Moving toward a consensus DSC-MRI protocol: Validation of a low-flip angle single-dose option as a reference standard for brain tumors

K. M. Schmainda, M. A. Prah, L. S. Hu, C. C. Quarles, N. Semmineh, S. D. Rand, J. M. Connelly, B. Anderies, Y. Zhou, Y. Liu, B. Logan, A. Stokes, G. Baird, J. L. Boxerman

Research output: Contribution to journalArticlepeer-review

8 Scopus citations


BACKGROUND AND PURPOSE: DSC-MR imaging using preload, intermediate (60°) flip angle and postprocessing leakage correction has gained traction as a standard methodology. Simulations suggest that DSC-MR imaging with flip angle = 30° and no preload yields relative CBV practically equivalent to the reference standard. This study tested this hypothesis in vivo. MATERIALS AND METHODS: Eighty-four patients with brain lesions were enrolled in this 3-institution study. Forty-three patients satisfied the inclusion criteria. DSC-MR imaging (3T, single-dose gadobutrol, gradient recalled-echo-EPI, TE = 20-35 ms, TR = 1.2-1.63 seconds) was performed twice for each patient, with flip angle = 30°-35° and no preload (P -), which provided preload (P+) for the subsequent intermediate flip angle = 60°. Normalized relative CBV and standardized relative CBV maps were generated, including postprocessing with contrast agent leakage correction (C+) and without (C -) contrast agent leakage correction. Contrast-enhancing lesion volume, mean relative CBV, and contrast-to-noise ratio obtained with 30°/P - /C -, 30°/P - /C +, and 60°/P+/C - were compared with 60°/P+/C + using the Lin concordance correlation coefficient and Bland-Altman analysis. Equivalence between the 30°/P - /C+ and 60°/P+/C + protocols and the temporal SNRfor the 30°/P - and 60°/P+ DSC-MR imaging data was also determined. RESULTS: Compared with 60°/P+/C+, 30°/P - /C+ had closest mean standardized relative CBV (P =.61), highest Lin concordance correlation coefficient (0.96), and lowest Bland-Altman bias (μ = 1.89), compared with 30°/P - /C - (P =.02, Lin concordance correlation coefficient = 0.59, μ = 14.6) and 60°/P+/C - (P =.03, Lin concordance correlation coefficient = 0.88, μ = - 10.1) with no statistical difference in contrast-to-noise ratios across protocols. The normalized relative CBV and standardized relative CBV were statistically equivalent at the 10% level using either the 30°/P - /C+ or 60°/P+/C+ protocols. Temporal SNR was not significantly different for 30°/P - and 60°/P+ (P =.06). CONCLUSIONS: Tumor relative CBV derived from low-flip angle, no-preload DSC-MR imaging with leakage correction is an attractive single-dose alternative to the higher dose reference standard.

Original languageEnglish (US)
Pages (from-to)626-633
Number of pages8
JournalAmerican Journal of Neuroradiology
Issue number4
StatePublished - 2019

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Clinical Neurology


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