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Radiology. 2018 Jun;287(3):933-943. doi: 10.1148/radiol.2017170362. Epub 2018 Jan 22.

Brain Gliomas: Multicenter Standardized Assessment of Dynamic Contrast-enhanced and Dynamic Susceptibility Contrast MR Images.

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From the Neuroradiology Unit and CERMAC, Vita-Salute San Raffaele University and IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy (N.A., A. Castellano, M. Cadioli, G.M.C.); Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy (V.C., A.B., D.A.); Department of Radiology, Humanitas Clinical and Research Hospital, Rozzano, Milan, Italy (M.G.); Department of Neuroradiology, Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, Milan, Italy (A. Costa); IRCCS Neuromed, Pozzilli (Isernia), Italy (G.G.); Neuroradiology Unit, C. Mondino National Neurologic Institute, Pavia, Italy (P.V.); Pathology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy (M.R.T.); Methodology for Clinical Research Laboratory, Department of Oncology, IRCCS Mario Negri, Milan, Italy (V.T.); Department of Radiology, Mayo Clinic, Rochester, Minn (B.J.E.); and Department of Neuroscience and Imaging and ITAB-Institute of Advanced Biomedical Technologies, University G. d'Annunzio, Chieti, Italy (M. Caulo).


Purpose To evaluate the feasibility of a standardized protocol for acquisition and analysis of dynamic contrast material-enhanced (DCE) and dynamic susceptibility contrast (DSC) magnetic resonance (MR) imaging in a multicenter clinical setting and to verify its accuracy in predicting glioma grade according to the new World Health Organization 2016 classification. Materials and Methods The local research ethics committees of all centers approved the study, and informed consent was obtained from patients. One hundred patients with glioma were prospectively examined at 3.0 T in seven centers that performed the same preoperative MR imaging protocol, including DCE and DSC sequences. Two independent readers identified the perfusion hotspots on maps of volume transfer constant (Ktrans), plasma (vp) and extravascular-extracellular space (ve) volumes, initial area under the concentration curve, and relative cerebral blood volume (rCBV). Differences in parameters between grades and molecular subtypes were assessed by using Kruskal-Wallis and Mann-Whitney U tests. Diagnostic accuracy was evaluated by using receiver operating characteristic curve analysis. Results The whole protocol was tolerated in all patients. Perfusion maps were successfully obtained in 94 patients. An excellent interreader reproducibility of DSC- and DCE-derived measures was found. Among DCE-derived parameters, vp and ve had the highest accuracy (are under the receiver operating characteristic curve [Az] = 0.847 and 0.853) for glioma grading. DSC-derived rCBV had the highest accuracy (Az = 0.894), but the difference was not statistically significant (P > .05). Among lower-grade gliomas, a moderate increase in both vp and rCBV was evident in isocitrate dehydrogenase wild-type tumors, although this was not significant (P > .05). Conclusion A standardized multicenter acquisition and analysis protocol of DCE and DSC MR imaging is feasible and highly reproducible. Both techniques showed a comparable, high diagnostic accuracy for grading gliomas. © RSNA, 2018 Online supplemental material is available for this article.

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