Inter-observer reproducibility of quantitative dynamic susceptibility contrast and diffusion MRI parameters in histogram analysis of gliomas

Background Dynamic-susceptibility contrast and diffusion-weighted imaging are promising techniques in diagnosing glioma grade. Purpose To compare the inter-observer reproducibility of multiple dynamic-susceptibility contrast and diffusion-weighted imaging parameters and to assess their potential in differentiating low- and high-grade gliomas. Material and Methods Thirty patients (16 men; mean age = 40.6 years) with low-grade (n = 13) and high-grade (n = 17) gliomas and known pathology, scanned with dynamic-susceptibility contrast and diffusion-weighted imaging were included retrospectively between March 2006 and March 2014. Three observers used three different methods to define the regions of interest: (i) circles at maximum perfusion and minimum apparent diffusion coefficient; (ii) freeform 2D encompassing the tumor at largest cross-section only; (iii) freeform 3D on all cross-sections. The dynamic-susceptibility contrast curve was analyzed voxelwise: maximum contrast enhancement; time-to-peak; wash-in rate; wash-out rate; and relative cerebral blood volume. The mean was calculated for all regions of interest. For 2D and 3D methods, histogram analysis yielded additional statistics: the minimum and maximum 5% and 10% pixel values of the tumor (min5%, min10%, max5%, max10%). Intraclass correlations coefficients (ICC) were calculated between observers. Low- and high-grade tumors were compared with independent t-tests or Mann–Whitney tests. Results ICCs were highest for 3D freeform (ICC = 0.836–0.986) followed by 2D freeform (ICC = 0.854–0.974) and circular regions of interest (0.141–0.641). High ICC and significant discrimination between low- and high-grade gliomas was found for the following optimized parameters: apparent diffusion coefficient ( P < 0.001; ICC = 0.641; mean; circle); time-to-peak ( P = 0.015; ICC = 0.986; mean; 3D); wash-in rate ( P = 0.004; ICC = 0.826; min10%; 3D); wash-out rate ( P < 0.001; ICC = 0.860; min10%; 2D); and relative cerebral blood volume ( P ≤ 0.001; ICC = 0.961; mean; 3D). Conclusion Dynamic-susceptibility contrast perfusion parameters relative cerebral blood volume and time-to-peak yielded high inter-observer reproducibility and significant glioma grade differentiation for the means of 2D and 3D freeform regions of interest. Choosing a freeform 2D method optimizes observer agreement and differentiation in clinical practice, while a freeform 3D method provides no additional benefit.