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<meta name="DC.Title" content="Automated Processing of Dynamic Contrast-Enhanced MRI: Correlation of Advanced Pharmacokinetic Metrics with Tumor Grade in Pediatric Brain Tumors" />
<meta name="DC.Identifier" content="10.3174/ajnr.A4949" />
<meta name="DC.Date" content="2017-01-01" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
<meta name="DC.Rights" content="© 2017 by American Journal of Neuroradiology" />
<meta name="DC.AccessRights" content="restricted" />
<meta name="DC.Description" content="BACKGROUND AND PURPOSE: Pharmacokinetic parameters from dynamic contrast-enhanced MR imaging have proved useful for differentiating brain tumor grades in adults. In this study, we retrospectively reviewed dynamic contrast-enhanced perfusion data from children with newly diagnosed brain tumors and analyzed the pharmacokinetic parameters correlating with tumor grade.

MATERIALS AND METHODS: Dynamic contrast-enhanced MR imaging data from 38 patients were analyzed by using commercially available software. Subjects were categorized into 2 groups based on pathologic analyses consisting of low-grade (World Health Organization I and II) and high-grade (World Health Organization III and IV) tumors. Pharmacokinetic parameters were compared between the 2 groups by using linear regression models. For parameters that were statistically distinct between the 2 groups, sensitivity and specificity were also estimated.

RESULTS: Eighteen tumors were classified as low-grade, and 20, as high-grade. Transfer constant from the blood plasma into the extracellular extravascular space ( K trans), rate constant from extracellular extravascular space back into blood plasma (Kep), and extracellular extravascular volume fraction (Ve) were all significantly correlated with tumor grade; high-grade tumors showed higher K trans, higher Kep, and lower Ve. Although all 3 parameters had high specificity (range, 82%–100%), Kep had the highest specificity for both grades. Optimal sensitivity was achieved for Ve, with a combined sensitivity of 76% (compared with 71% for K trans and Kep).

CONCLUSIONS: Pharmacokinetic parameters derived from dynamic contrast-enhanced MR imaging can effectively discriminate low- and high-grade pediatric brain tumors.

IAUGC60
:   initial area under gadolinium curve at 60 seconds
DCE
:   dynamic contrast-enhanced
Kep
:   rate constant from extracellular extravascular space back into blood plasma
K trans
:   transfer constant from the blood plasma into the extracellular extravascular space
Ve
:   extracellular extravascular volume fraction
Vp
:   fractional blood plasma volume" />
<meta name="DC.Contributor" content="S. Vajapeyam" />
<meta name="DC.Contributor" content="C. Stamoulis" />
<meta name="DC.Contributor" content="K. Ricci" />
<meta name="DC.Contributor" content="M. Kieran" />
<meta name="DC.Contributor" content="T. Young Poussaint" />
<meta name="article:published_time" content="2017-01-01" />
<meta name="article:section" content="PEDIATRICS" />
<meta name="citation_title" content="Automated Processing of Dynamic Contrast-Enhanced MRI: Correlation of Advanced Pharmacokinetic Metrics with Tumor Grade in Pediatric Brain Tumors" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;Pharmacokinetic parameters from dynamic contrast-enhanced MR imaging have proved useful for differentiating brain tumor grades in adults. In this study, we retrospectively reviewed dynamic contrast-enhanced perfusion data from children with newly diagnosed brain tumors and analyzed the pharmacokinetic parameters correlating with tumor grade.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;Dynamic contrast-enhanced MR imaging data from 38 patients were analyzed by using commercially available software. Subjects were categorized into 2 groups based on pathologic analyses consisting of low-grade (World Health Organization I and II) and high-grade (World Health Organization III and IV) tumors. Pharmacokinetic parameters were compared between the 2 groups by using linear regression models. For parameters that were statistically distinct between the 2 groups, sensitivity and specificity were also estimated.&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;Eighteen tumors were classified as low-grade, and 20, as high-grade. Transfer constant from the blood plasma into the extracellular extravascular space (&lt;i&gt;K&lt;/i&gt;&lt;sup&gt;trans&lt;/sup&gt;), rate constant from extracellular extravascular space back into blood plasma (K&lt;sub&gt;ep&lt;/sub&gt;), and extracellular extravascular volume fraction (V&lt;sub&gt;e&lt;/sub&gt;) were all significantly correlated with tumor grade; high-grade tumors showed higher &lt;i&gt;K&lt;/i&gt;&lt;sup&gt;trans&lt;/sup&gt;, higher K&lt;sub&gt;ep&lt;/sub&gt;, and lower V&lt;sub&gt;e&lt;/sub&gt;. Although all 3 parameters had high specificity (range, 82%–100%), K&lt;sub&gt;ep&lt;/sub&gt; had the highest specificity for both grades. Optimal sensitivity was achieved for V&lt;sub&gt;e&lt;/sub&gt;, with a combined sensitivity of 76% (compared with 71% for &lt;i&gt;K&lt;/i&gt;&lt;sup&gt;trans&lt;/sup&gt; and K&lt;sub&gt;ep&lt;/sub&gt;).&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;Pharmacokinetic parameters derived from dynamic contrast-enhanced MR imaging can effectively discriminate low- and high-grade pediatric brain tumors.&lt;/p&gt;" />
<meta name="citation_journal_title" content="American Journal of Neuroradiology" />
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<meta name="citation_publication_date" content="2017/01/01" />
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<meta name="citation_author" content="S. Vajapeyam" />
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<meta name="citation_author_institution" content="eHarvard Medical School (S.V., C.S., M.K., T.Y.P.), Boston, Massachusetts." />
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<meta name="twitter:title" content="Automated Processing of Dynamic Contrast-Enhanced MRI: Correlation of Advanced Pharmacokinetic Metrics with Tumor Grade in Pediatric Brain Tumors" />
<meta name="twitter:card" content="summary_large_image" />
<meta name="twitter:image" content="http://ajnr-stage2.stage.highwire.org/sites/default/files/highwire/ajnr/38/1.cover-source.jpg" />
<meta name="twitter:description" content="BACKGROUND AND PURPOSE: Pharmacokinetic parameters from dynamic contrast-enhanced MR imaging have proved useful for differentiating brain tumor grades in adults. In this study, we retrospectively reviewed dynamic contrast-enhanced perfusion data from children with newly diagnosed brain tumors and analyzed the pharmacokinetic parameters correlating with tumor grade.

MATERIALS AND METHODS: Dynamic contrast-enhanced MR imaging data from 38 patients were analyzed by using commercially available software. Subjects were categorized into 2 groups based on pathologic analyses consisting of low-grade (World Health Organization I and II) and high-grade (World Health Organization III and IV) tumors. Pharmacokinetic parameters were compared between the 2 groups by using linear regression models. For parameters that were statistically distinct between the 2 groups, sensitivity and specificity were also estimated.

RESULTS: Eighteen tumors were classified as low-grade, and 20, as high-grade. Transfer constant from the blood plasma into the extracellular extravascular space ( K trans), rate constant from extracellular extravascular space back into blood plasma (Kep), and extracellular extravascular volume fraction (Ve) were all significantly correlated with tumor grade; high-grade tumors showed higher K trans, higher Kep, and lower Ve. Although all 3 parameters had high specificity (range, 82%–100%), Kep had the highest specificity for both grades. Optimal sensitivity was achieved for Ve, with a combined sensitivity of 76% (compared with 71% for K trans and Kep).

CONCLUSIONS: Pharmacokinetic parameters derived from dynamic contrast-enhanced MR imaging can effectively discriminate low- and high-grade pediatric brain tumors.

IAUGC60
:   initial area under gadolinium curve at 60 seconds
DCE
:   dynamic contrast-enhanced
Kep
:   rate constant from extracellular extravascular space back into blood plasma
K trans
:   transfer constant from the blood plasma into the extracellular extravascular space
Ve
:   extracellular extravascular volume fraction
Vp
:   fractional blood plasma volume" />
<meta name="og-title" property="og:title" content="Automated Processing of Dynamic Contrast-Enhanced MRI: Correlation of Advanced Pharmacokinetic Metrics with Tumor Grade in Pediatric Brain Tumors" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/38/1/170" />
<meta name="og-site-name" property="og:site_name" content="American Journal of Neuroradiology" />
<meta name="og-description" property="og:description" content="BACKGROUND AND PURPOSE: Pharmacokinetic parameters from dynamic contrast-enhanced MR imaging have proved useful for differentiating brain tumor grades in adults. In this study, we retrospectively reviewed dynamic contrast-enhanced perfusion data from children with newly diagnosed brain tumors and analyzed the pharmacokinetic parameters correlating with tumor grade.

MATERIALS AND METHODS: Dynamic contrast-enhanced MR imaging data from 38 patients were analyzed by using commercially available software. Subjects were categorized into 2 groups based on pathologic analyses consisting of low-grade (World Health Organization I and II) and high-grade (World Health Organization III and IV) tumors. Pharmacokinetic parameters were compared between the 2 groups by using linear regression models. For parameters that were statistically distinct between the 2 groups, sensitivity and specificity were also estimated.

RESULTS: Eighteen tumors were classified as low-grade, and 20, as high-grade. Transfer constant from the blood plasma into the extracellular extravascular space ( K trans), rate constant from extracellular extravascular space back into blood plasma (Kep), and extracellular extravascular volume fraction (Ve) were all significantly correlated with tumor grade; high-grade tumors showed higher K trans, higher Kep, and lower Ve. Although all 3 parameters had high specificity (range, 82%–100%), Kep had the highest specificity for both grades. Optimal sensitivity was achieved for Ve, with a combined sensitivity of 76% (compared with 71% for K trans and Kep).

CONCLUSIONS: Pharmacokinetic parameters derived from dynamic contrast-enhanced MR imaging can effectively discriminate low- and high-grade pediatric brain tumors.

IAUGC60
:   initial area under gadolinium curve at 60 seconds
DCE
:   dynamic contrast-enhanced
Kep
:   rate constant from extracellular extravascular space back into blood plasma
K trans
:   transfer constant from the blood plasma into the extracellular extravascular space
Ve
:   extracellular extravascular volume fraction
Vp
:   fractional blood plasma volume" />
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    <div class="highwire-article-citation highwire-citation-type-highwire-article node20--5" data-node-nid="20" id="top-node-20--61687791331" data-pisa="ajnr;38/1/170" data-pisa-master="ajnr;ajnr.A4949" data-apath="/ajnr/38/1/170.atom" data-hw-author-tooltip-instance="highwire_author_tooltip"><div class="highwire-cite highwire-cite-highwire-article highwire-citation-jcore-article-title-complete clearfix has-author-tooltip highwire-citation-highwire-article-top-a">
  
  
      <div class="highwire-cite-overline"><span  class="highwire-cite-metadata-article-type highwire-cite-metadata">Research Article</span><span class="separator-pipe"></span><span  class="highwire-cite-metadata-art-cat highwire-cite-metadata"><span class="wrapper">PEDIATRICS</span></span></div>
  
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      <h1 class="highwire-cite-title" id="page-title">Automated Processing of Dynamic Contrast-Enhanced MRI: Correlation of Advanced Pharmacokinetic Metrics with Tumor Grade in Pediatric Brain Tumors</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">S. Vajapeyam</span>, <span class="highwire-citation-author" data-delta="1">C. Stamoulis</span>, <span class="highwire-citation-author" data-delta="2">K. Ricci</span>, <span class="highwire-citation-author" data-delta="3">M. Kieran</span> and <span class="highwire-citation-author" data-delta="4">T. Young Poussaint</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">January 2017,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">38 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(1) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">170-175; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A4949 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-20--61687791331" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">S. Vajapeyam </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Departments of Radiology (S.V., C.S., T.Y.P.)</div><div class='author-affiliation'><span class='nlm-sup'>e</span>Harvard Medical School (S.V., C.S., M.K., T.Y.P.), Boston, Massachusetts.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=S.%2BVajapeyam%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Vajapeyam%20S&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AS.%2BVajapeyam%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0002-1782-1919" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for S. Vajapeyam</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">C. Stamoulis </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Departments of Radiology (S.V., C.S., T.Y.P.)</div><div class='author-affiliation'><span class='nlm-sup'>b</span>Neurology (C.S.), Boston Children's Hospital, Boston, Massachusetts</div><div class='author-affiliation'><span class='nlm-sup'>e</span>Harvard Medical School (S.V., C.S., M.K., T.Y.P.), Boston, Massachusetts.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=C.%2BStamoulis%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Stamoulis%20C&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AC.%2BStamoulis%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0001-9814-1802" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for C. Stamoulis</a></li></ul></div><div class="author-tooltip-2"><div class="author-tooltip-name">K. Ricci </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>c</span>Cancer Center (K.R.), Massachusetts General Hospital, Boston, Massachusetts</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=K.%2BRicci%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Ricci%20K&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AK.%2BRicci%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0002-7662-1220" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for K. Ricci</a></li></ul></div><div class="author-tooltip-3"><div class="author-tooltip-name">M. Kieran </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>d</span>Department of Pediatric Oncology (M.K.), Dana-Farber Cancer Center, Boston, Massachusetts</div><div class='author-affiliation'><span class='nlm-sup'>e</span>Harvard Medical School (S.V., C.S., M.K., T.Y.P.), Boston, Massachusetts.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=M.%2BKieran%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Kieran%20M&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AM.%2BKieran%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0003-2184-7692" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for M. Kieran</a></li></ul></div><div class="author-tooltip-4"><div class="author-tooltip-name">T. Young Poussaint </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Departments of Radiology (S.V., C.S., T.Y.P.)</div><div class='author-affiliation'><span class='nlm-sup'>e</span>Harvard Medical School (S.V., C.S., M.K., T.Y.P.), Boston, Massachusetts.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=T.%2BYoung%2BPoussaint%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Poussaint%20TY&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AT.%2BYoung%2BPoussaint%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0002-0814-0791" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for T. Young Poussaint</a></li></ul></div></div></div>  </div>

  
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    <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" data-highwire-cite-ref-tooltip-instance="highwire_reflinks_tooltip" class="content-block-markup" xmlns:xhtml="http://www.w3.org/1999/xhtml"><div class="article abstract-view "><span class="highwire-journal-article-marker-start"></span><div class="section abstract" id="abstract-1"><h2>Abstract</h2><div id="sec-1" class="subsection"><p id="p-1"><strong>BACKGROUND AND PURPOSE:</strong> Pharmacokinetic parameters from dynamic contrast-enhanced MR imaging have proved useful for differentiating brain tumor grades in adults. In this study, we retrospectively reviewed dynamic contrast-enhanced perfusion data from children with newly diagnosed brain tumors and analyzed the pharmacokinetic parameters correlating with tumor grade.</p></div><div id="sec-2" class="subsection"><p id="p-2"><strong>MATERIALS AND METHODS:</strong> Dynamic contrast-enhanced MR imaging data from 38 patients were analyzed by using commercially available software. Subjects were categorized into 2 groups based on pathologic analyses consisting of low-grade (World Health Organization I and II) and high-grade (World Health Organization III and IV) tumors. Pharmacokinetic parameters were compared between the 2 groups by using linear regression models. For parameters that were statistically distinct between the 2 groups, sensitivity and specificity were also estimated.</p></div><div id="sec-3" class="subsection"><p id="p-3"><strong>RESULTS:</strong> Eighteen tumors were classified as low-grade, and 20, as high-grade. Transfer constant from the blood plasma into the extracellular extravascular space (<em>K</em><sup>trans</sup>), rate constant from extracellular extravascular space back into blood plasma (K<sub>ep</sub>), and extracellular extravascular volume fraction (V<sub>e</sub>) were all significantly correlated with tumor grade; high-grade tumors showed higher <em>K</em><sup>trans</sup>, higher K<sub>ep</sub>, and lower V<sub>e</sub>. Although all 3 parameters had high specificity (range, 82%–100%), K<sub>ep</sub> had the highest specificity for both grades. Optimal sensitivity was achieved for V<sub>e</sub>, with a combined sensitivity of 76% (compared with 71% for <em>K</em><sup>trans</sup> and K<sub>ep</sub>).</p></div><div id="sec-4" class="subsection"><p id="p-4"><strong>CONCLUSIONS:</strong> Pharmacokinetic parameters derived from dynamic contrast-enhanced MR imaging can effectively discriminate low- and high-grade pediatric brain tumors.</p></div></div><div class="section glossary" id="glossary-1"><h2 class="">ABBREVIATIONS:</h2><dl id="def-list-1"><dt id="def-item-1">IAUGC<sub>60</sub><span class="def-item-dt-sep"></span></dt><dd>initial area under gadolinium curve at 60 seconds<span class="def-item-dd-sep"></span></dd><dt id="def-item-2">DCE<span class="def-item-dt-sep"></span></dt><dd>dynamic contrast-enhanced<span class="def-item-dd-sep"></span></dd><dt id="def-item-3">K<sub>ep</sub><span class="def-item-dt-sep"></span></dt><dd>rate constant from extracellular extravascular space back into blood plasma<span class="def-item-dd-sep"></span></dd><dt id="def-item-4"><em>K</em><sup>trans</sup><span class="def-item-dt-sep"></span></dt><dd>transfer constant from the blood plasma into the extracellular extravascular space<span class="def-item-dd-sep"></span></dd><dt id="def-item-5">V<sub>e</sub><span class="def-item-dt-sep"></span></dt><dd>extracellular extravascular volume fraction<span class="def-item-dd-sep"></span></dd><dt id="def-item-6">V<sub>p</sub><span class="def-item-dt-sep"></span></dt><dd>fractional blood plasma volume</dd></dl></div><ul class="copyright-statement"><li class="fn" id="copyright-statement-1">© 2017 by American Journal of Neuroradiology</li></ul><span class="highwire-journal-article-marker-end"></span></div><span class="related-urls"></span></div><a href="http://ajnr-stage2.stage.highwire.org/content/38/1/170.full" class="hw-link hw-link-article-full-text" data-icon-position="" data-hide-link-title="0">View Full Text</a></div>  </div>

  
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        	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-volume highwire-cite-metadata">Vol. 38</span>, <span  class="highwire-cite-metadata-issue highwire-cite-metadata">Issue 1 </span><div  class="highwire-cite-metadata-pubdate highwire-cite-metadata">1 Jan 2017 </div></div>
      
      
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