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OBJECTIVE Grading of glioma according to the WHO classification plays an important role in the treatment of patients with glioma. It is widely recognized that malignant gliomas exhibit contrast enhancement on MRI, whereas low-grade gliomas do not exhibit contrast enhancement. However, we sometimes encounter malignant gliomas without contrast enhancement on MRI. In this study, we evaluated the diagnostic accuracy of contrast-enhanced MRI and PET for distinguishing the WHO grade of glioma. METHODS A total of 105 patients with newly diagnosed cerebral glioma were included in the study. All patients underwent 11C-Methionine (MET), 11C-Choline (CHO), 18F-Fluorodeoxyglucose (FDG) PET and MRI. The specificity and sensitivity of MRI contrast enhancement and mean T/N ratios of these three tracers for each WHO grade were analyzed. RESULTS Contrast enhancement was observed in 35 patients (33%) of the total. Contrast enhancement was observed in 1/30 (3%) in grade 2, 8/43 (19%) in grade 3, and 26/30 (87%) in grade 4. The sensitivity and specificity of MRI for differentiating grade 2 from grade 3 was 11.1% and 54.7%, respectively. In contrast, the cutoff value, sensitivity, and specificity of each tracer for differentiating grade 2 from grade 3 were: 1.70, 66.7%, and 58.1% for MET; 2.15, 76.7%, and 51.2% for CHO; and 0.64, 80.0%, and 32.6% for FDG, respectively. DISCUSSION: A correlation between contrast enhancement of MRI and WHO grade was observed to some extent; however, only 19% grade 3 gliomas showed contrast enhancement. The sensitivity and specificity of PET for differentiating between grade 2 and 3 was relatively higher than that of MRI; however, it was not suitable for clinical use. CONCLUSION Contrast-enhanced MRI may not be reliable for determining the WHO grade for glioma, in particular differentiating between grade 2 and 3. Comprehensive evaluation with MRI and PET can provide more accurate diagnosis.

NI-01 CONTRAST-ENHANCED MRI AND POSITRON EMISSION TOMOGRAPHY FOR DISTINGUISHING THE GRADE OF GLIOMA