Diffusion tensor imaging for preoperative evaluation of tumor grade in gliomas

The relationship between water diffusion parameters measured using diffusion tensor imaging (DTI) and histological malignancy of gliomas was investigated. DTI was performed using a 3.0T MR scanner in 41 consecutive patients with histologically proven gliomas. Fractional anisotropy (FA) and mean diffusivity (MD) were calculated and compared with the WHO classification of the gliomas. The FA values of grade 1 gliomas (0.150 +/- 0.017) were significantly lower than those of grade 3 (0.23 +/- 0.033) or grade 4 gliomas (0.229 +/- 0.033) (P < 0.0001, respectively). The FA values of grade 2 gliomas (0.159 +/- 0.018) were significantly lower than those of grade 3 or grade 4 gliomas (P = 0.0002, P < 0.0001, respectively). The FA threshold between low grade and high grade gliomas was 0.188. The MD values of grade 1 gliomas (1619.1 +/- 157.4 x 10(-6) mm2/s) were significantly higher than those of grade 3 (1084.5 +/- 218.9 x 10(-6) mm2/s) (P = 0.0036) or grade 4 gliomas (1098.0 +/- 291.6 x 10(-6) mm2/s) (P = 0.0002). The MD values were not correlated with the other grades of glioma. FA values can distinguish between high grade and low grade gliomas. This is useful in deciding the surgical strategy or selecting the site of stereotactic biopsy.

[1]  M Cercignani,et al.  Diffusion tensor magnetic resonance imaging in multiple sclerosis , 2001, Neurology.

[2]  Mark E Bastin,et al.  Diffusion tensor MR imaging of high-grade cerebral gliomas. , 2002, AJNR. American journal of neuroradiology.

[3]  J V Hajnal,et al.  MR imaging of anisotropically restricted diffusion of water in the nervous system: technical, anatomic, and pathologic considerations. , 1991, Journal of computer assisted tomography.

[4]  P M Black,et al.  Brain tumors. Part 1. , 1991, The New England journal of medicine.

[5]  T. Ptak,et al.  Investigation of apparent diffusion coefficient and diffusion tensor anisotrophy in acute and chronic multiple sclerosis lesions. , 1999, AJNR. American journal of neuroradiology.

[6]  E. Ryding,et al.  Evaluation of malignancy in ring enhancing brain lesions on CT by thallium-201 SPECT , 1997, Journal of neurology, neurosurgery, and psychiatry.

[7]  A. Anderson,et al.  Effects of osmotically driven cell volume changes on diffusion‐weighted imaging of the rat optic nerve , 1996, Magnetic resonance in medicine.

[8]  B. Mock,et al.  High-b-value diffusion-weighted MR imaging of suspected brain infarction. , 2000, AJNR. American journal of neuroradiology.

[9]  G J Barker,et al.  Investigation of MS normal-appearing brain using diffusion tensor MRI with clinical correlations , 2001, Neurology.

[10]  H S Markus,et al.  Characterization of white matter damage in ischemic leukoaraiosis with diffusion tensor MRI. , 1999, Stroke.

[11]  R. Gupta,et al.  Prospective evaluation of in vivo proton MR spectroscopy in differentiation of similar appearing intracranial cystic lesions. , 2001, Magnetic resonance imaging.

[12]  Y. Sonoda,et al.  Thallium-201 single-photon emission computed tomographic and proton magnetic resonance spectroscopic characteristics of intracranial ganglioglioma: three technical case reports. , 1999, Neurosurgery.

[13]  M R Symms,et al.  Reduced anisotropy of water diffusion in structural cerebral abnormalities demonstrated with diffusion tensor imaging. , 1999, Magnetic resonance imaging.

[14]  H. Shimizu,et al.  Correlation between choline level measured by proton MR spectroscopy and Ki-67 labeling index in gliomas. , 2000, AJNR. American journal of neuroradiology.

[15]  T. Yoshimoto,et al.  Prognostic value of complete response after the initial treatment for malignant astrocytoma. , 1996, Neurological research.

[16]  E. Melhem,et al.  Diffusion tensor MR imaging of the brain: effect of diffusion weighting on trace and anisotropy measurements. , 2000, AJNR. American journal of neuroradiology.

[17]  P. Basser,et al.  Toward a quantitative assessment of diffusion anisotropy , 1996, Magnetic resonance in medicine.

[18]  J. Tsuruda,et al.  Cytotoxic brain edema: assessment with diffusion-weighted MR imaging. , 1992, Radiology.

[19]  B. Scheithauer,et al.  Oligodendrogliomas: Reproducibility and Prognostic Value of Histologic Diagnosis and Grading , 2001, Journal of neuropathology and experimental neurology.

[20]  A. Snyder,et al.  Quantitative diffusion-tensor anisotropy brain MR imaging: normative human data and anatomic analysis. , 1999, Radiology.

[21]  P. Basser,et al.  Diffusion tensor MR imaging of the human brain. , 1996, Radiology.

[22]  S. El-Saden,et al.  Cerebral gangliogliomas: preoperative grading using FDG-PET and 201Tl-SPECT. , 1998, AJNR. American journal of neuroradiology.

[23]  L. Sobin,et al.  World Health Organization classification of tumors , 2000, Cancer.

[24]  K. Hara,et al.  Noninvasive evaluation of malignancy of brain tumors with proton MR spectroscopy. , 1996, AJNR. American journal of neuroradiology.

[25]  A G Sorensen,et al.  Highly diffusion‐sensitized MRI of brain: Dissociation of gray and white matter , 2001, Magnetic resonance in medicine.

[26]  T. Shibasaki,et al.  Assessment of malignancy of glioma by positron emission tomography with 18F-fluorodeoxyglucose and single photon emission computed tomography with thallium-201 chloride , 1998, Neuroradiology.

[27]  T Nakada,et al.  High-resolution T2-reversed magnetic resonance imaging on a high magnetic field system. Technical note. , 1998, Journal of neurosurgery.

[28]  R Stollberger,et al.  Magnetic resonance diffusion tensor imaging for characterizing diffuse and focal white matter abnormalities in multiple sclerosis , 2000, Magnetic resonance in medicine.

[29]  Toshinori Hirai,et al.  Usefulness of diffusion‐weighted MRI with echo‐planar technique in the evaluation of cellularity in gliomas , 1999, Journal of magnetic resonance imaging : JMRI.

[30]  K. Nabeshima,et al.  Brain surface ependymoma , 2000, Neuropathology : official journal of the Japanese Society of Neuropathology.

[31]  Dorothy S. Russell,et al.  Pathology of Tumours of the Nervous System , 1972 .

[32]  Proton (1H) MR Spectroscopy for Routine Diagnostic Evaluation of Brain Lesions , 1997, Acta radiologica.

[33]  M A Horsfield,et al.  Diffusion tensor MRI assesses corticospinal tract damage in ALS , 1999, Neurology.

[34]  P. Kelly,et al.  Grading of astrocytomas: A simple and reproducible method , 1988, Cancer.

[35]  T. Nakada,et al.  High-field magnetic resonance imaging in patients with moyamoya disease. , 2001, Journal of neurosurgery.