Prativa Sahoo1, Pradeep K Gupta2, Ashish Awasthi3, Chandra M Pandey3, Rana Patir4, Sandeep Vaishya4, Indrajit Saha5, Rakesh K Gupta6. 1. Philips Health Systems, Philips India Ltd, Bangalore, India. 2. Department of Radiology and Imaging, Fortis Memorial Research Institute, Gurgaon, India. 3. Biostatistics, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India. 4. Department of Neurosurgery, Fortis Memorial Research Institute, Gurgaon, India. 5. Philips Health Systems, Philips India Ltd, Gurgaon, India. 6. Department of Radiology and Imaging, Fortis Memorial Research Institute, Gurgaon, India. Electronic address: rakeshree1@gmail.com.
Abstract
PURPOSE: Dynamic contrast enhanced (DCE) MRI is used to grade and to monitor the progression of glioma while on treatment. Usually, a fixed hematocrit (Hct) value for adults is assumed to be ~45%; however, it is actually known for individual variations. Purpose of this study was to investigate the effect of measured Hct values in glioma grading using DCE-MRI. MATERIALS AND METHODS: Fifty glioma patients were included in this study. Kinetic and hemodynamic parameters were estimated for each patient using assumed as well as measured Hct values. To look the changes in Hct value over time, Hct was measured multiple times from 10 of these glioma patients who were on treatment. Simulation was done to look for the effect of extreme variations of Hct values on perfusion metrics. The data was compared to look for significant differences in the perfusion metrics derived from assumed and measured Hct values. RESULTS: The measured Hct value in patients was found to be (40.4±4.28)%. The sensitivity and specificity of DCE-MRI parameters in glioma grading were not significantly influenced by using measured vis-a-vis assumed Hct values. The serial Hct values from 10 patients who were on treatment showed a fluctuation of 15-20% over time. The simulated data showed linear influence of Hct values on kinetic parameters. The tumor grading was altered on altering the Hct values in borderline cases. CONCLUSION: Hct values influence the hemodynamic and kinetic metrics linearly and may affect glioma grading. However, perfusion metrics values might change significantly with large change in Hct values, especially in patients who are on chemotherapy necessitating its use in the DCE model.
PURPOSE: Dynamic contrast enhanced (DCE) MRI is used to grade and to monitor the progression of glioma while on treatment. Usually, a fixed hematocrit (Hct) value for adults is assumed to be ~45%; however, it is actually known for individual variations. Purpose of this study was to investigate the effect of measured Hct values in glioma grading using DCE-MRI. MATERIALS AND METHODS: Fifty gliomapatients were included in this study. Kinetic and hemodynamic parameters were estimated for each patient using assumed as well as measured Hct values. To look the changes in Hct value over time, Hct was measured multiple times from 10 of these gliomapatients who were on treatment. Simulation was done to look for the effect of extreme variations of Hct values on perfusion metrics. The data was compared to look for significant differences in the perfusion metrics derived from assumed and measured Hct values. RESULTS: The measured Hct value in patients was found to be (40.4±4.28)%. The sensitivity and specificity of DCE-MRI parameters in glioma grading were not significantly influenced by using measured vis-a-vis assumed Hct values. The serial Hct values from 10 patients who were on treatment showed a fluctuation of 15-20% over time. The simulated data showed linear influence of Hct values on kinetic parameters. The tumor grading was altered on altering the Hct values in borderline cases. CONCLUSION: Hct values influence the hemodynamic and kinetic metrics linearly and may affect glioma grading. However, perfusion metrics values might change significantly with large change in Hct values, especially in patients who are on chemotherapy necessitating its use in the DCE model.