Relative cerebral blood volume from dynamic susceptibility contrast perfusion in the grading of pediatric primary brain tumors

Chang Ho, Jeremy S. Cardinal, Aaron P. Kamer, Stephen F. Kralik

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Introduction: The aim of this study is to evaluate the utility of relative cerebral blood volume (rCBV) data from dynamic susceptibility contrast (DSC) perfusion in grading pediatric primary brain tumors. Methods: A retrospective blinded review of 63 pediatric brain tumors with DSC perfusion was performed independently by two neuroradiologists. A diagnosis of low- versus high-grade tumor was obtained from conventional imaging alone. Maximum rCBV (rCBVmax) was measured from manual ROI placement for each reviewer and averaged. Whole-tumor CBV data was obtained from a semi-automated approach. Results from all three analyses were compared to WHO grade. Results: Based on conventional MRI, the two reviewers had a concordance rate of 81 % (k = 0.62). Compared to WHO grade, the concordant cases accurately diagnosed high versus low grade in 82 %. A positive correlation was demonstrated between manual rCBVmax and tumor grade (r = 0.30, P = 0.015). ROC analysis of rCBVmax (area under curve 0.65, 0.52–0.77, P = 0.03) gave a low-high threshold of 1.38 with sensitivity of 92 % (74–99 %), specificity of 40 % (24–57 %), NPV of 88 % (62–98 %), and PPV of 50 % (35–65 %) Using this threshold on 12 discordant tumors between evaluators from conventional imaging yielded correct diagnoses in nine patients. Semi-automated analysis demonstrated statistically significant differences between low- and high-grade tumors for multiple metrics including average rCBV (P = 0.027). Conclusions: Despite significant positive correlation with tumor grade, rCBV from pediatric brain tumors demonstrates limited specificity, but high NPV in excluding high-grade neoplasms. In selective patients whose conventional imaging is nonspecific, an rCBV threshold may have further diagnostic value.

Original languageEnglish
Pages (from-to)299-306
Number of pages8
JournalNeuroradiology
Volume57
Issue number3
DOIs
StatePublished - 2015

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Brain Neoplasms
Perfusion
Pediatrics
Neoplasms
Cerebral Blood Volume
ROC Curve
Area Under Curve

Keywords

  • Dynamic susceptibility contrast perfusion
  • Primary pediatric brain tumors
  • Relative cerebral blood volume
  • World Health Organization tumor grading

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine

Cite this

Relative cerebral blood volume from dynamic susceptibility contrast perfusion in the grading of pediatric primary brain tumors. / Ho, Chang; Cardinal, Jeremy S.; Kamer, Aaron P.; Kralik, Stephen F.

In: Neuroradiology, Vol. 57, No. 3, 2015, p. 299-306.

Research output: Contribution to journalArticle

Ho, Chang ; Cardinal, Jeremy S. ; Kamer, Aaron P. ; Kralik, Stephen F. / Relative cerebral blood volume from dynamic susceptibility contrast perfusion in the grading of pediatric primary brain tumors. In: Neuroradiology. 2015 ; Vol. 57, No. 3. pp. 299-306.
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