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Simultaneous quantification of perfusion, permeability, and leakage effects in brain gliomas using dynamic spin-and-gradient-echo echoplanar imaging MRI.

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Title: Simultaneous quantification of perfusion, permeability, and leakage effects in brain gliomas using dynamic spin-and-gradient-echo echoplanar imaging MRI.
Authors: Sanvito, Francesco1,2,3 (AUTHOR), Raymond, Catalina1,2 (AUTHOR), Cho, Nicholas S.1,2,4,5 (AUTHOR), Yao, Jingwen1,2 (AUTHOR), Hagiwara, Akifumi1,2,6 (AUTHOR), Orpilla, Joey7 (AUTHOR), Liau, Linda M.7 (AUTHOR), Everson, Richard G.7 (AUTHOR), Nghiemphu, Phioanh L.8 (AUTHOR), Lai, Albert8 (AUTHOR), Prins, Robert7 (AUTHOR), Salamon, Noriko2 (AUTHOR), Cloughesy, Timothy F.8 (AUTHOR), Ellingson, Benjamin M.1,2,4,5,7,9 (AUTHOR) bellingson@mednet.ucla.edu
Source: European Radiology. May2024, Vol. 34 Issue 5, p3087-3101. 15p.
Subjects: Magnetic resonance imaging, Gliomas, Brain tumors, Permeability, Perfusion imaging
Abstract: Objective: To determine the feasibility and biologic correlations of dynamic susceptibility contrast (DSC), dynamic contrast enhanced (DCE), and quantitative maps derived from contrast leakage effects obtained simultaneously in gliomas using dynamic spin-and-gradient-echo echoplanar imaging (dynamic SAGE-EPI) during a single contrast injection. Materials and methods: Thirty-eight patients with enhancing brain gliomas were prospectively imaged with dynamic SAGE-EPI, which was processed to compute traditional DSC metrics (normalized relative cerebral blood flow [nrCBV], percentage of signal recovery [PSR]), DCE metrics (volume transfer constant [Ktrans], extravascular compartment [ve]), and leakage effect metrics: ΔR2,ss* (reflecting T2*-leakage effects), ΔR1,ss (reflecting T1-leakage effects), and the transverse relaxivity at tracer equilibrium (TRATE, reflecting the balance between ΔR2,ss* and ΔR1,ss). These metrics were compared between patient subgroups (treatment-naïve [TN] vs recurrent [R]) and biological features (IDH status, Ki67 expression). Results: In IDH wild-type gliomas (IDHwt—i.e., glioblastomas), previous exposure to treatment determined lower TRATE (p = 0.002), as well as higher PSR (p = 0.006), Ktrans (p = 0.17), ΔR1,ss (p = 0.035), ve (p = 0.006), and ADC (p = 0.016). In IDH-mutant gliomas (IDHm), previous treatment determined higher Ktrans and ΔR1,ss (p = 0.026). In TN-gliomas, dynamic SAGE-EPI metrics tended to be influenced by IDH status (p ranging 0.09–0.14). TRATE values above 142 mM−1s−1 were exclusively seen in TN-IDHwt, and, in TN-gliomas, this cutoff had 89% sensitivity and 80% specificity as a predictor of Ki67 > 10%. Conclusions: Dynamic SAGE-EPI enables simultaneous quantification of brain tumor perfusion and permeability, as well as mapping of novel metrics related to cytoarchitecture (TRATE) and blood–brain barrier disruption (ΔR1,ss), with a single contrast injection. Clinical relevance statement: Simultaneous DSC and DCE analysis with dynamic SAGE-EPI reduces scanning time and contrast dose, respectively alleviating concerns about imaging protocol length and gadolinium adverse effects and accumulation, while providing novel leakage effect metrics reflecting blood–brain barrier disruption and tumor tissue cytoarchitecture. Key Points: • Traditionally, perfusion and permeability imaging for brain tumors requires two separate contrast injections and acquisitions. • Dynamic spin-and-gradient-echo echoplanar imaging enables simultaneous perfusion and permeability imaging. • Dynamic spin-and-gradient-echo echoplanar imaging provides new image contrasts reflecting blood–brain barrier disruption and cytoarchitecture characteristics. [ABSTRACT FROM AUTHOR]
Copyright of European Radiology is the property of Springer Nature and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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  Data: Simultaneous quantification of perfusion, permeability, and leakage effects in brain gliomas using dynamic spin-and-gradient-echo echoplanar imaging MRI.
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  Data: <searchLink fieldCode="AR" term="%22Sanvito%2C+Francesco%22">Sanvito, Francesco</searchLink><relatesTo>1,2,3</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Raymond%2C+Catalina%22">Raymond, Catalina</searchLink><relatesTo>1,2</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Cho%2C+Nicholas+S%2E%22">Cho, Nicholas S.</searchLink><relatesTo>1,2,4,5</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Yao%2C+Jingwen%22">Yao, Jingwen</searchLink><relatesTo>1,2</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Hagiwara%2C+Akifumi%22">Hagiwara, Akifumi</searchLink><relatesTo>1,2,6</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Orpilla%2C+Joey%22">Orpilla, Joey</searchLink><relatesTo>7</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Liau%2C+Linda+M%2E%22">Liau, Linda M.</searchLink><relatesTo>7</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Everson%2C+Richard+G%2E%22">Everson, Richard G.</searchLink><relatesTo>7</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Nghiemphu%2C+Phioanh+L%2E%22">Nghiemphu, Phioanh L.</searchLink><relatesTo>8</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Lai%2C+Albert%22">Lai, Albert</searchLink><relatesTo>8</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Prins%2C+Robert%22">Prins, Robert</searchLink><relatesTo>7</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Salamon%2C+Noriko%22">Salamon, Noriko</searchLink><relatesTo>2</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Cloughesy%2C+Timothy+F%2E%22">Cloughesy, Timothy F.</searchLink><relatesTo>8</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Ellingson%2C+Benjamin+M%2E%22">Ellingson, Benjamin M.</searchLink><relatesTo>1,2,4,5,7,9</relatesTo> (AUTHOR)<i> bellingson@mednet.ucla.edu</i>
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  Data: <searchLink fieldCode="JN" term="%22European+Radiology%22">European Radiology</searchLink>. May2024, Vol. 34 Issue 5, p3087-3101. 15p.
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  Data: <searchLink fieldCode="DE" term="%22Magnetic+resonance+imaging%22">Magnetic resonance imaging</searchLink><br /><searchLink fieldCode="DE" term="%22Gliomas%22">Gliomas</searchLink><br /><searchLink fieldCode="DE" term="%22Brain+tumors%22">Brain tumors</searchLink><br /><searchLink fieldCode="DE" term="%22Permeability%22">Permeability</searchLink><br /><searchLink fieldCode="DE" term="%22Perfusion+imaging%22">Perfusion imaging</searchLink>
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Objective: To determine the feasibility and biologic correlations of dynamic susceptibility contrast (DSC), dynamic contrast enhanced (DCE), and quantitative maps derived from contrast leakage effects obtained simultaneously in gliomas using dynamic spin-and-gradient-echo echoplanar imaging (dynamic SAGE-EPI) during a single contrast injection. Materials and methods: Thirty-eight patients with enhancing brain gliomas were prospectively imaged with dynamic SAGE-EPI, which was processed to compute traditional DSC metrics (normalized relative cerebral blood flow [nrCBV], percentage of signal recovery [PSR]), DCE metrics (volume transfer constant [Ktrans], extravascular compartment [ve]), and leakage effect metrics: ΔR2,ss* (reflecting T2*-leakage effects), ΔR1,ss (reflecting T1-leakage effects), and the transverse relaxivity at tracer equilibrium (TRATE, reflecting the balance between ΔR2,ss* and ΔR1,ss). These metrics were compared between patient subgroups (treatment-naïve [TN] vs recurrent [R]) and biological features (IDH status, Ki67 expression). Results: In IDH wild-type gliomas (IDHwt—i.e., glioblastomas), previous exposure to treatment determined lower TRATE (p = 0.002), as well as higher PSR (p = 0.006), Ktrans (p = 0.17), ΔR1,ss (p = 0.035), ve (p = 0.006), and ADC (p = 0.016). In IDH-mutant gliomas (IDHm), previous treatment determined higher Ktrans and ΔR1,ss (p = 0.026). In TN-gliomas, dynamic SAGE-EPI metrics tended to be influenced by IDH status (p ranging 0.09–0.14). TRATE values above 142 mM−1s−1 were exclusively seen in TN-IDHwt, and, in TN-gliomas, this cutoff had 89% sensitivity and 80% specificity as a predictor of Ki67 > 10%. Conclusions: Dynamic SAGE-EPI enables simultaneous quantification of brain tumor perfusion and permeability, as well as mapping of novel metrics related to cytoarchitecture (TRATE) and blood–brain barrier disruption (ΔR1,ss), with a single contrast injection. Clinical relevance statement: Simultaneous DSC and DCE analysis with dynamic SAGE-EPI reduces scanning time and contrast dose, respectively alleviating concerns about imaging protocol length and gadolinium adverse effects and accumulation, while providing novel leakage effect metrics reflecting blood–brain barrier disruption and tumor tissue cytoarchitecture. Key Points: • Traditionally, perfusion and permeability imaging for brain tumors requires two separate contrast injections and acquisitions. • Dynamic spin-and-gradient-echo echoplanar imaging enables simultaneous perfusion and permeability imaging. • Dynamic spin-and-gradient-echo echoplanar imaging provides new image contrasts reflecting blood–brain barrier disruption and cytoarchitecture characteristics. [ABSTRACT FROM AUTHOR]
– Name: AbstractSuppliedCopyright
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  Data: <i>Copyright of European Radiology is the property of Springer Nature and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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        Value: 10.1007/s00330-023-10215-z
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      – SubjectFull: Magnetic resonance imaging
        Type: general
      – SubjectFull: Gliomas
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      – SubjectFull: Brain tumors
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      – SubjectFull: Permeability
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              Text: May2024
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