Abstract
PurposeTo quantitatively evaluate the diagnostic efficiency of parameters from diffusion and dynamic contrast-enhanced MR which based on tumor parenchyma (TP) and peritumoral (PT) area in classification of brain tumors.Methods45 patients (male: 23, female: 22; mean age: 46 y) were prospectively recruited and they underwent conventional, DCE-MR and DWI examination. With each tumor, 10–15 regions of interest (ROIs) were manually placed on TP and PT area. ADC and permeability parameters (Ktrans, Ve, Kep and iAUC) were calculated and their diagnostic efficiency was assessed.ResultsIn TP, all permeability parameters and ADC value could significantly discriminate Low- from High grade gliomas (HGG) (p<0.001); among theses parameters, Ve demonstrated the highest diagnostic power (iAUC: 0.79, cut-off point: 0.15); the most sensitive and specific index for gliomas grading were Ktrans (84%) and Kep (89%). While, in PT area, only Ktrans could help in gliomas grading (P = 0.009, cut-off point: 0.03 min-1). Moreover, in TP, mean Ve and iAUC of primary central nervous system lymphoma (PCNSL) and metastases were significantly higher than that in HGG (p<0.003). Further, in PT area, mean Ktrans (p≤0.004) could discriminate PCNSL from HGG and ADC (p≤0.003) could differentiate metastases with HGG.ConclusionsQuantitative ADC and permeability parameters from Diffusion and DCE-MR in TP and PT area, especially DCE-MR, can aid in gliomas grading and brain tumors discrimination. Their combined application is strongly recommended in the differential diagnosis of these tumor entities.
Highlights
Preoperative accurate brain tumor diagnosis plays an essential role in the selection of the optimum treatment strategy, as their management and prognosis are different
In tumor parenchyma (TP), all permeability parameters and ADC value could significantly discriminate Lowfrom High grade gliomas (HGG) (p
Our study demonstrated that quantitative ADC value, permeability parameters and measuring different regions of interest (ROIs) in and around tumor area could help with the differential diagnosis
Summary
Preoperative accurate brain tumor diagnosis plays an essential role in the selection of the optimum treatment strategy, as their management and prognosis are different. Conventional structural imaging for accurate tumor diagnosis and grading is still challenging [1, 2]. Approximately 20% of low-grade gliomas enhance after administration of a gadolinium-based MR contrast agent, whereas approximately one third of nonenhancing gliomas are malignant [3, 4]; the clinical application of conventional imaging in brain tumor diagnosis is limited and nonspecific. Advanced MR imaging techniques, such as dynamic contrast enhanced MRI [DCE-MR] [5, 6] and diffusion weighted imaging (DWI) [7] can provide information on physiology and metabolism in vivo which is not available from conventional MR imaging that could be aid in gliomas grading, tumor margin definition and differential diagnosis of brain tumors. Lam WW [13] found ADC is useless for gliomas grading while the study of Kono K [14] and Kitis O [15] showed ADC could significantly differentiate brain tumors
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