Differentiation of Infective from Neoplastic Brain Lesions by Dynamic Contrast-enhanced MRI

Overview

Journal Neuroradiology

Specialties Neurology
Radiology

Date 2008 Apr 2

PMID 18379766

Citations 32

Authors

Mohammad Haris

Rakesh Kumar Gupta

Anup Singh

Nuzhat Husain

Mazhar Husain

Chandra Mohan Pandey

Chhitij Srivastava

Sanjay Behari

Ram Kishore Singh Rathore

Affiliations

Soon will be listed here.

Abstract

Introduction: It is not always possible to differentiate infective from neoplastic brain lesions with conventional MR imaging. In this study, we assessed the utility of various perfusion indices in the differentiation of infective from neoplastic brain lesions.

Methods: A total of 103 patients with infective brain lesions (group I, n=26) and neoplastic brain lesions (high-grade glioma, HGG, group II, n=52; low-grade glioma, LGG, group III, n=25) underwent dynamic contrast-enhanced MR imaging. The perfusion indices, including relative cerebral blood volume (rCBV), relative cerebral blood flow (rCBF), transfer coefficient (k(trans)) and leakage (v(e)), were calculated and their degree of correlation with immunohistologically obtained microvessel density (MVD) and vascular endothelial growth factor (VEGF) determined. The rCBV was corrected for the leakage effect. Discriminant analysis for rCBV, rCBF, k(trans) and v(e) was performed to predict the group membership of each case and post hoc analysis was performed to look for group differences.

Results: The rCBV, rCBF, k(trans), v(e), MVD and VEGF were significantly different (P<0.001) between the three groups. Discriminant analysis showed that rCBV predicted 73.1% of the infective lesions, 84.6% of the HGG and 72.0% of the LGG. The rCBF classified 86.5% of the HGG, 80.0% of the LGG and 65.4% of the infective lesions. The k(trans) discriminated 98.1% of the HGG, 76.0% of the LGG and 88.5% of the infective lesions correctly. The v(e) classified 98.1% of the HGG, 76.0% of the LGG and 84.6% the infective lesions. The rCBV was correlated significantly with MVD and VEGF, while the correlation between k(trans) and MVD was not significant.

Conclusion: Physiological perfusion indices such as k(trans) and v(e) appear to be useful in differentiating infective from neoplastic brain lesions. Adding these indices to the current imaging protocol is likely to improve tissue characterization of these focal brain mass lesions.

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References

Mishra A, Gupta R, Jaggi R, Reddy J, Jha D, Husain N . Role of diffusion-weighted imaging and in vivo proton magnetic resonance spectroscopy in the differential diagnosis of ring-enhancing intracranial cystic mass lesions. J Comput Assist Tomogr. 2004; 28(4):540-7. DOI: 10.1097/00004728-200407000-00017. View

Abe Y, Sugisaki K, Dannenberg Jr A . Rabbit vascular endothelial adhesion molecules: ELAM-1 is most elevated in acute inflammation, whereas VCAM-1 and ICAM-1 predominate in chronic inflammation. J Leukoc Biol. 1996; 60(6):692-703. DOI: 10.1002/jlb.60.6.692. View

Folkman J . Role of angiogenesis in tumor growth and metastasis. Semin Oncol. 2003; 29(6 Suppl 16):15-8. DOI: 10.1053/sonc.2002.37263. View

Woods R, Grafton S, Holmes C, Cherry S, Mazziotta J . Automated image registration: I. General methods and intrasubject, intramodality validation. J Comput Assist Tomogr. 1998; 22(1):139-52. DOI: 10.1097/00004728-199801000-00027. View

Kielian T, Hickey W . Proinflammatory cytokine, chemokine, and cellular adhesion molecule expression during the acute phase of experimental brain abscess development. Am J Pathol. 2000; 157(2):647-58. PMC: 1850136. DOI: 10.1016/S0002-9440(10)64575-0. View

Jackson A . Imaging microvascular structure with contrast enhanced MRI. Br J Radiol. 2004; 76 Spec No 2:S159-73. DOI: 10.1259/bjr/22322389. View

Patankar T, Haroon H, Mills S, Baleriaux D, Buckley D, Parker G . Is volume transfer coefficient (K(trans)) related to histologic grade in human gliomas?. AJNR Am J Neuroradiol. 2005; 26(10):2455-65. PMC: 7976173. View

Baldwin A, Kielian T . Persistent immune activation associated with a mouse model of Staphylococcus aureus-induced experimental brain abscess. J Neuroimmunol. 2004; 151(1-2):24-32. DOI: 10.1016/j.jneuroim.2004.02.002. View

Gupta R, Kathuria M, Pradhan S . Magnetization transfer MR imaging in CNS tuberculosis. AJNR Am J Neuroradiol. 1999; 20(5):867-75. PMC: 7056166. View

10.

Uchida M, Chen Z, Liu Y, Black K . Overexpression of bradykinin type 2 receptors on glioma cells enhances bradykinin-mediated blood-brain tumor barrier permeability increase. Neurol Res. 2002; 24(8):739-46. DOI: 10.1179/016164102101200753. View

11.

Machein M, Kullmer J, Fiebich B, Plate K, Warnke P . Vascular endothelial growth factor expression, vascular volume, and, capillary permeability in human brain tumors. Neurosurgery. 1999; 44(4):732-40; discussion 740-1. DOI: 10.1097/00006123-199904000-00022. View

12.

Premack B, Schall T . Chemokine receptors: gateways to inflammation and infection. Nat Med. 1996; 2(11):1174-8. DOI: 10.1038/nm1196-1174. View

13.

van der Flier M, Hoppenreijs S, Van Rensburg A, Ruyken M, Kolk A, Springer P . Vascular endothelial growth factor and blood-brain barrier disruption in tuberculous meningitis. Pediatr Infect Dis J. 2004; 23(7):608-13. DOI: 10.1097/01.inf.0000131634.57368.45. View

14.

Law M, Yang S, Babb J, Knopp E, Golfinos J, Zagzag D . Comparison of cerebral blood volume and vascular permeability from dynamic susceptibility contrast-enhanced perfusion MR imaging with glioma grade. AJNR Am J Neuroradiol. 2004; 25(5):746-55. PMC: 7974484. View

15.

Cha S, Lu S, Johnson G, Knopp E . Dynamic susceptibility contrast MR imaging: correlation of signal intensity changes with cerebral blood volume measurements. J Magn Reson Imaging. 2000; 11(2):114-9. DOI: 10.1002/(sici)1522-2586(200002)11:2<114::aid-jmri6>3.0.co;2-s. View

16.

Garg M, Gupta R, Husain M, Chawla S, Chawla J, Kumar R . Brain abscesses: etiologic categorization with in vivo proton MR spectroscopy. Radiology. 2003; 230(2):519-27. DOI: 10.1148/radiol.2302021317. View

17.

Jackson A . Analysis of dynamic contrast enhanced MRI. Br J Radiol. 2005; 77 Spec No 2:S154-66. DOI: 10.1259/bjr/16652509. View

18.

Chan J, Tsui E, Chau L, Chow K, Chan M, Yuen M . Discrimination of an infected brain tumor from a cerebral abscess by combined MR perfusion and diffusion imaging. Comput Med Imaging Graph. 2001; 26(1):19-23. DOI: 10.1016/s0895-6111(01)00023-4. View

19.

Aronen H, Glass J, Pardo F, Belliveau J, Gruber M, Buchbinder B . Echo-planar MR cerebral blood volume mapping of gliomas. Clinical utility. Acta Radiol. 1995; 36(5):520-8. View

20.

Singh A, Haris M, Rathore D, Purwar A, Sarma M, Bayu G . Quantification of physiological and hemodynamic indices using T(1) dynamic contrast-enhanced MRI in intracranial mass lesions. J Magn Reson Imaging. 2007; 26(4):871-80. DOI: 10.1002/jmri.21080. View