Abstract
We evaluate the value of MR diffusion tensor imaging (DTI) and dynamic susceptibility-weighted contrast material-enhanced perfusion-weighted imaging (PWI) in preoperative grading of supratentorial nonenhancing gliomas. This institutional review board-approved, Health Insurance Portability and Accountability Act-compliant retrospective study involved 52 patients: 37 with low-grade gliomas (LGGs) and 15 with high-grade gliomas (HGGs). The mean trace apparent diffusion coefficient (ADC), minimal ADC, mean fractional anisotropy (FA), maximal FA, and maximal relative cerebral blood volume (rCBV) ratio of the lesions were measured and compared between LGG and HGG. The efficacy of the above parameters in grading supratentorial nonenhancing gliomas was evaluated. There was no significant difference in rCBV ratio, minimal ADC, and mean ADC between LGG and HGG (p > 0.05). The mean and maximal FA values of LGG were significantly lower than the values of HGG (p < 0.001). The receiver operating characteristic analysis showed that the mean FA with a cutoff value of 0.129 and the maximal FA with a cutoff value of 0.219 could differentiate between LGG and HGG with specificity of 69.2% and 76.9%, respectively, and sensitivity of 93.3% and 100.0%, respectively. The combination of mean FA and maximal FA based on the linear discriminant analysis improved the diagnostic accuracy with specificity of 92.3% and sensitivity of 86.7%. These findings were better than maximal rCBV ratio, mean ADC, and minimum ADC. The mean FA and maximal FA, used individually or combined, may be useful in preoperative grading of supratentorial nonenhancing gliomas.
Highlights
We evaluate the value of MR diffusion tensor imaging (DTI) and dynamic susceptibility-weighted contrast material-enhanced perfusion-weighted imaging (PWI) in preoperative grading of supratentorial nonenhancing gliomas
The purpose of this study is to evaluate various imaging parameters, including maximal relative cerebral blood volume (rCBV), mean apparent diffusion coefficient (ADC), minimum ADC, mean fractional anisotropy (FA), and maximal FA with regard to preoperative grading of supratentorial nonenhancing gliomas and to investigate the optimal thresholds of these imaging parameters, which may aid in differentiation of supratentorial nonenhancing low-grade gliomas (LGGs) from highgrade gliomas (HGGs)
The mean ADC and minimal ADC values have been reported to correlate with tumor cell density and have been used to grade astrocytomas.[14,15,16,17,18]
Summary
We evaluate the value of MR diffusion tensor imaging (DTI) and dynamic susceptibility-weighted contrast material-enhanced perfusion-weighted imaging (PWI) in preoperative grading of supratentorial nonenhancing gliomas. Apparent diffusion coefficient (ADC) is another advanced MR imaging parameter used in the evaluation of brain tumors.[14,15,16,17,18] Fan et al did not find significant difference of mean ADC comparing the nonenhancing LGG and HGG, they reported that the minimal ADC was a valuable tool in preoperative grading of astrocytomas.[2] Diffusion tensor imaging (DTI), besides providing ADC information, uniquely provides information on anisotropy, including fractional anisotropy (FA).
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