Abstract
Diffusion tensor metrics are potential in vivo quantitative neuroimaging biomarkers for the characterization of brain tumor subtype. This meta-analysis analyzes the ability of mean diffusivity and fractional anisotropy to distinguish low-grade from high-grade gliomas in the identifiable tumor core and the region of peripheral edema. A meta-analysis of articles with mean diffusivity and fractional anisotropy data for World Health Organization low-grade (I, II) and high-grade (III, IV) gliomas, between 2000 and 2013, was performed. Pooled data were analyzed by using the odds ratio and mean difference. Receiver operating characteristic analysis was performed for patient-level data. The minimum mean diffusivity of high-grade gliomas was decreased compared with low-grade gliomas. High-grade gliomas had decreased average mean diffusivity values compared with low-grade gliomas in the tumor core and increased average mean diffusivity values in the peripheral region. High-grade gliomas had increased FA values compared with low-grade gliomas in the tumor core, decreased values in the peripheral region, and a decreased fractional anisotropy difference between the tumor core and peripheral region. The minimum mean diffusivity differs significantly with respect to the World Health Organization grade of gliomas. Statistically significant effects of tumor grade on average mean diffusivity and fractional anisotropy were observed, supporting the concept that high-grade tumors are more destructive and infiltrative than low-grade tumors. Considerable heterogeneity within the literature may be due to systematic factors in addition to underlying lesion heterogeneity.
Highlights
BACKGROUND AND PURPOSEDiffusion tensor metrics are potential in vivo quantitative neuroimaging biomarkers for the characterization of brain tumor subtype
High-grade gliomas had increased FA values compared with low-grade gliomas in the tumor core, decreased values in the peripheral region, and a decreased fractional anisotropy difference between the tumor core and peripheral region
Multiple studies have examined the ability of basic diffusion tensor metrics such as mean diffusivity (MD) or the apparent diffusion coefficient and fractional anisotropy (FA) to discriminate the tumor grade of gliomas
Summary
A meta-analysis of articles with mean diffusivity and fractional anisotropy data for World Health Organization low-grade (I, II) and high-grade (III, IV) gliomas, between 2000 and 2013, was performed. Receiver operating characteristic analysis was performed for patient-level data. Articles were identified via PubMed and Science Citation Index query using the terms “diffusion” and “brain tumor.”. This search produced 1657 articles from PubMed and 2158 articles from the Science Citation Index. Articles were restricted to those with publication dates between 2000 and 2013 and containing the word “glioma,” which yielded. Study characteristics and technical factorsa Attribute MD FA. Of patients per tumor grade 15.3 Ϯ 12.0 13.4 Ϯ 8.6 category Average age of patients (yr).
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