Consensus recommendations for a dynamic susceptibility contrast MRI protocol for use in high-grade gliomas. Issue 9 (9th June 2020)

• Record Type: Journal Article
• Authors: Boxerman, Jerrold L; Quarles, Chad C; Hu, Leland S; Erickson, Bradley J; Gerstner, Elizabeth R; Smits, Marion; Kaufmann, Timothy J; Barboriak, Daniel P; Huang, Raymond H; Wick, Wolfgang; Weller, Michael; Galanis, Evanthia; Kalpathy-Cramer, Jayashree; Shankar, Lalitha; Jacobs, Paula; Chung, Caroline; van den Bent, Martin J; Chang, Susan; Al Yung, W K; Cloughesy, Timothy F; Wen, Patrick Y; Gilbert, Mark R; Rosen, Bruce R; Ellingson, Benjamin M; Schmainda, Kathleen M
• Is Part Of: Neuro-oncology. Volume 22:Issue 9(2020)
• Page Start: 1262
• Page End: 1275
• Publication Date: 2020-06-09
• Subjects: cerebral blood volume -- clinical trial -- consensus protocol -- DSC-MRI -- high-grade glioma; Brain Neoplasms -- Periodicals; Brain -- Tumors -- Periodicals; Brain -- Cancer -- Periodicals; Nervous system -- Cancer -- Periodicals; 616.99481
• DOI: 10.1093/neuonc/noaa141
• Languages: English
• ISSNs: 1522-8517

Abstract

Abstract: 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.