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., Pizer, B., Grundy, R., Morgan, P. S., Bailey, S., Mitra, D., Arvanitis, T. N., Auer, D. P., Avula, S., & 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: May 1, 2022
• 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