Department of Neuroimaging & Interventional Radiology, National Institute of Mental, Health and Neurosciences, Bangalore, Karnataka, India.
Department of Radiology and Imaging, Fortis Memorial Hospital and Research Institute, Gurgaon, Haryana, India.
PLoS One. 2019 Apr 24;14(4):e0215400. doi: 10.1371/journal.pone.0215400. eCollection 2019.
To assess the inter-technique agreement of relative cerebral blood volume (rCBV) measurements obtained using T1- and T2*-perfusion MRI on 3T scanner in glioma patients.
A total of 49 adult patients with gliomas underwent both on T1- and T2*-perfusion in the same scanning session, and rCBV maps were estimated using both methods. For the quantitative analysis; Two independent observers recorded the rCBV values from the tumor as well as contralateral brain tissue from both T1- and T2*-perfusion. Inter-observer and inter-technique rCBV measurement agreement were determined by using 95% Bland-Altman limits of agreement and intra-class correlation coefficient (ICC) statistics.
Qualitative analysis of the conventional and perfusion images showed that 16/49 (32.65%) tumors showed high susceptibility, and in these patients T2*-perfusion maps were suboptimal. Bland-Altman plots revealed an agreement between two independent observers recorded rCBV values for both T1- and T2*-perfusion. The ICC demonstrated strong agreement between rCBV values recorded by two observers for both T2* (ICC = 0.96, p = 0.040) and T1 (ICC = 0.97, p = 0.026) perfusion and similarly, good agreement was noted between rCBV estimated using two methods (ICC = 0.74, P<0.001). ROC analysis showed that rCBV estimated using T1- and T2*-perfusion methods were able to discriminate between grade-III and grade-IV tumors with AUC of 0.723 and 0.767 respectively. Comparison of AUC values of two ROC curves did not show any significant difference.
In the current study, T1- and T2*-perfusion showed similar diagnostic performance for discrimination of grade III and grade IV gliomas; however, T1-perfusion was found to be better for the evaluation of tumors with intratumoral hemorrhage, postoperative recurrent tumors, and lesions near skull base. We conclude that T1-perfusion MRI with a single dose of contrast could be used as an alternative to T2*-perfusion to overcome the issues associated with this technique in brain tumors for reliable perfusion quantification.
评估使用 3T 扫描仪对胶质瘤患者进行 T1 和 T2*灌注 MRI 获得的相对脑血容量（rCBV）测量的技术间一致性。
共 49 例成人胶质瘤患者在同一次扫描中同时进行 T1 和 T2灌注，使用两种方法估计 rCBV 图。对于定量分析；两位独立观察者分别记录来自肿瘤的 rCBV 值，以及来自 T1 和 T2灌注的对侧脑组织的 rCBV 值。使用 95% Bland-Altman 一致性界限和组内相关系数（ICC）统计来确定观察者间和技术间 rCBV 测量的一致性。
常规和灌注图像的定性分析显示，16/49（32.65%）肿瘤显示高敏感性，在这些患者中，T2灌注图不佳。Bland-Altman 图显示了两位独立观察者记录的 T1 和 T2灌注的 rCBV 值之间的一致性。ICC 显示了两位观察者记录的 rCBV 值之间的强一致性，T2*（ICC=0.96，p=0.040）和 T1（ICC=0.97，p=0.026）灌注，同样，两种方法估计的 rCBV 值之间也存在良好的一致性（ICC=0.74，P<0.001）。ROC 分析显示，T1 和 T2*灌注方法估计的 rCBV 值能够区分 III 级和 IV 级肿瘤，AUC 分别为 0.723 和 0.767。两种 ROC 曲线的 AUC 值比较没有显示出任何显著差异。
在目前的研究中，T1 和 T2灌注在区分 III 级和 IV 级胶质瘤方面具有相似的诊断性能；然而，T1 灌注在评估肿瘤内出血、术后复发性肿瘤和颅底附近的病变方面表现更好。我们得出结论，T1 灌注 MRI 单次剂量造影剂可以作为 T2灌注的替代方法，以克服该技术在脑肿瘤中用于可靠灌注定量的问题。
