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Dynamic Contrast–Enhanced Magnetic Resonance Perfusion Compared With Digital Subtraction Angiography for the Evaluation of Extradural Spinal Metastases: A Pilot Study

Mazura, Jan C. MD*; Karimi, Sasan MD; Pauliah, Mohan PhD; Banihashemi, Mohammad Amin MD; Gobin, Y. Pierre MD; Bilsky, Mark H. MD§; Patsalides, Athos MD

doi: 10.1097/BRS.0000000000000409
Diagnostics

Study Design. 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.

Summary of Background Data. 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).

Conclusion. 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.

Level of Evidence: 3

This study compares dynamic contrast–enhanced magnetic resonance perfusion with digital subtraction angiography, currently the “gold standard,” in determining the degree of vascularity in extradural spinal metastases. It concludes that the former is equivalent to the latter, thus providing for a noninvasive method of screening candidates for endovascular embolization.

*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.

Address correspondence and reprint requests to Athos Patsalides, MD, Department of Neurological Surgery, Weill Cornell Medical College, 525 East 68th St, Box 99, New York, NY 10065; E-mail: atp9002@med.cornell.edu

Acknowledgment date: January 16, 2014. Revision date: April 7, 2014. Acceptance date: April 21, 2014.

The device(s)/drug(s) is/are FDA approved or approved by corresponding national agency for this indication.

No funds were received in support of this work.

Relevant financial activities outside the submitted work: consultancy, payment for lectures, and royalties.

© 2014 by Lippincott Williams & Wilkins