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Correlation of Relative Permeability and Relative Cerebral Blood Volume in High-Grade Cerebral Neoplasms

James M. Provenzale1, Gerald York1, Marcelo Galvez Moya1, Lauren Parks2, Michael Choma3, Susan Kealey1, Patricia Cole4 and Humaira Serajuddin4

1 Department of Radiology, Duke University Medical Center, Box 3808, Durham, NC 27710.
2 Duke University School of Medicine, Durham, NC.
3 Department of Biomedical Engineering, Duke University, Durham, NC.
4 Novartis Pharmaceuticals, Inc., East Hanover, NJ.


Figure 1
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  		Fig. 1A —T1-weighted dynamic contrast-enhanced relative permeability and T2*-weighted dynamic susceptibility contrast (DSC) imaging studies in 51-year-old man with biopsy-proven glioblastoma multiforme. Contrast-enhanced T1-weighted image shows large enhancing mass in left temporal lobe.

 

Figure 2
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  		Fig. 1B —T1-weighted dynamic contrast-enhanced relative permeability and T2*-weighted dynamic susceptibility contrast (DSC) imaging studies in 51-year-old man with biopsy-proven glioblastoma multiforme. Color-coded relative permeability data (dynamic contrast-enhanced imaging) superimposed on image shown in A depict pixels that have peak signal intensity values between 3 and 5 SDs above mean signal intensity in normal right hemisphere in blue, those in the 5- to 7-SD range in yellow, and those greater than 7 SDs in red. Note that unenhancing region of central necrosis seen in tumor in A does not have any pixels denoting high-signal-intensity values. Mean relative permeability value in this lesion was 7.16 SDs above normal baseline, the highest seen in our series. Note that highest values are seen in medial and anterior aspects of tumor.

 

Figure 3
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  		Fig. 1C —T1-weighted dynamic contrast-enhanced relative permeability and T2*-weighted dynamic susceptibility contrast (DSC) imaging studies in 51-year-old man with biopsy-proven glioblastoma multiforme. DSC spin-echo echo-planar image at trough signal period (maximal susceptibility effect) during bolus injection of contrast material obtained at same level as A shows decreased signal intensity within lesion in left temporal lobe compared with remainder of brain. Bright signal due to vasogenic edema is seen posterior to temporal lobe mass lesion.

 

Figure 4
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  		Fig. 1D —T1-weighted dynamic contrast-enhanced relative permeability and T2*-weighted dynamic susceptibility contrast (DSC) imaging studies in 51-year-old man with biopsy-proven glioblastoma multiforme. Relative cerebral blood volume (rCBV) map derived from DSC series depicted in C in which high rCBV values are demarcated in red and yellow (see color-coding spectrum on left side of image) shows increased rCBV throughout much of mass, but rCBV is most increased in medial and anterior portions of mass (same general regions as highest enhancement values seen in B). This image corresponds to dynamic contrast-enhanced image shown in B. Mean rCBV value within all pixels was 122% of normal baseline values in right lentiform nucleus, which was the highest seen in this series of patients.

 

Figure 5
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  		Fig. 1E —T1-weighted dynamic contrast-enhanced relative permeability and T2*-weighted dynamic susceptibility contrast (DSC) imaging studies in 51-year-old man with biopsy-proven glioblastoma multiforme. Image in which rCBV map shown in D is superimposed on dynamic contrast-enhanced map shown in B (high-signal-intensity values now depicted in white so they can be seen against rCBV map) shows that medial and anterior portions of mass have both highest signal intensity and highest rCBV. Lateral aspect of mass has generally lower-signal-intensity values on dynamic contrast-enhanced imaging and lower rCBV.

 

Figure 6
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  		Fig. 2 —Line plot shows relationship of mean relative cerebral blood volume (rCBV) values (expressed as ratio of mean rCBV value of tumor relative to mean rCBV value of normal contralateral lentiform nucleus) along x-axis and mean relative permeability values (contrast enhancement signal expressed as number of SDs above mean value in normal unenhancing tissue in contralateral hemisphere) along y-axis. Pearson's correlation coefficient was 0.867, R2 correlation coefficient was 0.752, and Spearman's rank correlation was 0.794 (p < 0.001 for all comparisons), indicating strong correlation between mean relative permeability values on dynamic contrast-enhanced imaging and mean rCBV values on dynamic susceptibility contrast imaging.

 

Figure 7
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  		Fig. 3 —Line plot shows relationship of highest relative cerebral blood volume (rCBV) values (expressed as a ratio of highest rCBV value of tumor relative to highest rCBV value of normal contralateral lentiform nucleus) along x-axis and highest relative permeability values (contrast enhancement signal intensity expressed as number of SDs above mean value in normal unenhancing tissue in contralateral hemisphere) along y-axis. Kendall's tau correlation was 0.7778 (p = 0.0035), indicating strong correlation between highest relative permeability values on dynamic contrast-enhanced imaging and highest rCBV values on dynamic susceptibility contrast imaging.

 

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