figure 7d: Correspondence between increased ADC (increase > 55 x 10–5 mm2/sec) in pineal-region germ cell tumor and decreased tumor size after treatment. (a, c, e) Transverse T2-weighted MR images show color-coded regional spatial distribution of ADC changes on single sections, while (b, d, f) corresponding scatterplots (x-axis = ADC, y-axis = number of pixels) show ADC changes for three-dimensional tumor volume at (a, b) 1, (c, d) 3, and (e, f) 6 weeks after start of therapy. Increased ADC is shown as red pixels (on MR images) or points (on scatterplots); decreased ADC, as blue pixels or points; and unchanged ADC, as green pixels or points. At 1 week (a, b), 15% of pixels had ADC higher than baseline; at 3 weeks (c, d), 54% had ADC higher than baseline; and at 6 weeks (e, f), 63% had ADC higher than baseline. (Images courtesy of Brian Ross, PhD, University of Michigan, Ann Arbor.)

View larger version (121K): [in a new window]   Figure 7e: Correspondence between increased ADC (increase > 55 x 10–5 mm2/sec) in pineal-region germ cell tumor and decreased tumor size after treatment. (a, c, e) Transverse T2-weighted MR images show color-coded regional spatial distribution of ADC changes on single sections, while (b, d, f) corresponding scatterplots (x-axis = ADC, y-axis = number of pixels) show ADC changes for three-dimensional tumor volume at (a, b) 1, (c, d) 3, and (e, f) 6 weeks after start of therapy. Increased ADC is shown as red pixels (on MR images) or points (on scatterplots); decreased ADC, as blue pixels or points; and unchanged ADC, as green pixels or points. At 1 week (a, b), 15% of pixels had ADC higher than baseline; at 3 weeks (c, d), 54% had ADC higher than baseline; and at 6 weeks (e, f), 63% had ADC higher than baseline. (Images courtesy of Brian Ross, PhD, University of Michigan, Ann Arbor.)

View larger version (36K): [in a new window]   Figure 7f: Correspondence between increased ADC (increase > 55 x 10–5 mm2/sec) in pineal-region germ cell tumor and decreased tumor size after treatment. (a, c, e) Transverse T2-weighted MR images show color-coded regional spatial distribution of ADC changes on single sections, while (b, d, f) corresponding scatterplots (x-axis = ADC, y-axis = number of pixels) show ADC changes for three-dimensional tumor volume at (a, b) 1, (c, d) 3, and (e, f) 6 weeks after start of therapy. Increased ADC is shown as red pixels (on MR images) or points (on scatterplots); decreased ADC, as blue pixels or points; and unchanged ADC, as green pixels or points. At 1 week (a, b), 15% of pixels had ADC higher than baseline; at 3 weeks (c, d), 54% had ADC higher than baseline; and at 6 weeks (e, f), 63% had ADC higher than baseline. (Images courtesy of Brian Ross, PhD, University of Michigan, Ann Arbor.)