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AJNR - American Journal of Neuroradiology

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American Journal of Neuroradiology 27:1059-1069, May 2006
© 2006 American Society of Neuroradiology

BRAIN

Perfusion-Weighted MR Imaging Studies in Brain Hypervascular Diseases: Comparison of Arterial Input Function Extractions for Perfusion Measurement

D. Ducreux^a,b,d, I. Buvat^b, J.F. Meder^c, D. Mikulis^a,d, A. Crawley^d, D. Fredy^c, K. TerBrugge^d, P. Lasjaunias^a and J. Bittoun^e

^a Department of Neuroradiology, C.H.U. de Bicêtre, Paris XI University, Le Kremlin-Bicêtre, France
^b INSERM U 678, CHU Pitié-Salpêtrière, Paris, France
^c DIMF, Centre Hospitalier Sainte-Anne, Paris V University, Paris, France
^d Medical Imaging Department, Toronto Western Hospital, Toronto, Ontario, Canada
^e CIERM, CNRS U2R2M, Le Kremlin Bicêtre, France

Address correspondence to: Denis Ducreux, MD, Department of Neuroradiology, CHU de Bicêtre, Paris XI University, 78 rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France

BACKGROUND AND PURPOSE: Brain hypervascular diseases are complex and induce hemodynamic disturbances on brain parenchyma, which are difficult to accurately evaluate by using perfusion-weighted (PWI) MR imaging. Our purpose was to test and to assess the best AIF estimation method among 4 patients with brain hypervascular disease and healthy volunteers.

METHODS: Thirty-three patients and 10 healthy volunteers underwent brain perfusion studies by using a 1.5T MR imaging scanner with gadolinium-chelate bolus injection. PWI was performed with the indicator dilution method. AIF estimation methods were performed with local, regional, regional scaled, and global estimated arterial input function (AIF), and PWI measurements (cerebral blood volume [CBV] and cerebral blood flow [CBF]) were performed with regions of interest drawn on the thalami and centrum semiovale in all subjects, remote from the brain hypervascular disease nidus. Abnormal PWI results were assessed by using Z Score, and evaluation of the best AIF estimation method was performed by using a no gold standard evaluation method.

RESULTS: From 88% to 97% of patients had overall abnormal perfusion areas of hypo- (decreased CBV and CBF) and/or hyperperfusion (increased CBV and CBF) and/or venous congestion (increased CBV, normal or decreased CBF), depending on the AIF estimation method used for PWI computations. No gold standard evaluation of the 4 AIF estimates found the regional and the regional scaled methods to be the most accurate.

CONCLUSION: Brain hypervascular disease induces remote brain perfusion abnormalities that can be better detected by using PWI with regional or regional scaled AIF estimation methods.

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