Clinical utility of cerebrovascular reactivity mapping in patients with low grade gliomas

Figure 1 Axial T1 postcontrast 3D MPRAGE and T2 FLAIR images (A and B) breath-hold cerebrovascular reactivity maps (C) and relative cerebral blood flow maps (D) in a patient presenting with a left frontal lobe lesion, classified as grade II oligoastrocytoma after surgical resection, are displayed. Breath-hold cerebrovascular reactivity (BH CVR) maps were fused with axial T1 post Gadolinium images, and the threshold was set to 0.35 for blood oxygen level dependent PSC. Decreased CVR is present within and at the anterosuperolateral margin of the lesion (involving the infiltrated cortex of the left superior frontal gyrus) relative to contralateral hemispheric normal tissue. This represents an area of tumor-induced neurovascular uncoupling. Perfusion imaging did not provide equivalent information because the same area does not demonstrate any definite regional perfusion abnormality.