La radiologia medica

, Volume 123, Issue 7, pp 545–552 | Cite as

Dynamic susceptibility contrast (DSC) perfusion MRI in differential diagnosis between radionecrosis and neoangiogenesis in cerebral metastases using rCBV, rCBF and K2

  • Mario Muto
  • Giulia Frauenfelder
  • Rossana Senese
  • Fabio Zeccolini
  • Emiliano Schena
  • Francesco Giurazza
  • Hans Rolf Jäger



Distinction between treatment-related changes and tumour recurrence in patients who have received radiation treatment for brain metastases can be difficult on conventional MRI. In this study, we investigated the ability of dynamic susceptibility contrast (DSC) perfusion in differentiating necrotic changes from pathological angiogenesis and compared measurements of relative cerebral blood volume (rCBV), relative cerebral blood flow (rCBF) and K2, using a dedicated software.


Twenty-nine patients with secondary brain tumors were included in this retrospective study and underwent DSC perfusion MRI with a 3-month follow-up imaging after chemo- or radiation-therapy. Region-of-interests were drawn around the contrast enhancing lesions and measurements of rCBV, rCBF and K2 were performed in all patients. Based on subsequent histological examination or clinico-radiological follow-up, the cohort was divided in two groups: recurrent disease and stable disease. Differences between the two groups were analyzed using the Student’s t test. Sensitivity, specificity and diagnostic accuracy of rCBV measurements were analyzed considering three different cut-off values.


Between patients with and without disease, only rCBV and rCBF values were significant (p < 0.05). The only cut-off value giving the best diagnostic accuracy of 100% was rCBV = 2.1 (sensitivity = 100%; specificity = 100%). Patients with tumor recurrence showed a higher mean value of rCBV (mean = 4.28, standard deviation = 2.09) than patients with necrotic-related changes (mean = 0.77, standard deviation = 0.44).


DSC-MRI appears a clinically useful method to differentiate between tumor recurrence, tumor necrosis and pseudoprogression in patients treated for cerebral metastases. Relative CBV using a cut-off value of 2.1 proved to be the most accurate and reliable parameter.


Functional magnetic resonance imaging Perfusion Brain Neoplasm metastases Cerebral blood volume 



The authors declare that this study has not received any funding.

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. For this type of study formal consent is not required.

Informed consent

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


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Copyright information

© Italian Society of Medical Radiology 2018
corrected publication [March 2018]

Authors and Affiliations

  • Mario Muto
    • 1
  • Giulia Frauenfelder
    • 2
  • Rossana Senese
    • 3
  • Fabio Zeccolini
    • 1
  • Emiliano Schena
    • 4
  • Francesco Giurazza
    • 5
  • Hans Rolf Jäger
    • 6
  1. 1.Department of NeuroradiologyAONR CardarelliNaplesItaly
  2. 2.Department of Diagnostic and Interventional RadiologyUniversità Campus Bio-Medico di RomaRomeItaly
  3. 3.Emicenter European Medical ImagingCasavatore, NapoliItaly
  4. 4.Department of Measurement and Biomedical InstrumentationUniversità Campus Bio-Medico di RomaRomeItaly
  5. 5.Department of Interventional RadiologyAONR CardarelliNaplesItaly
  6. 6.Neuroradiological Academic Unit, Department of Brain Repair and RehabilitationUCL Institute of NeurologyLondonUK

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