Dynamic contrast-enhanced imaging techniques: CT and MRI

Abstract

ABSTRACT. Over the last few decades there has been considerable research into quantifying the cerebral microvasculature with imaging, for use in studies of the human brain and various pathologies including cerebral tumours. This review highlights key issues in dynamic contrast-enhanced CT, dynamic contrast-enhanced MRI and arterial spin labelling, the various applications of which are considered elsewhere in this special issue of the British Journal of Radiology. The tumour microvasculature can readily be imaged using X-ray, CT and MRI techniques. This review concentrates on three main methods. Dynamic contrast-enhanced CT (DCE-CT) and dynamic contrastenhanced MRI (DCE-MRI) are well-established techniques, where data acquisition and analysis are comparable despite inherent differences in signal production and mechanism of tissue contrast enhancement (reviewed in [1,2]). Although they can be performed on conventional clinical scanners, they require specialist image analysis to extract biomarkers of tumour vascular function. In distinction, arterial spin labelling (ASL) offers a highly specific method of measuring cerebral perfusion without exogenous contrast agent (CA) administration, but is at present a research technique. The practical applications of these techniques are considered elsewhere in this special issue. Basic principles of dynamic contrast-enhanced imagingDCE imaging describes the acquisition of a baseline image(s) without contrast enhancement followed by a series of images acquired over time after an intravenous bolus of conventional CA. The presence of CA within cerebral blood vessels and tissues affects measured X-ray attenuation on CT in a linear fashion and the calculated signal intensity on MRI in a non-linear manner. Thus, the temporal changes in contrast enhancement effectively provide a time-concentration curve, which can be analysed to quantify a range of physiological parameters that indicate the functional status of the vascular system within tumours and adjacent tissues. These parameters reflect the two-compartment pharmacokinetics exhibited by CA, comprising intravascular and extravascular components. During the first-pass of the CA through the circulation (typically 45-60 s after injection), CA is predominantly intravascular allowing evaluation of perfusion (i.e. blood flow per unit volume or mass of tissue), relative blood volume (rBV) and mean transit time. During the subsequent 2-10 min, there is increasing passage of CA into the extravascular space, and imaging during this delayed phase enables measurement of vascular permeability and relative extravascular volume. DCE-CT image acquisition protocolsA number of distinct DCE-CT techniques have been developed, reflecting the different analysis methodologies adopted by commercial software packages for perfusion CT. The main acquisition factors to be considered are summarised in Table 1. For DCE-CT, the need to keep the radiation burden as low as practicable is a constraint on the total number of images acquired and the X-ray exposure ...

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