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Neuroradiology. 2015 Mar;57(3):299-306. doi: 10.1007/s00234-014-1478-0. Epub 2014 Dec 13.

Relative cerebral blood volume from dynamic susceptibility contrast perfusion in the grading of pediatric primary brain tumors.

Author information

1
Department of Radiology, MRI Department, Indiana University School of Medicine, 705 Riley Hospital Drive, Indianapolis, IN, 46202, USA, cyho@iupui.edu.

Abstract

INTRODUCTION:

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.

PMID:
25504266
DOI:
10.1007/s00234-014-1478-0
[Indexed for MEDLINE]

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