title: Diagnostic performance of perfusion MRI in differentiating low-grade and high-grade gliomas: advanced MRI in glioma, A Siriraj project.
abstract: BACKGROUND
  To determine the usefulness of the perfusion MRI technique at Siriraj Hospital for differentiating between high- and low-grade gliomas by using pathological results as the gold standard.
  
  
  METHODS
  The authors prospectively investigated 64 consecutive patients who were suspected as cerebral glioma from prior conventional imaging. Cerebral perfusion study was achieved during the first pass of a bolus of gadolinium-based contrast agent. All post-processing MRI images were interpreted by two board-certified neuroradiologists (more than 10-year-experience), one radiology resident and one well-trained technician, who separately performed and blinded from the pathological results.
  
  
  RESULTS
  Forty-four patients diagnosed as glioma were included in this study. There were 26 cases of high-grade and 18 cases of low-grade gliomas. The cerebral blood volume and flow and its ratios had a strong association with the grade of glioma. The areas under the ROC curve for CB K CBVratio (rCBV), CBF and CBF ratio (rCBF) are 0.778, 0.769, 0.769, and 0.772, respectively. On the basis of equal misclassification rates, a cutoff value of 6.15 for CBV (sensitivity, 81.5%; specificity, 64.7%), a cutoff value of 2.38 for the rCBV (sensitivity, 88.9%; specificity, 64.7%), a cutoff value of 0.66 for CBF (sensitivity 81.5%; specificity 70.6%), and a cutoff value of 2.6 for the rCBF (sensitivity, 85.2%; specificity, 70.60%) best discriminated the high and low-grade gliomas.
  
  
  CONCLUSIONS
  Preoperative radiologic grading of gliomas based on conventional MR imaging is sometimes unreliable. The cerebral perfusion measurements can significantly improve the sensitivity and predictive values of radiologic glioma grading. The rCBV measurement is the best parameter for tumor grading due to the highest sensitivity.
authors.affiliation: Division of Diagnostic Radiology, Department of Radiology, Faculty of Medicine Siriraj Hospital, Bangkok, Thailand.
authors.forename: Thanyaporn
authors.initials: T
authors.lastname: Direksunthorn
authors.forename: Orasa
authors.initials: O
authors.lastname: Chawalparit
authors.forename: Tumtip
authors.initials: T
authors.lastname: Sangruchi
authors.forename: Theerapol
authors.initials: T
authors.lastname: Witthiwej
authors.forename: Siri-On
authors.initials: SO
authors.lastname: Tritrakarn
authors.forename: Siriwan
authors.initials: S
authors.lastname: Piyapittayanan
authors.forename: Panida
authors.initials: P
authors.lastname: Charnchaowanish
authors.forename: Prapaporn
authors.initials: P
authors.lastname: Pornpunyawut
authors.forename: Sith
authors.initials: S
authors.lastname: Sathornsumetee
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001810:Blood Volume; D001932:Brain Neoplasms / Q000175:diagnosis* / Q000473:pathology; D002648:Child; D003287:Contrast Media; D003937:Diagnosis, Differential; D005260:Female; D005910:Glioma / Q000175:diagnosis* / Q000473:pathology; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D012680:Sensitivity and Specificity
chemical_list: D003287:Contrast Media