title: Correlations between perfusion MR imaging cerebral blood volume, microvessel quantification, and clinical outcome using stereotactic analysis in recurrent high-grade glioma.
abstract: OBJECTIVE
  Quantifying MVA rather than MVD provides better correlation with survival in HGG. This is attributed to a specific "glomeruloid" vascular pattern, which is better characterized by vessel area than number. Despite its prognostic value, MVA quantification is laborious and clinically impractical. The DSC-MR imaging measure of rCBV offers the advantages of speed and convenience to overcome these limitations; however, clinical use of this technique depends on establishing accurate correlations between rCBV, MVA, and MVD, particularly in the setting of heterogeneous vascular size inherent to human HGG.
  
  
  METHODS
  We obtained preoperative 3T DSC-MR imaging in patients with HGG before stereotactic surgery. We histologically quantified MVA, MVD, and vascular size heterogeneity from CD34-stained 10-μm sections of stereotactic biopsies, and we coregistered biopsy locations with localized rCBV measurements. We statistically correlated rCBV, MVA, and MVD under conditions of high and low vascular-size heterogeneity and among tumor grades. We correlated all parameters with OS by using Cox regression.
  
  
  RESULTS
  We analyzed 38 biopsies from 24 subjects. rCBV correlated strongly with MVA (r = 0.83, P < .0001) but weakly with MVD (r = 0.32, P = .05), due to microvessel size heterogeneity. Among samples with more homogeneous vessel size, rCBV correlation with MVD improved (r = 0.56, P = .01). OS correlated with both rCBV (P = .02) and MVA (P = .01) but not with MVD (P = .17).
  
  
  CONCLUSIONS
  rCBV provides a reliable estimation of tumor MVA as a biomarker of glioma outcome. rCBV poorly estimates MVD in the presence of vessel size heterogeneity inherent to human HGG.
authors.affiliation: Department of Radiology, Mayo Clinic, Phoenix/Scottsdale, Arizona, USA. hu.leland@mayo.edu
authors.forename: L S
authors.initials: LS
authors.lastname: Hu
authors.forename: J M
authors.initials: JM
authors.lastname: Eschbacher
authors.forename: A C
authors.initials: AC
authors.lastname: Dueck
authors.forename: J E
authors.initials: JE
authors.lastname: Heiserman
authors.forename: S
authors.initials: S
authors.lastname: Liu
authors.forename: J P
authors.initials: JP
authors.lastname: Karis
authors.forename: K A
authors.initials: KA
authors.lastname: Smith
authors.forename: W R
authors.initials: WR
authors.lastname: Shapiro
authors.forename: D S
authors.initials: DS
authors.lastname: Pinnaduwage
authors.forename: S W
authors.initials: SW
authors.lastname: Coons
authors.forename: P
authors.initials: P
authors.lastname: Nakaji
authors.forename: J
authors.initials: J
authors.lastname: Debbins
authors.forename: B G
authors.initials: BG
authors.lastname: Feuerstein
authors.forename: L C
authors.initials: LC
authors.lastname: Baxter
mesh_terms: D000328:Adult; D001811:Blood Volume Determination; D001932:Brain Neoplasms / Q000098:blood supply / Q000473:pathology* / Q000601:surgery*; D005260:Female; D005910:Glioma / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D055806:Microvessels / Q000473:pathology*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000098:blood supply / Q000473:pathology* / Q000517:prevention & control; D009389:Neovascularization, Pathologic / Q000473:pathology; D011379:Prognosis; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013223:Statistics as Topic; D013238:Stereotaxic Techniques; D016896:Treatment Outcome
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