Whole tumor MR Perfusion histogram analysis in the preoperative assessment of patients with gliomas: Differentiation between high- and low-grade tumors (original) (raw)
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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-...
Indian Journal of Radiology and Imaging, 2024
Background: Despite documented correlation between glioma grades and dynamic contrast-enhanced (DCE) magnetic resonance (MR) perfusion-derived parameters, and its inherent advantages over dynamic susceptibility contrast (DSC) perfusion, the former remains underutilized in clinical practice. Given the inherent spatial heterogeneity in high-grade diffuse glioma (HGG) and assessment of different perfusion parameters by DCE (extravascular extracellular space volume [Ve] and volume transfer constant in unit time [k-trans]) and DSC (rCBV), integration of the two into a protocol could provide a holistic assessment. Considering therapeutic and prognostic implications of differentiating WHO grade 3 from 4, we analyzed the two grades based on a combined DCE and DSC perfusion. Methods: Perfusion sequences were performed on 3-T MR. Cumulative dose of 0.1 mmol/kg of gadodiamide, split into two equal boluses, was administered with an interval of 6 minutes between the DCE and DSC sequences. DCE data were analyzed utilizing commercially available GenIQ software. Results: Of the 41 cases of diffuse gliomas analyzed, 24 were WHO grade III and 17 grade IV gliomas (2016 WHO classification). To differentiate grade III and IV gliomas, Ve cutoff value of 0.178 provided the best combination of sensitivity (88.24%) and specificity (87.50%; AUC: 0.920; p < 0.001). A relative cerebral blood volume (rCBV) of value 3.64 yielded a sensitivity of 70.59% and specificity of 62.50% (p ¼ 0.018). The ktrans value, although higher in grade III than in grade IV gliomas, did not reach statistical significance (p ¼ 0.108).
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.
BioMed research international, 2014
Tumoral neoangiogenesis characterizes high grade gliomas. Relative Cerebral Blood Volume (rCBV), calculated with Dynamic Susceptibility Contrast (DSC) Perfusion-Weighted Imaging (PWI), allows for the estimation of vascular density over the tumor bed. The aim of the study was to characterize putative tumoral neoangiogenesis via the study of maximal rCBV with a Region of Interest (ROI) approach in three tumor areas-the contrast-enhancing area, the nonenhancing tumor, and the high perfusion area on CBV map-in patients affected by contrast-enhancing glioma (grades III and IV). Twenty-one patients were included: 15 were affected by grade IV and 6 by grade III glioma. Maximal rCBV values for each patient were averaged according to glioma grade. Although rCBV from contrast-enhancement and from nonenhancing tumor areas was higher in grade IV glioma than in grade III (5.58 and 2.68; 3.01 and 2.2, resp.), the differences were not significant. Instead, rCBV recorded in the high perfusion area ...
Prospective glioma grading using single-dose dynamic contrast-enhanced perfusion MRI
Clinical Radiology, 2015
To evaluate the sensitivity and specificity of single-dose dynamic contrast-enhanced (DCE) perfusion magnetic resonance imaging (MRI) in prospective evaluation of glioma grading and to correlate the relative cerebral blood volume (rCBV) values with mitotic and ki-67 indexes obtained at histopathology. MATERIALS AND METHODS: A total of 53 histologically proven patients with glioma were included in this study. DCE-MRI perfusion with a single dose of contrast medium was included in brain tumour protocol and prospective grading of glioma into low and high grade was done based on a previously reported rCBV cutoff value of 3. Tumours with rCBV !3 were considered to be high grade and rCBV <3 were considered to be low grade. The sensitivity and specificity of the cutoff value were estimated. Ki-67 and mitotic indexes were also obtained on histopathological analysis along with histological grading. RESULTS: Based on pre-defined rCBV cutoff values, prospective grading of low-and highgrade glioma was achieved with a sensitivity and specificity of 97.22% and 100%, respectively. Significant correlation was found between the mitotic/ki-67 indexes and rCBV values when data for high-and low-grade tumours was combined. CONCLUSION: DCE-MRI performed with a single dose of contrast medium is as effective as a protocol with a double-dose of contrast medium for glioma grading using 3 T MRI and could be added to the routine evaluation protocol of brain tumours.
Utility of Perfusion Weighted MRI and MR Spectroscopy in Intra Cerebral Glioma Grading
Back ground: Perfusion weighted MRI and MR Spectroscopy are advanced non-invasive imaging techniques.Advanced MR imaging techniques provide physiological information which complements the conventional imaging findings in preoperative glioma grading. Histopathology is gold standard, but invasive technique. Relative cerebral blood volume (rcbv) measurements derived from perfusion MR imaging and metabolite ratios from MR spectroscopy are useful in predicting glioma grading. AIM: To evaluate the role of Perfusion weighted MRI and MR SPECTROSCOPY in preoperative grading of gliomas. Materials And Methods: Fifty patients with primary cerebeal glioma underwent MR perfusion and MR Spectroscopy pre-operatively.The rcbv measurements were obtained from enhancing areas or FLAIR hyperintensities. Metobolite ratios (Cho/CR, Cho/NAAand NAA/Cr) were measured at Te 30 and 135ms.Tumor grade determined with the two methods was then compared with that from histopathological grading. Receiver operating characteristics analysis were performed to determine the optimum thresholds for tumor grading. Sensitivity, specificity, PPV and NPV for identifying high-grade gliomas were also calculated. Results: Statistical analysis demonstrated a threshold value of1.54 for rcbv to provide sensitivity, specificity, PPV and NPV of84.8%,82.4%.90.3% and 73.6%respectively.Threshold values of 1.65 for cHo/cr and 1.42 for Cho/NAA provided the minimum c1,c2 errors, for determining the high-grade glioma.The combination of rcbv,Cho/Cr and Cho/NAA resulted in Sensitivity,specificity,PPV and NPV of 100%,76.5%,89.2% and 100% respectively.Statistically significant difference were noted in rcbv,Cho/Cr.Cho/NAA and NAA/Cr ratios between low-grade and high-grade glioma.(p<0.005) Conclusion: The rcbv measurements and metabolite ratios both in combination can increase sensitivity,specificity and NPV, when compared with PWI alone or MRS alone in detern=mining glioma grade.Threshold values can be used in a clinical setting to evaluate tumors preoperatively for histologic grade and provide a means for guiding treatment and predicting postoperative patient outcome.
Neurosurgery, 2006
To determine whether relative cerebral blood volume (rCBV) can predict patient outcome, specifically tumor progression, in low-grade gliomas (LGGs) and thus provide a second reference standard in the surgical and postsurgical management of LGGs. METHODS: Thirty-five patients with histologically diagnosed LGGs (21 low-grade astrocytomas and 14 low-grade oligodendrogliomas and low-grade mixed oligoastrocytomas) were studied with dynamic susceptibility contrast-enhanced perfusion magnetic resonance imaging. Wilcoxon tests were used to compare patients in different response categories (complete response, stable, progressive, death) with respect to baseline rCBV. Log-rank tests were used to evaluate the association of rCBV with survival and time to progression. Kaplan-Meier time-toprogression curves were generated. Tumor volumes and CBV measurements were obtained at the initial examination and again at follow-up to determine the association of rCBV with tumor volume progression. RESULTS: Wilcoxon tests showed patients manifesting an adverse event (either death or progression) had significantly higher rCBV (P ϭ 0.003) than did patients without adverse events (complete response or stable disease). Log-rank tests showed that rCBV exhibited a significant negative association with disease-free survival (P ϭ 0.0015), such that low rCBV values were associated with longer time to progression. Kaplan-Meier curves demonstrated that lesions with rCBV less than 1.75 (n ϭ 16) had a median time to progression of 4620 Ϯ 433 days, and lesions with rCBV more than 1.75 (n ϭ 19) had a median time to progression of 245 Ϯ 62 days (P Ͻ 0.005). Lesions with low baseline rCBV (Ͻ1.75) demonstrated stable tumor volumes when followed up over time, and lesions with high baseline rCBV (Ͼ1.75) demonstrated progressively increasing tumor volumes over time. CONCLUSION: Dynamic susceptibility contrast-enhanced perfusion magnetic resonance imaging may be used to identify LGGs that are either high-grade gliomas, misdiagnosed because of sampling error at pathological examination or that have undergone angiogenesis in the progression toward malignant transformation. This suggests that rCBV measurements may be used as a second reference standard to determine the surgical management/risk-benefit equation and postsurgical adjuvant therapy for LGGs.
American Journal of Neuroradiology, 2009
BACKGROUND AND PURPOSE: It has been reported that high-resolution susceptibility-weighted imaging (HR-SWI) may demonstrate brain tumor vascularity. We determined whether the degree of intratumoral susceptibility signal intensity (ITSS) on HR-SWI correlates with maximum relative cerebral blood volume (rCBVmax) and to compare its diagnostic accuracy for glioma grading with that of dynamic susceptibility contrast (DSC) perfusion MR imaging. MATERIALS AND METHODS: Forty-one patients with diffuse astrocytomas underwent both non-contrast-enhanced HR-SWI and DSC at 3T. We correlated the degree and morphology of ITSS with rCBVmax within the same tumor segment. The degree of ITSS and rCBVmax were compared among 3 groups with different histopathologic grades. Spearman correlation coefficients were determined between the degree of ITSS, rCBVmax, and glioma grade. Receiver operating characteristic (ROC) curve analyses were performed to determine the diagnostic accuracy for glioma grading. RESULTS: The degree of ITSS showed a significant correlation with the value of rCBVmax in the same tumor segments (r ϭ 0.72, P Ͻ .0001). However, the areas of densely prominent ITSSs did not accurately correspond with those of rCBVmax. Spearman correlation coefficients between ITSS degree and glioma grade were 0.88 (95% confidence interval, 0.79-0.94). In the ROC curve analysis of histopathologic correlation by using the degree of ITSS, the optimal sensitivity, specificity, positive predictive value, and negative predictive value for determining a high-grade tumor were 85.2%, 92.9%, 95.8%, and 76.5%, respectively. CONCLUSIONS: The degree of ITSS shows a significant correlation with the value of rCBVmax in the same tumor segments, and its diagnostic performance for glioma grading is comparable with that of DSC.
Quantitative analysis of CT-perfusion parameters in the evaluation of brain gliomas and metastases
Journal of Experimental …, 2009
BackgroundThe paper reports a quantitative analysis of the perfusion maps of 22 patients, affected by gliomas or by metastasis, with the aim of characterizing the malignant tissue with respect to the normal tissue. The gold standard was obtained by histological exam or nuclear medicine techniques. The perfusion scan provided 11 parametric maps, including Cerebral Blood Volume (CBV), Cerebral Blood Flow (CBF), Average Perfusion (Pmean) and Permeability-surface area product (PS).MethodsThe perfusion scans were performed after the injection of 40 ml of non-ionic contrast agent, at an injection rate of 8 ml/s, and a 40 s cine scan with 1 s interval was acquired. An expert radiologist outlined the region of interest (ROI) on the unenhanced CT scan, by using a home-made routine. The mean values with their standard deviations inside the outlined ROIs and the contralateral ROIs were calculated on each map. Statistical analyses were used to investigate significant differences between diseased and normal regions. Receiving Operating Characteristic (ROC) curves were also generated.ResultsTumors are characterized by higher values of all the perfusion parameters, but after the statistical analysis, only the PS, PatRsq (Patlak Rsquare) and Tpeak (Time to Peak) resulted significant. ROC curves, confirmed both PatRsq and PS as equally reliable metrics for discriminating between malignant and normal tissues, with areas under curves (AUCs) of 0.82 and 0.81, respectively.ConclusionCT perfusion is a useful and non invasive technique for evaluating brain neoplasms. Malignant and normal tissues can be accurately differentiated using perfusion map, with the aim of performing tumor diagnosis and grading, and follow-up analysis.