title: Dynamic contrast-enhanced and dynamic susceptibility contrast perfusion MR imaging for glioma grading: Preliminary comparison of vessel compartment and permeability parameters using hotspot and histogram analysis.
abstract: BACKGROUND
  Dynamic susceptibility contrast (DSC)-MRI is a perfusion technique with high diagnostic accuracy for glioma grading, despite limitations due to inherent susceptibility effects. Dynamic contrast-enhanced (DCE)-MRI has been proposed as an alternative technique able to overcome the DSC-MRI shortcomings. This pilot study aimed at comparing the diagnostic accuracy of DSC and DCE-MRI for glioma grading by evaluating two estimates of blood volume, the DCE-derived plasma volume (Vp) and the DSC-derived relative cerebral blood volume (rCBV), and a measure of vessel permeability, the DCE-derived volume transfer constant K(trans).
  
  
  METHODS
  Twenty-six newly diagnosed glioma patients underwent 3T-MR DCE and DSC imaging. Parametric maps of CBV, Vp and K(trans) were calculated and the region of highest value (hotspot) was measured on each map. Histograms of rCBV, Vp and K(trans) values were calculated for the tumor volume. Statistical differences according to WHO grade were assessed. The diagnostic accuracy for tumor grading of the two techniques was determined by ROC analysis.
  
  
  RESULTS
  rCBV, Vp and K(trans) measures differed significantly between high and low-grade gliomas. Hotspot analysis showed the highest correlation with grading. K(trans) hotspots co-localized with Vp hotspots only in 56% of enhancing gliomas. For differentiating high from low-grade gliomas the AUC was 0.987 for rCBVmax, and 1.000 for Vpmax and K(trans)max. Combination of DCE-derived Vp and K(trans) parameters improved the diagnostic performance of the histogram method.
  
  
  CONCLUSIONS
  This initial experience of DCE-derived Vp evaluation shows that this parameter is as accurate as the well-established DSC-derived rCBV for glioma grading. DCE-derived K(trans) is equally useful for grading, providing different informations with respect to Vp.
authors.affiliation: Neuroradiology Unit and CERMAC, San Raffaele Scientific Institute and Vita-Salute San Raffaele University, Milan, Italy.
authors.forename: Corrado
authors.initials: C
authors.lastname: Santarosa
authors.affiliation: Neuroradiology Unit and CERMAC, San Raffaele Scientific Institute and Vita-Salute San Raffaele University, Milan, Italy.
authors.forename: Antonella
authors.initials: A
authors.lastname: Castellano
authors.affiliation: Neuroradiology Unit and CERMAC, San Raffaele Scientific Institute and Vita-Salute San Raffaele University, Milan, Italy.
authors.forename: Gian Marco
authors.initials: GM
authors.lastname: Conte
authors.affiliation: Neuroradiology Unit and CERMAC, San Raffaele Scientific Institute and Vita-Salute San Raffaele University, Milan, Italy; Philips Healthcare, Monza, Italy.
authors.forename: Marcello
authors.initials: M
authors.lastname: Cadioli
authors.affiliation: Neuroradiology Unit and CERMAC, San Raffaele Scientific Institute and Vita-Salute San Raffaele University, Milan, Italy.
authors.forename: Antonella
authors.initials: A
authors.lastname: Iadanza
authors.affiliation: Pathology Department, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Maria Rosa
authors.initials: MR
authors.lastname: Terreni
authors.affiliation: Department of Neurosurgery, San Raffaele Scientific Institute and Vita-Salute San Raffaele University, Milan, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Franzin
authors.affiliation: Department of Medical Biotechnology and Translational Medicine, Università degli Studi di Milano, Milan, Italy; Unit of Surgical Neurooncology, Humanitas Research Hospital, Rozzano, MI, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Bello
authors.affiliation: Department of Neuroscience and Imaging and ITAB-Institute of Advanced Biomedical Technologies, University "G. d'Annunzio", Chieti, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Caulo
authors.affiliation: Neuroradiology Unit and CERMAC, San Raffaele Scientific Institute and Vita-Salute San Raffaele University, Milan, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Falini
authors.affiliation: Neuroradiology Unit and CERMAC, San Raffaele Scientific Institute and Vita-Salute San Raffaele University, Milan, Italy. Electronic address: anzalone.nicoletta@hsr.it.
authors.forename: Nicoletta
authors.initials: N
authors.lastname: Anzalone
mesh_terms: D000328:Adult; D000368:Aged; D001810:Blood Volume / Q000502:physiology; D001932:Brain Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000503:physiopathology; D002199:Capillary Permeability / Q000502:physiology; D003287:Contrast Media; D005260:Female; D005910:Glioma / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000503:physiopathology; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D010865:Pilot Projects; D012372:ROC Curve; D015203:Reproducibility of Results
chemical_list: D003287:Contrast Media
keywords: Dynamic contrast-enhanced MRI; Dynamic susceptibility contrast; Glioma; Histogram analysis; MRI; Perfusion MRI