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Consensus recommendations for a dynamic susceptibility contrast MRI protocol for use in high-grade gliomas.

  • Author(s): 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, WK
  • Cloughesy, Timothy F
  • Wen, Patrick Y
  • Gilbert, Mark R
  • Rosen, Bruce R
  • Ellingson, Benjamin M
  • Schmainda, Kathleen M
  • Jumpstarting Brain Tumor Drug Development Coalition Imaging Standardization Steering Committee
  • et al.

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.

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