Glioma Grading: Sensitivity, Specificity, and Predictive Values of Perfusion MR Imaging and Proton MR Spectroscopic Imaging Compared with Conventional MR Imaging
Meng Lawa,
Stanley Yanga,
Hao Wangc,
James S. Babba,c,
Glyn Johnsona,
Soonmee Chad,
Edmond A. Knoppa,b and
David Zagzagc
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
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FIG 1. 20-year-old woman with biopsy-proved high-grade glioma.
A, Contrast-enhanced axial T1-weighted image (600/14/1 [TR/TE/NEX]) demonstrates an ill-defined nonenhancing mass (arrow) in the right frontal region. The lack of enhancement on the conventional MR image suggests a low-grade glioma.
B, Axial T2-weighted image (3400/119/1) shows increased signal intensity in the mass, with minimal peritumoral edema. This mass was graded as a low-grade glioma with conventional MR imaging because of lack of enhancement, minimal edema, no necrosis, and no mass effect.
C, Gradient-echo (1000/54) axial perfusion MR image with rCBV color overlay map shows increased perfusion with a high rCBV of 7.72, in keeping with a high-grade glioma.
D, Spectrum from proton MR spectroscopy with the PRESS sequence (1500/144) demonstrates markedly elevated Cho and decreased NAA with a Cho/NAA ratio of 2.60, as well as increased lactate (Lac), in keeping with a high-grade glioma.
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FIG 2. 43-year-old man with biopsy-proved low-grade glioma.
A, Contrast-enhanced axial T1-weighted image (600/14/1) demonstrates a peripherally enhancing mass (arrow) in the right frontal region. The presence of contrast material enhancement on the conventional MR image would suggest a high-grade glioma.
B, Axial T2-weighted image (3400/119/1) shows marked peritumoral edema with possible necrosis and blood products. This mass was graded as a high-grade glioma with conventional MR imaging because of the contrast material enhancement, heterogeneity, blood products, possible necrosis, and degree of edema.
C, Gradient-echo (1000/54) axial perfusion MR image with rCBV color overlay map shows a low rCBV of 1.70, in keeping with a low-grade glioma.
D, Spectrum from proton MR spectroscopy with the PRESS sequence (1500/144) demonstrates elevated Cho and slightly decreased NAA with a Cho/NAA ratio of 0.90, which is more in keeping with a low-grade glioma.
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FIG 3. ROC curves for rCBV plus metabolites, rCBV alone, Cho/Cr, and Cho/NAA demonstrate superior sensitivity and specificity of rCBV plus metabolites and rCBV alone compared with conventional MR imaging (cMRI, green asterisk) for glioma grading.
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