title: Vessel tortuosity and brain tumor malignancy: a blinded study.
abstract: OBJECTIVE
  Malignancy provokes regional changes to vessel shape. Characteristic vessel tortuosity abnormalities appear early during tumor development, affect initially healthy vessels, spread beyond the confines of tumor margins, and do not simply mirror tissue perfusion. The ability to detect and quantify tortuosity abnormalities on high-resolution magnetic resonance angiography (MRA) images offers a new approach to the noninvasive diagnosis of malignancy. This report evaluates a computerized, statistical method of analyzing the shapes of vessels extracted from MRA in diagnosing cancer.
  
  
  METHODS
  The regional vasculature of 34 healthy subjects was compared with the tumor-associated vasculature of 30 brain tumors before surgical resection. The operator performing the analysis was blinded to the diagnosis. Vessels were segmented from an MRA of each subject, a region of interest was defined in each tumor patient and was mapped to all healthy controls, and a statistical analysis of vessel shape measures was then performed over the region of interest. Many difficult cases were included, such as pinpoint, hemorrhagic, and irradiated tumors, as were hypervascular benign tumors. Tumors were identified as benign or malignant on the basis of histological evaluation.
  
  
  RESULTS
  A discriminant analysis performed at the study's conclusion successfully classified all but one of the 30 tumors as benign or malignant on the basis of vessel tortuosity.
  
  
  CONCLUSIONS
  Quantitative, statistical measures of vessel shape offer a new approach to the diagnosis and staging of disease. Although the methods developed under the current report must be tested against a new series of cases, initial results are promising.
authors.affiliation: Department of Surgery, University of North Carolina, Chapel Hill, CASILab, 349 Wing C, CB #7062, Chapel Hill, NC 27599, USA. bullitt@med.unc.edu
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Bullitt
authors.forename: Donglin
authors.initials: D
authors.lastname: Zeng
authors.forename: Guido
authors.initials: G
authors.lastname: Gerig
authors.forename: Stephen
authors.initials: S
authors.lastname: Aylward
authors.forename: Sarang
authors.initials: S
authors.lastname: Joshi
authors.forename: J Keith
authors.initials: JK
authors.lastname: Smith
authors.forename: Weili
authors.initials: W
authors.lastname: Lin
authors.forename: Matthew G
authors.initials: MG
authors.lastname: Ewend
mesh_terms: D000328:Adult; D000368:Aged; D001921:Brain / Q000098:blood supply / Q000473:pathology; D001932:Brain Neoplasms / Q000098:blood supply* / Q000150:complications / Q000175:diagnosis*; D002560:Cerebrovascular Circulation; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009389:Neovascularization, Pathologic / Q000175:diagnosis* / Q000209:etiology; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016037:Single-Blind Method; D013382:Subtraction Technique