Gliomas: application of cumulative histogram analysis of normalized cerebral blood volume on 3 T MRI to tumor grading

PLoS One. 2013 May 21;8(5):e63462. doi: 10.1371/journal.pone.0063462. Print 2013.


Background: Glioma grading assumes significant importance in that low- and high-grade gliomas display different prognoses and are treated with dissimilar therapeutic strategies. The objective of our study was to retrospectively assess the usefulness of a cumulative normalized cerebral blood volume (nCBV) histogram for glioma grading based on 3 T MRI.

Methods: From February 2010 to April 2012, 63 patients with astrocytic tumors underwent 3 T MRI with dynamic susceptibility contrast perfusion-weighted imaging. Regions of interest containing the entire tumor volume were drawn on every section of the co-registered relative CBV (rCBV) maps and T2-weighted images. The percentile values from the cumulative nCBV histograms and the other histogram parameters were correlated with tumor grades. Cochran's Q test and the McNemar test were used to compare the diagnostic accuracies of the histogram parameters after the receiver operating characteristic curve analysis. Using the parameter offering the highest diagnostic accuracy, a validation process was performed with an independent test set of nine patients.

Results: The 99th percentile of the cumulative nCBV histogram (nCBV C99), mean and peak height differed significantly between low- and high-grade gliomas (P = <0.001, 0.014 and <0.001, respectively) and between grade III and IV gliomas (P = <0.001, 0.001 and <0.001, respectively). The diagnostic accuracy of nCBV C99 was significantly higher than that of the mean nCBV (P = 0.016) in distinguishing high- from low-grade gliomas and was comparable to that of the peak height (P = 1.000). Validation using the two cutoff values of nCBV C99 achieved a diagnostic accuracy of 66.7% (6/9) for the separation of all three glioma grades.

Conclusion: Cumulative histogram analysis of nCBV using 3 T MRI can be a useful method for preoperative glioma grading. The nCBV C99 value is helpful in distinguishing high- from low-grade gliomas and grade IV from III gliomas.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Area Under Curve
  • Astrocytoma / pathology
  • Astrocytoma / physiopathology
  • Blood Volume / physiology*
  • Brain Neoplasms / pathology*
  • Brain Neoplasms / physiopathology*
  • Cerebrovascular Circulation / physiology*
  • Female
  • Glioma / pathology*
  • Glioma / physiopathology*
  • Humans
  • Magnetic Resonance Imaging*
  • Male
  • Middle Aged
  • Neoplasm Grading
  • ROC Curve

Grant support

This study was supported by a grant from the National R&D Program for Cancer Control, Ministry of Health & Welfare, Republic of Korea (1120300) and the Korea Healthcare technology R&D Projects, Ministry for Health, Welfare & Family Affairs (A112028). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.