- Boxerman, Jerrold;
- Quarles, Chad;
- Hu, Leland;
- Erickson, Bradley;
- Gerstner, Elizabeth;
- Smits, Marion;
- Kaufmann, Timothy;
- Barboriak, Daniel;
- Huang, Raymond;
- Wick, Wolfgang;
- Weller, Michael;
- Galanis, Evanthia;
- Kalpathy-Cramer, Jayashree;
- Shankar, Lalitha;
- Jacobs, Paula;
- Chung, Caroline;
- van den Bent, Martin;
- Schmainda, Kathleen;
- Al Yung, W;
- Cloughesy, Timothy;
- Wen, Patrick;
- Gilbert, Mark;
- Rosen, Bruce;
- Ellingson, Benjamin;
- Chang, Susan
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.