Korean J Radiol.  2001 Mar;2(1):1-7. 10.3348/kjr.2001.2.1.1.

Perfusion MR Imaging in Gliomas: Comparison with Histologic Tumor Grade

• Lee SJ
• Kim JH
• Kim YM
• Lee GK
• Lee EJ
• Park IS
• Jung JM
• Kang KH
• Shin T

• KMID: 754116
• DOI: http://doi.org/10.3348/kjr.2001.2.1.1

Abstract

OBJECTIVE
To determine the usefulness of perfusion MR imaging in assessing the histologic grade of cerebral gliomas. MATERIALS AND METHODS: In order to determine relative cerebral blood volume (rCBV), 22 patients with pathologically proven gliomas (9 glioblastomas, 9 anaplastic gliomas and 4 low-grade gliomas) underwent dynamic contrast-enhanced T2*-weighted and conventional T1- and T2-weighted imaging. rCBV maps were obtained by fitting a gamma-variate function to the contrast material concentration versus time curve. rCBV ratios between tumor and normal white matter (maximum rCBV of tumor / rCBV of contralateral white matter) were calcu-lated and compared between glioblastomas, anaplastic gliomas and low-grade gliomas. RESULTS: Mean rCBV ratios were 4.90'+/-1.01 for glioblastomas, 3.97'+/-0.56 for anaplastic gliomas and 1.75'+/-1.51 for low-grade gliomas, and were thus sig-nificantly different; p < .05 between glioblastomas and anaplastic gliomas, p <.05 between anaplastic gliomas and low-grade gliomas, p < .01 between glioblas-tomas and low-grade gliomas. The rCBV ratio cutoff value which permitted dis-crimination between high-grade (glioblastomas and anaplastic gliomas) and low-grade gliomas was 2.60, and the sensitivity and specificity of this value were 100% and 75%, respectively. CONCLUSION: Perfusion MR imaging is a useful and reliable technique for esti-mating the histologic grade of gliomas.

Keyword

Brain neoplasms, MR; Brain, blood flow; Cerebral blood vessels, flow, dynamics; Magnetic resonance (MR), contrast enhancement

MeSH Terms

Adult
Astrocytoma/*pathology
Brain/pathology
Brain Neoplasms/*pathology
Cerebrovascular Circulation
Contrast Media
Female
Gadolinium DTPA/diagnostic use
Glioblastoma/*pathology
Human
*Magnetic Resonance Imaging
Male
Support, Non-U.S. Gov't

Figure

• 

  Fig. 1 Case 7: Glioblastoma in a 47-year-old man. A. Postcontrast T1-weighted image shows a ring-enhancing necrotic tumor in the right frontal lobe. B. Relative cerebral blood volume (rCBV) map shows high rCBV in the solid portion of the tumor (arrow). The higher signal on the rCBV map represents a higher rCBV. C. rCBV map shows the placement of ROIs for measurement of rCBV in the tumor (black circle) and in contralateral frontal and parietal white matter (white circles). D. Signal intensity-time curves measured at ROIs in C show different patterns of signal reduction between tumor and normal white matter during the transit of contrast material. Remarkable reduction of signal intensity is noted in the tumor compared to normal white matter, suggesting tumor hypervascularity.

• 

  Fig. 2 Case 15: Anaplastic oligodendroglioma in a 56-year-old man. A. Postcontrast T1-weighted image shows a strongly enhancing solid tumor in the left basal ganglia. B. Relative cerebral blood volume (rCBV) map shows heterogeneously increased rCBV in the tumor (arrow). C. rCBV map shows the placement of ROIs for measurement of rCBV in the tumor (black circle) and in contralateral frontal and occipital white matter (white circles). D. Signal intensity-time curves measured at ROIs in C show different patterns of signal reduction between tumor and normal white matter, suggesting tumor hypervascularity.

• 

  Fig. 3 Case 19: Low-grade astrocytoma in a 41-year-old man. A. Postcontrast T1-weighted image shows a non-enhancing low signal intensity tumor in the right basal ganglia. B. Relative cerebral blood volume (rCBV) map shows low rCBV in the tumor (arrow). C. rCBV map shows the placement of ROIs for measurement of rCBV in the tumor (small circle) and in contralateral frontal and occipital white matter (large circles). D. Signal intensity-time curves measured at ROIs in C show less signal reduction in this tumor than in the high-grade gliomas seen in Figs. 1 and 2, suggesting that the vascularity of an astrocytoma is lower.

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  Fig. 4 Plot of relative cerebral blood volume (rCBV) ratios in glioblastomas, anaplastic gliomas and low-grade gliomas. The rCBV ratio is highest in glioblastomas and lowest in low-grade gliomas. A comparison of mean rCBV ratios in each tumor group shows statistically significant differences between them. The dotted horizontal line represents the rCBV ratio cutoff value (2.60) which permitted discrimination between high-grade (glioblastomas and anaplastic gliomas) and low-grade gliomas.

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