title: Improving the Grading Accuracy of Astrocytic Neoplasms Noninvasively by Combining Timing Information with Cerebral Blood Flow: A Multi-TI Arterial Spin-Labeling MR Imaging Study.
abstract: Systematic and accurate glioma grading has clinical significance. We present the utility of multi-TI arterial spin-labeling imaging and provide the bolus arrival time maps for grading astrocytomas.
  
  
  
  Forty-three patients with astrocytomas (21 men; mean age, 51 years) were recruited. The classification abilities of conventional MR imaging features, normalized CBF value derived from multi-TI arterial spin-labeling imaging, normalized bolus arrival time, and normalized CBF derived from single-TI arterial spin-labeling were compared in patients with World Health Organization (WHO) grade II, III, and IV astrocytomas.
  
  
  
  The normalized CBF value derived from multi-TI arterial spin-labeling imaging was higher in patients with higher grade astrocytoma malignancies compared with patients with lower grade astrocytomas, while the normalized bolus arrival time showed the opposite tendency. The normalized CBF value derived from the multi-TI arterial spin-labeling imaging showed excellent performance with areas under the receiver operating characteristic curve of 0.813 (WHO II versus III), 0.964 (WHO II versus IV), 0.872 (WHO III versus IV), and 0.883 (low-grade-versus-high-grade gliomas). The normalized CBF value derived from single-TI arterial spin-labeling imaging could statistically differentiate the WHO II and IV groups (area under the receiver operating characteristic curve = 0.826). The normalized bolus arrival time effectively identified the WHO grades II and III with an area under the receiver operating characteristic curve of 0.836. Combining the normalized CBF value derived from multi-TI arterial spin-labeling imaging and normalized bolus arrival time improved the diagnostic accuracy from 65.10% to 72.10% compared with the normalized CBF value derived from multi-TI arterial spin-labeling imaging being applied independently. The combination of multi-TI arterial spin-labeling imaging and conventional MR imaging had the best performance, with a diagnostic accuracy of 81.40%.
  
  
  
  Multi-TI arterial spin-labeling imaging can evaluate perfusion dynamics by combining normalized bolus arrival time and normalized CBF values derived from multiple TIs. It is superior to single-TI arterial spin-labeling imaging and conventional MR imaging features when applied independently and can improve the diagnostic accuracy when combined with conventional MR imaging for grading astrocytomas.
authors: From the Department of MR Imaging (S.Y., B.Z., G.W., J.X.), Shandong Medical Imaging Research Institute, Shandong University, Jinan, P.R. China.
authors: S
authors: 0000-0003-4099-4807
authors: S
authors: Yang
authors: From the Department of MR Imaging (S.Y., B.Z., G.W., J.X.), Shandong Medical Imaging Research Institute, Shandong University, Jinan, P.R. China zhaobin6025@163.com.
authors: B
authors: 0000-0002-3489-9435
authors: B
authors: Zhao
authors: From the Department of MR Imaging (S.Y., B.Z., G.W., J.X.), Shandong Medical Imaging Research Institute, Shandong University, Jinan, P.R. China.
authors: G
authors: 0000-0001-7410-5540
authors: G
authors: Wang
authors: From the Department of MR Imaging (S.Y., B.Z., G.W., J.X.), Shandong Medical Imaging Research Institute, Shandong University, Jinan, P.R. China.
authors: J
authors: 0000-0001-6063-111X
authors: J
authors: Xiang
authors: Department of Neurosurgery (S.X., Y.L., P.Z.), Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong, China.
authors: S
authors: 0000-0002-7839-8552
authors: S
authors: Xu
authors: Department of Neurosurgery (S.X., Y.L., P.Z.), Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong, China.
authors: Y
authors: 0000-0001-6025-7834
authors: Y
authors: Liu
authors: Department of Neurosurgery (S.X., Y.L., P.Z.), Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong, China.
authors: P
authors: 0000-0001-7818-2447
authors: P
authors: Zhao
authors: Application Development (J.P.), Siemens, Erlangen, Germany.
authors: J
authors: 0000-0001-9887-0458
authors: J
authors: Pfeuffer
authors: MR Collaborations NE Asia (T.Q.), Siemens Healthcare, Beijing, China.
authors: T
authors: 0000-0002-3825-268X
authors: T
authors: Qian
mesh_terms: D000328:Adult; D000368:Aged; D019540:Area Under Curve; D001254:Astrocytoma / Q000098:blood supply / Q000000981:diagnostic imaging / Q000473:pathology*; D001932:Brain Neoplasms / Q000098:blood supply / Q000000981:diagnostic imaging / Q000473:pathology*; D002560:Cerebrovascular Circulation; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading / Q000379:methods*; D012372:ROC Curve; D013113:Spin Labels
chemical_list: D013113:Spin Labels