Percentage Signal Recovery as an Upcoming Novel Perfusion Parameter Derived from MR Dynamic Susceptibility Contrast Imaging in Differentiating Common Intra-Axial Malignant Neoplasms of Brain

This article evaluates the role of percentage signal recovery (PSR) derived from magnetic resonance dynamic susceptibility contrast imaging in differentiating common enhancing intra-axial brain tumors. Prospective study was done on 50 patients with intra-axial enhancing brain tumors over one and half years from September 2022 to March 2024. All statistical calculations were done using Statistical Package for the Social Science (SPSS) 21 version (SPSS Inc., Chicago, Illinois, United States). Relative cerebral blood volume (rCBV) and relative cerebral blood flow (rCBF) values were lower in diffuse large B-cell lymphoma (DLBCL) (1.67 ± 0.36 and 1.51 ± 0.33) than in high-grade glioma (HGG) (3.59 ± 0.91 and 3.32 ± 0.75) and metastasis (3.28 ± 1.12 and 2.88 ± 0.86) with a p-value of 0.001. PSR value was high in DLBCL (131.55 ± 19.87), intermediate in HGG (77.25 ± 10.00), and low in metastasis (57.64 ± 5.90), with a p-value of 0.001. Relative PSR (rPSR) value in DLBCL was 1.47 ± 0.24, HGG was 0.89 ± 0.08, and metastasis was 0.73 ± 0.07, respectively, with a p-value of 0.001. Area under the receiver operating characteristic (ROC) curve for PSR was 1.000, rPSR was 0.992, rCBV was 0.003, and rCBF was 0.000 in differentiating DLBCL from HGG with a p-value of 0.001. Area under the ROC for PSR was 0.961, rPSR was 0.935, rCBV was 0.609, and rCBF was 0.631 in differentiating HGG from metastasis, which was statistically significant for PSR and rPSR with a p-value of 0.001. Area under the ROC for PSR was 1.000, rPSR was 1.000, rCBV was 0.029, and rCBF was 0.054 in differentiating DLBCL from metastasis with a p-value of 0.001. Analysis of variance F-test values for PSR (113.323) and rPSR (108.744) were better than rCBV (19.027) and rCBF (25.487) in differentiating the three groups with significant p-values. PSR and rPSR can be used in addition to rCBV and rCBF in differentiating intra-axial enhancing brain tumors. Overshoot or high signal recovery was seen in DLBCL, intermediate signal recovery was seen in HGGs, and low signal recovery was seen in metastasis.