Grading Gliomas Capability: Comparison between Visual Assessment and Apparent Diffusion Coefficient (ADC) Value Measurement on Diffusion-Weighted Imaging (DWI)

Warinthorn Phuttharak,Jureerat Thammaroj,Sakda Wara-Asawapati,Kobporn Panpeng

doi:10.31557/apjcp.2020.21.2.385

Warinthorn Phuttharak, Jureerat Thammaroj + Show 2 more

Open Access

https://doi.org/10.31557/apjcp.2020.21.2.385

Copy DOI

Abstract

Background:To compare diagnostic accuracy between DWI visual scale assessment and ADC value measurement of solid portion of the tumor in grading gliomas. Methods:This retrospective study included 38 patients who had pathologically proven gliomas between January 2013 and August 2018 with 18 low grade and 20 high grade tumors. All patients underwent MRI and biopsy. Two readers reviewed DWI visual scale independently. Disagreement was resolved by consensus. One reviewer measured ADC value of entire solid part of the tumor in single axial slice with greatest dimension of tumor which was chosen by consensus. Two data sets of visual scale and ADC value were analyzed and comparison of diagnostic accuracy in glioma grading was done by using area under the curve (AUC) of receiver operating characteristic curve (ROC). Results:Visual scale and ADC value could be used to distinguish between low and high grade gliomas with a statistically significant difference. (P-value 0.002 and <0.001). Almost all high grade gliomas had visual scale 5. The sensitivity, specificity, PPV NPV and accuracy were 50%, 100%, 100% , 64.3%,73.68% respectively. The cutoff level for the ADC value was determined to be 1119.48 x10-6 mm2/s in differentiation between low and high grade gliomas with the sensitivity, specificity, PPV, NPV, accuracy of 90%, 88.89% , 90%, 88.9% and 89.47% respectively. There was no statistically significant difference(P-value = 0.163). Conclusion:Both Visual scale and ADC value were capable of differentiating between low and high grade gliomas. Although visual scale may not replace ADC measurement, larger scale prospective study is needed for validate this initial result.

Highlights

Gliomas are the most common primary intracranial tumor
Distinguishing low grade from high grade gliomas on the basis of conventional MR imaging findings can be challenging since high grade and low grade gliomas can have overlapping features on MR imaging (Sugahara et al, 1999; Okamoto et al, 2000; Kono et al, 2001)
Diffusion-weighted imaging (DWI) provides additional unique information derived from microscopic motion of the water molecule, which cannot be obtained with conventional magnetic resonance imaging (MRI)

Summary

Introduction

Gliomas are the most common primary intracranial tumor. relatively rare, they cause significant mortality and morbidity. Diffusion-weighted imaging (DWI) is based on the irregular diffusion motion of water molecules and provides more detailed information at the cellular level than conventional magnetic resonance imaging (MRI) Because it is non-invasive and relatively low cost, DWI has been widely applied to the diagnosis of various diseases, including the detection of acute cerebral infarction, abscesses from cystic tumors and distinguishing epidermoid from arachnoid cysts (Schaefer et al, 2000; Stadnik et al, 2001; Holdsworth and Bammer, 2008). To compare diagnostic accuracy between DWI visual scale assessment and ADC value measurement of solid portion of the tumor in grading gliomas. Results: Visual scale and ADC value could be used to distinguish between low and high grade gliomas with a statistically significant difference. The cutoff level for the ADC value was determined to be 1119.48 x10-6 mm2/s in differentiation between low and high grade gliomas with the sensitivity, specificity, PPV, NPV, accuracy of 90%, 88.89% , 90%, 88.9% and 89.47% respectively. Visual scale may not replace ADC measurement, larger scale prospective study is needed for validate this initial result

Methods

Results

Conclusion