RT Journal Article
SR Electronic
T1 Does MR Perfusion Imaging Impact Management Decisions for Patients with Brain Tumors? A Prospective Study
JF American Journal of Neuroradiology
JO Am. J. Neuroradiol.
FD American Society of Neuroradiology
SP 556
OP 562
DO 10.3174/ajnr.A2811
VO 33
IS 3
A1 C.P. Geer
A1 J. Simonds
A1 A. Anvery
A1 M.Y. Chen
A1 J.H. Burdette
A1 M.E. Zapadka
A1 T.L. Ellis
A1 S.B. Tatter
A1 G.J. Lesser
A1 M.D. Chan
A1 K.P. McMullen
A1 A.J. Johnson
YR 2012
UL http://www.ajnr.org/content/33/3/556.abstract
AB BACKGROUND AND PURPOSE: MR perfusion imaging can be used to help predict glial tumor grade and disease progression. Our purpose was to evaluate whether perfusion imaging has a diagnostic or therapeutic impact on clinical management planning in patients with glioma. MATERIALS AND METHODS: Standard MR imaging protocols were interpreted by a group of 3 NRs in consensus, with each case being interpreted twice: first, including routine sequences; and second, with the addition of perfusion imaging. A multidisciplinary team of treating physicians assessed tumor status and created hypothetical management plans, on the basis of clinical presentation and routine MR imaging and then routine MR imaging plus perfusion MR imaging. Physicians' confidence in the tumor status assessment and management plan was measured by using Likert-type items. RESULTS: Fifty-nine consecutive subjects with glial tumors were evaluated; 50 had known pathologic diagnoses. NRs and the treatment team agreed on tumor status in 45/50 cases (κ = 0.81). With the addition of perfusion, confidence in status assessment increased in 20 (40%) for NRs and in 28 (56%) for the treatment team. Of the 59 patient-care episodes, the addition of perfusion was associated with a change in management plan in 5 (8.5%) and an increase in the treatment team's confidence in their management plan in 34 (57.6%). NRs and the treatment team found perfusion useful in most episodes of care and wanted perfusion included in future MR images for >80% of these subjects. CONCLUSIONS: Perfusion imaging appears to have a significant impact on clinical decision-making and subspecialist physicians' confidence in management plans for patients with brain tumor. ASLarterial spin-labeledCOECenter of ExcellenceDSCdynamic susceptibility contrastGBMglioblastoma multiformeNRneuroradiologistPASLpulsed arterial spin-labelingROCreceiver operating characteristicSPGRspoiled gradient-recalled