[Perfusion measurement using the T2* contrast media dynamics in neuro-oncology. Physical basics and clinical...

Perfusion imaging in the central nervous system (CNS) is mostly performed using the first-pass dynamic susceptibility-weighted contrast-enhanced (DSC) MRI. The first-pass of a contrast bolus in brain tissue is monitored by a series of T2*-weighted MR images. The susceptibility effect of the paramagnetic contrast agent leads to a signal loss that can be converted, using the principles of the indicator dilution theory, into an increase of the contrast agent concentration. From these data, parameter maps of cerebral blood volume (CBV) and flow (CBF) can be derived. Regional CBF and CBV values can be obtained by region-of-interest analysis. This review article describes physical basics of DSC MRI and summarizes the literature of DSC MRI in neurooncological issues.Studies, all with relatively limited patient numbers, report that DSC MRI is useful in the preoperative diagnosis of gliomas, CNS-lymphomas, and solitary metastases, as well as in the differentiation of these neoplastic lesions from infections and tumor-like manifestations of demyelinating disease. Additionally, DSC MRI is suitable for determining glioma grade and regions of active tumor growth which should be the target of stereotactic biopsy. After therapy, DSC MRI helps better assessing the tumor response to therapy, residual tumor after therapy, and possible treatment failure and therapy-related complications, such as radiation necrosis. The preliminary results show that DSC MRI is a diagnostic tool depicting regional variations in microvasculature of normal and diseased brains.