Comparison of perfusion, diffusion, and MR spectroscopy between low-grade enhancing pilocytic astrocytomas and high-grade astrocytomas.
OBJECTIVE
The differentiation of pilocytic astrocytomas and high-grade astrocytomas is sometimes difficult. There are limited comparisons in the literature of the advanced MR imaging findings of pilocytic astrocytomas versus high-grade astrocytomas. The purpose of this study was to assess the MR imaging, PWI, DWI, and MR spectroscopy characteristics of pilocytic astrocytomas compared with high-grade astrocytomas.


METHODS
Sixteen patients with pilocytic astrocytomas and 22 patients with high-grade astrocytomas (8-66 years of age; mean, 36 ± 17 years) were evaluated by using a 1.5T MR imaging unit. MR imaging, PWI, DWI, and MR spectroscopy were used to determine the differences between pilocytic astrocytomas and high-grade astrocytomas. The sensitivity, specificity, and the area under the receiver operating characteristic curve of all analyzed parameters at respective cutoff values were determined.


RESULTS
The relative cerebral blood volume values were significantly lower in pilocytic astrocytomas compared with the high-grade astrocytomas (1.4 ± 0.9 versus 3.3 ± 1.4; P = .0008). The ADC values were significantly higher in pilocytic astrocytomas compared with high-grade astrocytomas (1.5 × 10(-3) ± 0.4 versus 1.2 × 10(-3) ± 0.3; P = .01). The lipid-lactate in tumor/creatine in tumor ratios were significantly lower in pilocytic astrocytomas compared with high-grade astrocytomas (8.3 ± 11.2 versus 43.3 ± 59.2; P = .03). The threshold values ≥1.33 for relative cerebral blood volume provide sensitivity, specificity, positive predictive values, and negative predictive values of 100%, 67%, 87%, and 100%, respectively, for differentiating high-grade astrocytomas from pilocytic astrocytomas. The optimal threshold values were ≤1.60 for ADC, ≥7.06 for lipid-lactate in tumor/creatine in tumor, and ≥2.11 for lipid-lactate in tumor/lipid-lactate in normal contralateral tissue.


CONCLUSIONS
Lower relative cerebral blood volume and higher ADC values favor a diagnosis of pilocytic astrocytoma, while higher lipid-lactate in tumor/creatine in tumor ratios plus necrosis favor a diagnosis of high-grade astrocytomas.
From the Departments of Radiology (M.d.F.V.A., D.B.d.A., B.D., A.S.B., M.P.)Centro Diagnóstico Multimagem (M.d.F.V.A.), Recife, BrazilDepartment of Neuropsychiatry and Behavioral Studies (M.d.F.V.A., M.M.V.), Federal University of Pernambuco, Recife, Brazil fatima.vascoaragao@gmail.com.
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de Fatima Vasco Aragao
Department of Radiology (M.L.), University of Southern California, Los Angeles, California.
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Law
From the Departments of Radiology (M.d.F.V.A., D.B.d.A., B.D., A.S.B., M.P.).
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Batista de Almeida
Department of Radiology (G.F.), New York University Langone Medical Center, New York, New York.
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Fatterpekar
From the Departments of Radiology (M.d.F.V.A., D.B.d.A., B.D., A.S.B., M.P.).
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Delman
From the Departments of Radiology (M.d.F.V.A., D.B.d.A., B.D., A.S.B., M.P.).
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Bader
From the Departments of Radiology (M.d.F.V.A., D.B.d.A., B.D., A.S.B., M.P.).
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Pelaez
Pathology (M.F.), Mount Sinai School of Medicine, New York, New York.
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Fowkes
Department of Pathology (R.V.d.M.), Federal University of Pernambuco, Recife, Brazil.
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Vieira de Mello
Department of Neuropsychiatry and Behavioral Studies (M.d.F.V.A., M.M.V.), Federal University of Pernambuco, Recife, Brazil.
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Moraes Valenca
D000293:Adolescent; D000328:Adult; D000368:Aged; D001254:Astrocytoma / Q000378:metabolism / Q000473:pathology*; D001932:Brain Neoplasms / Q000378:metabolism / Q000473:pathology*; D002648:Child; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods; D005260:Female; D006801:Humans; D009682:Magnetic Resonance Spectroscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods*; D060787:Neoplasm Grading; D059906:Neuroimaging / Q000379:methods*; D012372:ROC Curve; D055815:Young Adult