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

  • Diagnostic Neuroradiology
  • Published:
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Abstract

Purpose

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.

Methods

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.

Results

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).

Conclusion

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.

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Funding

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.

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Authors and Affiliations

  1. Institute of Diagnostic and Interventional Radiology, University Hospital Zurich and University of Zurich, Zurich, Switzerland

    Sonja Stieb, Andreas Boss, Pinar S. Özbay, Daniel Nanz & Cristina Rossi

  2. Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Switzerland, Zurich, Switzerland

    Sonja Stieb, Oliver Riesterer & Matthias Guckenberger

  3. Center for Radiation-Oncology KSA-KSB, Cantonal Hospital Aarau, Aarau, Switzerland

    Oliver Riesterer

  4. Department of Neurology and Brain Tumor Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland, Zurich, Switzerland

    Tobias Weiss

  5. Institute for Biomedical Engineering, University of Zurich and ETH Zurich, Zurich, Switzerland

    Pinar S. Özbay

  6. Advanced MRI Section, Laboratory of Functional and Molecular Imaging, National Institutes of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA

    Pinar S. Özbay

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  1. Sonja Stieb
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Correspondence to Cristina Rossi.

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Stieb, S., Riesterer, O., Boss, A. et al. Dependency of the blood oxygen level dependent-response to hyperoxic challenges on the order of gas administration in intracranial malignancies. Neuroradiology 61, 783–793 (2019). https://doi.org/10.1007/s00234-019-02200-5

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