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Tumour Enhancing Fraction (EnF) in Glioma: Relationship to Tumour Grade
Mills S, Soh CC, O'Connor JP B, Rose CJ, Buonaccorsi G, Cheung SW, Zhao S, Parker GJM, Jackson A-
European Radiology. 2009;19:1489-1498.
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Abstract
The aim of this researchwas to determine whether the proportionof a tumour that enhances (enhancingfraction, EnF) and changes inEnF with enhancement threshold differbetween low and high grade glioma.Forty-four patients (45 gliomascomprising 16 grade II, 5 grade III and24 grade IV) were studied. Imagingincluded pre- and post-contrast-enhancedT1-weighted sequences andT1-weighted DCE-MRI. Thresholdedenhancement maps were generated foreach tumour by using a range ofvalues of the initial area under thecontrast concentration curve (IAUC).A plot of EnF versus threshold valuewas generated. We examined therelationship between tumour gradeand enhancement metrics including:EnF (threshold IAUC>0 mMol s),EnF (threshold IAUC>2.5 mMol s),initial slope of the EnF/thresholdcurve (∂EnF), IAUC, and two previouslydescribed signal-intensitybasedmetrics. EnF, defined as theproportion of tumour showing anyenhancement (threshold IAUC>0 mMol s), showed no differencebetween low and high grade glioma.All other measures demonstrated significantdifferences between grade IIand IV, and low (grade II) and highgrade (grades III/ IV) gliomas (p<0.01). Two measures, ∂EnF and Pronin’smeasure of enhancement,showed differences between grade IIIand IV (p<0.05). No measure separatedgrade II from III. Metrics whichdescribe the enhancing fraction and itsvariation with enhancement threshold∂EnF show considerably differentbehaviour in low and high gradetumours. These observations suggestthat these metrics may provideimportant biological informationconcerning tumour biology andtherapeutic responses and encouragefurther research to characterise andvalidate these novel biomarkers.Keywords Glioma . Enhancement .DCE-MRI . Enhancing fraction