gms | German Medical Science

55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

25. bis 28.04.2004, Köln

Beyond morphometry. Perfusion weighted MR imaging (PWI) displays arterio-venous shunting as specific hemodynamic pathomechanisms in high grade glioma

Jenseits der Morphometrie. Die perfusions-gewichtete MRT (PWI) spiegelt spezifisch für hochgradige Gliome ein arterio-venöses Shunting als hämodynamischen Pathomechanismus wider

Meeting Abstract

  • corresponding author Stephan Ulmer - Sektion Neuroradiologie, Klinik für Neurochirurgie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel
  • C. Liess - Medizinische Physik, Klinik für Diagnostische Radiologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel
  • N. Otto - Sektion Neuroradiologie, Klinik für Neurochirurgie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel
  • K. Engellandt - Sektion Neuroradiologie, Klinik für Neurochirurgie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel
  • C. C. Glüer - Medizinische Physik, Klinik für Diagnostische Radiologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel
  • O. Jansen - Sektion Neuroradiologie, Klinik für Neurochirurgie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel

Deutsche Gesellschaft für Neurochirurgie. Ungarische Gesellschaft für Neurochirurgie. 55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie. Köln, 25.-28.04.2004. Düsseldorf, Köln: German Medical Science; 2004. DocMO.09.05

The electronic version of this article is the complete one and can be found online at: http://www.egms.de/en/meetings/dgnc2004/04dgnc0093.shtml

Published: April 23, 2004

© 2004 Ulmer et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

Text

Objective

Highly malignant brain tumors often present a sudden onset of neurological symptoms due to their rapid displacing growth. Additionally there is a need for an increase in blood supply. However, as the amount of pathological neoangiogenesis may not be able to compensate for the rate of tumor growth, necrosis of the tumor center occurs, which is even more obvious in gliomas with enlarged tumor size. We investigated specific hemodynamic changes in the tumor and the surrounding and contralateral brain.

Methods

Using a bolus traced dynamic multislice T2*-weighted EPI MR perfusion technique (PWI, TR / TE = 2000 / 62 ms, FOV 240mm, matrix 128x128) on a 1.5 T Vision Scanner (Siemens, Erlangen, Germany) relative regional blood flow (rrCBF) and volume (rrCBV) were determined in 15 patients after determining the arterial input function.

Results

Both, rrCBV and rrCBF were increased in the grey matter compared to the white matter with a significant correlation between the two. There was no significant difference between the affected and the non-affected hemispheres. Highest values were always found in the tumor margin (p<0.001) with highly significant correlations of hemodynamic changes in the adjacent grey matter (rCBVt: R2=0,64; p<0,001; rCBFt: R2=0,58; p<0,001).

Conclusions

As demonstrated by conventional MR imaging, blood volume and flow is increased in the tumor margin, resulting in strong enhancement after i.v. contrast agent administration. Our data demonstrates that pathological new tumor vessels follow hemispheric hemodynamics, but steal blood by AV-shunting from the surrounding tissue to supply the tumor needs, which seems to be compensated by vascular autoregulation capacities at baseline conditions. Neurological symptoms could also occur because of a mismatch of blood supply and increased tumor demands to the disadvantage of the surrounding brain tissue.