Consensus recommendations for a dynamic susceptibility contrast MRI protocol for use in high-grade gliomas.
Despite the widespread clinical use of dynamic susceptibility contrast (DSC) MRI, DSC-MRI methodology has not been standardized, hindering its utilization for response assessment in multicenter trials. Recently, the DSC-MRI Standardization Subcommittee of the Jumpstarting Brain Tumor Drug Development Coalition issued an updated consensus DSC-MRI protocol compatible with the standardized brain tumor imaging protocol (BTIP) for high-grade gliomas that is increasingly used in the clinical setting and is the default MRI protocol for the National Clinical Trials Network. After reviewing the basis for controversy over DSC-MRI protocols, this paper provides evidence-based best practices for clinical DSC-MRI as determined by the Committee, including pulse sequence (gradient echo vs spin echo), BTIP-compliant contrast agent dosing (preload and bolus), flip angle (FA), echo time (TE), and post-processing leakage correction. In summary, full-dose preload, full-dose bolus dosing using intermediate (60°) FA and field strength-dependent TE (40-50 ms at 1.5 T, 20-35 ms at 3 T) provides overall best accuracy and precision for cerebral blood volume estimates. When single-dose contrast agent usage is desired, no-preload, full-dose bolus dosing using low FA (30°) and field strength-dependent TE provides excellent performance, with reduced contrast agent usage and elimination of potential systematic errors introduced by variations in preload dose and incubation time.
Boxerman, JL; Quarles, CC; Hu, LS; Erickson, BJ; Gerstner, ER; Smits, M; Kaufmann, TJ; Barboriak, DP; Huang, RH; Wick, W; Weller, M; Galanis, E; Kalpathy-Cramer, J; Shankar, L; Jacobs, P; Chung, C; van den Bent, MJ; Chang, S; Al Yung, WK; Cloughesy, TF; Wen, PY; Gilbert, MR; Rosen, BR; Ellingson, BM; Schmainda, KM; Jumpstarting Brain Tumor Drug Development Coalition Imaging Standardization Steering Committee,
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