Moving toward a consensus DSC-MRI protocol: Validation of a low-flip angle single-dose option as a reference standard for brain tumors

K. M. Schmainda, M. A. Prah, Leland S Hu, C. C. Quarles, N. Semmineh, S. D. Rand, J. M. Connelly, B. Anderies, Y. Zhou, Y. Liu, B. Logan, A. Stokes, G. Baird, J. L. Boxerman

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

BACKGROUND AND PURPOSE: DSC-MR imaging using preload, intermediate (60°) flip angle and postprocessing leakage correction has gained traction as a standard methodology. Simulations suggest that DSC-MR imaging with flip angle = 30° and no preload yields relative CBV practically equivalent to the reference standard. This study tested this hypothesis in vivo. MATERIALS AND METHODS: Eighty-four patients with brain lesions were enrolled in this 3-institution study. Forty-three patients satisfied the inclusion criteria. DSC-MR imaging (3T, single-dose gadobutrol, gradient recalled-echo-EPI, TE = 20-35 ms, TR = 1.2-1.63 seconds) was performed twice for each patient, with flip angle = 30°-35° and no preload (P -), which provided preload (P+) for the subsequent intermediate flip angle = 60°. Normalized relative CBV and standardized relative CBV maps were generated, including postprocessing with contrast agent leakage correction (C+) and without (C -) contrast agent leakage correction. Contrast-enhancing lesion volume, mean relative CBV, and contrast-to-noise ratio obtained with 30°/P - /C -, 30°/P - /C +, and 60°/P+/C - were compared with 60°/P+/C + using the Lin concordance correlation coefficient and Bland-Altman analysis. Equivalence between the 30°/P - /C+ and 60°/P+/C + protocols and the temporal SNRfor the 30°/P - and 60°/P+ DSC-MR imaging data was also determined. RESULTS: Compared with 60°/P+/C+, 30°/P - /C+ had closest mean standardized relative CBV (P =.61), highest Lin concordance correlation coefficient (0.96), and lowest Bland-Altman bias (μ = 1.89), compared with 30°/P - /C - (P =.02, Lin concordance correlation coefficient = 0.59, μ = 14.6) and 60°/P+/C - (P =.03, Lin concordance correlation coefficient = 0.88, μ = - 10.1) with no statistical difference in contrast-to-noise ratios across protocols. The normalized relative CBV and standardized relative CBV were statistically equivalent at the 10% level using either the 30°/P - /C+ or 60°/P+/C+ protocols. Temporal SNR was not significantly different for 30°/P - and 60°/P+ (P =.06). CONCLUSIONS: Tumor relative CBV derived from low-flip angle, no-preload DSC-MR imaging with leakage correction is an attractive single-dose alternative to the higher dose reference standard.

Original languageEnglish (US)
Pages (from-to)626-633
Number of pages8
JournalAmerican Journal of Neuroradiology
Volume40
Issue number4
DOIs
StatePublished - Jan 1 2019
Externally publishedYes

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Brain Neoplasms
Contrast Media
Noise
Traction
Brain
Neoplasms
gadobutrol
TR-35

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Clinical Neurology

Cite this

Moving toward a consensus DSC-MRI protocol : Validation of a low-flip angle single-dose option as a reference standard for brain tumors. / Schmainda, K. M.; Prah, M. A.; Hu, Leland S; Quarles, C. C.; Semmineh, N.; Rand, S. D.; Connelly, J. M.; Anderies, B.; Zhou, Y.; Liu, Y.; Logan, B.; Stokes, A.; Baird, G.; Boxerman, J. L.

In: American Journal of Neuroradiology, Vol. 40, No. 4, 01.01.2019, p. 626-633.

Research output: Contribution to journalArticle

Schmainda, KM, Prah, MA, Hu, LS, Quarles, CC, Semmineh, N, Rand, SD, Connelly, JM, Anderies, B, Zhou, Y, Liu, Y, Logan, B, Stokes, A, Baird, G & Boxerman, JL 2019, 'Moving toward a consensus DSC-MRI protocol: Validation of a low-flip angle single-dose option as a reference standard for brain tumors', American Journal of Neuroradiology, vol. 40, no. 4, pp. 626-633. https://doi.org/10.3174/ajnr.A6015
Schmainda, K. M. ; Prah, M. A. ; Hu, Leland S ; Quarles, C. C. ; Semmineh, N. ; Rand, S. D. ; Connelly, J. M. ; Anderies, B. ; Zhou, Y. ; Liu, Y. ; Logan, B. ; Stokes, A. ; Baird, G. ; Boxerman, J. L. / Moving toward a consensus DSC-MRI protocol : Validation of a low-flip angle single-dose option as a reference standard for brain tumors. In: American Journal of Neuroradiology. 2019 ; Vol. 40, No. 4. pp. 626-633.
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abstract = "BACKGROUND AND PURPOSE: DSC-MR imaging using preload, intermediate (60°) flip angle and postprocessing leakage correction has gained traction as a standard methodology. Simulations suggest that DSC-MR imaging with flip angle = 30° and no preload yields relative CBV practically equivalent to the reference standard. This study tested this hypothesis in vivo. MATERIALS AND METHODS: Eighty-four patients with brain lesions were enrolled in this 3-institution study. Forty-three patients satisfied the inclusion criteria. DSC-MR imaging (3T, single-dose gadobutrol, gradient recalled-echo-EPI, TE = 20-35 ms, TR = 1.2-1.63 seconds) was performed twice for each patient, with flip angle = 30°-35° and no preload (P -), which provided preload (P+) for the subsequent intermediate flip angle = 60°. Normalized relative CBV and standardized relative CBV maps were generated, including postprocessing with contrast agent leakage correction (C+) and without (C -) contrast agent leakage correction. Contrast-enhancing lesion volume, mean relative CBV, and contrast-to-noise ratio obtained with 30°/P - /C -, 30°/P - /C +, and 60°/P+/C - were compared with 60°/P+/C + using the Lin concordance correlation coefficient and Bland-Altman analysis. Equivalence between the 30°/P - /C+ and 60°/P+/C + protocols and the temporal SNRfor the 30°/P - and 60°/P+ DSC-MR imaging data was also determined. RESULTS: Compared with 60°/P+/C+, 30°/P - /C+ had closest mean standardized relative CBV (P =.61), highest Lin concordance correlation coefficient (0.96), and lowest Bland-Altman bias (μ = 1.89), compared with 30°/P - /C - (P =.02, Lin concordance correlation coefficient = 0.59, μ = 14.6) and 60°/P+/C - (P =.03, Lin concordance correlation coefficient = 0.88, μ = - 10.1) with no statistical difference in contrast-to-noise ratios across protocols. The normalized relative CBV and standardized relative CBV were statistically equivalent at the 10{\%} level using either the 30°/P - /C+ or 60°/P+/C+ protocols. Temporal SNR was not significantly different for 30°/P - and 60°/P+ (P =.06). CONCLUSIONS: Tumor relative CBV derived from low-flip angle, no-preload DSC-MR imaging with leakage correction is an attractive single-dose alternative to the higher dose reference standard.",
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T1 - Moving toward a consensus DSC-MRI protocol

T2 - Validation of a low-flip angle single-dose option as a reference standard for brain tumors

AU - Schmainda, K. M.

AU - Prah, M. A.

AU - Hu, Leland S

AU - Quarles, C. C.

AU - Semmineh, N.

AU - Rand, S. D.

AU - Connelly, J. M.

AU - Anderies, B.

AU - Zhou, Y.

AU - Liu, Y.

AU - Logan, B.

AU - Stokes, A.

AU - Baird, G.

AU - Boxerman, J. L.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - BACKGROUND AND PURPOSE: DSC-MR imaging using preload, intermediate (60°) flip angle and postprocessing leakage correction has gained traction as a standard methodology. Simulations suggest that DSC-MR imaging with flip angle = 30° and no preload yields relative CBV practically equivalent to the reference standard. This study tested this hypothesis in vivo. MATERIALS AND METHODS: Eighty-four patients with brain lesions were enrolled in this 3-institution study. Forty-three patients satisfied the inclusion criteria. DSC-MR imaging (3T, single-dose gadobutrol, gradient recalled-echo-EPI, TE = 20-35 ms, TR = 1.2-1.63 seconds) was performed twice for each patient, with flip angle = 30°-35° and no preload (P -), which provided preload (P+) for the subsequent intermediate flip angle = 60°. Normalized relative CBV and standardized relative CBV maps were generated, including postprocessing with contrast agent leakage correction (C+) and without (C -) contrast agent leakage correction. Contrast-enhancing lesion volume, mean relative CBV, and contrast-to-noise ratio obtained with 30°/P - /C -, 30°/P - /C +, and 60°/P+/C - were compared with 60°/P+/C + using the Lin concordance correlation coefficient and Bland-Altman analysis. Equivalence between the 30°/P - /C+ and 60°/P+/C + protocols and the temporal SNRfor the 30°/P - and 60°/P+ DSC-MR imaging data was also determined. RESULTS: Compared with 60°/P+/C+, 30°/P - /C+ had closest mean standardized relative CBV (P =.61), highest Lin concordance correlation coefficient (0.96), and lowest Bland-Altman bias (μ = 1.89), compared with 30°/P - /C - (P =.02, Lin concordance correlation coefficient = 0.59, μ = 14.6) and 60°/P+/C - (P =.03, Lin concordance correlation coefficient = 0.88, μ = - 10.1) with no statistical difference in contrast-to-noise ratios across protocols. The normalized relative CBV and standardized relative CBV were statistically equivalent at the 10% level using either the 30°/P - /C+ or 60°/P+/C+ protocols. Temporal SNR was not significantly different for 30°/P - and 60°/P+ (P =.06). CONCLUSIONS: Tumor relative CBV derived from low-flip angle, no-preload DSC-MR imaging with leakage correction is an attractive single-dose alternative to the higher dose reference standard.

AB - BACKGROUND AND PURPOSE: DSC-MR imaging using preload, intermediate (60°) flip angle and postprocessing leakage correction has gained traction as a standard methodology. Simulations suggest that DSC-MR imaging with flip angle = 30° and no preload yields relative CBV practically equivalent to the reference standard. This study tested this hypothesis in vivo. MATERIALS AND METHODS: Eighty-four patients with brain lesions were enrolled in this 3-institution study. Forty-three patients satisfied the inclusion criteria. DSC-MR imaging (3T, single-dose gadobutrol, gradient recalled-echo-EPI, TE = 20-35 ms, TR = 1.2-1.63 seconds) was performed twice for each patient, with flip angle = 30°-35° and no preload (P -), which provided preload (P+) for the subsequent intermediate flip angle = 60°. Normalized relative CBV and standardized relative CBV maps were generated, including postprocessing with contrast agent leakage correction (C+) and without (C -) contrast agent leakage correction. Contrast-enhancing lesion volume, mean relative CBV, and contrast-to-noise ratio obtained with 30°/P - /C -, 30°/P - /C +, and 60°/P+/C - were compared with 60°/P+/C + using the Lin concordance correlation coefficient and Bland-Altman analysis. Equivalence between the 30°/P - /C+ and 60°/P+/C + protocols and the temporal SNRfor the 30°/P - and 60°/P+ DSC-MR imaging data was also determined. RESULTS: Compared with 60°/P+/C+, 30°/P - /C+ had closest mean standardized relative CBV (P =.61), highest Lin concordance correlation coefficient (0.96), and lowest Bland-Altman bias (μ = 1.89), compared with 30°/P - /C - (P =.02, Lin concordance correlation coefficient = 0.59, μ = 14.6) and 60°/P+/C - (P =.03, Lin concordance correlation coefficient = 0.88, μ = - 10.1) with no statistical difference in contrast-to-noise ratios across protocols. The normalized relative CBV and standardized relative CBV were statistically equivalent at the 10% level using either the 30°/P - /C+ or 60°/P+/C+ protocols. Temporal SNR was not significantly different for 30°/P - and 60°/P+ (P =.06). CONCLUSIONS: Tumor relative CBV derived from low-flip angle, no-preload DSC-MR imaging with leakage correction is an attractive single-dose alternative to the higher dose reference standard.

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