Glioma grading using an optimized T1-weighted dynamic contrast-enhanced magnetic resonance imaging paradigm

Abstract

Abstract Background Glioma grading is a critical procedure for selecting the most effective treatment policy. Biopsy result is the gold standard method for glioma grading, but inherent sampling errors in the biopsy procedure could lead to tumor misclassification. Aim This study evaluated grading performances of a more comprehensive collection of the physiological indices quantified using an optimized dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) paradigm for glioma grading. Methods Thirty-five patients with glioma underwent DCE-MR imaging to evaluate the grading performances of DCE-MRI-derived physiological indices. The statistical differences in the physiological indices between the different grades of gliomas were studied, and the grading performances of these parameters were evaluated using the leave-one-out cross-validation method. Results There were significant statistical differences in DCE-MRI-derived physiological indices between the different grades of gliomas. The mean rCBVs for grade II (low-grade glioma, LGG), grade III, grade IV, and high-grade (HGG) gliomas were 2.03 ± 0.78, 3.61 ± 1.64, 7.14 ± 3.19, and 5.28 ± 3.02, respectively. The mean rCBFs of 1.94 ± 0.97, 2.67 ± 0.96, 4.57 ± 1.77, and 3.57 ± 1.68 were, respectively, quantified for grade II (LGG), grade III, grade IV, and high-grade gliomas. The leave-one-out cross-validation method indicates that the grades of glioma tumors could be determined based on a specific threshold for each physiological index; for example, the optimal cutoff values for rCBF, rCBV, Ktrans, Kep, and Vp indices to distinguish between HGGs and LGGs were 2.11, 2.80, 0.025 mL/g min, 0.29 min−1, and 0.065 mL/g, respectively. Conclusions From the results, it could be concluded that glioma grades could be determined using DCE-MRI-derived physiological indices with an acceptable agreement with histopathological results.

Keywords

• Glioma grading
• Dynamic contrast-enhanced MRI
• Cerebral hemodynamic indices
• Permeability indices
• Perfusion-weighted MRI