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CC BY-NC-ND 4.0 · Indian J Radiol Imaging 2024; 34(03): 382-389
DOI: 10.1055/s-0043-1777742
Original Article

Diagnostic Utility of Integration of Dynamic Contrast-Enhanced and Dynamic Susceptibility Contrast MR Perfusion Employing Split Bolus Technique in Differentiating High-Grade Glioma

Virender Malik
1   Army Hospital (Research & Referral), Delhi, India
,
Chandrasekharan Kesavadas 
2   Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences & Technology, Thiruvananthapuram, India
,
Bejoy Thomas
2   Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences & Technology, Thiruvananthapuram, India
,
Deepti A. N.
3   Department of Pathology, Sree Chitra Tirunal Institute for Medical Sciences & Technology, Thiruvananthapuram, India
,
Krishna Kumar K.
4   Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Sciences & Technology, Thiruvananthapuram, India
› Author Affiliations Funding None.
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Abstract

Background: Despite documented correlation between glioma grades and dynamic contrast-enhanced (DCE) magnetic resonance (MR) perfusion-derived parameters, and its inherent advantages over dynamic susceptibility contrast (DSC) perfusion, the former remains underutilized in clinical practice. Given the inherent spatial heterogeneity in high-grade diffuse glioma (HGG) and assessment of different perfusion parameters by DCE (extravascular extracellular space volume [Ve] and volume transfer constant in unit time [k-trans]) and DSC (rCBV), integration of the two into a protocol could provide a holistic assessment. Considering therapeutic and prognostic implications of differentiating WHO grade 3 from 4, we analyzed the two grades based on a combined DCE and DSC perfusion.

Methods: Perfusion sequences were performed on 3-T MR. Cumulative dose of 0.1 mmol/kg of gadodiamide, split into two equal boluses, was administered with an interval of 6 minutes between the DCE and DSC sequences. DCE data were analyzed utilizing commercially available GenIQ software.

Results: Of the 41 cases of diffuse gliomas analyzed, 24 were WHO grade III and 17 grade IV gliomas (2016 WHO classification). To differentiate grade III and IV gliomas, Ve cut-off value of 0.178 provided the best combination of sensitivity (88.24%) and specificity (87.50%; AUC: 0.920; p < 0.001). A relative cerebral blood volume (rCBV) of value 3.64 yielded a sensitivity of 70.59% and specificity of 62.50% (p = 0.018). The k-trans value, although higher in grade III than in grade IV gliomas, did not reach statistical significance (p = 0.108).

Conclusion: Uniqueness of employed combined perfusion technique, treatment naïve patients at imaging, user-friendly postprocessing software utilization, and ability of Ve and rCBV to differentiate between grade III and IV gliomas (p < 0.05) are the strengths of the present study, contributing to the existing literature and moving a step closer to achieving accurate MR perfusion-based glioma grading.

Keywords

combined perfusion technique - split bolus contrast - grade III from grade IV glioma

Note

This work was carried out at Sree Chitra Tirunal Institute for Medical Sciences & Technology, Thiruvananthapuram, India.




Publication History

Article published online:
17 January 2024

© 2024. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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