AUTHOR=Shiroishi Mark S. , Weinert Dane , Cen Steven Y. , Varghese Bino , Dondlinger Timothy , Prah Melissa , Mendoza Jesse , Nazemi Sina , Ameli Nima , Amini Negin , Shohas Salman , Chen Shannon , Bigjahan Bavrina , Zada Gabriel , Chen Thomas , Neman-Ebrahim Josh , Chang Eric L. , Chow Frances E. , Fan Zhaoyang , Yang Wensha , Attenello Frank J. , Ye Jason , Kim Paul E. , Patel Vishal N. , Lerner Alexander , Acharya Jay , Hu Leland S. , Quarles C. Chad , Boxerman Jerrold L. , Wu Ona , Schmainda Kathleen M. 

TITLE=A cross-sectional study to test equivalence of low- versus intermediate-flip angle dynamic susceptibility contrast MRI measures of relative cerebral blood volume in patients with high-grade gliomas at 1.5 Tesla field strength

JOURNAL=Frontiers in Oncology

VOLUME=Volume 13 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2023.1156843

DOI=10.3389/fonc.2023.1156843

ISSN=2234-943X

ABSTRACT=INTRODUCTION: Recent studies at 3T MRI have suggested that DSC-MR imaging using a 30° flip angle ("low-FA") with model-based leakage correction and no gadolinium-based contrast agent (GBCA) preload provides equivalent relative cerebral blood volume (rCBV) measurements to the reference-standard acquisition using a single-dose GBCA preload with 60° flip angle ("intermediate-FA") and model-based leakage correction. However, it remains unclear whether this holds true at 1.5T. The purpose of this study was to test this at 1.5T in human high-grade glioma (HGG). METHODS: This was a single-institution cross-sectional study of patients who had undergone 1.5T MRI for HGG. DSC-MR imaging consisted of gradient-echo echo-planar imaging with a low-FA without preload (30°/P-); this then subsequently served as a preload for the standard intermediate-FA acquisition (60°/P+). Both normalized (nrCBV) and standardized relative cerebral blood volumes (srCBV) were calculated using model-based leakage correction (C+) with IB Neuro TM software. Whole enhancing lesion mean and median nrCBV and srCBV from the low-and intermediate-flip angle methods were compared using Pearson's, Spearman's and intraclass correlation coefficients (ICC). RESULTS: Twenty-three HGG patients composing a total of 31 scans were analyzed. The Pearson and Spearman correlations and ICCs between the 30°/P-/C+ and 60°/P+/C+ acquisitions demonstrated high correlations for both mean and median nrCBV and srCBV. CONCLUSIONS: Our study provides preliminary evidence that for HGG patients at 1.5T MRI, a low FA, no preload DSC-MRI acquisition can be an appealing alternative to the reference standard higher FA acquisition that utilizes a preload for 1.5T MRI scanners.Dynamic-susceptibility contrast (DSC)-MRI-derived relative cerebral blood volume (rCBV) is the most used brain tumor perfusion imaging technique. DSC-MRI using an intermediate flip angle with singledose gadolinium-based contrast agent (GBCA) preload with model-based leakage correction is the current reference standard given its utility, accuracy and precision. However, recent computer simulations and clinical studies at 3T MRI have suggested that a simpler method using a low flip angle without the need for a GBCA preload could provide equivalent rCBV than the more complex reference standard technique in high-grade glioma (HGG) patients. This current clinical study provides further evidence that this may also hold at 1.5T in HGG patients.