The impact of EPI-based distortion correction of dynamic susceptibility contrast MRI on cerebral blood volume estimation in patients with glioblastoma.

PURPOSE:Relative cerebral blood volume (rCBV) from dynamic susceptibility contrast (DSC)-MRI is a valuable biomarker in patients with glioblastoma for assessing treatment response and predicting overall survival. DSC-MRI based on echo planar images (EPI) may possess severe geometric distortions from magnetic field inhomogeneities up to the order of centimeters. The aim of this study is to assess how much two readily available EPI-based geometric distortion correction methods, FSL TOPUP and EPIC, affect rCBV values from DSC-MRI in patients with confirmed glioblastoma. METHOD:We used a combined single-shot 2D gradient-echo (T2*), spin-echo (T2) EPI sequence to estimate both T2* and T2-weighted rCBV from the same contrast agent injection. Effects of distortion correction on the positive phase-encoded T2- and T2*-images were assessed in healthy anatomical brain regions in terms of Wilcoxon signed rank tests on median rCBV change and on Dice coefficients, as well as in tumor lesions in terms of Wilcoxon signed rank tests on median rCBV change. RESULTS:Our results show that following distortion correction, both gradient-echo and spin-echo rCBV increased in cortical areas of the frontal, temporal and occipital lobe, including the posterior orbital gyri in the frontal lobe and middle frontal gyri (p < 0.0008). Similar, improved Dice coefficients were observed for gradient-echo EPI in temporal, occipital and frontal lobe. Only spin-echo rCBV in enhancing lesion increased with correction (p = 0.0002). CONCLUSION:Our study sheds light on the importance of performing geometric distortion correction on EPI-based MRI data before assessing functional information such as rCBV values. Our findings may indicate that uncorrected rCBV values can be underestimated from positive phase-encoding EPI and that geometric distortion correction is warranted when comparing EPI-based data to conventional MRI.