Abstract
BackgroundTo compare the diagnostic performance of neurite orientation dispersion and density imaging (NODDI), mean apparent propagator magnetic resonance imaging (MAP-MRI), diffusion kurtosis imaging (DKI), diffusion tensor imaging (DTI) and diffusion-weighted imaging (DWI) in distinguishing high-grade gliomas (HGGs) from solitary brain metastases (SBMs).MethodsPatients with previously untreated, histopathologically confirmed HGGs (n = 20) or SBMs (n = 21) appearing as a solitary and contrast-enhancing lesion on structural MRI were prospectively recruited to undergo diffusion-weighted MRI. DWI data were obtained using a q-space Cartesian grid sampling procedure and were processed to generate parametric maps by fitting the NODDI, MAP-MRI, DKI, DTI and DWI models. The diffusion metrics of the contrast-enhancing tumor and peritumoral edema were measured. Differences in the diffusion metrics were compared between HGGs and SBMs, followed by receiver operating characteristic (ROC) analysis and the Hanley and McNeill test to determine their diagnostic performances.ResultsNODDI-based isotropic volume fraction (Viso) and orientation dispersion index (ODI); MAP-MRI-based mean-squared displacement (MSD) and q-space inverse variance (QIV); DKI-generated radial, mean diffusivity and fractional anisotropy (RDk, MDk and FAk); and DTI-generated radial, mean diffusivity and fractional anisotropy (RD, MD and FA) of the contrast-enhancing tumor were significantly different between HGGs and SBMs (p < 0.05). The best single discriminative parameters of each model were Viso, MSD, RDk and RD for NODDI, MAP-MRI, DKI and DTI, respectively. The AUC of Viso (0.871) was significantly higher than that of MSD (0.736), RDk (0.760) and RD (0.733) (p < 0.05).ConclusionNODDI outperforms MAP-MRI, DKI, DTI and DWI in differentiating between HGGs and SBMs. NODDI-based Viso has the highest performance.
Highlights
To compare the diagnostic performance of neurite orientation dispersion and density imaging (NODDI), mean apparent propagator magnetic resonance imaging (MAP-Magnetic resonance imaging (MRI)), diffusion kurtosis imaging (DKI), diffusion tensor imaging (DTI) and diffusion-weighted imaging (DWI) in distinguishing high-grade gliomas (HGGs) from solitary brain metastases (SBMs)
Study population Twenty patients (13 males and 7 females; mean age, 55.70 years; age, 19–67 years) with HGGs diagnosed by histopathology including seven patients with anaplastic astrocytoma (WHO grade III) and thirteen patients with glioblastoma (WHO grade IV) and twenty-one patients (13 males and 8 females; mean age, 54.05 years; age, 43–81 years) with SBMs confirmed by histopathology were included
The Radial diffusivity (RD), Mean diffusivity (MD), R Dk, DKI-generated mean diffusivity (MDk), meansquared displacement (MSD), q-space inverse variance (QIV), Isotropic volume fraction (Viso) and orientation dispersion index (ODI) of the contrast-enhancing tumors were significantly lower in the HGGs than in the SBMs (p = 0.006, p = 0.016, p = 0.002, p = 0.007, p = 0.002, p = 0.039, p = 0.001, and p = 0.003, respectively)
Summary
To compare the diagnostic performance of neurite orientation dispersion and density imaging (NODDI), mean apparent propagator magnetic resonance imaging (MAP-MRI), diffusion kurtosis imaging (DKI), diffusion tensor imaging (DTI) and diffusion-weighted imaging (DWI) in distinguishing high-grade gliomas (HGGs) from solitary brain metastases (SBMs). High-grade gliomas (HGGs) and brain metastases are common malignancies in the central nervous system (CNS). Metastatic tumors occur ten times more frequently than primary malignancy in the brain [2]. For patients with HGGs, surgical resection is the first choice, and it is usually not necessary to perform a systemic examination [2]. For patients with suspected brain metastases, comprehensive systemic examinations are needed, and if confirmed, stereotactic radiosurgery or systemic therapy such as targeted therapy and immunotherapy are recommended [3]
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