Gd-enhanced MR imaging of brain metastases: Contrast as a function of dose and lesion size

doi:10.1016/S0730-725X(97)00015-5

Magnetic Resonance Imaging

Volume 15, Issue 5, 1997, Pages 535-541

https://doi.org/10.1016/S0730-725X(97)00015-5 Get rights and content

Abstract

MR imaging contrast of brain metastases after cumulative doses of gadolinium chelate is quantitated and compared in order to assess the clinical utility of high dosage. T1-weighted spin-echo MR images of 39 patients with metastatic brain tumors were made before and after each of three equal doses cumulating to 0.1, 0.2 and 0.3 mmol Gd-complex per kg body weight. Quantitation of MRI contrast was limited to homogeneous brain metastases larger than 3 mm (n = 246). Post-Gd MRI contrast doubled with dose escalation from 0.1 to 0.3 mmol/kg and also increased with lesion size, by a factor of 2.5 between metastases of 3 and 16 mm diameter, that is after correcting for partial volume effect. At 0.2 and 0.3 mmol/kg the respective numbers of visible metastases increased by 15% and 43% compared with 0.1 mmol/kg (p < 0.0001, both). Image contrast figures differed significantly between doses (p = 0.018). Both the number of metastases and the image contrast is significantly higher when dose escalation is performed. It is indicated that the number of detected metastases will increase further at Gd doses beyond 0.3 mmol/kg. Post-Gd MRI contrast increases with lesion size, to an extent that can not be attributed to partial volume attenuation.

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Radiation therapy for brain metastases
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The injection of a contrast agent before performing fluid attenuated inversion recovery (FLAIR) or T2 sequences improves the detection of cortical metastases smaller than 10 mm [43]. Although double or triple injections appear to be beneficial, it is impossible to recommend their use due to the risk of nephrogenic systemic fibrosis [44]. A preoperative MRI is not systematically required; however, it is recommended for surgical-cavity irradiation.
We present the update of the recommendations of the French society for radiation oncology on radiation therapy for the management of brain metastases. It has evolved in recent years and has become more complex. As the life expectancy of patients has increased and retreatments have become more frequent, side effects must be absolutely avoided. Cognitive side effects must in particular be prevented, and the most modern radiation therapy techniques must be used systematically. New prognostic classifications specific to the primary tumour of patients, advances in imaging and radiation therapy technology and new systemic therapeutic strategies, are making treatment more relevant. Stereotactic radiation therapy has supplanted whole-brain radiation therapy both for patients with metastases in place and for those who underwent surgery. Hippocampus protection is possible with intensity-modulated radiation therapy. Its relevance in terms of cognitive functioning should be more clearly demonstrated but the requirement for its use is constantly increasing. New targeted cancer treatment therapies based on the nature of the primitive have complicated the notion of the place and timing of radiation therapy and the discussion during multidisciplinary care meeting to indicate the best sequences is becoming a challenging issue as data on the interaction between treatments remain to be documented. In the end, although aimed at patients in the palliative phase, the management of brain metastases is one of the locations for which technical reflection is the most challenging and treatment become increasingly personalized.
Nous présentons la mise à jour des recommandations de la Société française de radiothérapie oncologique sur la prise en charge des métastases cérébrales par la radiothérapie. Celle-ci a évolué ces dernières années et est devenue plus complexe. En effet, l’espérance de vie des patients ayant augmenté et les retraitements devenus fréquents, les effets secondaires doivent être absolument évités. Les effets secondaires cognitifs doivent particulièrement être prévenus et les techniques les plus modernes de radiothérapie doivent être utilisées systématiquement. Des nouvelles classifications pronostiques spécifiques à la tumeur primitive des patients, des avancées technologiques en imagerie et en radiothérapie et des nouvelles stratégies thérapeutiques systémiques permettent d’orienter le traitement de façon plus pertinente. La radiothérapie en conditions stéréotaxiques a supplanté l’irradiation encéphalique en totalité, tant pour les patients avec des métastases en place, que pour ceux qui ont été opérés. La protection hippocampique est possible avec les traitements avec modulation d’intensité. Sa pertinence en termes de conservation des fonctions cognitives reste à démontrer clairement mais la demande est de plus en plus forte. Les progrès des thérapies ciblées du traitement du cancer selon la nature du primitif ont complexifié la notion de place et du moment de la radiothérapie et la discussion des séquences de soin en réunion de concertation pluridisciplinaire devient une question difficile, car les données d’interaction entre les traitements restent à documenter. Finalement, bien que s’adressant à des patients en phase palliative, la prise en charge des métastases cérébrales est l’une des localisations pour laquelle la réflexion technique est la plus exigeante et le traitement de plus en plus personnalisé.
Effect of contrast agent dosage on longitudinal relaxation time, signal and apparent tumor volume in glioblastoma at 9.4 T
2019, Zeitschrift fur Medizinische Physik
Citation Excerpt :
Thus, they worked out that standard dose of CA might be insufficient at low fields [19]. Several studies reported that the detection of metastases was improved by increasing CA dosage [12,20,21]. Especially for smaller lesions, an increase of CA dosage was recommended [14].
Glioblastoma multiforme is the most frequent innate brain tumor and still yields an unfavorable prognosis of 15 months of survival after diagnosis. Animal models play an important role in the investigation of therapeutic strategies of brain tumors. Thereby, MRI is substantial to individual follow-up examination for therapeutic response. Contrast agent dosage at 1.5 and 3 T MRI has been thoroughly tested, while there is hardly any data for 9.4 T. Therefore, the aim of this study was to find the optimal contrast agent dosage at 9.4 T for examination of T1 relaxation time and apparent tumor volume in an animal model.
Six animals with a U-87 glioblastoma were part of this study. Scans were performed on a 9.4 T MRI. The MRI protocol contained a standard T1w sequence, which was employed for tumor volumetry and signal intensity measurement after single, double and triple contrast agent dosage injections and a T2w sequence for volumetry of tumor and edema. From a T1 map, T1 relaxation times and tumor area were measured. Histologic tumor size measurements were also performed for two animals.
The mean apparent tumor volume in T1w MRI increased significantly with each additional contrast agent injection, mainly due to the increase of the hyperintense tumor rim. Volumetry based on T2w MRI resulted in a higher tumor volume than in T1w volumetry, whereas the tumor volume in T1w MRI approached the volume in T2w MRI with increasing contrast agent dosage. Histology revealed an apparent tumor volume that corresponded to the volume of the hypointense center in T1w MRI. In contrast, T1 time decrease and T1w signal increase occurred mainly in the tumor rim.
Increasing the contrast agent dosage led to an increase in apparent tumor volume. High-dose T1 MRI, however, overestimated the tumor volume that was determined by histology. Thereby, it can be concluded that standard contrast agent dosage is sufficient to visualize the core tumor volume in T1w MRI. Measurement of tumor volume after increasing contrast agent dosage depicts tumor core and edema, which can be due to diffusion or accumulation or both. Tumor core and edema, however, can be visualized by T2w MRI without need of additional contrast agent.
Hemorrhagic cerebrovascular disease
2016, Handbook of Clinical Neurology
Citation Excerpt :
Detection of neoplastic tissue in hemorrhagic lesions is challenging given the amount of mass effect over adjacent tissue. However, gadolinium-enhanced MRI of the brain is superior in the detection of enhancing neoplastic tissue compared to contrast-enhanced CT and is the technique of choice for this purpose (Russell et al., 1987; Van Dijk et al., 1997). Other imaging clues to an underlying neoplastic mass are the heterogeneous phases of blood product evolution and persistent peripheral edema, even in the late stages (Atlas et al., 1987).
Primary or nontraumatic spontaneous intracerebral hemorrhage (ICH) accounts for 10–15% of all strokes, and has a poor prognosis. ICH has a mortality rate of almost 50% when associated with intraventricular hemorrhage within the first month, and 80% rate of dependency at 6 months from onset. Neuroimaging is critical in identifying the underlying etiology and thus assisting in the important therapeutic decisions. There are several imaging modalities available in the workup of patients who present with ICH, including computed tomography (CT), magnetic resonance imaging (MRI), and digital subtraction angiography (DSA). A review of the current imaging approach, as well as a differential diagnosis of etiologies and imaging manifestations of primary versus secondary intraparenchymal hemorrhage, is presented. Active bleeding occurs in the first hours after symptom onset, with early neurologic deterioration. Identifying those patients who are more likely to have hematoma expansion is an active area of research, and there are many ongoing therapeutic trials targeting this specific patient population at risk.
Radiotherapy for brain metastases
2016, Cancer/Radiotherapie
La radiothérapie des métastases cérébrales est devenue plus complexe. En effet, l’espérance de vie des patients ayant augmenté, les effets secondaires doivent être absolument évités et les retraitements sont monnaie courante. Les effets secondaires cognitifs doivent être prévenus et les techniques les plus modernes de radiothérapie sont utilisées de façon récurrente. Les nouvelles classifications des patients atteints de métastases cérébrales permettent d’orienter le traitement de façon plus pertinente. La radiothérapie en conditions stéréotaxiques a supplanté l’irradiation encéphalique en totalité tant pour les patients atteints de métastases en place que pour ceux qui ont été opérés. La protection hippocampique est possible avec les traitements avec modulation d’intensité. Sa pertinence en termes de conservation des fonctions cognitives reste à démontrer clairement mais la demande est de plus en plus forte. Bien que s’adressant à des malades en phase palliative, la prise en charge des métastases cérébrales est l’une des localisations pour laquelle la réflexion technique est la plus exigeante.
Radiotherapy for brain metastases has become more multifaceted. Indeed, with the improvement of the patient's life expectancy, side effects must be undeniably avoided and the retreatments or multiple treatments are common. The cognitive side effects should be warned and the most modern techniques of radiation therapy are used regularly to reach this goal. The new classifications of patients with brain metastases help guiding treatment more appropriately. Stereotactic radiotherapy has supplanted whole brain radiation therapy both for patients with metastases in place and for those who underwent surgery. Hippocampus protection is possible with intensity-modulated radiotherapy. Its relevance in terms of cognitive functioning should be more clearly demonstrated but the requirement, for using it, is increasingly strong. While addressing patients in palliative phase, the treatment of brain metastases is one of the localisations where technical thinking is the most challenging.
Diagnostic imaging of intracranial metastasis
2015, Current Problems in Cancer
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Dosage of MRI contrast can affect detection of metastatic disease. Studies have shown increasing detection of metastases with increasing doses of MRI contrast and increased detection of brain metastases with double or triple contrast doses compared with single contrast dose MRIs.10,21-24 More recent studies have demonstrated a significant improvement in effects of T1 shortening and lesion detection using even half the dose of contrast agent if the examination is performed using higher field strength magnet of 3 T compared with 1.5 T.25 Furthermore, advances in gadolinium-based contrast have produced newer agents that produce a greater relaxivity of the surrounding tissue, leading to increased T1 signal on the MRI scan.26
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2012, Magnetic Resonance Imaging Clinics of North America
Citation Excerpt :
The authors therefore conclude that routine triple-dose contrast administration in all cases of suspected brain metastasis is not helpful. The effect of higher dosage on lesion size in metastatic brain tumors was assessed in a study from.77 The contrast of brain metastases after cumulative doses of gadolinium chelate was quantified and compared to assess the clinical utility of high dosage in a series of 39 patients with metastatic brain tumors.

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Original contributionGd-enhanced MR imaging of brain metastases: Contrast as a function of dose and lesion size

Abstract

Multiple cerebral metastases: detectability with Gd-DTPA-enhanced MR imaging

Radiology

Increased detection of intracranial metastases with intravenous Gd-DTPA

Radiology

Administration of gadopentetate dimeglumine in MR imaging of intracranial tumors: Dosage and field strength

AJNR

Dosing of Gd-DTPA in MR imaging of intracranial tumors

Magn. Reson. Med.

Triple-dose versus standard-dose gadopentetate dimeglumine: A randomized study in 199 patients

Radiology

High-dose applications of gadolinium chelates in magnetic resonance imaging

Magn. Reson. Med.

High-dose Gadoteridol in MR imaging of intracranial neoplasms

J. Magn. Reson. Imaging

Experience with highdose gadolinium MR imaging in the evaluation of brain metastases

AJNR

The effect of contrast dose, imaging time, and lesion size in the MR detection of intracerebral metastasis

AJNR

Time-dependent changes in image contrast in brain tumors after Gadolinium-DTPA

AJNR

Original contribution
Gd-enhanced MR imaging of brain metastases: Contrast as a function of dose and lesion size