ASFNR Recommendations for Clinical Performance of MR Dynamic Susceptibility Contrast Perfusion Imaging of the Brain

Abstract

SUMMARY MR perfusion imaging is becoming an increasingly common means of evaluating a variety of cerebral pathologies, including tumors and ischemia. In particular, there has been great interest in the use of MR perfusion imaging for both assessing brain tumor grade and for monitoring for tumor recurrence in previously treated patients. Of the various techniques devised for evaluating cerebral perfusion imaging, the dynamic susceptibility contrast method has been employed most widely among clinical MR imaging practitioners. However, when implementing DSC MR perfusion imaging in a contemporary radiology practice, a neuroradiologist is confronted with a large number of decisions. These include choices surrounding appropriate patient selection, scan-acquisition parameters, data-postprocessing methods, image interpretation, and reporting. Throughout the imaging literature, there is conflicting advice on these issues. In an effort to provide guidance to neuroradiologists struggling to implement DSC perfusion imaging in their MR imaging practice, the Clinical Practice Committee of the American Society of Functional Neuroradiology has provided the following recommendations. This guidance is based on review of the literature coupled with the practice experience of the authors. While the ASFNR acknowledges that alternate means of carrying out DSC perfusion imaging may yield clinically acceptable results, the following recommendations should provide a framework for achieving routine success in this complicated-but-rewarding aspect of neuroradiology MR imaging practice.

Conventional and advanced magnetic resonance imaging in patients with high-grade glioma

“…Reproducible technical parameters and well-established imaging markers will allow for the incorporation of these approaches into future radiographic response assessment criteria necessary for optimization of clinical trials. Towards that goal standardized protocols for implementation in glioma treatment trials 100 and also for perfusion imaging 17 have been proposed and are being widely adopted.…”

“…16 Despite the widespread use of DSC-MRI in the clinical setting and proposals for standardized techniques, considerable heterogeneity exists across institutions which often limits the generalizability of DSC findings. 17 …”

MR Imaging Biomarkers in Oncology Clinical Trials

“…With the increasing use of DSC-MRI in clinical trials and routine practice there is growing interest in the field to standardize image acquisition and post-processing strategies (37). While there is a general consensus on the most robust acquisition strategies (e.g., pulse sequence type and parameters, CBV quantification, correction techniques for contrast agent leakage effects), current efforts aim to address the challenges of harmonizing these techniques across MRI vendors and data analysis packages.…”

Optimization of DSC MRI Echo Times for CBV Measurements Using Error Analysis in a Pilot Study of High-Grade Gliomas

“…Recently, the American Society of Functional Neuroradiology (ASFNR) recommended GRE-based DSC-MRI for brain tumor imaging because of the higher signal to noise, better sensitivity and more uniform vessel size sensitivity compared to SE. 11 Accordingly, it is important to determine an optimal TE for GRE-based DSC-MRI.…”