Al-Agha Mansour, Abushab Khaled, Quffa Khetam, Al-Agha Samy, Alajerami Yasser, Tabash Mohammed
Radiology Department, Al-Shifa Medical Complex, Ministry of Health, Gaza, State of Palestine.
Medical Imaging Department, Faculty of Applied Medical Sciences, Al Azhar University-Gaza, Gaza, State of Palestine.
J Oncol. 2020 Sep 14;2020:6942406. doi: 10.1155/2020/6942406. eCollection 2020.
Glioma is the most common fatal malignant tumor of the CNS. Early detection of glioma grades based on diffusion-weighted imaging (DWI) properties is considered one of the most recent noninvasive promising tools in the assessment of glioma grade and could be helpful in monitoring patient prognosis and response to therapy.
This study aimed to investigate the accuracy of DWI at both standard and high values ( = 1000 s/mm and = 3000 s/mm) to distinguish high-grade glioma (HGG) from low-grade glioma (LGG) in clinical practice based on histopathological results.
Twenty-three patients with glioma had DWI at l.5 T MR using two different values ( = 1000 s/mm and = 3000 s/mm) at Al-Shifa Medical Complex after obtaining ethical and administrative approvals, and data were collected from March 2019 to March 2020. Minimum, maximum, and mean of apparent diffusion coefficient (ADC) values were measured through drawing region of interest (ROI) on a solid part at ADC maps. Data were analyzed by using the MedCalc analysis program, version 19.0.4, receiver operating characteristic (ROC) curve analysis was done, and optimal cutoff values for grading gliomas were determined. Sensitivity and specificity were also calculated.
The obtained results showed the ADC, ADC, ADC, and ADC were performed to differentiate between LGG and HGG at both standard and high values. Moreover, ADC values were inversely proportional to glioma grade, and these differences are more obvious at high value. Minimum ADC values using standard value were 1.13 ± 0.17 × 10 mm/s, 0.89 ± 0.85 × 10 mm/s, and 0.82 ± 0.17 × 10 mm/s for grades II, III, and IV, respectively. Concerning high value, ADC values were 0.76 ± 0.07 × 10 mm/s, 0.61 ± 0.01 × 10 mm/s, and 0.48 ± 0.07 × 10 mm/s for grades II, III, and IV, respectively. ADC values were inversely correlated with results of glioma grades, and the correlation was stronger at ADC ( = -0.722, ≤ 0.001). The ADC achieved the highest diagnostic accuracy with an area under the curve (AUC) of 0.618, 100% sensitivity, 85.7% specificity, and 85.7% accuracy for glioma grading at a cutoff point of ≤0.618 × 10 mm/s. The high value showed stronger agreement with histopathology compared with standard value results ( = 0.89 and 0.79), respectively.
The ADC values decrease with an increase in tumor cellularity. Meanwhile, high value provides better tissue contrast by reflecting more tissue diffusivity. Therefore, ADC-derived parameters at high value are more useful in the grading of glioma than those obtained at standard value. They might be a better surrogate imaging sequence in the preoperative evaluation of gliomas.
胶质瘤是中枢神经系统最常见的致命性恶性肿瘤。基于扩散加权成像（DWI）特性早期检测胶质瘤分级被认为是评估胶质瘤分级中最新的无创性有前景的工具之一，有助于监测患者预后及对治疗的反应。
本研究旨在基于组织病理学结果，探讨在临床实践中标准值（=1000 s/mm²）和高值（=3000 s/mm²）的DWI区分高级别胶质瘤（HGG）和低级别胶质瘤（LGG）的准确性。
在获得伦理和行政批准后，23例胶质瘤患者于Al-Shifa医疗中心接受1.5 T MR的DWI检查，采用两个不同的值（=1000 s/mm²和=3000 s/mm²），数据收集时间为2019年3月至2020年3月。通过在表观扩散系数（ADC）图的实性部分绘制感兴趣区（ROI）测量ADC值的最小值、最大值和平均值。使用MedCalc分析程序（版本19.0.4）进行数据分析，绘制受试者工作特征（ROC）曲线，并确定胶质瘤分级的最佳截断值。还计算了敏感性和特异性。
所得结果表明，在标准值和高值时，均进行了ADC、ADC、ADC和ADC以区分LGG和HGG。此外，ADC值与胶质瘤分级呈负相关，在高值时这些差异更明显。使用标准值时，II级、III级和IV级胶质瘤的最小ADC值分别为1.13±0.17×10⁻³mm²/s、0.89±0.85×10⁻³mm²/s和0.82±0.17×10⁻³mm²/s。对于高值，II级、III级和IV级胶质瘤的ADC值分别为0.76±0.07×10⁻³mm²/s、0.61±0.01×10⁻³mm²/s和0.48±0.07×10⁻³mm²/s。ADC值与胶质瘤分级结果呈负相关，在ADC时相关性更强（= -0.722，P≤0.001）。ADC在截断点≤0.618×10⁻³mm²/s时，诊断准确性最高，曲线下面积（AUC）为0.618，敏感性为100%，特异性为85.7%，胶质瘤分级准确性为85.7%。与标准值结果相比，高值与组织病理学的一致性更强（分别为=0.89和0.79）。
ADC值随肿瘤细胞密度增加而降低。同时，高值通过反映更多的组织扩散性提供更好的组织对比度。因此，高值时基于ADC的参数在胶质瘤分级中比标准值时获得的参数更有用。它们可能是胶质瘤术前评估中更好的替代成像序列。
