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Cerebral Blood Volume Measurements and Proton MR Spectroscopy in Grading of Oligodendroglial Tumors

¹ Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599.
² Present address: Department of Radiology, Medical University of South Carolina, 169 Ashley Ave., PO Box 250322, Charleston, SC 29425.
³ Division of Neurosurgery, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599.

OBJECTIVE. The purpose of this study was to determine whether perfusion-weighted imaging (PWI) and proton MR spectroscopy (MRS) are useful in differentiating high- and low-grade oligodendroglial tumors.

MATERIALS AND METHODS. PWI and MRS studies of 22 patients with histologically proven oligodendroglioma or oligoastrocytoma (13 low-grade and nine anaplastic tumors) were retrospectively reviewed. PWI of 14 subjects was performed with a dynamic contrast-enhanced susceptibility-weighted echo-planar technique. Intratumoral relative cerebral blood volume ratio was calculated and normalized to the same value in contralateral normal-appearing white matter. Multivoxel MRS was performed with a point-resolved spectroscopy sequence at a TE of 135 milliseconds in 20 patients and with the addition of a TE of 30 seconds in 17 patients. MRS data were expressed as intratumoral metabolite ratios (choline to creatine [Cho/Cr], choline to N-acetyl aspartate, N-acetyl aspartate to creatine, and myoinositol to creatine).

RESULTS. Relative cerebral blood volume ratios were significantly different (p = 0.004) between low-grade (1.61 ± 1.20) and high-grade tumors (5.45 ± 1.96). The optimal relative cerebral blood volume ratio cutoff value in identification of anaplastic oligodendroglial tumors was 2.14. Analysis of MRS data showed significantly higher Cho/Cr ratios (p = 0.002) in high-grade than in low-grade tumors. A Cho/Cr ratio cutoff value of 2.33 had the highest accuracy in identification of high-grade tumors.

CONCLUSION. Relative cerebral blood volume measurement and MRS are helpful in differentiating low-grade from anaplastic oligodendroglial tumors.

Keywords: brain • MR technique • MRI • oncologic imaging • perfusion-weighted MRI

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