• Jitender Saini, Rakesh Kumar Gupta, Manoj Kumar, Anup Singh, Indrajit Saha, Vani Santosh, Manish Beniwal, Thennarasu Kandavel, and CauterenMarc VanMVPhilips Health Tech Asia Pacific, Minato-ku Tokyo, Japan..
• Department of Neuroimaging & Interventional Radiology, National Institute of Mental, Health and Neurosciences, Bangalore, Karnataka, India.
• Plos One. 2019 Jan 1; 14 (4): e0215400.

ObjectiveTo assess the inter-technique agreement of relative cerebral blood volume (rCBV) measurements obtained using T1- and T2*-perfusion MRI on 3T scanner in glioma patients.MethodsA total of 49 adult patients with gliomas underwent both on T1- and T2*-perfusion in the same scanning session, and rCBV maps were estimated using both methods. For the quantitative analysis; Two independent observers recorded the rCBV values from the tumor as well as contralateral brain tissue from both T1- and T2*-perfusion. Inter-observer and inter-technique rCBV measurement agreement were determined by using 95% Bland-Altman limits of agreement and intra-class correlation coefficient (ICC) statistics.ResultsQualitative analysis of the conventional and perfusion images showed that 16/49 (32.65%) tumors showed high susceptibility, and in these patients T2*-perfusion maps were suboptimal. Bland-Altman plots revealed an agreement between two independent observers recorded rCBV values for both T1- and T2*-perfusion. The ICC demonstrated strong agreement between rCBV values recorded by two observers for both T2* (ICC = 0.96, p = 0.040) and T1 (ICC = 0.97, p = 0.026) perfusion and similarly, good agreement was noted between rCBV estimated using two methods (ICC = 0.74, P<0.001). ROC analysis showed that rCBV estimated using T1- and T2*-perfusion methods were able to discriminate between grade-III and grade-IV tumors with AUC of 0.723 and 0.767 respectively. Comparison of AUC values of two ROC curves did not show any significant difference.ConclusionsIn the current study, T1- and T2*-perfusion showed similar diagnostic performance for discrimination of grade III and grade IV gliomas; however, T1-perfusion was found to be better for the evaluation of tumors with intratumoral hemorrhage, postoperative recurrent tumors, and lesions near skull base. We conclude that T1-perfusion MRI with a single dose of contrast could be used as an alternative to T2*-perfusion to overcome the issues associated with this technique in brain tumors for reliable perfusion quantification.

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