Utility of Perfusion Weighted MRI and MR Spectroscopy in Intra Cerebral Glioma Grading (original) (raw)
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High-grade and low-grade gliomas: differentiation by using perfusion MR imaging
Clinical Radiology, 2005
Relative cerebral blood volume (rCBV) is a commonly used perfusion magnetic resonance imaging (MRI) technique for the evaluation of tumour grade. Relative cerebral blood flow (rCBF) has been less studied. The goal of our study was to determine the usefulness of these parameters in evaluating the histopathological grade of the cerebral gliomas.This study involved 33 patients (22 high-grade and 11 low-grade glioma cases). MRI was performed for all tumours by using a first-passage gadopentetate dimeglumine T2*-weighted gradient-echo single-shot echo-planar sequence followed by conventional MRI. The rCBV and rCBF were calculated by deconvolution of an arterial input function. The rCBV and rCBF ratios of the lesions were obtained by dividing the values obtained from the normal white matter of the contralateral hemisphere. For statistical analysis Mann–Whitney testing was carried out. A p value of less than 0.05 indicated a statistically significant difference. Receiver operating characteristic curve (ROC) analysis was performed to assess the relationship between the rCBV and rCBF ratios and grade of gliomas. Their cut-off value permitting discrimination was calculated. The correlation between rCBV and CBF ratios and glioma grade was assessed using Pearson correlation analysis.In high-grade gliomas, rCBV and rCBF ratios were measured as 6.50±4.29 and 3.32±1.87 (mean±SD), respectively. In low-grade gliomas, rCBV and rCBF ratios were 1.69±0.51 and 1.16±0.38, respectively. The rCBV and rCBF ratios for high-grade gliomas were statistically different from those of low-grade gliomas (p<0.001). The rCBV and CBF ratios were significantly matched with respect to grade, but difference between the two areas was not significant (ROC analysis, p>0.05). The cut-off value was taken as 1.98 in the rCBV ratio and 1.25 in the rCBF ratio. There was a strong correlation between the rCBV and CBF ratios (Pearson correlation=0.830, p<0.05).Perfusion MRI is useful in the preoperative assessment of the histopathologicalal grade of gliomas; the rCBF ratio in addition to the rCBV ratio can be incorporated in MR perfusion analysis for the evaluation.
The Neuroradiology Journal, 2012
The aim of our study was to evaluate if both spectroscopy and perfusion magnetic resonance (MR) imaging are necessary to differentiate high grade gliomas from low grade tumour, or if only one of these techniques is sufficient. Sixty-five patients with cerebral glioma were retrospectively evaluated. All patients were studied both with spectroscopy and perfusion imaging. In 43 cases histological examination showed a high grade glioma while a low grade glioma was found in 22 patients. For every patient spectroscopic maximum Cho/NAA ratio and lactate presence was established maximum relative CBV value was evaluated by perfusion MR. Both for Cho/NAA and rCBV threshold values were obtained by means of ROC curves. Then diagnostic sensitivity and specificity for high grade gliomas identification was evaluated for spectroscopic data only (Cho/NAA and lactate presence that was considered a high grade glioma marker), for perfusional data only (rCBV) and finally for both spectroscopic and perfu...
ROLE OF MAGNETIC RESONANCE SPECTROSCOPY IN GRADING OF BRAIN GLIOMAS.
International Journal of Advanced Research (IJAR), 2019
Background: MR spectroscopic imaging (MRSI), or chemical shift imaging (CSI), is a newer noninvasive modality which provides biochemical information about different tissues that cannot be obtained by conventional MRI. It allows one to collect the spectral information from a volume consisting of many voxels where the ratios of peak areas or signal intensity of the metabolites are converted to an image and overlaid onto anatomic MR images, thus showing the quantitative or qualitative distribution of the metabolite within the brain area examined. Objective:To assess the role of MR Spectroscopy using various metabolite ratios in grading of brain gliomas into high grade and low grade. Methodology: 30 patients with gliomas evaluated on 1.5T conventional MR imaging followed by multivoxel proton MR spectroscopy, using Cho/Cr, Cho/NAA, NAA/Cr and lipid/lactate resonances. Observations: The mean Cho/Cr and Cho/NAA ratio was significantly elevated in high grade gliomas as compared to low grade gliomas. Higher ratios indicate increasing grade of malignancy. The presence of lactate and lipid resonancesindicates necrosis and appears to correlate with higher grades of malignancy. Conclusion: MR Spectroscopy evaluation of gliomas using Cho/Cr and Cho/NAA ratio when used in adjunct with conventional MRI findings can be near conclusive in grading of gliomas into high grade and low grade.
2017
Purpose: To compare the diagnostic accuracy of normalized Blood Volume (nBV) histogram metrics in differentiating low from high-grade gliomas. Material and Methods: Forty-four patients (22 female, 22 male) with histologically confirmed gliomas were included. Group A comprised 10 patients with low grade gliomas (all grade II) while group B comprised 34 patients (4 grade III and 30 grade IV). Three-dimensional whole tumor segmentation was based on intensity level clustering in T2 FLAIR for the non-enhancing lesions or post contrast T1 weighted images for the enhancing lesions. Dynamic Susceptibility Contrast (DSC) perfusion was applied in all patients, and leakage corrected nBV maps were created. Corresponding histograms were generated from all the pixels included in the tumor volume. Minimum, maximum, mean, standard deviation, median, skewness, kurtosis, 5%, 30%, 70% and 95% percentiles, as well as normalized peak height and maximum peak position derived from normalized blood volume ...
A potential role of CT perfusion parameters in grading of brain gliomas q
Background and purpose: Gliomas are very heterogeneous tumors, glioma grading is currently based on the histologic assessment. With noninvasive measurement of vascular permeabil-ity by CT Perfusion (CTP) multiple perfusion parameters which can be obtained with a single acquisition the aim of this study was to find the most sensitive and specific CTP parameters and their cutoffs that can be used to differentiate between low and high grade brain gliomas. Material and methods: Twenty-five patients were included in this study divided into two groups: group A includes 15 patients with high grade glioma, group B includes 10 patients with low grade glioma; CTP was done for all patients, perfusion values of tumors were then calculated, and statistical analysis was done using IBM SPSS. Results: A statistically highly significant difference was found between the two groups regarding the BF, BV and PS with P values of 0.0003, 0.00026 and 0.0009 respectively. The two groups were found to be self-discriminated by BV and PS with sensitivity of 95% and 86% respectively. Conclusion: CTP shows high sensitivity in terms of differentiation between high and low grade adult gliomas.
American Journal of Neuroradiology, 2011
In cerebral gliomas, rCBV correlates with tumor grade and histologic findings of vascular proliferation. Moreover, ADC assesses water diffusivity and is inversely correlated with tumor grade. In the present work, we have studied whether combined rCBV and ADC values improve the diagnostic accuracy of MR imaging in the preoperative grading of gliomas. MATERIALS AND METHODS: One hundred sixty-two patients with histopathologically confirmed diffuse gliomas underwent DWI and DSC. Mean rCBV and ADC values were compared among the tumor groups with the Student t test or ANOVA. ROC analysis was used to determine rCBV and ADC threshold values for glioma grading. RESULTS: rCBV had significantly different values between grade II and IV gliomas and between grade III and IV tumors, but there were no significant differences between grade II and III gliomas (P Ͼ .05). Grade II and III tumors also did not differ when astrocytomas, oligodendrogliomas, and oligoastrocytomas were considered separately. ADC values were significantly different for all 3 grades. The ADC threshold value of 1.185 ϫ 10 Ϫ3 mm 2 /s and the rCBV cutoff value of 1.74 could be used with high sensitivity in the characterization of high-grade gliomas. The area under the ROC curve for the maximum rCBV and minimum ADC was 0.72 and 0.75, respectively. The combination of rCBV and ADC values increased the area under the ROC curve to 0.83. CONCLUSIONS: ADC measurements are better than rCBV values for distinguishing the grades of gliomas. The combination of minimum ADC and maximum rCBV improves the diagnostic accuracy of glioma grading. ABBREVIATIONS: DSC ϭ dynamic susceptibility-weighted contrast-enhanced perfusion MR imaging; GBM ϭ glioblastoma multiforme; GBM-O ϭ glioblastoma with oligodendroglial component; IR ϭ inversion recovery; rCBV ϭ relative cerebral blood volume; ROC ϭ receiver operating characteristic analysis; WHO ϭ World Health Organization
A potential role of CT perfusion parameters in grading of brain gliomas
The Egyptian Journal of Radiology and Nuclear Medicine, 2015
Background and purpose: Gliomas are very heterogeneous tumors, glioma grading is currently based on the histologic assessment. With noninvasive measurement of vascular permeability by CT Perfusion (CTP) multiple perfusion parameters which can be obtained with a single acquisition the aim of this study was to find the most sensitive and specific CTP parameters and their cutoffs that can be used to differentiate between low and high grade brain gliomas. Material and methods: Twenty-five patients were included in this study divided into two groups: group A includes 15 patients with high grade glioma, group B includes 10 patients with low grade glioma; CTP was done for all patients, perfusion values of tumors were then calculated, and statistical analysis was done using IBM SPSS. Results: A statistically highly significant difference was found between the two groups regarding the BF, BV and PS with P values of 0.0003, 0.00026 and 0.0009 respectively. The two groups were found to be self-discriminated by BV and PS with sensitivity of 95% and 86% respectively. Conclusion: CTP shows high sensitivity in terms of differentiation between high and low grade adult gliomas.
Clinical neurology and neurosurgery, 2018
To assess the usefulness of intra-tumor and peri-tumoral relative cerebral blood volume (rCBV) in preoperative glioma grading. 21 patients with histopathologically confirmed glioma were included. Imaging was achieved on a 1.5T MRI scanner. Dynamic susceptibility contrast (DSC) MRI was performed using T2* weighted gradient echo-planner imaging (EPI). Multiple regions of interest (ROIs) have been drawn in the hotspots regions, the highest ROI has been selected to represent the rCBV of each intra-tumoral and peri-tumoral regions. Based on histopathology, tumors were subdivided into low grade and high grade. Receiver operating characteristic analysis (ROC) of rCBV, of both intra-tumoral and peri-tumoral regions, was performed to find cut-off values between high and low-grade tumors. The resulting sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated. Based on the histopathology, high-grade glioma (HGG) represented 76.2% whereas low-...
Frontiers in aging neuroscience, 2017
To evaluate the feasibility of a simplified method based on diffusion-weighted imaging (DWI) acquired with three b-values to measure tissue perfusion linked to microcirculation, to validate it against from perfusion-related parameters derived from intravoxel incoherent motion (IVIM) and dynamic contrast-enhanced (DCE) magnetic resonance (MR) imaging, and to investigate its utility to differentiate low-from high-grade gliomas. Materials and Methods: The prospective study was approved by the local institutional review board and written informed consent was obtained from all patients. From May 2016 and May 2017, 50 patients confirmed with glioma were assessed with multib-value DWI and DCE MR imaging at 3.0 T. Besides conventional apparent diffusion coefficient (ADC 0,1000) map, perfusion-related parametric maps for IVIM-derived perfusion fraction (f) and pseudodiffusion coefficient (D *), DCE MR imaging-derived pharmacokinetic metrics, including K trans , v e and v p , as well as a metric named simplified perfusion fraction (SPF), were generated. Correlation between perfusionrelated parameters was analyzed by using the Spearman rank correlation. All imaging parameters were compared between the low-grade (n = 19) and high-grade (n = 31) groups by using the Mann-Whitney U test. The diagnostic performance for tumor grading was evaluated with receiver operating characteristic (ROC) analysis. Results: SPF showed strong correlation with IVIM-derived f and D * (ρ = 0.732 and 0.716, respectively; both P < 0.001). Compared with f, SPF was more correlated with DCE MR imaging-derived K trans (ρ = 0.607; P < 0.001) and v p (ρ = 0.397; P = 0.004). Among all parameters, SPF achieved the highest accuracy for differentiating low-from high-grade gliomas, with an area under the ROC curve value of 0.942, which was significantly higher than that of ADC 0,1000 (P = 0.004). By using SPF as a discriminative index, the diagnostic sensitivity and specificity were 87.1% and 94.7%, respectively, at the optimal cutoff value of 19.26%. Conclusion: The simplified method to measure tissue perfusion based on DWI by using three b-values may be helpful to differentiate low-from high-grade gliomas. SPF may
Purpose: Dynamic contrast enhanced (DCE) MRI is used to grade and to monitor the progression of glioma while on treatment. Usually, a fixed hematocrit (Hct) value for adults is assumed to be ~45%; however, it is actually known for individual variations. Purpose of this study was to investigate the effect of measured Hct values in glioma grading using DCE-MRI. Materials and methods: Fifty glioma patients were included in this study. Kinetic and hemodynamic parameters were estimated for each patient using assumed as well as measured Hct values. To look the changes in Hct value over time, Hct was measured multiple times from 10 of these glioma patients who were on treatment. Simulation was done to look for the effect of extreme variations of Hct values on perfusion metrics. The data was compared to look for significant differences in the perfusion metrics derived from assumed and measured Hct values. Results: The measured Hct value in patients was found to be (40.4 ± 4.28)%. The sensitivity and specificity of DCE-MRI parameters in glioma grading were not significantly influenced by using measured vis-a-vis assumed Hct values. The serial Hct values from 10 patients who were on treatment showed a fluctuation of 15–20% over time. The simulated data showed linear influence of Hct values on kinetic parameters. The tumor grading was altered on altering the Hct values in borderline cases. Conclusion: Hct values influence the hemodynamic and kinetic metrics linearly and may affect glioma grading. However, perfusion metrics values might change significantly with large change in Hct values, especially in patients who are on chemotherapy necessitating its use in the DCE model.