Abstract
Purpose: It is critical and difficult to accurately discriminate between high- and low-grade gliomas preoperatively. This study aimed to ascertain the role of several scalar measures in distinguishing high-grade from low-grade gliomas, especially the axial diffusivity (AD), radial diffusivity (RD), planar tensor (Cp), spherical tensor (Cs), and linear tensor (Cl) derived from diffusion tensor imaging (DTI).Materials and Methods: Fifty-three patients with pathologically confirmed brain gliomas (21 low-grade and 32 high-grade) were included. Contrast-enhanced T1-weighted images and DTI were performed in all patients. The AD, RD, Cp, Cs, and Cl values in the tumor zone, peritumoral edema zone, white matter (WM) adjacent to edema and contralateral normal-appearing white matter (NAWM) were calculated. The DTI parameters and tumor grades were statistically analyzed, and receiver operating characteristic (ROC) curve analysis was also performed.Results: The DTI metrics in the affected hemisphere showed significant differences from those in the NAWM, except for the AD values in the tumor zone and the RD values in WM adjacent to edema in the low-grade groups, as well as the Cp values in WM adjacent to edema in the high-grade groups. AD in the tumor zone as well as Cs and Cl in WM adjacent to edema revealed significant differences between the low- and high-grade gliomas. The areas under the curve (Az) of all three metrics were greater than 0.5 in distinguishing low-grade from high-grade gliomas by ROC curve analysis, and the best DTI metric was Cs in WM adjacent to edema (Az: 0.692).Conclusion: AD in the tumor zone as well as Cs and Cl in WM adjacent to edema will provide additional information to better classify gliomas and can be used as non-invasive reliable biomarkers in glioma grading.
Highlights
Gliomas are the most common primary brain tumors with an annual incidence of 5/100,000 individuals (Ricard et al, 2012; Louis et al, 2016; Miranda-Filho et al, 2017)
This study mainly demonstrated that most DTI metrics in the affected hemisphere were significantly different from those in the normal-appearing white matter (NAWM), except for the AD values in the tumor zone and the RD values in white matter (WM) adjacent to edema in the low-grade groups along with the Cp values in WM adjacent to edema in the highgrade groups
We found that the AD values in the tumor zone as well as the Cs and Cl values in WM adjacent to edema allowed for the differential diagnosis of low- and highgrade gliomas
Summary
Gliomas are the most common primary brain tumors with an annual incidence of 5/100,000 individuals (Ricard et al, 2012; Louis et al, 2016; Miranda-Filho et al, 2017). Glioma grading is important for the determination of appropriate treatment methods and prognostic evaluations (Sugahara et al, 1999; Law et al, 2003; Inoue et al, 2005; Kang et al, 2011; Ricard et al, 2012). Grade III tumors have a better prognosis than GBM but may progress and follow a similar course (Omuro and DeAngelis, 2013). It is important to accurately distinguish the glioma grade before an operation
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