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Low-Grade Gliomas: Dynamic Susceptibility-weighted Contrast-enhanced Perfusion MR Imaging—Prediction of Patient Clinical Response¹

¹ From the Departments of Radiology (M.L., S.O., J.S.B., E.W., M.I., E.A.K., G.J.), Pathology (D.Z.), and Neurosurgery (D.Z., E.A.K.), New York University Medical Center, MRI Department, Schwartz Building, Basement HCC, 530 First Ave, New York, NY 10016. Received December 23, 2004; revision requested February 23, 2005; revision received March 30; final version accepted May 2. Supported by grant RO1CA093992 from the National Institutes of Health. Address correspondence to M.L. (e-mail: lawm01{at}med.nyu.edu).

View larger version (16K): [in a new window]   Figure 1: Kaplan-Meier survival curves for time to progression within groups with low (<1.75) and high (>1.75) relative CBV. Low-grade gliomas with low relative CBV had a median time to progression of 4620 days ± 433 (solid curve that is far right shifted). Low-grade gliomas with high relative CBV had a median time to progression of 245 days ± 62 (dotted curve that is far left shifted) (P < .005). Data suggest that baseline relative CBV may be a stronger predictor of patient outcome than the initial histopathologic diagnosis, because if these were all true low-grade gliomas, the median time to progression would have been much longer than 245 days (8 months).

View larger version (109K): [in a new window]   Figure 2: MR images in 41-year-old woman with a pathologically proved low-grade oligodendroglioma and low baseline relative CBV of 1.42. A, Transverse FLAIR image (9000/110/2500). B, Transverse T2-weighted image (3400/119) shows increased signal intensity within the posterior right thalamus with minimal mass effect (arrow). C, Transverse contrast-enhanced T1-weighted image (600/14) demonstrates subtle decrease in signal intensity in the corresponding region without contrast enhancement. The lack of enhancement suggests a low-grade glioma at conventional MR imaging. D, Transverse gradient-echo (1000/54) dynamic susceptibility-weighted perfusion contrast-enhanced MR image with relative CBV color overlay map shows a lesion with relatively low perfusion (relative CBV of 1.42), in keeping with a low-grade glioma. E, Transverse FLAIR image (9000/110/2500) at 473 days (68 weeks) of follow-up. F, Transverse T2-weighted image (3400/119) demonstrates both very minimal change in tumor volume and signal abnormality. G, Transverse contrast-enhanced T1-weighted image (600/14) demonstrates nonenhancing lesion that remained stable after 473 days of follow-up, suggesting a true low-grade lesion without malignant transformation or components. H, Transverse gradient-echo (1000/54) dynamic susceptibility-weighted perfusion contrast-enhanced MR image with relative CBV color overlay map shows lesion with stable perfusion and relative CBV of 1.01.

View larger version (106K): [in a new window]   Figure 3: MR images in 80-year-old man with pathologically proved low-grade oligodendroglioma and high baseline relative CBV of 3.21. A, Transverse FLAIR image (9000/110/2500). B, Transverse T2-weighted image (3400/119) shows area of increased signal intensity in right insula, with some mass effect on adjacent basal ganglionic structures, and in right posterior thalamus. C, Transverse contrast-enhanced T1-weighted image (600/14) demonstrates subtle enhancement at posterior right insula (arrow). D, Transverse gradient-echo (1000/54) dynamic susceptibility-weighted perfusion contrast-enhanced MR image with relative CBV color overlay map shows lesion with high initial perfusion and relative CBV of 3.28, more in keeping with high-grade glioma than with low-grade glioma. E, Transverse FLAIR image (9000/110/2500) at 165 days (24 weeks) of follow-up shows tumor infiltration into periventricular white matter (arrow). F, Transverse T2-weighted image (3400/119) shows increased tumor volume. Measured T2 signal volume increased to 28.30 cm3. Increased mass effect on occipital horn of lateral ventricle and infiltration of tumor into periventricular white matter (arrow), when compared with B, were observed. G, Transverse contrast-enhanced T1-weighted image (600/14) demonstrates increase in T1 volume, but degree of contrast enhancement is unchanged. H, Transverse gradient-echo (1000/54) dynamic susceptibility-weighted perfusion contrast-enhanced MR image with relative CBV color overlay map demonstrates that relative CBV increased from 3.28 to 3.65 at follow-up.

View larger version (114K): [in a new window]   Figure 4: MR images in a 53-year-old man with pathologically proved low-grade mixed oligoastrocytoma and high baseline relative CBV of 4.29. A, Transverse FLAIR image (9000/110/2500) shows area of increased signal intensity within right mesial frontal lobe (arrow). B, Transverse T2-weighted image (3400/119) shows area of increased signal intensity within right mesial frontal lobe (arrow), with some mass effect on adjacent genu of corpus callosum. C, Transverse contrast-enhanced T1-weighted image (600/14) demonstrates no appreciable enhancement, a finding compatible with imaging and pathologic diagnosis of low-grade glioma. D, Transverse gradient-echo (1000/54) dynamic susceptibility-weighted perfusion contrast-enhanced MR image with relative CBV color overlay map shows lesion with high initial perfusion and relative CBV of 4.23, more in keeping with high-grade glioma than with low-grade glioma. E, Transverse FLAIR image (9000/110/2500) obtained at 127 days (18 weeks) of follow-up. F, Transverse T2-weighted image (3400/119) shows substantial increase in tumor volume and in volume of T2 signal abnormality to 220.97 cm3. Obvious evidence of tumor crossing corpus callosum to the contralateral left frontal lobe is seen. G, Transverse contrast-enhanced T1-weighted image (600/14) demonstrates increase in enhancing tumor volume to 58.23 cm3. More mass effect, with almost complete effacement of frontal horns, is seen. H, Transverse gradient-echo (1000/54) dynamic susceptibility-weighted perfusion contrast-enhanced MR image with relative CBV color overlay map demonstrates progressively increasing relative CBV from 4.23 to 13.37.