Glioma Grading by Using Cerebral Blood Volume Measurements at Dynamic Susceptibility- Weighted Contrast Enhanced Perfusion MR Imaging
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Glioma Grading by Using Cerebral Blood Volume Measurements at Dynamic Susceptibility- Weighted Contrast Enhanced Perfusion MR Imaging,MOUSTAFA E.M. RADWAN, AHMED E.A. ABO KRISHA HASSAN M.H. ABDULLAH and RABAB A.A. MOHAMMED
Abstract
Introduction: MRI plays a critical role in the preoperative assessment of brain gliomas. Mass effect, cyst formation and necrosis on MRI studies do correlate significantly with ma-lignant behaviour. Recent developments in MR imaging have allowed the assessment of CBV and perfusion abnormalities in brain tumours and this leads to the usefulness of MR perfusion imaging for preoperative grading of gliomas and have indicated that the technique significantly augments the sensitivity and specificity of conventional MR imaging in predicting histologic grade.
Aim of the Work: To determine the role of Cerebral Blood Volume Measurements at Dynamic Susceptibility-Weighted Contrast Enhanced Perfusion MR Imaging in diagnosis and grading of Gliomas.
Patients and Methods: Twenty one patients diagnosed as gliomas during the period from October 2009 and September 2010 were involved in this study; 13 were males and 8 were females with their age ranged from 32 to 73 years old with a mean age 54.84. Patients were referred from neurosurgery department, Assiut University; All patients were subjected to full history taking: Including onset of neurological manifes-tations and their progress, Clinical assessment: (By referring neurosurgeons); for neurological deficit and MRI brain in-cluding the following following protocol; Axial Diffusion weighted imaging, Axial T1W, Axial T2WI, Axial FLAIR, post contrast T 1 WI, and perfusion-weighted image. All patients underwent Perfusion MRI before surgery; the surgical proce-dures consisted respectively of seven burr hole biopsy, 10 subtotal and 4 total removals. Pathological diagnosis and grading of the glial tumors after resection were obtained then compared with PWI data.
Results: In this study; The rCBV correlates with the histological grade and is higher in high grade gliomas than in low-grade gliomas first two grades of gliomas (G1 and G2) were considered low-grade gliomas and (G3 and G4) were considered as high-grade gliomas.
Conclusion: Perfusion MR provides additional information to MRI in diagnosis of Gliomas. It detects the most malignant areas even when not enhancing. When added routinely to diagnostic MRI, rCBV maps offer meaningful functional parameter for assessing grade of cerebral gliomas.