Elsevier

Neurologic Clinics

Volume 25, Issue 4, November 2007, Pages 947-973
Neurologic Clinics

Advanced MRI of Adult Brain Tumors

https://doi.org/10.1016/j.ncl.2007.07.010Get rights and content

This article is intended to provide clinical neurologists with an overview of the major techniques of advanced MRI of brain tumor: diffusion-weighted imaging, perfusion-weighted imaging, dynamic contrast-enhanced T1 permeability imaging, diffusion-tensor imaging, and magnetic resonance spectroscopy. These techniques represent a significant addition to conventional anatomic MRI T2-weighted images, fluid attenuated inversion recovery (FLAIR) T2-weighted images, and gadolinium-enhanced T1-weighted images for assessing tumor cellularity, white matter invasion, metabolic derangement including hypoxia and necrosis, neovascular capillary blood volume, and permeability. Although a brief introduction and more extensive references to the technical literature is provided, the major focus is to provide a summary of recent clinical experience in application of these major advanced MRI techniques to differential diagnosis, grading, surgical planning, and monitoring of therapeutic response of tumors.

Section snippets

Brain tumor cellularity: diffusion-weighted imaging

DWI contrast reflects the brownian motion of tissue water. Because the mean path length of water diffusion within each tissue voxel, characterized by the “apparent diffusion coefficient” (ADC), is determined by tissue barriers to diffusion on a scale of roughly 10 μm, the ADC in brain tissue is principally determined by tissue cellularity, as measured by the intracellular volume fraction and extracellular volume fractions [2], [3].

Tissue microstructural derangement: diffusion-tensor imaging

DTI is similar to DWI but involves the collection of additional data necessary to define the tensor (vector) describing the preferential direction and magnitude of water diffusion [32], [33]. The degree to which water diffusion in tissue is facilitated in one direction and hindered in another—referred to as “diffusion anisotropy”—is often characterized by a scalar value derived from the diffusion tensor: fractional anisotropy (FA).

Metabolite imaging in brain tumor: spectroscopy

MRS techniques essentially allow nuclear MR (NMR) spectroscopy to be performed in vivo, albeit at much lower field strength and sensitivity than in synthetic chemistry laboratory NMR scanners. As in NMR, proton MRS assays the number of each chemically distinct proton (1H0) species present in each voxel by detecting slight differences in the NMR frequency (“chemical shift”) of each proton nucleus that result from shielding by the surrounding covalent bond electron cloud. The differences in

Microvascular imaging in brain tumor: perfusion-weighted imaging MRI and dynamic contrast-enhanced T1 permeability imaging

Much current basic biology research focuses on the interaction of tumor hypoxia, macrophage activation, and glioma gene expression in the transition from normal permeability and blood volume to increased native vessel permeability and volume and finally to frank neoangiogenesis during transformation from low-grade glioma to GBM [87]. In areas in which infiltrative and cellular glioma supplied by native vessels becomes hypoxic, secretion of vasoactive substances (including vascular endothelial

Microvascular permeability imaging: dynamic contrast-enhanced T1 permeability imaging

Low-grade astrocytomas supply their metabolic demand through co-optation of native brain capillaries and are thus limited in the rate of growth and bulk that they can achieve. Neoangiogenesis driven by autologous secretion of VEGF and other cytokines is one of the critical steps in the progression from lower-grade astrocytoma to anaplastic astrocytoma and GBM, enabling the rapid growth of solid tumor that conveys such poor prognosis. Cytokine-mediated abnormality of tight junctions in co-opted

Summary

Advanced brain tumor MRI evaluation can now routinely produce an impressive array of in vivo data reflecting tumor cellularity, metabolism, invasiveness, neocapillary density, and permeability. Ongoing technical improvements and additional metrics, currently reported in the literature but too preliminary to review here, promise to bring to the clinic further dramatic increases in the quantity and quality of imaging data over the next 5 years. The clinical principles outlined in this article

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