MR Imaging of Neoplastic Central Nervous System Lesions: Review and Recommendations for Current Practice

SUMMARY: MR imaging is the preferred technique for the diagnosis, treatment planning, and monitoring of patients with neoplastic CNS lesions. Conventional MR imaging, with gadolinium-based contrast enhancement, is increasingly combined with advanced, functional MR imaging techniques to offer morphologic, metabolic, and physiologic information. This article provides updated recommendations to neuroradiologists, neuro-oncologists, neurosurgeons, and radiation oncologists on the practical applications of MR imaging of neoplastic CNS lesions in adults, with particular focus on gliomas, based on a review of the clinical trial evidence and personal experiences shared at a recent international meeting of experts in neuroradiology, neuro-oncology, neurosurgery, and radio-oncology.

[1]  Rohit Bakshi,et al.  Brain MRI Lesion Load at 1.5T and 3T versus Clinical Status in Multiple Sclerosis , 2011, Journal of neuroimaging : official journal of the American Society of Neuroimaging.

[2]  T. Mikkelsen,et al.  In Vivo Correlation of Tumor Blood Volume and Permeability with Histologic and Molecular Angiogenic Markers in Gliomas , 2011, American Journal of Neuroradiology.

[3]  Bram Stieltjes,et al.  Biopsy Targeting Gliomas: Do Functional Imaging Techniques Identify Similar Target Areas? , 2010, Investigative radiology.

[4]  E. Shaw,et al.  Radiation oncology in brain tumors: current approaches and clinical trials in progress. , 2010, Neuroimaging clinics of North America.

[5]  N. Anzalone Comparative Studies of Different Gadolinium Agents in Brain Tumors: Differences between Gadolinium Chelates and Their Possible Influence on Imaging Features , 2010, American Journal of Neuroradiology.

[6]  M. Forsting,et al.  Prevalence of acute adverse reactions to gadobutrol--a highly concentrated macrocyclic gadolinium chelate: review of 14,299 patients from observational trials. , 2010, European journal of radiology.

[7]  S. Lee,et al.  Diagnostic Yield of Double-Dose Gadobutrol in the Detection of Brain Metastasis: Intraindividual Comparison with Double-Dose Gadopentetate Dimeglumine , 2010, American Journal of Neuroradiology.

[8]  Susan M. Chang,et al.  Updated response assessment criteria for high-grade gliomas: response assessment in neuro-oncology working group. , 2010, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[9]  V. Runge,et al.  Evaluation of gadobutrol, a macrocyclic, nonionic gadolinium chelate in a brain glioma model: Comparison with gadoterate meglumine and gadopentetate dimeglumine at 1.5 T, combined with an assessment of field strength dependence, specifically 1.5 versus 3 T , 2010, Journal of magnetic resonance imaging : JMRI.

[10]  T. Struffert,et al.  Dynamic contrast enhancement of experimental glioma an intra-individual comparative study to assess the optimal time delay. , 2010, Academic radiology.

[11]  S. Cha,et al.  Diffusion-Weighted MR Imaging Derived Apparent Diffusion Coefficient Is Predictive of Clinical Outcome in Primary Central Nervous System Lymphoma , 2010, American Journal of Neuroradiology.

[12]  G. Reifenberger,et al.  NOA-04 randomized phase III trial of sequential radiochemotherapy of anaplastic glioma with procarbazine, lomustine, and vincristine or temozolomide. , 2009, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[13]  M. Law,et al.  Magnetic resonance perfusion and permeability imaging in brain tumors. , 2009, Neuroimaging clinics of North America.

[14]  M. Law Neurological complications. , 2009, Cancer imaging : the official publication of the International Cancer Imaging Society.

[15]  R. Scotti,et al.  Detection of cerebral metastases on magnetic resonance imaging: intraindividual comparison of gadobutrol with gadopentetate dimeglumine , 2009, Acta radiologica.

[16]  J. Polimeni,et al.  96‐Channel receive‐only head coil for 3 Tesla: Design optimization and evaluation , 2009, Magnetic resonance in medicine.

[17]  Soonmee Cha,et al.  Neuroimaging in neuro-oncology , 2009, Neurotherapeutics.

[18]  Patrick Y Wen,et al.  End point assessment in gliomas: novel treatments limit usefulness of classical Macdonald's Criteria. , 2009, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[19]  H. Kauczor,et al.  Intraindividual comparison between gadopentetate dimeglumine and gadobutrol for magnetic resonance perfusion in normal brain and intracranial tumors at 3 tesla , 2009, Acta radiologica.

[20]  Toshinori Hirai,et al.  Grading astrocytic tumors by using apparent diffusion coefficient parameters: superiority of a one- versus two-parameter pilot method. , 2009, Radiology.

[21]  S. Schoenberg,et al.  Comparative Evaluation of Lesion Enhancement Using 1 M Gadobutrol vs. 2 Conventional Gadolinium Chelates, All at a Dose of 0.1 mmol/kg, in a Rat Brain Tumor Model at 3 T , 2009, Investigative radiology.

[22]  R. Mirimanoff,et al.  Effects of radiotherapy with concomitant and adjuvant temozolomide versus radiotherapy alone on survival in glioblastoma in a randomised phase III study: 5-year analysis of the EORTC-NCIC trial. , 2009, The Lancet. Oncology.

[23]  Susan Chang,et al.  Pseudoprogression and pseudoresponse: Challenges in brain tumor imaging , 2009, Current neurology and neuroscience reports.

[24]  J. Maldjian,et al.  Multicenter, double‐blind, randomized, intra‐individual crossover comparison of gadobenate dimeglumine and gadopentetate dimeglumine in MRI of brain tumors at 3 tesla , 2009, Journal of magnetic resonance imaging : JMRI.

[25]  À. Rovira,et al.  Proton MR Spectroscopy Improves Discrimination between Tumor and Pseudotumoral Lesion in Solid Brain Masses , 2009, American Journal of Neuroradiology.

[26]  T. Frenzel,et al.  Stability of Gadolinium-Based Magnetic Resonance Imaging Contrast Agents in Human Serum at 37°C , 2008, Investigative radiology.

[27]  E. Kanal,et al.  Assessment of adverse reaction rates to a newly approved MRI contrast agent: review of 23,553 administrations of gadobenate dimeglumine. , 2008, AJR. American journal of roentgenology.

[28]  J. Maldjian,et al.  Contrast-Enhanced MR Imaging of Brain Lesions: A Large-Scale Intraindividual Crossover Comparison of Gadobenate Dimeglumine versus Gadodiamide , 2008, American Journal of Neuroradiology.

[29]  Holly Ning,et al.  Comparison of T2 and FLAIR imaging for target delineation in high grade gliomas , 2008, Radiation oncology.

[30]  Lawrence L. Wald,et al.  Event-related single-shot volumetric functional magnetic resonance inverse imaging of visual processing , 2008, NeuroImage.

[31]  T. Frenzel,et al.  Preclinical investigation to compare different gadolinium-based contrast agents regarding their propensity to release gadolinium in vivo and to trigger nephrogenic systemic fibrosis-like lesions , 2008, European Radiology.

[32]  A. Brandes,et al.  Disease progression or pseudoprogression after concomitant radiochemotherapy treatment: pitfalls in neurooncology. , 2008, Neuro-oncology.

[33]  M. Bellin,et al.  Extracellular gadolinium-based contrast media: differences in diagnostic efficacy. , 2008, European journal of radiology.

[34]  Douglas C. Miller,et al.  Gliomas: predicting time to progression or survival with cerebral blood volume measurements at dynamic susceptibility-weighted contrast-enhanced perfusion MR imaging. , 2008, Radiology.

[35]  Dieta Brandsma,et al.  Clinical features, mechanisms, and management of pseudoprogression in malignant gliomas. , 2008, The Lancet. Oncology.

[36]  A. Doerfler,et al.  High-molar contrast agents for CNS application , 2008 .

[37]  S. Stuckey,et al.  Hyperintensity in the subarachnoid space on FLAIR MRI. , 2007, AJR. American journal of roentgenology.

[38]  M. Knopp,et al.  Evaluation of intraaxial enhancing brain tumors on magnetic resonance imaging: intraindividual crossover comparison of gadobenate dimeglumine and gadopentetate dimeglumine for visualization and assessment, and implications for surgical intervention. , 2007, Journal of neurosurgery.

[39]  Wei Chen Clinical Applications of PET in Brain Tumors* , 2007, Journal of Nuclear Medicine.

[40]  R. Quencer,et al.  Metabolite Findings in Tumefactive Demyelinating Lesions Utilizing Short Echo Time Proton Magnetic Resonance Spectroscopy , 2007, American Journal of Neuroradiology.

[41]  S. Schoenberg,et al.  Brain Tumor Enhancement in MR Imaging at 3 Tesla: Comparison of SNR and CNR Gain Using TSE and GRE Techniques , 2007, Investigative radiology.

[42]  B. Scheithauer,et al.  The 2007 WHO classification of tumours of the central nervous system , 2007, Acta Neuropathologica.

[43]  Sukru Mehmet Erturk,et al.  Sensitivity of immediate and delayed gadolinium-enhanced MRI after injection of 0.5 M and 1.0 M gadolinium chelates for detecting multiple sclerosis lesions. , 2007, AJR. American journal of roentgenology.

[44]  Gerhard Adam,et al.  Clinical Safety and Diagnostic Value of the Gadolinium Chelate Gadoterate Meglumine (Gd-DOTA) , 2007, Investigative radiology.

[45]  M. Knopp,et al.  Contrast enhancement of central nervous system lesions: multicenter intraindividual crossover comparative study of two MR contrast agents. , 2006, Radiology.

[46]  L. Wald,et al.  32‐channel 3 Tesla receive‐only phased‐array head coil with soccer‐ball element geometry , 2006, Magnetic resonance in medicine.

[47]  F. Zanella,et al.  Fluorescence-guided surgery with 5-aminolevulinic acid for resection of malignant glioma: a randomised controlled multicentre phase III trial. , 2006, The Lancet. Oncology.

[48]  Mike P. Wattjes,et al.  Higher sensitivity in the detection of inflammatory brain lesions in patients with clinically isolated syndromes suggestive of multiple sclerosis using high field MRI: an intraindividual comparison of 1.5 T with 3.0 T , 2006, European Radiology.

[49]  W. Yuh,et al.  Contrast-Enhanced Magnetic Resonance Imaging of Central Nervous System Tumors: Agents, Mechanisms, and Applications , 2006, Topics in magnetic resonance imaging : TMRI.

[50]  T. Grobner Gadolinium--a specific trigger for the development of nephrogenic fibrosing dermopathy and nephrogenic systemic fibrosis? , 2006, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[51]  S. Cha,et al.  Update on brain tumor imaging: from anatomy to physiology. , 2006, AJNR. American journal of neuroradiology.

[52]  M. Essig,et al.  Intraindividual Comparison of Gadobenate Dimeglumine and Gadobutrol for Cerebral Magnetic Resonance Perfusion Imaging at 1.5 T , 2006, Investigative radiology.

[53]  G Johnson,et al.  Comparison of microvascular permeability measurements, K(trans), determined with conventional steady-state T1-weighted and first-pass T2*-weighted MR imaging methods in gliomas and meningiomas. , 2006, AJNR. American journal of neuroradiology.

[54]  Val M Runge,et al.  Brain Tumor Enhancement in Magnetic Resonance Imaging: Comparison of Signal-to-Noise Ratio (SNR) and Contrast-to-Noise Ratio (CNR) at 1.5 Versus 3 Tesla , 2005, Investigative radiology.

[55]  Wen Qin,et al.  Diffusion tensor tractography in patients with cerebral tumors: a helpful technique for neurosurgical planning and postoperative assessment. , 2005, European journal of radiology.

[56]  J. Mintorovitch,et al.  Comparison of Magnetic Properties of MRI Contrast Media Solutions at Different Magnetic Field Strengths , 2005, Investigative radiology.

[57]  M. Port,et al.  How to Compare the Efficiency of Albumin-Bound and Nonalbumin-Bound Contrast Agents In Vivo: The Concept of Dynamic Relaxivity , 2005, Investigative radiology.

[58]  Andrew L Alexander,et al.  Diffusion Tensor Imaging in Cerebral Tumor Diagnosis and Therapy , 2004, Topics in magnetic resonance imaging : TMRI.

[59]  Khader M Hasan,et al.  Diffusion tensor eigenvector directional color imaging patterns in the evaluation of cerebral white matter tracts altered by tumor , 2004, Journal of magnetic resonance imaging : JMRI.

[60]  E. Shaw,et al.  Current controversies in the radiotherapeutic management of adult low-grade glioma. , 2004, Seminars in oncology.

[61]  J. Le Bas,et al.  In Vivo Measurement of Gadolinium Concentration in a Rat Glioma Model by Monochromatic Quantitative Computed Tomography: Comparison Between Gadopentetate Dimeglumine and Gadobutrol , 2004, Investigative radiology.

[62]  R. Pickering,et al.  The effectiveness of implementing a care pathway for femoral neck fracture in older people: a prospective controlled before and after study. , 2004, Age and ageing.

[63]  Glyn Johnson,et al.  Glioma grading: sensitivity, specificity, and predictive values of perfusion MR imaging and proton MR spectroscopic imaging compared with conventional MR imaging. , 2003, AJNR. American journal of neuroradiology.

[64]  D. Birchall,et al.  Use of serial proton magnetic resonance spectroscopy to differentiate low grade glioma from tumefactive plaque in a patient with multiple sclerosis. , 2003, The British journal of radiology.

[65]  Soonmee Cha,et al.  Perfusion MR imaging: basic principles and clinical applications. , 2003, Magnetic resonance imaging clinics of North America.

[66]  Mauricio Castillo,et al.  MR spectroscopy of brain tumors. , 2003, Magnetic resonance imaging clinics of North America.

[67]  E. Shaw,et al.  Prospective clinical trials of intracranial low-grade glioma in adults and children. , 2003, Neuro-oncology.

[68]  Siegfried Trattnig,et al.  Effect of Contrast Dose and Field Strength in the Magnetic Resonance Detection of Brain Metastases , 2003, Investigative radiology.

[69]  S. Nelson Multivoxel magnetic resonance spectroscopy of brain tumors. , 2003, Molecular cancer therapeutics.

[70]  A. Sorensen,et al.  Do highly concentrated gadolinium chelates improve MR brain perfusion imaging? Intraindividually controlled randomized crossover concentration comparison study of 0.5 versus 1.0 mol/L gadobutrol. , 2003, Radiology.

[71]  A. Jackson,et al.  Reproducibility of quantitative dynamic contrast-enhanced MRI in newly presenting glioma. , 2003, The British journal of radiology.

[72]  Soonmee Cha,et al.  Imaging Glioblastoma Multiforme , 2003, Cancer journal.

[73]  S. Cha,et al.  Spectroscopic magnetic resonance imaging of a tumefactive demyelinating lesion , 2002, Neuroradiology.

[74]  Meng Law,et al.  Proton MR spectroscopy of tumefactive demyelinating lesions. , 2002, AJNR. American journal of neuroradiology.

[75]  Glyn Johnson,et al.  High-grade gliomas and solitary metastases: differentiation by using perfusion and proton spectroscopic MR imaging. , 2002, Radiology.

[76]  C. Colosimo,et al.  Gadobenate dimeglumine‐enhanced magnetic resonance imaging of intracranial metastases: Effect of dose on lesion detection and delineation , 2001, Journal of magnetic resonance imaging : JMRI.

[77]  V. Runge,et al.  Central Nervous System: Review of Clinical Use of Contrast Media , 2001, Topics in magnetic resonance imaging : TMRI.

[78]  S. Nelson Analysis of volume MRI and MR spectroscopic imaging data for the evaluation of patients with brain tumors , 2001, Magnetic resonance in medicine.

[79]  M P Carol,et al.  MR-spectroscopy guided target delineation for high-grade gliomas. , 2001, International journal of radiation oncology, biology, physics.

[80]  M. McNamara,et al.  Phase Iii, Randomized, Double-Blind, Cross-Over Comparison of Gadoteridol and Gadopentetate Dimeglumine in Magnetic Resonance Imaging of Patients with Intracranial Lesions , 2001, Australasian radiology.

[81]  G. Johnson,et al.  Dynamic contrast-enhanced T2*-weighted MR imaging of tumefactive demyelinating lesions. , 2001, AJNR. American journal of neuroradiology.

[82]  R. Gonzalez,et al.  Diffusion-weighted MR imaging of the brain. , 2000, Radiology.

[83]  M. Filippi,et al.  Vanishing Balò-like lesions in multiple sclerosis , 2000, Journal of neurology, neurosurgery, and psychiatry.

[84]  T. Benner,et al.  Cerebral MR perfusion imaging: First clinical application of a 1 M gadolinium chelate (Gadovist 1.0) in a double‐blinded randomized dose‐finding study , 2000, Journal of magnetic resonance imaging : JMRI.

[85]  A. Jackson,et al.  Improved 3D quantitative mapping of blood volume and endothelial permeability in brain tumors , 2000, Journal of magnetic resonance imaging : JMRI.

[86]  G. R. Stevens,et al.  Magnetic resonance imaging in patients with central nervous system pathology: a comparison of OptiMARK (Gd-DTPA-BMEA) and Magnevist (Gd-DTPA). , 2000, Investigative radiology.

[87]  J. Petrella,et al.  MR perfusion imaging of the brain: techniques and applications. , 2000, AJR. American journal of roentgenology.

[88]  W P Dillon,et al.  Quantitative measurement of microvascular permeability in human brain tumors achieved using dynamic contrast-enhanced MR imaging: correlation with histologic grade. , 2000, AJNR. American journal of neuroradiology.

[89]  W. Shabana,et al.  Use of diffusion-weighted MR imaging in differential diagnosis between intracerebral necrotic tumors and cerebral abscesses. , 1999, AJNR. American journal of neuroradiology.

[90]  M. Horsfield,et al.  A multi-centre longitudinal study comparing the sensitivity of monthly MRI after standard and triple dose gadolinium-DTPA for monitoring disease activity in multiple sclerosis. Implications for phase II clinical trials. , 1998, Brain : a journal of neurology.

[91]  D. Arnold,et al.  In vivo differentiation of astrocytic brain tumors and isolated demyelinating lesions of the type seen in multiple sclerosis using 1H magnetic resonance spectroscopic imaging , 1998, Annals of neurology.

[92]  G. Sze,et al.  Comparison of single- and triple-dose contrast material in the MR screening of brain metastases. , 1998, AJNR. American journal of neuroradiology.

[93]  N. Lundbom,et al.  Increased choline signal coinciding with malignant degeneration of cerebral gliomas: a serial proton magnetic resonance spectroscopy imaging study. , 1997, Journal of Neurosurgery.

[94]  W. Pegios,et al.  [Diagnosis of cerebral metastasis with standard dose gadobutrol vs. a high dose protocol. Intraindividual evaluation of a phase II high dose study]. , 1995, Der Radiologe.

[95]  K. L. Nelson,et al.  Clinical safety of gadopentetate dimeglumine. , 1995, Radiology.

[96]  E. Larsson,et al.  Brain Metastases — Comparison of Gadodiamide Injection-Enhanced MR Imaging at Standard and High Dose, Contrast-Enhanced CT and Non-Contrast-Enhanced MR Imaging , 1995, Acta radiologica.

[97]  S. Holtås,et al.  Contrast-enhanced MRI of the central nervous system: Comparison between gadodiamide injection and gadolinium-DTPA , 1995, Neuroradiology.

[98]  W. Yuh,et al.  The effect of contrast dose, imaging time, and lesion size in the MR detection of intracerebral metastasis. , 1995, AJNR. American journal of neuroradiology.

[99]  M Oudkerk,et al.  Safety and Efficacy of Dotarem (Gd-DOTA) versus Magnevist (Gd-DTPA) in Magnetic Resonance Imaging of the Central Nervous System , 1995, Investigative radiology.

[100]  S. Cook,et al.  Triple‐Dose Versus Single‐Dose Gadoteridol in Multiple Sclerosis Patients , 1994, Journal of neuroimaging : official journal of the American Society of Neuroimaging.

[101]  W. Yuh,et al.  Dose of contrast material in the MR imaging evaluation of central nervous system tumors , 1994, Journal of magnetic resonance imaging : JMRI.

[102]  P. Kelly,et al.  Computed tomography and histologic limits in glial neoplasms: tumor types and selection for volumetric resection. , 1993, Surgical neurology.

[103]  T. Cascino,et al.  Response criteria for phase II studies of supratentorial malignant glioma. , 1990, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[104]  C R Bird,et al.  Gliomas: classification with MR imaging. , 1990, Radiology.

[105]  P. Kelly,et al.  Volumetric stereotactic surgical resection of intra-axial brain mass lesions. , 1988, Mayo Clinic proceedings.

[106]  R. Floris,et al.  Cerebral neoplastic enhancing lesions: multicenter, randomized, crossover intraindividual comparison between gadobutrol (1.0M) and gadoterate meglumine (0.5M) at 0.1 mmol Gd/kg body weight in a clinical setting. , 2013, European journal of radiology.

[107]  Armin Thron,et al.  Diagnostic Accuracy of MRI Compared to CCT in Patients with Brain Metastases , 2004, Journal of Neuro-Oncology.

[108]  J. Valk,et al.  A double-blind, comparative study of gadodiamide injection and gadopentetate dimeglumine in MRI of the central nervous system , 2004, Neuroradiology.

[109]  S. Nelson Multivoxel magnetic resonance spectroscopy of brain tumors. , 2003, Molecular cancer therapeutics.

[110]  A. Jackson,et al.  Simultaneous mapping of blood volume and endothelial permeability surface area product in gliomas using iterative analysis of first-pass dynamic contrast enhanced MRI data. , 2003, The British journal of radiology.

[111]  W. Dillon,et al.  Quantitative estimation of microvascular permeability in human brain tumors: correlation of dynamic Gd-DTPA-enhanced MR imaging with histopathologic grading. , 2002, Academic radiology.

[112]  V. Runge,et al.  Principles of contrast enhancement in the evaluation of brain diseases: An overview , 1997, Journal of magnetic resonance imaging : JMRI.

[113]  M. Oudkerk,et al.  Gd-enhanced MR imaging of brain metastases: contrast as a function of dose and lesion size. , 1997, Magnetic resonance imaging.

[114]  V. Runge,et al.  High‐dose gadoteridol in MR imaging of intracranial neoplasms , 1992, Journal of magnetic resonance imaging : JMRI.

[115]  P. Kelly Stereotactic imaging, surgical planning and computer-assisted resection of intracranial lesions: methods and results. , 1990, Advances and technical standards in neurosurgery.

[116]  R. Barnard,et al.  The classification of tumours of the central nervous system. , 1982, Neuropathology and applied neurobiology.

[117]  I. Kaplan,et al.  Radiation Therapy , 2006 .