Intra-Arterial MR Perfusion Imaging of Meningiomas: Comparison to Digital Subtraction Angiography and Intravenous MR Perfusion Imaging

Abstract

Background and PurposeTo evaluate the ability of IA MR perfusion to characterize meningioma blood supply.MethodsStudies were performed in a suite comprised of an x-ray angiography unit and 1.5T MR scanner that permitted intraprocedural patient movement between the imaging modalities. Patients underwent intra-arterial (IA) and intravenous (IV) T2* dynamic susceptibility MR perfusion immediately prior to meningioma embolization. Regional tumor arterial supply was characterized by digital subtraction angiography and classified as external carotid artery (ECA) dural, internal carotid artery (ICA) dural, or pial. MR perfusion data regions of interest (ROIs) were analyzed in regions with different vascular supply to extract peak height, full-width at half-maximum (FWHM), relative cerebral blood flow (rCBF), relative cerebral blood volume (rCBV), and mean transit time (MTT). Linear mixed modeling was used to identify perfusion curve parameter differences for each ROI for IA and IV MR imaging techniques. IA vs. IV perfusion parameters were also directly compared for each ROI using linear mixed modeling.Results18 ROIs were analyzed in 12 patients. Arterial supply was identified as ECA dural (n = 11), ICA dural (n = 4), or pial (n = 3). FWHM, rCBV, and rCBF showed statistically significant differences between ROIs for IA MR perfusion. Peak Height and FWHM showed statistically significant differences between ROIs for IV MR perfusion. RCBV and MTT were significantly lower for IA perfusion in the Dural ECA compared to IV perfusion. Relative CBF in IA MR was found to be significantly higher in the Dural ICA region and MTT significantly lower compared to IV perfusion.

Preoperative embolization of skull base meningiomas: current indications, techniques, and pearls for complication avoidance

“…Although its use is in the experimental stages, intraarterial MR perfusion may allow quantitative evaluation of ECA versus ICA pial supply to the tumor. 36 This may help surgeons better determine the benefit of embolization prior to beginning intervention.…”

Non-invasive qualitative and semiquantitative presurgical investigation of the feeding vasculature to intracranial meningiomas using superselective arterial spin labeling

“…The methodology used in the study restricted the use of ASL to the flow territories of the ECA. Lum and coworkers used DSC-MRI with intraarterial bolus injection to differentiate between pial and dural supply [8]. Their approach is invasive, requires contrast injection and further postprocessing.…”

“…CT or MRI based angiography techniques like CTA or TOF are non-selective and cannot quantitatively differentiate the contribution of multiple feeding vessels [5,6]. Perfusion techniques like CTP or DSC-MRI require the administration of contrast agent and additional tracer kinetic analysis [7,8].…”

PET/MR Imaging of Somatostatin Receptor Expression and Tumor Vascularity in Meningioma: Implications for Pathophysiology and Tumor Outcomes

“…Meningiomas, highly vascular neoplasms arising from the arachnoid cap cells, are the most common primary intracranial tumor, accounting for approximately 40% of all primary brain tumors (1). Various histopathological classification systems have been utilized for their characterization, with the current 2021 World Health Organization (WHO) classification of central nervous system (CNS) tumors recognizing 15 distinct histological subtypes, subdivided into three grades-Grade 1 (benign), Grade 2 (atypical), and Grade 3 (malignant)-relying largely on mitotic rate, histological, and cytomorphological criteria (2,3).…”