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 ORIGINAL ARTICLE
Year : 2020  |  Volume : 57  |  Issue : 1  |  Page : 36-43

Percentage signal intensity recovery: A step ahead of rCBV in DSC MR perfusion imaging for the differentiation of common neoplasms of brain


Department of Radiology, Columbia Asia Referral Hospital, Bangalore, Karnataka, India

Correspondence Address:
Sriram Patwari
Department of Radiology, Columbia Asia Referral Hospital, Bangalore, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijc.IJC_421_18

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Context: Relative cerebral blood volume (rCBV) and percentage signal recovery (PSR) obtained from T2* dynamic susceptibility contrast magnetic resonance imaging are important parameters for brain tumor assessment. Aim: To study the accuracy of PSR in the differentiation of low-grade glioma, high-grade glioma, lymphoma, and metastases particularly in comparison to rCBV. Settings and Design: Retrospective observational study. Subjects and Methods: Study included pathologically confirmed cases of 10 low-grade glioma, 22 high-grade glioma, 6 lymphoma, and 12 metastases (Total 50). PSR, relative PSR (rPSR), and rCBV were calculated. Statistical Analysis Used: Accuracy of these parameters studied statistically using analysis of variance and ROC (Receiver operating characteristic) curves. Results: rCBV was higher in metastases (3.45 ± 2.82) and high-grade glioma (3.47 ± 1.62), whereas was low in lymphoma (1.03 ± 0.74) and low-grade glioma (1.43 ± 0.47) with P value of 0.030. PSR was low in metastases (48 ± 16.18), intermediate in glioma (73.24 ± 6.39 and 88.26 ± 6.05, high and low grade), and high in lymphoma (112.16 ± 10.57) with P value < 0.000. rPSR was higher for lymphoma (1.73 ± 0.57) than high-grade glioma (0.85 ± 0.11) and metastasis (0.69 ± 0.19) with P value <.000. Area under ROC for PSR was greater than rCBV in differentiating metastases from lymphoma (1.00 vs 0.13), high-grade glioma from lymphoma (1.00 vs 0.38), high-grade glioma from metastases (0.89 vs 0.58), and high-grade glioma from low-grade glioma (0.96 vs 0.03) with excellent curve characteristics. F values for PSR and rPSR from ANOVA analysis were 71.47 and 36.77, was better than rCBV (3.84) in differentiating these groups. Conclusions: Percentage of signal recovery shows low recovery values in metastases, intermediate recovery values in glioma, and overshoot in lymphoma. PSR values show lower overlap than rCBV between lymphoma and metastases; and between high grade glioma and metastases. PSR difference is also higher than rCBV between low- and high-grade gliomas. Hence, PSR can potentially help as an additional perfusion parameter in the preoperative differentiation of these tumors.






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