Usefulness of diffusion/perfusion-weighted MRI in patients with non-enhancing supratentorial brain gliomas: a valuable tool to predict tumour grading?

22 patients with non-enhancing supratentorial gliomas on contrast-enhanced MRI underwent both diffusion- and perfusion-weighted MRI (DWI/PWI) before surgical resection. 14 low-grade gliomas (WHO Grade I and II) and 8 anaplastic gliomas were verified histologically. Both apparent diffusion coefficient (ADC) values and relative cerebral blood volume (rCBV) ratios were calculated on the solid portion of the tumour, on peritumoural area, as well as on the contralateral normal white matter, respectively. The results showed that lower ADC values were present in the solid portions of anaplastic gliomas, but not in low grade (p < 0.01). All ADC values in peritumoural regions of tumours were decreased compared with the contralateral normal white matter. However, there was no significant difference between anaplastic gliomas and low-grade gliomas. Meanwhile, higher rCBV ratios were present in both solid portions and peritumoural regions of anaplastic gliomas, but not in low grade gliomas (p < 0.01). In conclusion, non-enhancing brain gliomas with lower ADC values in the solid portions and higher rCBV ratios in both solid portions and peritumoural regions of tumours are significantly correlated with anaplasia. Therefore, DWI and PWI should be integrated in the diagnostic work-up of non-enhancing gliomas in order to predict grading.

[1]  F. Mihara,et al.  Non-enhancing supratentorial malignant astrocytomas: MR features and possible mechanisms. , 1995, Radiation medicine.

[2]  Z. Wu,et al.  In vivo single-voxel proton MR spectroscopy in the differentiation of high-grade gliomas and solitary metastases. , 2004, Clinical radiology.

[3]  C. Eskey,et al.  Diffusion-weighted imaging in the follow-up of treated high-grade gliomas: tumor recurrence versus radiation injury. , 2004, AJNR. American journal of neuroradiology.

[4]  Glyn Johnson,et al.  Glioma grading: sensitivity, specificity, and predictive values of perfusion MR imaging and proton MR spectroscopic imaging compared with conventional MR imaging. , 2003, AJNR. American journal of neuroradiology.

[5]  I. Ercan,et al.  High-grade and low-grade gliomas: differentiation by using perfusion MR imaging. , 2005, Clinical radiology.

[6]  R. Tripathi,et al.  Perfusion magnetic resonance imaging and magnetic resonance spectroscopy of cerebral gliomas showing imperceptible contrast enhancement on conventional magnetic resonance imaging. , 2004, Australasian radiology.

[7]  Glyn Johnson,et al.  Diffusion-tensor MR imaging of intracranial neoplasia and associated peritumoral edema: introduction of the tumor infiltration index. , 2004, Radiology.

[8]  A. Maia,et al.  MR cerebral blood volume maps correlated with vascular endothelial growth factor expression and tumor grade in nonenhancing gliomas. , 2005, AJNR. American journal of neuroradiology.

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

[10]  R. Sevick,et al.  How often are nonenhancing supratentorial gliomas malignant? A population study , 2002, Neurology.

[11]  J. Bruner.  Neuropathology of malignant gliomas. , 1994, Seminars in oncology.

[12]  H. Zhen,et al.  Survivin expression and its relation with proliferation, apoptosis, and angiogenesis in brain gliomas , 2005, Cancer.

[13]  M. Takahashi,et al.  Perfusion-sensitive MR imaging of gliomas: comparison between gradient-echo and spin-echo echo-planar imaging techniques. , 2001, AJNR. American journal of neuroradiology.

[14]  N. Bulakbaşı,et al.  Assessment of diagnostic accuracy of perfusion MR imaging in primary and metastatic solitary malignant brain tumors. , 2005, AJNR. American journal of neuroradiology.

[15]  N. Bulakbaşı,et al.  Combination of single-voxel proton MR spectroscopy and apparent diffusion coefficient calculation in the evaluation of common brain tumors. , 2003, AJNR. American journal of neuroradiology.

[16]  H Kalimo,et al.  MR classification of brain gliomas: value of magnetization transfer and conventional imaging. , 1995, Magnetic resonance imaging.

[17]  G. Fan,et al.  Usefulness of diffusion/perfusion-weighted MRI in rat gliomas: correlation with histopathology. , 2005, Academic radiology.

[18]  N. Bulakbaşı,et al.  The Added Value of the Apparent Diffusion Coefficient Calculation to Magnetic Resonance Imaging in the Differentiation and Grading of Malignant Brain Tumors , 2004, Journal of computer assisted tomography.

[19]  Karl-Josef Langen,et al.  Can the apparent diffusion coefficient be used as a noninvasive parameter to distinguish tumor tissue from peritumoral tissue in cerebral gliomas? , 2004, Journal of magnetic resonance imaging : JMRI.

[20]  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.

[21]  R D Tien,et al.  MR imaging of high-grade cerebral gliomas: value of diffusion-weighted echoplanar pulse sequences. , 1994, AJR. American journal of roentgenology.

[22]  J. Rees.  Advances in magnetic resonance imaging of brain tumours , 2003, Current opinion in neurology.

[23]  Glyn Johnson,et al.  Comparison of cerebral blood volume and vascular permeability from dynamic susceptibility contrast-enhanced perfusion MR imaging with glioma grade. , 2004, AJNR. American journal of neuroradiology.

[24]  Carlo Giussani,et al.  Angiogenesis and invasion in gliomas. , 2004, Cancer treatment and research.

[25]  Susan M. Chang,et al.  Dynamic susceptibility-weighted perfusion imaging of high-grade gliomas: characterization of spatial heterogeneity. , 2005, AJNR. American journal of neuroradiology.