Objectives

Objectives: At the end of this lecture participants should be able to:
· Summarize major perfusion imaging methods for brain tumor imaging
· Identify robust acquisition protocols for perfusion imaging
· Describe clinical scenarios that inform choice of perfusion methodology
· Describe advanced perfusion techniques and the derived biomarkers relevant to brain cancer

Syllabus

Perfusion imaging methods enable interrogation of a brain tumor’s hemodynamic and vascular status. Clinically, perfusion metrics enable robust differentiation of glioma grades, identification of higher-grade tumor components in non-enhancing glioma, differentiation of tumor recurrence from post-treatment radiation effects, reflect relevant molecular and genetic drivers of tumor status, and prediction of treatment response and patient survival after radiotherapy, chemotherapy, molecularly targeted therapy (e.g., bevacizumab) and tumor treatment fields.

The perfusion imaging methods most evaluated in clinical use include dynamic susceptibility contrast (DSC)-MRI, dynamic contrast enhanced (DCE)-MRI, and arterial spin labeling (ASL). DSC- and DCE-MRI methods rely upon the acquisition of dynamic MRI signals to track the dynamic passage of exogenously administered contrast agents (CA), whereas ASL leverages endogenous labeling of arterial blood to introduce perfusion sensitivity. For each technique, acquisition details should account for the underlying biophysical basis of the contrast mechanisms, spatial, and temporal resolution and SNR requirements. The choice of which perfusion imaging technique to employ is influenced by the clinical question being addressed and patient specific factors (e.g. potential for confounding susceptibility artifacts, tumor size, and blood brain barrier status). The goal of this lecture will be to describe the motivation and requirements for robust perfusion imaging measures, current best practices, and recent advances in each technique.

Acknowledgements

No acknowledgement found.

References

No reference found.