Dynamic susceptibility-contrast magnetic resonance imaging with contrast agent leakage correction aids in predicting grade in pediatric brain tumours: a multicenter study

Withey, Stephanie B.; MacPherson, Lesley; Oates, Adam; Powell, Stephen; Novak, Jan; Abernethy, Laurence; Pizer, Barry; Grundy, Richard; Morgan, Paul S.; Bailey, Simon; Mitra, Dipayan; Arvanitis, Theodoros N.; Auer, Dorothee P.; Avula, Shivaram; Peet, Andrew C.

Abstract

Background
Relative cerebral blood volume (rCBV) measured using dynamic susceptibility-contrast MRI can differentiate between low- and high-grade pediatric brain tumors. Multicenter studies are required for translation into clinical practice.

Objective
We compared leakage-corrected dynamic susceptibility-contrast MRI perfusion parameters acquired at multiple centers in low- and high-grade pediatric brain tumors.

Materials and methods
Eighty-five pediatric patients underwent pre-treatment dynamic susceptibility-contrast MRI scans at four centers. MRI protocols were variable. We analyzed data using the Boxerman leakage-correction method producing pixel-by-pixel estimates of leakage-uncorrected (rCBVuncorr) and corrected (rCBVcorr) relative cerebral blood volume, and the leakage parameter, K2. Histological diagnoses were obtained. Tumors were classified by high-grade tumor. We compared whole-tumor median perfusion parameters between low- and high-grade tumors and across tumor types.

Results
Forty tumors were classified as low grade, 45 as high grade. Mean whole-tumor median rCBVuncorr was higher in high-grade tumors than low-grade tumors (mean ± standard deviation [SD] = 2.37±2.61 vs. –0.14±5.55; P<0.01). Average median rCBV increased following leakage correction (2.54±1.63 vs. 1.68±1.36; P=0.010), remaining higher in high-grade tumors than low grade-tumors. Low-grade tumors, particularly pilocytic astrocytomas, showed T1-dominant leakage effects; high-grade tumors showed T2*-dominance (mean K2=0.017±0.049 vs. 0.002±0.017). Parameters varied with tumor type but not center. Median rCBVuncorr was higher (mean = 1.49 vs. 0.49; P=0.015) and K2 lower (mean = 0.005 vs. 0.016; P=0.013) in children who received a pre-bolus of contrast agent compared to those who did not. Leakage correction removed the difference.

Conclusion
Dynamic susceptibility-contrast MRI acquired at multiple centers helped distinguish between children’s brain tumors. Relative cerebral blood volume was significantly higher in high-grade compared to low-grade tumors and differed among common tumor types. Vessel leakage correction is required to provide accurate rCBV, particularly in low-grade enhancing tumors.

Citation

Withey, S. B., MacPherson, L., Oates, A., Powell, S., Novak, J., Abernethy, L., …Peet, A. C. (2022). Dynamic susceptibility-contrast magnetic resonance imaging with contrast agent leakage correction aids in predicting grade in pediatric brain tumours: a multicenter study. Pediatric Radiology, 52(6), 1134-1149. https://doi.org/10.1007/s00247-021-05266-7

• Journal Article Type: Article
• Acceptance Date: Dec 11, 2021
• Online Publication Date: Mar 15, 2022
• Publication Date: 2022-05
• Deposit Date: Dec 5, 2023
• Publicly Available Date: Dec 6, 2023
• Journal: Pediatric Radiology
• Print ISSN: 0301-0449
• Electronic ISSN: 1432-1998
• Publisher: Springer Verlag
• Peer Reviewed: Peer Reviewed
• Volume: 52
• Issue: 6
• Pages: 1134-1149
• DOI: https://doi.org/10.1007/s00247-021-05266-7
• Keywords: Radiology, Nuclear Medicine and imaging; Pediatrics, Perinatology and Child Health
• Public URL: https://nottingham-repository.worktribe.com/output/28140372
• Publisher URL: https://link.springer.com/article/10.1007/s00247-021-05266-7