Abstract
To compare the efficacy of ultra-high and conventional mono-b-value DWI for glioma grading, in 109 pathologically confirmed glioma patients, ultra-high apparent diffusion coefficient (ADCuh)was calculated using a tri-exponential mode, distributed diffusion coefficients (DDCs) and α values were calculated using a stretched-exponential model, and conventional ADC values were calculated using a mono-exponential model. The efficacy and reliability of parameters for grading gliomas were investigated using receiver operating characteristic (ROC) curve and intra-class correlation (ICC) analyses, respectively. The ADCuh values differed (P < 0.001) between low-grade gliomas (LGGs; 0.436 ×10−3 mm2/sec) and high-grade gliomas (HGGs; 0.285 × 10−3 mm2/sec). DDC, a and various conventional ADC values were smaller in HGGs (all P ≤ 0.001, vs. LGGs). The ADCuh parameter achieved the highest diagnostic efficacy with an area under curve (AUC) of 0.993, 92.9% sensitivity and 98.8% specificity for glioma grading at a cutoff value of 0.362×10−3 mm2/sec. ADCuh measurement appears to be an easy-to-perform technique with good reproducibility (ICC = 0.9391, P < 0.001). The ADCuh value based in a tri-exponential model exhibited greater efficacy and reliability than other DWI parameters, making it a promising technique for glioma grading.
Highlights
The preoperative grading of gliomas, which is critical to determine the optimal therapy, remains unsatisfactory [1, 2]
Diffusion-weighted imaging (DWI) is considered to be the most sensitive to detect early pathological changes and demonstrated potentials for noninvasive glioma grading in previous studies [3, 5, 6]
28 patients were pathologically diagnosed as low-grade gliomas (LGGs) (WHO grade I: pilocytic astrocytoma (n = 3); Grade II: diffuse astrocytoma (n = 6), oligodendroglioma (n = 3), oligoastrocytoma (n = 13), ependymoma (n = 2) and pleomorphic xanthoastrocytoma (n = 1)), and 81 as high-grade gliomas (HGGs) (WHO grade III: anaplastic astrocytoma (n = 7), anaplastic oligoastrocytoma (n = 14) and anaplastic oligodendroglioma (n = 3) ; Grade IV: glioblastoma (n = 57))
Summary
The preoperative grading of gliomas, which is critical to determine the optimal therapy, remains unsatisfactory [1, 2]. The histopathological grading of glioma is frequently biased because of the intratumoral heterogeneity of the tumor sample from stereotactic biopsy or surgical resection. This biased histopathological grading leads to the improper therapeutic strategy [4]. Conventional DWI based on only two b-values (so-called monoexponential model, usually 0 and 1000 sec/mm in the brain) provides unique information on tissue functional structure [8]. We retrospectively FRPSDUHGWKHHI¿FDF\DQGUHOLDELOLW\DPRQJWULPRQR and stretched-exponential model DWI for glioma grading, and a tri-component model was used to calculate ADC uh value based on 18 b-values (up to 4,500 sec/mm2)
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