Significance of Dynamic MRI in Brain Tumors.

Kim, Dong Woo; Sung, Soon Ki; Song, Young Jin; Choi, Soon Seop; Kim, Dae Cheol; Choi, Young Min; Huh, Won Ju; Kim, Ki Uk

Original Article

Journal of Korean Neurosurgical Society 2007;42(1): 27-34.

Dong Woo Kim, Soon Ki Sung, Young Jin Song, Soon Seop Choi, Dae Cheol Kim, Young Min Choi, Won Ju Huh, Ki Uk Kim

¹Department of Neurosurgery, College of Medicine, Dong-A University, Busan, Korea. kukim@donga.ac.kr
²Department of Diagnostic Radiology, College of Medicine, Dong-A University, Busan, Korea.
³Department of Pathology, College of Medicine, Dong-A University, Busan, Korea.
⁴Department of Radiation Oncology, College of Medicine, Dong-A University, Busan, Korea.

ABSTRACT

OBJECTIVE
On the magnetic resonance image (MRI) of the infiltrating brain tumor, enhancement is usually higher in malignant tumor than in benign tumor, and tumor cells can invade into the peritumoral area without definite enhancement. In various pathological conditions, the blood brain barrier (BBB) becomes changed to pathological condition, allowing various materials extravasating into the interstitial space, and degree of enhancement is depend on the pathology. Authors performed dynamic MRI on enhancing and surrounding edematous area in order to evaluate the degrees of opening of BBB, to differentiate tumor from non-tumorous condition, and to determine its relationship with the recurrence of the tumor.
METHODS
Dynamic MRI was performed in 25 patients. Dynamic scans were done every 15 seconds after administration of Gd-DTPA on the enhancing and surrounding area for maximum 300 seconds, and the patterns of enhancement were analysed. The enhancement curve with initial steep increase followed by slow decrease was defined as "N pattern", those with initial steep increase followed by additional slow increase as "T pattern", and those with initial steep increase followed by plateau as "E pattern". Histopathological findings were compared with the dynamic scan.
RESULTS
The graphs taken from enhancing area showed "T pattern" regardless of pathology. In the surrounding area, "T pattern" was noticed in the malignant tumors, but "E pattern" or "N pattern" was noted in low-grade or benign tumors and non-tumorous condition. "T pattern" in the surrounding area was related to the malignancy with tumor cell infiltration and recurrence.
CONCLUSION
The results suggest that the malignant tumor infiltration changes the condition of BBB enough to extravasate the Gd-DTPA. Enhancement pattern in the surrounding edematous area may be a useful information to differentiate the malignant glioma with the low-grade and benign tumors or other non-tumorous conditions.

Key Words: Dynamic MRI; lBrain tumor; Glioblastoma