Article Figures & Data
Figures
- Fig 1.
The ROC curves associated with the model to diagnose high-grade tumors on the basis of rCBV, rCBV with Ktrans, and Ktrans alone. Diagnostic models based on Ktrans with rCBV and rCBV alone each had significantly higher (P < .01) area under the ROC curve (AUC = 0.94, 0.90, respectively) than did the model based on Ktrans alone (AUC = 0.63). Max indicates maximum.
- Fig 2.
Scatterplot of rCBV versus Ktrans shows true low-grade gliomas as crosses and true high grade gliomas as black points. The figure demonstrates that rCBV and Ktrans together are good predictors of glioma grade. The performance of the diagnostic model to predict high-grade tumors using both Ktrans and Max rCBV when overall diagnostic accuracy is highest (sensitivity = 90.7%, specificity = 76.7%) is shown.
- Fig 3.
A–H, Low-grade astrocytoma (grade II/IV). Top row, left to right.
A, Axial FLAIR image (TR/TE/TI, 9000/110/2500 ms) demonstrates a lesion in the left midbrain with high signal intensity and minor mass effect.
B, Axial T1-weighted postcontrast image (TR/TE, 600/14 ms; 1 excitation) demonstrates no evidence of contrast enhancement, in keeping with a low-grade astrocytoma.
C and D, Gradient-echo (TR/TE, 1000/54 ms) axial DSC MR imaging and SD25 color map suggests low permeability throughout the lesion.
E–G, Bottom row (left to right). rCBV, CBV, and CBF maps demonstrate a few foci of mildly elevated rCBV, CBV, and CBF within the glioma.
H, MTT map demonstrates some prolongation in MTT within the tumor.
- Fig 4.
A–H, Anaplastic astrocytoma (grade III/IV). Top row, left to right.
A, Axial FLAIR image (TR/TE/TI, 9000/110/2500 ms) demonstrates a dominant lesion in the right thalamus with extension to the left thalamus and parietooccipital region.
B, Axial T1-weighted postcontrast image (TR/TE, 600/14 ms; 1 excitation) demonstrates heterogeneous contrast enhancement in keeping with an anaplastic astrocytoma.
C, Gradient-echo axial DSC MR image (TR/TE, 1000/54 ms).
D, SD25 color map shows foci of increased permeability throughout the lesion.
E–G, Bottom row (left to right). rCBV, CBV, and CBF maps demonstrate elevated rCBV, CBV, and CBF within the glioma.
H, MTT map demonstrates some prolongation in MTT within the tumor.
- Fig 5.
A–H, Glioblastoma multiforme (grade IV/IV). Top row, left to right.
A, Axial FLAIR image (TR/TE/TI, 9000/110/2500 ms) demonstrates a lesion with surrounding increased signal intensity in the left parietooccipital region.
B, Axial T1-weighted postcontrast image (TR/TE, 600/14 ms; 1 excitation) demonstrates heterogeneous contrast enhancement in keeping with a glioblastoma multiforme.
C, Gradient-echo axial DSC MR image (TR/TE, 1000/54 ms).
D, SD25 color map shows foci of increased permeability anteriorly in the lesion, which appears to “washout” on the axial postcontrast T1-weighted image (arrows), possibly indicating hyperpermeability during the first pass of contrast. The areas of enhancement more posteriorly may reflect more delayed permeability.
E–G, Bottom row (left to right). rCBV, CBV, and CBF maps demonstrate elevated rCBV, CBV, and CBF within the glioblastoma multiforme.
H, MTT map demonstrates some prolongation in MTT within the tumor.
Tables
Glioma Grade/Type rCBV VP Ktrans CBF CBV MTT Low-grade glioma 1.61 ± 0.8 0.99 ± 0.7 0.050 ± 0.09 67.37 ± 84.2 2.95 ± 2.4 3.02 ± 1.12 Low-grade ODG 2.03 ± 0.9 1.12 ± 0.5 0.034 ± 0.06 124.05 ± 104.0 4.43 ± 3.4 3.21 ± 1.31 Low: Glioma + ODG 1.75 ± 0.9 1.03 ± 0.7 0.044 ± 0.08 85.66 ± 93.3 3.43 ± 2.8 3.08 ± 1.16 Anaplastic astrocytoma 3.69 ± 1.5 1.30 ± 0.7 0.167 ± 0.20 99.75 ± 37.3 4.92 ± 2.5 2.98 ± 0.82 Glioblastoma multiforme 6.06 ± 2.2 1.86 ± 1.4 0.234 ± 0.23 274.49 ± 430.9 21.68 ± 62.7 3.37 ± 1.45 Note:—Values are expressed as means ± SD. rCBV indicates maximum relative cerebral blood volume; VP, blood plasma volume; Ktrans, vascular permeability; CBF, absolute cerebral blood flow; CBV, absolute cerebral blood volume; MTT, mean transit time; ODG, oligodendroglioma.
- Table 2:
P values from an exact Mann-Whitney test for all pairwise comparisons among the tumor grades
Tumor Grades Compared rCBV VP Ktrans CBF CBV MTT LG glioma : LG ODG .17 .254 .381 .017 .081 .909 LG glioma : ana Astro .0002 .115 .014 .0044 .0037 .86 LG glioma : GBM .0001 .017 .0015 .0001 .0001 .439 LG ODG : ana Astro .0033 .637 .019 .941 .388 .98 LG ODG : GBM .0001 .204 .0036 .027 .0013 .777 Ana Astro : GBM .0009 .438 .291 .0027 .0009 .563 Note:—LG indicates low grade; ODG, oligodendroglioma; ana astro, anaplastic astrocytoma; GBM, glioblastoma multiforme; rCBV, maximum relative cerebral blood volume; VP, blood plasma volume; Ktrans, vascular permeability; CBF, absolute cerebral blood flow; CBV, absolute cerebral blood volume; MTT, mean transit time. Significant P values are in bold face type.
rCBV VP Ktrans CBF CBV MTT Correlation 0.81237 0.30173 0.45763 0.67768 0.60417 0.08954 P value <.0001 .009 <.0001 <.0001 <.0001 .448 Note:—rCBV denotes maximum relative cerebral blood volume; VP, blood plasma volume; Ktrans, vascular permeability; CBF, absolute cerebral blood flow; CBV, absolute cerebral blood volume; MTT, mean transit time.
- Table 4:
Selected combinations of sensitivity and specificity achieved (corresponding to points on the receiver operating characteristic curve) on the basis of diagnostic models using Ktrans and rCBV when considered alone and in combination
rCBV and Ktrans rCBV Ktrans Sensitivity (%) Specificity (%) Sensitivity (%) Specificity (%) Sensitivity (%) Specificity (%) 100.0 33.3 100.0 46.7 100.0 0.0 97.7 60.0 97.7 66.7 72.1 40.0 95.3 66.7 95.3 70.0 62.8 66.7 90.7 76.7 88.4 76.7 60.5 70.0 81.4 83.3 86.0 83.3 32.6 86.7 72.1 93.3 83.7 93.3 30.2 90.0 62.8 96.7 74.4 96.7 25.6 93.3 16.3 100.0 69.8 100.0 2.3 100.0 Note:—rCBV indicates maximum relative cerebral blood volume; Ktrans, vascular permeability.
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