Diagnostic Utility of Integration of Dynamic Contrast-Enhanced and Dynamic Susceptibility Contrast MR Perfusion Employing Split Bolus Technique in Differentiating High-Grade Glioma

IF 0.9 Q4 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Indian Journal of Radiology and Imaging Pub Date : 2024-01-17 DOI:10.1055/s-0043-1777742

Virender Malik, C. Kesavadas, B. Thomas, Deepti A. N., Krishna Kumar K.

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Abstract

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 cutoff 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.

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采用分注技术的动态对比增强和动态感知对比磁共振灌注整合疗法在鉴别高级别胶质瘤中的诊断效用

摘要背景：尽管有文献记载胶质瘤分级与动态对比增强（DCE）磁共振（MR）灌注衍生参数之间存在相关性，而且DCE与动态感性对比（DSC）灌注相比具有固有优势，但前者在临床实践中仍未得到充分利用。鉴于高级别弥漫性胶质瘤（HGG）固有的空间异质性，以及 DCE（血管外细胞外空间容积[Ve]和单位时间内容积转移常数[k-trans]）和 DSC（rCBV）对不同灌注参数的评估，将两者整合到一个方案中可提供整体评估。考虑到区分 WHO 3 级和 4 级的治疗和预后意义，我们根据 DCE 和 DSC 联合灌注对这两个级别进行了分析。方法：灌注序列在 3-T MR 上进行。累计剂量为 0.1 mmol/kg 的钆二胺被分成两个等量的栓剂，DCE 和 DSC 序列之间的间隔为 6 分钟。利用市售的 GenIQ 软件对 DCE 数据进行分析。结果：在分析的41例弥漫性胶质瘤中，24例为WHO III级胶质瘤，17例为IV级胶质瘤（2016年WHO分类）。要区分 III 级和 IV 级胶质瘤，Ve 临界值 0.178 提供了灵敏度（88.24%）和特异度（87.50%；AUC：0.920；p < 0.001）的最佳组合。相对脑血量 (rCBV) 值为 3.64 时，灵敏度为 70.59%，特异性为 62.50% ( p = 0.018)。虽然三级胶质瘤的 k-trans 值高于四级胶质瘤，但没有统计学意义 ( p = 0.108)。结论：本研究采用的联合灌注技术具有独特性，患者在成像时未接受过治疗，使用的后处理软件易于操作，Ve 和 rCBV 能够区分 III 级和 IV 级胶质瘤 ( p < 0.05) ，这些都是本研究的优势所在，为现有文献做出了贡献，并向基于磁共振灌注的胶质瘤精确分级迈进了一步。

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