Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
Neuroradiology. 2020 Jul;62(7):815-823. doi: 10.1007/s00234-020-02456-2. Epub 2020 May 18.
Diffusion-weighted imaging (DWI) plays an important role in the preoperative assessment of gliomas; however, the diagnostic performance of histogram-derived parameters from mono-, bi-, and stretched-exponential DWI models in the grading of gliomas has not been fully investigated. Therefore, we compared these models' ability to differentiate between high-grade and low-grade gliomas.
This retrospective study included 22 patients with diffuse gliomas (age, 23-74 years; 12 males; 11 high-grade and 11 low-grade gliomas) who underwent preoperative 3 T-magnetic resonance imaging from October 2014 to August 2019. The apparent diffusion coefficient was calculated from the mono-exponential model. Using 13 b-values, the true-diffusion coefficient, pseudo-diffusion coefficient, and perfusion fraction were obtained from the bi-exponential model, and the distributed-diffusion coefficient and heterogeneity index were obtained from the stretched-exponential model. Region-of-interests were drawn on each imaging parameter map for subsequent histogram analyses.
The skewness of the apparent diffusion, true-diffusion, and distributed-diffusion coefficients was significantly higher in high-grade than in low-grade gliomas (0.67 ± 0.67 vs. - 0.18 ± 0.63, 0.68 ± 0.74 vs. - 0.08 ± 0.66, 0.63 ± 0.72 vs. - 0.15 ± 0.73; P = 0.0066, 0.0192, and 0.0128, respectively). The 10th percentile of the heterogeneity index was significantly lower (0.77 ± 0.08 vs. 0.88 ± 0.04; P = 0.0004), and the 90th percentile of the perfusion fraction was significantly higher (12.64 ± 3.44 vs. 7.14 ± 1.70%: P < 0.0001), in high-grade than in low-grade gliomas. The combination of the 10th percentile of the true-diffusion coefficient and 90th percentile of the perfusion fraction showed the best area under the receiver operating characteristic curve (0.96).
The bi-exponential model exhibited the best diagnostic performance for differentiating high-grade from low-grade gliomas.
弥散加权成像（DWI）在术前评估胶质瘤中起着重要作用；然而，单指数、双指数和扩展指数 DWI 模型的直方图衍生参数在胶质瘤分级中的诊断性能尚未得到充分研究。因此，我们比较了这些模型在区分高级别和低级别胶质瘤方面的能力。
这项回顾性研究纳入了 22 名弥漫性胶质瘤患者（年龄 23-74 岁；男性 12 名；高级别胶质瘤 11 例，低级别胶质瘤 11 例），他们于 2014 年 10 月至 2019 年 8 月在 3T 磁共振成像上进行了术前检查。单指数模型计算表观扩散系数。使用 13 个 b 值，从双指数模型中获得真实扩散系数、假性扩散系数和灌注分数，从扩展指数模型中获得分布扩散系数和异质性指数。在每个成像参数图上画出感兴趣区，以便进行后续的直方图分析。
高级别胶质瘤的表观扩散、真实扩散和分布扩散系数的偏度明显高于低级别胶质瘤（0.67±0.67 与-0.18±0.63，0.68±0.74 与-0.08±0.66，0.63±0.72 与-0.15±0.73；P=0.0066、0.0192 和 0.0128）。异质性指数的第 10 百分位数明显较低（0.77±0.08 与 0.88±0.04；P=0.0004），灌注分数的第 90 百分位数明显较高（12.64±3.44 与 7.14±1.70%：P<0.0001），高级别胶质瘤明显高于低级别胶质瘤。真实扩散系数的第 10 百分位数和灌注分数的第 90 百分位数的组合显示出最佳的受试者工作特征曲线下面积（0.96）。
双指数模型在区分高级别和低级别胶质瘤方面表现出最佳的诊断性能。
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