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CC BY-NC-ND 4.0 · Asian J Neurosurg 2023; 18(04): 751-760
DOI: 10.1055/s-0043-1774820
Original Article

Role of Permeability Surface Area Product in Grading of Brain Gliomas using CT Perfusion

Ira Agrawal
1   Department of Radiodiagnosis, PGIMER, Dr. RML Hospital, New Delhi, India
,
Shahina Bano
1   Department of Radiodiagnosis, PGIMER, Dr. RML Hospital, New Delhi, India
,
Ajay Chaudhary 
2   Department of Neurosurgery, PGIMER, Dr. RML Hospital, New Delhi, India
,
Arvind Ahuja
3   Department of Pathology, PGIMER, Dr. RML Hospital, New Delhi, India
› Author Affiliations Funding None.
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Abstract

Purpose The aim of this study was to evaluate the role of permeability surface area product in grading brain gliomas using computed tomography (CT) perfusion

Materials and Methods CT perfusion was performed on 33 patients with brain glioma diagnosed on magnetic resonance imaging. Of these, 19 had high-grade glioma and 14 had low-grade glioma on histopathological follow-up. CT perfusion values were obtained and first compared between the tumor region and normal brain parenchyma. Then the relative values of perfusion parameters were compared between high- and low-grade gliomas. Cut-off values, sensitivity, specificity, and strength of agreement for each parameter were calculated and compared subsequently. A conjoint factor (permeability surface area product + cerebral blood volume) was also evaluated since permeability surface area product and cerebral blood volume are considered complimentary factors for tumor vascularity.

Results All five perfusion parameters namely permeability surface area product, cerebral blood volume, cerebral blood flow, mean transit time, and time to peak were found significantly higher in the tumor region than normal brain parenchyma. Among these perfusion parameters, only relative permeability surface area product and relative cerebral blood volume were found significant in differentiating high- and low-grade glioma. Moreover, relative permeability surface area product was significantly better than all other perfusion parameters with highest sensitivity and specificity (97.74 and 100%, respectively, at a cut-off of 9.0065). Relative permeability surface area product had a very good agreement with the histopathology grade. The conjoint factor did not yield any significant diagnostic advantage over permeability surface area product.

Conclusion Relative permeability surface area product and relative cerebral blood volume were helpful in differentiating high- and low-grade glioma; however, relative permeability surface area product was significantly better than all other perfusion parameters. Grading brain gliomas using relative permeability surface area product can add crucial value in their management and prognostication; hence, it should be evaluated in the routine CT perfusion imaging protocol.

Keywords

CT perfusion - brain glioma - permeability surface area - cerebral blood volume - cerebral blood flow - mean transit time - time to peak - conjoint factor

Ethical Statement

The study was conducted after obtaining ethical clearance from the institutional ethical committee. Informed consent was obtained from all patients included in the study.




Publication History

Article published online:
07 November 2023

© 2023. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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