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Research ArticleBrain
Open Access

Comparison of Multiple Parameters Obtained on 3T Pulsed Arterial Spin-Labeling, Diffusion Tensor Imaging, and MRS and the Ki-67 Labeling Index in Evaluating Glioma Grading

H. Fudaba, T. Shimomura, T. Abe, H. Matsuta, Y. Momii, K. Sugita, H. Ooba, T. Kamida, T. Hikawa and M. Fujiki
American Journal of Neuroradiology November 2014, 35 (11) 2091-2098; DOI: https://doi.org/10.3174/ajnr.A4018
H. Fudaba
aFrom the Department of Neurosurgery, Oita University Faculty of Medicine, Oita, Japan.
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T. Shimomura
aFrom the Department of Neurosurgery, Oita University Faculty of Medicine, Oita, Japan.
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T. Abe
aFrom the Department of Neurosurgery, Oita University Faculty of Medicine, Oita, Japan.
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H. Matsuta
aFrom the Department of Neurosurgery, Oita University Faculty of Medicine, Oita, Japan.
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Y. Momii
aFrom the Department of Neurosurgery, Oita University Faculty of Medicine, Oita, Japan.
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K. Sugita
aFrom the Department of Neurosurgery, Oita University Faculty of Medicine, Oita, Japan.
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H. Ooba
aFrom the Department of Neurosurgery, Oita University Faculty of Medicine, Oita, Japan.
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T. Kamida
aFrom the Department of Neurosurgery, Oita University Faculty of Medicine, Oita, Japan.
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T. Hikawa
aFrom the Department of Neurosurgery, Oita University Faculty of Medicine, Oita, Japan.
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M. Fujiki
aFrom the Department of Neurosurgery, Oita University Faculty of Medicine, Oita, Japan.
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  • Fig 1.
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    Fig 1.

    A 62-year-old man with a grade II oligoastrocytoma. The contrast-enhanced T1-weighted image shows a nonenhancing mass in the right hippocampus (A). The lesions presented high-intensity signals on FLAIR images (B). The rCBF map on PASL shows no areas of hyperperfusion (C). The FA map shows low FA values (D). The ADC map shows increased tumor diffusion values (E). The tumor MR spectrum shows decreased NAA and slightly increased Cho and Lac (F). The Ki-67 labeling index is 5.0% (original magnification × 400) (G).

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    Fig 2.

    A 60-year-old woman with a grade IV glioblastoma. The lesion on the left frontotemporal lobe exhibits strong enhancement on gadolinium T1-weighted image (A). The neoplasm is clearly hyperperfused compared with the healthy parenchyma on the PASL image (B). The FA map shows slightly low FA values (C). The ADC map shows heterogeneous tumor diffusion values (D). The tumor MR spectrum shows decreased NAA with a marked increase in Cho and Lac (E). The Ki-67 labeling index is 27.0% (original magnification × 400) (F).

Tables

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    Table 1:

    Threshold values for multiple parameters for differentiating high- and low-grade gliomas

    ParametersBased on Minimum C1 ErrorErrorsBased on Minimum C2 ErrorErrors
    ThresholdSensitivitySpecificityPPVNPVC1C2ThresholdSensitivitySpecificityPPVNPVC1C2
    rCBF ratio mean2.5620.6520.7780.8820.4670.2850.1702.5620.6520.7780.8820.4670.2850.170
    rCBF ratio max2.8450.6090.7780.8750.4380.3070.2022.8450.6090.7780.8750.4380.3070.202
    rCBF ratio min2.0170.7390.6670.8500.5000.2970.1792.0170.7390.6670.8500.5000.2970.179
    rCBF ratio meana1.8000.8240.6670.9330.4010.2550.1421.8000.8240.6670.9330.4010.2550.142
    rCBF ratio maxa2.2580.7650.6670.9290.3340.2840.1662.2580.7650.6670.9290.3340.2840.166
    rCBF ratio mina1.2540.8820.6670.9380.4990.2260.1251.2540.8820.6670.9380.4990.2260.125
    FA ratio mean0.2360.8700.5560.8340.6260.2870.2140.2670.7390.6670.8500.5000.2970.179
    FA ratio max0.2880.8700.6670.8700.6680.2320.1280.2880.8700.6670.8700.6680.2320.128
    FA ratio min0.2790.5650.6670.8130.3750.3840.3000.2790.5650.6670.8130.3750.3840.300
    ADC ratio mean1.6590.9130.6670.8750.7500.2100.1181.6590.9130.6670.8750.7500.2100.118
    ADC ratio max1.5380.8260.5560.8260.5560.3090.2271.5380.8260.5560.8260.5560.3090.227
    ADC ratio min1.5640.9130.6670.8750.7500.2100.1181.5640.9130.6670.8750.7500.2100.118
    Cho/Cr1.7890.9130.7780.9130.7780.1550.0571.7890.9130.7780.9130.7780.1550.057
    NAA/Cho0.3490.6960.7780.8890.5000.2630.1420.3490.6960.7780.8890.5000.2630.142
    NAA/Cr1.2890.3041.0001.0000.3600.3480.4840.8940.4780.7780.8460.3680.3720.322
    Lac/Cr1.7890.7391.0001.0000.6000.1310.0681.7890.7391.0001.0000.6000.1310.068
    • Note:—min indicates minimum; max, maximum.

    • ↵a rCBF ratios derived from purely astrocytomas.

    • View popup
    Table 2:

    Threshold values for multiple parameters for differentiating glioblastomas and other-grade gliomas

    ParametersBased on Minimum C1 ErrorErrorsBased on Minimum C2 ErrorErrors
    ThresholdSensitivitySpecificityPPVNPVC1C2ThresholdSensitivitySpecificityPPVNPVC1C2
    rCBF ratio mean2.5620.8670.7650.7650.8670.1840.0732.5620.8670.7650.7650.8670.1840.073
    rCBF ratio max2.8450.8670.8240.8130.8750.1550.0492.8450.8670.8240.8130.8750.1550.049
    rCBF ratio min2.0170.8670.5880.6500.8340.2730.1872.1640.8000.6470.6670.7860.2770.165
    rCBF ratio meana1.8570.9290.8330.9280.8340.1190.0331.8570.9290.8330.9280.8340.1190.033
    rCBF ratio maxa2.2580.9290.8330.9280.8340.1190.0332.2580.9290.8330.9280.8340.1190.033
    rCBF ratio mina2.1640.7860.8330.9170.6250.1910.0742.1640.7860.8330.9170.6250.1910.074
    FA ratio mean0.3800.7330.7650.7330.7650.2510.1270.3800.7330.7650.7330.7650.2510.127
    FA ratio max0.3710.8000.5880.6310.7690.3060.2100.4180.6670.7060.6670.7060.3140.197
    FA ratio min0.3330.6000.6470.6000.6470.3770.2850.3330.6000.6470.6000.6470.3770.285
    ADC ratio mean1.3050.8000.7650.7500.8130.2180.0951.3050.8000.7650.7500.8130.2180.095
    ADC ratio max1.4940.9330.5290.6360.8990.2690.2261.4940.9330.5290.6360.8990.2690.226
    ADC ratio min1.4490.9330.6470.7000.9160.2100.1291.1480.7330.8240.7860.7780.2220.102
    Cho/Cr1.7890.9330.4710.6090.8880.2980.2842.8130.7330.6470.6470.7330.3100.196
    NAA/Cho0.3380.7330.6470.6470.7330.3100.1960.3380.7330.6470.6470.7330.3100.196
    NAA/Cr1.9220.2001.0001.0000.5860.4000.6400.7250.6000.4120.4740.5390.4940.506
    Lac/Cr2.7780.6670.8820.8330.7500.2260.1252.7780.6670.8820.8330.7500.2260.125
    • ↵a rCBF ratio derived from purely astrocytomas.

    • View popup
    Table 3:

    Combination of the minimum ADC ratio and Cho/Cr for differentiating high- and low-grade gliomas

    Based on Minimum C1 ErrorErrorsBased on Minimum C2 ErrorErrors
    SensitivitySpecificityPPVNPVC1C2SensitivitySpecificityPPVNPVC1C2
    0.8700.8890.9520.7270.1210.0290.8700.8890.9520.7270.1210.029
    • View popup
    Table 4:

    Combination of the maximum rCBF ratio and mean ADC ratio for differentiating glioblastomas and other-grade gliomas

    Based on Minimum C1 ErrorErrorsBased on Minimum C2 ErrorErrors
    SensitivitySpecificityPPVNPVC1C2SensitivitySpecificityPPVNPVC1C2
    0.7330.9410.9170.8000.1630.0750.7330.9410.9170.8000.1630.075
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American Journal of Neuroradiology: 35 (11)
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H. Fudaba, T. Shimomura, T. Abe, H. Matsuta, Y. Momii, K. Sugita, H. Ooba, T. Kamida, T. Hikawa, M. Fujiki
Comparison of Multiple Parameters Obtained on 3T Pulsed Arterial Spin-Labeling, Diffusion Tensor Imaging, and MRS and the Ki-67 Labeling Index in Evaluating Glioma Grading
American Journal of Neuroradiology Nov 2014, 35 (11) 2091-2098; DOI: 10.3174/ajnr.A4018

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Comparison of Multiple Parameters Obtained on 3T Pulsed Arterial Spin-Labeling, Diffusion Tensor Imaging, and MRS and the Ki-67 Labeling Index in Evaluating Glioma Grading
H. Fudaba, T. Shimomura, T. Abe, H. Matsuta, Y. Momii, K. Sugita, H. Ooba, T. Kamida, T. Hikawa, M. Fujiki
American Journal of Neuroradiology Nov 2014, 35 (11) 2091-2098; DOI: 10.3174/ajnr.A4018
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