Glioma Grading Capability: Comparisons among Parameters from Dynamic Contrast-Enhanced MRI and ADC Value on DWI

Abstract

ObjectivePermeability parameters from dynamic contrast-enhanced MRI (DCE-MRI) and apparent diffusion coefficient (ADC) value on diffusion-weighted imaging (DWI) can be quantitative physiologic metrics for gliomas. The transfer constant (Ktrans) has shown efficacy in grading gliomas. Volume fraction of extravascular extracellular space (ve) has been underutilized to grade gliomas. The purpose of this study was to evaluate ve in its ability to grade gliomas and to assess the correlation with other permeability parameters and ADC values.Materials and MethodsA total of 33 patients diagnosed with pathologically-confirmed gliomas were examined by 3 T MRI including DCE-MRI and ADC map. A region of interest analyses for permeability parameters from DCE-MRI and ADC were performed on the enhancing solid portion of the tumors. Permeability parameters form DCE-MRI and ADC between low- and high-grade gliomas; the diagnostic performances of presumptive metrics and correlation among those metrics were statistically analyzed.ResultsHigh-grade gliomas showed higher Ktrans (0.050 vs. 0.010 in median value, p = 0.002) and higher ve (0.170 vs. 0.015 in median value, p = 0.001) than low-grade gliomas. Receiver operating characteristic curve analysis showed significance in both Ktrans and ve for glioma grading. However, there was no significant difference in diagnostic performance between Ktrans and ve. ADC value did not correlate with any of the permeability parameters from DCE-MRI.ConclusionExtravascular extracellular space (ve) appears to be comparable with transfer constant (Ktrans) in differentiating high-grade gliomas from low-grade gliomas. ADC value does not show correlation with any permeability parameters from DCE-MRI.

Automated Processing of Dynamic Contrast-Enhanced MRI: Correlation of Advanced Pharmacokinetic Metrics with Tumor Grade in Pediatric Brain Tumors

“…Several studies have examined the role of K trans and have shown K trans correlates well with tumor grade, particularly in gliomas in adults. [24][25][26][30][31][32] The role of angiogenesis in promoting leakiness of the tumor vasculature and development of new vessels is well-documented, and our findings of increased K trans in higher grade tumors supports that hypothesis. K trans in gliomas has also been shown to be a marker of progression 31,33 in adults.…”

“…[24][25][26] In fact, the optimal sensitivity appears to be achieved for V e , with a combined sensitivity of 76% (compared with 71% for K trans and K ep ) and individual sensitivities of 75% and 78%, respectively, for high-and low-grade tumors. The role of V e , which is an indicator of extracellular extravascular space, is poorly understood in the brain tumor literature.…”

“…While vessel permeability metrics derived from DCE-MR imaging have been associated with tumor grade in adult populations, [24][25][26] such studies in pediatric brain tumors have been lacking. Dynamic susceptibility contrast perfusion MR imaging has been studied in children by Ho et al 27 to associate tumor grade with maximal relative cerebral blood volume and with the postbolus shape of the enhancement curve.…”

Advances in Magnetic Resonance Imaging and Positron Emission Tomography Imaging for Grading and Molecular Characterization of Glioma

“…Several studies have suggested that high-grade gliomas have greater vascular permeability, possibly reflecting local breakdown of the blood barrier, and therefore have higher K trans values than low-grade gliomas, although a consistent threshold value for distinguishing low-from high-grade gliomas has not yet been identified. [22][23][24] Higher v e values have also been found in high-grade gliomas compared with low-grade gliomas. [24] The practical ability of DCE-MRI to determine tumor grade is currently limited by the sensitivity of results to the specific image acquisition protocols, which can vary across vendors and across institutions; a matter which is further complicated by the significant differences in approaches to image analysis undertaken in the various studies.…”

“…[22][23][24] Higher v e values have also been found in high-grade gliomas compared with low-grade gliomas. [24] The practical ability of DCE-MRI to determine tumor grade is currently limited by the sensitivity of results to the specific image acquisition protocols, which can vary across vendors and across institutions; a matter which is further complicated by the significant differences in approaches to image analysis undertaken in the various studies.…”