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Whole-body PET/MRI of Pediatric Patients: The Details That Matter
Published on: December 19, 2017
Perfusion magnetic resonance imaging in pediatric brain tumors
F Dallery1, R Bouzerar2, D Michel3
1Department of Radiology, University Hospital, Amiens, France. dallery.florine@chu-amiens.fr.
Insights
Dynamic susceptibility contrast-enhanced (DSC) MR imaging effectively differentiates pediatric brain tumor grades. Perfusion parameters like relative cerebral blood volume (rCBV) and relative cerebral blood flow (rCBF), along with a novel permeability indicator (K2/PSR), show significant potential for accurate tumor grading.
Area of Science:
- Neuroradiology
- Pediatric Oncology
- Medical Imaging
Background:
- Dynamic susceptibility contrast-enhanced (DSC) MR imaging is increasingly utilized in pediatric neuroradiology.
- Limited studies currently exist on its application in pediatric brain tumor grading.
- Assessing perfusion and permeability parameters may aid in differentiating tumor grades.
Purpose of the Study:
- To evaluate the efficacy of DSC-MR imaging in assessing perfusion and permeability parameters for pediatric brain tumor grading.
- To compare these parameters between high-grade (HG) and low-grade (LG) pediatric brain tumors.
Main Methods:
- Retrospective analysis of 30 pediatric brain tumor patients who underwent DSC-MR perfusion.
- Calculation of relative cerebral blood flow (rCBF) and relative cerebral blood volume (rCBV) using region of interest (ROI) analysis.
- Assessment of lesion permeability using semi-quantitative (PSR) and model-based (K2) parameters, with statistical comparison and ROC analysis between HG and LG groups.
Main Results:
- Significant differences were observed between LG and HG groups for mean rCBV, rCBF, and PSR (p < 0.001, p < 0.001, and p = 0.03, respectively).
- The K2 factor alone did not show significant differentiation (p = 0.5).
- The K2/PSR ratio demonstrated strong discriminatory power (p < 0.001), with ROC AUC > 0.9 for rCBV, rCBF, and K2/PSR.
Conclusions:
- DSC-MR perfusion imaging provides reliable, objective whole-lesion ROI data for pediatric brain tumor analysis.
- Perfusion parameters (rCBV, rCBF) and a novel permeability indicator (K2/PSR) can effectively distinguish between high-grade and low-grade pediatric brain lesions.
Purpose:
The use of DSC-MR imaging in pediatric neuroradiology is gradually growing. However, the number of studies listed in the literature remains limited. We propose to assess the perfusion and permeability parameters in pediatric brain tumor grading.
Methods:
Thirty children with a brain tumor having benefited from a DSC-MR perfusion sequence have been retrospectively explored. Relative CBF and CBV were computed on the ROI with the largest lesion coverage. Assessment of the lesion's permeability was also performed through the semi-quantitative PSR parameter and the K2 model-based parameter on the whole-lesion ROI and a reduced ROI drawn on the permeability maps. A statistical comparison of high- and low-grade groups (HG, LG) as well as a ROC analysis was performed on the histogram-based parameters.
Results:
Our results showed a statistically significant difference between LG and HG groups for mean rCBV (p < 10-3), rCBF (p < 10-3), and for PSR (p = 0.03) but not for the K2 factor (p = 0.5). However, the ratio K2/PSR was shown to be a strong discriminating factor between the two groups of lesions (p < 10-3). For rCBV and rCBF indicators, high values of ROC AUC were obtained (> 0.9) and mean value thresholds were observed at 1.07 and 1.03, respectively. For K2/PSR in the reduced area, AUC was also superior to 0.9.
Conclusions:
The implementation of a dynamic T2* perfusion sequence provided reliable results using an objective whole-lesion ROI. Perfusion parameters as well as a new permeability indicator could efficiently discriminate high-grade from low-grade lesions in the pediatric population.
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