Abstract
BACKGROUND: Dynamic susceptibility contrast perfusion-weighted imaging (DSC-PWI) can be used to differentiate the glioma grade and characterize the high-perfusion cores of gliomas. However, the arterial input function (AIF) and gamma-variate fitting (GVF) can both derive perfusion metrics [e.g., the relative cerebral blood volume (rCBV)]. The study aimed to compare the consistency of the normalized rCBV (nrCBV) between AIF and GVF in adult-type gliomas with different grades and isocitrate dehydrogenase (IDH) statuses, and then investigated the efficiency of percentage of signal recovery (PSR) and gadolinium (Gd) leakage effects in evaluating adult-type gliomas. METHODS: A total of 60 patients with preoperative adult-type gliomas [IDH-mutant (IDH(M)): 37 vs. IDH wild-type (IDH(W)): 23] were retrospectively imaged via DSC-PWI, which was processed to obtain the nrCBV via AIF (AIF-nrCBV) and GVF (GVF-nrCBV). IDH(M) includes adult-type gliomas with grade 2 [19] and grade 3 [18]. IDH(W) includes 23 adult-type gliomas with grade 4. The PSR was calculated from the raw time-signal intensity curve (TIC). T(2)* and T1 leakage effects derived from AIF were graded via a Likert scale (ranging from 0 to 3). The correlation and paired difference of nrCBV between AIF and GVF were analyzed by linear correlation analysis and Bland-Altman plots in adult-type gliomas with different grades and IDH statuses. Spearman correlation analysis was used to test the correlation between PSR and two leakage effects. The differences of PSR and both leakage effect in adult-type gliomas with different grades and IDH statuses (IDH(M) vs. IDH(W)) were evaluated by one-way analysis of variance and Fisher's exact test. RESULTS: AIF-nrCBV was correlated with GVF-nrCBV in adult-type gliomas with different grades and IDH statuses (r=0.56-0.90, all P<0.01). However, the AIF slightly underestimated the nrCBV compared with the GVF in adult-type gliomas with grade 2 (-0.09±0.27) and IDH(M) (-0.04±0.32); conversely, the AIF slightly overestimated the nrCBV in adult-type gliomas with grades 3 (0.01±0.37), 4 (0.06±0.40), and IDH(W) (0.06±0.40). The PSR was negatively correlated with the point difference between two leakage effects (r=-0.64, P<0.001). The PSR of gliomas with grade 4 and IDH(W) was greater than that of those with grade 2 and IDH(M) (all P<0.05). Although the point difference in leakage effects was not significant between different grades and IDH statuses, the adult-type gliomas with high grades and IDH(W) were more prone to T(2)* and T(1) leakage. CONCLUSIONS: AIF-nrCBV is correlated with the GVF-nrCBV in adult-type gliomas, regardless of grades and IDH statuses; however, the grades and IDH statuses could affect the consistency of the nrCBV between AIF and GVF. The T(2)* and T(1) leakage effects are dependent on grades and IDH statuses, the PSR is more effective than leakage effects in evaluating adult-type gliomas.