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BioMed Research International
Volume 2014, Article ID 154350, 5 pages
Clinical Study

Facing Contrast-Enhancing Gliomas: Perfusion MRI in Grade III and Grade IV Gliomas according to Tumor Area

1Neuro-Oncology Unit, C. Mondino National Neurological Institute, 27100 Pavia, Italy
2Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy
3Magnetic Resonance Laboratory, IRCCS Don Gnocchi Foundation, 20148 Milan, Italy
4Neuroscience Consortium, University of Pavia, Monza Policlinico and Pavia Mondino, 27100 Pavia, Italy
5Neuroradiological Department, C. Mondino National Neurological Institute, 27100 Pavia, Italy
6General Neurology Unit, C. Mondino National Neurological Institute, 27100 Pavia, Italy
7Department of Neuroradiology, IRCCS Foundation Neurological Institute C. Besta, 20133 Milan, Italy
8Department of Neurosurgery, IRCCS Neuromed, Pozzilli (IS), University of Rome La Sapienza, 00185 Rome, Italy
9Department of Neurosurgery, University of Messina, 98122 Messina, Italy

Received 14 February 2014; Accepted 6 March 2014; Published 3 April 2014

Academic Editor: Lombardi Giuseppe

Copyright © 2014 Anna Luisa Di Stefano et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Tumoral neoangiogenesis characterizes high grade gliomas. Relative Cerebral Blood Volume (rCBV), calculated with Dynamic Susceptibility Contrast (DSC) Perfusion-Weighted Imaging (PWI), allows for the estimation of vascular density over the tumor bed. The aim of the study was to characterize putative tumoral neoangiogenesis via the study of maximal rCBV with a Region of Interest (ROI) approach in three tumor areas—the contrast-enhancing area, the nonenhancing tumor, and the high perfusion area on CBV map—in patients affected by contrast-enhancing glioma (grades III and IV). Twenty-one patients were included: 15 were affected by grade IV and 6 by grade III glioma. Maximal rCBV values for each patient were averaged according to glioma grade. Although rCBV from contrast-enhancement and from nonenhancing tumor areas was higher in grade IV glioma than in grade III (5.58 and 2.68; 3.01 and 2.2, resp.), the differences were not significant. Instead, rCBV recorded in the high perfusion area on CBV map, independently of tumor compartment, was significantly higher in grade IV glioma than in grade III (7.51 versus 3.78, ). In conclusion, neoangiogenesis encompasses different tumor compartments and CBV maps appear capable of best characterizing the degree of neovascularization. Facing contrast-enhancing brain tumors, areas of high perfusion on CBV maps should be considered as the reference areas to be targeted for glioma grading.