Correlations between Perfusion MR Imaging Cerebral Blood Volume, Microvessel Quantification, and Clinical Outcome Using Stereotactic Analysis in Recurrent High-Grade Glioma

Abstract

BACKGROUND AND PURPOSE:Quantifying MVA rather than MVD provides better correlation with survival in HGG. This is attributed to a specific "glomeruloid" vascular pattern, which is better characterized by vessel area than number. Despite its prognostic value, MVA quantification is laborious and clinically impractical. The DSC-MR imaging measure of rCBV offers the advantages of speed and convenience to overcome these limitations; however, clinical use of this technique depends on establishing accurate correlations between rCBV, MVA, and MVD, particularly in the setting of heterogeneous vascular size inherent to human HGG.

Survival prediction in high-grade gliomas using CT perfusion imaging

“…Angiogenesis leads to an increase in tumor microvessel area that facilitates tumor growth, and it is an active target in cancer therapies [28]. It has been shown to correlate with tumor BV and patient survival [10]. More recently, vasculogenesis, a process by which bone marrow-derived cells are recruited to form new tumor blood vessels, has been shown to govern tumor recurrence after radiotherapy [29].…”

“…Measurements of tumor blood flow (BF), blood volume (BV), and permeability obtained by perfusion imaging have been shown to correlate with WHO grade [7,8], histopathologic marker of tumor angiogenesis (e.g. microvessel density) [9,10], and outcome [11][12][13]. Most perfusion imaging studies that evaluated the relationships between tumor perfusion parameters and overall survival (OS) have focused on MR perfusion imaging at a single time point [14] or two time points [15].…”

Dynamic perfusion CT in brain tumors

“…While statistically significant, PCT correlations with MVD and MVCP were moderate, possibly because MVD and MVCP cannot fully reflect the complexity of tumor vessels, which are tortuous and variable in size. MR perfusion measure of relative BV (rBV) showed higher correlation with microvessel area (MVA) than MVD (r = 0.83 and 0.32, respectively; P ≤ 0.05) [12]. More importantly, MVA and rBV correlated with overall survival (OS) (P < 0.02) and MVD did not (P = 0.17), suggesting rBV and MVA could be superior to MVD for predicting OS.…”

Arterial Spin-Labeling Perfusion MRI Stratifies Progression-Free Survival and Correlates with Epidermal Growth Factor Receptor Status in Glioblastoma

“…1,2 Increased perfusion of gliomas is associated with higher grade and shorter survival (even within a tumor grade). [3][4][5][6][7][8][9] Information on tumor perfusion and hemodynamics can be acquired by using various MR imaging techniques. For instance, numerous studies have used dynamic susceptibility-weighted perfusion-weighted imaging, a contrast-enhanced bolus-tracking method, to determine the relative cerebral blood volume within tumors.…”