Skip to main content Accessibility help
×
Hostname: page-component-76d6cb85b7-xh428 Total loading time: 0 Render date: 2026-07-14T04:45:42.779Z Has data issue: false hasContentIssue false

11 - MR perfusion imaging in oncology: neuro applications

from Section 2 - Clinical applications

Published online by Cambridge University Press:  05 May 2013

By
Ramon Francisco Barajas  and
Soonmee Cha
Edited by
Peter B. Barker ,
Xavier Golay  and
Gregory Zaharchuk
Peter B. Barker
Affiliation:
The Johns Hopkins University School of Medicine
Xavier Golay
Affiliation:
National Hospital for Neurology and Neurosurgery, London
Gregory Zaharchuk
Affiliation:
Stanford University Medical Center
Get access

Summary

Introduction

The application of perfusion MRI in clinical neuro-oncology hinges upon the differential expression of angiogenic processes within neoplastic tissues when compared with surrounding normal brain. All neoplastic tissues rely upon the formation of new blood vessels, a biological process known as angiogenesis, to constantly supply nutrients and remove metabolic waste materials. Angiogenesis is a complex biological process that is upregulated by a number of cytokines, including vascular endothelial growth factor (VEGF), which is released within tumors, endothelial cells, and surrounding immune cells [1–5]. As tumor growth occurs beyond its existing blood supply, regional cellular hypoxic and hypoglycemic conditions ensue. This change within the cellular microenvironment promotes the transcription of VEGF that ultimately results in endothelial mitosis, cellular migration, and the formation of new microvasculature, thereby improving tumor nutrient supply that is essential to continued tumor growth and development [1–7].

VEGF expression and angiogenesis is known to vary by tumor type and grade. VEGF expression within gliomas and meningiomas has been associated with increased tumor grade and expression of histologically aggressive vascular features [8–11]. Tumor-related VEGF expression ultimately leads to the abnormal development of microvasculature, resulting in elevated vascular density with disrupted flow characteristics [12–14]. The observation that angiogenesis plays a critical role in tumor growth has led to the development of therapeutic agents which directly inhibit angiogenic activity. The clinical implementation of anti-angiogenic chemotherapeutics has necessitated histological and imaging-based quantification of angiogenic activity.

Information

Type
Chapter
Information
Clinical Perfusion MRI
Techniques and Applications
 , pp. 204 - 237
Publisher: Cambridge University Press
Print publication year: 2013

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Book purchase

Temporarily unavailable

References

Lund, EL, Spang-Thomsen, M, Skovgaard-Poulsen, H, Kristjansen, PE.Tumor angiogenesis–a new therapeutic target in gliomas. Acta Neurol Scand 1998;97:52–62.CrossRefGoogle ScholarPubMed
Tate, MC, Aghi, MK.Biology of angiogenesis and invasion in glioma. Neurotherapeutics 2009;6:447–57.CrossRefGoogle ScholarPubMed
Jensen, RL.Brain tumor hypoxia: tumorigenesis, angiogenesis, imaging, pseudoprogression, and as a therapeutic target. J Neurooncol 2009;92:317–35.CrossRefGoogle ScholarPubMed
Wong, ML, Prawira, A, Kaye, AH, Hovens, CM.Tumour angiogenesis: its mechanism and therapeutic implications in malignant gliomas. J Clin Neurosci 2009;16:1119–30.CrossRefGoogle ScholarPubMed
Damert, A, Machein, M, Breier, G, et al. Up-regulation of vascular endothelial growth factor expression in a rat glioma is conferred by two distinct hypoxia-driven mechanisms. Cancer Res 1997;57:3860–4.Google Scholar
Jouanneau, E.Angiogenesis and gliomas: current issues and development of surrogate markers. Neurosurgery 2008;62:31–50; discussion 50–2.CrossRefGoogle ScholarPubMed
Damert, A, Ikeda, E, Risau, W.Activator-protein-1 binding potentiates the hypoxia-inducible factor-1-mediated hypoxia-induced transcriptional activation of vascular-endothelial growth factor expression in C6 glioma cells. Biochem J 1997;327(Pt 2):419–23.CrossRefGoogle Scholar
Sage, MR.Blood-brain barrier: phenomenon of increasing importance to the imaging clinician. AJR Am J Roentgenol 1982;138:887–98.CrossRefGoogle ScholarPubMed
Pietsch, T, Valter, MM, Wolf, HK, et al. Expression and distribution of vascular endothelial growth factor protein in human brain tumors. Acta Neuropathol 1997;93:109–17.CrossRefGoogle ScholarPubMed
Provias, J, Claffey, K, delAguila, L, et al. Meningiomas: role of vascular endothelial growth factor/vascular permeability factor in angiogenesis and peritumoral edema. Neurosurgery 1997;40:1016–26.CrossRefGoogle ScholarPubMed
Dietzmann, K, von Bossanyi, P, Warich-Kirches, M, et al. Immunohistochemical detection of vascular growth factors in angiomatous and atypical meningiomas, as well as hemangiopericytomas. Pathol Res Pract 1997;193:503–10.CrossRefGoogle ScholarPubMed
Assimakopoulou, M, Sotiropoulou-Bonikou, G, Maraziotis, T, Papadakis, N, Varakis, I.Microvessel density in brain tumors. Anticancer Res 1997;17:4747–53.Google ScholarPubMed
Rojiani, AM, Dorovini-Zis, K.Glomeruloid vascular structures in glioblastoma multiforme: an immunohistochemical and ultrastructural study. J Neurosurg 1996;85:1078–84.CrossRefGoogle ScholarPubMed
Izycka-Swieszewska, E.[Immunomorphological analysis of the vascular stroma in glioblastoma]. Neurol Neurochir Pol 2003;37:59–71.Google Scholar
Prayson, RA, Agamanolis, DP, Cohen, ML, et al. Interobserver reproducibility among neuropathologists and surgical pathologists in fibrillary astrocytoma grading. J Neurol Sci 2000;175:33–9.CrossRefGoogle ScholarPubMed
Coons, SW, Johnson, PC, Scheithauer, BW, Yates, AJ, Pearl, DK.Improving diagnostic accuracy and interobserver concordance in the classification and grading of primary gliomas. Cancer 1997;79:1381–93.3.0.CO;2-W>CrossRefGoogle ScholarPubMed
Peters, AM.Fundamentals of tracer kinetics for radiologists. Br J Radiol 1998;71:1116–29.CrossRefGoogle ScholarPubMed
Aronen, HJ, Gazit, IE, Louis, DN, et al. Cerebral blood volume maps of gliomas: comparisons with tumor grade and histological findings. Radiology 1994;191:41–51.CrossRefGoogle Scholar
Knopp, EA, Cha, S, Johnson, G, et al. Glial neoplasms: dynamic contrast-enhanced T2*-weighted MR imaging. Radiology 1999;211:791–8.CrossRefGoogle ScholarPubMed
Cha, S, Knopp, EA, Johnson, G, et al. Dynamic contrast-enhanced T2-weighted MR imaging of recurrent malignant gliomas treated with thalidomide and carboplatin. AJNR Am J Neuroradiol 2000;21:881–90.Google ScholarPubMed
Sugahara, T, Korogi, Y, Shigematsu, Y, et al. Perfusion-sensitive MRI of cerebral lymphomas: a preliminary report. J Comput Assist Tomogr 1999;23:232–7.CrossRefGoogle ScholarPubMed
Sugahara, T, Korogi, Y, Shigematsu, Y, et al. Value of dynamic susceptibility contrast magnetic resonance imaging in the evaluation of intracranial tumors. Top Magn Reson Imaging 1999;10:114–24.CrossRefGoogle ScholarPubMed
Villringer, A, Rosen, BR, Belliveau, JW, et al. Dynamic imaging with lanthanide chelates in normal brain: contrast due to magnetic susceptibility effects. Magn Reson Med 1988;6:164–74.CrossRefGoogle ScholarPubMed
Rosen, BR, Belliveau, JW, Vevea, JM, Brady, TJ.Perfusion imaging with NMR contrast agents. Magn Reson Med 1990;14:249–65.CrossRefGoogle ScholarPubMed
Vonken, EJ, van Osch, MJ, Bakker, CJ, Viergever, MA.Measurement of cerebral perfusion with dual-echo multi-slice quantitative dynamic susceptibility contrast MRI. J Magn Reson Imaging 1999;10:109–17.3.0.CO;2-#>CrossRefGoogle ScholarPubMed
Newbould, RD, Skare, ST, Jochimsen, TH, et al. Perfusion mapping with multiecho multishot parallel imaging EPI. Magn Reson Med 2007;58:70–81.CrossRefGoogle ScholarPubMed
Paulson, ES, Schmainda, KM.Comparison of dynamic susceptibility-weighted contrast-enhanced MR methods: recommendations for measuring relative cerebral blood volume in brain tumors. Radiology 2008;249:601–13.CrossRefGoogle ScholarPubMed
Boxerman, JL, Schmainda, KM, Weisskoff, RM.Relative cerebral blood volume maps corrected for contrast agent extravasation significantly correlate with glioma tumor grade, whereas uncorrected maps do not. AJNR Am J Neuroradiol 2006;27:859–67.Google ScholarPubMed
Sugahara, T, Korogi, Y, Kochi, M, et al. Correlation of MR imaging-determined cerebral blood volume maps with histologic and angiographic determination of vascularity of gliomas. AJR Am J Roentgenol 1998;171:1479–86.CrossRefGoogle ScholarPubMed
Barajas, RF, Hodgson, JG, Chang, JS, et al. Glioblastoma multiforme regional genetic and cellular expression patterns: influence on anatomic and physiologic MR imaging. Radiology 2010;254:564–76.CrossRefGoogle ScholarPubMed
Cha, S, Tihan, T, Crawford, F, et al. Differentiation of low-grade oligodendrogliomas from low-grade astrocytomas by using quantitative blood-volume measurements derived from dynamic susceptibility contrast-enhanced MR imaging. AJNR Am J Neuroradiol 2005;26:266–73.Google ScholarPubMed
Senturk, S, Oguz, KK, Cila, A.Dynamic contrast-enhanced susceptibility-weighted perfusion imaging of intracranial tumors: a study using a 3T MR scanner. Diagn Interv Radiol 2009;15:3–12.Google ScholarPubMed
Sugahara, T, Korogi, Y, Kochi, M, Ushio, Y, Takahashi, M.Perfusion-sensitive MR imaging of gliomas: comparison between gradient-echo and spin-echo echo-planar imaging techniques. AJNR Am J Neuroradiol 2001;22:1306–15.Google ScholarPubMed
Law, M, Cha, S, Knopp, EA, et al. High-grade gliomas and solitary metastases: differentiation by using perfusion and proton spectroscopic MR imaging. Radiology 2002;222:715–21.CrossRefGoogle ScholarPubMed
Cha, S, Lupo, JM, Chen, MH, et al. 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. AJNR Am J Neuroradiol 2007;28:1078–84.CrossRefGoogle ScholarPubMed
Barajas, RF, Chang, JS, Segal, MR, et al. Differentiation of recurrent glioblastoma multiforme from radiation necrosis after external beam radiation therapy with dynamic susceptibility-weighted contrast-enhanced perfusion MR imaging. Radiology 2009;253:486–96.CrossRefGoogle ScholarPubMed
Sugahara, T, Korogi, Y, Tomiguchi, S, et al. Posttherapeutic intraaxial brain tumor: the value of perfusion-sensitive contrast-enhanced MR imaging for differentiating tumor recurrence from nonneoplastic contrast-enhancing tissue. AJNR Am J Neuroradiol 2000;21:901–9.Google ScholarPubMed
Barajas, RF, Chang, JS, Sneed, PK, et al. Distinguishing recurrent intra-axial metastatic tumor from radiation necrosis following gamma knife radiosurgery using dynamic susceptibility-weighted contrast-enhanced perfusion MR imaging. AJNR Am J Neuroradiol 2009;30:367–72.CrossRefGoogle ScholarPubMed
Essig, M, Waschkies, M, Wenz, F, et al. Assessment of brain metastases with dynamic susceptibility-weighted contrast-enhanced MR imaging: initial results. Radiology 2003;228:193–9.CrossRefGoogle ScholarPubMed
Giang, DW, Poduri, KR, Eskin, TA, et al. Multiple sclerosis masquerading as a mass lesion. Neuroradiology 1992;34:150–4.CrossRefGoogle ScholarPubMed
Nesbit, GM, Forbes, GS, Scheithauer, BW, Okazaki, H, Rodriguez, M.Multiple sclerosis: histopathologic and MR and/or CT correlation in 37 cases at biopsy and three cases at autopsy. Radiology 1991;180:467–74.CrossRefGoogle Scholar
Cha, S, Pierce, S, Knopp, EA, et al. Dynamic contrast-enhanced T2*-weighted MR imaging of tumefactive demyelinating lesions. AJNR Am J Neuroradiol 2001;22:1109–16.Google ScholarPubMed
Tofts, PS, Brix, G, Buckley, DL, et al. Estimating kinetic parameters from dynamic contrast-enhanced T(1)-weighted MRI of a diffusable tracer: standardized quantities and symbols. J Magn Reson Imaging 1999;10:223–32.3.0.CO;2-S>CrossRefGoogle Scholar
Tofts, PS, Kermode, AG.Measurement of the blood-brain barrier permeability and leakage space using dynamic MR imaging. 1. Fundamental concepts. Magn Reson Med 1991;17:357–67.CrossRefGoogle ScholarPubMed
Tofts, PS.Modeling tracer kinetics in dynamic Gd-DTPA MR imaging. J Magn Reson Imaging 1997;7:91–101.CrossRefGoogle ScholarPubMed
Patankar, TF, Haroon, HA, Mills, SJ, et al. Is volume transfer coefficient (K(trans)) related to histologic grade in human gliomas?AJNR Am J Neuroradiol 2005;26:2455–65.Google ScholarPubMed
Roberts, HC, Roberts, TP, Bollen, AW, et al. Correlation of microvascular permeability derived from dynamic contrast-enhanced MR imaging with histologic grade and tumor labeling index: a study in human brain tumors. Acad Radiol 2001;8:384–91.CrossRefGoogle ScholarPubMed
Zhu, XP, Li, KL, Kamaly-Asl, ID, et al. Quantification of endothelial permeability, leakage space, and blood volume in brain tumors using combined T1 and T2* contrast-enhanced dynamic MR imaging. J Magn Reson Imaging 2000;11:575–85.3.0.CO;2-1>CrossRefGoogle ScholarPubMed
Hazle, JD, Jackson, EF, Schomer, DF, Leeds, NE.Dynamic imaging of intracranial lesions using fast spin-echo imaging: differentiation of brain tumors and treatment effects. J Magn Reson Imaging 1997;7:1084–93.CrossRefGoogle ScholarPubMed
Lehmann, P, Monet, P, de Marco, G, et al. A comparative study of perfusion measurement in brain tumours at 3 Tesla MR: arterial spin labeling versus dynamic susceptibility contrast-enhanced MRI. Eur Neurol 2010;64:21–6.CrossRefGoogle ScholarPubMed
Jarnum, H, Steffensen, EG, Knutsson, L, et al. Perfusion MRI of brain tumours: a comparative study of pseudo-continuous arterial spin labelling and dynamic susceptibility contrast imaging. Neuroradiology 2010;52:307–17.CrossRefGoogle ScholarPubMed
Tourdias, T, Rodrigo, S, Oppenheim, C, et al. Pulsed arterial spin labeling applications in brain tumors: practical review. J Neuroradiol 2008;35:79–89.CrossRefGoogle ScholarPubMed
Warmuth, C, Gunther, M, Zimmer, C.Quantification of blood flow in brain tumors: comparison of arterial spin labeling and dynamic susceptibility-weighted contrast-enhanced MR imaging. Radiology 2003;228:523–32.CrossRefGoogle ScholarPubMed
Wolf, RL, Wang, J, Wang, S, et al. Grading of CNS neoplasms using continuous arterial spin labeled perfusion MR imaging at 3 Tesla. J Magn Reson Imaging 2005;22:475–82.CrossRefGoogle ScholarPubMed
Kim, HS, Kim, SY.A prospective study on the added value of pulsed arterial spin-labeling and apparent diffusion coefficients in the grading of gliomas. AJNR Am J Neuroradiol 2007;28:1693–9.CrossRefGoogle ScholarPubMed
Weber, MA, Zoubaa, S, Schlieter, M, et al. Diagnostic performance of spectroscopic and perfusion MRI for distinction of brain tumors. Neurology 2006;66:1899–906.CrossRefGoogle ScholarPubMed
Weber, MA, Thilmann, C, Lichy, MP, et al. Assessment of irradiated brain metastases by means of arterial spin-labeling and dynamic susceptibility-weighted contrast-enhanced perfusion MRI: initial results. Invest Radiol 2004;39:277–87.CrossRefGoogle ScholarPubMed
Fellah, S, Girard, N, Chinot, O, Cozzone, PJ, Callot, V.Early evaluation of tumoral response to anti-angiogenic therapy by arterial spin labeling perfusion magnetic resonance imaging and susceptibility weighted imaging in a patient with recurrent glioblastoma receiving bevacizumab. J Clin Oncol 2011;29:e308–11.CrossRefGoogle Scholar
Yamashita, K, Yoshiura, T, Hiwatashi, A, et al. Arterial spin labeling of hemangioblastoma: differentiation from metastatic brain tumors based on quantitative blood flow measurement. Neuroradiology 2012;54:809–13.CrossRefGoogle ScholarPubMed
Luh, WM, Wong, EC, Bandettini, PA, Hyde, JS.QUIPSS II with thin-slice TI1 periodic saturation: a method for improving accuracy of quantitative perfusion imaging using pulsed arterial spin labeling. Magn Reson Med 1999;41:1246–54.3.0.CO;2-N>CrossRefGoogle ScholarPubMed
Petersen, ET, Lim, T, Golay, X.Model-free arterial spin labeling quantification approach for perfusion MRI. Magn Reson Med 2006;55:219–32.CrossRefGoogle ScholarPubMed
Dai, W, Garcia, D, de Bazelaire, C, Alsop, DC.Continuous flow driven inversion for arterial spin labeling using pulsed radiofrequency and gradient fields. Magn Reson Med 2008;60:1488–97.CrossRefGoogle Scholar
Guenther, M, Oshio, K, Feinberg, DA.Single-shot 3D imaging techniques improve arterial spin labeling perfusion measurements. Magn Reson Med 2005;54:491–8.CrossRefGoogle Scholar
Zhang, J, Zaharchuk, G, Moseley, M, et al. Pulsed continuous arterial spin labeling (pcASL) with prospective motion correction (PROMO). Proc Intl Soc Magn Reson Med, Stockholm, Sweden, 2010;5034.Google Scholar

Accessibility standard: Unknown

Why this information is here

This section outlines the accessibility features of this content - including support for screen readers, full keyboard navigation and high-contrast display options. This may not be relevant for you.

Accessibility Information

Accessibility compliance for the PDF of this chapter is currently unknown and may be updated in the future.

Save book to Kindle

To save this book to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×