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Dynamic susceptibility contrast perfusion weighted imaging in grading of nonenhancing astrocytomas
Naomi Morita1, Sumei Wang, Sanjeev Chawla
1Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA. nmorita@clin.med.tokushima-u.ac.jp
Purpose:
To evaluate if the relative tumor blood volume (rTBV) using dynamic susceptibility contrast magnetic resonance imaging (DSC-MRI) can aid in distinguishing low- from high-grade nonenhancing astrocytomas.
Materials And Methods:
Seventeen patients with histologically proven astrocytomas underwent MRI including DSC-MRI. Maximum TBV regions of interest were recorded from each neoplasm and normalized to contralateral normal white matter. Demographic features, diagnostic MRI findings including tumor volumes, and the normalized rTBV ratios were compared between low-grade (I and II, LGA, n = 6) and high-grade (III) astrocytomas (HGA, n = 11) using Mann-Whitney's U-test and receiver operating characteristic (ROC) analysis.
Results:
Maximum rTBV ratios were statistically higher for HGA (1.11 ± 0.13) than LGA (0.66 ± 0.17, P < 0.005) with the best cutoff threshold at 0.94 (sensitivity of 90.9%, specificity of 100%). Differences in mean age and tumor volume on fluid-attenuated inversion recovery (FLAIR) imaging between the two groups did not reach statistical difference (P = 0.22, 0.36).
Conclusion:
The addition of DSC-MRI can aid in accurate grading of nonenhancing astrocytomas with high sensitivity and specificity.
Insights
Dynamic susceptibility contrast-magnetic resonance imaging (DSC-MRI) effectively differentiates high-grade from low-grade nonenhancing astrocytomas. Relative tumor blood volume (rTBV) measured by DSC-MRI shows high sensitivity and specificity for accurate tumor grading.
Area of Science:
- Neuro-oncology
- Radiology
- Medical Imaging
Background:
- Accurate grading of astrocytomas is crucial for treatment planning and prognosis.
- Distinguishing between low-grade and high-grade astrocytomas can be challenging with conventional MRI.
- Nonenhancing astrocytomas present a particular diagnostic difficulty.
Purpose of the Study:
- To determine if relative tumor blood volume (rTBV) derived from dynamic susceptibility contrast-magnetic resonance imaging (DSC-MRI) can differentiate low-grade from high-grade nonenhancing astrocytomas.
- To assess the diagnostic performance of rTBV in astrocytoma grading.
Main Methods:
- Seventeen patients with histologically confirmed astrocytomas underwent MRI, including DSC-MRI.
- Maximum rTBV was measured and normalized to contralateral white matter.
- rTBV ratios were compared between low-grade (LGA) and high-grade (HGA) astrocytomas using statistical analysis and receiver operating characteristic (ROC) curves.
Main Results:
- Maximum rTBV ratios were significantly higher in HGAs (1.11 ± 0.13) compared to LGAs (0.66 ± 0.17, P < 0.005).
- An rTBV cutoff threshold of 0.94 demonstrated high diagnostic performance (90.9% sensitivity, 100% specificity).
- No statistically significant differences were observed in mean age or tumor volume on FLAIR imaging between the groups.
Conclusions:
- Dynamic susceptibility contrast-magnetic resonance imaging (DSC-MRI) can significantly aid in the accurate grading of nonenhancing astrocytomas.
- The addition of rTBV measurements to MRI provides high sensitivity and specificity for distinguishing between low- and high-grade astrocytomas.
- DSC-MRI is a valuable tool for improving diagnostic accuracy in neuro-oncology.
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