Magnetic Resonance Perfusion Characteristics of Hypervascular Renal and Hypovascular Prostate Spinal Metastases

Saha, Atin; Peck, Kyung K.; Lis, Eric; Holodny, Andrei I.; Yamada, Yoshiya; Karimi, Sasan

doi:10.1097/brs.0000000000000570

Cited by 40 publications

(22 citation statements)

References 27 publications

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“…These quantitative parameters have demonstrated their value in detecting the differences in microvascular environment among metastatic lesions before and after treatment 9 , benign and pathological fractures 10 , and hypovascular and hypervascular lesions. 11,12 Vertebral metastases demonstrate very different histological patterns depending on the primary tumor. There is, however, a common feature in all of them: neoangiogenesis.…”

Section: Introductionmentioning

confidence: 99%

Differentiating Atypical Hemangiomas and Metastatic Vertebral Lesions: The Role of T1-Weighted Dynamic Contrast-Enhanced MRI

Morales

Arévalo-Pérez²,

Peck

et al. 2018

AJNR Am J Neuroradiol

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Background and Purpose Vertebral hemangiomas are benign vascular lesions that are almost always incidentally found in the spine. Their classic typical hyperintense appearance on T1- and T2-weighted MR images is diagnostic. Unfortunately, not all hemangiomas have the typical appearance and can mimic metastases on routine MRI. These are generally referred to as atypical hemangiomas and can result in misdiagnosis and ultimately to additional imaging, biopsy and unnecessary costs. Our objective is to assess the utility of DCE-MRI perfusion in distinguishing vertebral atypical hemangiomas and malignant vertebral metastases. We hypothesize that permeability and vascular density will be increased in metastases compared to atypical hemangiomas. Materials and Methods Consecutive patients from 2011-2015 with confirmed diagnoses of atypical hemangiomas and spinal metastases from breast and lung carcinoma with available DCE-MRI were analyzed. Time-intensity curves were qualitatively compared among the groups. Perfusion parameters, plasma volume (Vp) and permeability constant (Ktrans), were quantified using an extended Toft’s two-compartment pharmacokinetic model. Statistical significance was tested using Mann-Whitney U test. Results Qualitative inspection of DCE-MRI time-intensity curves demonstrated differences in signal intensity and morphology, between metastases and atypical hemangiomas. Quantitative analysis of Vp and Ktrans perfusion parameters showed a significantly higher values in metastatic lesions when compared to atypical hemangiomas (p<0.001). Conclusions Our data demonstrate that Vp and Ktrans perfusion parameters and qualitative inspection of contrast enhancement curves can be used to differentiate atypical hemangiomas from vertebral metastatic lesions. This works highlights the benefits of adding perfusion maps to conventional sequences that can improve diagnostic accuracy.

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Section: Introductionmentioning

confidence: 99%

Differentiating Atypical Hemangiomas and Metastatic Vertebral Lesions: The Role of T1-Weighted Dynamic Contrast-Enhanced MRI

Morales

Arévalo-Pérez²,

Peck

et al. 2018

AJNR Am J Neuroradiol

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“…Regardless of the analysis methods, most studies found DCE parameters showing significant differences between diseased and normal bone marrow, or between different lesions(8–15). Khadem et al used heuristic DCE analysis to discriminate hypervascular from hypovascular spinal metastases (12), and later Saha et al from the same research group showed that pharmacokinetic parameters analyzed by using a commercial software (NordicNeuroLab) could distinguish hypervascular renal cell carcinoma from hypovascular prostate carcinoma (13). DCEMRI using heuristic analysis and model fitting has been applied to characterize vascular properties of different hematologic malignancies (eg, myeloma and lymphoma) with different grades of bone marrow involvement (8,9,15).…”

Section: Discussionmentioning

confidence: 99%

“…DCE-MRI has been applied to diagnose different spinal lesions (8–11) and distinguish between hypervascular (eg, renal cell carcinoma) and hypovascular (eg, prostate cancer) metastases (12,13). It has also been used to characterize vascular properties of hematologic malignancies (eg, myeloma and lymphoma) with different grades of bone marrow involvement, as well as to evaluate changes after various therapies for predicting treatment outcome and prognosis (8,9,14–20).…”

Section: Introductionmentioning

confidence: 99%

Diagnosis of Spinal Lesions Using Heuristic and Pharmacokinetic Parameters Measured by Dynamic Contrast-Enhanced MRI

Yuan

et al. 2017

Academic Radiology

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Rationale and Objectives: This study aimed to evaluate the diagnostic performance of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in differentiation of four spinal lesions by using heuristic and pharmacokinetic parameters analyzed from DCE signal intensity time course. Materials and Methods: DCE-MRI of 62 subjects with confirmed myeloma (n=9), metastatic cancer (n= 22), lymphoma (n= 7), and inflammatory tuberculosis (TB) (n= 24) in the spine were analyzed retrospectively. The region of interest was placed on strongly enhanced tissues. The DCE time course was categorized as the “wash-out,” “plateau,” or “persistent enhancement” pattern. The maximum enhancement, steepest wash-in enhancement, and wash-out slope using the signal intensity at 67 seconds after contrast injection as reference were measured. The Tofts 2-compartmental pharmacokinetic model was applied to obtain Ktrans and kep. Pearson correlation between heuristic and pharmacokinetic parameters was evaluated, and receiver operating characteristic curve analysis was performed for pairwise group differentiation. Results: The mean wash-out slope was −22% ± 10% for myeloma, 1% ± 0.4% for metastatic cancer, 3% ± 3% for lymphoma, and 7% ± 10% for TB, and it could significantly distinguish myeloma from metastasis (area under the curve [AUC] = 0.884), lymphoma (AUC = 1.0), and TB (AUC = 1.0) with P = .001, and distinguish metastasis from TB (AUC = 0.741) with P = .005. The kep and wash-out slope were highly correlated (r = 0.92), and they showed a similar diagnostic performance. The Ktrans was significantly correlated with the maximum enhancement (r = 0.71) and the steepest wash-in enhancement (r = 0.85), but they had inferior diagnostic performance compared to the wash-out slope. Conclusions: DCE-MRI may provide additional diagnostic information, and a simple wash-out slope had the best diagnostic performance. The heuristic and pharmacokinetic parameters were highly correlated.

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“…DCE-MRI involves assessing changes in signal intensity over time: before and after contrast injection (12). Previous studies have shown that DCE-MRI is useful for monitoring response to therapy in spinal bone metastases (13), and for discriminating between the hypo- and hyper- vascular spinal lesions of prostate carcinoma and renal cell carcinoma, respectively (14). More recently, DCE-MRI has shown clinical utility in chordoma diagnosis, effectively discriminating between chordoma and giant cell tumors of the axial skeleton (15).…”

Section: Introductionmentioning

confidence: 99%

T1-Weighted Dynamic Contrast-Enhanced MR Perfusion Imaging Characterizes Tumor Response to Radiation Therapy in Chordoma

Santos¹,

Peck²,

Arévalo-Pérez³

et al. 2017

AJNR Am J Neuroradiol

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Background and Purpose Chordomas notoriously demonstrate a paucity of changes following radiation therapy on conventional MRI. We hypothesize that dynamic contrast enhanced (DCE) MR perfusion imaging parameters of chordomas would change significantly following radiation therapy. Materials and Methods Eleven pathology-proven chordoma patients who completed DCE MR perfusion imaging pre -and post-radiation therapy were enrolled. Quantitative tumor measurements were taken by two attending neuroradiologists. ROIs were used to calculate vascular permeability (Ktrans) and plasma volume (Vp), and generate dynamic contrast enhancement curves. Quantitative analysis was performed to determine mean and maximum Vp and Ktrans values, while semi-quantitative analysis on averaged concentration curves was used to determine the area under the curve (AUC). A Mann-Whitney U test at a significance level of p<0.05 was used to assess differences of above parameters between pre- and post-radiation therapy. Results Vp mean (pre-treatment μ=0.82, post-treatment μ=0.42), Vp maximum (pre- treatment μ=3.56; post- treatment μ=2.27), and Ktrans mean (pre- treatment μ=0.046; post- treatment μ=0.028) in the ROIs significantly decreased after radiation therapy (p<0.05), thereby demonstrating potential for assessing tumor response. AUC values also demonstrated significant differnces (p<0.05). Conclusions Vp and Ktrans, decreased after radiation therapy, suggesting that these DCE-MR perfusion parameters may be useful for monitoring chordoma growth and response to radiation therapy. Additionally, the characteristic dynamic MR signal intensity time curve of chordoma may provide a radiographic means of distinguishing chordoma from other spinal lesions.

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Magnetic Resonance Perfusion Characteristics of Hypervascular Renal and Hypovascular Prostate Spinal Metastases

Cited by 40 publications

References 27 publications

Differentiating Atypical Hemangiomas and Metastatic Vertebral Lesions: The Role of T1-Weighted Dynamic Contrast-Enhanced MRI

Differentiating Atypical Hemangiomas and Metastatic Vertebral Lesions: The Role of T1-Weighted Dynamic Contrast-Enhanced MRI

Diagnosis of Spinal Lesions Using Heuristic and Pharmacokinetic Parameters Measured by Dynamic Contrast-Enhanced MRI

T1-Weighted Dynamic Contrast-Enhanced MR Perfusion Imaging Characterizes Tumor Response to Radiation Therapy in Chordoma

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