Magnetic resonance perfusion and permeability imaging in brain tumors.

Recent evidence suggests that vascular permeability and the presence of vascular endothelial growth factor/vascular permeability factor (VEGF/VPF) are important mediators of brain tumor growth in addition to angiogenesis. Perfusion and permeability magnetic resonance (MR) imaging can now measure parameters such as cerebral blood volume and vascular permeability, which can be directly correlated with these histopathologic changes as well as molecular markers such as VEGF. The major techniques currently used in both the clinical and research settings are T1-weighted steady-state dynamic contrast-enhanced MR imaging (DCE MR imaging) and T2 *-weighted first-pass, dynamic susceptibility contrast MR imaging (DSC MR imaging). The advantages and disadvantages of each technique with regard to characterizing tumor biology are discussed in this article. Most clinicians and investigators are currently using the DSC MR imaging T2 *-weighted technique for brain tumor perfusion MR imaging. The existence of multiple approaches to pathologic classification of human glioma implies that there is a lack of consensus among experts as to which is the single best approach. These multiple grading systems do, however, agree on the histologic parameters that are important in the determination of glioma biology, namely hypercellularity, pleomorphism, vascular endothelial proliferation, mitotic activity, and necrosis.