Abstract
Purpose The primary aim of this prospective observational study was to assess whether diffusion MRI metrics correlate with isocitrate dehydrogenase (IDH) status in grade II and III gliomas. A secondary aim was to investigate whether multishell acquisitions with advanced models such as neurite orientation dispersion and density imaging (NODDI) and diffusion kurtosis imaging offer greater diagnostic accuracy than diffusion-tensor imaging (DTI). Materials and Methods Diffusion MRI (b = 700 and 2000 sec/mm2) was performed preoperatively in 192 consecutive participants (113 male and 79 female participants; mean age, 46.18 years; age range, 14-77 years) with grade II (n = 62), grade III (n = 58), or grade IV (n = 72) gliomas. DTI, diffusion kurtosis imaging, and NODDI metrics were measured in regions with or without hyperintensity on diffusion MR images and compared among groups defined according to IDH genotype, 1p/19q codeletion status, and tumor grade by using Mann-Whitney tests. Results In grade II and III IDH wild-type gliomas, the maximum fractional anisotropy, kurtosis anisotropy, and restriction fraction were significantly higher and the minimum mean diffusivity was significantly lower than in IDH-mutant gliomas (P = .011, P = .002, P = .044, and P = .027, respectively); areas under the receiver operating characteristic curve ranged from 0.72 to 0.76. In IDH wild-type gliomas, no difference among grades II, III, and IV was found. In IDH-mutant gliomas, no difference between those with and those without 1p/19q loss was found. Conclusion Diffusion MRI metrics showed correlation with isocitrate dehydrogenase status in grade II and III gliomas. Advanced diffusion MRI models did not add diagnostic accuracy, supporting the inclusion of a single-shell diffusion-tensor imaging acquisition in brain tumor imaging protocols. Published under a CC BY 4.0 license. Online supplemental material is available for this article.
Highlights
MethodsParticipants All participants gave informed written consent for the surgical procedure and this prospective study, according to the World Medical Association Declaration of Helsinki statement for research involving human subjects
Diffusion MRI has the potential to contribute to stratifying patients with lower-grade glioma in clinical trials
The establishment of in vivo biomarkers that enable prediction of Isocitrate dehydrogenase (IDH) and 1p/19q status would be relevant for patient management [4] and clinical trials
Summary
Participants All participants gave informed written consent for the surgical procedure and this prospective study, according to the World Medical Association Declaration of Helsinki statement for research involving human subjects. This prospective study was approved by the local institutional review board and performed between April 2012 and November 2015. The conventional MRI protocol included a T2-weighted turbo spin-echo sequence (repetition time msec/ echo time msec, 5420/106; 40 sections; field of view, 240 3 240 mm; voxel size, 0.47 3 0.47 3 3 mm3) and a T1-weighted magnetization-prepared rapid acquisition gradient-echo sequence (repetition time msec/echo time msec/inversion time msec, 1800/2.7/900; nominal isotropic spatial resolution of 1 mm) before and after injection of a gadolinium-based contrast agent (Gadovist, Bayer Schering Pharma, Berlin, Germany; 0.1 mL per kilogram of body weight)
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