, Volume 56, Issue 12, pp 1031–1038 | Cite as

Discrimination between glioma grades II and III in suspected low-grade gliomas using dynamic contrast-enhanced and dynamic susceptibility contrast perfusion MR imaging: a histogram analysis approach

  • Anna FalkEmail author
  • Markus Fahlström
  • Egill Rostrup
  • Shala Berntsson
  • Maria Zetterling
  • Arvid Morell
  • Henrik B.W. Larsson
  • Anja Smits
  • Elna-Marie Larsson
Diagnostic Neuroradiology



Perfusion magnetic resonance imaging (MRI) can be used in the pre-operative assessment of brain tumours. The aim of this prospective study was to identify the perfusion parameters from dynamic contrast-enhanced (DCE) and dynamic susceptibility contrast (DSC) perfusion imaging that could best discriminate between grade II and III gliomas.


MRI (3 T) including morphological ((T2 fluid attenuated inversion recovery (FLAIR) and T1-weighted (T1W)+Gd)) and perfusion (DCE and DSC) sequences was performed in 39 patients with newly diagnosed suspected low-grade glioma after written informed consent in this review board-approved study. Regions of interests (ROIs) in tumour area were delineated on FLAIR images co-registered to DCE and DSC, respectively, in 25 patients with histopathological grade II (n = 18) and III (n = 7) gliomas. Statistical analysis of differences between grade II and grade III gliomas in histogram perfusion parameters was performed, and the areas under the curves (AUC) from the ROC analyses were evaluated.


In DCE, the skewness of transfer constant (k trans) was found superior for differentiating grade II from grade III in all gliomas (AUC 0.76). In DSC, the standard deviation of relative cerebral blood flow (rCBF) was found superior for differentiating grade II from grade III gliomas (AUC 0.80).


Histogram parameters from k trans (DCE) and rCBF (DSC) could most efficiently discriminate between grade II and grade III gliomas.


Dynamic contrast-enhanced MRI Dynamic susceptibility contrast MRI Perfusion MRI Glioma Histogram analysis 



Area under the curve


Dynamic contrast-enhanced


Dynamic susceptibility contrast


Fluid attenuated inversion recovery


Internal carotid artery


Transfer constant


Apparent transfer constant


Region of interest


Receiver operating characteristics




Echo time


Repetition time


Ethical standards and patient consent

We declare that all human studies have been approved by the Uppsala Ethics Committee and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. We declare that all patients gave informed consent prior to inclusion in this study.


The authors would like to thank Lars Berglund, Statistician, Uppsala Clinical Research Center, Sweden, Monika Gelotte, Research Assistant, Uppsala University, Sweden, and Håkan Petterson, IT Manager, Uppsala University, Sweden.

Conflict of interest

We declare that we have no conflict of interest.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Anna Falk
    • 1
    Email author
  • Markus Fahlström
    • 1
  • Egill Rostrup
    • 2
  • Shala Berntsson
    • 3
  • Maria Zetterling
    • 3
  • Arvid Morell
    • 1
  • Henrik B.W. Larsson
    • 2
  • Anja Smits
    • 3
  • Elna-Marie Larsson
    • 1
  1. 1.Department of Radiology, Oncology and Radiation Science, Section of RadiologyUppsala UniversityUppsalaSweden
  2. 2.Functional Imaging Unit, Glostrup Hospital, GlostrupUniversity of CopenhagenCopenhagenDenmark
  3. 3.Department of Neuroscience, NeurologyUppsala UniversityUppsalaSweden

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