This retrospective study evaluated magnetic resonance (MR) perfusion imaging in the study of intracranial tumors; 218 patients were studied with 509 MR examinations. The first aim was to establish the usefulness of perfusion imaging for the differential diagnosis between neoplastic tissue and other lesions both in the first MR examination and in the post therapeutic controls (differentiation of tumor recurrence from radionecrosis). Then we evaluated the presence of infiltrating neoplastic tissue in CBV maps outside the enhancement area to differentiate infiltrating gliomas from metastases. In addition, post surgical evaluation was performed to identify residual neoplastic tissue, mainly if bleeding or inflammatory post surgical cerebral damage did not allow a definitive diagnosis with conventional morphologic images. Lastly, it was assessed whether hypervascularization (evaluated in CBV maps) is a favourable prognostic factor for a positive outcome to radiotherapy. The diagnostic gain of perfusion imaging in all these cases was established evaluating our case records.
BergerMS: Perfusion MR and the evaluation of meningiomas: Is it important surgically?Am J Neuroradiol24: 1499–500, 2003.
5.
CatalaaIHenryRDillonWP: Perfusion, diffusion and spectroscopy values in newly diagnosed cerebral gliomas. NMR Biomed19: 463–75, 2006.
6.
ChaSLupoJMChenMH: Differentiation of glioblastoma multiforme and single brain metastasis by peak height and percentage of signal intensity recovery derived from dynamic susceptibility-weighted contrast-enhanced perfusion MR imaging. Am J Neuroradiol28: 1078–84, 2007.
ChaSJohnsonGWadghiriYZ: Dynamic, contrast-enhanced perfusion MRI in mouse gliomas: Correlation with histopathology. Magn Reson Med49: 848–855, 2003.
9.
ErdoganCHakyemezBYildirimN: Brain abscess and cystic brain tumor: Discrimination with dynamic susceptibility contrast perfusion-weighted MRI. J Comput Assist Tomogr29: 663–7, 2005.
10.
ErnstTMChangLWittMD: Cerebral toxoplasmasmosis and lymphoma in AIDS: Perfusion MR imaging experience in 13 patients. Radiology208: 663–9, 1998.
11.
GriebelJMayrNAde VriesA: Assessment of tumor microcirculation: a New role of dynamic contrast MR imaging. J Magn Reson Imaging7: 111–119, 1997.
12.
HakyemezBErdoganCBolcaN: Evaluation of different cerebral mass lesions by perfusion-weighted MR imaging. J Magn Reson Imaging24: 817–24, 2006.
13.
HacklanderTHoferMReichenbachJ: Possibilities of the use of MR tomography-based cerebral blood volume maps in the diagnosis of brain tumors. ROFO163: 484–9, 1995.
14.
HakyemezBErdaganCErcanI: High-grade and low-grade gliomas: Differentiation by using perfusion MR imaging. Clin Radiol60: 493–502, 2005.
15.
HartmannMHeilandSSartorK: Functional MRI procedures in the diagnosis of brain tumors: Perfusion and diffusion-weighted imaging. ROFO174: 955–64, 2002.
16.
HenryRGVigneronDBFischbeinNJ: Comparison of relative cerebral blood volume and proton spectroscopy in patients with treated gliomas. Am J Neuroradiol21: 357–366, 2002.
17.
HuismanTAGM: Posterior Fossa tumors in children: Differential diagnosis and advanced imaging techniques. Neuroradiol J20: 449, 2007
KremerSGrandSRemyC: Contribution of dynamic contrast MR imaging to the differentation between dural metastasis and meningioma. Neuroradiology46: 642–8, 2004.
20.
KremerSGrandSRemyC: Cerebral blood volume mapping by MR imaging in the initial evaluation of brain tumors. J Neuroradiol29: 105–13, 2002.
21.
LawMChaSKnoppEA: High-grade gliomas and solitary metastases: Differentiation by using perfusion and proton spectroscopic MR imaging. Radiology222: 715–21, 2002.
22.
LawMHamburgerMJohnsonG: Differentiating surgical from nonsurgical lesions using perfusion MR imaging and proton spectroscopic imaging. Technol Cancer Res Treat3: 557–65, 2004.
23.
LawMKatzmiKWetzelS: Dynamic susceptibility contrast-enhanced perfusion and conventional MR imaging findings for adult patients with cerebral primitive neuroectodermal tumors. Am J Neuroradiol25: 997–1005, 2004.
LawMYoungSWongH: Glioma grading: Sensitivity, specificity and predictive values of perfusion MR imaging and proton spectroscopy imaging compared with conventional MR imaging. Am J Neuroradiol24: 1989–98, 2003.
26.
LawMYoungRBabbJ: Histogram analysis versus region of interest analysis of dynamic susceptibility contrast perfusion MR imaging data in the grading of cerebral gliomas. Am J Neuroradiol28: 761–6, 2007.
27.
Le BasJF: Is perfusion imaging useful for the characterization of brain tumors?J Neuroradiol34: 287–9, 2007.
28.
LefournierVPeoc'hMUssonY: Magnetic resonance cerebral blood volume maps. Comparison with histologic findings in differents types of brain lesions. J Neuroradiol30: 3–9, 2003.
29.
LevMHOzsunarYHensonJW: Glial tumor and grading and outcome prediction using dynamic spin-echo MR susceptibility mapping compared with conventional contrast-enhanced MR: Confounding effect of elevated rCBV of oligodendrogliomas. Am J Neuroradiol25: 214–21(erratum), 2004.
30.
LupoJMChaSChangSM: Dynamic susceptibility-weighted perfusion imaging of high grade gliomas: Characterization of spatial heterogenity. Am J Neuroradiol26: 1446–54, 2005.
31.
MaiaACJrMalheirosSMda RochaAJ: MR cerebral blood volume maps correlated with vascular endothelial growth factor expression and tumor grade in nonenhancing gliomas. Am J Neuroradiol26: 777–83, 2005.
32.
MetellusPAit AmeurAFaillotT: Contribution of magnetic resonance perfusion imaging in a patient with cerebral ganglioglioma. Neurochirurgie48: 426–30, 2002.
33.
PivawerGLawMZagzagD: Perfusion MR imaging and proton MR spectroscopic imaging in differentiating necrotizing cerebritis from glioblastoma multiforme. Magn Reson Imaging25: 238–43, 2007.
34.
PreulCKuhnBLangEW: Differentiating of cerebral tumors using multi-section echo planar MR perfusion imaging. Eur J Radiol48: 244–51, 2003.
35.
PrincipiMItalianiMGuiducciA: Perfusion MRI in the evaluation of the relationship between tumor growth, necrosis and angiogenesis in glioblastomas and grade 1 meningiomas. Neuroradiology45: 205–11, 2003.
36.
RobertsHCRobertsTPBraschRC: Quantitative measurement of microvascular permeability in human brain tumors achieved using dynamic contrast-enhanced MR imaging: Correlation with histologic grade. Am J Neuroradiol21: 891–99, 2000.
37.
SchmaidaKMRandSDJosephAM: Characterization of a first-pass gradient-echo spin-echo method to predict brain tumor grade and angiogenesis. Am J Neuroradiol25: 1524–32, 2004. Erratum in: Am J Neuroradiol26: 686, 2005.
38.
ShinJHLeeHKKwunBD: Using relative cerebral blood flow and volume to evaluate the histopathologic grade of cerebral gliomas: Preliminary results. Am I Roentgenol179: 783–9, 2002.
39.
SiegalTRubisteinRTzuk-ShinaT: Utility of relative cerebral blood mapping derived from perfusion magnetic resonance imaging in the routin follow-up of brain tumors. J Neurosurg86: 22–7, 1997.
40.
SpampinatoMVSmithJKKwockL: Cerebral blood volume measurements and proton MR spectroscopy in grading of oligodendroglial tumors. Am J Roentgenol188: 204–12, 2007.
41.
SugaharaTKorogiYTomiguchiS: Posttherapeutic intraaxial brain tumor: The value of perfusion-sensitive contrast-enhanced MR imaging for differentiating tumor recurrence from nonneoplastic contrast-enhancing tissue. Am J Neuroradiol21: 901–9, 2000.
42.
SugaharaTKorogiYShigematsuY. Perfusion-sensitive MRI of cerebral lymphomas: a Preliminary report. J Comput Assist Tomogr23: 232–7, 1999.
43.
SugaharaTKorogiYKochiM: Correlation of MR imaging determined cerebral blood volume maps with histologic and angiographic determination of vascularity of gliomas. Am J Roentgenol17: 1479–86, 1998.
44.
WeberMALichyMPThilmannC: Monitoring of irradiated brain metastases using MR perfusion imaging and 1H MR spectroscopy. Radiologe43: 388–95, 2003.
45.
WongJCProvenzaleJMPetrellaJR: Perfusion MR imaging of brain neoplasms. Am J Roentgenol174: 1147–57, 2000.
46.
YangSWetzelSLawM: Dynamic contrast-enhanced T2*-weighted MR imaging of gliomatosis cerebri. Am J Neuroradiol23: 350–5, 2002. Erratum in: Am J Neuroradiol 23: A 14, 2002.
47.
BendszusMWarmuth-MetzMKleinR: MR spectroscopy in gliomatosis cerebri. Am J Neuroradiol21: 375–80, 2000.
48.
BulakbasiNKocaoglumM: Efficacy of in vivo 31 Phosphorus Magnetic Resonance Spectroscopy in differentiation and staging of adult human brain tumors. Neuroradiol J20: 646, 2007.
49.
BulakbasiNKocaogluMOrsF: Combination of single-voxel proton MR spectroscopy and apparent diffusion coefficient calculation in the evaluation of common brain tumors. Am J Neuroradiol24: 225–33, 2003.
50.
ButzenJProstRChettyV: Discrimination between neoplastic and nonneoplastic brain lesions by use of proton MR spectroscopy: The limits of accuracy with a logistic regression model. Am J Neuroradiol21: 1213–9, 2000.
51.
ChiangICKuoYTLuCY: Distinction between high-grade gliomas and solitary metastases using peritumoral 3-T magnetic resonance spectroscopy, diffusion and perfusion imagings. Neuroradiology46: 619–27, 2004.
52.
CroteauDScarpaceLHearshenD: Correlation between magnetic resonance spectroscopy imaging and image-guided biopsies: Semiquantitative and qualitative histopathological analyses of patients with untreated glioma. Neurosurgery49: 823–9, 2001.
53.
Di CostanzoAScarabinoTTrojsiF: Multiparametric 3T MR approach to the assessment of cerebral gliomas: Tumor extent and malignancy. Neuroradiology48: 622–31, 2006.
54.
DowlingCBollenAWNoworolskiSM: Preoperative proton MR spectroscopic imaging of brain tumors: Correlation with histopathologic analysis of resection specimens. Am J Neuroradiol22: 597–8, 2001.
55.
GravesEENelsonSJVigneronDB: Serial proton MR spectroscopic imaging of recurrent malignant gliomas after gamma knife radiosurgery. Am J Neuroradiol22: 598–9, 2001.
56.
JenkinsonMDDu PlessisDGWalkerC: Advanced MRI in the management of adult gliomas. Br J Neurosurg21: 550–61, 2007.
57.
MagalhaesAGodfreyWShenY: Proton magnetic resonance spectroscopy of brain tumors correlated with pathology. Acad Radiol12: 51–7, 2005.
58.
Moller-HartmannWHerminghausSKringsT: Clinical application of proton magnetic resonance spectroscopy in the diagnosis of intracranial mass lesions. Neuroradiology44: 371–81, 2002.
59.
OhJHenryRGPirzkallA: Survival analysis in patients with glioblastoma multiforme: Predictive value of choline-to-N-acetyl aspartate index, apparent diffusion coefficient, and relative cerebral blood volume. J Magn Reson Imaging19: 546–54, 2004.
60.
PlotkinMEisenacherJBruhnH: 123I-IMT SPECT and 1H MR-spectroscopy at 3.0 T in the differential diagnosis of recurrent of residual gliomas: a comparative study. J Neurooncol70: 49–58, 2004.
61.
PoptaniHGuptaRKRoyR: Characterization of intracranial mass lesions with in vivo proton MR spectroscopy. Am J Neuroradiol16: 1593–603, 1995.
62.
RockJPHearshenDScarpaceL: Correlations between magnetic resonance spectroscopy and image-guided histopathology, with special attention to radiation necrosis. Neurosurgery51: 912–9, 2002.
63.
SaindaneAMChaSLawM: Proton MR spectroscopy of tumefactive demyelinating lesions. Am J Neuroradiol23: 1378–86, 2002.
64.
ShimizuHKumabeTTominagaT: Noninvasive evaluation of malignancy of brain tumors with proton MR spectoscopy. Am J Neutoradiol17: 737–47, 1996.
65.
TzikaAAAstrakasLGZafiriMK: Spectroscopic and perfusion magnetic resonance imaging predictors of progression in pediatric brain tumors. Cancer100: 1246–56, 2004.
66.
TzikaAAChengLLGoumnerovaL: Biochemical Characterization of pediatric brain tumors by using in vivo and ex vivo magnetic resonance spectroscopy. J Neurosurg96: 1023–31, 2002.
67.
VirtaAPatronasNRamanR: Spectroscopic imaging of radiation-induced effects in the white matter of glioma patients. Magn Reson Imaging18: 851–7, 2000.
68.
WeberMAZoubaaSSchlieterM: Diagnostic performance of spectroscopic and perfusion MRI for distinction of brain tumors. Neurology66: 1899–906, 2006. Erratum in: Neurology67: 920, 2006.
WuWCChenCYChungHW: Discrepant MR spectroscopic and perfusion imaging results in a case of malignant transformation of cerebral glioma. Am J Neuroradiol23: 1775–8, 2002.
71.
Al-OkailiRNKrejzaJWangS: Advanced MR imaging techniques in the diagnosis of intraaxial brain tumors in adults. Radiographics26: 173–89, 2006.
72.
BulakbasiNGuvencIOnguruO: The added value of the apparent diffusion coefficient calculation to magnetic resonance imaging in the differentiation and grading of malignant brain tumors. J Comput Assist Tomogr2886: 735–46, 2004.
73.
CastilloMSmithJKKwockL: Apparent diffusion coefficients in the evaluation of high-grade cerebral gliomas. Am J Neuroradiol22: 60–4, 2001.
74.
CottonFOngolo-ZogoPLouis-TisserandG: Diffusion and perfusion MR imaging in cerebral lymphomas. J Neuroradiol33: 220–8, 2006.
75.
HartingIHartmannMBonsantoMM: Characterization of necrotic meningioma using diffusion MRI, perfusion MRI and MR spectroscopy: Case report and review of the literature. Neuroradiology46: 189–93, 2004.
76.
HeinPAEskeyCJDunnJF: Diffusion-weighted imaging in the follow-up of treated high-grade gliomas: Tumor recurrence versus radiation injury. Am J Neuroradiol25: 201–9, 2004.
77.
KonoKInoueYNakayamaK. The role of diffusion-weighted imaging in patients with brain tumors. Am J Neuroradiol26: 1081–8, 2001.
78.
KrabbeKGideonPWagnP: MR diffusion imaging of human intracranial tumors. Neuroradiology39: 483–9, 1997.
79.
Le BarsECondry-JouetCDeramondH: MR diffusion and perfusion imaging in clinical practice. J Neuroradiol27: 39–51, 2000.
80.
MutiMAprileIPrincipiM: Study on the variations of the apparent diffusion coefficientin areas of solid tumor in high grade glioma. Magn Reson Imaging20: 635–41, 2002.
81.
PauleitDLangenKJFloethF: Can the apparent diffusion coefficient be used as a noninvasive parameter to distinguish tumor tissue from peritumoral tissue in cerebral gliomas?J Magn Reson Imaging20: 758–64, 2004.
82.
PriceSJ: The role of advanced MR imaging in understanding brain tumour pathology. Br J Neurosurg21: 562–75, 2007.
83.
RollinNGuyotatJStreichenbergerN: Clinical relevance of diffusion and perfusion magnetic resonance imaging in assessing intra-axial brain tumors. Neuroradiology48: 150–9, 2006.
84.
StadnikTWChaskisCMichotteA: Diffusion-weighted MR imaging of intracerebral masses: Comparison with conventional MR imaging and histologic findings. Am J Neuroradiol22: 969–76, 2001.
85.
SugaharaTKorogiYKochiM: Usefulness of diffusion-weighted MRI with echo-planar technique in the evaluation of cellularity in gliomas. J Magn Reson Imaging9: 53–60, 1999.
86.
TienRDFelsbergGJFriedmanH: MR imaging of high-grade cerebral gliomas: Value of diffusion-weighted echoplanar pulse sequences. Am J Roentgenol162: 671–7, 1994.
87.
TokgozNCelikH: Is there a role for Apparent Diffusion Coefficients in the differential diagnosis of brain tumors. The Neuroradiol J19: 322, 2006.
88.
TzikaAAZafiriMKGoumnerovaL: Neuroimaging in pediatric brain tumors: Gd-DTPA-enhanced, hemodynamic, and diffusion MR imaging compared with MR spectroscopic imaging. Am J Neuroradiol23: 322–33, 2002.
89.
YamasakyFKurisuKSatohK: Apparent diffusion coefficient of human brain tumors at MR imaging. Radiology235: 985–91, 2005.
90.
YuhWTTaliETNguyedUD: The effect of contrast dose, imaging time, and lesion size in the MR detection of intracerebral metastasis. Am J Neuroradiol16: 373–80, 1995.
