Clinical Utility of Dynamic Contrast-Enhanced and Dynamic Susceptibility Contrast MRI Perfusion in Differentiating Grades of Intra-axial Brain Tumors: Correlation with Histopathology

Accurate grading of intra-axial brain tumors is essential for prognosis and treatment planning. While histopathology remains the gold standard, noninvasive imaging biomarkers can provide valuable preoperative insights. This study aimed to evaluate the diagnostic utility of perfusion parameters derived from dynamic susceptibility contrast (DSC) and dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) in differentiating low-grade from high-grade intra-axial brain tumors, using histopathology as the reference standard. This prospective study, conducted between February 2023 and January 2025, included 67 adult patients (mean age: 44.7 ± 12.9 years; 38 males, 29 females) with treatment-naïve intra-axial brain tumors who underwent preoperative 3-T MRI with DSC and DCE perfusion sequences. Perfusion parameters assessed included relative cerebral blood volume (rCBV), relative cerebral blood flow (rCBF), mean transit time, volume transfer constant (Ktrans), extracellular extravascular volume fraction (Ve), and rate constant (Kep). Values were normalized to contralateral normal-appearing white matter. Surgical resection or biopsy with histopathological confirmation and grading per the 2021 World Health Organization (WHO) classification was available in 52 patients. Receiver operating characteristic (ROC) analysis was performed to assess diagnostic performance. Among the 52 histopathologically confirmed cases, 44 primary intra-axial tumors were graded (11 low-grade [WHO grades 1–2] and 33 high-grade [grades 3–4]). High-grade tumors showed significantly higher rCBV, rCBF, and Ktrans values compared to low-grade tumors (p < 0.05). ROC analysis demonstrated that Ktrans had the highest diagnostic accuracy (AUC ∼0.88). Combined DSC and DCE analysis improved predictive performance. DSC and DCE MRI perfusion parameters serve as reliable, noninvasive biomarkers for preoperative grading of intra-axial brain tumors. Their combined application enhances diagnostic accuracy and aids surgical planning.