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Review
, 20 (4), 699-713

Advanced Techniques Using Contrast Media in Neuroimaging

Affiliations
Review

Advanced Techniques Using Contrast Media in Neuroimaging

Jean-Christophe Ferré et al. Magn Reson Imaging Clin N Am.

Abstract

This article presents an overview of advanced magnetic resonance (MR) imaging techniques using contrast media in neuroimaging, focusing on T2*-weighted dynamic susceptibility contrast MR imaging and T1-weighted dynamic contrast-enhanced MR imaging. Image acquisition and data processing methods and their clinical application in brain tumors, stroke, dementia, and multiple sclerosis are discussed.

Conflict of interest statement

Conflict of Interest:

Dr Ferré: none

Dr Shiroishi: Consultant, Bayer Healthcare

Dr Law serves on the scientific advisory boards for Bayer HealthCare, Toshiba Medical, has received speaker honoraria from Siemens Medical Solutions, iCAD Inc, Bayer HealthCare, Bracco, Prism Clinical Imaging

Figures

Fig. 1
Fig. 1
Dynamic susceptibility contrast imaging (DSC-MRI)- left column- and dynamic contrast-enhanced MRI imaging (DCE-MRI) - right column- principles overview. Sample time series images during the passage of the contrast agent - first row- and the resulting time signal course - second row. The image processing based on the time curve allows to extract qualitative or quantitative metrics of perfusion (DSC-MRI) and/or permeability (DCE-MRI) and obtain parametric maps.
Fig. 2
Fig. 2
Differential diagnostic of brain tumor using DSC-MRI. Both patients presented with a mass demonstraing central necrosis and peripheral enhancement (A, D). In a brain abscess, (upper row) DSC-MRI demonstrates a low rCBV ratio (C) without visible increased perfusion on the rCBV color map (B), whereas in a brain tumor, in this case a metastasis, (lower row), DSC-MRI demonstrates an increase perfusion within enhanced parts of the lesion (E) with a high rCBV ratio (F).
Fig. 3
Fig. 3
Differential diagnosis of an intracranial mass using DSC-MRI. Both patients presented with a peripherally enhancing, centrally necrotic mass (A, E). In Balo concentric sclerosis (upper row), DSC-MRI demonstrates a low rCBV ratio (C) without visible increased perfusion on the rCBV color map (B). Concentric enhancement of the lesion is seen on sagittal post-contrast T1-weighted image (D). In a high-grade glioma (lower row), DSC-MRI demonstrates increased perfusion within the enhancing portions s of the lesion (F) with a high rCBV ratio (G).
Fig. 4
Fig. 4
Differentiation of brain tumors involving the corpus callosum using DSC-MRI: glioblastoma (upper row), primary CNS lymphoma (middle row) and low-grade glioma (lower row). Contrast enhancement within the tumor seen on axial T1-weighted image post-gadolinium does not discriminate glioblastoma (A) from and lymphoma (D). rCBV color maps demonstrates increased perfusion within glioblastoma(B), but not within lymphoma (E). The rCBV ratio - tumoral rCBV /normal brain rCBV- is elevated (>1.75) for glioblastoma and low for lymphoma. The non-enhancing low-grade glioma, seen with increased signal on FLAIR images (G) has decreased perfusion on rCBV map (H) with a low rCBV ratio. Visual inspection of the curve demonstrates a high percentage signal recovery within lymphoma (F-double arrow), not visible for low grade glioma (I).
Fig. 5
Fig. 5
Post-therapeutic evaluation of high-grade glioma using DSC-MRI and DCE-MRI. Both patients demonstrate increased contrast enhancement 3 months following combined chemoradiotherapy with temozolomide. (A, F). Pseudoprogression may demonstrate decreased perfusion with a low rCBV ratio using DSC-MRI (B, C) and moderate vascular permeability (D, E) with a progressive enhancement (E) using DCE-MRI. True early progression may demonstrate increased perfusion with a high rCBV ratio (G, H) with high permeability and rapid enhancement (I, J).
Fig. 6
Fig. 6
Acute ischemic stroke in left middle cerebral artery territory, due to a left internal carotid artery occlusion (C). Diffusion-weighted image (A) and ADC map (B) demonstrates an ischemic core smaller than the hypoperfused territory seen on TTP (D) or MTT (E) maps, as red area. The perfusion/diffusion mismatch – difference between these two volumes- is considered as the tissue at risk to infarction without arterial recanalization.

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