Pre- and post-contrast three-dimensional double inversion-recovery MRI in human glioblastoma
- 418 Downloads
Fluid attenuated inversion recovery (FLAIR) MRI sequences have become an indispensible tool for defining the malignant boundary in patients with brain tumors by nulling the signal contribution from cerebrospinal fluid allowing both regions of edema and regions of non-enhancing, infiltrating tumor to become hyperintense on resulting images. In the current study we examined the utility of a three-dimensional double inversion recovery (DIR) sequence that additionally nulls the MR signal associated with white matter, implemented either pre-contrast or post-contrast, in order to determine whether this sequence allows for better differentiation between tumor and normal brain tissue. T1- and T2-weighted, FLAIR, dynamic susceptibility contrast (DSC)-MRI estimates of cerebral blood volume (rCBV), contrast-enhanced T1-weighted images (T1+C), and DIR data (pre- or post-contrast) were acquired in 22 patients with glioblastoma. Contrast-to-noise (CNR) and tumor volumes were compared between DIR and FLAIR sequences. Line profiles across regions of tumor were generated to evaluate similarities between image contrasts. Additionally, voxel-wise associations between DIR and other sequences were examined. Results suggested post-contrast DIR images were hyperintense (bright) in regions spatially similar those having FLAIR hyperintensity and hypointense (dark) in regions with contrast-enhancement or elevated rCBV due to the high sensitivity of 3D turbo spin echo sequences to susceptibility differences between different tissues. DIR tumor volumes were statistically smaller than tumor volumes as defined by FLAIR (Paired t test, P = 0.0084), averaging a difference of approximately 14 mL or 24 %. DIR images had approximately 1.5× higher lesion CNR compared with FLAIR images (Paired t test, P = 0.0048). Line profiles across tumor regions and scatter plots of voxel-wise coherence between different contrasts confirmed a positive correlation between DIR and FLAIR signal intensity and a negative correlation between DIR and both post-contrast T1-weighted image signal intensity and rCBV. Additional discrepancies between FLAIR and DIR abnormal regions were also observed, together suggesting DIR may provide additional information beyond that of FLAIR.
KeywordsDouble inversion-recovery DIR MRI Glioblastoma Multiparametric MRI
UCLA Institute for Molecular Medicine Seed Grant (BME); UCLA Radiology Exploratory Research Grant (BME); University of California Cancer Research Coordinating Committee Grant (BME); ACRIN Young Investigator Initiative Grant (BME); Art of the Brain (TFC); Ziering Family Foundation in memory of Sigi Ziering (TFC); Singleton Family Foundation (TFC); Clarence Klein Fund for Neuro-Oncology (TFC).
- 1.Lima FR, Kahn SA, Soletti RC, Biasoli D, Alves T, da Fonseca AC, Garcia C, Romao L, Brito J, Holanda-Afonso R, Faria J, Borges H, Moura-Neto V (1826) Glioblastoma: therapeutic challenges, what lies ahead. Biochim Biophys Acta 338–349:2012Google Scholar
- 4.Farace P, Giri MG, Meliado G, Amelio D, Widesott L, Ricciardi GK, Dall’Oglio S, Rizzotti A, Sbarbati A, Beltramello A, Maluta S, Amichetti M (2011) Clinical target volume delineation in glioblastomas: pre-operative versus post-operative/pre-radiotherapy MRI. Br J Radiol 84:271–278PubMedCrossRefGoogle Scholar
- 16.Simon B, Schmidt S, Lukas C, Gieseke J, Traber F, Knol DL, Willinek WA, Geurts JJ, Schild HH, Barkhof F, Wattjes MP (2010) Improved in vivo detection of cortical lesions in multiple sclerosis using double inversion recovery MR imaging at 3 Tesla. Eur Radiol 20(7):1675–1683PubMedCrossRefGoogle Scholar
- 20.Geurts JJ, Roosendaal SD, Calabrese M, Ciccarelli O, Agosta F, Chard DT, Gass A, Huerga E, Moraal B, Pareto D, Rocca MA, Wattjes MP, Yousry TA, Uitdehaag BM, Barkhof F (2011) Consensus recommendations for MS cortical lesion scoring using double inversion recovery MRI. Neurology 76:418–424PubMedCrossRefGoogle Scholar
- 21.Morimoto E, Kanagaki M, Okada T, Yamamoto A, Mori N, Matsumoto R, Ikeda A, Mikuni N, Kunieda T, Paul D, Miyamoto S, Takahashi R, Togashi K (2012) Anterior temporal lobe white matter abnormal signal (ATLAS) as an indicator of seizure focus laterality in temporal lobe epilepsy: comparison of double inversion recovery, FLAIR and T2W MR imaging. Eur Radiol 23(1):3–11PubMedCrossRefGoogle Scholar
- 24.Zhang Q, Li Q, Zhang J, Zhang Y (2011) Double inversion recovery magnetic resonance imaging (MRI) in the preoperative evaluation of hippocampal sclerosis: correlation with volumetric measurement and proton magnetic resonance spectroscopy (1H MRS). J Comput Assist Tomogr 35:406–410PubMedCrossRefGoogle Scholar
- 26.Stupp R, Mason WP, van den Bent MJ, Weller M, Fisher B, Taphoorn MJ, Belanger K, Brandes AA, Marosi C, Bogdahn U, Curschmann J, Janzer RC, Ludwin SK, Gorlia T, Allgeier A, Lacombe D, Cairncross JG, Eisenhauer E, Mirimanoff RO (2005) Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med 352:987–996PubMedCrossRefGoogle Scholar
- 29.Nelson F, Poonawalla AH, Hou P, Huang F, Wolinsky JS, Narayana PA (2007) Improved identification of intracortical lesions in multiple sclerosis with phase-sensitive inversion recovery in combination with fast double inversion recovery MR imaging. AJNR Am J Neuroradiol 28:1645–1649PubMedCrossRefGoogle Scholar