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Using Relative Cerebral Blood Flow and Volume to Evaluate the Histopathologic Grade of Cerebral Gliomas: Preliminary Results

Ji Hoon Shin1, Ho Kyu Lee1, Byung Duk Kwun2, Jin-Suh Kim3, Weechang Kang4, Choong Gon Choi1 and Dae Chul Suh1

1 Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Poongnapdong, Songpa-gu, Seoul, 138-736, South Korea.
2 Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 138-736, South Korea.
3 Department of Radiology, Armed Forces Capital Hospital, San 13-4 Yooldong, Boondang-gu, Seongnam, Seoul, 463-040, South Korea.
4 Department of Information and Statistics, Daejeon University, 96-3 Yongwoo-dong, Daejeon, 300-716, Korea.



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  		Fig. 1. —Axial T1-weighted MR image. Region of interest of 20 x 20 pixel size was manually positioned on area covering M2 portion of middle cerebral artery to obtain arterial input function (AIF). Scanning region-of-interest area (arrow), program calculates most suitable AIF and marks point (asterisk).

 


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  		Fig. 2A. —63-year-old woman with glioblastoma multiforme in right frontal lobe. Contrast-enhanced T1-weighted MR image shows irregular strong enhancement of mass (arrows).

 


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  		Fig. 2B. —63-year-old woman with glioblastoma multiforme in right frontal lobe. On relative cerebral blood volume (B) and cerebral blood flow (C) maps, there are correspondingly high cerebral blood volume and cerebral blood flow color values, respectively (arrows). Note match between perfusion maps (B and C) and contrast-enhanced T1-weighted MR images (A). Maximal relative cerebral blood volume and relative cerebral blood flow ratios are also high at 4.82 and 5.85, respectively.

 


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  		Fig. 2C. —63-year-old woman with glioblastoma multiforme in right frontal lobe. On relative cerebral blood volume (B) and cerebral blood flow (C) maps, there are correspondingly high cerebral blood volume and cerebral blood flow color values, respectively (arrows). Note match between perfusion maps (B and C) and contrast-enhanced T1-weighted MR images (A). Maximal relative cerebral blood volume and relative cerebral blood flow ratios are also high at 4.82 and 5.85, respectively.

 


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  		Fig. 2D. —63-year-old woman with glioblastoma multiforme in right frontal lobe. Relative cerebral blood flow map shows placement of rectangular regions of interest for measurement of relative cerebral blood flow in tumor (GM) and in contralateral peritrigonal white matter (WM). Relative cerebral blood flow ratio was relative cerebral blood flow of tumor divided by that of white matter.

 


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  		Fig. 3A. —55-year-old woman with glioblastoma multiforme in right temporal lobe. Contrast-enhanced T1-weighted MR image shows strong enhancement of entire rim of mass (arrows).

 


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  		Fig. 3B. —55-year-old woman with glioblastoma multiforme in right temporal lobe. On relative cerebral blood volume (B) and cerebral blood flow (C) maps, there are focal high cerebral blood volume and cerebral blood flow color values in medial portion (arrows) of tumor and low cerebral blood volume and cerebral blood flow color values in other portion of tumor. Note mismatch between perfusion maps (B and C) and contrast-enhanced T1-weighted MR image (A). Maximal relative cerebral blood volume and relative cerebral blood flow ratios are high at 5.48 and 4.58, respectively, in medial portion of tumor.

 


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  		Fig. 3C. —55-year-old woman with glioblastoma multiforme in right temporal lobe. On relative cerebral blood volume (B) and cerebral blood flow (C) maps, there are focal high cerebral blood volume and cerebral blood flow color values in medial portion (arrows) of tumor and low cerebral blood volume and cerebral blood flow color values in other portion of tumor. Note mismatch between perfusion maps (B and C) and contrast-enhanced T1-weighted MR image (A). Maximal relative cerebral blood volume and relative cerebral blood flow ratios are high at 5.48 and 4.58, respectively, in medial portion of tumor.

 


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  		Fig. 4A. —50-year-old man with low-grade pilocytic astrocytoma in right basal ganglia. Contrast-enhanced T1-weighted MR image shows heterogeneous strong enhancement of mass (arrows).

 


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  		Fig. 4B. —50-year-old man with low-grade pilocytic astrocytoma in right basal ganglia. On relative cerebral blood volume (B) and cerebral blood flow (C) maps, there are low cerebral blood volume and cerebral blood flow color values, respectively (arrows). Note mismatch between perfusion maps (B and C) and contrast-enhanced T1-weighted MR image (A). Maximal relative cerebral blood volume and relative cerebral blood flow ratios are also low, at 2.44 and 1.36, respectively.

 


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  		Fig. 4C. —50-year-old man with low-grade pilocytic astrocytoma in right basal ganglia. On relative cerebral blood volume (B) and cerebral blood flow (C) maps, there are low cerebral blood volume and cerebral blood flow color values, respectively (arrows). Note mismatch between perfusion maps (B and C) and contrast-enhanced T1-weighted MR image (A). Maximal relative cerebral blood volume and relative cerebral blood flow ratios are also low, at 2.44 and 1.36, respectively.

 


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  		Fig. 5. —Receiver operating characteristic curves for relative cerebral blood volume (dashed line) and relative cerebral blood flow (solid line) ratios. Area under curve is 0.864 for relative cerebral blood volume ratio and 0.879 for relative cerebral blood flow ratio, with no significant difference between the two (p > 0.05).

 


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  		Fig. 6. —Scatterplot shows high correlation between relative cerebral blood volume and relative cerebral blood flow ratios. Line represents linear regression between relative cerebral blood volume and relative cerebral blood flow ratios. Spearman's correlation coefficient = 0.762, p < 0.05.

 

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