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Review ArticleReview Article
Open Access

Perfusion CT Imaging of Brain Tumors: An Overview

R. Jain
American Journal of Neuroradiology October 2011, 32 (9) 1570-1577; DOI: https://doi.org/10.3174/ajnr.A2263
R. Jain
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  • Fig 1.
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    Fig 1.

    CBV and PS perfusion CT maps in a 45-year-old woman with WHO grade II astrocytoma show low blood volume (CBV = 0.70 mL/100 g) and low permeability (PS = 0.65 mL/100 g/min) within the tumor (arrows). Inset: Postcontrast T1-weighted image shows a nonenhancing left temporal tumor with no surrounding perilesional edema.

  • Fig 2.
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    Fig 2.

    PCT maps in a 50-year-old man with glioblastoma multiforme. The CBV map shows high blood volume (CBV = 4.56 mL/100 g), and the PS map shows high permeability (PS = 3.78 mL/100 g/min) along the enhancing nodular margins of the tumor (arrow). Inset: Postcontrast T1-weighted image shows a heterogeneously enhancing mass with irregular central necrosis in the right parietal region.

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    Fig 3.

    PCT maps in a 39-year-old woman with heterogeneously enhancing grade III glioma involving the left temporal lobe. CBV and PS maps show an enhancing region laterally. Region of interest 7 demonstrates the highest PS (8.52 mL/100 g/min), but not the highest CBV (4.73 mL/100 g) within the tumor; whereas region of interest 8 shows relatively lower PS (1.14 mL/100 g/min) but the highest CBV within the tumor (11.65 mL/100 g), suggesting that there is marked heterogeneity within high-grade gliomas, which could be due to the heterogeneity of tumor angiogenesis. Inset: Postcontrast T1-weighted axial images show a heterogeneously enhancing left temporal lobe tumor.

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    Fig 4.

    A, A 56-year-old man who was previously treated for a right occipital anaplastic astrocytoma, shows a progressive enhancing lesion in the medial aspect of the surgical resection cavity (inset) and PCT CBV map shows high CBV (CBV = 3.5 ml/100 g), suggesting recurrent/progressive tumor (arrows). B, Histopathology proven radiation/treatment necrosis (arrows) in a 34-year-old woman who underwent radiation and chemotherapy for a right fronto-parietal anaplastic astrocytoma shows low CBV (CBV = 1.1 ml/100 g) in a recurrent/progressive enhancing lesion (inset).

  • Fig 5.
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    Fig 5.

    A, Same case as in Fig 4A. PCT PS map shows high PS (PS = 4.2 ml/100 g/min) in the medial aspect of the surgical resection cavity (arrows) in a histopathology proven recurrent/progressive tumor (inset). B, A 41-year-old man with initial diagnosis of WHO grade II astrocytoma received chemotherapy and radiation. A 33 month follow-up MR image (inset) shows development of a recurrent enhancing lesion. PCT PS map shows low PS (PS = 1.1 ml/100 g/min) suggesting radiation necrosis. The patient underwent open biopsy and histopathology revealed radiation necrosis without viable tumor cells.

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    Fig 6.

    Histopathology-proved TDL in a 45-year-old woman who presented with a very heterogeneously enhancing large lesion in the left frontoparietal periventricular region (inset). PCT CBV and PS maps show low to minimally increased blood volume (CBV = 1.01 mL/100 g) and permeability (PS = 0.40 mL/100 g/min), unlike a high-grade tumor that it was mimicking on postcontrast images, hence, suggesting a non-neoplastic lesion.

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    Fig 7.

    MR image (inset) shows a large nonenhancing mass lesion in the left frontal lobe in a 65-year-old man who presented with headaches. PCT CBV and PS maps show low blood volume and permeability (arrows), suggesting either a low-grade glioma (however, this is slightly unusual considering the associated edema and mass effect) or, more likely, a non-neoplastic lesion. The patient underwent open biopsy, which showed amyloid angiopathy.

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American Journal of Neuroradiology: 32 (9)
American Journal of Neuroradiology
Vol. 32, Issue 9
1 Oct 2011
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Perfusion CT Imaging of Brain Tumors: An Overview
R. Jain
American Journal of Neuroradiology Oct 2011, 32 (9) 1570-1577; DOI: 10.3174/ajnr.A2263

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Perfusion CT Imaging of Brain Tumors: An Overview
R. Jain
American Journal of Neuroradiology Oct 2011, 32 (9) 1570-1577; DOI: 10.3174/ajnr.A2263
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  • Article
    • Abstract
    • Abbreviations
    • In Vivo Perfusion Imaging versus Histopathology
    • Perfusion Parameters and Their Importance
    • PCT Technique
    • Relationship between Glioma Grade and PCT Parameters
    • Heterogeneity of Glioma Angiogenesis and Perfusion Imaging
    • Role of PCT in Differentiating Recurrent Tumor from Radiation Necrosis
    • Differentiating Gliomas from Other Non-Neoplastic Lesions and from Lymphomas
    • Advantages and Limitations of PCT for Brain Tumor Assessment
    • Conclusions
    • References
  • Figures & Data
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  • Clinical Value of Vascular Permeability Estimates Using Dynamic Susceptibility Contrast MRI: Improved Diagnostic Performance in Distinguishing Hypervascular Primary CNS Lymphoma from Glioblastoma
  • Whole-brain Volume Perfusion Computed Tomography: Acquisition Techniques and Radiation Dose
  • Glioma Angiogenesis and Perfusion Imaging: Understanding the Relationship between Tumor Blood Volume and Leakiness with Increasing Glioma Grade
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