American Journal of Neuroradiology 24:1989-1998, November-December 2003
© 2003 American Society of Neuroradiology
BRAIN
Glioma Grading: Sensitivity, Specificity, and Predictive Values of Perfusion MR Imaging and Proton MR Spectroscopic Imaging Compared with Conventional MR Imaging
a Department of Radiology, New York University Medical Center, NY
b Department of Neurosurgery, New York University Medical Center, NY
c Department of Pathology, New York University Medical Center, NY
d Department of Biostatistics, Fox Chase Cancer Center, Philadelphia, PA
e Department of Radiology, University of California at San Francisco Medical Center, San Francisco, CA
Address reprint requests to Meng Law, MD, Department of Radiology, NYU Medical Center, MR Imaging Dept, Schwartz Bldg, Basement HCC, 530 First Ave, New York, NY 10016
BACKGROUND AND PURPOSE: Sensitivity, positive predictive value (PPV), and negative predictive value (NPV) of conventional MR imaging in predicting glioma grade are not high. Relative cerebral blood volume (rCBV) measurements derived from perfusion MR imaging and metabolite ratios from proton MR spectroscopy are useful in predicting glioma grade. We evaluated the sensitivity, specificity, PPV, and NPV of perfusion MR imaging and MR spectroscopy compared with conventional MR imaging in grading primary gliomas.
METHODS: One hundred sixty patients with a primary cerebral glioma underwent conventional MR imaging, dynamic contrast-enhanced T2*-weighted perfusion MR imaging, and proton MR spectroscopy. Gliomas were graded as low or high based on conventional MR imaging findings. The rCBV measurements were obtained from regions of maximum perfusion. Metabolite ratios (choline [Cho]/creatine [Cr], Cho/N-acetylaspartate [NAA], and NAA/Cr) were measured at a TE of 144 ms. Tumor grade determined with the three methods was then compared with that from histopathologic grading. Logistic regression and receiver operating characteristic analyses were performed to determine optimum thresholds for tumor grading. Sensitivity, specificity, PPV, and NPV for identifying high-grade gliomas were also calculated.
RESULTS: Sensitivity, specificity, PPV, and NPV for determining a high-grade glioma with conventional MR imaging were 72.5%, 65.0%, 86.1%, and 44.1%, respectively. Statistical analysis demonstrated a threshold value of 1.75 for rCBV to provide sensitivity, specificity, PPV, and NPV of 95.0%, 57.5%, 87.0%, and 79.3%, respectively. Threshold values of 1.08 and 1.56 for Cho/Cr and 0.75 and 1.60 for Cho/NAA provided the minimum C2 and C1 errors, respectively, for determining a high-grade glioma. The combination of rCBV, Cho/Cr, and Cho/NAA resulted in sensitivity, specificity, PPV, and NPV of 93.3%, 60.0%, 87.5%, and 75.0%, respectively. Significant differences were noted in the rCBV and Cho/Cr, Cho/NAA, and NAA/Cr ratios between low- and high-grade gliomas (P < .0001, .0121, .001, and .0038, respectively).
CONCLUSION: The rCBV measurements and metabolite ratios both individually and in combination can increase the sensitivity and PPV when compared with conventional MR imaging alone in determining glioma grade. The rCBV measurements had the most superior diagnostic performance (either with or without metabolite ratios) in predicting glioma grade. Threshold values can be used in a clinical setting to evaluate tumors preoperatively for histologic grade and provide a means for guiding treatment and predicting postoperative patient outcome.
This article has been cited by other articles:
 |
|
 |
|
  M. Buijs, J. A. Vossen, K. Hong, C. S. Georgiades, J.-F. H. Geschwind, and I. R. Kamel Chemoembolization of Hepatic Metastases from Ocular Melanoma: Assessment of Response with Contrast-Enhanced and Diffusion-Weighted MRI Am. J. Roentgenol., July 1, 2008; 191(1): 285 - 289. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. B. Caseiras, J.S. Thornton, T. Yousry, C. Benton, J. Rees, A.D. Waldman, and H.R. Jager Inclusion or Exclusion of Intratumoral Vessels in Relative Cerebral Blood Volume Characterization in Low-Grade Gliomas: Does It Make a Difference? AJNR Am. J. Neuroradiol., June 1, 2008; 29(6): 1140 - 1141. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. E. Emblem, B. Nedregaard, T. Nome, P. Due-Tonnessen, J. K. Hald, D. Scheie, O. C. Borota, M. Cvancarova, and A. Bjornerud Glioma Grading by Using Histogram Analysis of Blood Volume Heterogeneity from MR-derived Cerebral Blood Volume Maps Radiology, June 1, 2008; 247(3): 808 - 817. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Plathow and W. A. Weber Tumor Cell Metabolism Imaging J. Nucl. Med., June 1, 2008; 49(Suppl_2): 43S - 63S. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Law, R. J. Young, J. S. Babb, N. Peccerelli, S. Chheang, M. L. Gruber, D. C. Miller, J. G. Golfinos, D. Zagzag, and G. Johnson Gliomas: Predicting Time to Progression or Survival with Cerebral Blood Volume Measurements at Dynamic Susceptibility-weighted Contrast-enhanced Perfusion MR Imaging Radiology, May 1, 2008; 247(2): 490 - 498. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. Danchaivijitr, A. D. Waldman, D. J. Tozer, C. E. Benton, G. Brasil Caseiras, P. S. Tofts, J. H. Rees, and H. R. Jager Low-Grade Gliomas: Do Changes in rCBV Measurements at Longitudinal Perfusion-weighted MR Imaging Predict Malignant Transformation? Radiology, April 1, 2008; 247(1): 170 - 178. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. Sadeghi, N. D'Haene, C. Decaestecker, M. Levivier, T. Metens, C. Maris, D. Wikler, D. Baleriaux, I. Salmon, and S. Goldman Apparent Diffusion Coefficient and Cerebral Blood Volume in Brain Gliomas: Relation to Tumor Cell Density and Tumor Microvessel Density Based on Stereotactic Biopsies AJNR Am. J. Neuroradiol., March 1, 2008; 29(3): 476 - 482. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Bartha, J.F. Megyesi, and C.J. Watling Low-Grade Glioma: Correlation of Short Echo Time 1H-MR Spectroscopy with 23Na MR Imaging AJNR Am. J. Neuroradiol., March 1, 2008; 29(3): 464 - 470. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Lu, E. Pollack, R. Young, J.S. Babb, G. Johnson, D. Zagzag, R. Carson, J.H. Jensen, J.A. Helpern, and M. Law Predicting Grade of Cerebral Glioma Using Vascular-Space Occupancy MR Imaging AJNR Am. J. Neuroradiol., February 1, 2008; 29(2): 373 - 378. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Hourani, L.J. Brant, T. Rizk, J.D. Weingart, P.B. Barker, and A. Horska Can Proton MR Spectroscopic and Perfusion Imaging Differentiate Between Neoplastic and Nonneoplastic Brain Lesions in Adults? AJNR Am. J. Neuroradiol., February 1, 2008; 29(2): 366 - 372. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. L. Sah, R. Sharma, H. Kandpal, A. Seith, S. Rastogi, S. Bandhu, and N. R. Jagannathan In Vivo Proton Spectroscopy of Giant Cell Tumor of the Bone Am. J. Roentgenol., February 1, 2008; 190(2): W133 - W139. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S.K. Ellika, R. Jain, S.C. Patel, L. Scarpace, L.R. Schultz, J.P. Rock, and T. Mikkelsen Role of Perfusion CT in Glioma Grading and Comparison with Conventional MR Imaging Features AJNR Am. J. Neuroradiol., November 1, 2007; 28(10): 1981 - 1987. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H.S. Kim and S.Y. Kim A Prospective Study on the Added Value of Pulsed Arterial Spin-Labeling and Apparent Diffusion Coefficients in the Grading of Gliomas AJNR Am. J. Neuroradiol., October 1, 2007; 28(9): 1693 - 1699. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Chawla, S. Wang, R.L. Wolf, J.H. Woo, J. Wang, D.M. O'Rourke, K.D. Judy, M.S. Grady, E.R. Melhem, and H. Poptani Arterial Spin-Labeling and MR Spectroscopy in the Differentiation of Gliomas AJNR Am. J. Neuroradiol., October 1, 2007; 28(9): 1683 - 1689. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J.M. Lupo, S. Cha, S.M. Chang, and S.J. Nelson Analysis of Metabolic Indices in Regions of Abnormal Perfusion in Patients with High-Grade Glioma AJNR Am. J. Neuroradiol., September 1, 2007; 28(8): 1455 - 1461. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Pinker, I.M. Noebauer-Huhmann, I. Stavrou, R. Hoeftberger, P. Szomolanyi, G. Karanikas, M. Weber, A. Stadlbauer, E. Knosp, K. Friedrich, et al. High-Resolution Contrast-Enhanced, Susceptibility-Weighted MR Imaging at 3T in Patients with Brain Tumors: Correlation with Positron-Emission Tomography and Histopathologic Findings AJNR Am. J. Neuroradiol., August 1, 2007; 28(7): 1280 - 1286. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. N. Al-Okaili, J. Krejza, J. H. Woo, R. L. Wolf, D. M. O'Rourke, K. D. Judy, H. Poptani, and E. R. Melhem Intraaxial Brain Masses: MR Imaging-based Diagnostic Strategy--Initial Experience Radiology, May 1, 2007; 243(2): 539 - 550. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. A. Altman, D. S. Atkinson Jr, and D. J. Brat Best Cases from the AFIP: Glioblastoma Multiforme RadioGraphics, May 1, 2007; 27(3): 883 - 888. [Full Text] [PDF]
|
|
|
|
|
|
M. Law, R. Young, J. Babb, E. Pollack, and G. Johnson Histogram Analysis versus Region of Interest Analysis of Dynamic Susceptibility Contrast Perfusion MR Imaging Data in the Grading of Cerebral Gliomas AJNR Am. J. Neuroradiol., April 1, 2007; 28(4): 761 - 766. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. Sadeghi, I. Salmon, C. Decaestecker, M. Levivier, T. Metens, D. Wikler, V. Denolin, S. Rorive, N. Massager, D. Baleriaux, et al. Stereotactic Comparison among Cerebral Blood Volume, Methionine Uptake, and Histopathology in Brain Glioma AJNR Am. J. Neuroradiol., March 1, 2007; 28(3): 455 - 461. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. V. Spampinato, J. K. Smith, L. Kwock, M. Ewend, J. D. Grimme, D. L. A. Camacho, and M. Castillo Cerebral Blood Volume Measurements and Proton MR Spectroscopy in Grading of Oligodendroglial Tumors Am. J. Roentgenol., January 1, 2007; 188(1): 204 - 212. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Law, R. Young, J. Babb, M. Rad, T. Sasaki, D. Zagzag, and G. Johnson Comparing Perfusion Metrics Obtained from a Single Compartment Versus Pharmacokinetic Modeling Methods Using Dynamic Susceptibility Contrast-Enhanced Perfusion MR Imaging with Glioma Grade. AJNR Am. J. Neuroradiol., October 1, 2006; 27(9): 1975 - 1982. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. N. Al-Okaili, J. Krejza, S. Wang, J. H. Woo, and E. R. Melhem Advanced MR Imaging Techniques in the Diagnosis of Intraaxial Brain Tumors in Adults RadioGraphics, October 1, 2006; 26(suppl_1): S173 - S189. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. Hollingworth, L.S. Medina, R.E. Lenkinski, D.K. Shibata, B. Bernal, D. Zurakowski, B. Comstock, and J.G. Jarvik A Systematic Literature Review of Magnetic Resonance Spectroscopy for the Characterization of Brain Tumors AJNR Am. J. Neuroradiol., August 1, 2006; 27(7): 1404 - 1411. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. Goebell, J. Fiehler, X.-Q. Ding, S. Paustenbach, S. Nietz, O. Heese, T. Kucinski, C. Hagel, M. Westphal, and H. Zeumer Disarrangement of Fiber Tracts and Decline of Neuronal Density Correlate in Glioma Patients--A Combined Diffusion Tensor Imaging and 1H-MR Spectroscopy Study AJNR Am. J. Neuroradiol., August 1, 2006; 27(7): 1426 - 1431. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G G Fan, Q L Deng, Z H Wu, and Q Y Guo Usefulness of diffusion/perfusion-weighted MRI in patients with non-enhancing supratentorial brain gliomas: a valuable tool to predict tumour grading? Br. J. Radiol., August 1, 2006; 79(944): 652 - 658. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. A. Weber, S. Zoubaa, M. Schlieter, E. Juttler, H. B. Huttner, K. Geletneky, C. Ittrich, M. P. Lichy, A. Kroll, J. Debus, et al. Diagnostic performance of spectroscopic and perfusion MRI for distinction of brain tumors Neurology, June 27, 2006; 66(12): 1899 - 1906. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S.J. Mills, T.A. Patankar, H.A. Haroon, D. Baleriaux, R. Swindell, and A. Jackson Do cerebral blood volume and contrast transfer coefficient predict prognosis in human glioma? AJNR Am. J. Neuroradiol., April 1, 2006; 27(4): 853 - 858. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N. A. Butowski, P. K. Sneed, and S. M. Chang Diagnosis and Treatment of Recurrent High-Grade Astrocytoma J. Clin. Oncol., March 10, 2006; 24(8): 1273 - 1280. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. Bullitt, P.A. Wolthusen, L. Brubaker, W. Lin, D. Zeng, and T. Van Dyke Malignancy-Associated Vessel Tortuosity: A Computer-Assisted, MR Angiographic Study of Choroid Plexus Carcinoma in Genetically Engineered Mice AJNR Am. J. Neuroradiol., March 1, 2006; 27(3): 612 - 619. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Stadlbauer, S. Gruber, C. Nimsky, R. Fahlbusch, T. Hammen, R. Buslei, B. Tomandl, E. Moser, and O. Ganslandt Preoperative Grading of Gliomas by Using Metabolite Quantification with High-Spatial-Resolution Proton MR Spectroscopic Imaging Radiology, March 1, 2006; 238(3): 958 - 969. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Cha, L. Yang, G. Johnson, A. Lai, M.-H. Chen, T. Tihan, M. Wendland, and W.P. Dillon Comparison of Microvascular Permeability Measurements, Ktrans, Determined with Conventional Steady-State T1-Weighted and First-Pass T2*-Weighted MR Imaging Methods in Gliomas and Meningiomas. AJNR Am. J. Neuroradiol., February 1, 2006; 27(2): 409 - 417. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Law, S. Oh, J. S. Babb, E. Wang, M. Inglese, D. Zagzag, E. A. Knopp, and G. Johnson Low-Grade Gliomas: Dynamic Susceptibility-weighted Contrast-enhanced Perfusion MR Imaging--Prediction of Patient Clinical Response Radiology, February 1, 2006; 238(2): 658 - 667. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. F. Patankar, H. A. Haroon, S. J. Mills, D. Baleriaux, D. L. Buckley, G. J.M. Parker, and A. Jackson Is Volume Transfer Coefficient (Ktrans) Related to Histologic Grade in Human Gliomas? AJNR Am. J. Neuroradiol., November 1, 2005; 26(10): 2455 - 2465. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. B. Pope, J. Sayre, A. Perlina, J. P. Villablanca, P. S. Mischel, and T. F. Cloughesy MR Imaging Correlates of Survival in Patients with High-Grade Gliomas AJNR Am. J. Neuroradiol., November 1, 2005; 26(10): 2466 - 2474. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. Bulakbasi, M. Kocaoglu, A. Farzaliyev, C. Tayfun, T. Ucoz, and I. Somuncu Assessment of Diagnostic Accuracy of Perfusion MR Imaging in Primary and Metastatic Solitary Malignant Brain Tumors AJNR Am. J. Neuroradiol., October 1, 2005; 26(9): 2187 - 2199. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. M. Brubaker, E. Bullitt, C. Yin, T. Van Dyke, and W. Lin Magnetic Resonance Angiography Visualization of Abnormal Tumor Vasculature in Genetically Engineered Mice Cancer Res., September 15, 2005; 65(18): 8218 - 8223. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Wintermark, M. Sesay, E. Barbier, K. Borbely, W. P. Dillon, J. D. Eastwood, T. C. Glenn, C. B. Grandin, S. Pedraza, J.-F. Soustiel, et al. Comparative Overview of Brain Perfusion Imaging Techniques Stroke, September 1, 2005; 36(9): e83 - e99. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. M. Lupo, S. Cha, S. M. Chang, and S. J. Nelson Dynamic Susceptibility-Weighted Perfusion Imaging of High-Grade Gliomas: Characterization of Spatial Heterogeneity AJNR Am. J. Neuroradiol., June 1, 2005; 26(6): 1446 - 1454. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. C. M. Maia Jr, S. M. F. Malheiros, A. J. da Rocha, C. J. da Silva, A. A. Gabbai, F. A. P. Ferraz, and J. N. Stavale MR Cerebral Blood Volume Maps Correlated with Vascular Endothelial Growth Factor Expression and Tumor Grade in Nonenhancing Gliomas AJNR Am. J. Neuroradiol., April 1, 2005; 26(4): 777 - 783. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. R. Jager, A. D Waldman, C. Benton, N. Fox, and J. Rees Differential Chemosensitivity of Tumor Components in a Malignant Oligodendroglioma: Assessment with Diffusion-Weighted, Perfusion-Weighted, and Serial Volumetric MR Imaging AJNR Am. J. Neuroradiol., February 1, 2005; 26(2): 274 - 278. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. M. Schmainda, S. D. Rand, A. M. Joseph, R. Lund, B. D. Ward, A. P. Pathak, J. L. Ulmer, M. A. Baddrudoja, and H. G. J. Krouwer Characterization of a First-Pass Gradient-Echo Spin-Echo Method to Predict Brain Tumor Grade and Angiogenesis AJNR Am. J. Neuroradiol., October 1, 2004; 25(9): 1524 - 1532. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Law, S. Yang, J. S. Babb, E. A. Knopp, J. G. Golfinos, D. Zagzag, and G. Johnson Comparison of Cerebral Blood Volume and Vascular Permeability from Dynamic Susceptibility Contrast-Enhanced Perfusion MR Imaging with Glioma Grade AJNR Am. J. Neuroradiol., May 1, 2004; 25(5): 746 - 755. [Abstract] [Full Text] [PDF]
|
|