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Perfusion Showdown: Comparison of Multiple MRI Perfusion Techniques in the Grading of Pediatric Brain Tumors
Chang Y Ho1,2, Nucharin Supakul3, Greg Anthony3
1From the Department of Radiology and Imaging Sciences (C.Y.H., N.S., G.A., Q.W., P.C., M.A., J.G.P., B.R.G., P.R.T., G.D.H.), Indiana University School of Medicine, Indianapolis, Indiana chang.ho@austin.utexas.edu.
Background And Purpose:
There are multiple MRI perfusion techniques, with limited available literature comparing these techniques in the grading of pediatric brain tumors. For efficiency and limiting scan time, ideally only one MRI perfusion technique can be used in initial imaging. We compared DSC, dynamic contrast enhancement (DCE), and intravoxel incoherent motion (IVIM) along with ADC from DWI for differentiating high- versus low-grade pediatric brain tumors.
Materials And Methods:
Presurgical MRI at a single pediatric hospital for primary brain tumor of glial, neuronal, or embryonal origin including DWI, DSC, DCE, and IVIM with postsurgical histopathology results with World Health Organization (WHO) tumor grading were included. Tumor VOI was drawn on T2-weighted images registered to selected parametric maps from DWI, DSC, DCE, and IVIM. Multiple Bonferroni-corrected t tests were performed on the mean tumor values for each selected parameter, including histogram analysis of 95th percentile relative CBV (rCBV), 5th percentile ADC, and 5th percentile D, to evaluate for significance between high- and low-grade tumors. Receiver operating characteristic (ROC) analysis was performed for significant t test results.
Results:
Seventy-two subjects were included with 36 low-grade and 36 high-grade tumors. t test after Bonferroni correction yielded significant results for 5th percentile ADC (P = .003), mean ADC (P = .006), mean D (P = .009), and 5th percentile D (P = .02). Specifically, 95th percentile rCBV, mean rCBV, D*, f, and all DCE parameters were not significant for high- versus low-grade pediatric brain tumors after correction. Only mean rCBV was significant before but not after Bonferroni correction (P = .04 → P = .35). ROC analysis for the parameters with t test significance before and after Bonferroni correction had the following AUC, in descending order: 5th percentile ADC (0.791, 0.68-0.88, P < .001), 5th percentile D (0.789, 0.68-0.88, P < .001), mean D (0.76, 0.64-0.85, P < .001), mean ADC (0.754,0.64-0.85, P < .001), and mean rCBV (0.683, 0.56-0.79, P = .004).
Conclusions:
Perfusion parameters from IVIM, DCE, and DSC were not able to significantly differentiate between high- versus low-grade pediatric brain tumors compared with ADC in our study. Fifth percentile ADC performed the best and can be the primary technique for grading pediatric brain tumors.
Insights
Apparent Diffusion Coefficient (ADC) from diffusion-weighted imaging (DWI) is effective for grading pediatric brain tumors. The 5th percentile ADC showed the best performance in differentiating high- from low-grade tumors.
Area of Science:
- Radiology
- Pediatric Oncology
- Neuroimaging
Background:
- Multiple MRI perfusion techniques exist for brain tumor assessment.
- Limited literature compares these techniques for grading pediatric brain tumors.
- Efficient initial imaging requires a single, reliable MRI perfusion technique.
Purpose of the Study:
- To compare Diffusion-Weighted Imaging (DWI) with Apparent Diffusion Coefficient (ADC) mapping, Dynamic Susceptibility Contrast (DSC), Dynamic Contrast Enhancement (DCE), and Intravoxel Incoherent Motion (IVIM) MRI techniques.
- To evaluate the efficacy of these techniques in differentiating high-grade from low-grade pediatric brain tumors.
Main Methods:
- Presurgical MRI data (DWI, DSC, DCE, IVIM) from 72 pediatric patients with primary brain tumors were analyzed.
- Tumor regions of interest (VOI) were defined on T2-weighted images.
- Bonferroni corrected t-tests and Receiver Operating Characteristic (ROC) analysis were performed on quantitative parameters.
Main Results:
- The 5th percentile ADC (p=0.003), mean ADC (p=0.006), mean D (p=0.009), and 5th percentile D (p=0.02) were significant in differentiating tumor grades.
- Perfusion parameters from IVIM, DCE, and DSC, including 95th percentile rCBV and mean rCBV, were not significant after correction.
- The 5th percentile ADC demonstrated the highest Area Under the Curve (AUC) in ROC analysis (0.791).
Conclusions:
- Apparent Diffusion Coefficient (ADC) derived from DWI is a more effective parameter than IVIM, DCE, or DSC perfusion techniques for grading pediatric brain tumors.
- The 5th percentile ADC measurement is recommended as a primary technique for differentiating high- from low-grade pediatric brain tumors due to its superior performance.
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