Perfusion Magnetic Resonance Imaging Predicts Patient Outcome as an Adjunct to Histopathology: A Second Reference Standard in the Surgical and Nonsurgical Treatment of Low-grade Gliomas

Abstract

Dynamic susceptibility contrast-enhanced perfusion magnetic resonance imaging may be used to identify LGGs that are either high-grade gliomas, misdiagnosed because of sampling error at pathological examination or that have undergone angiogenesis in the progression toward malignant transformation. This suggests that rCBV measurements may be used as a second reference standard to determine the surgical management/risk-benefit equation and postsurgical adjuvant therapy for LGGs.

Cerebral Blood Volume Measurements by Perfusion-Weighted MR Imaging in Gliomas: Ready for Prime Time in Predicting Short-Term Outcome and Recurrent Disease?

“…The ROC curve analysis in the group of astrocytomas corroborates these results and our hypothesis that CBV measurements may be used as an adjunct to histopathology and even as an independent prognostic factor. The latter was also demonstrated by Law et al 10,11 in a mixed population of low-grade gliomas, in which the low-grade oligodendrogliomas had predominantly low perfusion values resembling astrocytomas (in contrast to our study).…”

“…Another limitation is that our study lacks results regarding the predictive role of age, sex, tumor volume, and treatment protocols. Our choice not to analyze these parameters was justified by the small population size (the significance level of the multiple regression analysis including all these factors was P ϭ .08) and the diverse results found regarding age and sex in the literature, 11,17 whereas the predictive role of different treatment protocols has been demonstrated in recent larger studies.…”

“…7,8,10 As a rule, the histopathologic findings were considered the standard of reference, and these studies concentrated on establishing concordance with the histopathologic tumor grade and not on predicting outcomes, except as an adjunct to histopathology in 1 study. 11 Our intention was to conduct an investigation without the bias introduced by patient classification according to the histopathologic tumor grade. We designed a study with the primary objective of examining the role of MR imagingϪderived rCBV values in predicting prognosis in a setting that includes the following: 1) a population of all patients with gliomas, 2) a short-term end point (1-year progression-free survival [PFS] rate) because it seems to be critical for dedifferentiation of astrocytomas from anaplastic astrocytomas or glioblastomas and for survival time in patients with glioblastomas, 12 and 3) no patient stratification according to the WHO grade.…”

Perfusion CT Imaging of Brain Tumors: An Overview

“…Many of these parameters have been correlated with tumor grade, aggressiveness, and prognosis. 3,5,7,9 Tumor Blood Volume Regional tumor blood volume measurements reflect an assessment of tumor vasculature and perfusion and have been correlated with glioma grading as well as prognosis. Measurement of tumor blood volume is a good surrogate marker for MVD, a measure of angiogenesis and an important prognostic indicator [10][11][12] in many human cancers.…”

Automatic glioma characterization from dynamic susceptibility contrast imaging: Brain tumor segmentation using knowledge‐based fuzzy clustering

“…The high level of soft tissue contrast makes MR images an important aid in the identification and treatment of gliomas (1)(2)(3). Furthermore, in combination with conventional MR imaging, several studies have shown that dynamic susceptibility contrast (DSC) MR imaging of gliomas is a good presurgical indicator of glioma grade (4 -6) and patient outcome regardless of glioma grade (7,8). Typically, glioma grading from DSC is based on analysis of cerebral blood volume (CBV) values within the glioma area, using either a hot-spot method (4,9) or a histogram analysis method (10,11).…”