RCBVmax from DSC Perfusion MRI as a Supportive Imaging Biomarker for Differentiating IDH-Mutant Astrocytomas and Oligodendroglioma

Background Gliomas, particularly astrocytomas (IDH-mutated, 1p/19q intact) and oligodendrogliomas (IDH-mutated, 1p/19q co-deleted), differ significantly in their clinical behavior and prognosis. Accurate differentiation between these subtypes is crucial for guiding therapeutic decisions. Non-invasive imaging biomarkers, such as T2-Flair mismatch sign and relative cerebral blood volume (rCBV), have shown promise in glioma classification. Methods This retrospective multicenter study analyzed 42 patients with astrocytoma and 21 with oligodendroglioma. Demographic, histopathological, and imaging data were collected, with a focus on rCBV parameters derived from dynamic susceptibility contrast perfusion MRI. Statistical analyses were conducted to assess differences between the groups and evaluate the discriminatory power of rCBV metrics. After correction for multiple corrections, level of significance was set at p< 0.01. Results Patients with astrocytoma and oligodendroglioma were similar in age and gender distribution (mean age and male-female-ratio; p= 0.01 respectively p= 0.04). The rCBVmax value was significantly higher in oligodendrogliomas (11.64 vs. 7.69, p< 0.001) and demonstrated a good discriminatory power (AUC = 0.764). Median and mean rCBV values showed non-significant differences between oligodendroglioma and astrocytoma (p= 0.02 respectively p= 0.03). Conclusion rCBVmax emerges as a potential imaging marker for differentiating oligodendrogliomas from astrocytomas. These findings can be explained by biological properties of oligodendrogliomas and thereby underscore the potential of advanced imaging techniques in non-invasive glioma classification. However, larger prospective studies are required to validate these results and standardize imaging protocols.