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Performance of Standardized Relative CBV for Quantifying Regional Histologic Tumor Burden in Recurrent High-Grade

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Summary

Standardized relative cerebral blood volume (CBV) measurements in high-grade gliomas show comparable accuracy to normalized CBV for distinguishing recurrent tumors from radiation effects. This advancement simplifies workflow and promotes standardized methodology in neuro-oncology imaging.

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Area of Science:

  • Neuroimaging
  • Oncology
  • Radiology

Background:

  • Perfusion MR imaging measures relative cerebral blood volume (CBV) to differentiate high-grade glioma recurrence from radiation effects.
  • Current methods rely on user-defined normalization, introducing variability.
  • A new standardization method eliminates user input for relative CBV measurement.

Purpose of the Study:

  • To compare the predictive performance of standardized relative CBV against normalized relative CBV.
  • To evaluate their accuracy in quantifying tumor burden versus posttreatment radiation effects in high-grade gliomas.

Main Methods:

  • 38 patients with high-grade gliomas and suspected recurrence were analyzed.
  • 112 image-localized biopsies were obtained and histologically analyzed for tumor content.
  • Normalized and standardized relative CBV metrics were measured and compared against histologic tumor burden.

Main Results:

  • Both normalized and standardized relative CBV showed significant correlations with tumor content (r=0.63-0.66, P<.001).
  • Predictive accuracies for binary tumor content cutoffs were similar between standardized and normalized metrics.
  • Median relative CBV performed best for predicting ≥50% tumor (AUC=0.86-0.87), while fractional tumor burden was best for ≥80% tumor (AUC=0.77-0.80).

Conclusions:

  • Standardized relative CBV offers comparable performance to normalized relative CBV.
  • This standardization is a key step toward optimizing workflow and establishing consensus in neuro-oncology imaging.