MR Perfusion-Weighted Imaging May Help in Differentiating Between Nonenhancing Gliomas and Nonneoplastic Lesions in the Cervicomedullary Junction

Department of Imaging Sciences, University of Rochester Medical Center, Rochester, New York 14641-8638, USA.
Journal of Magnetic Resonance Imaging (Impact Factor: 2.57). 07/2011; 34(1):196-202. DOI: 10.1002/jmri.22594
Source: PubMed

ABSTRACT To evaluate the ability of dynamic susceptibility-weighted contrast-enhanced magnetic resonance (MR) perfusion imaging (DSC-PWI) in distinguishing between nonenhancing gliomas and nonenhancing, nonneoplastic lesions in the cervicomedullary junction region.
This retrospective study involved eight patients with nonenhancing gliomas in the medulla oblongata and eight patients with nonenhancing nonneoplastic lesions. The relative cerebral blood volume (rCBV) ratios, peak heights, and percentage of signal intensity recovery derived from time-signal intensity curves of these nonenhancing lesions were compared.
The mean peak height of nonenhancing gliomas was significantly higher than the value of their reference regions of interest (ROIs). In contrast, mean peak height of nonneoplastic lesions was significantly lower than their reference ROIs. The mean peak height and mean maximal rCBV ratio of nonenhancing gliomas were significantly higher than those of nonenhancing, nonneoplastic lesions (P<0.05). There was no significant difference with regard to percentage of signal intensity recovery between the two groups.
DSC-PWI could be a useful adjuvant tool to differentiate between nonenhancing gliomas and nonenhancing, nonneoplastic lesions in the cervicomedullary junction region.

  • [Show abstract] [Hide abstract]
    ABSTRACT: Differential diagnosis between intramedullary tumors and tumor-like lesions (TLL) in the cervicomedullary junction region and cervical spinal cord is important, sometimes clinical dilemma on conventional MR imaging and empirical treatment. We evaluated advanced MR diffusion tensor imaging (DTI) and perfusion weighted imaging (PWI) in 25 patients, including 12 with intramedullary tumors and 13 with TLL in the cervicomedullary junction region and cervical spinal cord. We found that mean fractional anisotropy value of tumors was significantly lower than the value found in TLL, and the mean trace apparent diffusion coefficient and peak height values of tumors were significantly higher (P < 0.05). The receiver operating characteristic curve analysis showed that peak height was better than any of the other imaging parameters, with a sensitivity of 90.9 % and specificity of 80 % using a cutoff value of 4.523 to differentiate between tumors and TLL. In conclusion, the MR DTI and PWI could be useful in differentiating between intramedullary tumors and TLL in the cervicomedullary junction region and cervical spinal cord.
    Journal of Neuro-Oncology 12/2013; 116(3). DOI:10.1007/s11060-013-1323-z · 3.12 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: BACKGROUND AND PURPOSE:Both technical and pathophysiologic factors affect PSR in DSC-MR imaging. We aimed to determine how TE, flip angle (α), and contrast dose impact PSR in high-grade gliomas.MATERIALS AND METHODS:We retrospectively computed PSR maps for 22 patients with high-grade gliomas, comparing 3 DSC-MR imaging methods by using single-dose gadodiamide without preload administration: A (n = 7), α = 35°, TE = 54 ms; B (n = 5), α = 72°, TE = 30 ms; C (n = 10), α = 90°, TE = 30 ms. Methods A-C served as preload for subsequent dynamic imaging using method D (method C parameters but with double-dose contrast). We compared first- and second-injection tumor PSR for methods C and D (paired t test) and tumor PSR for both injections grouped by the first-injection acquisition method (3-group nonparametric 1-way ANOVA). We compared PSR in tumor and normal brain for each first- and second-injection method group (paired t test).RESULTS:First-injection PSR in tumor and normal brain differed significantly for methods B (P = .01) and C (P = .05), but not A (P = .71). First-injection tumor PSR increased with T1 weighting with a significant main effect of method groupings (P = .0012), but there was no significant main effect for first-injection normal brain (P = .93), or second-injection tumor (P = .95) or normal brain (P = .13). In patients scanned with methods C and D, first-injection PSR significantly exceeded second-injection PSR for tumor (P = .037) and normal brain (P < .001).CONCLUSIONS:PSR strongly depends on the T1 weighting of DSC-MR imaging, including pulse sequence (TE, α) and contrast agent (dose, preload) parameters, with implications for protocol design and the interpretation and comparison of PSR values across tumor types and imaging centers.
    American Journal of Neuroradiology 02/2013; 34(7). DOI:10.3174/ajnr.A3477 · 3.17 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: A growing number of studies have reported altered functional connectivity in schizophrenia during putatively "task-free" states and during the performance of cognitive tasks. However, there have been few systematic examinations of functional connectivity in schizophrenia across rest and different task states to assess the degree to which altered functional connectivity reflects a stable characteristic or whether connectivity changes vary as a function of task demands. We assessed functional connectivity during rest and during three working memory loads of an N-back task (0-back, 1-back, 2-back) among: (1) individuals with schizophrenia (N = 19); (2) the siblings of individuals with schizophrenia (N = 28); (3) healthy controls (N = 10); and (4) the siblings of healthy controls (N = 17). We examined connectivity within and between four brain networks: (1) frontal-parietal (FP); (2) cingulo-opercular (CO); (3) cerebellar (CER); and (4) default mode (DMN). In terms of within-network connectivity, we found that connectivity within the DMN and FP increased significantly between resting state and 0-back, while connectivity within the CO and CER decreased significantly between resting state and 0-back. Additionally, we found that connectivity within both the DMN and FP was further modulated by memory load. In terms of between network connectivity, we found that the DMN became significantly more "anti-correlated" with the FP, CO, and CER networks during 0-back as compared to rest, and that connectivity between the FP and both CO and CER networks increased with memory load. Individuals with schizophrenia and their siblings showed consistent reductions in connectivity between both the FP and CO networks with the CER network, a finding that was similar in magnitude across rest and all levels of working memory load. These findings are consistent with the hypothesis that altered functional connectivity in schizophrenia reflects a stable characteristic that is present across cognitive states.
    Frontiers in Human Neuroscience 05/2012; 6:137. DOI:10.3389/fnhum.2012.00137 · 2.90 Impact Factor
    This article is viewable in ResearchGate's enriched format