Article Figures & Data
Figures
- 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.
- 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.
- 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.
Tables
- TABLE 1:
Threshold values for rCBV for differentiation between low- and high-grade gliomas
Description rCBV Sensitivity Specificity PPV NPV C2 Error C1 Error Minimum C2 Error* 1.75 95.0 57.5 87.0 79.3 14.4 23.8 Minimum C1 Error† 2.97 72.5 87.5 94.6 51.5 23.8 20.0 Same sensitivity as cMRI 2.97 72.5 87.5 94.6 51.5 23.8 20.0 Same specificity as cMRI 2.18 87.5 65.0 88.2 63.4 18.1 23.0 Note.—Conventional MR imaging (cMRI) sensitivity 72.5%, specificity 65.0%, PPV 86.1%, NPV 44.1%, C2 error 29.4%, and C1 error 31.8%.
* C2 = the percentage of observed data points misclassified.
† C1 = 1 − (sensitivity + specificity)/2. This maximizes the average of sensitivity and specificity.
- TABLE 2:
Threshold values for Cho/Cr ratio for differentiation between low- and high-grade gliomas
Description Cho/Cr Sensitivity Specificity PPV NPV C2 Error C1 Error Minimum C2 Error* 1.08 97.5 12.5 77.0 62.5 23.8 45.0 Minimum C1 Error† 1.56 75.8 47.5 81.2 39.6 31.3 38.3 Same sensitivity as cMRI 1.61 72.5 50.0 81.3 37.7 33.1 38.8 Same specificity as cMRI 1.88 55.0 65.0 83.5 33.3 41.9 38.8 Note.—Conventional MR imaging (cMRI) sensitivity 72.5%, specificity 65.0%, PPV 86.1%, NPV 44.1%, C2 error 29.4%, and C1 error 31.8%.
* C2 = the percentage of observed data points misclassified.
† C1 = 1 − (sensitivity + specificity)/2. This maximizes the average of sensitivity and specificity.
- TABLE 3:
Threshold values for Cho/NAA ratio for differentiation between low- and high-grade gliomas
Description Cho/NAA Sensitivity Specificity PPV NPV C2 Error C1 Error Minimum C2 Error* 0.75 96.7 10.0 76.3 50.0 25.0 46.7 Minimum C1 Error† 1.60 74.2 62.5 85.6 44.6 28.8 31.7 Same sensitivity as cMRI 1.66 72.5 62.5 85.3 43.1 30.0 32.5 Same specificity as cMRI 1.78 67.5 65.0 85.3 40.0 33.1 33.8 Note.—Conventional MR imaging (cMRI) sensitivity 72.5%, specificity 65.0%, PPV 86.1%, NPV 44.1%, C2 error 29.4%, and C1 error 31.8%.
* C2 = the percentage of observed data points misclassified.
† C1 = 1 − (sensitivity + specificity)/2. This maximizes the average of sensitivity and specificity.
- TABLE 4:
rCBV, Cho/Cr ratio, and Cho/NAA ratio together for differentiation between low- and high-grade glioma
Description Sensitivity Specificity PPV NPV C2 Error C1 Error Minimum C2 Error* 93.3 60.0 87.5 75.0 15.0 23.3 Minimum C1 Error† 70.8 92.5 96.6 51.4 23.7 18.3 Same sensitivity as cMRI 72.5 87.5 94.6 51.5 23.8 20.0 Same specificity as cMRI 89.2 65.0 88.4 66.7 16.9 22.9 Note.—Conventional MR imaging (cMRI) sensitivity 72.5%, specificity 65.0%, PPV 86.1%, NPV 44.1%, C2 error 29.4%, and C1 error 31.8%.
* C2 = the percentage of observed data points misclassified.
† C1 = 1 − (sensitivity + specificity)/2. This maximizes the average of sensitivity and specificity.
- TABLE 5:
Perfusion MR measure and metabolite ratios for low- and high-grade gliomas and normal values
Technique and Measure Low-Grade Glioma (n = 40) High-Grade Glioma (n = 120) P Value* Range Mean SD Range Mean SD Perfusion MR imaging rCBV 0.77–9.84 2.14 1.67 0.96–19.80 5.18 3.29 < 0.0001 MR Spectroscopy Cho/Cr 0.85–4.00 1.75 0.60 0.83–13.80 2.43 1.92 0.0121 Cho/NAA 0.60–6.80 1.96 1.43 0.53–28.90 3.22 3.65 0.001 NAA/Cr 0.33–3.60 1.20 0.71 0.10–3.93 0.90 0.62 0.0038 Normal values† Cho/Cr 0.43–1.37 0.88 0.19 0.44–2.00 0.87 0.24 0.425 NAA/Cr 1.11–2.89 1.72 0.41 0.45–4.74 1.73 0.51 0.958 * Mann-Whitney test.
† Ratios in normal-appearing contralateral brain.
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