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66th Annual Meeting of the German Society of Neurosurgery (DGNC)
Friendship Meeting with the Italian Society of Neurosurgery (SINch)

German Society of Neurosurgery (DGNC)

7 - 10 June 2015, Karlsruhe

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Improving the diagnostic quality of glioma biopsies using T1-DCE MRI permeability maps

Meeting Abstract

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  • Vera C. Keil - Radiologische Klinik, Universitätsklinikum Bonn, Bonn
  • Bogdan Pintea - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Bonn, Bonn
  • Gerrit Gielen - Institut für Neuropathologie, Universitätsklinikum Bonn, Bonn
  • Dariusch R. Hadizadeh - Radiologische Klinik, Universitätsklinikum Bonn, Bonn
  • Hans H. Schild - Radiologische Klinik, Universitätsklinikum Bonn, Bonn
  • Matthias Simon - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Bonn, Bonn

Deutsche Gesellschaft für Neurochirurgie. 66. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Karlsruhe, 07.-10.06.2015. Düsseldorf: German Medical Science GMS Publishing House; 2015. DocMI.03.04

doi: 10.3205/15dgnc264, urn:nbn:de:0183-15dgnc2644

Published: June 2, 2015

© 2015 Keil et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

Text

Objective: A considerable percentage of glioma biopsies fail to retrieve diagnostically accurate tissue specimens. This study investigates if the diagnostic quality can be increased using the quantitative information of Ktrans maps based on T1-weighted dynamic contrast-enhanced (T1-DCE) MRI sequences.

Method: Nineteen pre-operative glioma patients (13 glioblastoma, 3 astrocytoma WHO III, 2 oligoastrocytoma WHO III, 1 oligoastrocytoma WHO II) received a T1-DCE MRI sequence at 3.0 Tesla (flip angle 8°; 50 dynamic scans; slice thickness 3 mm; trial method) and a gadobutrol-enhanced 3D T1 navigator map (0.1 mmol/kg BW Gadovist; standard method). In addition to their planned tumor resection all patients also had biopsies of the tumor during its removal as part of this study. Target regions for biopsies were defined by a neurosurgeon based on the T1 navigator map, or by a neuroradiologist based on permeability (Ktrans) and extravascular extracellular volume fraction (ve) maps. A blinded neuropathologist ranked all biopsies for diagnostic quality defined as concordance with the final diagnosis.

Results: Fifty glioblastoma, 9 WHO III astrocytoma, 7 WHO III oligodendroglioma and 1 WHO II oligodendroglioma biopsies were taken. Ktrans map based biopsies were more frequently rated diagnostically accurate as compared to T1 navigator map-based biopsies (63.3% vs. 50.0%; P=NS). Ratiometric analyses of Ktrans and ve revealed higher values for accurate biopsies (Ktrans accurate: 3.68 ± 3.51/min, incorrect: 2.80 ± 3.48; ve accurate: 4.74 ± 5.28, ve incorrect: 3.03 ± 3.80; both P=NS). In 3/11 cases only Ktrans map based specimens allowed a correct diagnosis, while no case could exclusively be diagnosed based on T1 map specimens. Ktrans values correlated significantly with the WHO grade (one way ANOVA, P<0.001) and a trend was seen for ve (P=0.078).

Conclusions: T1-DCE MR imaging allows for a quantitative visualisation of intratumoral disruption of the blood brain barrier in gliomas. In presumed WHO III and IV gliomas, the diagnostic quality of a biopsy can be improved if Ktrans permeability maps are used for target selection when compared to standard T1w images. T1-DCE MR imaging may also help with the pre-operative differentiation between WHO grades.