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AJNR - American Journal of Neuroradiology

Published ahead of print on September 20, 2007
doi: 10.3174/ajnr.A0674

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A Prospective Study on the Added Value of Pulsed Arterial Spin-Labeling and Apparent Diffusion Coefficients in the Grading of Gliomas

H.S. Kim^a and S.Y. Kim^a

^a From the Department of Diagnostic Radiology, Ajou University, School of Medicine, Mt. 5, Woncheon-dong, Yeongtong-gu, Suwon-si, Gyeonggi-do, 442-749, Korea

View larger version (31K): [in this window] [in a new window]   Fig 1. A 41-year-old man with a suspected recurred tumor after surgery. There is a contrast-enhancing lesion around the previous tumor resection site on contrast-enhanced T1-weighted axial image (A). Tumor perfusion score (sTP) on pulsed arterial spin-labeling map is 4 (B, arrow). Visual apparent diffusion coefficient score (sADC) is 3 (C, arrow); therefore, the combined sTP and sADC is 7. Initial imaging diagnosis was glioblastoma multiforme (grade 4); however, on pathologic examination this tumor was confirmed as an anaplastic astrocytoma (grade 3).

View larger version (30K): [in this window] [in a new window]   Fig 2. A 45-year-old woman with a suspected brain tumor in the right basal ganglia. Contrast-enhanced T1-weighted axial image shows enhancing mass in the right basal ganglia (A). Tumoral perfusion score (sTP) is 3 (B, arrow). The visual apparent diffusion coefficient score (sADC) is 2 (C); therefore, the combined sTP and sADC is 5. On pathologic examination, this tumor was confirmed as an anaplastic astrocytoma (grade 3).

View larger version (13K): [in this window] [in a new window]   Fig 3. Interactive dot diagram. The sensitivity and specificity for the determination of a glioma grade with the ratio of maximum tumoral perfusion signal intensity (rTPmax) were 95.1 and 81.8, with a threshold value of 1.24.

View larger version (13K): [in this window] [in a new window]   Fig 4. Interactive dot diagram. The sensitivity and specificity for the determination of a glioma grade with a minimum apparent diffusion coefficient value (mADC) were 90.9 and 81.8, with a threshold value of 0.98 x 10–3 mm/s2.

View larger version (18K): [in this window] [in a new window]   Fig 5. The ROC curve of 2 quantitative (rTPmax, mADC) and 3 qualitative (sTP, sADC, sTP and sADC) parameters for glioma grading. The areas under the ROC curve for the 5 parameters are as follows: rTPmax, 0.97; sTP and sADC, 0.96; mADC, 0.93; sTP, 0.90; and sADC, 0.80.