Santarosa Corrado, Castellano Antonella, Conte Gian Marco, Cadioli Marcello, Iadanza Antonella, Terreni Maria Rosa, Franzin Alberto, Bello Lorenzo, Caulo Massimo, Falini Andrea, Anzalone Nicoletta
Neuroradiology Unit and CERMAC, San Raffaele Scientific Institute and Vita-Salute San Raffaele University, Milan, Italy.
Neuroradiology Unit and CERMAC, San Raffaele Scientific Institute and Vita-Salute San Raffaele University, Milan, Italy; Philips Healthcare, Monza, Italy.
Eur J Radiol. 2016 Jun;85(6):1147-56. doi: 10.1016/j.ejrad.2016.03.020. Epub 2016 Mar 22.
Dynamic susceptibility contrast (DSC)-MRI is a perfusion technique with high diagnostic accuracy for glioma grading, despite limitations due to inherent susceptibility effects. Dynamic contrast-enhanced (DCE)-MRI has been proposed as an alternative technique able to overcome the DSC-MRI shortcomings. This pilot study aimed at comparing the diagnostic accuracy of DSC and DCE-MRI for glioma grading by evaluating two estimates of blood volume, the DCE-derived plasma volume (Vp) and the DSC-derived relative cerebral blood volume (rCBV), and a measure of vessel permeability, the DCE-derived volume transfer constant K(trans).
Twenty-six newly diagnosed glioma patients underwent 3T-MR DCE and DSC imaging. Parametric maps of CBV, Vp and K(trans) were calculated and the region of highest value (hotspot) was measured on each map. Histograms of rCBV, Vp and K(trans) values were calculated for the tumor volume. Statistical differences according to WHO grade were assessed. The diagnostic accuracy for tumor grading of the two techniques was determined by ROC analysis.
rCBV, Vp and K(trans) measures differed significantly between high and low-grade gliomas. Hotspot analysis showed the highest correlation with grading. K(trans) hotspots co-localized with Vp hotspots only in 56% of enhancing gliomas. For differentiating high from low-grade gliomas the AUC was 0.987 for rCBVmax, and 1.000 for Vpmax and K(trans)max. Combination of DCE-derived Vp and K(trans) parameters improved the diagnostic performance of the histogram method.
This initial experience of DCE-derived Vp evaluation shows that this parameter is as accurate as the well-established DSC-derived rCBV for glioma grading. DCE-derived K(trans) is equally useful for grading, providing different informations with respect to Vp.
动态磁敏感对比（DSC）-MRI是一种灌注技术，尽管存在因固有磁敏感效应导致的局限性，但对胶质瘤分级具有较高的诊断准确性。动态对比增强（DCE）-MRI已被提议作为一种能够克服DSC-MRI缺点的替代技术。这项前瞻性研究旨在通过评估两种血容量估计值、DCE衍生的血浆容量（Vp）和DSC衍生的相对脑血容量（rCBV）以及一种血管通透性测量值、DCE衍生的容积转移常数Ktrans，比较DSC和DCE-MRI对胶质瘤分级的诊断准确性。
26例新诊断的胶质瘤患者接受了3T-MR DCE和DSC成像。计算CBV、Vp和Ktrans的参数图，并在每张图上测量最高值区域（热点）。计算肿瘤体积的rCBV、Vp和Ktrans值的直方图。评估根据世界卫生组织分级的统计学差异。通过ROC分析确定两种技术对肿瘤分级的诊断准确性。
高级别和低级别胶质瘤之间的rCBV、Vp和Ktrans测量值存在显著差异。热点分析显示与分级的相关性最高。Ktrans热点仅在56%的强化胶质瘤中与Vp热点共定位。对于区分高级别和低级别胶质瘤，rCBVmax的AUC为0.987，Vpmax和Ktransmax的AUC为1.000。DCE衍生的Vp和Ktrans参数的组合提高了直方图法的诊断性能。
这项DCE衍生的Vp评估的初步经验表明，该参数在胶质瘤分级方面与成熟的DSC衍生的rCBV一样准确。DCE衍生的Ktrans在分级方面同样有用，提供了与Vp不同的信息。
