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Diffusion kurtosis imaging of gliomas grades II and III - A study of perilesional tumor infiltration, tumor grades and subtypes at clinical presentation

Delgado, Anna F.; Fahlström, Markus; Nilsson, Markus LU ; Berntsson, Shala G.; Zetterling, Maria; Libard, Sylwia; Alafuzoff, Irina; Van Westen, Danielle LU ; Lätt, Jimmy LU and Smits, Anja, et al. (2017) In Radiotherapy and Oncology 51(2). p.121-129
Abstract

Diffusion kurtosis imaging (DKI) allows for assessment of diffusion influenced by microcellular structures. We analyzed DKI in suspected low-grade gliomas prior to histopathological diagnosis. The aim was to investigate if diffusion parameters in the perilesional normal-appearing white matter (NAWM) differed from contralesional white matter, and to investigate differences between glioma malignancy grades II and III and glioma subtypes (astrocytomas and oligodendrogliomas). Forty-eight patients with suspected low-grade glioma were prospectively recruited to this institutional review board-approved study and investigated with preoperative DKI at 3T after written informed consent. Patients with histologically proven glioma grades II or III... (More)

Diffusion kurtosis imaging (DKI) allows for assessment of diffusion influenced by microcellular structures. We analyzed DKI in suspected low-grade gliomas prior to histopathological diagnosis. The aim was to investigate if diffusion parameters in the perilesional normal-appearing white matter (NAWM) differed from contralesional white matter, and to investigate differences between glioma malignancy grades II and III and glioma subtypes (astrocytomas and oligodendrogliomas). Forty-eight patients with suspected low-grade glioma were prospectively recruited to this institutional review board-approved study and investigated with preoperative DKI at 3T after written informed consent. Patients with histologically proven glioma grades II or III were further analyzed (n=35). Regions of interest (ROIs) were delineated on T2FLAIR images and co-registered to diffusion MRI parameter maps. Mean DKI data were compared between perilesional and contralesional NAWM (student's t-test for dependent samples, Wilcoxon matched pairs test). Histogram DKI data were compared between glioma types and glioma grades (multiple comparisons of mean ranks for all groups). The discriminating potential for DKI in assessing glioma type and grade was assessed with receiver operating characteristics (ROC) curves. There were significant differences in all mean DKI variables between perilesional and contralesional NAWM (p=<0.000), except for axial kurtosis (p=0.099). Forty-four histogram variables differed significantly between glioma grades II (n=23) and III (n=12) (p=0.003-0.048) and 10 variables differed significantly between ACs (n=18) and ODs (n=17) (p=0.011-0.050). ROC curves of the best discriminating variables had an area under the curve (AUC) of 0.657-0.815. Mean DKI variables in perilesional NAWM differ significantly from contralesional NAWM, suggesting altered microstructure by tumor infiltration not depicted on morphological MRI. Histogram analysis of DKI data identifies differences between glioma grades and subtypes.

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publication status
published
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keywords
diffusion kurtosis imaging (DKI), glioma, grade, perilesional, subtype, tumor infiltration
in
Radiotherapy and Oncology
volume
51
issue
2
pages
9 pages
publisher
Elsevier
external identifiers
  • scopus:85020427841
  • wos:000401697000001
ISSN
1318-2099
DOI
10.1515/raon-2017-0010
language
English
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yes
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61b530ff-ac09-4faf-ad2a-3cc1861e3eee
date added to LUP
2017-08-21 10:11:36
date last changed
2017-09-18 11:42:12
@article{61b530ff-ac09-4faf-ad2a-3cc1861e3eee,
  abstract     = {<p>Diffusion kurtosis imaging (DKI) allows for assessment of diffusion influenced by microcellular structures. We analyzed DKI in suspected low-grade gliomas prior to histopathological diagnosis. The aim was to investigate if diffusion parameters in the perilesional normal-appearing white matter (NAWM) differed from contralesional white matter, and to investigate differences between glioma malignancy grades II and III and glioma subtypes (astrocytomas and oligodendrogliomas). Forty-eight patients with suspected low-grade glioma were prospectively recruited to this institutional review board-approved study and investigated with preoperative DKI at 3T after written informed consent. Patients with histologically proven glioma grades II or III were further analyzed (n=35). Regions of interest (ROIs) were delineated on T2FLAIR images and co-registered to diffusion MRI parameter maps. Mean DKI data were compared between perilesional and contralesional NAWM (student's t-test for dependent samples, Wilcoxon matched pairs test). Histogram DKI data were compared between glioma types and glioma grades (multiple comparisons of mean ranks for all groups). The discriminating potential for DKI in assessing glioma type and grade was assessed with receiver operating characteristics (ROC) curves. There were significant differences in all mean DKI variables between perilesional and contralesional NAWM (p=&lt;0.000), except for axial kurtosis (p=0.099). Forty-four histogram variables differed significantly between glioma grades II (n=23) and III (n=12) (p=0.003-0.048) and 10 variables differed significantly between ACs (n=18) and ODs (n=17) (p=0.011-0.050). ROC curves of the best discriminating variables had an area under the curve (AUC) of 0.657-0.815. Mean DKI variables in perilesional NAWM differ significantly from contralesional NAWM, suggesting altered microstructure by tumor infiltration not depicted on morphological MRI. Histogram analysis of DKI data identifies differences between glioma grades and subtypes.</p>},
  author       = {Delgado, Anna F. and Fahlström, Markus and Nilsson, Markus and Berntsson, Shala G. and Zetterling, Maria and Libard, Sylwia and Alafuzoff, Irina and Van Westen, Danielle and Lätt, Jimmy and Smits, Anja and Larsson, Elna Marie},
  issn         = {1318-2099},
  keyword      = {diffusion kurtosis imaging (DKI),glioma,grade,perilesional,subtype,tumor infiltration},
  language     = {eng},
  month        = {05},
  number       = {2},
  pages        = {121--129},
  publisher    = {Elsevier},
  series       = {Radiotherapy and Oncology},
  title        = {Diffusion kurtosis imaging of gliomas grades II and III - A study of perilesional tumor infiltration, tumor grades and subtypes at clinical presentation},
  url          = {http://dx.doi.org/10.1515/raon-2017-0010},
  volume       = {51},
  year         = {2017},
}