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Discrimination between glioma grades II and III in suspected low-grade gliomas using dynamic contrast-enhanced and dynamic susceptibility contrast perfusion MR imaging: a histogram analysis approach

  • Diagnostic Neuroradiology
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Abstract

Introduction

Perfusion magnetic resonance imaging (MRI) can be used in the pre-operative assessment of brain tumours. The aim of this prospective study was to identify the perfusion parameters from dynamic contrast-enhanced (DCE) and dynamic susceptibility contrast (DSC) perfusion imaging that could best discriminate between grade II and III gliomas.

Methods

MRI (3 T) including morphological ((T2 fluid attenuated inversion recovery (FLAIR) and T1-weighted (T1W)+Gd)) and perfusion (DCE and DSC) sequences was performed in 39 patients with newly diagnosed suspected low-grade glioma after written informed consent in this review board-approved study. Regions of interests (ROIs) in tumour area were delineated on FLAIR images co-registered to DCE and DSC, respectively, in 25 patients with histopathological grade II (n = 18) and III (n = 7) gliomas. Statistical analysis of differences between grade II and grade III gliomas in histogram perfusion parameters was performed, and the areas under the curves (AUC) from the ROC analyses were evaluated.

Results

In DCE, the skewness of transfer constant (k trans) was found superior for differentiating grade II from grade III in all gliomas (AUC 0.76). In DSC, the standard deviation of relative cerebral blood flow (rCBF) was found superior for differentiating grade II from grade III gliomas (AUC 0.80).

Conclusions

Histogram parameters from k trans (DCE) and rCBF (DSC) could most efficiently discriminate between grade II and grade III gliomas.

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Abbreviations

AUC:

Area under the curve

DCE:

Dynamic contrast-enhanced

DSC:

Dynamic susceptibility contrast

FLAIR:

Fluid attenuated inversion recovery

ICA:

Internal carotid artery

k trans :

Transfer constant

K app :

Apparent transfer constant

ROI:

Region of interest

ROC:

Receiver operating characteristics

T1W:

T1-weighted

TE:

Echo time

TR:

Repetition time

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Ethical standards and patient consent

We declare that all human studies have been approved by the Uppsala Ethics Committee and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. We declare that all patients gave informed consent prior to inclusion in this study.

Acknowledgments

The authors would like to thank Lars Berglund, Statistician, Uppsala Clinical Research Center, Sweden, Monika Gelotte, Research Assistant, Uppsala University, Sweden, and Håkan Petterson, IT Manager, Uppsala University, Sweden.

Conflict of interest

We declare that we have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Radiology, Oncology and Radiation Science, Section of Radiology, Uppsala University, BFC Akademiska sjukhuset, SE 751 85, Uppsala, Sweden

    Anna Falk, Markus Fahlström, Arvid Morell & Elna-Marie Larsson

  2. Functional Imaging Unit, Glostrup Hospital, Glostrup, University of Copenhagen, Copenhagen, Denmark

    Egill Rostrup & Henrik B.W. Larsson

  3. Department of Neuroscience, Neurology, Uppsala University, Uppsala, Sweden

    Shala Berntsson, Maria Zetterling & Anja Smits

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  1. Anna Falk
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  2. Markus Fahlström
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Correspondence to Anna Falk.

Additional information

Elna-Marie Larsson and Anja Smits share senior authorship.

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Falk, A., Fahlström, M., Rostrup, E. et al. Discrimination between glioma grades II and III in suspected low-grade gliomas using dynamic contrast-enhanced and dynamic susceptibility contrast perfusion MR imaging: a histogram analysis approach. Neuroradiology 56, 1031–1038 (2014). https://doi.org/10.1007/s00234-014-1426-z

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  • DOI: https://doi.org/10.1007/s00234-014-1426-z

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