Perfusion imaging of high-grade gliomas: a comparison between contrast harmonic and magnetic resonance imaging

Technical note

Restricted access

✓ Transcranial contrast harmonic (CH) imaging is emerging as a promising tool for the evaluation of brain perfusion. The authors report on two cases of histologically proven high-grade gliomas evaluated using CH imaging in comparison to perfusion magnetic resonance (pMR) imaging. In both cases, pMR imaging results demonstrated a massive decrease in signal intensity and an elevated regional cerebral blood volume (rCBV) in the tumor region; however, signal decrease was less prominent and rCBV was lower in healthy brain tissue. In one patient, the rCBV ratio of tumor/brain was 5.0 and the maximal signal decay occurred 3.1 times deeper in the tumor than in the healthy brain tissue. Results of an ultrasonography examination using CH imaging revealed similar data: the tumor/brain ratio for the area under the curve, a parameter corresponding to rCBV, was 4.1. The maximal signal intensity in the tumor was 3.3 times greater than in adjacent healthy brain. Comparable data were obtained in a second patient. Taken together, these findings indicate that CH imaging may be a valuable alternative to pMR imaging. This new, cost-effective bedside ultrasonic technique could be helpful not only as a means of noninvasive staging of gliomas but also as a follow-up imaging modality to evaluate postoperative tumor recurrence or response to antiangiogenic therapy.

Article Information

Address reprint requests to: Judith U. Harrer, M.D., Department of Neurology, Aachen University Hospital, Pauwelsstrasse 30, D-52074 Aachen, Germany. email: Judith.Harrer@web.de.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    Case 2. A FLAIR (left) and native B-mode image (right) demonstrating a high-grade glioma in corresponding transverseaxial planes of section. The tumor (arrow) is located in the left thalamus, infiltrating the pellucid septum with considerable midline shift. Anteriorly, the anterior horns of the lateral ventricles are depicted (double arrows), and posteriorly, the plexus within the posterior horns of the lateral ventricle is demonstrated (triple arrows).

  • View in gallery

    Graphs demonstrating time-intensity curves of pMR- (left) and CH-imaging (right) data: the curves associated with the tumor have a significantly greater peak than the curves associated with healthy tissue. The TTPI values are approximately equal in tumor and healthy brain tissue. In the CH imaging—derived time-intensity curves, a recirculation peak of the contrast agent is visible.

References

  • 1.

    Aronen HJPerkio J: Dynamic susceptibility MRI of gliomas. Neuroimaging Clin N Am 12:5015232002Aronen HJ Perkio J: Dynamic susceptibility MRI of gliomas. Neuroimaging Clin N Am 12:501–523 2002

  • 2.

    Becker GHofmann EWoydt Met al: Postoperative neuroimaging of high-grade gliomas: comparison of transcranial sonography, magnetic resonance imaging, and computed tomography. Neurosurgery 44:4694781999Becker G Hofmann E Woydt M et al: Postoperative neuroimaging of high-grade gliomas: comparison of transcranial sonography magnetic resonance imaging and computed tomography. Neurosurgery 44:469–478 1999

  • 3.

    Becker GKrone AKoulis Det al: Reliability of transcranial color-coded real-time sonography in assessment of brain tumors: correlation of ultrasound, computed tomography and biopsy findings. Neuroradiology 36:5855901994Becker G Krone A Koulis D et al: Reliability of transcranial color-coded real-time sonography in assessment of brain tumors: correlation of ultrasound computed tomography and biopsy findings. Neuroradiology 36:585–590 1994

  • 4.

    Blomley MJKCooke JCUnger ECet al: Microbubble contrast agents: a new era in ultrasound. Br Med J 322:122212252001Blomley MJK Cooke JC Unger EC et al: Microbubble contrast agents: a new era in ultrasound. Br Med J 322:1222–1225 2001

  • 5.

    Burns PN: Harmonic imaging with ultrasound contrast agents. Clin Radiol 51 (Suppl 1):50551996Burns PN: Harmonic imaging with ultrasound contrast agents. Clin Radiol 51 (Suppl 1):50–55 1996

  • 6.

    Eyding JWilkening WReckhardt Met al: Contrast burst depletion imaging (CODIM): a new imaging procedure and analysis method for semiquantitative ultrasonic perfusion imaging. Stroke 34:77832003Eyding J Wilkening W Reckhardt M et al: Contrast burst depletion imaging (CODIM): a new imaging procedure and analysis method for semiquantitative ultrasonic perfusion imaging. Stroke 34:77–83 2003

  • 7.

    Federlein JPostert TMeves Set al: Ultrasonic evaluation of pathological brain perfusion in acute stroke using second harmonic imaging. J Neurol Neurosurg Psychiatry 69:6166222000Federlein J Postert T Meves S et al: Ultrasonic evaluation of pathological brain perfusion in acute stroke using second harmonic imaging. J Neurol Neurosurg Psychiatry 69:616–622 2000

  • 8.

    Greenberg RSTaylor GAStapleton JCet al: Analysis of regional cerebral blood flow in dogs, with an experimental microbubble-based US contrast agent. Radiology 201:1191231996Greenberg RS Taylor GA Stapleton JC et al: Analysis of regional cerebral blood flow in dogs with an experimental microbubble-based US contrast agent. Radiology 201:119–123 1996

  • 9.

    Harrer JUMayfrank LMull Met al: Second harmonic imaging: A new ultrasound technique to assess human brain tumour perfusion. J Neurol Neurosurg Psychiatry 74:3333382003Harrer JU Mayfrank L Mull M et al: Second harmonic imaging: A new ultrasound technique to assess human brain tumour perfusion. J Neurol Neurosurg Psychiatry 74:333–338 2003

  • 10.

    Harvey CJAlbrecht T: Ultrasound of focal liver lesions. Eur Radiol 11:157815932001Harvey CJ Albrecht T: Ultrasound of focal liver lesions. Eur Radiol 11:1578–1593 2001

  • 11.

    Jackson AKassner AAnnesley-Williams Det al: Abnormalities of the recirculation phase of contrast agent bolus passage in cerebral gliomas: comparison with relative blood volume and tumor grade. AJNR 23:7142002Jackson A Kassner A Annesley-Williams D et al: Abnormalities of the recirculation phase of contrast agent bolus passage in cerebral gliomas: comparison with relative blood volume and tumor grade. AJNR 23:7–14 2002

  • 12.

    Law MCha SKnopp EAet al: High-grade gliomas and solitary metastases: differentiation by using perfusion and proton spectroscopic MR imaging. Radiology 222:7157212002Law M Cha S Knopp EA et al: High-grade gliomas and solitary metastases: differentiation by using perfusion and proton spectroscopic MR imaging. Radiology 222:715–721 2002

  • 13.

    Meves SHWilkening WThies Tet al: Comparison between echo contrast agent-specific imaging modes and perfusion-weighted magnetic resonance imaging for the assessment of brain perfusion. Stroke 33:243324372002Meves SH Wilkening W Thies T et al: Comparison between echo contrast agent-specific imaging modes and perfusion-weighted magnetic resonance imaging for the assessment of brain perfusion. Stroke 33:2433–2437 2002

  • 14.

    Meyer KSeidel GKnopp U: Transcranial sonography of brain tumors in the adult: an in vitro and in vivo study. J Neuroimaging 11:2872922001Meyer K Seidel G Knopp U: Transcranial sonography of brain tumors in the adult: an in vitro and in vivo study. J Neuroimaging 11:287–292 2001

  • 15.

    Schrope BNewhouse VL: Second harmonic ultrasonic blood perfusion measurement. Ultrasound Med Biol 19:5675791993Schrope B Newhouse VL: Second harmonic ultrasonic blood perfusion measurement. Ultrasound Med Biol 19:567–579 1993

  • 16.

    Seidel GMeyer K: Harmonic imaging-a new method for the sonographic assessment of cerebral perfusion. Eur J Ultrasound 14:1031132001Seidel G Meyer K: Harmonic imaging-a new method for the sonographic assessment of cerebral perfusion. Eur J Ultrasound 14:103–113 2001

  • 17.

    Sugahara TKorogi YKochi Met al: Correlation of MR imaging-determined cerebral blood volume maps with histologic and angiographic determination of vascularity of gliomas. AJR 171:147914861998Sugahara T Korogi Y Kochi M et al: Correlation of MR imaging-determined cerebral blood volume maps with histologic and angiographic determination of vascularity of gliomas. AJR 171:1479–1486 1998

TrendMD

Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 39 39 3
Full Text Views 109 109 0
PDF Downloads 57 57 1
EPUB Downloads 0 0 0

PubMed

Google Scholar