Grading of Cerebral Glioma with Multiparametric MR Imaging and 18F-FDG-PET: Concordance and Accuracy

Objectives

To retrospectively evaluate concordance rates and predictive values in concordant cases among multiparametric MR techniques and FDG-PET to grade cerebral gliomas.

Methods

Multiparametric MR imaging and FDG-PET were performed in 60 consecutive patients with cerebral gliomas (12 low-grade and 48 high-grade gliomas). As the dichotomic variables, conventional MRI, minimum apparent diffusion coefficient in diffusion-weighted imaging, maximum relative cerebral blood volume ratio in perfusion-weighted imaging, choline/creatine ratio and (lipid and lactate)/creatine ratio in MR spectroscopy, and maximum standardised uptake value ratio in FDG-PET in low- and high-grade gliomas were compared. Their concordance rates and positive/negative predictive values (PPV/NPV) in concordant cases were obtained for the various combinations of multiparametric MR techniques and FDG-PET.

Results

There were significant differences between low- and high-grade gliomas in all techniques. Combinations of two, three, four, and five out of the five techniques showed concordance rates of 77.0?±?4.8 %, 65.5?±?4.0 %, 58.3?±?2.6 % and 53.3 %, PPV in high-grade concordant cases of 97.3?±?1.7 %, 99.1?±?1.4 %, 100.0?±?0 % and 100.0 % and NPV in low-grade concordant cases of 70.2?±?7.5 %, 78.0?±?6.0 %, 80.3?±?3.4 % and 80.0 %, respectively.

Conclusion

Multiparametric MR techniques and FDG-PET have a concordant tendency in a two-tiered classification for the grading of cerebral glioma. If at least two examinations concordantly indicated high-grade gliomas, the PPV was about 95 %.

Key Points

? Modern imaging techniques can help predict the aggressiveness of cerebral gliomas. ? Multiparametric MRI and FDG-PET have a concordant tendency to grade cerebral gliomas. ? Their high-grade concordant cases revealed at least 95 % positive predictive values. ? Their low-grade concordant cases revealed about 70–80 % negative predictive values.