Measurement of Blood Perfusion in Spinal Metastases With Dynamic Contrast-Enhanced Magnetic Resonance Imaging

Chu, Stacy; Karimi, Sasan; Peck, Kyung K.; Yamada, Yoshiya; Lis, Eric; Lyo, John; Bilsky, Mark H.; Holodny, Andrei I.

doi:10.1097/brs.0b013e3182a40838

Cited by 64 publications

(80 citation statements)

References 19 publications

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“…The greater vascularity of RCC, when compared with PC, does not imply that RCC must be more permeable than PC. Based on previous a study, 22 post-treatment V p goes down, but K trans does not change or changes to a lesser extent, which may not be significant. Leakage does not mean high vascularity.…”

Section: Discussionmentioning

confidence: 83%

“…18–21 Furthermore, perfusion imaging has been shown to be adept in monitoring the response to radiotherapy of tumors in spinal bone metastases. 22 A recent study has shown that the semi-quantitative metrics extracted from DCE-MRI can differentiate between hypervascular and hypovascular metastatic lesions of the spine. 18 Our aim in this study was to evaluate spinal metastases from RCC and PC using the T1 DCE-MRI perfusion technique and to assess the sensitivity and specificity of perfusion parameters obtained by both quantitative (derived from pharmacokinetic modeling) and semi-quantitative methods, which would allow for noninvasive discrimination between hypovascular and hypervascular spinal metastases.…”

Section: Introductionmentioning

confidence: 99%

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Magnetic Resonance Perfusion Characteristics of Hypervascular Renal and Hypovascular Prostate Spinal Metastases

Saha¹,

Peck²,

Lis³

et al. 2014

Spine

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Study Design Total of 40 patients with spinal metastases from renal cell carcinomas (RCC) or prostate carcinomas (PC) were studied using DCE (Dynamic contrast-enhanced) MRI. Objective Our aim was to evaluate spinal metastases from RCC and PC to assess the sensitivity and specificity of perfusion parameters obtained by quantitative and semi-quantitative methods, which would allow for noninvasive discrimination between hypovascular and hypervascular lesions. Summary of Background Data Conventional MRI can be inconclusive in assessing diagnostically complex spinal lesions in cancer patients in whom fibrosis, infarction, edema related to compression fractures, and infection may simulate malignant neoplasm. Conventional MRI is also of limited value in assessing tumor vascularity and identifying hypervascular tumors. DCE MRI offers an advantage over conventional MRI in that it provides anatomical, physiological, and hemodynamic information about neoplastic lesions. Methods DCE perfusion parameters: vascular permeability (Ktrans), plasma volume (Vp), wash-in slope, and peak-enhancement were measured to assess their potential as discriminators of tumor vascularity. A Mann-Whitney test (at p≤0.01), was performed to quantify and compare significance of perfusion parameters between the two groups. Results Of the four perfusion parameters studied, Vp was observed to have the largest difference in mean (µ) between PC (µ=3.29/sec) and RCC metastases (µ=5.92/sec). This was followed by the peak-enhancement, Ktrans, and wash-in parameters. A Mann-Whitney test showed a significant difference between Vp values for PC and RCC lesions (p≤0.001). Similarly, peak-enhancement showed a significant difference between the two histologies (p≤0.001), as did Ktrans (p≤0.01). The receiver operating characteristic curve showed that Vp recorded the highest area under the curve (0.867). Conclusion Vp was shown to be the best discriminator between spinal metastases from PC and RCC with the mean Vp of RCC metastasis being 1.8 times that of the PC lesions, thus discriminating between hyper- and hypovascular metastases, which has important clinical implications.

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Section: Discussionmentioning

confidence: 83%

Section: Introductionmentioning

confidence: 99%

Magnetic Resonance Perfusion Characteristics of Hypervascular Renal and Hypovascular Prostate Spinal Metastases

Saha¹,

Peck²,

Lis³

et al. 2014

Spine

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“…These quantitative parameters have demonstrated their value in detecting the differences in microvascular environment among metastatic lesions before and after treatment 9 , benign and pathological fractures 10 , and hypovascular and hypervascular lesions. 11,12 Vertebral metastases demonstrate very different histological patterns depending on the primary tumor.…”

Section: Introductionmentioning

confidence: 99%

Differentiating Atypical Hemangiomas and Metastatic Vertebral Lesions: The Role of T1-Weighted Dynamic Contrast-Enhanced MRI

Morales

Arévalo-Pérez²,

Peck

et al. 2018

AJNR Am J Neuroradiol

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Background and Purpose Vertebral hemangiomas are benign vascular lesions that are almost always incidentally found in the spine. Their classic typical hyperintense appearance on T1- and T2-weighted MR images is diagnostic. Unfortunately, not all hemangiomas have the typical appearance and can mimic metastases on routine MRI. These are generally referred to as atypical hemangiomas and can result in misdiagnosis and ultimately to additional imaging, biopsy and unnecessary costs. Our objective is to assess the utility of DCE-MRI perfusion in distinguishing vertebral atypical hemangiomas and malignant vertebral metastases. We hypothesize that permeability and vascular density will be increased in metastases compared to atypical hemangiomas. Materials and Methods Consecutive patients from 2011-2015 with confirmed diagnoses of atypical hemangiomas and spinal metastases from breast and lung carcinoma with available DCE-MRI were analyzed. Time-intensity curves were qualitatively compared among the groups. Perfusion parameters, plasma volume (Vp) and permeability constant (Ktrans), were quantified using an extended Toft’s two-compartment pharmacokinetic model. Statistical significance was tested using Mann-Whitney U test. Results Qualitative inspection of DCE-MRI time-intensity curves demonstrated differences in signal intensity and morphology, between metastases and atypical hemangiomas. Quantitative analysis of Vp and Ktrans perfusion parameters showed a significantly higher values in metastatic lesions when compared to atypical hemangiomas (p<0.001). Conclusions Our data demonstrate that Vp and Ktrans perfusion parameters and qualitative inspection of contrast enhancement curves can be used to differentiate atypical hemangiomas from vertebral metastatic lesions. This works highlights the benefits of adding perfusion maps to conventional sequences that can improve diagnostic accuracy.

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“…DCE-MRI involves assessing changes in signal intensity over time: before and after contrast injection (12). Previous studies have shown that DCE-MRI is useful for monitoring response to therapy in spinal bone metastases (13), and for discriminating between the hypo- and hyper- vascular spinal lesions of prostate carcinoma and renal cell carcinoma, respectively (14). More recently, DCE-MRI has shown clinical utility in chordoma diagnosis, effectively discriminating between chordoma and giant cell tumors of the axial skeleton (15).…”

Section: Introductionmentioning

confidence: 99%

T1-Weighted Dynamic Contrast-Enhanced MR Perfusion Imaging Characterizes Tumor Response to Radiation Therapy in Chordoma

Santos¹,

Peck²,

Arévalo-Pérez³

et al. 2017

AJNR Am J Neuroradiol

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Background and Purpose Chordomas notoriously demonstrate a paucity of changes following radiation therapy on conventional MRI. We hypothesize that dynamic contrast enhanced (DCE) MR perfusion imaging parameters of chordomas would change significantly following radiation therapy. Materials and Methods Eleven pathology-proven chordoma patients who completed DCE MR perfusion imaging pre -and post-radiation therapy were enrolled. Quantitative tumor measurements were taken by two attending neuroradiologists. ROIs were used to calculate vascular permeability (Ktrans) and plasma volume (Vp), and generate dynamic contrast enhancement curves. Quantitative analysis was performed to determine mean and maximum Vp and Ktrans values, while semi-quantitative analysis on averaged concentration curves was used to determine the area under the curve (AUC). A Mann-Whitney U test at a significance level of p<0.05 was used to assess differences of above parameters between pre- and post-radiation therapy. Results Vp mean (pre-treatment μ=0.82, post-treatment μ=0.42), Vp maximum (pre- treatment μ=3.56; post- treatment μ=2.27), and Ktrans mean (pre- treatment μ=0.046; post- treatment μ=0.028) in the ROIs significantly decreased after radiation therapy (p<0.05), thereby demonstrating potential for assessing tumor response. AUC values also demonstrated significant differnces (p<0.05). Conclusions Vp and Ktrans, decreased after radiation therapy, suggesting that these DCE-MR perfusion parameters may be useful for monitoring chordoma growth and response to radiation therapy. Additionally, the characteristic dynamic MR signal intensity time curve of chordoma may provide a radiographic means of distinguishing chordoma from other spinal lesions.

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Measurement of Blood Perfusion in Spinal Metastases With Dynamic Contrast-Enhanced Magnetic Resonance Imaging

Cited by 64 publications

References 19 publications

Magnetic Resonance Perfusion Characteristics of Hypervascular Renal and Hypovascular Prostate Spinal Metastases

Magnetic Resonance Perfusion Characteristics of Hypervascular Renal and Hypovascular Prostate Spinal Metastases

Differentiating Atypical Hemangiomas and Metastatic Vertebral Lesions: The Role of T1-Weighted Dynamic Contrast-Enhanced MRI

T1-Weighted Dynamic Contrast-Enhanced MR Perfusion Imaging Characterizes Tumor Response to Radiation Therapy in Chordoma

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