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Comparison of Permeability in High-Grade and Low-Grade Brain Tumors Using Dynamic Susceptibility Contrast MR Imaging

James M. Provenzale1, Gin R. Wang2, Thomas Brenner2, Jeffrey R. Petrella1 and A. Gregory Sorensen2

1 Department of Radiology, Duke University Medical Center, Box 3808, Durham, NC 27710.
2 Department of Radiology, Massachusetts General Hospital, 55 Fruit St., Boston MA 02114.



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  		Fig. 1. —Graph shows median of mean regional permeability values in low-grade tumors and high-grade tumors and mean for control regions in normal thalami. Error bars for regional permeability values represent 68% confidence interval calculated on basis of order statistics. Error bar for thalamic mean represents standard error. Note that values for high-grade tumors are substantially higher than those for low-grade tumors and that both differ substantially from thalamus values. Note also that no overlap of error bars is seen.

 


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  		Fig. 2. —Graph shows side-by-side representation of mean regional permeability values in high-grade and low-grade tumors. Note that generally little overlap is seen between two groups although a few high-grade tumors have values that overlap those of low-grade tumors.

 


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  		Fig. 3A. —70-year-old man who had undergone partial resection of glioblastoma multiforme 4 months before permeability imaging. Contrast-enhanced axial T1-weighted MR image shows rim-enhancing mass in left temporal lobe representing residual tumor. Region of interest (green circle) has been placed at site of maximum permeability value measured on permeability map seen in B.

 


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  		Fig. 3B. —70-year-old man who had undergone partial resection of glioblastoma multiforme 4 months before permeability imaging. Permeability map generated from dynamic susceptibility contrast sequence, in which high permeability values are shown in red, reveals crescentic region of high permeability in left temporal lobe. This region corresponds to anterior portion of rim-enhancing mass seen in A. In this tumor, mean regional permeability value measured 0.064, and single area of maximum permeability value measured 0.072. Note that other red regions are seen that represent normal vessels rather than regions of elevated permeability.

 


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  		Fig. 4A. —34-year-old man with recent onset of seizures. Contrast-enhanced axial T1-weighted MR image shows unenhancing left insular mass lesion. Region of interest (green circle) that has been placed on site shows area of highest permeability that was found on permeability map seen in B.

 


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  		Fig. 4B. —34-year-old man with recent onset of seizures. Permeability map shows no areas of elevated permeability in tumor region seen in A. Mean regional permeability value in this tumor measured 0.016, and single area of maximum permeability value measured 0.018. At surgery, low-grade glioma was diagnosed.

 


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  		Fig. 5A. —34-year-old man with new onset of generalized seizures. Permeability maps show that areas of high permeability can be seen in regions that do not densely enhance on T1-weighted images. Contrast-enhanced axial T1-weighted MR image shows large mildly enhancing left frontal and temporal lobe mass. Region of interest (green circle) corresponds to site having highest permeability on this image as seen on permeability maps (B).

 


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  		Fig. 5B. —34-year-old man with new onset of generalized seizures. Permeability maps show that areas of high permeability can be seen in regions that do not densely enhance on T1-weighted images. Permeability map shows multiple cortical and subcortical areas of elevated permeability in tumor region seen in A. Mean regional permeability value in tumor measured 0.041, and single area of maximum permeability value measured 0.045. Surgical biopsy showed World Health Organization grade II well-differentiated astrocytoma, but pathology report noted that MIB-1 labeling index (a measure of mitotic activity) measured 5-10%, which is much more indicative of aggressive high-grade neoplasm than of typical low-grade neoplasm.

 

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