title: High-grade and low-grade gliomas: differentiation by using perfusion MR imaging.
abstract: OBJECTIVE
  Relative cerebral blood volume (rCBV) is a commonly used perfusion magnetic resonance imaging (MRI) technique for the evaluation of tumour grade. Relative cerebral blood flow (rCBF) has been less studied. The goal of our study was to determine the usefulness of these parameters in evaluating the histopathological grade of the cerebral gliomas.
  
  
  METHODS
  This study involved 33 patients (22 high-grade and 11 low-grade glioma cases). MRI was performed for all tumours by using a first-passage gadopentetate dimeglumine T2*-weighted gradient-echo single-shot echo-planar sequence followed by conventional MRI. The rCBV and rCBF were calculated by deconvolution of an arterial input function. The rCBV and rCBF ratios of the lesions were obtained by dividing the values obtained from the normal white matter of the contralateral hemisphere. For statistical analysis Mann-Whitney testing was carried out. A p value of less than 0.05 indicated a statistically significant difference. Receiver operating characteristic curve (ROC) analysis was performed to assess the relationship between the rCBV and rCBF ratios and grade of gliomas. Their cut-off value permitting discrimination was calculated. The correlation between rCBV and CBF ratios and glioma grade was assessed using Pearson correlation analysis.
  
  
  RESULTS
  In high-grade gliomas, rCBV and rCBF ratios were measured as 6.50+/-4.29 and 3.32+/-1.87 (mean+/-SD), respectively. In low-grade gliomas, rCBV and rCBF ratios were 1.69+/-0.51 and 1.16+/-0.38, respectively. The rCBV and rCBF ratios for high-grade gliomas were statistically different from those of low-grade gliomas (p < 0.001). The rCBV and CBF ratios were significantly matched with respect to grade, but difference between the two areas was not significant (ROC analysis, p > 0.05). The cut-off value was taken as 1.98 in the rCBV ratio and 1.25 in the rCBF ratio. There was a strong correlation between the rCBV and CBF ratios (Pearson correlation = 0.830, p < 0.05).
  
  
  CONCLUSIONS
  Perfusion MRI is useful in the preoperative assessment of the histopathologicalal grade of gliomas; the rCBF ratio in addition to the rCBV ratio can be incorporated in MR perfusion analysis for the evaluation.
authors.affiliation: Department of Radiology, BURTOM Radioimaging Center, Bursa, Turkey. bahattinh@hotmail.com
authors.forename: B
authors.initials: B
authors.lastname: Hakyemez
authors.forename: C
authors.initials: C
authors.lastname: Erdogan
authors.forename: I
authors.initials: I
authors.lastname: Ercan
authors.forename: N
authors.initials: N
authors.lastname: Ergin
authors.forename: S
authors.initials: S
authors.lastname: Uysal
authors.forename: S
authors.initials: S
authors.lastname: Atahan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001254:Astrocytoma / Q000175:diagnosis / Q000473:pathology; D001810:Blood Volume; D001932:Brain Neoplasms / Q000175:diagnosis* / Q000473:pathology; D002560:Cerebrovascular Circulation; D005260:Female; D005909:Glioblastoma / Q000175:diagnosis / Q000473:pathology; D005910:Glioma / Q000175:diagnosis* / Q000473:pathology; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods; D011446:Prospective Studies; D012372:ROC Curve