Dynamic contrast-enhanced magnetic resonance perfusion compared with digital subtraction angiography for the evaluation of extradural spinal metastases: a pilot study.
METHODS
This was a retrospective study comparing dynamic contrast-enhanced magnetic resonance (DCE-MR) perfusion with digital subtraction angiography (DSA) in determining the vascularity of spinal tumors.


OBJECTIVE
To report on the efficacy of DCE-MR perfusion as a potential noninvasive surrogate for measuring vascularity and thus determine the need for preoperative embolization.


BACKGROUND
Although primary spinal tumors are rare, spine metastases are relatively common and symptomatic in approximately 14% of patients. Symptomatic patients require palliation with radiotherapy and/or surgery, with possible preoperative endovascular embolization of the tumor.


METHODS
A retrospective review revealed 10 patients with 11 diseased vertebral bodies who had received spine DCE-MR perfusion studies and subsequently underwent spinal DSA. Processed MR data were used to calculate a blood flow ratio comparing blood flow with a diseased and an adjacent normal vertebral body. Spinal tumor vascularity was graded on the basis of angiographic tumor blush from 0 (decreased enhancement compared with a normal vertebral body) to 4 (marked tumor blush with early arteriovenous shunting).


RESULTS
Eight vertebral bodies demonstrated increased vascularity on DSA with blood flow ratios of greater than 1.8, 2 vertebral bodies demonstrated normal enhancement on DSA with cerebral blood flow (CBF) ratio of 0.55 to 1.14, and 1 vertebral body level had decreased enhancement on DSA, with a CBF ratio of 0.43. There was a strong correlation between CBF ratio and DSA score, with Spearman ρ = 0.87 (P = 0.00012).


CONCLUSIONS
These data show a statistically significant correlation between CBF ratio and DSA and suggest that DCE-MR perfusion can serve as a surrogate to DSA for determining tumor vascularity in patients with extramedullary spinal metastases.
*Department of Radiology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY †Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY ‡Division of Interventional Neuroradiology, Department of Neurological Surgery, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY; and §Department of Neurological Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
Jan C
JC
Mazura
Sasan
S
Karimi
Mohan
M
Pauliah
Mohammad Amin
MA
Banihashemi
Y Pierre
YP
Gobin
Mark H
MH
Bilsky
Athos
A
Patsalides
D015901:Angiography, Digital Subtraction / Q000379:methods*; D003287:Contrast Media; D004388:Dura Mater / Q000098:blood supply / Q000473:pathology; D004621:Embolization, Therapeutic; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D007700:Kinetics; D018810:Magnetic Resonance Angiography / Q000379:methods*; D009389:Neovascularization, Pathologic / Q000175:diagnosis / Q000000981:diagnostic imaging; D010865:Pilot Projects; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013125:Spinal Neoplasms / Q000098:blood supply* / Q000556:secondary / Q000628:therapy
D003287:Contrast Media