AUTHOR=Schneider Tanja , Kemmling André , Schroeder Julian , Pantel Klaus , Glatzel Markus , Schoen Gerhard , Mohme Malte , Fiehler Jens , Gellißen Susanne 

TITLE=Inverse Perfusion Requirements of Supra- and Infratentorial Brain Metastases Formation

JOURNAL=Frontiers in Neurology

VOLUME=9

YEAR=2018

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2018.00391

DOI=10.3389/fneur.2018.00391

ISSN=1664-2295

ABSTRACT=<p><bold>Background and Aims:</bold> Vascular border zones and the gray-white matter junction are preferred sites for the development of brain metastases (BM), whereas microvascular lesions are known to be a protective factor. In this proof of concept study, we aim to study the relationship of blood perfusion and the spatial distribution of BM.</p><p><bold>Materials and Methods:</bold> An average CT perfusion atlas of 107 healthy patients was created. Voxel-wise reference perfusion values were extracted from BM-negative and BM-positive regions in a second cohort of 100 untreated patients harboring 809 BM confirmed by MRI. A comparison of regional perfusion values was performed using the independent <italic>t</italic>-test.</p><p><bold>Results:</bold> In contrast to supratentorial BM that develop preferably in areas with lower CBV/CBF and longer MTT/TTP compared to the average regional perfusion (<italic>p</italic> &lt; 0.001), infratentorial BM showed a higher CBV/CBF and shorter MTT/TTP (<italic>p</italic> &lt; 0.001).</p><p><bold>Conclusion:</bold> Our results imply differing pathophysiological mechanisms underlying supra- and infratentorial BM spreading. The inverse perfusion patterns may result from differences in vascular supply, hemodynamic requirements, and/or production of pro-angiogenic factors.</p>