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Imaging
values. However, rare benign subtypes such as angiomatous blood flow in the tumour parenchyma. What is interesting in our
meningiomas might show different perfusion characteristics. results is that the maximal rCBV and corresponding rMTE of peri-
tumoral oedema of malignant meningiomas were significantly greater
Differentiating between malignant and benign meningiomas before than those of benign ones (p<0.05). The increase in rCBV in the peri-
surgery is important for both treatment planning and the prognosis tumoral oedema of malignant meningiomas might be attributed to
appraisal. Although meningiomas do have some identifiable imaging tumour invasion and angiogenesis in the adjacent brain tissue.
29
Our
features on conventional MR images, no special feature has been results were also supported by previous molecular studies of
found to be reliable in predicting tumour grade. Sometimes, the meningiomas, which have shown that FLT1- and VEGF-positive cells
aggressiveness of the tumour cannot be accurately characterised are increased in the endothelium of intratumoral vessels and are
even on the basis of histopathological findings.
24,25
associated with microvascular proliferations in peri-tumoral brain
tissue of anaplastic meningiomas.
30
DSC perfusion MRI has also been used to assess the grade of
meningiomas. However, the results of different studies are Conclusion
inconsistent. While Hakyemez et al.
21
found that the rCBV of typical DSC perfusion MRI can provide critical information on the vascularity
and atypical meningiomas were statistically different, Zhu et al.
26
found of meningiomas that is not available with conventional MRI. DSC
no correlation between rCBV and tumour grade in two malignant and perfusion MRI measurements are helpful in the pre-operative
12 benign meningiomas. In another study Yang et al.
27
found no subtyping and grading of meningiomas. Because of the limited patient
significant difference between the rCBV values of seven atypical and numbers and the inconsistent results in published papers, perfusion
15 benign meningiomas. In a series of 33 supratentorial meningiomas MRI studies of meningioma with larger sample sizes are needed to
(25 benign and eight malignant), we measured the maximal rCBV investigate the reliability and reproducibility of this new technique
(relative to the contralateral normal white matter) and corresponding before it can be used as clinical routine. n
relative MTE (rMTE) in the tumour parenchyma and peri-tumoral
oedema.
28
While the maximal rCBV derived from the maximal blood
Hao Zhang is a Professor of Radiology at the Shanghai
volume regions in the parenchyma of benign meningiomas was higher
Jiaotong University Affiliated First Hospital, a position
than that of malignant meningiomas, the difference between the two he has held since 2005. He is also working on a PhD
showed no statistical significance. The rMTE in the parenchyma of
at the University of Groningen in The Netherlands. His
major research interests include brain perfusion
both benign and malignant meningiomas were longer than those
magnetic resonance imaging (MRI) diagnostic
of normal brain tissue, but there was no statistically significant computed tomgraphy (CT) and MRI of coronary artery
difference between benign and malignant meningiomas. We supposed
and hepatic tumours. He received his MD from
Shandong University of China in 1988 and his PhD
these findings could be attributed to the immature and tortuous
from Fudan University of China in 2003.
tumour vessels, which could result in increased leakage of contrast
agent from vessels into the extravascular space and deceleration of
1. Guyton AC, Cerebral blood flow, the cerebrospinal 11. Rosen BR, Belliveau JW, Buchbinder BR, et al., Contrast 22. Kimura H, Takeuchi H, Koshimoto Y, et al., Perfusion
fluid, and brain metabolism. In: Basic neuroscience: anatomy agents and cerebral hemodynamics, Magn Reson Med, Imaging of Meningioma by Using Continuous Arterial
and physiology. 2nd ed, Philadelphia, PA: Saunders, 1991;19:285–92. Spin-Labeling: Comparison with Dynamic Susceptibility-
1991;285–7. 12. Belliveau JW. Kennedy DN, McKinstry RC, et al., Weighted Contrast-Enhanced MR Images and
2. Meier R, Zieler K, On the theory of the indicator-dilution Functional mapping of the human visual cortex by Histopathologic Features, AJNR Am J Neuroradiol,
method for measurement of blood flow and volume, magnetic resonance imaging, Science, 1991;254:716–19. 2006;27:85–93.
J Appl Physiol, 1973; 6:731–44. 13. Keston P, Murray AD, Jackson A, Cerebral Perfusion 23. Zhang H, Rödiger LA, Shen T, et al., Preoperative
3. Roberts G, Larson K, The interpretation of mean transit Imaging using Contrast-enhanced MRI, Clin Radiol, subtyping of meningiomas by perfusion MR imaging,
time measurements for multi-phase tissue systems, 2003;58:505–13. Neuroradiology, 2008;50:835–40.
J Theor Biol, 1973; 39:447–75. 14. CBTRUS (2005-2006), Primary Brain Tumors in the United 24. Brainard JA, Prayson RA, Barnett GH, Frozen section
4. Rosen BR, Belliveau JW, Aronen HJ, et al., Susceptibility States Statistical Report 1998–2002, Central Brain Tumor evaluation of stereotactic brain biopsies: diagnostic
contrast imaging of cerebral blood volume: human Registry of the United States. yield at the stereotactic target position in 188 cases,
experience, Magn Reson Med, 1991;22:293–9. 15. Folkman J, Role of angiogenesis in tumor growth and Arch Pathol Lab Med, 1997; 121:481–4.
5. Boxerman JL, Rosen BR, Weisskoff RM, Signal-to-noise metastasis, Semin Oncol, 2002;29(6 Suppl. 16):15–18. 25. Hall WA, The safety and efficacy of stereotactic biopsy
analysis of cerebral blood volume maps from dynamic 16. Folkman J, New perspectives in clinical oncology from for intracranial lesions, Cancer, 1998;82:1749–55.
NMR imaging studies, J Magn Reson Imaging, 1997;7: angiogenesis research, Eur J Cancer, 1996;32:2534–9. 26. Zhu F, Zhou Y, Wang C, et al., Perfusion MRI evaluation of
528–37. 17. Cha S, Knopp EA, Johnson G, et al., Intracranial mass correlating perfusion constants with histologic findings
6. Fisel CR, Ackerman JL, Buxton RB, et al., MR contrast lesions: dynamic contrast-enhanced susceptibility- in meningiomas, Proceedings of the Annual Meeting of
due to microscopically heterogeneous magnetic weighted echo-planar perfusion MR imaging, Radiology, the International Society for Magnetic Resonance in
susceptibility: numerical simulations and applications 2002;223:11–29. Medicine, Berkeley, CA, 2008.
to cerebral physiology, Magn Reson Med, 1991;17: 18. Sugahara T, Korogi Y, Kochi M, et al., Perfusion-sensitive 27. Yang S, Law M, Zagzag D ,et al., Dynamic contrast-
336–47. MR imaging of gliomas: comparison between gradient- enhanced perfusion MR imaging measurements of
7. Boxerman JL, Hamberg LM, Rosen BR, et al., MR echo and spin-echo echo-planar imaging techniques, endothelial permeability: differentiation between
contrast due to intravascular magnetic susceptibility AJNR Am J Neuroradiol, 2001;22:1306–15. atypical and typical meningiomas, AJNR Am J Neuroradiol,
perturbations, Magn Reson Med, 1995;34:555–66. 19. Uematsu H, Maeda M, Sadato N, et al., Blood volume of 2003;24:1554–9.
8. Weisskoff RM, Zuo CS, Boxerman JL, et al., Microscopic gliomas determined by double-echo dynamic perfusion- 28. Zhang H, Rödiger LA, Shen T, et al., Perfusion MR
susceptibility variation and transverse relaxation: weighted MR imaging: a preliminary study, AJNR Am J imaging for differentiation of benign and malignant
theory and experiment, Magn Reson Med, 1994;31: Neuroradiol, 2001;22:1915–19. meningiomas, Neuroradiology, 2008;50:525–30.
601–10. 20. Hakyemez B, Yildirim N, Erdogan C, et al., Meningiomas 29. Arai M, Kashihara K, Kaizaki Y, Enhancing gliotic cyst
9. Simonsen CZ, Østergaard L, Vestergaard-Poulsen P, et with conventional MRI findings resembling intraaxial wall with microvascular proliferation adjacent to a
al., CBF and CBV measurements by USPIO bolus tumors: can perfusion-weighted MRI be helpful in meningioma, J Clin Neurosci, 2006;13:136–9.
tracking: reproducibility and comparison with Gd-based differentiation?, Neuroradiology, 2006;48:695–702 30. Yoshioka H, Hama S, Taniguchi E, et al., Peritumoral
values, J Magn Reson Imaging, 1999;9:342–7. 21. Hakyemez B, Erdogan C, Bolca N, et al., Evaluation of brain edema associated with meningioma: influence of
10. Ostergaard L, Cerebral Perfusion Imaging by Bolus different cerebral mass lesions by perfusion-weighted vascular endothelial growth factor expression and
Tracking, Top Magn Reson Imaging, 2004;15:3–9. MR imaging, J Magn Reson Imaging, 2006;24:817–24. vascular blood supply, Cancer, 1999;85:936–44.
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