Astrocytic tumour grading: a comparative study of three-dimensional pseudocontinuous arterial spin labelling, dynamic susceptibility contrast-enhanced perfusion-weighted imaging, and diffusion-weighted imaging

• Published in: European radiology 2015-12, Vol.25 (12), p.3423-3430
• Main Authors: Xiao, Hua-Feng, Chen, Zhi-Ye, Lou, Xin, Wang, Yu-Lin, Gui, Qiu-Ping, Wang, Yan, Shi, Kai-Ning, Zhou, Zhen-Yu, Zheng, Dan-Dan, Wang, Danny J. J., Ma, Lin
• Format: Article
• Language: English
• Subjects: Accuracy; Adolescent; Adult; Aged; Astrocytoma - pathology; Astrocytoma - physiopathology; Blood; Brain cancer; Brain Neoplasms - pathology; Brain Neoplasms - physiopathology; Cerebrovascular Circulation - physiology; Child; Contrast Media; Diagnostic Radiology; Diffusion Magnetic Resonance Imaging - methods; Female; Humans; Image Enhancement; Imaging; Imaging, Three-Dimensional - methods; Internal Medicine; Interventional Radiology; Labeling; Magnetic resonance imaging; Magnetic Resonance Imaging - methods; Male; Medicine; Medicine & Public Health; Middle Aged; Neoplasm Grading; Neuro; Neuroradiology; Observer Variation; Prospective Studies; Radiology; Reproducibility of Results; Risk Factors; Spin Labels; Tumors; Ultrasound; Young Adult
• ISSN: 0938-7994; 1432-1084
• DOI: 10.1007/s00330-015-3768-2

Objectives We hypothesized that three-dimensional pseudocontinuous arterial spin labelling (pCASL) may have similar efficacy in astrocytic tumour grading as dynamic susceptibility contrast-enhanced perfusion-weighted imaging (DSC-PWI), and the grading accuracy may be further improved when combined with apparent diffusion coefficient (ADC) values. Methods Forty-three patients with astrocytic tumours were studied using diffusion weighted imaging (DWI), pCASL, and DSC-PWI. Histograms of ADC and normalized tumour cerebral blood flow values (nCBF on pCASL and nrCBF on DSC-PWI) were measured and analyzed. Results The mean 10 % ADC value was the DWI parameter that provided the best differentiation between low-grade astrocytoma (LGA) and high-grade astrocytoma (HGA). The nCBF and nrCBF (1.810 ± 0.979 and 2.070 ± 1.048) in LGA were significantly lower than those (4.505 ± 2.270 and 5.922 ± 2.630) in HGA. For differentiation between LGA and HGA, the cutoff values of 0.764 × 10 -3  mm 2 /s for mean 10 % ADC, 2.374 for nCBF, and 3.464 for nrCBF provided the optimal accuracy (74.4 %, 86.1 %, and 88.6 %, respectively). Combining the ADC values with nCBF or nrCBF could further improve the grading accuracy to 97.7 % or 95.3 %, respectively. Conclusions pCASL is an alternative to DSC-PWI for astrocytic tumour grading. The combination of DWI and contrast-free pCASL offers a valuable choice in patients with risk factors. Key Points • pCASL shows positive correlation with DSC-PWI in astrocytic tumour grading. • ADC values based on ADC histograms can be an objective method. • Combination of DWI and pCASL or DSC-PWI can improve grading accuracy.