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DSC-PWI presurgical differentiation of grade 4 astrocytoma and glioblastoma in young adults: rCBV percentile analysis across enhancing and non-enhancing regions

  • 0Radiology Department, Hospital Universitari de Bellvitge, Barcelona, Spain. albert.pons@bellvitgehospital.cat.
Neuroradiology +

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June 4, 2024

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June 4, 2024

View abstract on PubMed

Summary

This summary is machine-generated.

This study reveals that relative-cerebral-blood-volume (rCBV) percentiles in non-enhancing tumor regions can effectively differentiate IDH-mutant astrocytoma grade 4 from glioblastoma. Lower rCBV percentiles in these areas are a key distinguishing feature.

Area Of Science

  • Neuro-oncology
  • Radiology
  • Medical imaging

Background

  • Accurate presurgical discrimination between IDH-mutant astrocytoma grade 4 and IDH-wildtype glioblastoma is vital for patient management in younger adults.
  • This distinction impacts prognosis, molecular diagnostics, surgical planning, and eligibility for targeted therapies.
  • Dynamic susceptibility contrast perfusion-weighted imaging (DSC-PWI) shows potential but requires further exploration for optimal application.

Purpose Of The Study

  • To evaluate the efficacy of relative-cerebral-blood-volume (rCBV) percentile values in differentiating IDH-mutant astrocytoma grade 4 from IDH-wildtype glioblastoma.
  • To compare the diagnostic performance of rCBV percentiles with traditional mean and maximum rCBV values in enhancing and non-enhancing tumor regions.

Main Methods

  • Retrospective analysis of 59 patients under 55 years with grade 4 astrocytic tumors and known IDH status (2016-2023).
  • Presurgical MR with DSC-PWI was performed, with 3D segmentation of enhancing and non-enhancing tumor regions.
  • Voxel-level rCBV was calculated to derive mean, maximum, and percentile values; statistical analysis used Mann-Whitney U test and AUC-ROC.

Main Results

  • No significant difference in rCBV was found in enhancing regions between glioblastoma and astrocytoma grade 4.
  • Non-enhancing regions of astrocytoma grade 4 showed significantly higher rCBV, particularly at lower percentiles.
  • The 30th rCBV percentile in non-enhancing regions distinguished astrocytoma grade 4 (0.705) from glioblastoma (0.458) with high accuracy (AUC-ROC = 0.811).

Conclusions

  • An automated percentile-based rCBV analysis, especially in non-enhancing regions, improves the differentiation of IDH-mutant astrocytoma grade 4 from glioblastoma.
  • Elevated rCBV in lower percentiles of non-enhancing astrocytoma grade 4 regions may indicate infiltrated edema, a key differentiator from glioblastoma's pure edema.

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