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Assessment of Diagnostic Accuracy of Perfusion MR Imaging in Primary and Metastatic Solitary Malignant Brain Tumors

Nail Bulakbasi, Murat Kocaoglu, Anar Farzaliyev, Cem Tayfun, Taner Ucoz and Ibrahim Somuncu

From the Department of Radiology, Gulhane Military Medical School, Ankara, Turkey



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  		FIG 1. A 22-year-old man with low-grade oligoastocytoma (WHO II) in left frontoparietal lobe.

A, Axial T2-weighted spin-echo image (2295/90) shows hyperintense mass involving left insula and temporal operculum.

B, Tumor does not demonstrate contrast-enhancement on axial T1-weighted image (583/15), which suggests a LGGT.

C, Gradient-echo axial perfusion MR image (627/30) with rCBV color overlay map shows a low rCBVT value of 1.50 and rCBVP value of 1.18, in keeping with LGGTs.

D, Time-signal intensity and gamma-variate fitted curves from tumoral (red), peritumoral (blue), and normal (purple) areas show prominent decrease in signal intensity from tumoral area. Decreased signal intensity in peritumoral area is at least equal to that of normal gray matter.



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  		FIG 2. A 22-year-old man with centrally located glioblastoma multiforme (WHO IV).

A, Tumor shows heterogeneous hyperintensity with prominent peritumoral edema and/or tumoral infiltration (arrow) on axial T2-weighted SE image (2295/90).

B, There is a significant heterogeneous enhancement in tumoral borders but not in peritumoral area (arrow) on axial T1-weighted image (583/15).

C, Gradient-echo axial perfusion MR image (627/30) with rCBV color overlay map shows both high rCBVT value of 6.58 and rCBVP value of 2.21, which are consistent with HGGT. Peritumoral increased rCBV (arrow) shows tumoral infiltration outside the tumoral margins, which is not perceptible on T2- and contrast-enhanced T1-weighted images.

D, Time-signal intensity and gamma-variate fitted curves from tumoral (red), peritumoral (blue), and normal (purple) areas show prominent decrease in signal intensity from tumoral and peritumoral areas, when compared with signal intensity of normal gray matter.



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  		FIG 3. Scatter plots of the tumoral (A–C) and peritumoral (D–E) rCBV values of different tumor groups show that higher rCBV values are linearly related to higher degree malignancy. Lines are fitted by linear regression with 95% confidence interval. LGGT indicates low-grade glial tumor; HGGT, high-grade glial tumor; MET, metastasis; LGA, low-grade astrocytoma; LGMT, low-grade mixed tumor; HGA, high-grade astrocytoma; HGMT, high-grade mixed tumor; DAS, diffuse astrocytoma; PAS, pilocytic astrocytoma; AAS, anaplastic astrocytoma; GBM, glioblastoma multiforme.



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  		FIG 4. Correlation plots of individual data points show linear correlation between tumoral and peritumoral rCBV values of different tumor groups. Lines are fitted by linear regression with 95% confidence interval.



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  		FIG 5. A 51-year-old man with cystic METs from lung carcinoma located in right temporal lobe.

A, Axial T2-weighted spin-echo image (2295/90), shows hyperintense cystic mass with peritumoral edema and/or infiltration (arrows).

B, Axial contrast-enhanced T1-weighted image (583/15) reveals an irregularly ringlike enhancing mass without any peritumoral contrast enhancement (arrows).

C, Gradient-echo axial perfusion MR image (627/30) with rCBV color overlay map shows a high rCBVT value of 3.05 but low rCBVP value of 1.05, which is consistent with METs. No rCBV increase is present on peritumoral area (arrows).

D, Time-signal intensity and gamma-variate fitted curves from tumoral (red), peritumoral (green), and normal (blue) areas show prominent decrease in signal intensity from tumoral area. Decreased signal intensity in peritumoral area is at least equal to or less than that of normal gray matter.



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  		FIG 6. A 20-year-old man with pilocytic astocytoma (WHO I) in the brain stem.

A, Axial T2-weighted spin-echo image (2295/90), shows hyperintense mass involving brain stem without significant peritumoral edema.

B, Tumor strongly enhances on postcontrast axial T1-weighted image (583/15), which suggests a HGGT.

C, Gradient-echo axial perfusion MR image (627/30) with rCBV color overlay map shows no significant perfusion with a low rCBVT value of 1.14 and rCBVP value of 0.88, in keeping with a LGGT. Very low rCBVP value helps to differentiate it from low-grade astrocytomas (WHO II).

D, Time-signal intensity and gamma-variate fitted curves from tumoral (red), peritumoral (blue), and normal (yellow) areas show prominent decrease in signal intensity from tumoral area. Decreased signal intensity in peritumoral area is similar to that of normal gray matter.





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