Assessment of Angiographic Vascularity of Meningiomas with Dynamic Susceptibility Contrast-Enhanced Perfusion-Weighted Imaging and Diffusion Tensor Imaging

Abstract

BACKGROUND AND PURPOSE:The roles of DTI and dynamic susceptibility contrast-enhanced-PWI in predicting the angiographic vascularity of meningiomas have not been studied. We aimed to investigate if these 2 techniques could reflect the angiographic vascularity of meningiomas.

Utility of arterial spin labeling perfusion magnetic resonance imaging in prediction of angiographic vascularity of meningiomas

“…Our study demonstrated a significant positive correlation between the nCBF and angiographic vascularity, in keeping with the finding of the previous study, in which normalized cerebral blood volume obtained from dynamic susceptibility contrast-enhanced PWI was used. 17 Conventional angiography can provide some valuable information that may help in planning surgery. However, a non-negligible neurological complication rate of up to 1.3% has been previously reported, suggesting that special care needs to be taken in patient selection.…”

“…A neurointerventionist (Y.D.C., with 10 years of experience) and a neuroradiologist (T.J.Y., with 12 years of experience), who were blinded to ASL-PWI findings, reviewed the entire series of angiographic images and graded the degree of angiographic vascularity on the basis of previously reported criteria: Grade 0, none; Grade 1, minimal; Grade 2, moderate; and Grade 3, marked. 17 Interobserver differences were resolved by consensus. In cases of multiple feeders, the vascularity of the tumor as a whole was estimated by summing tumor stains observed in each selective angiography.…”

“…Meningiomas were then further classified into 2 groups, according to the angiographic vascularity grade: low-vascularity meningiomas (Grades 0 and 1), for which preoperative embolization or even DSA is considered unnecessary; and high-vascularity meningiomas (Grades 2 and 3), which are potential candidates for embolization. 17 Quantitative Analysis of CBF on ASL-PWI On a picture archiving and communication system workstation, regions of interest that contained the entire contrast-enhancing areas, excluding the areas of necrosis or cysts, were drawn in the most representative (i.e., largest) sections of each CBF map by 1 neuroradiologist (R.E.Y., with 5 years of experience) to determine the absolute CBF of the tumor (CBF tumor ). At the same time, to adjust for the interindividual variation among MR scanners and basal CBF, additional regions of interest were drawn within the gray matter of normal contralateral parenchyma at the same slice levels for CBF normalization.…”

“…cularity or vascular anatomy of feeding arteries and draining veins, can also help surgical planning. 17 Nonetheless, digital subtraction angiography (DSA) is an invasive imaging modality, with reported neurological complication rates ranging from 0.34% to 1.3%. 4,16,21 More recently, normalized cerebral blood volume derived from dynamic susceptibility contrast-enhanced perfusion-weighted imaging (PWI) has been found to correlate well with angiographic vascularity of meningiomas and to aid in the differential diagnosis of low-vascularity from high-vascularity meningiomas.…”

“…4,16,21 More recently, normalized cerebral blood volume derived from dynamic susceptibility contrast-enhanced perfusion-weighted imaging (PWI) has been found to correlate well with angiographic vascularity of meningiomas and to aid in the differential diagnosis of low-vascularity from high-vascularity meningiomas. 17 Over the past decade, cerebral blood flow (CBF), determined from arterial spin labeling (ASL)-PWI, has been shown to have a strong association with perfusion parameters obtained from dynamic susceptibility contrast-enhanced PWI in several studies. 3,[8][9][10]18,19,23 ASL, unlike dynamic susceptibility contrast-enhanced PWI, is a noninvasive perfusion MR technique that uses magnetically labeled water as a diffusible tracer in place of an exogenous contrast material, such as a gadolinium-based agent, to measure CBF values.…”