Relative cerebral blood volume from dynamic susceptibility contrast perfusion in the grading of pediatric primary brain tumors

Neuroradiology. 2015 Mar;57(3):299-306. doi: 10.1007/s00234-014-1478-0. Epub 2014 Dec 13.


Introduction: The aim of this study is to evaluate the utility of relative cerebral blood volume (rCBV) data from dynamic susceptibility contrast (DSC) perfusion in grading pediatric primary brain tumors.

Methods: A retrospective blinded review of 63 pediatric brain tumors with DSC perfusion was performed independently by two neuroradiologists. A diagnosis of low- versus high-grade tumor was obtained from conventional imaging alone. Maximum rCBV (rCBVmax) was measured from manual ROI placement for each reviewer and averaged. Whole-tumor CBV data was obtained from a semi-automated approach. Results from all three analyses were compared to WHO grade.

Results: Based on conventional MRI, the two reviewers had a concordance rate of 81% (k = 0.62). Compared to WHO grade, the concordant cases accurately diagnosed high versus low grade in 82%. A positive correlation was demonstrated between manual rCBVmax and tumor grade (r = 0.30, P = 0.015). ROC analysis of rCBVmax (area under curve 0.65, 0.52-0.77, P = 0.03) gave a low-high threshold of 1.38 with sensitivity of 92% (74-99%), specificity of 40% (24-57%), NPV of 88% (62-98%), and PPV of 50% (35-65%) Using this threshold on 12 discordant tumors between evaluators from conventional imaging yielded correct diagnoses in nine patients. Semi-automated analysis demonstrated statistically significant differences between low- and high-grade tumors for multiple metrics including average rCBV (P = 0.027).

Conclusions: Despite significant positive correlation with tumor grade, rCBV from pediatric brain tumors demonstrates limited specificity, but high NPV in excluding high-grade neoplasms. In selective patients whose conventional imaging is nonspecific, an rCBV threshold may have further diagnostic value.

MeSH terms

  • Adolescent
  • Blood Volume Determination / methods*
  • Blood Volume*
  • Brain Neoplasms / diagnosis*
  • Brain Neoplasms / physiopathology*
  • Cerebrovascular Circulation
  • Child
  • Child, Preschool
  • Contrast Media
  • Female
  • Humans
  • Image Enhancement / methods
  • Image Interpretation, Computer-Assisted / methods*
  • Infant
  • Magnetic Resonance Angiography / methods*
  • Male
  • Meglumine / analogs & derivatives
  • Observer Variation
  • Organometallic Compounds
  • Pattern Recognition, Automated / methods
  • Reproducibility of Results
  • Sensitivity and Specificity


  • Contrast Media
  • Organometallic Compounds
  • gadobenic acid
  • Meglumine