2 mmol/Kg of Gd-DTPA, with TR/TE = 20 ms/460 ms, selleck chemical and the same spatial resolution parameters indicated above. Volumes of signal abnormality on both axial FLAIR and contrast-enhanced T1-weighted images (VFLAIR and VT1), pre-treatment and at the first follow-up, were segmented using a semi-automated region growing algorithm with 3D Slicer Software . All defined volumes of check details interest (VOIs) excluded resection cavities and special attention was paid to consistency of tumor and edema delineations between the two MRI scans. CT perfusion imaging PCT examinations were performed by using a 128-section (Brilliance CT 128-slice CT system-
Philips Medical Systems, Eindhoven, Holland) multidetector-row computed tomography scanner. A preliminary un-enhanced CT scan was obtained to localize the tumor at a slice thickness of 5 mm. Fifty milliliters of nonionic iodinated contrast medium (iopamidol-370 mg I/mL, Bracco, Milan, Italy) was injected at a rate of 5 mL/s through the antecubital vein. Five seconds after the injection began, ERK inhibitor a 60 s cine
scan with 2 s interval was acquired at the chosen slice locations. Eight 5-mm-thick axial sections were acquired resulting in a total coverage of 4 cm. Particular attention was paid to investigate the same portion of brain volume before and during treatment for each patient, assuring that the head and neck were relaxed but without rotation in either plane. The dose per scan was calculated by ImPACT CT Patient Dosimetry Calculator (v. 0.99×, Medical Devices Agency, London), resulting
in a total effective dose less than 5 mSv. CT acquired images were sent to a commercially available workstation (Brain Perfusion, Brilliance Workspace Portal, v. 18.104.22.168, Philips Medical Solutions, Eindhoven, Holland) to generate perfusion maps. A neuroradiologist (blinded to the review process) selected the Anterior Cerebral Artery (ACA) or alternatively the Middle Cerebral Artery (MCA) as input artery; a large venous Methamphetamine structure, such as the sagittal sinus was chosen as the input vein. To avoid partial volume effects the reference vessels had to be well recognizable, large enough and sufficiently orthogonal to the scan section. Parametric Cerebral Blood Volume (CBV) maps were then generated and stored. Volume of interest definition on the CBV maps For each patient, pre-treatment contrast-enhanced T1-weighted images were accurately co-registered with the two PCT studies, using the rigid body transformation module of 3D Slicer Software, based on the mutual information algorithm. Before delineating the VOI on the CBV maps, a visual inspection was performed to ensure an adequate alignment between MR/CT studies. CBV maps were then overlaid on the co-registered T1-weighted images that were used to guide the tumor location. An expert radiologist was asked to manually identify the abnormal CBV areas (necrotic as well as hyper-perfused), on the eight slices acquired.