Gliomas: Diffusion Kurtosis MR Imaging in Grading

• Published in: Radiology Vol. 263; no. 2; pp. 492 - 501
• Main Authors: Van Cauter, Sofie, Veraart, Jelle, Sijbers, Jan, Peeters, Ronald R., Himmelreich, Uwe, De Keyzer, Frederik, Van Gool, Stefaan W., Van Calenbergh, Frank, De Vleeschouwer, Steven, Van Hecke, Wim, Sunaert, Stefan
• Format: Journal Article
• Language: English
• Published: Oak Brook, IL Radiological Society of North America 01.05.2012
• Subjects: Adult; Aged; Anisotropy; Area Under Curve; Biological and medical sciences; Brain Neoplasms - pathology; Contrast Media; Diffusion Magnetic Resonance Imaging - methods; Female; Glioma - pathology; Humans; Image Interpretation, Computer-Assisted; Imaging, Three-Dimensional; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Meglumine; Middle Aged; Neoplasm Grading; Neurology; Organometallic Compounds; Prospective Studies; ROC Curve; Sensitivity and Specificity; Statistics, Nonparametric; Tumors of the nervous system. Phacomatoses; Nuclear medicine; Nervous system diseases; Glioma; Central nervous system disease; Radiology; Diffusion imaging; Medical imagery; Tumor; Nuclear magnetic resonance imaging
• ISSN: 0033-8419; 1527-1315; 1527-1315
• DOI: 10.1148/radiol.12110927

To assess the diagnostic accuracy of diffusion kurtosis magnetic resonance imaging parameters in grading gliomas. The institutional review board approved this prospective study, and informed consent was obtained from all patients. Diffusion parameters-mean diffusivity (MD), fractional anisotropy (FA), mean kurtosis, and radial and axial kurtosis-were compared in the solid parts of 17 high-grade gliomas and 11 low-grade gliomas (P<.05 significance level, Mann-Whitney-Wilcoxon test, Bonferroni correction). MD, FA, mean kurtosis, radial kurtosis, and axial kurtosis in solid tumors were also normalized to the corresponding values in contralateral normal-appearing white matter (NAWM) and the contralateral posterior limb of the internal capsule (PLIC) after age correction and were compared among tumor grades. Mean, radial, and axial kurtosis were significantly higher in high-grade gliomas than in low-grade gliomas (P = .02, P = .015, and P = .01, respectively). FA and MD did not significantly differ between glioma grades. All values, except for axial kurtosis, that were normalized to the values in the contralateral NAWM were significantly different between high-grade and low-grade gliomas (mean kurtosis, P = .02; radial kurtosis, P = .03; FA, P = .025; and MD, P = .03). When values were normalized to those in the contralateral PLIC, none of the considered parameters showed significant differences between high-grade and low-grade gliomas. The highest sensitivity and specificity for discriminating between high-grade and low-grade gliomas were found for mean kurtosis (71% and 82%, respectively) and mean kurtosis normalized to the value in the contralateral NAWM (100% and 73%, respectively). Optimal thresholds for mean kurtosis and mean kurtosis normalized to the value in the contralateral NAWM for differentiating high-grade from low-grade gliomas were 0.52 and 0.51, respectively. There were significant differences in kurtosis parameters between high-grade and low-grade gliomas; hence, better separation was achieved with these parameters than with conventional diffusion imaging parameters.