CLINICAL STUDY - PATIENT STUDY Use of dynamic susceptibility-contrast MRI (DSC-MRI) to assess perfusion changes in the ipsilateral brain parenchyma from glioblastoma Stephan Ulmer Æ Carsten Liess Æ Santosh Kesari Æ Nadine Otto Æ Torsten Straube Æ Olav Jansen Received: 11 May 2008 / Accepted: 8 September 2008 / Published online: 21 September 2008 Ó Springer Science+Business Media, LLC. 2008 Abstract Introduction We investigated the effect of increased tumor perfusion using dynamic susceptibility- contrast magnetic resonance imaging (DSC-MRI) in glio- blastoma (GBM) patients on the surrounding ipsilateral brain tissue with respect to perfusion of the normal, unaf- fected contralateral brain and of the tumor. Material and methods DSC-MRI was performed in 11 patients with glioblastoma using a multislice T2*-weighed EPI sequence (TR/TE = 2,000/62 ms; FOV 240 mm; matrix 128 9 128; slice thickness 6 mm) on a standard clinical 1.5 Tesla scanner during intravenous injection of 40 cc Gadolinium- DTPA at a flow rate of 5 cc/s. Maps for relative regional cerebral blood volume (rCBV) and relative regional cere- bral blood flow (rCBF) were created and relative values analyzed in relation to the arterial input. Results Relative CBV and CBF were significantly higher in gray matter than in the respective white matter (paired t-test; P \ 0.001) with a high correlation for both perfusion parameters between the gray and the white matter in both ipsilateral and contralateral brain (P \ 0.001). The highest values for rCBV and rCBF were found in solid tumor tissue with a significant positive correlation between tumor and the adjacent gray matter (for both rCBV and rCBF; P \ 0.001). Conclusion In GBM patients there is increased metabolism and thus increased rCBV and rCBF within the tumor. This increased perfusion of the tumor is not at the expense of perfusion of the ipsilateral normal brain parenchyma and in fact, the rCBV and rCBF values are linked to tumor-induced changes in rCBV and rCBF. Keywords Glioblastoma Á DSC-MRI Á Brain parenchyma Á Blood supply Á Pathophysiology Á Perfusion Introduction Glioblastomas are the most common brain tumors in adults and cause significant neurological dysfunction in these patients due to direct damage of brain structures and indirectly through mass effect from edema. These tumors arise either as primary (de novo) glioblastomas or as sec- ondary glioblastomas from low-grade gliomas [1, 2]. Typical histopathological findings include nuclear atypia, mitosis, necrosis, and neovascular proliferation [1, 2]. Long-term prognosis is poor; however, newer treatment regimens are yielding statistically significant survival benefit [3]. Neovascular proliferation is a hallmark feature of glioblastoma. Expression of the endothelial cell-specific mitogen, vascular endothelial growth factor (VEGF), is induced in low-grade tumor cells but is highly upregulated in glioblastoma [4, 5]. Similarly, there is a considerable increase in the number of receptors for VEGF: neither Disclosures This work was supported by the ‘‘Werner und Klara Kreytz Stiftung,’’ which enabled computer based data analysis. Otherwise no other conflicts of interest and this data has not been submitted or published elsewhere. S. Ulmer (&) Á N. Otto Á T. Straube Á O. Jansen Institute of Neuroradiology, University Hospital of Schleswig- Holstein, Schittenhelmstrasse 10, 24105 Kiel, Germany e-mail: ulmer@email.com C. Liess Division of Medical Physics of the Department of Radiology, University Hospital of Schleswig-Holstein, Schittenhelmstrasse 10, 24105 Kiel, Germany S. Kesari Dana-Farber Cancer Institute, Brigham and Women’s Hospital and Harvard Medical School, 44 Binney Street, Boston, MA 02115, USA 123 J Neurooncol (2009) 91:213–220 DOI 10.1007/s11060-008-9701-7