Dynamic Magnetic Resonance Perfusion Imaging of Brain Tumors

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Abstract
Learning Objectives: After completing this course, the reader will be able to: Understand the rationale and validity of using MR perfusion techniques for selecting the optimal biopsy site for brain neoplasms. Understand the rationale and validity of using MR perfusion techniques to differentiate tumor recurrence from radiation necrosis. Understand the technical difficulties and limitations of this technique in the setting of high-grade neoplasms with severe blood-brain barrier breakdown, as well as the multiple methods available to address this problem. Access and take the CME test online and receive 1 hour of AMA PRA category 1 credit at CME.TheOncologist.com In this paper, we review the technique of contrast-enhanced magnetic resonance (MR) perfusion imaging of brain neoplasms, with an emphasis on its clinical applications and utility. We start with a discussion of MR perfusion techniques available today and their relative merits and shortcomings. Next, the ability of MR perfusion to provide a preoperative assessment of tumor histology is examined. We also discuss the role of MR perfusion in helping guide tumor biopsy, and its advantages over more conventional methods. We will scrutinize the use of MR perfusion for assessing true lesion extent, in contrast to conventional MR imaging and other MR techniques. We will discuss the role of MR perfusion in differentiating treatment effects, such as radiation necrosis, from tumor recurrence. Finally, the future potential applications of this technology in the setting of novel antiangiogenic therapies for brain tumors will be addressed.