title: Comparison of multiple parameters obtained on 3T pulsed arterial spin-labeling, diffusion tensor imaging, and MRS and the Ki-67 labeling index in evaluating glioma grading.
abstract: OBJECTIVE
  Pulsed arterial spin-labeling, DTI, and MR spectroscopy provide useful data for tumor evaluation. We evaluated multiple parameters by using these pulse sequences and the Ki-67 labeling index in newly diagnosed supratentorial gliomas.
  
  
  METHODS
  All 32 patients, with grade II (3 each of diffuse astrocytoma, oligodendroglioma, and oligoastrocytoma), grade III (3 anaplastic astrocytomas, 4 anaplastic oligodendrogliomas, and 1 anaplastic oligoastrocytoma), and grade IV (14 glioblastomas and 1 glioblastoma with an oligodendroglioma component) cases underwent pulsed arterial spin-labeling, DTI, and MR spectroscopy studies by using 3T MR imaging. The following variables were used to compare the tumors: relative cerebral blood flow, fractional anisotropy; ADC tumor/normal ratios; and the Cho/Cr, NAA/Cho, NAA/Cr, and lactate/Cr ratios. A logistic regression and receiver operating characteristic analysis were used to assess parameters with a high sensitivity and specificity to identify the threshold values for separate grading. We compared the Ki-67 index with various MR imaging parameters in tumor specimens.
  
  
  RESULTS
  Significant correlations were observed between the Ki-67 index and the mean, maximum, and minimum ADC, Cho/Cr, and lactate/Cr ratios. The receiver operating characteristic analysis showed that the combination of the minimum ADC and Cho/Cr ratios could differentiate low-grade and high-grade gliomas, with a sensitivity and specificity of 87.0% and 88.9%, respectively. The mean and maximum relative cerebral blood flow ratios were used to classify glioblastomas from other-grade astrocytomas, with a sensitivity and specificity of 92.9% and 83.3%, respectively.
  
  
  CONCLUSIONS
  Our findings indicate that pulsed arterial spin-labeling, DTI, and MR spectroscopy are useful for predicting glioma grade. Additionally, the parameters obtained on DTI and MR spectroscopy closely correlated with the proliferative potential of gliomas.
authors.affiliation: From the Department of Neurosurgery, Oita University Faculty of Medicine, Oita, Japan. fudaba@oita-u.ac.jp.
authors.forename: H
authors.initials: H
authors.lastname: Fudaba
authors.affiliation: From the Department of Neurosurgery, Oita University Faculty of Medicine, Oita, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Shimomura
authors.affiliation: From the Department of Neurosurgery, Oita University Faculty of Medicine, Oita, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Abe
authors.affiliation: From the Department of Neurosurgery, Oita University Faculty of Medicine, Oita, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Matsuta
authors.affiliation: From the Department of Neurosurgery, Oita University Faculty of Medicine, Oita, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Momii
authors.affiliation: From the Department of Neurosurgery, Oita University Faculty of Medicine, Oita, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Sugita
authors.affiliation: From the Department of Neurosurgery, Oita University Faculty of Medicine, Oita, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Ooba
authors.affiliation: From the Department of Neurosurgery, Oita University Faculty of Medicine, Oita, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Kamida
authors.affiliation: From the Department of Neurosurgery, Oita University Faculty of Medicine, Oita, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Hikawa
authors.affiliation: From the Department of Neurosurgery, Oita University Faculty of Medicine, Oita, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Fujiki
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000473:pathology*; D056324:Diffusion Tensor Imaging; D005260:Female; D005910:Glioma / Q000473:pathology*; D006801:Humans; D019394:Ki-67 Antigen / Q000032:analysis; D009682:Magnetic Resonance Spectroscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods*; D060787:Neoplasm Grading / Q000379:methods*; D059906:Neuroimaging / Q000379:methods*; D012372:ROC Curve; D013113:Spin Labels
chemical_list: D019394:Ki-67 Antigen; D013113:Spin Labels