Preoperative Grading of Glioma Using Dynamic Susceptibility Contrast MRI: Relative Cerebral Blood Volume Analysis of Intra-tumoural and Peri-tumoural Tissue

• Published in: Clinical neurology and neurosurgery 2018-04, Vol.167, p.86-92
• Main Authors: Soliman, Radwa K., Gamal, Sara A., Essa, Abdel-Hakeem A., Othman, Mostafa H.
• Format: Article
• Language: English
• Subjects: Accuracy; Adult; Aged; Angiogenesis; Blood; Blood volume; Brain cancer; Brain Neoplasms - blood supply; Brain Neoplasms - surgery; Cerebral blood flow; Cerebral Blood Volume - physiology; Cerebrovascular Circulation - physiology; DSC-MRI; Female; Glioma; Glioma - blood supply; Glioma - surgery; Glioma grading; Humans; Magnetic resonance imaging; Magnetic Resonance Imaging - methods; Male; Middle Aged; Morphology; Neoplasm Grading; Patients; Peri-tumoral tissue; rCBV; Software packages; Studies; Tumors
• ISSN: 0303-8467; 1872-6968
• DOI: 10.1016/j.clineuro.2018.01.003

•Intar-tumoral and peri-tumoural rCBV (rCBVt and rCBVp) were measured to evaluate the glioma grade.•Each of rCBVt and rCBVp significantly distinguished between low and high-grade glioma.•Integration of both rCBVt and rCBVp provided better overall diagnostic accuracy for the preoperative glioma grading. 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-grade glioma (LGG) represented 23.8%. Both intra-tumoral and peri-tumoral rCBV of HGG were significantly higher than those of LGG. A cut-off value >2.9 for intra-tumoral rCBV provided sensitivity, specificity, and accuracy of 80%, 100%, and 85.7% respectively to differentiate between HGG and LGG. Additionally, the cut-off value >0.7 for peri-tumoral rCBV provided sensitivity, specificity, and accuracy of 100%, 66.6%, and 90.5% respectively to differentiate between HGG and LGG. rCBV of each of intra-tumoral and peri-tumoral rCBV are significantly reliable for the preoperative distinction between HGG and LGG. Combined intra-tumoral and peri-tumoral rCBV provides overall better diagnostic accuracy and helps to decrease the invasive intervention for non-surgical candidates.