Dependency of the blood oxygen level dependent-response to hyperoxic challenges on the order of gas administration in intracranial malignancies

  • Sonja Stieb
  • Oliver Riesterer
  • Andreas Boss
  • Tobias Weiss
  • Matthias Guckenberger
  • Pinar S. Özbay
  • Daniel Nanz
  • Cristina RossiEmail author
Diagnostic Neuroradiology



Literature reports contradicting results on the response of brain tumors to vascular stimuli measured in T2*-weighted MRI. Here, we analyzed the potential dependency of the MRI-response to (hypercapnic) hyperoxia on the order of the gas administration.


T2* values were quantified at 3 Tesla in eight consenting patients at rest and during inhalation of hyperoxic/hypercapnic gas mixtures. Patients were randomly divided into two groups undergoing different gas administration protocols (group A: medical air-pure oxygen–carbogen; group B: medical air–carbogen-pure oxygen). Mann-Whitney U test and Wilcoxon signed rank test have been used to proof differences in T2* regarding respiratory challenge or different groups, respectively.


T2* values at rest for gray and white matter were 50.3 ± 2.6 ms and 46.1 ± 2.0 ms, respectively, and slightly increased during challenge. In tumor areas, T2* at rest were: necrosis = 74.1 ± 10.1 ms; edema = 60.3 ± 17.6 ms; contrast-enhancing lesions = 48.6 ± 20.7 ms; and solid T2-hyperintense lesions = 45.0 ± 3.0 ms. Contrast-enhancing lesions strongly responded to oxygen (+ 20.7%) regardless on the gas protocol (p = 0.482). However, the response to carbogen significantly depended on the order of gas administration (group A, + 18.6%; group B, − 6.4%, p = 0.042). In edemas, a different trend between group was found when breathing oxygen (group A, − 9.9%; group B, + 19.5%, p = 0.057).


Preliminary results show a dependency of the T2* response of contrast-enhancing brain tumor lesions on the order of the gas administration. The gas administration protocol is an important factor in the interpretation of the T2*-response in areas of abnormal vascular growth.


BOLD MRI Oxygen Carbogen T2* R2* Vascular reactivity 



This work was supported by the CRPP Tumor Oxygenation of the University of Zurich and by the CRPP Molecular Imaging Network Zurich (minz) of the University of Zurich.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Institute of Diagnostic and Interventional RadiologyUniversity Hospital Zurich and University of ZurichZurichSwitzerland
  2. 2.Department of Radiation OncologyUniversity Hospital Zurich, University of Zurich, SwitzerlandZurichSwitzerland
  3. 3.Center for Radiation-Oncology KSA-KSBCantonal Hospital AarauAarauSwitzerland
  4. 4.Department of Neurology and Brain Tumor CenterUniversity Hospital Zurich and University of Zurich, Zurich, SwitzerlandZurichSwitzerland
  5. 5.Institute for Biomedical EngineeringUniversity of Zurich and ETH ZurichZurichSwitzerland
  6. 6.Advanced MRI Section, Laboratory of Functional and Molecular Imaging, National Institutes of Neurological Disorders and Stroke, National Institutes of HealthBethesdaUSA

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