Review Article

Clinical Applications of Contrast-Enhanced Perfusion MRI Techniques in Gliomas: Recent Advances and Current Challenges

Table 4

Differential diagnosis in glioma, metastasis, and PCNSL.

Study (year) (ref)Tumor type ()Average age (year)Imaging modality (method or model; parameter analysis)IndexesResultsLimitations

Law et al. (2002) [116]HGG (24) 
MET (12)
52DSC-MRI (leakage effect uncorrected; ROI-based analysis)rCBVrCBV in peritumoral region was significantly different between HGG and METThe peritumoral region was not defined clearly; the threshold value was not provided

Cha et al. (2007) [117]GBM (27) 
MET (16)
52DSC-MRI (alteration of and flip angle for leakage correction; ROI-based analysis)PSR 
PH
Significant difference of all parameters between GBM and MET; PSR was the most powerful with 100% specificitySmall sample size; some cases were not confirmed by histopathology

Mangla et al. (2011) [118]GBM (22) 
MET (22) 
PCNSL (22)
54DSC-MRI (preload for leakage correction; ROI-based analysis)rCBV  
PSR
PSR was better than rCBV for differentiationSmall sample size; impact of steroid treatment on parameter evaluation

Toh et al. (2013) [119]GBM (20) 
PCNSL (15)
60DSC-MRI (algorithm for leakage correction; ROI-based analysis)rCBV 
Uncorrected rCBV is much better for differentiatingLack of direct correlation between parameters and histopathologic features

Xing et al. (2014) [120]HGG (26) 
PCNSL (12)
51DSC-MRI (leakage effect uncorrected; ROI-based analysis)rCBV  
PSR
The combination of rCBV with PSR might help in more accurate differentiationImpact of leakage effect on parameter measurements

Kickingereder et al. (2014) [121]GBM (60) 
PCNSL (11)
N/ADCE-MRI (TK model; ROI-based analysis)

and could identify the two tumors. was the optimum parameterRelative small sample size of PCNSL

Kickingereder et al. (2014) [122]GBM (28) 
PCNSL (19)
66DSC-MRI (preload for leakage correction; ROI-based analysis), DWI, SWIrCBV 
ADC  
ITSS
Multiparametric MRI allowed differentiation of GBM from PCNSLSmall sample size

Zhao et al. (2015) [52]LGG (9) 
HGG (15) 
MET (5)
46DCE-MRI (TK model; ROI-based analysis)

IAUC
All parameters were significantly different between LGG, HGG, and MET. IAUC had the most diagnostic powerSmall sample size; subjectivity of ROI selection

Jung et al. (2016) [123]GBM (26) 
MET (32)
N/ADCE-MRI (ETK model, ROI-based analysis)

AUC
Washout log slope
Semiquantitative parameters could differentiate between GBM and hypovascular metastasisSubjectivity of ROI selection