Measurement of Blood-Brain Barrier Permeability with T1-Weighted Dynamic Contrast-Enhanced MRI in Brain Tumors: A Comparative Study with Two Different Algorithms
The purpose of this study was to assess the feasibility of measuring different permeability parameters with T1-weighted dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) in order to investigate the blood brain-barrier permeability associated with different brain tumors. The Patlak algorithm and the extended Tofts-Kety model were used to this aim. Twenty-five adult patients with tumors of different histological grades were enrolled in this study. MRI examinations were performed at 1.5？T. Multiflip angle, fast low-angle shot, and axial 3D T1-weighted images were acquired to calculate T1 maps, followed by a DCE acquisition. A region of interest was placed within the tumor of each patient to calculate the mean value of different permeability parameters. Differences in permeability measurements were found between different tumor grades, with higher histological grades characterized by higher permeability values. A significant difference in transfer constant ( ) values was found between the two methods on high-grade tumors; however, both techniques revealed a significant correlation between the histological grade of tumors and their values. Our results suggest that DCE acquisition is feasible in patients with brain tumors and that maps can be easily obtained by these two algorithms, even if the theoretical model adopted could affect the final results. 1. Introduction The blood-brain barrier (BBB) is formed by specialized endothelial cells lining capillaries in the central nervous system (CNS), and it prevents or slows the passage of some drugs and other chemical compounds, radioactive ions, and disease-causing organisms, such as viruses, from the blood into the CNS. BBB breakdown is associated with many CNS-related pathologies, including inflammatory diseases such as multiple sclerosis [1] and chronic and acute cerebrovascular pathology [2, 3]. Pathological modifications of the BBB have also been well described in degenerative diseases such as Alzheimer disease [4]; in addition, it has been shown that in brain tumors the BBB is structurally and functionally abnormal [5]. Quantitative investigation of BBB permeability is possible using Magnetic Resonance Imaging (MRI) [5], and it has been applied to the study of brain tumors [6, 7]. In particular, experimental and clinical studies have demonstrated that dynamic contrast-enhanced (DCE) MRI, with a macromolecular contrast agent (CA), can be used to quantify microvascular permeability in tumors [8] and that permeability increases with increasing histological tumor grade [7, 9]. Different
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