Effects of Three Different Doses of a Bolus Injection of Gadodiamide: Assessment of Regional Cerebral Blood Volume Maps in a Blinded Reader Study
Roland Bruening
,a,
Christian Berchtenbreitera,
Nicolaus Holzknechta,
Marco Essiga,
Ren Hua Wua,
Andrew Simmonsa,
Andreas Heucka,
Anne Mascheka,
Monika Meusela,
Steve C. R. Williamsa,
Tim Coxa,
Michael V Knoppa and
Maximilian Reisera
a From the Institute of Clinical Radiology, Klinikum Grosshadern, University of Munich, Germany (R.B., C.B., N.H., R.H.W., A.H., M.R.); German Cancer Research Center (DKFZ), Heidelberg, Germany (M.E., M.V.K.); Neuroimaging Research, Institute of Psychiatry & Maudsley Hospital, London, United Kingdom (A.S., S.C.R.W., T.C.); and Nycomed Amersham Arzneimittel GmbH, Ismaning, Germany (A.M., M.M.).
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FIG 1. Tumor grade versus dose (given for the three dose groups: 0.1, 0.2, and 0.3 mmol/kg body weight (bw) (n = 72)
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FIG 2. Low-grade tumor: injected dose, 0.1 mmol/kg.
A, Proton density–weighted image (2300/20/1) in a 38-year-old woman with a homogeneous lesion in the left parietal cortex. The tumor (arrow) was proved histologically to be a grade II glioma according to WHO criteria.
B, Contrast-enhanced T1-weighted image (530/20/1) shows no apparent enhancement in the tumor (arrow).
C, rCBV map confirms a low-grade lesion by exhibiting values below that of normal gray matter (arrows). However, at this dose the contrast within the rCBV maps was rated as limited.
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FIG 3. Low-grade tumor: injected dose, 0.2 mmol/kg.
A, T2-weighted image (2300/85/1) in a 31-year-old man shows a mass in the right frontal cortex with an appearance not unlike that of a low-grade intraaxial brain tumor.
B, Contrast-enhanced T1-weighted image (530/20/1) shows a tumor without contrast enhancement (arrow).
C, rCBV map shows low values in the tumor (arrows), confirmed to be a WHO grade II glioma. The contrast effect and the image quality of the rCBV map were graded superior to that in figure 2.
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FIG 4. Low-grade tumor: injected dose, 0.3 mmol/kg.
A, T2-weighted image (2300/85/1) in a 22-year-old woman shows a large mass in the right insular region (white arrow). The dark dots are flow voids from the branches of the middle cerebral artery (black arrow).
B, rCBV map shows low values in the tumor (arrow), even below those of adjacent white matter. The lesion was confirmed to be a WHO grade II glioma.
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FIG 5. High-grade tumor: injected dose, 0.1 mmol/kg.
A, Contrast-enhanced T1-weighted image (530/20/1) in a 44-year-old man with a mass in the left central region shows irregular contrast enhancement (arrow).
B, rCBV map shows elevation of the rCBV of the tumor (arrow) but with little contrast. The lesion was confirmed to be a WHO grade VI glioma.
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FIG 6. High-grade tumor: injected dose, 0.2 mmol/kg.
A, Contrast-enhanced T1-weighted image (530/20/1) in a 50-year-old man examined 4 month after initial surgery for a WHO grade VI glioma suggests recurrent tumor (arrow).
B, rCBV map shows elevated values of the tumor in a small rim (arrow), indicative of only a small portion of active tumor with high rCBV.
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FIG 7. High-grade tumor: injected dose, 0.3 mmol/kg.
A, Contrast-enhanced T1-weighted image (530/20/1) shows a large enhancing lesion in a 60-year-old woman. Mass effect and poorly defined margins are also present.
B, rCBV map shows increased values in almost the entire tumor, except for a necrotic region (arrow) in this WHO grade VI glioma.
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