Quantitative measurement of leakage volume and permeability in gliomas, meningiomas and brain metastases with dynamic contrast-enhanced MRI

The spatial properties and function of the tumor vasculature differ with the tumor type and grade. T1-weighted dynamic contrast-enhanced imaging technique enables the simultaneous quantification of some functional parameters of the vasculature. These are the fractional contrast-enhancing volumes of the tissue compartments (blood volume and leakage/extravascular extracellular volume) and the exchange parameters (perfusion and permeability). The relatively long monitoring duration of 12 min used here made it necessary to divide the extravascular extracellular compartment into two subcompartments, a slowly and a fast enhancing one with different permeabilities. Forty-one gliomas (WHO grades II–IV), six meningiomas and eight distant metastases were investigated. It was shown that the technique noninvasively provides information for separating different tumor types and characterizing their microenvironment. Fast permeability describes vessel permeability and was significantly increased in meningiomas as compared with intra-axial tumors. The corresponding volume of the fast enhancing compartment was significantly increased in meningiomas compared to all gliomas taken together. Slow permeability describes diffusion within the extravascular extracellular space and was significantly reduced in low-grade gliomas, indicating short diffusion distances. The slowly enhancing extravascular extracellular space was found to be increased in high-grade gliomas and distant metastases. Blood volume differed significantly among some tumor entities and glioma grades. Perfusion was shown to increase linearly with blood volume for volumes of up to 20%, flattening out thereafter. The scatter plots of extravascular extracellular volume and blood volume were shown to differ among the tumor entities.