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Botros NE, Polinger-Hyman D, Beck RT, Kleefisch C, Mrachek EKS, Connelly J, Schmainda KM, Krucoff MO. Magnetic resonance imaging-derived relative cerebral blood volume characteristics in a case of pathologically confirmed neurocysticercosis: illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2023; 6:CASE23446. [PMID: 38109728 PMCID: PMC10732321 DOI: 10.3171/case23446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 11/10/2023] [Indexed: 12/20/2023]
Abstract
BACKGROUND Neurocysticercosis (NCC) is a parasitic infection of the brain caused by ingesting water or food contaminated with tapeworm eggs. When it presents as a solitary mass, differentiation from a primary brain tumor on imaging can be difficult. Magnetic resonance imaging (MRI)-derived relative cerebral blood volume (rCBV) is a newer imaging technique used to identify areas of neovascularization in tumors, which may advance the differential diagnosis. OBSERVATIONS A 25-year-old male presented after a seizure. Computed tomography (CT) and MRI demonstrated a partially enhancing lesion with microcalcifications and vasogenic edema. Follow-up rCBV assessment demonstrated mild hyperperfusion and/or small vessels at the lesional margins consistent with either an intermediate grade glioma or infection. Given the radiological equipoise, surgical accessibility, and differential diagnosis including primary neoplasm, metastatic disease, NCC, and abscess, resection was pursued. The calcified mass was excised en bloc and was confirmed as larval-stage NCC. LESSONS CT or MRI may not always provide sufficient information to distinguish NCC from brain tumors. Although reports have suggested that rCBV may aid in identifying NCC, here the authors describe a case of pathologically confirmed NCC in which preoperative, qualitative, standardized rCBV findings raised concern for a primary neoplasm. This case documents the first standardized rCBV values reported in a pathologically confirmed case of NCC in the United States.
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Affiliation(s)
| | | | | | | | - E Kelly S Mrachek
- 4Pathology, and Division of Neuropathology, Froedtert Hospital, Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | | | - Max O Krucoff
- Departments of2Neurosurgery
- 7Joint Department of Biomedical Engineering, Marquette University & Medical College of Wisconsin, Wisconsin
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2
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Senger KPS, Kesavadas C, Thomas B, Singh A, Multani GS, AN D, Label M, Suchandrima B, Shin D. Experimenting with ASL-based arterialized cerebral blood volume as a novel imaging biomarker in grading glial neoplasms. Neuroradiol J 2023; 36:728-735. [PMID: 37548164 PMCID: PMC10649543 DOI: 10.1177/19714009231193163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023] Open
Abstract
BACKGROUND Perfusion imaging is one of the methods used to grade glial neoplasms, and in this study we evaluated the role of ASL perfusion in grading brain glioma. PURPOSE The aim is to evaluate the role of arterialized cerebral blood volume (aCBV) of multi-delay ASL perfusion for grading glial neoplasm. MATERIALS AND METHODS This study is a prospective observational study of 56 patients with glial neoplasms of the brain who underwent surgery, and only cases with positive diagnosis of glioma are included to evaluate the novel diagnostic parameter. RESULTS In the study, ASL-derived normalized aCBV (naCBV) and T2*DSC-derived normalized CBV (nCBV) are showing very high correlation (Pearson's correlation coefficient value of 0.94) in grading glial neoplasms. naCBV and nCBF are also showing very high correlation (Pearson's correlation coefficient value of 0.876). The study also provides cutoff values for differentiating LGG from HGG for normalized aCBV(naCBV) of ASL, normalized CBV (nCBV), and normalized nCBF derived from T2* DCS as 1.12, 1.254, and 1.31, respectively. ASL-derived aCBV also shows better diagnostic accuracy than ASL-derived CBF. CONCLUSION This study is one of its kind to the best of our knowledge where multi-delay ASL perfusion-derived aCBV is used as a novel imaging biomarker for grading glial neoplasms, and it has shown high statistical correlation with T2* DSC-derived perfusion parameters.
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Affiliation(s)
- Krishna Pratap Singh Senger
- 1Department of Imaging Sciences and Interventional Radiology, Sree Chita Institute of Medical Sciences and Technology, Trivandrum, Kerala, India
| | - C Kesavadas
- 1Department of Imaging Sciences and Interventional Radiology, Sree Chita Institute of Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Bejoy Thomas
- 1Department of Imaging Sciences and Interventional Radiology, Sree Chita Institute of Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Ankita Singh
- Department of Research, Army Hospital Research and Referral, New Delhi, India
| | - Gurpreet Singh Multani
- 1Department of Imaging Sciences and Interventional Radiology, Sree Chita Institute of Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Deepti AN
- 1Department of Imaging Sciences and Interventional Radiology, Sree Chita Institute of Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Marc Label
- Department of Research and Development, GEHealthcare, Calgary, AB, Canada
| | | | - David Shin
- Department of Research and Development, GEHealthcare, Calgary, AB, Canada
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Mustafa S, Matarneh AS, Mohamed A, Fadul A, Musa M, Mohamed RI, Abdallah E, Mohamed TG. Cerebral Neuroschistosomiasis Presenting as a Brain Mass. Cureus 2023; 15:e45418. [PMID: 37854757 PMCID: PMC10581503 DOI: 10.7759/cureus.45418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2023] [Indexed: 10/20/2023] Open
Abstract
Neuroschistosomiasis is a rare manifestation of schistosomal infections presenting with cerebral and spinal cord involvement. We reported a case of a 31-year-old woman who presented with a history of headache, dizziness, and nausea. Brain MRI with contrast showed features suggestive of brain lesion with edema, and a serology test for Schistosoma was positive. She was diagnosed with neuroschistosomiasis and treated with intravenous steroids followed by praziquantel resulting in a significant regression of the brain mass. Cerebral neuroschistosomiasis is a rare complication of Schistosoma infection, and clinicians should consider it among the differential diagnosis of unexplained brain lesions.
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Affiliation(s)
- Salma Mustafa
- Internal Medicine, Hamad Medical Corporation, Doha, QAT
| | | | | | - Abdalla Fadul
- Internal Medicine, Hamad Medical Corporation, Doha, QAT
| | - Muzamil Musa
- Internal Medicine, Hamad Medical Corporation, Doha, QAT
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Korbecki A, Machaj W, Korbecka J, Sobański M, Kaczorowski M, Tabakow P, Hałoń A, Trybek G, Podgórski P, Bladowska J. Evaluation of the Value of Perfusion-Weighted Magnetic Resonance Imaging in the Differential Diagnosis of Sellar and Parasellar Tumors. J Clin Med 2023; 12:jcm12082957. [PMID: 37109292 PMCID: PMC10144489 DOI: 10.3390/jcm12082957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 04/12/2023] [Accepted: 04/13/2023] [Indexed: 04/29/2023] Open
Abstract
The purpose of this study was to assess the value of perfusion-weighted imaging (PWI) in the differential diagnosis of sellar and parasellar tumors, as an additional sequence in the magnetic resonance imaging (MRI) protocol. Analysis was based on a substantial group of subjects and included 124 brain and pituitary MRI examinations with a dynamic susceptibility contrast (DSC) PWI sequence. The following perfusion parameters were determined for the tumors: relative cerebral blood volume (rCBV), relative peak height (rPH) and relative percentage of signal intensity recovery (rPSR). To ensure greater repeatability, each of the aforementioned parameters was calculated as: arithmetic mean of the values of the whole tumor, arithmetic mean of the maximum values on each axial slice within the tumor and maximum values derived from the whole tumor. In our study, we established that meningiomas compared to both non-functional and hormone-secreting pituitary adenomas (pituitary neuroendocrine tumors-PitNET) had significantly higher values of rCBV with cut-off points set at 3.45 and 3.54, respectively (mean rCBV). Additionally, meningiomas presented significantly higher maximum and mean maximum rPH values compared to adenomas. DSC PWI imaging adds significant value to conventional MRI examinations and can be helpful in differentiating equivocal pituitary tumors.
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Affiliation(s)
- Adrian Korbecki
- Department of General Radiology, Interventional Radiology and Neuroradiology, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland
| | - Weronika Machaj
- Department of Physiology and Pathophysiology, Wroclaw Medical University, Chalubinskiego 10, 50-368 Wroclaw, Poland
| | - Justyna Korbecka
- Department of Neurology, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland
| | - Michał Sobański
- Department of General Radiology, Interventional Radiology and Neuroradiology, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland
| | - Maciej Kaczorowski
- Department of Clinical and Experimental Pathology, Wroclaw Medical University, Marcinkowsiego 1, 50-368 Wroclaw, Poland
| | - Paweł Tabakow
- Department of Neurosurgery, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland
| | - Agnieszka Hałoń
- Department of Clinical and Experimental Pathology, Wroclaw Medical University, Marcinkowsiego 1, 50-368 Wroclaw, Poland
| | - Grzegorz Trybek
- 4th Military Clinical Hospital in Wroclaw, Rudolfa Weigla 5, 50-981 Wroclaw, Poland
- Department of Oral Surgery, Pomeranian Medical University in Szczecin, 70-111 Szczecin, Poland
| | - Przemysław Podgórski
- Department of General Radiology, Interventional Radiology and Neuroradiology, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland
| | - Joanna Bladowska
- Department of General Radiology, Interventional Radiology and Neuroradiology, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland
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Abdelgawad MS, Kayed MH, Reda MIS, Abdelzaher E, Farhoud AH, Elsebaie N. Contribution of advanced neuro-imaging (MR diffusion, perfusion and proton spectroscopy) in differentiation between low grade gliomas GII and MR morphologically similar non neoplastic lesions. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2022. [DOI: 10.1186/s43055-022-00695-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Non-neoplastic brain lesions can be misdiagnosed as low-grade gliomas. Conventional magnetic resonance (MR) imaging may be non-specific. Additional imaging modalities such as spectroscopy (MRS), perfusion and diffusion imaging aid in diagnosis of such lesions. However, contradictory and overlapping results are still present. Hence, our purpose was to evaluate the role of advanced neuro-imaging in differentiation between low-grade gliomas (WHO grade II) and MR morphologically similar non-neoplastic lesions and to prove which modality has the most accurate results in differentiation.
Results
All patients were classified into two main groups: patients with low-grade glioma (n = 12; mean age, 38.8 ± 16; 8 males) and patients with non-neoplastic lesions (n = 27; mean age, 36.6 ± 15; 19 males) based on the histopathological and clinical–radiological diagnosis. Using ROC curve analysis, a threshold value of 0.93 for rCBV (AUC = 0.875, PPV = 92%, NPV = 71.4%) and a threshold value of 2.5 for Cho/NAA (AUC = 0.829, PPV = 92%, NPV = 71.4%) had 85.2% sensitivity and 83.3% specificity for predicting neoplastic lesions. The area under the curve (AUC) of ROC analysis was good for relative cerebral blood volume (rCBV) and Cho/NAA ratios (> 0.80) and fair for Cho/Cr and NAA/Cr ratios (0.70–0.80). When the rCBV measurements were combined with MRS ratios, significant improvement was observed in the area under the curve (AUC) (0.969) with improved diagnostic accuracy (89.7%) and sensitivity (88.9%).
Conclusions
Evaluation of rCBV and metabolite ratios at MRS, particularly Cho/NAA ratio, may be helpful in differentiating low-grade gliomas from non-neoplastic lesions. The combination of dynamic susceptibility contrast (DSC) perfusion and MRS can significantly improve the diagnostic accuracy and can help avoiding the need for an invasive biopsy.
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Role of Positron Emission Tomography in Primary Central Nervous System Lymphoma. Cancers (Basel) 2022; 14:cancers14174071. [PMID: 36077613 PMCID: PMC9454946 DOI: 10.3390/cancers14174071] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 08/05/2022] [Accepted: 08/19/2022] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Primary central nervous system lymphoma (PCNSL) is a rare but highly aggressive lymphoma with increasing incidence in immunocompetent patients. To date, the only established biomarkers for survival are age and functional status. Currently, the magnetic resonance imaging (MRI) criteria of the International Collaborative Group on Primary Central Nervous System Lymphoma are the only ones recommended for follow-up. However, early occurrence of recurrence after treatment in patients with a complete response on MRI raises the question of its performance in assessing residual disease. While the use of 18F-fluorodeoxyglucose body positron emission tomography for identification of systemic disease has been established and can be pivotal in patient treatment decisions, the role of brain PET scan is less clear. Here we review the potential role of PET in the management of patients with PCNSL, both at diagnosis and for follow-up under treatment. Abstract The incidence of primary central nervous system lymphoma has increased over the past two decades in immunocompetent patients and the prognosis remains poor. A diagnosis and complete evaluation of the patient is needed without delay, but histologic evaluation is not always available and PCNSL can mimic a variety of brain lesions on MRI. In this article, we review the potential role of 18F-FDG PET for the diagnosis of PCNSL in immunocompetent and immunocompromised patients. Its contribution to systemic assessment at the time of diagnosis has been well established by expert societies over the past decade. In addition, 18F-FDG provides valuable information for differential diagnosis and outcome prediction. The literature also shows the potential role of 18F-FDG as a therapeutic evaluation tool during the treatment and the end of the treatment. Finally, we present several new radiotracers that may have a potential role in the management of PCNSL in the future.
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Daftari Besheli L, Ahmed A, Hamam O, Luna L, Sun LR, Urrutia V, Hillis AE, Tekes-Brady A, Yedavalli V. Arterial Spin Labeling technique and clinical applications of the intracranial compartment in stroke and stroke mimics - A case-based review. Neuroradiol J 2022; 35:437-453. [PMID: 35635512 PMCID: PMC9437493 DOI: 10.1177/19714009221098806] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2023] Open
Abstract
Magnetic resonance imaging perfusion (MRP) techniques can improve the selection of acute ischemic stroke patients for treatment by estimating the salvageable area of decreased perfusion, that is, penumbra. Arterial spin labeling (ASL) is a noncontrast MRP technique that is used to assess cerebral blood flow without the use of intravenous gadolinium contrast. Thus, ASL is of particular interest in stroke imaging. This article will review clinical applications of ASL in stroke such as assessment of the core infarct and penumbra, localization of the vascular occlusion, and collateral status. Given the nonspecific symptoms that patients can present with, differentiating between stroke and a stroke mimic is a diagnostic dilemma. ASL not only helps in differentiating stroke from stroke mimic but also can be used to specify the exact mimic when used in conjunction with the symptomatology and structural imaging. In addition to a case-based overview of clinical applications of the ASL in stroke and stroke mimics in this article, the more commonly used ASL labeling techniques as well as emerging ASL techniques, future developments, and limitations will be reviewed.
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Affiliation(s)
| | - Amara Ahmed
- Florida State University College of
Medicine, Tallahassee, FL, USA
| | - Omar Hamam
- Johns Hopkins School of
Medicine, Baltimore, MD, USA
| | - Licia Luna
- Johns Hopkins School of
Medicine, Baltimore, MD, USA
| | - Lisa R Sun
- Johns Hopkins School of
Medicine, Baltimore, MD, USA
| | | | - Argye E Hillis
- Johns Hopkins University School of
Medicine, Baltimore, MD, USA
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8
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Hu WZ, Guo F, Xu YQ, Xi YB, He B, Yin H, Kang XW. Differentiation of Neoplastic and Non-neoplastic Intracranial Enhancement Lesions Using Three-Dimensional Pseudo-Continuous Arterial Spin Labeling. Front Neurosci 2022; 16:812997. [PMID: 35299623 PMCID: PMC8923048 DOI: 10.3389/fnins.2022.812997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 01/17/2022] [Indexed: 11/13/2022] Open
Abstract
Background and Purpose It is sometimes difficult to effectively distinguish non-neoplastic from neoplastic intracranial enhancement lesions using conventional magnetic resonance imaging (MRI). This study aimed to evaluate the diagnostic performance of three-dimensional pseudo-continuous arterial spin labeling (3D-pCASL) to differentiate non-neoplastic from neoplastic enhancement lesions intracranially. Materials and Methods This prospective study included thirty-five patients with high-grade gliomas (HGG), twelve patients with brain metastasis, and fifteen non-neoplastic patients who underwent conventional, contrast enhancement and 3D-pCASL imaging at 3.0-T MR; all lesions were significantly enhanced. Quantitative parameters including cerebral blood flow (CBF) and relative cerebral blood flow (rCBF) were compared between neoplastic and non-neoplastic using Student’s t-test. In addition, the area under the receiver operating characteristic (ROC) curve (AUC) was measured to assess the differentiation diagnostic performance of each parameter. Results The non-neoplastic group demonstrated significantly lower rCBF values of lesions and perilesional edema compared with the neoplastic group. For the ROC analysis, both relative cerebral blood flow of lesion (rCBF-L) and relative cerebral blood flow of perilesional edema (rCBF-PE) had good diagnostic performance for discriminating non-neoplastic from neoplastic lesions, with an AUC of 0.994 and 0.846, respectively. Conclusion 3D-pCASL may contribute to differentiation of non-neoplastic from neoplastic lesions.
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Affiliation(s)
- Wen-zhong Hu
- Department of Radiology, Xi’an People’s Hospital, Xi’an Fourth Hospital, Xi’an, China
- Department of Radiology, Xijing Hospital, The Fourth Military Medical University, Xi’an, China
| | - Fan Guo
- Department of Radiology, Xijing Hospital, The Fourth Military Medical University, Xi’an, China
| | - Yong-qiang Xu
- Department of Radiology, Xijing Hospital, The Fourth Military Medical University, Xi’an, China
| | - Yi-bin Xi
- Department of Radiology, Xi’an People’s Hospital, Xi’an Fourth Hospital, Xi’an, China
| | - Bei He
- Department of Radiology, Xi’an People’s Hospital, Xi’an Fourth Hospital, Xi’an, China
| | - Hong Yin
- Department of Radiology, Xi’an People’s Hospital, Xi’an Fourth Hospital, Xi’an, China
- Department of Radiology, Xijing Hospital, The Fourth Military Medical University, Xi’an, China
- *Correspondence: Hong Yin,
| | - Xiao-wei Kang
- Department of Radiology, Xi’an People’s Hospital, Xi’an Fourth Hospital, Xi’an, China
- *Correspondence: Hong Yin,
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Luo X, Zhu Y, Zhang Y, Zhang Q, Wang X, Deng X. Parameters of MR perfusion-weighted imaging predict the response and prognosis to high-dose methotrexate-based chemotherapy in immunocompetent patients with primary central nervous system lymphoma. J Clin Neurosci 2022; 95:151-158. [DOI: 10.1016/j.jocn.2021.12.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 11/26/2021] [Accepted: 12/07/2021] [Indexed: 01/04/2023]
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Trinh A, Wintermark M, Iv M. Clinical Review of Computed Tomography and MR Perfusion Imaging in Neuro-Oncology. Radiol Clin North Am 2021; 59:323-334. [PMID: 33926680 DOI: 10.1016/j.rcl.2021.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Neuroimaging plays an essential role in the initial diagnosis and continued surveillance of intracranial neoplasms. The advent of perfusion techniques with computed tomography and MR imaging have proven useful in neuro-oncology, offering enhanced approaches for tumor grading, guiding stereotactic biopsies, and monitoring treatment efficacy. Perfusion imaging can help to identify treatment-related processes, such as radiation necrosis, pseudoprogression, and pseudoregression, and can help to inform treatment-related decision making. Perfusion imaging is useful to differentiate between tumor types and between tumor and nonneoplastic conditions. This article reviews the clinical relevance and implications of perfusion imaging in neuro-oncology and highlights promising perfusion biomarkers.
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Affiliation(s)
- Austin Trinh
- Division of Neuroimaging and Neurointervention, Department of Radiology, Stanford University, 300 Pasteur Drive, Grant Building, Room S031, Stanford, CA 94305-5105, USA
| | - Max Wintermark
- Division of Neuroimaging and Neurointervention, Department of Radiology, Stanford University, 300 Pasteur Drive, Grant Building, Room S047, Stanford, CA 94305-5105, USA. https://twitter.com/mwNRAD
| | - Michael Iv
- Division of Neuroimaging and Neurointervention, Department of Radiology, Stanford University, 300 Pasteur Drive, Grant Building, Room S031E, Stanford, CA 94305-5105, USA.
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Abstract
Nonneoplastic entities may closely resemble the imaging findings of primary or metastatic intracranial neoplasia, posing diagnostic challenges for the referring provider and radiologist. Prospective identification of brain tumor mimics is an opportunity for the radiologist to add value to patient care by decreasing time to diagnosis and avoiding unnecessary surgical procedures and medical therapies, but requires familiarity with mimic entities and a high degree of suspicion on the part of the interpreting radiologist. This article provides a framework for the radiologist to identify "brain tumor mimics," highlighting imaging and laboratory pearls and pitfalls, and illustrating unique and frequently encountered lesions.
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Affiliation(s)
- Joseph H Donahue
- Department of Radiology and Medical Imaging, University of Virginia Health System, PO Box 800170, Charlottesville, VA 22908-0170, USA
| | - Sohil H Patel
- Department of Radiology and Medical Imaging, University of Virginia Health System, PO Box 800170, Charlottesville, VA 22908-0170, USA
| | - Camilo E Fadul
- Department of Neurology, University of Virginia Health System, PO Box 800432, Charlottesville, VA 22908-0170, USA
| | - Sugoto Mukherjee
- Department of Radiology and Medical Imaging, University of Virginia Health System, PO Box 800170, Charlottesville, VA 22908-0170, USA.
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Abstract
OBJECTIVE The purpose of this study is to determine the potential role of dynamic susceptibility contrast (DSC) magnetic resonance (MR) perfusion imaging in diagnosing brain death. MATERIALS AND METHODS The study population was composed of 61 subjects (the Glasgow Coma Scale [GCS] score was 3 for all subjects), and 26 subjects were assigned to the control group (GCS scores between 4 and 6). At least four regions of interest (ROIs) from different anatomical regions were measured, the mean transit time (MTT), cerebral blood flow (CBF), and signal intensity time-to-course graphic were calculated. A second neurological examination (including an apnea test) was accepted as the gold standard method for the diagnosis of brain death. RESULTS DSC-MR perfusion imaging diagnosed brain death with a specificity of 100% (61/61) and a sensitivity of 86.8% (53/61). A cut-off value of maximum 3.5% decrease in the signal intensity time-to-course graphic was calculated by the Youden's index and established for the to differentiate brain death from other conditions. CONCLUSION DSC-MR perfusion imaging is a promising tool that may be used as a reliable add-on confirmatory diagnostic test for the brain death.
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Park JE, Kim HS. [Current Applications and Future Perspectives of Brain Tumor Imaging]. TAEHAN YONGSANG UIHAKHOE CHI 2020; 81:467-487. [PMID: 36238631 PMCID: PMC9431910 DOI: 10.3348/jksr.2020.81.3.467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 05/04/2020] [Accepted: 05/07/2020] [Indexed: 11/29/2022]
Abstract
뇌종양의 진단 및 치료 반응 평가의 기본이 되는 영상기법은 해부학적 영상이다. 현재 임상에서 사용 가능한 영상기법들 중 확산 강조 영상 및 관류 영상이 추가적인 정보를 제공하고 있다. 최근에는 종양의 유전체 변이와 이질성 평가가 중요해지면서 라디오믹스와 딥러닝을 이용한 영상분석기법의 임상 응용이 기대되고 있다. 본 종설에서는 뇌종양 영상 임상 적용에서 여전히 중요한 해부학적 영상을 중심으로 한 자기공명영상 촬영 권고안, 최신 영상기법 중 확산 강조 영상 및 관류 영상의 기본 원리, 병태생리학적 배경 및 임상응용, 마지막으로 최근 컴퓨터 기술의 발전으로 많이 연구되고 있는 라디오믹스와 딥러닝의 뇌종양에서의 향후 활용가치에 대해 기술하고자 한다.
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Tong E, McCullagh KL, Iv M. Advanced Imaging of Brain Metastases: From Augmenting Visualization and Improving Diagnosis to Evaluating Treatment Response. Front Neurol 2020; 11:270. [PMID: 32351445 PMCID: PMC7174761 DOI: 10.3389/fneur.2020.00270] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 03/24/2020] [Indexed: 12/11/2022] Open
Abstract
Early detection of brain metastases and differentiation from other neuropathologies is crucial. Although biopsy is often required for definitive diagnosis, imaging can provide useful information. After treatment commences, imaging is also performed to assess the efficacy of treatment. Contrast-enhanced magnetic resonance imaging (MRI) is the traditional imaging method for the evaluation of brain metastases, as it provides information about lesion size, morphology, and macroscopic properties. Newer MRI sequences have been developed to increase the conspicuity of detecting enhancing metastases. Other advanced MRI techniques, that have the capability to probe beyond the anatomic structure, are available to characterize micro-structures, cellularity, physiology, perfusion, and metabolism. Artificial intelligence provides powerful computational tools for detection, segmentation, classification, prediction, and prognosis. We highlight and review a few advanced MRI techniques for the assessment of brain metastases-specifically for (1) diagnosis, including differentiating between malignancy types and (2) evaluation of treatment response, including the differentiation between radiation necrosis and disease progression.
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Affiliation(s)
- Elizabeth Tong
- Stanford University Medical Center, Stanford, CA, United States
| | | | - Michael Iv
- Stanford University Medical Center, Stanford, CA, United States
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Soni N, Kumar S, Srindharan K, Mishra P, Gupta N, Bathla G, kalita J, Behari S. Comparative Evaluation of Brain Tuberculosis and Metastases Using Combined Analysis of Arterial Spin Labeling Perfusion and Diffusion Tensor Imaging. Curr Probl Diagn Radiol 2019; 48:547-553. [DOI: 10.1067/j.cpradiol.2018.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 09/17/2018] [Accepted: 09/28/2018] [Indexed: 11/22/2022]
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Lakshmi A, Choudary GPV, Bodagala VD, Chandra VVR, Thota N, Chowhan A. Perfusion-weighted imaging in differentiating ring-enhancing lesions in brain. JOURNAL OF DR. NTR UNIVERSITY OF HEALTH SCIENCES 2019. [DOI: 10.4103/jdrntruhs.jdrntruhs_63_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Ghosh RN, Vyas S, Singh P, Khandelwal N, Sankhyan N, Singhi P. Perfusion magnetic resonance imaging in differentiation of neurocysticercosis and tuberculoma. Neuroradiology 2018; 61:257-263. [DOI: 10.1007/s00234-018-2118-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 10/16/2018] [Indexed: 12/18/2022]
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Soni N, Srindharan K, Kumar S, Mishra P, Bathla G, Kalita J, Behari S. Arterial spin labeling perfusion: Prospective MR imaging in differentiating neoplastic from non-neoplastic intra-axial brain lesions. Neuroradiol J 2018; 31:544-553. [PMID: 29890916 DOI: 10.1177/1971400918783058] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
PURPOSE The purpose of this article is to assess the diagnostic performance of arterial spin-labeling (ASL) magnetic resonance perfusion imaging to differentiate neoplastic from non-neoplastic brain lesions. MATERIAL AND METHODS This prospective study included 60 consecutive, newly diagnosed, untreated patients with intra-axial lesions with perilesional edema (PE) who underwent clinical magnetic resonance imaging including ASL sequences at 3T. Region of interest analysis was performed to obtain mean cerebral blood flow (CBF) values from lesion (L), PE and normal contralateral white matter (CWM). Normalized (n) CBF ratio was obtained by dividing the mean CBF value of L and PE by mean CBF value of CWM. Discriminant analyses were performed to determine the best cutoff value of nCBFL and nCBFPE in differentiating neoplastic from non-neoplastic lesions. RESULTS Thirty patients were in the neoplastic group (15 high-grade gliomas (HGGs), 15 metastases) and 30 in the non-neoplastic group (12 tuberculomas, 10 neurocysticercosis, four abscesses, two fungal granulomas and two tumefactive demyelination) based on final histopathology and clincoradiological diagnosis. We found higher nCBFL (6.65 ± 4.07 vs 1.68 ± 0.80, p < 0.001) and nCBFPE (1.86 ± 1.43 vs 0.74 ± 0.21, p < 0.001) values in the neoplastic group than non-neoplastic. For predicting neoplastic lesions, we found an nCBFL cutoff value of 1.89 (AUC 0.917; 95% CI 0.854 to 0.980; sensitivity 90%; specificity 73%) and nCBFPE value of 0.76 (AUC 0.783; 95% CI 0.675 to 0.891; sensitivity 80%; specificity 58%). Mean nCBFL was higher in HGGs (8.70 ± 4.16) compared to tuberculomas (1.98 ± 0.87); and nCBFPE was higher in HGGs (3.06 ± 1.53) compared to metastases (0.86 ± 0.34) and tuberculomas (0.73 ± 0.22) ( p < 0.001). CONCLUSION ASL perfusion may help in distinguishing neoplastic from non-neoplastic brain lesions.
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Affiliation(s)
- Neetu Soni
- 1 Neuroradiology Department, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Karthika Srindharan
- 2 Department of Radiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, Uttar Pradesh, India
| | - Sunil Kumar
- 2 Department of Radiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, Uttar Pradesh, India
| | - Prabhakar Mishra
- 3 Department of Biostatistics and Health Informatics, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - Girish Bathla
- 1 Neuroradiology Department, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Jyantee Kalita
- 4 Department of Neurology, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - Sanjay Behari
- 5 Department of Neurosurgery, SGPGIMS, Lucknow, Uttar Pradesh, India
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Brain perfusion alterations in tick-borne encephalitis-preliminary report. Int J Infect Dis 2018; 68:26-30. [PMID: 29337197 DOI: 10.1016/j.ijid.2018.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 12/27/2017] [Accepted: 01/04/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Magnetic resonance imaging (MRI) changes in tick-borne encephalitis (TBE) are non-specific and the pathophysiological mechanisms leading to their formation remain unclear. This study investigated brain perfusion in TBE patients using dynamic susceptibility-weighted contrast-enhanced magnetic resonance perfusion imaging (DSC-MRI perfusion). METHODS MRI scans were performed for 12 patients in the acute phase, 3-5days after the diagnosis of TBE. Conventional MRI and DSC-MRI perfusion studies were performed. Cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT), and time to peak (TTP) parametric maps were created. The bilateral frontal, parietal, and temporal subcortical regions and thalamus were selected as regions of interest. Perfusion parameters of TBE patients were compared to those of a control group. RESULTS There was a slight increase in CBF and CBV, with significant prolongation of TTP in subcortical areas in the study subjects, while MTT values were comparable to those of the control group. A significant increase in thalamic CBF (p<0.001) and increased CBV (p<0.05) were observed. Increased TTP and a slight reduction in MTT were also observed within this area. CONCLUSIONS The DSC-MRI perfusion study showed that TBE patients had brain perfusion disturbances, expressed mainly in the thalami. These results suggest that DSC-MRI perfusion may provide important information regarding the areas affected in TBE patients.
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Abstract
Magnetic resonance imaging (MRI) is the cornerstone for evaluating patients with brain masses such as primary and metastatic tumors. Important challenges in effectively detecting and diagnosing brain metastases and in accurately characterizing their subsequent response to treatment remain. These difficulties include discriminating metastases from potential mimics such as primary brain tumors and infection, detecting small metastases, and differentiating treatment response from tumor recurrence and progression. Optimal patient management could be benefited by improved and well-validated prognostic and predictive imaging markers, as well as early response markers to identify successful treatment prior to changes in tumor size. To address these fundamental needs, newer MRI techniques including diffusion and perfusion imaging, MR spectroscopy, and positron emission tomography (PET) tracers beyond traditionally used 18-fluorodeoxyglucose are the subject of extensive ongoing investigations, with several promising avenues of added value already identified. These newer techniques provide a wealth of physiologic and metabolic information that may supplement standard MR evaluation, by providing the ability to monitor and characterize cellularity, angiogenesis, perfusion, pH, hypoxia, metabolite concentrations, and other critical features of malignancy. This chapter reviews standard and advanced imaging of brain metastases provided by computed tomography, MRI, and amino acid PET, focusing on potential biomarkers that can serve as problem-solving tools in the clinical management of patients with brain metastases.
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Affiliation(s)
- Whitney B Pope
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, United States.
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Dibble EH, Boxerman JL, Baird GL, Donahue JE, Rogg JM. Toxoplasmosis versus lymphoma: Cerebral lesion characterization using DSC-MRI revisited. Clin Neurol Neurosurg 2016; 152:84-89. [PMID: 27940418 DOI: 10.1016/j.clineuro.2016.11.023] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Revised: 11/21/2016] [Accepted: 11/30/2016] [Indexed: 11/24/2022]
Abstract
OBJECTIVE CNS toxoplasmosis and lymphoma are often indistinguishable by conventional contrast-enhanced MRI. There is limited literature on the diagnostic efficacy of dynamic susceptibility contrast (DSC) MRI for differentiating these entities. This study assesses the clinical utility of relative cerebral blood volume (rCBV) for making a diagnosis and determines rCBV thresholds for differentiation using contemporary DSC-MRI. PATIENTS AND METHODS Thirteen patients with 25 lesions (13 toxoplasmosis and 12 lymphoma) and pre-treatment DSC-MRI were identified retrospectively. Volumetric regions of interest of segmented enhancement were used to extract mean rCBV normalized to normal-appearing white matter for each lesion. We compared average mean rCBV between all toxoplasmosis and lymphoma lesions using a general mixed model. Three models were also compared for evaluating rCBV-based disease status in each patient: 1) mean rCBV of each lesion using a generalized estimating equation, 2) volume-weighted mean rCBV, and 3) maximum mean rCBV of all lesions using logistic regression. RESULTS The average mean rCBV for all toxoplasmosis lesions was 0.98 (95% CI 0.55-1.41) compared to 2.07 (95% CI 1.71-2.43) for all lymphoma lesions, a significant difference (1.09, 95% CI 0.53-1.65, p=0.0013). For the three models used to evaluate rCBV-based disease status in each patient, a significant relationship was observed, with an optimal rCBV threshold of approximately 1.5 for distinguishing lymphoma from toxoplasmosis in each model. CONCLUSION RCBV derived from contemporary DSC-MRI is helpful for distinguishing between cerebral toxoplasmosis and cerebral lymphoma on an individual patient basis and may facilitate more timely initiation of appropriate directed therapy.
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Affiliation(s)
- Elizabeth H Dibble
- Rhode Island Hospital, Department of Diagnostic Imaging, 593 Eddy Street, Providence, RI, 02903, United States; The Warren Alpert Medical School of Brown University, 222 Richmond Street, Providence, RI, 02903, United States.
| | - Jerrold L Boxerman
- Rhode Island Hospital, Department of Diagnostic Imaging, 593 Eddy Street, Providence, RI, 02903, United States; The Warren Alpert Medical School of Brown University, 222 Richmond Street, Providence, RI, 02903, United States.
| | - Grayson L Baird
- Rhode Island Hospital, Department of Diagnostic Imaging, 593 Eddy Street, Providence, RI, 02903, United States; The Warren Alpert Medical School of Brown University, 222 Richmond Street, Providence, RI, 02903, United States.
| | - John E Donahue
- Rhode Island Hospital, Department of Neuropathology, 593 Eddy Street, Providence, RI, 02903, United States; The Warren Alpert Medical School of Brown University, 222 Richmond Street, Providence, RI, 02903, United States.
| | - Jeffrey M Rogg
- Rhode Island Hospital, Department of Diagnostic Imaging, 593 Eddy Street, Providence, RI, 02903, United States; The Warren Alpert Medical School of Brown University, 222 Richmond Street, Providence, RI, 02903, United States.
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Dynamic Susceptibility Contrast MR Imaging in Glioma: Review of Current Clinical Practice. Magn Reson Imaging Clin N Am 2016; 24:649-670. [PMID: 27742108 DOI: 10.1016/j.mric.2016.06.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Dynamic susceptibility contrast (DSC) MR imaging, a perfusion-weighted MR imaging technique typically used in neuro-oncologic applications for estimating the relative cerebral blood volume within brain tumors, has demonstrated much potential for determining prognosis, predicting therapeutic response, and assessing early treatment response of gliomas. This review highlights recent developments using DSC-MR imaging and emphasizes the need for technical standardization and validation in prospective studies in order for this technique to become incorporated into standard-of-care imaging for patients with brain tumors.
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Copen WA, Lev MH, Rapalino O. Brain perfusion: computed tomography and magnetic resonance techniques. HANDBOOK OF CLINICAL NEUROLOGY 2016; 135:117-135. [PMID: 27432662 DOI: 10.1016/b978-0-444-53485-9.00006-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Cerebral perfusion imaging provides assessment of regional microvascular hemodynamics in the living brain, enabling in vivo measurement of a variety of different hemodynamic parameters. Perfusion imaging techniques that are used in the clinical setting usually rely upon X-ray computed tomography (CT) or magnetic resonance imaging (MRI). This chapter reviews CT- and MRI-based perfusion imaging techniques, with attention to image acquisition, clinically relevant aspects of image postprocessing, and fundamental differences between CT- and MRI-based techniques. Correlations with cerebrovascular physiology and potential clinical applications of perfusion imaging are reviewed, focusing upon the two major classes of neurologic disease in which perfusion imaging is most often performed: primary perfusion disorders (including ischemic stroke, transient ischemic attack, and reperfusion syndrome), and brain tumors.
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Affiliation(s)
- William A Copen
- Division of Neuroradiology, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
| | - Michael H Lev
- Division of Neuroradiology, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Otto Rapalino
- Division of Neuroradiology, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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Differentiation of brain abscesses from glioblastomas and metastatic brain tumors: comparisons of diagnostic performance of dynamic susceptibility contrast-enhanced perfusion MR imaging before and after mathematic contrast leakage correction. PLoS One 2014; 9:e109172. [PMID: 25330386 PMCID: PMC4201450 DOI: 10.1371/journal.pone.0109172] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 09/09/2014] [Indexed: 11/21/2022] Open
Abstract
Purpose To compare the diagnostic performance of dynamic susceptibility contrast-enhanced perfusion MRI before and after mathematic contrast leakage correction in differentiating pyogenic brain abscesses from glioblastomas and/or metastatic brain tumors. Materials and Methods Cerebral blood volume (CBV), leakage-corrected CBV and leakage coefficient K2 were measured in enhancing rims, perifocal edema and contralateral normal appearing white matter (NAWM) of 17 abscesses, 19 glioblastomas and 20 metastases, respectively. The CBV and corrected CBV were normalized by dividing the values in the enhancing rims or edema to those of contralateral NAWM. For each study group, a paired t test was used to compare the K2 of the enhancing rims or edema with those of NAWM, as well as between CBV and corrected CBV of the enhancing rims or edema. ANOVA was used to compare CBV, corrected CBV and K2 among three lesion types. The diagnostic performance of CBV and corrected CBV was assessed with receiver operating characteristic (ROC) curve analysis. Results The CBV and correction CBV of enhancing rim were 1.45±1.17 and 1.97±1.01 for abscesses, 3.85±2.19 and 4.39±2.33 for glioblastomas, and 2.39±0.90 and 2.97±0.78 for metastases, respectively. The CBV and corrected CBV in the enhancing rim of abscesses were significantly lower than those of glioblastomas and metastases (P = 0.001 and P = 0.007, respectively). In differentiating abscesses from glioblastomas and metastases, the AUC values of corrected CBV (0.822) were slightly higher than those of CBV (0.792). Conclusions Mathematic leakage correction slightly increases the diagnostic performance of CBV in differentiating pyogenic abscesses from necrotic glioblastomas and cystic metastases. Clinically, DSC perfusion MRI may not need mathematic leakage correction in differentiating abscesses from glioblastomas and/or metastases.
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