Article Figures & Data
Figures
- Fig 1.
Summary of Gd-based DSC methodology: staged injection technique. Gradient-echo DSC-MRI (0.1-mmol/kg gadodiamide bolus) provides no preload (P−) rCBV data and serves as a preload (P+) for subsequent DSC-MRI (0.2 mmol/kg bolus). Gd-rCBV without (C−) and with (C+) application of postprocessing leakage correction are computed for both P− and P+ data, thereby testing P−C−, P−C+, P+C−, and P+C+ permutations of the 2 leakage-correction techniques.
- Fig 2.
Gd-rCBV for initial (P−) and second (P+) injection data was computed by using voxelwise trapezoidal integration of ΔR2* (t) without (C−) and with (C+) postprocessing leakage correction. A, Examples of P+C− and P+C+ curves in tumor and reference brain. B, The ratio of mean rCBV from tumor (gray) and contralateral brain (black) ROIs was computed for all injections, providing normalized rCBV values.
- Fig 3.
Comparison of preload-dominant and postprocessing-dominant corrective effects on relaxivity time curves for 2 different tumors. A, Preload alone (solid gray line) eliminates most of the T1 leakage contamination (dashed gray line with blunted peak relaxivity and negative ΔR2* values; shift between gray arrows), whereas postprocessing correction does not (dashed black line; shift between black arrows). B, Postprocessing algorithm has more substantial corrective effect than preload in the tail portion of the curves (dashed black versus dashed gray lines; shift between black versus gray arrows), but the converse is true during the first pass (solid versus dashed lines), demonstrating synergy between the 2 correction schemes. Combining preload and postprocessing (solid black lines) yields the greatest peak ΔR2* without negative relaxivity values.
- Fig 4.
Comparison of rCBV discrepancies ([Gd − MION] / MION) for each correction scheme permutation (mean and 95% CI). Although there is no statistically significant intrascheme or interscheme bias, mean discrepancy is closest to zero for P+C+ (−1.8%), followed by P+C− (+7.6%), P−C+ (+38.3%), and P−C− (−142.8%). The variance of rCBV discrepancies differed substantially between correction schemes, with P+C− (22-fold), P−C+ (32-fold), and P+C+ (267-fold) all statistically significantly lower compared with P−C−. The use of both correction techniques (P+C+) further significantly reduced the variance compared with that for each individually (12-fold versus P+C−, 8-fold versus P−C+).
- Fig 5.
Gd-rCBV with preload and with (P+C+) and without (P+C−) leakage correction is plotted against MION-rCBV. The linear fit for P+C+ data is much closer to the ideal line of identity than the linear fit for P+C−, arguing that the use of both correction schemes outperforms the use of only preload.
Tables
Category Technique Examples Image acquisition Low flip angle, long TE, double-echo T2*-weighted Knopp et al,11 Cha et al38 Vonken et al,27 Uematsu et al28 Contrast agent Use of loading dosesa Donahue et al,3 Schmainda et al,21 Simonsen et al35 Intravascular agents (eg, ferumoxytol) Gahramanov et al20 Postprocessing Linear fit + leakage modela Weisskoff et al,31 Schmainda et al21 Boxerman et al22 γ-Variate fit Law et al4 Limited integration Wong et al30 Baseline subtraction Wetzel et al29 ↵a Designates the 2 techniques investigated in this article.
- Table 2:
Summary of discrepancy between Gd-rCBV and MION-rCBV for each correction scheme permutation
Scheme rCBV Discrepancy Intercept Slope Mean (%) 95% CI (%) Mean 95% CI Mean 95% CI P−C− −142.8 −471.5, +186.0 +1.4 +1.1, +1.6 −0.01 −0.04, +0.02 P−C+ +38.3 −32.0, +108.6 +1.3 +0.8, +1.8 +0.16 +0.02, +0.31 P+C− +7.6 −50.1, +65.9 +1.0 +0.5, +1.5 +0.02 −0.29, +0.33 P+C+ −1.8 −22.0, +18.3 +0.6 −0.2, +1.4 +0.58 +0.17, +1.00 -
Note:—rCBV discrepancy indicates (Gd-rCBV − MION-rCBV) / MION-rCBV (ideal equals zero); intercept and slope, the linear fit of MION-rCBV versus Gd-rCBV (ideal equals zero intercept with unity slope).
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