Assessment Of Preoperative Grading Of Supratentorial Glioma With Function MRI And The Choice Of Superior Grading Parameter: A Preliminary Result

PartiAssessment of susceptibility effect using 3.0T High Field High Resolution Susceptibility Weighted Imaging in Patients with supratentorial Gliomas:Comparison with MR Perfusion ImagingObjective:Our aim was to determine whether the degree of susceptibility effect (SED) on high-resolution susceptibility-weighted imaging (HR-SWI) could be used for suparatentorial glioma grading, assess the correlates with maximum relative cerebral blood volume (rCBVmax) and to compare its diagnostic accuracy for glioma grading with that of dynamic susceptibility-weighted contrast-enhanced perfusion MR imaging (DSC).Methods and materials:44 suparatentorial gliomas (29 for low-grade,15 for high-grade) confirmed by craniotomy surgery and histopathology underwent conventional MRI plus enhancement, non contrast enhanced HR-SWI and DSC-PWI. Measured the maximum relative cerebral blood volume (rCBV) in tumor parenchyma with the most high perfusion region. According to the SED classified the suparatentorial glioma in four grades. Assessed the correlation of SED, rCBV with pathologic grade of suparatentorial glioma respectively and compared their diagnostic accuracy for glioma grading. Assessed the correlation of SED and maximum rCBV in parenchyma of tumor. All the data were used SPSS 13.0 for statistics, tested the Homogeneity of variance and Normal distribution before statistcs. We used Independent samples t test, Pearson and Spearman correlation analysis and Fishers exact test, and P<0.05 was considered Statistically significant.Results:1. SED of tumor parenchyma between low-grade and high-grade gliomas had significant difference(P<0.01); rCBV in parenchyma of high-grade glioma was 4.15±1.21,which was obvious higher than that of low-grade glioma (2.62±1.59) (P<0.01). SED of tumor parenchyma between low-grade and high-grade Oligodendroglial tumours had significant difference(P<0.05) but rCBV had no significant difference(P>0.05).2. SED and rCBV of tumor parenchyma between low-grade and high-grade astrocytoma had significant difference respectively (P<0.01); both of them had significant correlation with pathology grade (P<0.01, respectively).3. The SED and rCBV had significant correlation in parenchyma of astrocytoma (P<0.01).4. Using SED for astrocytoma grade, the sensitivity was 90.0%, specificity was 90.5%, positive predictive value (PPV) was 83.8%, negative predictive value (NPV) was 95%, fraction of misclassified (FM) was 9.4%,and (false positive ratio plus false negative ratio) was 18.6%,the area of Roc Curve was 0.916;when rCBV was 2.38, the grading sensitivity was 100%, specificity was 71.4%, PPV was 64.7%, NPV was 100%, fraction of misclassified (FM) was 18.8%,and (false positive ratio plus false negative ratio) was 28.6%, the area of Roc Curve was 0.892.5. There were significant difference among SWI method, PWI-rCBV method and conventional MRI method for grade astrocytoma and SWI method was the best one.Conclusion:The SED and rCBV had significant correlation in parenchyma of astrocytoma; both SWI method and PWI-rCBV method could improve diagnostic accuracy for grading and SED was better than PWI-rCBV. For Oligodendroglial tumours, SED may used for grading. Part 2 In the assessment of supratentorial glioma grade by using 3.0T high-field multiplex function MRI methodsThe first segment In the assessment of supratentorial glioma grade by using 3.0T high field dynamic susceptibility weighted contrast-enhanced perfusion MR imagingObjective:Our aim was to determine whether the dynamic susceptibility-weighted contrast-enhanced perfusion MR imaging (DSC) could be used for suparatentorial glioma grading and assess its diagnostic accuracy.Methods and materials:41 suparatentorial glioma (28 for low-grade,13 for high-grade) confirmed by craniotomy surgery and histopathology underwent conventional MRI plus enhancement and DSC-PWI. Measured the maximum relative cerebral blood volume (rCBV), maximim relative cerebral blood flow (rCBF) in tumor parenchyma with the most high perfusion region. Calculated the percentage of signal intensity recovery derived from perfusion curve. Selected the most appropriate threshold values according to ROC curves. Assessed the correlation of rCB V, rCBF and the percentage of signal intensity recovery with pathologic grade of suparatentorial glioma respectively and compared their diagnostic accuracy for glioma grading. All the data were used SPSS 13.0 for statistics, tested the Homogeneity of variance and Normal distribution before statistics. We used Independent samples t test, Spearman correlation analysis and Fisher's exact test, and P<0.05 was considered Statistically significant.Results:1. rCBV in tumor parenchyma of high-grade glioma(4.29±1.23) was obvious higher than that of low-grade glioma (2.71±1.58) (P<0.01), and the percentage of signal intensity recovery in high-grade glioma (0.56±0.17) was significant lower than that of low-grade (0.78±0.12) (P<0.01). rCBV, rCBF and the percentage of signal intensity recovery in tumor parenchyma of high-grade Oligodendroglial tumours had no difference compared with low-grade. rCBV and the percentage of signal intensity recovery in tumor parenchyma of high-grade astrocytoma had significant difference with that of in low-grade.2. rCBV and the percentage of signal intensity recovery in tumor parenchyma of astrocytoma had significant correlation with pathology grade (P<0.01,respectively).3. when rCBV was 2.35 and the percentage of signal intensity recovery was 0.689, both of their grading results had significant difference compared with conventional MRI method, and the grading result according to the percentage of signal intensity recovery was obvious better than conventional MRI method.Conclusion:rCBV and the percentage of signal intensity recovery in tumor parenchyma of astrocytoma could be used for grading, which could improve the diagnostic accuracy for grading than conventional MRI, and the percentage of signal intensity recovery has the higher efficacy. The second segment In the assessment of supratentorial glioma grade by using 3.0T high-field Multi-voxel proton MR spectroscopyObjective:Our aim was to determine whether the Multi-voxel proton MR spectroscopy (1H MRS) could be used for suparatentorial glioma grading and assess its diagnostic accuracy.Methods and materials:43 suparatentorial gliomas (30 for low-grade,13 for high-grade) confirmed by craniotomy surgery and histopathology underwent conventional MRI plus enhancement and 1H MRS. Measured the NAA/Cr, Cho/Cr, Cho/NAA in tumor parenchyma and their Contralateral normal brain tissue. Selected the most appropriate threshold values according to ROC curves. Assessed the correlation of NAA/Cr,,Cho/Cr,Cho/NAA with pathologic grade of suparatentorial glioma respectively and compared their diagnostic accuracy for glioma grading. All the data were used SPSS 13.0 for statistics, tested the Homogeneity of variance and Normal distribution before statistics. We used Independent samples t test, Spearman correlation analysis and Fisher's exact test, and P<0.05 was considered Statistically significant.Results:1. There were significant difference of NAA/Cr and Cho/NAA in tumor parenchyma between high-grade and low-grade glioma(P<0.05). NAA/Cr, Cho/Cr and Cho/NAA in tumor parenchyma of high-grade Oligodendroglial tumours had no difference compared with that of in low-grade (P>0.05). NAA/Cr and Cho/NAA in tumor parenchyma of high-grade astrocytoma had significant difference compared with that of in low-grade (P<0.01)2. NAA/Cr and Cho/NAA in tumor parenchyma of astrocytoma had significant correlation with pathology grade (P<0.01, respectively).3. When NAA/Cr was 0.51 and Cho/NAA was 2.76, both of their grading results had no significant difference compared with conventional MRI method, but the sensitivity, specificity, PPV,NPV resulted from Cho/NAA were larger and FM, (false positive ratio plus false negative ratio) were lower than conventional MRI method. The grading result of Cho/NAA had significant difference compared with result of NAA/Cr.Conclusions:Both NAA/Cr and Cho/NAA in tumor parenchyma of astrocytoma could be used for grading, while the diagnostic accuracy of NAA/Cr was equal to conventional MRI method and Cho/NAA could improve the diagnostic accuracy for grading. Objective:Our aim was to determine whether the ADC value derived from diffusion weighted imaging (DWI) could be used for suparatentorial glioma grading and assess its diagnostic accuracy.Methods and materials:35 suparatentorial glioma (23 for low-grade,12 for high-grade) confirmed by craniotomy surgery and histopathology underwent conventional MRI plus enhancement and DWI. Measured the minimume ADC value in tumor parenchyma and their contralateral normal brain tissue. Selected the most appropriate cut-off values according to ROC curves. Assessed the correlation of minimum ADC value with pathologic grade of suparatentorial glioma and its diagnostic accuracy for glioma grading. All the data were used SPSS 13.0 for statistics, tested the Homogeneity of variance and Normal distribution before statistics. We used Independent samples t test, Spearman correlation analysis and Fisher's exact test, and P<0.05 was considered Statistically.Results:1. The ADC value in parenchyma of glioma was significant higher than that in Contralateral normal brain tissue. The ADC value ((1134.05±135.59)×10-6mm2/s) in parenchyma of high-grade glioma was significant lower than that in low-grade glioma ((1472.93±326.52)×10-6mm2/s) (P<0.01).The ADC value in parenchyma of high-grade Oligodendroglial tumors had no difference compared with that in low-grade (P>0.05) but there was significant difference between high-grade astrocytoma and low-grade astrocytoma (P<0.01)2. The ADC value in tumor parenchyma of astrocytoma had significant correlation with pathology grade (P<0.01). The area of ROC curve was 0.922, P<0.01.3. When the ADC value was (1241.05)×10-6mm2/s, its grading results had significant difference compared with conventional MRI method, and the sensitivity, specificity, PPV, NPV resulted from ADC value were larger and FM, (false positive ratio plus false negative ratio) were lower than conventional MRI method.Conclusion:The ADC value in tumor parenchyma of astrocytoma could be used for grading, and its diagnostic accuracy was higher than conventional MRI method which could improve the diagnostic accuracy for grading. Part 3 Superior parameter of multiple MRI method for the assessment of supratentorial glioma gradeObjective:Our aim was to determine which parameter was the best one derived from PWI, SWI, DWI, and 1H MRS that used for the assessment of suparatentorial glioma grading.Methods and materials:32 suparatentorial glioma (21 for low-grade,11 for high-grade) confirmed by craniotomy surgery and histopathology underwent conventional MRI plus enhancement, SWI, PWI, DWI and 1H MRS. According to the degree susceptibility effect (SED) classified the suparatentorial glioma in high-grade and low-grade. Measured the Cho/NAA and mimnmum ADC value in parenchyma of tumor. Calculated the percentage of signal intensity recovery derived from peufusion curve. Selected the most appropriate threshold values of Cho/NAA, ADC value and the percentage of signal intensity recovery according to ROC curves. Assessed the correlation of SED, Cho/NAA, ADC value and the percentage of signal intensity recovery with pathologic grade of suparatentorial glioma respectively and compared their diagnostic accuracy for glioma grading. All the data were used SPSS 13.0 for statistcs, tested the Homogeneity of variance and Normal distribution before statistcs. We used Independent samples t test, Pearson and Spearman correlation analysis and Fisher's exact test, and P<0.05 was considered Statistically significant. Results:1. SED, Cho/NAA, ADC value and the percentage of signal intensity recovery of tumor parenchyma between low-grade and high-grade gliomas had significant difference (P<0.01).2. SED of tumor parenchyma between low-grade and high-grade Oligodendroglial tumors had significant difference (P<0.05) but other three parameters had no significant difference between low-grade and high-grade Oligodendroglial tumours(P>0.05).3. SED, Cho/NAA, ADC value and the percentage of signal intensity recovery of tumor parenchyma between low-grade and high-grade astrocytoma had significant difference respectively (P<0.01); all of the upper four parameters had significant correlation with pathology grade (P<0.01, respectively).4. Using SED, Cho/NAA, ADC value and the percentage of signal intensity recovery of tumor parenchyma for astrocytoma grading, the sensitivity, specificity, PPV, NPV resulted from ADC value, SED and the percentage of signal intensity recovery were larger and FM, (false positive ratio plus false negative ratio) were lower than conventional MRI method. The grading result between SED and the percentage of signal intensity recovery also had significant difference (P<0.01).Conclusion:Using SED, Cho/NAA, ADC value and the percentage of signal intensity recovery of tumor parenchyma could improve the diagnostic accuracy for grading; the parameters of SED and the percentage of signal intensity recovery had the higher grading efficiency, but the SED had the hightest value for clinical application.