Quantification of cerebral perfusion using the "bookend technique": an evaluation in CNS tumors

Magn Reson Imaging. 2008 Dec;26(10):1352-9. doi: 10.1016/j.mri.2008.04.010. Epub 2008 Jun 5.


We present a method of quantifying cerebral blood volume using dynamic susceptibility contrast. Our approach combines T(2)-weighted echo planar imaging (EPI) pulse sequences and reference scans that determine the parenchymal T(1) changes resulting from an injection of a gadolinium chelate. This combined T(2)- and T(1)-weighted approach (the "bookend" technique) has been shown to be effective in the quantification of gradient-echo (GRE) (T(2)*-weighted) perfusion images but has not been applied to spin-echo EPI (SE-EPI) (T(2)-weighted) images. The physics related to blood volume measurement based on T(2)- and T(2)*-weighted EPI sequences is known to be different, and there is a question as to whether the bookend approach is effective with SE-EPI. We have compared the quantitative SE-EPI with GRE-EPI in a series of patients with central nervous system (CNS) tumors. We found that quantitative cerebral blood volume (qCBV) values for SE-EPI and GRE-EPI are in agreement with each other and with historical reference values. A subjective evaluation of image quality showed that image quality in the SE-EPI scans was high and exhibited high interreader agreement. We conclude that measuring qCBV using the bookend technique with SE-EPI images is possible and may be a viable alternative to GRE-EPI in the evaluation of CNS tumors.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Blood Volume
  • Brain Neoplasms / diagnosis*
  • Cerebrovascular Circulation
  • Contrast Media
  • Feasibility Studies
  • Female
  • Gadolinium DTPA
  • Humans
  • Image Interpretation, Computer-Assisted
  • Magnetic Resonance Imaging / methods*
  • Male
  • Middle Aged
  • Retrospective Studies


  • Contrast Media
  • Gadolinium DTPA