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Research ArticleBRAIN

Cerebral Blood Volume Measurements by Perfusion-Weighted MR Imaging in Gliomas: Ready for Prime Time in Predicting Short-Term Outcome and Recurrent Disease?

S. Bisdas, M. Kirkpatrick, P. Giglio, C. Welsh, M.V. Spampinato and Z. Rumboldt
American Journal of Neuroradiology April 2009, 30 (4) 681-688; DOI: https://doi.org/10.3174/ajnr.A1465
S. Bisdas
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M. Kirkpatrick
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P. Giglio
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C. Welsh
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M.V. Spampinato
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Z. Rumboldt
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  • Fig 1.
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    Fig 1.

    Source dynamic MR image (A), signal intensity time curves (S) (B), and color-coded perfusion map (overlaid on the corresponding FLAIR image) (C) of a male patient with a supratentorial astrocytoma (WHO grade III) in the left hemisphere (patient 21). The tumor pixel with the highest CBV value is represented as a small blue cross (L10). The contralateral corresponding white matter pixel is a purple cross (L16). The 2 pixels have distinct signal intensity curves with markedly deeper signal intensity drop in the tumor pixel (which begins 24 seconds after perfusion-weighted MR imaging initiation).

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    Fig 2.

    Scatterplot of the PFS and rCBVmax of the astrocytoma population. The plot presents the 2 population subgroups: the recurrent (solid triangles) and the nonrecurrent (open circles) astrocytomas. Note the high perfusion values of the recurrent tumors combined with shorter survival.

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    Fig 3.

    The ROC curves analyzing the sensitivity and specificity of rCBVmax values in astrocytomas for 1-year survival (A) and recurrence (B) show the optimal threshold value as ≤3.8 (sensitivity, 93.7% [95% confidence interval (CI), 69.7–99%]; specificity, 72.7% [95% CI, 39.1–93.7%], P = .0002) for 1-year survival and as >4.2 (sensitivity, 77.8% [95% CI, 40–96.5%]; specificity, 94.4% [72.6–99.1%], P = .0001) for recurrence. C, Kaplan-Meier curve of PFS probability (hazard ratio [HR] = 0.09, P = .0007). The thresholdmax represents the rCBVmax cutoff value, in which 1 corresponds to rCBVmax ≤4.2.

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    Fig 4.

    A and B, The ROC curves analyzing the sensitivity and specificity of the WHO grading system (I-IV) for the 1-year survival (A) and recurrence (B) show the optimal threshold value as <2 (WHO grade II) (sensitivity, 81.2% [95% confidence interval (CI), 54.3–95.7%]; specificity, 90.9% [95% CI, 58.7–98.5%], P = .0002) for 1-year survival and as >2 (sensitivity, 88.9% [95% CI, 51.7–98.2%]; specificity, 72.2% [95% CI, 46.5–90.2%], P = .0001) for recurrence. C, Kaplan-Meier curve of PFS probability is based on stratification according to the WHO grade (1 = low grade [WHO I-II], 2 = high grade [WHO III and IV)]; HR = 0.15, P = .05).

Tables

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    Table 1:

    Patient population demographics, histologic diagnosis with WHO grade, KPS, PFS, and maximum rCBV values

    PatientAge (yr)SexPathologyWHOKPSPFS (days)rCBVmax
    126MAstro21002981.1
    264FAstro470999.1
    361MAstro4801914.7
    443FAstro1906682.1
    545MAstro21004852.1
    669FAstro4607493.5
    779MAstro2602103.0
    837MAstro2501174.8
    956FAstro410015211.9
    1019FAstro1909751.8
    1146MOligoastro28010411.2
    1256FOligoastro29014026.2
    1343MAstro21004286.1
    1449MAstro4601344.2
    1553FAstro29016082.9
    1641MOligoastro31007911.2
    1719MAstro39013232.7
    1820MAstro1803923.8
    1931MAstro17018311.2
    2037MAstro3906936.2
    2130FAstro3905671.2
    2216FOligodendro37013022.2
    2340MOligodendro2805461.1
    2437FOligodendro210015405.6
    2543FOligodendro21003804.1
    2668FAstro380577.8
    2761MAstro4508511
    2881MAstro470288.0
    2938FAstro2805461.0
    3053MAstro4100764.4
    3151MAstro2903861.1
    3241MAstro31003341.5
    3341FAstro2809111.3
    3446MAstro2906992.4
    • Note:—Astro indicates astrocytoma; oligoastro, oligoastrocytoma; oligodendro, oligodendroglioma; KPS, Kornofsky performance score; PFS, progression-free survival; rCBV, relative cerebral blood volume.

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    Table 2:

    Summary statistics of mean and maximum rCBV values, KPS, and PFS of the 3 subgroups of the patient population

    rCBVmeanrCBVmaxKPS, Median (range)PFS (average in days)
    Astrocytomas (n = 27)3.5 (±2.7)3.7 (±2.7)90 (50–100)576 (±505)
    Oligodendrogliomas (n = 4)3.1 (±2.2)3.3 (±2.0)90 (70–100)942 (±566)
    Oligoastrocytomas (n= 3)2.4 (±1.7)2.9 (±2.3)90 (70–90)1030 (±401)
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American Journal of Neuroradiology: 30 (4)
American Journal of Neuroradiology
Vol. 30, Issue 4
April 2009
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Cerebral Blood Volume Measurements by Perfusion-Weighted MR Imaging in Gliomas: Ready for Prime Time in Predicting Short-Term Outcome and Recurrent Disease?
S. Bisdas, M. Kirkpatrick, P. Giglio, C. Welsh, M.V. Spampinato, Z. Rumboldt
American Journal of Neuroradiology Apr 2009, 30 (4) 681-688; DOI: 10.3174/ajnr.A1465

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Cerebral Blood Volume Measurements by Perfusion-Weighted MR Imaging in Gliomas: Ready for Prime Time in Predicting Short-Term Outcome and Recurrent Disease?
S. Bisdas, M. Kirkpatrick, P. Giglio, C. Welsh, M.V. Spampinato, Z. Rumboldt
American Journal of Neuroradiology Apr 2009, 30 (4) 681-688; DOI: 10.3174/ajnr.A1465
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