Functional Information on Meningiomas Through Perfusion Magnetic Resonance Imaging

Functional Information on Meningiomas Through Perfusion Magnetic Resonance Imaging

Oudkerk Matthijs, Zhang Guixiang, Zhang Hao

European Neurological Review, 009;4(1):88-90
US Neurology, 009;5(1):78-80

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Abstract
This article focuses on the use of perfusion magnetic resonance imaging (MRI), and in particular dynamic susceptibility contrast-enhanced MRI (DSCMRI), to assess hemodynamics in meningiomas. We first introduce the basic principles of DSC-MRI and the most popular imaging techniques and perfusion parameters for data analysis of DSC-MRI. We then review the blood supply characteristics of meningiomas and how perfusion MRI is applied in meningiomas to help the subtyping of different meningiomas and to differentiate between benign and malignant meningiomas. Our firsthand experiences are also included. We conclude that DSC perfusion MRI can provide critical information on the vascularity of meningiomas that is not available with conventional MRI. DSC perfusion MRI measurements are helpful in the pre-operative subtyping and grading of meningiomas.

Keywords
Perfusion, magnetic resonance imaging (MRI),meningioma, brain, tumors, diagnosis

Disclosure: The authors have no conflicts of interest to declare.
Received: January 22, 2009 Accepted: July 27, 2009
Correspondence: Hao Zhang, MD, PhD, Department of Radiology, Shanghai Jiaotong University Affiliated First Hospital, 100# Haining Road, Shanghai, 20080, China. E: chlzhcx@163.com

Perfusion is defined as the steady-state delivery of nutrients and oxygen via blood to tissue per unit volume or mass and is typically measured in milliliters per 100g of tissue per minute.1 Because blood flow brings crucial nutrients, and because it is disturbed in many disease processes, monitoring of this key physiological parameter can often provide insight into disease.

The brain is an unusual organ in the hemodynamic sense, with a high metabolic rate that is sustained through high cerebral blood flow (CBF).CBF is defined as the volume of blood moving through a given brain region per unit time. Normal CBF is typically greater than 50–60ml/100g/min. Unlike other high-flow organs, the limited space inside the bony cranium requires an efficient regulation system, which is accomplished with a high capillary density but remarkably low cerebral blood volume (CBV). CBV is defined as the total volume of blood in a given region of the brain. CBV has units of milliliters of blood per 100g of brain tissue (ml/100g); normal CBV is 2–5ml/100g. Mean transit time (MTT) is a slightly more complex concept. Because the transit time of blood through the brain parenchyma varies depending on the distance traveled between arterial inflow and venous outflow, the MTT is defined as the average of the transit time of blood through a given brain region, integrated across these different paths. Mathematically, MTT is related to both CBV and CBF according to the central volume principle, which states that MTT = CBV/CBF.2,3 Conceptually, MTT can be thought of as the time required for blood to cross from the arterial to the venous side of the circulation. MTT is typically measured in seconds.

While magnetic resonance imaging (MRI) has traditionally been used to evaluate anatomy, with its main application being the central nervous system (CNS), the recent application of MRI to visualise tissue physiology or function has met with great success. Indeed, a whole new field known as functional MRI has arisen to apply these techniques. Because blood flow is altered in many pathophysiological states, from abnormal cognition through stroke to brain tumours, use of MRI to study blood flow is one of the most clinically relevant of the many forms of functional MRI. Dynamic susceptibility contrast, arterial spin labelling (ASL) and methods to measure permeability are the three techniques that have been used to quantify the perfusion of brain in many research and clinical applications. Rather than surveying the entire field of brain perfusion imaging, this article focuses on the use of perfusion MRI and, in particular, dynamic susceptibility contrast-enhanced MR imaging (DSC-MRI) to assess haemodynamics in meni giomas.

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Keywords:
Perfusion, magnetic resonance imaging (MRI), meningioma, brain, tumors, diagnosis, treatment meningiomas, meningiomas of the lateral ventricle, meningiomas of the cerebellopontine angle, management meningiomas, meningiomas symptoms, meningiomas embolization, contrast enhancement, MRI meningioma, ventilation perfusion, cerebral perfusion,

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