Open AccessDifferentiation of High-Grade from Low-Grade Astrocytoma: Improvement in Diagnostic Accuracy and Reliability of Pharmacokinetic Parameters from DCE MR Imaging by Using Arterial Input Functions Obtained from DSC MR Imaging
Author(s) -
Sung Hyun You,
Seung Hong Choi,
Tae Min Kim,
ChulKee Park,
Sunghye Park,
Jae Kyung Won,
Il Han Kim,
Sang Kun Lee,
Hye Jeong Choi,
Roh Eul Yoo,
Koung Mi Kang,
Tae Jin Yun,
Ji Hoon Kim,
ChulHo Sohn
Publication year - 2018
Publication title -
radiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.118
H-Index - 295
eISSN - 1527-1315
pISSN - 0033-8419
DOI - 10.1148/radiol.2017170764
Subject(s) - medicine , intraclass correlation , nuclear medicine , receiver operating characteristic , magnetic resonance imaging , dynamic contrast , area under the curve , radiology , clinical psychology , psychometrics
Purpose To evaluate whether arterial input functions (AIFs) derived from dynamic susceptibility-contrast (DSC) magnetic resonance (MR) imaging, or AIF DSC values, improve diagnostic accuracy and reliability of the pharmacokinetic (PK) parameters of dynamic contrast material-enhanced (DCE) MR imaging for differentiating high-grade from low-grade astrocytomas, compared with AIFs obtained from DCE MR imaging (AIF DCE ). Materials and Methods This retrospective study included 226 patients (138 men, 88 women; mean age, 52.27 years ± 15.17; range, 24-84 years) with pathologically confirmed astrocytomas (World Health Organization grade II = 21, III = 53, IV = 152; isocitrate dehydrogenase mutant, 11.95% [27 of 226]; 1p19q codeletion 0% [0 of 226]). All patients underwent both DSC and DCE MR imaging before surgery, and AIF DSC and AIF DCE were obtained from each image. Volume transfer constant (K trans ), volume of vascular plasma space (v p) , and volume of extravascular extracellular space (v e ) were processed by using postprocessing software with two AIFs. The diagnostic accuracies of individual parameters were compared by using receiver operating characteristic curve (ROC) analysis. Intraclass correlation coefficients (ICCs) and the Bland-Altman method were used to assess reliability. Results The AIF DSC -driven mean K trans and v e were more accurate for differentiating high-grade from low-grade astrocytoma than those derived by using AIF DCE (area under the ROC curve: mean K trans , 0.796 vs 0.645, P = .038; mean v e , 0.794 vs 0.658, P = .020). All three parameters had better ICCs with AIF DSC than with AIF DCE (K trans , 0.737 vs 0.095; v p , 0.848 vs 0.728; v e , 0.875 vs 0.581, respectively). In AIF analysis, maximal signal intensity (0.837 vs 0.524) and wash-in slope (0.800 vs 0.432) demonstrated better ICCs with AIF DSC than AIF DCE . Conclusion AIF DSC -driven DCE MR imaging PK parameters showed better diagnostic accuracy and reliability for differentiating high-grade from low-grade astrocytoma than those derived from AIF DCE . © RSNA, 2017 Online supplemental material is available for this article.