Prognostic value of perfusion-weighted imaging in brain glioma: a prospective study.
OBJECTIVE
Biopsy targeting based on MR imaging alone may fail to identify malignant areas in brain gliomas. Considering the differences in relative Cerebral Blood Volume (rCBV) ratios reported among tumour grades, we evaluated whether perfusion-weighted MR imaging (PWI) could usefully implement the routine preoperative imaging by detecting those areas bearing a higher yield for malignancy to guide the stereotactic biopsy or the surgical removal.


METHODS
We studied a series of 55 consecutive patients with newly diagnosed brain glioma using both conventional MR imaging and PWI in the preoperative assessment. The pathological diagnosis was established by stereotactic biopsy in 29 cases and by craniotomy in 24 cases. We evaluated the patient survival to detect undergrading.


CONCLUSIONS
Independent from contrast-enhancement, perfusion-weighted MR imaging improved the target selection in stereotactic biopsy guidance and the removal of malignant areas in tumours amenable to surgery. Particularly sensitive to the perfused part of the tumour as to small regional changes, rCBV maps allowed a better detection of malignant areas. The rCBV ratios correlated significantly to the tumour grade and the final outcome (p < 0.01).


CONCLUSIONS
We found PWI valuable in the preoperative assessment of brain gliomas, discriminating high from low-grade gliomas. PWI can easily be performed on widely available MR imaging systems as part of the routine imaging of gliomas.
Chaskis
C
C
Department of Neurosurgery, Academic Hospital, Vrije Universiteit Brussel, Belgium. cristo.chaskis@az.vub.ac.be
Stadnik
T
T
Michotte
A
A
Van Rompaey
K
K
D'Haens
J
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D001706:Biopsy; D001921:Brain / Q000098:blood supply / Q000473:pathology* / Q000503:physiopathology; D001931:Brain Mapping / Q000379:methods; D001932:Brain Neoplasms / Q000175:diagnosis* / Q000601:surgery; D002536:Cerebral Arteries / Q000503:physiopathology; D002560:Cerebrovascular Circulation / Q000502:physiology*; D002648:Child; D003951:Diagnostic Errors / Q000517:prevention & control; D005260:Female; D005910:Glioma / Q000175:diagnosis* / Q000601:surgery; D006801:Humans; D018810:Magnetic Resonance Angiography / Q000379:methods* / Q000592:standards; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods / Q000639:trends; D011379:Prognosis; D011446:Prospective Studies; D013238:Stereotaxic Techniques / Q000592:standards