Volumetric Measurement of Relative CBV Using T1-Perfusion-Weighted MRI with High Temporal Resolution Compared with Traditional T2*-Perfusion-Weighted MRI in Postoperative Patients with High-Grade Gliomas

A 53-year-old woman with primary glioblastoma located in the left thalamus. On the follow-up image 10 months after the operation (7 months after the last radiation therapy), new enhancing lesions are noticed in the left temporal lobe base and fourth ventricle (A and B). Owing to its location and considerable amount of internal hemorrhage (C), signal loss shades the portions of the left temporal lobe lesion, resulting in grade 1 visualization on T2*-PWI (D, rCBV 90th percentile, 8.18). Grade 3 visualization is achieved on T1-PWI (E, rCBV 90th percentile, 23.92). Susceptibility-induced signal loss of the T2*-PWI is also well-noticed on the histogram, with the leftmost peak of near-zero voxels (F). The patient died in 1 month and was assigned to the progression group on ROC curve analysis.

Scatterplots of rCBV values derived from T1- and T2*-PWI. A, Ninetieth percentile of the whole lesion rCBV values, with fair consistency (ICC = 0.558) and a positive correlation (R = 0.614). B, Mean of the whole-lesion rCBV values, with fair consistency (ICC = 0.566) and a positive correlation (R = 0.663).

A Bland-Altman plot representing the 90th percentile of rCBV values derived from T1- and T2*-PWI. The upper and lower dashed lines represent the 1.96 and −1.96 limits of agreement, respectively (95% confidence interval not indicated).

Cumulative histogram of T1- and T2*-rCBV values in all included examinations. With T2*-rCBV measurement, the leftmost beginning point of the cumulative fraction is >0.2 (horizontal dashed line) in 17 lesions (37.8%), implying that in each entire VOI of those lesions, more than one-fifth of the voxels contained rCBV values of <0.3 (the first bin of histogram). With T1-PWI–based rCBV measurements, in contrast, only 2 lesions (4.4%) show an initial cumulative fraction above 0.2.