Perfusion MR Imaging: Clinical Utility for the Differential Diagnosis of Various Brain Tumors

Cho, Sung Ki; Na, Dong Gyu; Ryoo, Jae Wook; Roh, Hong Gee; Moon, Chan Hong; Byun, Hong Sik; Kim, Jong Hyun

doi:10.3348/kjr.2002.3.3.171

Cited by 56 publications

(41 citation statements)

References 22 publications

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“…Metastatic tumors spread into the CNS via hematogenous routes and induce neovascularization as they grow and expand. Several studies in the literature reported that rCBV ratios are not useful for discrimination (20,23). In our study we also demonstrated that the rCBV ratios of 25 patients with metastasis were not helpful for discriminating these tumors from high-grade gliomas.…”

Section: Metastasismentioning

confidence: 99%

“…In our study the nidus was hypervascular in all cases with PWI. Cho et al (20) demonstrated that increased rCBV ratios are helpful for differentiating pilocytic astrocytomas from hemangioblastomas, which is not possible with conventional images. In our study we also demonstrated that rCBV ratios were clearly increased and there was a statistically significant difference from all other intracranial masses.…”

Section: Hemangioblastomamentioning

confidence: 99%

“…There are several intracranial extraaxial neoplasms (e.g., meningioma and choroid plexus papilloma) that can be highly vascular but rather benign in terms of biological behavior (14). Although recent PWI studies have focused mostly on glial tumor grading, a limited number of studies about the differential diagnosis of various intracranial tumors have been published (15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27).…”

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confidence: 99%

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Evaluation of different cerebral mass lesions by perfusion‐weighted MR imaging

Hakyemez

Erdoğan

Bolca

et al. 2006

Magnetic Resonance Imaging

198

111

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Purpose:To investigate the contribution of perfusionweighted MR imaging (PWI) by using the relative cerebral blood volume (rCBV) ratio in the differential diagnosis of various intracranial space-occupying lesions. Materials and Methods:This study involved 105 patients with lesions (high-grade glioma (N ϭ 26), low-grade glioma (Nϭ 11), meningioma (N ϭ 23), metastasis (N ϭ 25), hemangioblastoma (N ϭ 6), pyogenic abscess (N ϭ 4), schwannoma (N ϭ 5), and lymphoma (N ϭ 5)). The patients were examined with a T2*-weighted (T2*W) gradient-echo singleshot EPI sequence. The rCBV ratios of the lesions were obtained by dividing the values obtained from the normal white matter. Statistical analysis was performed with the Mann-Whitney U-test. A P-value less than 0.05 was considered statistically significant. Results:The rCBV ratio was 5.76 Ϯ 3.35 in high-grade gliomas, 1.69 Ϯ 0.51 in low-grade gliomas, 8.02 Ϯ 3.89 in meningiomas, 5.27 Ϯ 3.22 in metastases, 11.36 Ϯ 4.41 in hemangioblastomas, 0.76 Ϯ 0.12 in abscesses, 1.10 Ϯ 0.32 in lymphomas, and 3.23 Ϯ 0.81 in schwannomas. The rCBV ratios were used to discriminate between 1) high-and low-grade gliomas (P Ͻ 0.001), 2) hemangioblastomas and metastases (PϽ 0.05), 3) abscesses from high-grade gliomas and metastases (P Ͻ 0.001), 4) schwannomas and meningiomas (P Ͻ 0.001), 5) lymphomas from high-grade gliomas and metastases (P Ͻ 0.001), and 6) typical meningiomas and atypical meningiomas (P Ͻ 0.01).Conclusion: rCBV ratios can help discriminate intracranial space-occupying lesions by demonstrating lesion vascularity. It is possible to discriminate between 1) high-and low-grade gliomas, 2) hemangioblastomas and other intracranial posterior fossa masses, 3) abscesses from highgrade gliomas and metastases, 4) schwannomas and meningiomas, 5) lymphomas and high-grade gliomas and metastases, and 6) typical and atypical meningiomas.

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Section: Metastasismentioning

confidence: 99%

Section: Hemangioblastomamentioning

confidence: 99%

mentioning

confidence: 99%

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Evaluation of different cerebral mass lesions by perfusion‐weighted MR imaging

Hakyemez

Erdoğan

Bolca

et al. 2006

Magnetic Resonance Imaging

198

111

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“…Lymphomas were found to be associated with lower rCBV values (5,9,10). The rCBV values of lymphoma are noted to be much less compared to high-grade gliomas (11,12). Few earlier studies highlighted salient features of enhancing malignant lesions based on rCBV measurements on DSC perfusion and with diffusion (DWI-ADC), but were not always confirmatory (9,13).…”

Section: Introductionmentioning

confidence: 99%

Usefulness of enhancement-perfusion mismatch in differentiation of CNS lymphomas from other enhancing malignant tumors of the brain

Goyal¹,

Kumar²,

Gupta³

et al. 2017

Quant. Imaging Med. Surg.

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Background: Surgical planning and treatment options for primary or secondary central nervous system lymphomas (PCNSL or SCNSL) are different from other enhancing malignant lesions such as glioblastoma multiforme (GBM), anaplastic gliomas and metastases; so, it is critical to distinguish them preoperatively.We hypothesized that enhancement-perfusion (E-P) mismatch on dynamic susceptibility weighted magnetic resonance (DSC-MR) perfusion imaging which corresponds to low mean relative cerebral blood volume (mean rCBV) in an enhancing portion of the tumor should allow differentiation of CNS lymphomas from other enhancing malignant lesions. Methods:We retrospectively reviewed pre-treatment MRI exams, including DSC-MR perfusion images of 15 lymphoma patients. As a control group, pre-treatment DSC-MR perfusion images of biopsy proven 18 GBMs (group II), 13 metastases (group III), and 10 anaplastic enhancing gliomas (group IV) patients were also reviewed.Region of interests (ROIs) were placed around the most enhancing part of tumor on contrast-enhanced T1WI axial images and images were transferred onto co-registered DSC perfusion maps to obtain CBV in all 4 groups.The mean and maximum relative CBV values were obtained. Statistical analysis was performed on SPSS software and significance of the results between the groups was done with Mann-Whitney test, whereas optimal thresholds for tumor differentiation were done by receiver operating characteristic (ROC) analysis.Results: The enhancing component of CNS lymphomas were found to have significantly lower mean rCBV compared to enhancing component of GBM (1.2 versus 4.3; P<0.001), metastasis (1.2 versus 2.7; P<0.001), and anaplastic enhancing gliomas (1.2 versus 2.4; P<0.001). Maximum rCBV of enhancing component of lymphoma were significantly lower than GBM (3.1 versus 6.5; P<0.001) and metastasis (3.1 versus 4.9; P<0.013), and not significantly lower than anaplastic enhancing gliomas (3.9 versus 4.2; P<0.08).On the basis of ROC analysis, mean rCBV provided the best threshold [area under the curve (AUC) =0.92] and had better accuracy in differentiating malignant lesions.Conclusions: E-P mismatch in DSC perfusion MR, i.e., low mean rCBV in an enhancing portion of the tumor is strongly suggestive of lymphoma and should allow differentiation of CNS lymphoma from other enhancing malignant lesions.

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“…However, advanced MRI techniques like proton MR spectroscopy and perfusion helps in differentiating between them [1,2]. However, other approach to study and characterise various intracranial mass lesions would be to study their energy status and metabolic profile.…”

Section: Introductionmentioning

confidence: 99%

Energy Status And Metabolism in Intracranial Space Occupying Lesions: A Prospective 31p Spectroscopic Study

Kamble¹

2014

JCDR

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Aim: Intracranial space occupying lesions can be infective or tumour. There are various advanced Magnetic resonance imaging techniques like perfusion, diffusion and proton spectroscopy which can differentiate between them. However, 31 Phosphorus spectroscopy studies the energy status and the metabolism pattern of various tissues and can be used potentially to differentiate between them depending on their Metabolism pattern. Thus, we aimed to study energy status of various intracranial lesions and try to differentiate between them including grades of gliomas. Materials and Methods:31 PMRS was done in 1.5T MRI in 43 patients prior to surgery or through/via stereo-tactic biopsy, of which 25 were men and 18 women with mean age 41.34 y ranging from 7-71 y. Single voxel phosphorus spectroscopy was done from the solid portion of the lesions and data was analysed and post processed.Results: Study includes Lymphoma (n=6), Grade 1 and 2 glioma (n=5), grade 3 glioma (n=9), grade 4 glioma(n=6), metastases (n=5), tuberculoma (n=7) and pyogenic abscesses (n=5). The integral values of PME, Pi, PDE, γ-ATP, α-ATP, β-ATP with reference to the position of PCr were calculated along with various ratios. Integral values of Pi and PDE were significantly increased in metastases but decreased in gliomas grade 1-2 compared to other pathologic conditions. Mean integral values of LEP (low energy phosphates) and total phosphates were significantly decreased in gliomas grades 1 and 2 and increased in metastases when compared with other pathologic conditions. PCr /Pi was increased in glioma grades 1, 2 and 3 but decreased in metastases; the significance was observed only in gliomas grade 3 and metastases. Metabolic ratios of PDE/βATP and Pi/ βATP were decreased in glioma grades 1 and 2 and increased in metastases with statistical significance. Conclusion:31 PMRS may help in differentiating primary from secondary lesions and assess grades of gliomas. P MR spectroscopy (TR = 400ms, TE=1ms, 512 acquisitions) using intravoxel in-vivo spectroscopy localization method with head quadrature dual-tuned coil. Care was taken to include mainly the solid portion of the lesion in the MRS voxel which ranged from 2 cm 3 -4 cm 3 . The duration of spectroscopy examination was about 5 min. Spectroscopy data were transferred to an installed software programme (Numaris spectroscopy analysis package VB33A). All post-processing techniques like apodization, zero and first order phase corrections were performed and spectra were plotted, analyzed and fitted to Lorentzian lines shapes.The following well resolved phosphorus metabolite peaks were observed in all patients-Phosphomonoesters (PME), Inorganic phosphate (Pi), Phosphodiesters (PDE), Phosphocreatine (PCr), γ, β, and α resonances of adenosine triphosphate (ATP). The chemical

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Perfusion MR Imaging: Clinical Utility for the Differential Diagnosis of Various Brain Tumors

Cited by 56 publications

References 22 publications

Evaluation of different cerebral mass lesions by perfusion‐weighted MR imaging

Evaluation of different cerebral mass lesions by perfusion‐weighted MR imaging

Usefulness of enhancement-perfusion mismatch in differentiation of CNS lymphomas from other enhancing malignant tumors of the brain

Energy Status And Metabolism in Intracranial Space Occupying Lesions: A Prospective 31p Spectroscopic Study

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