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- Title
Diagnostic Utility of Integration of Dynamic Contrast-Enhanced and Dynamic Susceptibility Contrast MR Perfusion Employing Split Bolus Technique in Differentiating High-Grade Glioma.
- Authors
Malik, Virender; Kesavadas, Chandrasekharan; Thomas, Bejoy; N., Deepti A.; K., Krishna Kumar
- Abstract
Background : Despite documented correlation between glioma grades and dynamic contrast-enhanced (DCE) magnetic resonance (MR) perfusion-derived parameters, and its inherent advantages over dynamic susceptibility contrast (DSC) perfusion, the former remains underutilized in clinical practice. Given the inherent spatial heterogeneity in high-grade diffuse glioma (HGG) and assessment of different perfusion parameters by DCE (extravascular extracellular space volume [Ve] and volume transfer constant in unit time [k-trans]) and DSC (rCBV), integration of the two into a protocol could provide a holistic assessment. Considering therapeutic and prognostic implications of differentiating WHO grade 3 from 4, we analyzed the two grades based on a combined DCE and DSC perfusion. Methods : Perfusion sequences were performed on 3-T MR. Cumulative dose of 0.1 mmol/kg of gadodiamide, split into two equal boluses, was administered with an interval of 6 minutes between the DCE and DSC sequences. DCE data were analyzed utilizing commercially available GenIQ software. Results : Of the 41 cases of diffuse gliomas analyzed, 24 were WHO grade III and 17 grade IV gliomas (2016 WHO classification). To differentiate grade III and IV gliomas, Ve cut-off value of 0.178 provided the best combination of sensitivity (88.24%) and specificity (87.50%; AUC: 0.920; p < 0.001). A relative cerebral blood volume (rCBV) of value 3.64 yielded a sensitivity of 70.59% and specificity of 62.50% (p = 0.018). The k-trans value, although higher in grade III than in grade IV gliomas, did not reach statistical significance (p = 0.108). Conclusion : Uniqueness of employed combined perfusion technique, treatment naïve patients at imaging, user-friendly postprocessing software utilization, and ability of Ve and rCBV to differentiate between grade III and IV gliomas (p < 0.05) are the strengths of the present study, contributing to the existing literature and moving a step closer to achieving accurate MR perfusion-based glioma grading.
- Subjects
WORLD Health Organization; GLIOMAS; DIAGNOSTIC imaging; BRAIN; MAGNETIC resonance imaging; TUMOR grading; DESCRIPTIVE statistics; PERFUSION imaging; PERFUSION; DATA analysis software; BLOOD volume; EXTRACELLULAR space; CEREBRAL circulation; CONTRAST media; SENSITIVITY &; specificity (Statistics); DRUG dosage; DRUG administration
- Publication
Indian Journal of Radiology & Imaging, 2024, Vol 34, Issue 3, p382
- ISSN
0971-3026
- Publication type
Article
- DOI
10.1055/s-0043-1777742