Correlations between Perfusion MR Imaging Cerebral Blood Volume, Microvessel Quantification, and Clinical Outcome Using Stereotactic Analysis in Recurrent High-Grade Glioma

Quantifying MVA rather than MVD provides better correlation with survival in HGG. This is attributed to a specific "glomeruloid" vascular pattern, which is better characterized by vessel area than number. Despite its prognostic value, MVA quantification is laborious and clinically impracti...

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Bibliographic Details
Published in:American journal of neuroradiology : AJNR 2012-01, Vol.33 (1), p.69-76
Main Authors: HU, L. S, ESCHBACHER, J. M, NAKAJI, P, DEBBINS, J, FEUERSTEIN, B. G, BAXTER, L. C, DUECK, A. C, HEISERMAN, J. E, LIU, S, KARIS, J. P, SMITH, K. A, SHAPIRO, W. R, PINNADUWAGE, D. S, COONS, S. W
Format: Article
Language:English
Subjects:
Adult
Biological and medical sciences
Blood Volume Determination
Brain
Brain Neoplasms - blood supply
Brain Neoplasms - pathology
Brain Neoplasms - surgery
Cardiovascular system
Female
Glioma - pathology
Glioma - surgery
Humans
Investigative techniques, diagnostic techniques (general aspects)
Magnetic Resonance Angiography - methods
Male
Medical sciences
Microvessels - pathology
Middle Aged
Neoplasm Recurrence, Local - blood supply
Neoplasm Recurrence, Local - pathology
Neoplasm Recurrence, Local - prevention & control
Neovascularization, Pathologic - pathology
Nervous system
Prognosis
Radiodiagnosis. Nmr imagery. Nmr spectrometry
Reproducibility of Results
Sensitivity and Specificity
Statistics as Topic
Stereotaxic Techniques
Treatment Outcome
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Summary:Quantifying MVA rather than MVD provides better correlation with survival in HGG. This is attributed to a specific "glomeruloid" vascular pattern, which is better characterized by vessel area than number. Despite its prognostic value, MVA quantification is laborious and clinically impractical. The DSC-MR imaging measure of rCBV offers the advantages of speed and convenience to overcome these limitations; however, clinical use of this technique depends on establishing accurate correlations between rCBV, MVA, and MVD, particularly in the setting of heterogeneous vascular size inherent to human HGG. We obtained preoperative 3T DSC-MR imaging in patients with HGG before stereotactic surgery. We histologically quantified MVA, MVD, and vascular size heterogeneity from CD34-stained 10-μm sections of stereotactic biopsies, and we coregistered biopsy locations with localized rCBV measurements. We statistically correlated rCBV, MVA, and MVD under conditions of high and low vascular-size heterogeneity and among tumor grades. We correlated all parameters with OS by using Cox regression. We analyzed 38 biopsies from 24 subjects. rCBV correlated strongly with MVA (r = 0.83, P < .0001) but weakly with MVD (r = 0.32, P = .05), due to microvessel size heterogeneity. Among samples with more homogeneous vessel size, rCBV correlation with MVD improved (r = 0.56, P = .01). OS correlated with both rCBV (P = .02) and MVA (P = .01) but not with MVD (P = .17). rCBV provides a reliable estimation of tumor MVA as a biomarker of glioma outcome. rCBV poorly estimates MVD in the presence of vessel size heterogeneity inherent to human HGG.
ISSN:0195-6108
1936-959X
DOI:10.3174/ajnr.a2743