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AJNR Am J Neuroradiol. 2019 Apr;40(4):626-633. doi: 10.3174/ajnr.A6015. Epub 2019 Mar 28.

Moving Toward a Consensus DSC-MRI Protocol: Validation of a Low-Flip Angle Single-Dose Option as a Reference Standard for Brain Tumors.

Author information

1
From the Departments of Biophysics (K.M.S., M.A.P.) kathleen@mcw.edu.
2
Radiology (K.M.S., S.D.R.).
3
From the Departments of Biophysics (K.M.S., M.A.P.).
4
Departments of Radiology (L.S.H., Y.Z.).
5
Division of Imaging Research (C.C.Q., N.S., A.S.), Barrow Neurological Institute, Phoenix, Arizona.
6
Neurology (J.M.C.).
7
Neurosurgery (B.A.), Mayo Clinic, Scottsdale, Arizona.
8
Division of Biostatistics, Institute for Health and Society (Y.L., B.L.), Medical College of Wisconsin, Milwaukee, Wisconsin.
9
Department of Diagnostic Imaging (J.L.B., G.B.), Rhode Island Hospital and Warren Alpert Medical School of Brown University, Providence, Rhode Island.

Abstract

BACKGROUND AND PURPOSE:

DSC-MR imaging using preload, intermediate (60°) flip angle and postprocessing leakage correction has gained traction as a standard methodology. Simulations suggest that DSC-MR imaging with flip angle = 30° and no preload yields relative CBV practically equivalent to the reference standard. This study tested this hypothesis in vivo.

MATERIALS AND METHODS:

Eighty-four patients with brain lesions were enrolled in this 3-institution study. Forty-three patients satisfied the inclusion criteria. DSC-MR imaging (3T, single-dose gadobutrol, gradient recalled-echo-EPI, TE = 20-35 ms, TR = 1.2-1.63 seconds) was performed twice for each patient, with flip angle = 30°-35° and no preload (P-), which provided preload (P+) for the subsequent intermediate flip angle = 60°. Normalized relative CBV and standardized relative CBV maps were generated, including postprocessing with contrast agent leakage correction (C+) and without (C-) contrast agent leakage correction. Contrast-enhancing lesion volume, mean relative CBV, and contrast-to-noise ratio obtained with 30°/P-/C-, 30°/P-/C+, and 60°/P+/C- were compared with 60°/P+/C+ using the Lin concordance correlation coefficient and Bland-Altman analysis. Equivalence between the 30°/P-/C+ and 60°/P+/C+ protocols and the temporal SNR for the 30°/P- and 60°/P+ DSC-MR imaging data was also determined.

RESULTS:

Compared with 60°/P+/C+, 30°/P-/C+ had closest mean standardized relative CBV (P = .61), highest Lin concordance correlation coefficient (0.96), and lowest Bland-Altman bias (μ = 1.89), compared with 30°/P-/C- (P = .02, Lin concordance correlation coefficient = 0.59, μ = 14.6) and 60°/P+/C- (P = .03, Lin concordance correlation coefficient = 0.88, μ = -10.1) with no statistical difference in contrast-to-noise ratios across protocols. The normalized relative CBV and standardized relative CBV were statistically equivalent at the 10% level using either the 30°/P-/C+ or 60°/P+/C+ protocols. Temporal SNR was not significantly different for 30°/P- and 60°/P+ (P = .06).

CONCLUSIONS:

Tumor relative CBV derived from low-flip angle, no-preload DSC-MR imaging with leakage correction is an attractive single-dose alternative to the higher dose reference standard.

PMID:
30923088
PMCID:
PMC6461489
[Available on 2019-10-01]
DOI:
10.3174/ajnr.A6015

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