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Dynamic contrast-enhanced and dynamic susceptibility contrast perfusion MR imaging for glioma grading: Preliminary

Corrado Santarosa¹, Antonella Castellano¹, Gian Marco Conte¹

¹Neuroradiology Unit and CERMAC, San Raffaele Scientific Institute and Vita-Salute San Raffaele University, Milan, Italy.

European Journal of Radiology

|May 11, 2016

Abstract

Introduction:

Dynamic susceptibility contrast (DSC)-MRI is a perfusion technique with high diagnostic accuracy for glioma grading, despite limitations due to inherent susceptibility effects. Dynamic contrast-enhanced (DCE)-MRI has been proposed as an alternative technique able to overcome the DSC-MRI shortcomings. This pilot study aimed at comparing the diagnostic accuracy of DSC and DCE-MRI for glioma grading by evaluating two estimates of blood volume, the DCE-derived plasma volume (Vp) and the DSC-derived relative cerebral blood volume (rCBV), and a measure of vessel permeability, the DCE-derived volume transfer constant K(trans).

Methods:

Twenty-six newly diagnosed glioma patients underwent 3T-MR DCE and DSC imaging. Parametric maps of CBV, Vp and K(trans) were calculated and the region of highest value (hotspot) was measured on each map. Histograms of rCBV, Vp and K(trans) values were calculated for the tumor volume. Statistical differences according to WHO grade were assessed. The diagnostic accuracy for tumor grading of the two techniques was determined by ROC analysis.

Results:

rCBV, Vp and K(trans) measures differed significantly between high and low-grade gliomas. Hotspot analysis showed the highest correlation with grading. K(trans) hotspots co-localized with Vp hotspots only in 56% of enhancing gliomas. For differentiating high from low-grade gliomas the AUC was 0.987 for rCBVmax, and 1.000 for Vpmax and K(trans)max. Combination of DCE-derived Vp and K(trans) parameters improved the diagnostic performance of the histogram method.

Conclusion:

This initial experience of DCE-derived Vp evaluation shows that this parameter is as accurate as the well-established DSC-derived rCBV for glioma grading. DCE-derived K(trans) is equally useful for grading, providing different informations with respect to Vp.

Insights

Dynamic contrast-enhanced MRI (DCE-MRI) shows high accuracy for glioma grading, comparable to dynamic susceptibility contrast MRI (DSC-MRI). DCE-MRI parameters like plasma volume (Vp) and K(trans) effectively differentiate glioma grades.

Area of Science:

Radiology and Medical Imaging
Neuro-oncology
Quantitative MRI

Background:

Dynamic susceptibility contrast (DSC)-MRI is a standard perfusion technique for glioma grading but has limitations.
Dynamic contrast-enhanced (DCE)-MRI offers an alternative with potential to overcome DSC-MRI's shortcomings.
This study compares the diagnostic accuracy of DSC and DCE-MRI for glioma grading.

Purpose of the Study:

To compare the diagnostic accuracy of DSC-MRI and DCE-MRI for glioma grading.
To evaluate DCE-derived plasma volume (Vp) and K(trans) against DSC-derived relative cerebral blood volume (rCBV).
To assess the utility of Vp and K(trans) in differentiating high-grade from low-grade gliomas.

Main Methods:

Twenty-six newly diagnosed glioma patients underwent 3T-MR DCE and DSC imaging.
Parametric maps of rCBV, Vp, and K(trans) were generated, with hotspot and histogram analyses performed.
Diagnostic accuracy was determined using ROC analysis.

Main Results:

All measures (rCBV, Vp, K(trans)) significantly differed between high and low-grade gliomas.
Hotspot analysis demonstrated the highest correlation with tumor grade.
Area under the curve (AUC) values for Vpmax and K(trans)max were 1.000, indicating excellent diagnostic performance.

Conclusions:

DCE-derived Vp is as accurate as DSC-derived rCBV for glioma grading.
DCE-derived K(trans) is also valuable for grading and provides complementary information to Vp.
DCE-MRI shows high potential as an alternative or adjunct to DSC-MRI for glioma grading.

Read full analysis

Keywords:

Dynamic contrast-enhanced MRI Dynamic susceptibility contrast Glioma Histogram analysis MRI Perfusion MRI

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