title: Correlation of MR relative cerebral blood volume measurements with cellular density and proliferation in high-grade gliomas: an image-guided biopsy study.
abstract: OBJECTIVE
  As newer MR imaging techniques are used to assist with tumor grading, biopsy planning, and therapeutic response assessment, there is a need to relate the imaging characteristics to underlying pathologic processes. The aim of this study was to see how rCBV, a known marker of tumor vascularity, relates to cellular packing attenuation and cellular proliferation.
  
  
  METHODS
  Nine patients with histologically proved high-grade gliomas and 1 with a supratentorial PNET requiring an image-guided biopsy were recruited. Patients underwent a DSC study. The rCBV at the intended biopsy sites was determined by using a histogram measure to derive the mean, maximum, and 75th centile and 90th centile values. This measure was correlated with histologic markers of the MIB-1 labeling index (as a marker of glioma cell proliferation) and the total number of neoplastic cells in a high-power field (cellular packing attenuation).
  
  
  RESULTS
  There was a good correlation between rCBV and MIB-1 by using all the measures of rCBV. The mean rCBV provided the best results (r = 0.66, P < .001). The only correlation with cellular packing attenuation was with the 90% centile (rCBV(90%), r = 0.36, P = .03). The increase in rCBV could be seen over 1 cm from the edge of enhancement in 4/10 cases, and at 2 cm in 1/10.
  
  
  CONCLUSIONS
  rCBV correlated with cellular proliferation in high-grade gliomas but not with cellular packing attenuation. The increase in rCBV extended beyond the contrast-enhancing region in 50% of our patients.
authors.affiliation: Academic Neurosurgery Division, Department of Clinical Neurosciences, University of Cambridge, UK. sjp58@cam.ac.uk
authors.forename: S J
authors.initials: SJ
authors.lastname: Price
authors.forename: H A L
authors.initials: HA
authors.lastname: Green
authors.forename: A F
authors.initials: AF
authors.lastname: Dean
authors.forename: J
authors.initials: J
authors.lastname: Joseph
authors.forename: P J
authors.initials: PJ
authors.lastname: Hutchinson
authors.forename: J H
authors.initials: JH
authors.lastname: Gillard
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy / Q000379:methods*; D001811:Blood Volume Determination / Q000379:methods*; D001932:Brain Neoplasms / Q000175:diagnosis*; D002452:Cell Count; D049109:Cell Proliferation; D005260:Female; D005910:Glioma / Q000175:diagnosis*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013223:Statistics as Topic; D025321:Surgery, Computer-Assisted / Q000379:methods*