학술논문
Consensus recommendations for a dynamic susceptibility contrast MRI protocol for use in high-grade gliomas
Document Type
article
Author
Boxerman, Jerrold L; Quarles, Chad C; Hu, Leland S; Erickson, Bradley J; Gerstner, Elizabeth R; Smits, Marion; Kaufmann, Timothy J; Barboriak, Daniel P; Huang, Raymond H; Wick, Wolfgang; Weller, Michael; Galanis, Evanthia; Kalpathy-Cramer, Jayashree; Shankar, Lalitha; Jacobs, Paula; Chung, Caroline; van den Bent, Martin J; Chang, Susan; Al Yung, WK; Cloughesy, Timothy F; Wen, Patrick Y; Gilbert, Mark R; Rosen, Bruce R; Ellingson, Benjamin M; Schmainda, Kathleen M; Arons, David F; Kingston, Ann; Sandak, David; Wallace, Max; Musella, Al; Haynes, Chas
Source
Neuro-Oncology. 22(9)
Subject
Language
Abstract
Despite the widespread clinical use of dynamic susceptibility contrast (DSC) MRI, DSC-MRI methodology has not been standardized, hindering its utilization for response assessment in multicenter trials. Recently, the DSC-MRI Standardization Subcommittee of the Jumpstarting Brain Tumor Drug Development Coalition issued an updated consensus DSC-MRI protocol compatible with the standardized brain tumor imaging protocol (BTIP) for high-grade gliomas that is increasingly used in the clinical setting and is the default MRI protocol for the National Clinical Trials Network. After reviewing the basis for controversy over DSC-MRI protocols, this paper provides evidence-based best practices for clinical DSC-MRI as determined by the Committee, including pulse sequence (gradient echo vs spin echo), BTIP-compliant contrast agent dosing (preload and bolus), flip angle (FA), echo time (TE), and post-processing leakage correction. In summary, full-dose preload, full-dose bolus dosing using intermediate (60°) FA and field strength-dependent TE (40-50 ms at 1.5 T, 20-35 ms at 3 T) provides overall best accuracy and precision for cerebral blood volume estimates. When single-dose contrast agent usage is desired, no-preload, full-dose bolus dosing using low FA (30°) and field strength-dependent TE provides excellent performance, with reduced contrast agent usage and elimination of potential systematic errors introduced by variations in preload dose and incubation time.