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AJNR - American Journal of Neuroradiology

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Analysis of Metabolic Indices in Regions of Abnormal Perfusion in Patients with High-Grade Glioma

J.M. Lupo^a, S. Cha^a, S.M. Chang^b and S.J. Nelson^a,c

^a Departments of Radiology, University of California, San Francisco, Calif
^b Neurological Surgery, University of California, San Francisco, Calif
^c Program in Bioengineering (S.J.N.), University of California, San Francisco, Calif

View larger version (79K): [in this window] [in a new window]   Fig 1. Heterogeneity in the distribution of abnormal perfusion regions within a representative grade IV glioma. A, The region describing only abnormal peak height (aPH) and normal recovery patterns. B, The region consisting of only abnormal recovery (aRec) with normal peak height values. C, The intersection of both abnormal peak height and abnormal recovery (aPH+aRec) is displayed. D and E, The T2 hyperintensity lesion (T2h), which excludes all regions of abnormal perfusion, contrast enhancement, and macroscopic necrosis, and contralateral normal appearing white matter (NAWM).

View larger version (34K): [in this window] [in a new window]   Fig 2. Spectral patterns and regions of abnormal perfusion for a representative patient with nonenhancing grade III glioma. From the summed spectra, a clear elevation of choline (Cho), especially in the aPH region (yellow), and a reduction in creatine (Cre) levels, most notably in the aRec region (red), are observed compared with the contralateral NAWM spectra. Increased lactate (Lac) levels that persist throughout the T1-hypointense lesion are shown by the difference spectra.

View larger version (84K): [in this window] [in a new window]   Fig 3. Perfusion-derived nonparametric maps of peak height (A) and percent recovery (B) overlaid on postcontrast T1-weighted images with corresponding R2* curves (C) for a representative grade IV glioma. D–F, Corresponding metabolite maps of choline (D), creatine (E), and lactate (F).