Abstract
Purpose
This study was performed to clarify the role of perfusion-weighted imaging (PWI) at 3 Tesla in the characterisation of haemodynamic heterogeneity within gliomas and surrounding tissues and in the differentiation of high-grade from low-grade gliomas.
Materials and methods
We examined 36 patients with histologically verified gliomas (25 with high-grade and 11 with low-grade gliomas). PWI was performed by first-pass gadopentetate dimeglumine T2*-weighted echo-planar images, and cerebral blood volume (CBV) maps were computed with a nondiffusible tracer model. Relative CBV (rCBV) was calculated by dividing CBV in pathological areas by that in contralateral white matter.
Results
In high-grade gliomas, rCBV were markedly increased in mass [mean±standard deviation (SD), 4.3±1.2] and margins (4.0±1.1) and reduced in necrotic areas (0.3±0.3). Oedematous-appearing areas were divided in two groups according to signal intensity on T2-weighted images: tumour with lower (nearly isointense to grey matter) and oedema with higher (scarcely isointense to cerebrospinal fluid) signal intensity. Tumour showed significantly higher rCBV than did oedema (1.8±0.5 vs. 0.5±0.2; p<0.001) areas. In low-grade gliomas, mass (2.0±1.5) and margin (2.2±1.2) rCBV were significantly lower than in high-grade gliomas (p<0.001).
Conclusions
Three-Tesla PWI helps to distinguish necrosis from tumour mass, infiltrating tumour from oedema and high-grade from low-grade gliomas. It enhances the magnetic resonance (MR) assessment of cerebral gliomas and provides useful information for planning surgical and radiation treatment.
Riassunto
Obiettivo
Chiarire il ruolo dell’imaging pesato in perfusione (PWI) a 3 Tesla nella caratterizzazione dell’eterogeneità emodinamica dei gliomi cerebrali e dei tessuti circostanti, e nella differenziazione dei gliomi di alto grado da quelli di basso grado.
Materiali e metodi
Abbiamo esaminato 36 pazienti con gliomi verificati istologicamente (25 con alto ed 11 con basso grado). Il PWI è stato ottenuto mediante immagini eco-planari T2*-pesate con primo passaggio di gadopentetato di dimeglumina, e le mappe di volume ematico cerebrale (CBV) sono state elaborate con il modello del tracciante non diffusibile. Il volume ematico cerebrale relativo (rCBV) è stato calcolato dividendo il CBV nelle aree patologiche per quello nella sostanza bianca controlaterale.
Risultati
Nei gliomi di alto grado, l’rCBV appariva marcatamente incrementato nella massa (media±SD, 4,3±1,2) ed ai margini (4,0±1,1), e ridotto nelle aree necrotiche (0,3±0,3). Le regioni apparentemente edematose sono state divise in due gruppi sulla base dell’intensità di segnale nelle immagini pesate in T2: “tumore” con più basso segnale (quasi isointenso alla sostanza grigia) ed “edema” con segnale più elevato (quasi isointenso al liquido cefalorachidiano). Le aree “tumore” presentavano rCBV significativamente più elevato rispetto a quelle “edema” (1,8±0,5 vs 0,5±0,2; p<0,001). Nei gliomi di basso grado, l’rCBV nella massa (2,0±1,5) e nel margine (2,2±1,2) erano significativamente più bassi che nei gliomi di alto grado (p<0,001).
Conclusioni
Il PWI a 3T aiuta a differenziare la necrosi dalla massa tumorale, il tumore infiltrante dall’edema, e i gliomi di alto grado da quelli di basso grado. Esso facilita la caratterizzazione in RM dei gliomi cerebrali e fornisce utili informazioni per la pianificazione del trattamento chirurgico e radiante.
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Di Costanzo, A., Pollice, S., Trojsi, F. et al. Role of perfusion-weighted imaging at 3 Tesla in the assessment of malignancy of cerebral gliomas. Radiol med 113, 134–143 (2008). https://doi.org/10.1007/s11547-008-0232-2
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DOI: https://doi.org/10.1007/s11547-008-0232-2