title: Relative cerebral blood volume from dynamic susceptibility contrast perfusion in the grading of pediatric primary brain tumors.
abstract: BACKGROUND
  The aim of this study is to evaluate the utility of relative cerebral blood volume (rCBV) data from dynamic susceptibility contrast (DSC) perfusion in grading pediatric primary brain tumors.
  
  
  METHODS
  A retrospective blinded review of 63 pediatric brain tumors with DSC perfusion was performed independently by two neuroradiologists. A diagnosis of low- versus high-grade tumor was obtained from conventional imaging alone. Maximum rCBV (rCBVmax) was measured from manual ROI placement for each reviewer and averaged. Whole-tumor CBV data was obtained from a semi-automated approach. Results from all three analyses were compared to WHO grade.
  
  
  RESULTS
  Based on conventional MRI, the two reviewers had a concordance rate of 81% (k = 0.62). Compared to WHO grade, the concordant cases accurately diagnosed high versus low grade in 82%. A positive correlation was demonstrated between manual rCBVmax and tumor grade (r = 0.30, P = 0.015). ROC analysis of rCBVmax (area under curve 0.65, 0.52-0.77, P = 0.03) gave a low-high threshold of 1.38 with sensitivity of 92% (74-99%), specificity of 40% (24-57%), NPV of 88% (62-98%), and PPV of 50% (35-65%) Using this threshold on 12 discordant tumors between evaluators from conventional imaging yielded correct diagnoses in nine patients. Semi-automated analysis demonstrated statistically significant differences between low- and high-grade tumors for multiple metrics including average rCBV (P = 0.027).
  
  
  CONCLUSIONS
  Despite significant positive correlation with tumor grade, rCBV from pediatric brain tumors demonstrates limited specificity, but high NPV in excluding high-grade neoplasms. In selective patients whose conventional imaging is nonspecific, an rCBV threshold may have further diagnostic value.
authors.affiliation: Department of Radiology, MRI Department, Indiana University School of Medicine, 705 Riley Hospital Drive, Indianapolis, IN, 46202, USA, cyho@iupui.edu.
authors.forename: Chang Y
authors.initials: CY
authors.lastname: Ho
authors.forename: Jeremy S
authors.initials: JS
authors.lastname: Cardinal
authors.forename: Aaron P
authors.initials: AP
authors.lastname: Kamer
authors.forename: Stephen F
authors.initials: SF
authors.lastname: Kralik
mesh_terms: D000293:Adolescent; D001810:Blood Volume; D001811:Blood Volume Determination / Q000379:methods*; D001932:Brain Neoplasms / Q000175:diagnosis* / Q000503:physiopathology*; D002560:Cerebrovascular Circulation; D002648:Child; D002675:Child, Preschool; D003287:Contrast Media; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D007223:Infant; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D008536:Meglumine / Q000031:analogs & derivatives; D015588:Observer Variation; D009942:Organometallic Compounds; D010363:Pattern Recognition, Automated / Q000379:methods; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
chemical_list: D003287:Contrast Media; D009942:Organometallic Compounds; C064572:gadobenic acid; D008536:Meglumine