Establishing the clinical utility of a consensus DSC-MRI Protocol

Abstract This multi-site study aims to establish best practice recommendations and clinical value of a new consensus protocol for dynamic susceptibility contrast (DSC) MRI. DSC-MRI is one of the most widely used physiologic imaging techniques in neuro-oncology, with a reported use in 85% of all routine brain tumor scans at sites across the US and Europe. DSC-MRI measures of relative cerebral blood volume (rCBV) can differentiate glioma grades, identify tumor components in non-enhancing glioma, distinguish tumor recurrence from post-treatment effects (including pseudoprogression and radiation necrosis) and predict treatment response and patient survival after targeted therapy. Despite this demonstrated value, translation of consistent clinical DSC-MRI guidelines across multiple institutions remains challenging owing to variability in acquisition and post-processing protocols. To improve the accuracy, repeatability, and multi-site consistency of DSC-MRI, the team of investigators on this proposal identified and validated a DSC-MRI protocol that has since become a consensus recommendation for patients with glioma. Accordingly, we are well positioned to address critical gaps in this field that, once solved, will accelerate the widespread adoption of the consensus protocol and direct its use in clinical practice. We first aim to establish best practices for the pre- and post-processing methods for DSC-MRI. We will then leverage our expertise with image-localized biopsies and matched image-tissue correlations to establish guidelines for interpreting rCBV maps generated with the consensus protocol, specifically applied to the differentiation of low- from high-grade glioma, and progression of high-grade glioma from post-treatment effects. Finally, we aim to establish the clinical value added of the consensus DSC-MRI protocol for impacting brain tumor patient management. These studies will address key practical and clinical unmet needs that will directly facilitate the future use of DSC-MRI in glioma patients, thereby promoting widespread adoption of the consensus DSC-MRI protocol.