title: Contrast-enhanced magnetization transfer imaging: improvement of brain tumor conspicuity and delineation for radiosurgical target volume definition.
abstract: OBJECTIVE
  To assess the contrast-noise-ratio (CNR), and thus tumor conspicuity and delineation, on contrast-enhanced T1-weighted magnetization transfer (MT) images compared to conventional T1-weighted spin echo (SE) images as a strategy to improve definition of the macroscopic boost volume in radiosurgery treatment planning in patients with high grade gliomas or metastatic brain lesions.
  
  
  METHODS
  Fifty patients (mean age, 51 years) with histologically proven or suspected high grade glioma or cerebral metastases were prospectively examined by MR imaging. Following gadolinium dimeglumine administration (0.1 mmol/kg body weight) the brain was imaged with both a T1-weighted MT-fast low angle shot (FLASH) pulse sequence and with a conventional T1-weighted SE sequence without MT saturation. Lesion conspicuity, size and CNR were compared for both techniques.
  
  
  RESULTS
  The mean tumor diameter of malignant gliomas was significantly (P < 0.01) larger when measured on T1-weighted MT-FLASH images compared to T1-weighted SE images and was comparable for metastatic lesions. The mean CNR of enhancing lesions on T1-weighted MT-FLASH was 14 +/- 5 compared to 10 +/- 4 on SE images, representing a significant (P < 0.05) improvement. Lesion conspicuity and delineation was improved in 10 of 20 patients (50%) with high grade gliomas and in 15 of 30 patients (50%) with metastases. Additional contrast enhancing lesions were detected in 8 of 30 patients (27%) with metastases on MT-FLASH images. Lesion conspicuity was markedly improved in the posterior fossa.
  
  
  CONCLUSIONS
  Contrast-enhanced T1-weighted MT-FLASH images improve lesion detection and delineation in the planning process of radiosurgery in patients with intracranial high grade gliomas or metastases and may even alter the treatment approach.
authors.affiliation: Department of Radiology, German Cancer Research Center (dkfz), Heidelberg.
authors.forename: H
authors.initials: H
authors.lastname: Hawighorst
authors.forename: J
authors.initials: J
authors.lastname: Debus
authors.forename: W
authors.initials: W
authors.lastname: Schreiber
authors.forename: M V
authors.initials: MV
authors.lastname: Knopp
authors.forename: R
authors.initials: R
authors.lastname: Engenhart-Cabillic
authors.forename: M
authors.initials: M
authors.lastname: Essig
authors.forename: G
authors.initials: G
authors.lastname: Brix
authors.forename: G
authors.initials: G
authors.lastname: van Kaick
mesh_terms: D000328:Adult; D001932:Brain Neoplasms / Q000175:diagnosis* / Q000556:secondary / Q000601:surgery*; D005260:Female; D005910:Glioma / Q000175:diagnosis* / Q000601:surgery*; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016634:Radiosurgery / Q000379:methods*