title: Astrocytic tumour grading: a comparative study of three-dimensional pseudocontinuous arterial spin labelling, dynamic susceptibility contrast-enhanced perfusion-weighted imaging, and diffusion-weighted imaging.
abstract: OBJECTIVE
  We hypothesized that three-dimensional pseudocontinuous arterial spin labelling (pCASL) may have similar efficacy in astrocytic tumour grading as dynamic susceptibility contrast-enhanced perfusion-weighted imaging (DSC-PWI), and the grading accuracy may be further improved when combined with apparent diffusion coefficient (ADC) values.
  
  
  METHODS
  Forty-three patients with astrocytic tumours were studied using diffusion weighted imaging (DWI), pCASL, and DSC-PWI. Histograms of ADC and normalized tumour cerebral blood flow values (nCBF on pCASL and nrCBF on DSC-PWI) were measured and analyzed.
  
  
  RESULTS
  The mean 10 % ADC value was the DWI parameter that provided the best differentiation between low-grade astrocytoma (LGA) and high-grade astrocytoma (HGA). The nCBF and nrCBF (1.810 ± 0.979 and 2.070 ± 1.048) in LGA were significantly lower than those (4.505 ± 2.270 and 5.922 ± 2.630) in HGA. For differentiation between LGA and HGA, the cutoff values of 0.764 × 10(-3) mm(2)/s for mean 10 % ADC, 2.374 for nCBF, and 3.464 for nrCBF provided the optimal accuracy (74.4 %, 86.1 %, and 88.6 %, respectively). Combining the ADC values with nCBF or nrCBF could further improve the grading accuracy to 97.7 % or 95.3 %, respectively.
  
  
  CONCLUSIONS
  pCASL is an alternative to DSC-PWI for astrocytic tumour grading. The combination of DWI and contrast-free pCASL offers a valuable choice in patients with risk factors.
  
  
  CONCLUSIONS
  • pCASL shows positive correlation with DSC-PWI in astrocytic tumour grading. • ADC values based on ADC histograms can be an objective method. • Combination of DWI and pCASL or DSC-PWI can improve grading accuracy.
authors.affiliation: Department of Radiology, 302 Hospital of Chinese People's Liberation Army, Beijing, 100039, China.
authors.forename: Hua-Feng
authors.initials: HF
authors.lastname: Xiao
authors.affiliation: Department of Radiology, People's Liberation Army General Hospital, No. 28 Fuxing Road, Beijing, 100853, China.
authors.forename: Zhi-Ye
authors.initials: ZY
authors.lastname: Chen
authors.affiliation: Department of Radiology, People's Liberation Army General Hospital, No. 28 Fuxing Road, Beijing, 100853, China. louxin301@gmail.com.|Department of Neurology, University of California, Los Angeles, CA, USA. louxin301@gmail.com.
authors.forename: Xin
authors.initials: X
authors.lastname: Lou
authors.affiliation: Department of Radiology, People's Liberation Army General Hospital, No. 28 Fuxing Road, Beijing, 100853, China.
authors.forename: Yu-Lin
authors.initials: YL
authors.lastname: Wang
authors.affiliation: Department of Pathology, People's Liberation Army General Hospital, Beijing, China.
authors.forename: Qiu-Ping
authors.initials: QP
authors.lastname: Gui
authors.affiliation: Department of Radiology, People's Liberation Army General Hospital, No. 28 Fuxing Road, Beijing, 100853, China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Wang
authors.affiliation: General Electric Healthcare (China) Co., Ltd., Beijing, China.
authors.forename: Kai-Ning
authors.initials: KN
authors.lastname: Shi
authors.affiliation: General Electric Healthcare (China) Co., Ltd., Beijing, China.
authors.forename: Zhen-Yu
authors.initials: ZY
authors.lastname: Zhou
authors.affiliation: General Electric Healthcare (China) Co., Ltd., Beijing, China.
authors.forename: Dan-Dan
authors.initials: DD
authors.lastname: Zheng
authors.affiliation: Department of Neurology, University of California, Los Angeles, CA, USA.
authors.forename: Danny J J
authors.initials: DJ
authors.lastname: Wang
authors.affiliation: Department of Radiology, People's Liberation Army General Hospital, No. 28 Fuxing Road, Beijing, 100853, China. cjr.malin@vip.163.com.
authors.forename: Lin
authors.initials: L
authors.lastname: Ma
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001254:Astrocytoma / Q000473:pathology* / Q000503:physiopathology; D001932:Brain Neoplasms / Q000473:pathology* / Q000503:physiopathology; D002560:Cerebrovascular Circulation / Q000502:physiology; D002648:Child; D003287:Contrast Media; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods; D005260:Female; D006801:Humans; D007089:Image Enhancement; D021621:Imaging, Three-Dimensional / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D015588:Observer Variation; D011446:Prospective Studies; D015203:Reproducibility of Results; D012307:Risk Factors; D013113:Spin Labels; D055815:Young Adult
chemical_list: D003287:Contrast Media; D013113:Spin Labels
keywords: Astrocytic tumours; Diffusion-weighted imaging; Dynamic susceptibility contrast-enhanced perfusion-weighted imaging; Grading; Three-dimensional pseudocontinuous arterial spin labelling