Purpose:

It has been well demonstrated that the accuracy and reliability of pharmacokinetic parameters from dynamic contrast-enhanced (DCE) magnetic resonance (MR) imaging are affected by arterial input function (AIF).^1-4 However, the most optimal method to obtain AIF has not yet been fully determined. The aim of the present study was to compare two AIFs derived from DCE (AIF_DCE) and dynamic susceptibility-contrast (DSC) MR imaging (AIF_DSC) in terms of the diagnostic accuracy and reliability of pharmacokinetic parameters from DCE MR imaging for differentiation of high grade from low grade glioma.

Methods:

This retrospective study included 70 patients (39 men, 31 women; mean age, 45.3 years; age range, 28–79 years) with pathologically confirmed gliomas (World Health Organization grade II, n=21; grade III, n=16; grade IV, n=33). In all of the patients, we performed DSC and DCE MR imaging before operation, and two AIFs (AIF_DSC and AIF_DCE) were obtained from each image. Pharmacokinetic parameters from DCE MRI using both AIF_DSC and AIF_DCE, including K_trans, V_p, and V_e, were processed by using a dedicated post-processing software (Nordic ICE; Nordic NeuroLab, Bergen, Norway). The diagnostic accuracies of individual parameters to differentiate high grade from low grade glioma were compared using Receiver operating characteristic (ROC) curve analysis. To compare the intra-observer reliability, those parameters were re-measured with same method, and the result of that were analyzed using intra-class correlation coefficient (ICC) and Bland-Altman analysis.

Results:

The mean K_trans and V_e measured by using AIF_DSC were more accurate to differentiate high grade glioma than AIF_DCE (AUC; mean K_trans, 0.855 (0.751, 0.928) and 0.636 (0.512, 0.747) for AIF_DSC and AIF_DCE, respectively, P<.001; mean V_e, 0.840 (0.732, 0.916) and 0.635 (0.511, 0747) for AIF_DSC and AIF_DCE, respectively, P<.001). All of the three parameters, K_trans, V_p, and V_e, showed better ICC using AIF_DSC than that from AIF_DCE (K_trans, 0.946 and 0.164; V_p, 0.974 and 0.831; V_e, 0.913 and 0.744 for AIF_DSC and AIF_DCE, respectively).

Conclusion:

DCE MR imaging parameters obtained using AIF_DSC showed better accuracy and reliability for differentiating high grade glioma from low grade glioma than those derived from AIF_DCE. We believe that this new method using AIF_DSC to process pharmacokinetic parameters from DCE MR imaging can be an alternative to improve clinical applications of DCE MR imaging.

Acknowledgements

No acknowledgement found.

References

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