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American Journal of Neuroradiology 26:2187-2199, October 2005
© 2005 American Society of Neuroradiology

BRAIN

Assessment of Diagnostic Accuracy of Perfusion MR Imaging in Primary and Metastatic Solitary Malignant Brain Tumors

Nail Bulakbasi, Murat Kocaoglu, Anar Farzaliyev, Cem Tayfun, Taner Ucoz and Ibrahim Somuncu

From the Department of Radiology, Gulhane Military Medical School, Ankara, Turkey

Address correspondence to Nail Bulakbasi, MD, Department of Radiology, Gulhane Military Medical Academy, Etlik, 06018 Ankara, Turkey

PURPOSE: The purpose of this study was to estimate the diagnostic accuracy of relative cerebral blood volume (rCBV) measurement in preoperative grading and differentiation of solitary intra-axial malignant brain tumors.

METHODS: Thirty-six low-grade glial tumors (LGGTs), 22 high-grade glial tumors (HGGTs), and 17 metastases (METs) were prospectively evaluated by MR imaging and standard dynamic susceptibility contrast-enhanced gradient echo, echoplanar imaging during first pass of a bolus injection of contrast material. Normalized rCBV values from tumoral (rCBVT) and peritumoral (rCBVP) areas were calculated by standard software and statistically tested independently.

RESULTS: The mean differences of rCBVT and rCBVP values between LGGT (2.30 ± 1.12 and 1.18 ± 0.24) and HGGT (5.42 ± 1.52 and 2.17 ± 0.82) (P < .001); HGGTs and METs (3.21 ± 0.98 and 0.97 ± 0.09) (P < .001); and LGGTs and METs (P < .05 and P < .001, respectively) were significant. No clear cutoff value was present. A clear rCBVT cutoff value of 2.6 was detected for differentiation of low- (1.75 ± 0.38; LGA) versus high-grade (4.78 ± 0.99; HGA) astrocytomas when nonastrocytic glial tumors were excluded. The rCBVT values were linearly correlated with degree of malignancy (r = 0.869; P < .001). Cutoff rCBVP values of 1.1 and 1.2 were quite effective in differentiation of METs from LGGTs and HGGTs, respectively. The overall efficacy of rCBV was higher in grading than in differentiation.

CONCLUSION: The diagnostic accuracy of rCBV measurement is higher in grading of glial brain tumors than in differentiation of HGGTs from solitary intra-axial METs. The astrocytic and nonastrocytic glial tumors have to be evaluated separately for precise grading.




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