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Brain tumor

Case Study
Lutterbey, Goetz, M.D. Bonn, University of Bonn Germany

Patient history:

A 43-year-old male patient with first onset of grand-mal seizures was presented for a first MRI-examination in May 2004. He was diagnosed with a glioblastoma, located in the right frontal lobe. The patient underwent surgery.

 

The current MRI-examination is a follow-up study after tumor resection. 

MR examination:

In case tumor pathology is expected, a routine brain examination is acquired. In addition, several pre- and post-contrast sequences and diffusion-weighted images are generated.

 

The routine brain examination consists of T2W_TSE in the axial plane with full brain coverage and high spatial resolution, T2W_FLAIR in the axial plane, T2W_FLAIR in the coronal plane with high through-plane resolution. Finally, a single shot diffusion-weighted sequence with SENSE is added.

 

Additionally, a T1W_SE sequence in the axial plane is added. This sequence serves as pre-contrast scan. A PRESTO_perfusion scan is acquired. This is a 3D-sequence with full brain coverage and dynamic scan time less than 2 seconds. A contrast bolus of 10 ml Gd contrast agent with flow of 5 ml/s is administered. Wash-in wash-out of the contrast agent is visualized already during scanning if real-time reconstruction is enabled.

 

Directly after finishing the PRESTO_perfusion scan, three T1W_SE sequences in three orthogonal directions are acquired, to visualize possible enhancement of the lesion.

MR images and interpretation:

T2W_FLAIR axial T1W_SE axial Pre-contrast imageT2W_TSE axial
T2W_FLAIR axial
T1W_SE axial
T2W_TSE axial
Pre-contrast image
Single shot diffusion weighted image SENSE is used to reduce echo train length.3D-PRESTO perfusion imaging Full brain coverage. dynamic scan time less than 2 seconds.Coronal T1W_SE Post-contrast images show contrast enhancement.
Single shot diffusion weighted image
3D-PRESTO perfusion imaging
Coronal T1W_SE
SENSE is used to reduce echo train length.
Full brain coverage. dynamic scan time less than 2 seconds.
Post-contrast images show contrast enhancement.

 

The images show the post surgery defect at the level of the ventricles with enhancement of the resection margins (see post-contrast images).

 

The PRESTO perfusion images show no blood circulation in the lesion: no signal drop is detected during the passage of the contrast bolus.

 

Perfusion analysis can be performed on ViewForum.

 

perfusion analysis Perfusion analysis on ViewForum shows statistical results in color.
perfusion analysis
Perfusion analysis on ViewForum shows statistical results in color.

 

Perfusion analysis was performed on ViewForum. Two single seeded ROI's are shown.

 

ROI L1 shows signal intensity over time in the lesion. No signal drop is detected, meaning that no contrast agent is passing through the tumor.

 

ROI L2 shows signal drop and recovery as the contrast bolus washes in and out of the brain tissue.

Impact of 3.0T imaging:

Sensitivity for susceptibility related signal changes is very high at 3.0T. This is especially important for PRESTO perfusion in this clinical case, where signal change during contrast passage is caused by susceptibility changes.

 

SENSE is used in the diffusion-weighted sequence. By using SENSE, echo train length and related susceptibility related distortions are reduced. Also, shortest TE will be shorter if echo train length is reduced, thereby increasing signal-to-noise ratio.



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Case Study
Achieva 3.0T
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