Discrimination between Glioma Grades II and III Using Dynamic Susceptibility Perfusion MRI: A Meta-Analysis
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Updated: Mar 2, 2026
Diffusion Tensor Magnetic Resonance Imaging in the Analysis of Neurodegenerative Diseases
Published on: July 28, 2013
Anna F Delgado1, Alberto F Delgado2
1From the Department of Clinical Neuroscience (Anna F.D.), Karolinska Institute, Stockholm, Sweden.
Background:
DSC perfusion has been evaluated in the discrimination between low-grade and high-grade glioma but the diagnostic potential to discriminate beween glioma grades II and III remains unclear.
Purpose:
Our aim was to evaluate the diagnostic accuracy of relative maximal CBV from DSC perfusion MR imaging to discriminate glioma grades II and III.
Data Sources:
A systematic literature search was performed in PubMed/MEDLINE, Embase, Web of Science, and ClinicalTrials.gov.
Study Selection:
Eligible studies reported on patients evaluated with relative maximal CBV derived from DSC with a confirmed neuropathologic diagnosis of glioma World Health Organization grades II and III. Studies reporting on mean or individual patient data were considered for inclusion.
Data Analysis:
Data were analyzed by using inverse variance with the random-effects model and receiver operating characteristic curves describing optimal cutoffs and areas under the curve. Bivariate diagnostic random-effects meta-analysis was used to calculate diagnostic accuracy.
Data Synthesis:
Twenty-eight studies evaluating 727 individuals were included in the meta-analysis. Individual data were available from 10 studies comprising 190 individuals. The mean difference of relative maximal CBV between glioma grades II and III (n = 727) was 1.76 (95% CI, 1.27-2.24; P < .001). Individual patient data (n = 190) had an area under the curve of 0.77 for discriminating glioma grades II and III at an optimal cutoff of 2.02. When we analyzed astrocytomas separately, the area under the curve increased to 0.86 but decreased to 0.61 when we analyzed oligodendrogliomas.
Limitations:
A substantial heterogeneity was found among included studies.
Conclusions:
Glioma grade III had higher relative maximal CBV compared with glioma grade II. A high diagnostic accuracy was found for all patients and astrocytomas; however, the diagnostic accuracy was substantially reduced when discriminating oligodendroglioma grades II and III.
Insights
Dynamic susceptibility contrast (DSC) perfusion MR imaging shows promise in differentiating glioma grades. Relative maximal cerebral blood volume (rCBV) effectively distinguishes high-grade (grade III) from low-grade (grade II) gliomas, particularly astrocytomas.
Area of Science:
- Neuro-oncology
- Radiology
- Medical Imaging
Background:
- Distinguishing between low-grade (II) and high-grade (III) gliomas is crucial for treatment planning.
- Dynamic susceptibility contrast (DSC) perfusion imaging has shown potential in glioma grading.
- The diagnostic accuracy of DSC perfusion for differentiating World Health Organization (WHO) glioma grades II and III requires further clarification.
Purpose of the Study:
- To evaluate the diagnostic accuracy of relative maximal cerebral blood volume (rCBV) derived from DSC perfusion MR imaging in discriminating between WHO glioma grades II and III.
Main Methods:
- A systematic literature search was conducted across major databases (PubMed/MEDLINE, Embase, Web of Science, ClinicalTrials.gov).
- Studies included patients with confirmed neuropathologic diagnoses of WHO glioma grades II or III, utilizing DSC perfusion and reporting rCBV values.
- Bivariate diagnostic random-effects meta-analysis was employed to calculate diagnostic accuracy, including receiver operating characteristic (ROC) curve analysis.
Main Results:
- The meta-analysis included 28 studies with 727 individuals; individual patient data were available for 190 patients from 10 studies.
- A significant difference in rCBV was observed between glioma grades II and III (mean difference = 1.76, P < .001).
- The area under the curve (AUC) for discriminating grades II and III gliomas was 0.77, with an optimal cutoff of 2.02 for rCBV. AUC increased to 0.86 for astrocytomas but decreased to 0.61 for oligodendrogliomas.
Conclusions:
- Relative maximal CBV is higher in glioma grade III compared to glioma grade II.
- DSC perfusion imaging demonstrates high diagnostic accuracy for differentiating glioma grades II and III overall and specifically for astrocytomas.
- Diagnostic accuracy is significantly reduced when attempting to differentiate between oligodendroglioma grades II and III, indicating a limitation for this specific subtype.
