Korean J Radiol.  2002 Sep;3(3):171-179. 10.3348/kjr.2002.3.3.171.

Perfusion MR Imaging: Clinical Utility for the Differential Diagnosis of Various Brain Tumors

• Cho SK
• Na DG
• Ryoo JW
• Roh HG
• Moon CH
• Byun HS
• Kim JH

• KMID: 754059
• DOI: http://doi.org/10.3348/kjr.2002.3.3.171

Abstract

OBJECTIVE
To determine the utility of perfusion MR imaging in the differential diagnosis of brain tumors.
MATERIALS AND METHODS
Fifty-seven patients with pathologically proven brain tumors (21 high-grade gliomas, 8 low-grade gliomas, 8 lymphomas, 6 hemangioblastomas, 7 metastases, and 7 various other tumors) were included in this study. Relative cerebral blood volume (rCBV) and time-to-peak (TTP) ratios were quantitatively analyzed and the rCBV grade of each tumor was also visually assessed on an rCBV map.
RESULTS
The highest rCBV ratios were seen in hemangioblastomas, followed by high-grade gliomas, metastases, low-grade gliomas, and lymphomas. There was no significant difference in TTP ratios between each tumor group (p<0.05). At visual assessment, rCBV was high in 17 (81%) of 21 high-grade gliomas and in 4 (50%) of 8 low-grade gliomas. Hemangioblastomas showed the highest rCBV and lymphomas the lowest.
CONCLUSION
Perfusion MR imaging may be helpful in the differentiation of thevarious solid tumors found in the brain, and in assessing the grade of the various glial tumors occurring there.

Keyword

Brain neoplasms, diagnosis; Brain neoplasms, diagnosis; Brain, perfusion; Magnetic resonance (MR), perfusion study

MeSH Terms

Adolescent
Adult
Aged
Aged, 80 and over
Analysis of Variance
Blood Volume/physiology
Brain/*pathology/physiopathology
Brain Neoplasms/*pathology/physiopathology/secondary
Diagnosis, Differential
Female
Human
Magnetic Resonance Angiography
Magnetic Resonance Imaging
Male
Middle Age
Time Factors

Figure

• 

  Fig. 1 Malignant mixed oligoastrocytoma in a 30-year-old man. Conventional T2-weighted MR image (A) shows a large infiltrative mass with high signal intensity in both frontal lobes and the genu of the corpus callosum. Enhanced T1-weighted MR image (B) reveals no contrast enhancement. rCBV map (C) depicts foci of increased rCBV within the tumor (arrow). The measured rCBV ratio was 16.27.

• 

  Fig. 2 Low-grade astrocytoma in a 39-year-old woman. Conventional T2-weighted MR image (A) reveals the presence of a large infiltrative mass with very high signal intensity in the right frontal lobe. Enhanced T1-weighted MR image (B) shows no contrast enhancement. rCBV map (C) demonstrates homogeneous low rCBV, the ratio of which was 1.82.

• 

  Fig. 3 Diffuse large B-cell lymphoma in a 68-year-old woman. Conventional T2-weighted MR image (A) depicts a round mass with intermediate signal intensity in the left thalamus. Enhanced T1-weighted MR image (B) demonstrates homogeneous intense enhancement, while rCBV map (C) shows homogeneous low rCBV (ratio, 1.72).

• 

  Fig. 4 Metastatic squamous cell carcinoma of the lung in a 56-year-old man. Conventional T2-weighted MR image (A) demonstrates a lobulated mass with intermediate signal intensity in the right cerebellum. Enhanced T1-weighted MR image (B) shows relatively strong enhancement. rCBV map (C) depicts the tumor's relatively high rCBV, the ratio of which was 7.88.

• 

  Fig. 5 Solid hemangioblastoma in a 62-year-old woman. Conventional T2-weighted MR image (A) shows that in the left cerebellum, a lobulated mass with inhomogeneously high signal intensity is present. Enhanced T1-weighted MR image (B) shows strong enhancement. rCBV map (C) demonstrates very high rCBV (ratio, 40.75).

• 

  Fig. 6 Cystic hemangioblastoma in a 16-year-old boy. Enhanced T1-weighted MR image (A) depicts a cystic mass with a strongly enhancing mural nodule (arrow) in the cerebellum. rCBV map (B) reveals very high rCBV (arrow), the measured ratio of which was 34.77.

• 

  Fig. 7 Pilocytic astrocytoma in a 13-year-old girl. Enhanced T1-weighted MR image (A) shows that the cerebellum contains a cystic mass with strongly enhancing mural nodules, similar to the hemangioblastoma shown in Fig. 6. rCBV map (B) indicates that the rCBV ratio of these nodules in high (4.65) (arrows), but lower than that of the hemangioblastoma.

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