Blood oxygenation level‐dependent MRI of cerebral gliomas during breath holding

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Abstract
Purpose To assess the cerebrovascular responses to short breath holding of cerebral gliomas using blood oxygenation level‐dependent (BOLD) magnetic resonance imaging (MRI). Materials and Methods Six patients with a low‐grade glioma and one patient with a high‐grade glioma were studied using T2*‐weighted echo planar imaging (EPI) during repeated periods of 15‐second or 20‐second breath‐holding. Tumor vascularity was evaluated using dynamic susceptibility contrast perfusion MRI. Results Increases in BOLD signal intensity during repeated breath‐holding were consistently identified in patients' normal appearing gray matter, comparable with those in healthy adults. Absence of significant BOLD signal enhancement was noted both in low‐grade and high‐grade gliomas, which is either due to overwhelming hypoxia in a tumor, inadequacy or absence of hypercapnia‐induced vasodilatation of tumor vessels, or both. Breath‐hold regulated decreases in BOLD signals occurred only in the high‐grade glioma, which is most likely due to the hypercapnia‐induced steal effect that redistributes blood flow from tumor regions with unresponsive neovasculature to surrounding normal tissue. Conclusion BOLD MRI during short breath holding can disclose differential cerebrovascular response between normal tissue and cerebral glioma. J. Magn. Reson. Imaging 2004;19:160–167.