Quantitative MRI for analysis of peritumoral edema in malignant gliomas

PLoS One. 2017 May 23;12(5):e0177135. doi: 10.1371/journal.pone.0177135. eCollection 2017.

Abstract

Background and purpose: Damage to the blood-brain barrier with subsequent contrast enhancement is a hallmark of glioblastoma. Non-enhancing tumor invasion into the peritumoral edema is, however, not usually visible on conventional magnetic resonance imaging. New quantitative techniques using relaxometry offer additional information about tissue properties. The aim of this study was to evaluate longitudinal relaxation R1, transverse relaxation R2, and proton density in the peritumoral edema in a group of patients with malignant glioma before surgery to assess whether relaxometry can detect changes not visible on conventional images.

Methods: In a prospective study, 24 patients with suspected malignant glioma were examined before surgery. A standard MRI protocol was used with the addition of a quantitative MR method (MAGIC), which measured R1, R2, and proton density. The diagnosis of malignant glioma was confirmed after biopsy/surgery. In 19 patients synthetic MR images were then created from the MAGIC scan, and ROIs were placed in the peritumoral edema to obtain the quantitative values. Dynamic susceptibility contrast perfusion was used to obtain cerebral blood volume (rCBV) data of the peritumoral edema. Voxel-based statistical analysis was performed using a mixed linear model.

Results: R1, R2, and rCBV decrease with increasing distance from the contrast-enhancing part of the tumor. There is a significant increase in R1 gradient after contrast agent injection (P < .0001). There is a heterogeneous pattern of relaxation values in the peritumoral edema adjacent to the contrast-enhancing part of the tumor.

Conclusion: Quantitative analysis with relaxometry of peritumoral edema in malignant gliomas detects tissue changes not visualized on conventional MR images. The finding of decreasing R1 and R2 means shorter relaxation times closer to the tumor, which could reflect tumor invasion into the peritumoral edema. However, these findings need to be validated in the future.

MeSH terms

  • Adult
  • Aged
  • Brain Edema / diagnostic imaging*
  • Brain Edema / etiology
  • Brain Edema / pathology
  • Brain Edema / physiopathology
  • Brain Neoplasms / diagnostic imaging*
  • Brain Neoplasms / pathology
  • Brain Neoplasms / physiopathology
  • Brain Neoplasms / surgery
  • Cerebral Blood Volume
  • Contrast Media
  • Female
  • Gadolinium DTPA
  • Glioma / diagnostic imaging*
  • Glioma / pathology
  • Glioma / physiopathology
  • Glioma / surgery
  • Humans
  • Image Interpretation, Computer-Assisted*
  • Linear Models
  • Magnetic Resonance Imaging / methods*
  • Male
  • Middle Aged
  • Neoplasm Grading
  • Prospective Studies

Substances

  • Contrast Media
  • Gadolinium DTPA

Grant support

This work was supported by a grant from the Medical Research Council of Southeast Sweden, grant number FORSS-234551 (http://www.fou.nu/is/forss/).