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Preoperative Assessment of Intracranial Tumors with Perfusion MR and a Volumetric Interpolated Examination: A Comparative Study with DSA

Stephan G. Wetzela, Soonmee Chaa, Meng Lawa, Glyn Johnsona, John Golfinosb, Peter Leea and Peter Kim Nelsona

a Department of Radiology, New York University Medical Center, NY
b Department of Neurosurgery, New York University Medical Center, NY



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  		FIG 1. Relationship between maximum rCBV and angiographic vascularity. Scores are as follows: 0 indicates occult; 1, mild blush; 2, moderate blush; and 3, exuberant. The correlation between the two parameters is shown by the dotted line (r = 0.75; P < .05). The average rCBV and the standard deviation are displayed for each group of angiographic vascularity scores.



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  		FIG 2. Images in a 57-year-old patient with left parietal glioblastoma multiforme.

A, Color overlay map reconstructed from pMRI (1000/54) shows marked hyperperfusion of the lesion compared with normal white matter.

B, Para-axial source image of the 3D VIBE acquisition (8.8/4.4; flip angle, 18°) shows a contrast-enhancing tumor with a necrotic center. Note the prominent cerebral vein posterior to the tumor (arrow).

C, Real-time MIP image with 30-mm thickness was reconstructed in position of the image in A and shows the relation of the tumor to the cortical veins and the superior sagittal sinus. The more distal part of the overlying cortical vein (arrow) is not included in the volume. As a result of the MIP algorithm, the tumor appears solid.

D, Coronal source image shows an overlying cortical vein (arrow) in relation to the tumor. The line in parasagittal plane shows the orientation of the image in E.

E, Real-time parasagittal MIP image with 10-mm thickness shows the distal part of the vein in its course (arrows).

F, Venous-phase DSA image obtained with an injection in the left internal carotid artery shows persistent tumor blush (arrow). Compare the display of the overlying cortical vein (arrowheads) to the image in E.



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  		FIG 3. Images in a 46-year-old patient with left parasagittal meningioma.

A, Real-time para-axial MIP image with 30-mm thickness shows occlusion (open arrow) of the superior sagittal sinus by the tumor, which has lower signal intensity compared with that of the sinus. Note the extensive collateral cortical veins (solid arrows) draining the frontal part of the sinus.

B, Venous-phase DSA obtained with an injection in the left common carotid artery shows occlusion of the sinus (solid arrow) and prominent frontal collateral cortical veins (open arrow).



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  		FIG 4. Sagittal (A) and parasagittal (B) images in a 44-year-old patient with recurrent left parietal glioblastoma multiforme. Sagittal source images lateral to the contrast-enhancing part of the tumor show a cortical vein (large arrow), which blends with the tumor in the medial part (small arrows in B) and can not be distinguished from the tumor. On conventional angiograms (not shown), the vein was patent.



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  		FIG 5. Images in a 42-year-old patient with meningioma in right cerebellopontine angle.

A, Real-time para-axial MIP image with 15-mm thickness shows the sigmoid sinus (small arrows) in relation to a meningioma (large arrow), which has signal intensity lower than that of the sinus. No signs of tumor infiltration are depicted.

B, Real-time paracoronal MIP image with 2-mm thickness shows the relation of the posterior fossa arteries to the tumor. Gaps in the basilar artery (large horizontal arrows) and in the right posterior cerebral artery (large vertical arrow) are due to partial volume effects. The proximal superior cerebellar artery is shown with great detail (small arrows).





Copyright © 2009 by the American Society of Neuroradiology. Print ISSN: 0195-6108 Online ISSN: 1936-959X