title: Does MR perfusion imaging impact management decisions for patients with brain tumors? A prospective study.
abstract: OBJECTIVE
  MR perfusion imaging can be used to help predict glial tumor grade and disease progression. Our purpose was to evaluate whether perfusion imaging has a diagnostic or therapeutic impact on clinical management planning in patients with glioma.
  
  
  METHODS
  Standard MR imaging protocols were interpreted by a group of 3 NRs in consensus, with each case being interpreted twice: first, including routine sequences; and second, with the addition of perfusion imaging. A multidisciplinary team of treating physicians assessed tumor status and created hypothetical management plans, on the basis of clinical presentation and routine MR imaging and then routine MR imaging plus perfusion MR imaging. Physicians' confidence in the tumor status assessment and management plan was measured by using Likert-type items.
  
  
  RESULTS
  Fifty-nine consecutive subjects with glial tumors were evaluated; 50 had known pathologic diagnoses. NRs and the treatment team agreed on tumor status in 45/50 cases (κ = 0.81). With the addition of perfusion, confidence in status assessment increased in 20 (40%) for NRs and in 28 (56%) for the treatment team. Of the 59 patient-care episodes, the addition of perfusion was associated with a change in management plan in 5 (8.5%) and an increase in the treatment team's confidence in their management plan in 34 (57.6%). NRs and the treatment team found perfusion useful in most episodes of care and wanted perfusion included in future MR images for >80% of these subjects.
  
  
  CONCLUSIONS
  Perfusion imaging appears to have a significant impact on clinical decision-making and subspecialist physicians' confidence in management plans for patients with brain tumor.
authors: Department of Radiology, Wake Forest University Health Sciences, Wake Forest Baptist Health, Winston-Salem, North Carolina 27157, USA.
authors: C P
authors: CP
authors: Geer
authors: J
authors: J
authors: Simonds
authors: A
authors: A
authors: Anvery
authors: M Y
authors: MY
authors: Chen
authors: J H
authors: JH
authors: Burdette
authors: M E
authors: ME
authors: Zapadka
authors: T L
authors: TL
authors: Ellis
authors: S B
authors: SB
authors: Tatter
authors: G J
authors: GJ
authors: Lesser
authors: M D
authors: MD
authors: Chan
authors: K P
authors: KP
authors: McMullen
authors: A J
authors: AJ
authors: Johnson
mesh_terms: D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000473:pathology* / Q000628:therapy*; D005260:Female; D005910:Glioma / Q000473:pathology* / Q000628:therapy*; D006801:Humans; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D010818:Practice Patterns, Physicians'; D011379:Prognosis; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D055815:Young Adult