PT  - JOURNAL ARTICLE
AU  - Weber, M. A.
AU  - Zoubaa, S.
AU  - Schlieter, M.
AU  - Jüttler, E.
AU  - Huttner, H. B.
AU  - Geletneky, K.
AU  - Ittrich, C.
AU  - Lichy, M. P.
AU  - Kroll, A.
AU  - Debus, J.
AU  - Giesel, F. L.
AU  - Hartmann, M.
AU  - Essig, M.
TI  - Diagnostic performance of spectroscopic and perfusion MRI for distinction of brain tumors
AID  - 10.1212/01.wnl.0000219767.49705.9c
DP  - 2006 Jun 27
TA  - Neurology
PG  - 1899--1906
VI  - 66
IP  - 12
4099  - http://n.neurology.org/content/66/12/1899.short
4100  - http://n.neurology.org/content/66/12/1899.full
SO  - Neurology2006 Jun 27; 66
AB  - Objective: To assess the value of spectroscopic and perfusion MRI for glioma grading and for distinguishing glioblastomas from metastases and from CNS lymphomas. Methods: The authors examined 79 consecutive patients with first detection of a brain neoplasm on nonenhanced CT scans and no therapy prior to evaluation. Spectroscopic MRI; arterial spin-labeling MRI for measuring cerebral blood flow (CBF); first-pass dynamic, susceptibility-weighted, contrast-enhanced MRI for measuring cerebral blood volume; and T1-weighted dynamic contrast-enhanced MRI were performed. Receiver operating characteristic analysis was performed, and optimum thresholds for tumor classification and glioma grading were determined. Results: Perfusion MRI had a higher diagnostic performance than spectroscopic MRI. Because of a significantly higher tumor blood flow in glioblastomas compared with CNS lymphomas, a threshold value of 1.2 for CBF provided sensitivity of 97%, specificity of 80%, positive predictive value (PPV) of 94%, and negative predictive value (NPV) of 89%. Because CBF was significantly higher in peritumoral nonenhancing T2-hyperintense regions of glioblastomas compared with metastases, a threshold value of 0.5 for CBF provided sensitivity, specificity, PPV, and NPV of 100%, 71%, 94%, and 100%. Glioblastomas had the highest tumor blood flow values among all other glioma grades. For discrimination of glioblastomas from grade 3 gliomas, sensitivity was 97%, specificity was 50%, PPV was 84%, and NPV was 86% (CBF threshold value of 1.4), and for discrimination of glioblastomas from grade 2 gliomas, sensitivity was 94%, specificity was 78%, PPV was 94%, and NPV was 78% (CBF threshold value of 1.6). Conclusion: Perfusion MRI is predictive in distinguishing glioblastomas from metastases, CNS lymphomas and other gliomas vs MRI and magnetic resonance spectroscopy.