Assessment of diffusion tensor imaging metrics in differentiating low-grade from high-grade gliomas

El-Serougy, Lamiaa; Razek, Ahmed Abdel Khalek Abdel; Ezzat, A.; Eldawoody, Hany; El-Morsy, Ahmad

doi:10.1177/1971400916665382

Cited by 104 publications

(72 citation statements)

References 38 publications

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“…DTI takes the advantage of diffusion of water in brain tissue within three main directions, which is decreased perpendicularly to the myelin sheaths and cell membranes of white-matter axons [6].…”

Section: Discussionmentioning

confidence: 99%

Diffusion tensor imaging for assessment of normally appearing white matter of the brain and spinal cord in cases of multiple sclerosis: a multi-parametric correlation in view of patient’s clinical status

ElSayed¹,

Eltoukhy

Asaad

et al. 2019

Egypt J Radiol Nucl Med

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Background: Conventional MRI provides important morphologic information regarding the brain and spinal cord involvement by demyelinating plaques. However, it is of almost no value in assessing the normal-appearing white matter which has been proved by multiple pathologic studies to be directly and indirectly involved in the process of multiple sclerosis. Diffusion-weighted imaging and diffusion tensor imaging MRI have been widely used in multiple researches as a better solution for studying the normal-appearing white matter. The purpose of this study was to evaluate the role of diffusion tensor imaging examination of the normal-appearing white matter of the brain and spinal cord in patients with multiple sclerosis and to determine the relationship between diffusion tensor imaging metrics and patient's clinical status. Results: The significant negative correlation found between expanded disability status scale score of secondary progressive MS patients and global (brain and spinal cord) average fractional anisotropy values in normal-appearing white matter and tracts (P = 0.000). Correlation between average apparent diffusion coefficient of corpus callosum tract and expanded disability status scale score revealed a significant positive correlation in RRMS (P = 0.001). While in secondary progressive MS, a significant negative correlation between fractional anisotropy average of the corpus callosum tract and expanded disability status scale score was noted (P = 0.015). Conclusion: There is a strong relationship between diffusion tensor imaging readings and clinical status of patients can be used to understand unexplained deterioration over disease course and also can be used when conventional MRI findings are equivocal. Corpus callosum affection in MS patients is intimately related to clinical status and its assessment should be done whenever possible.

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Section: Discussionmentioning

confidence: 99%

Diffusion tensor imaging for assessment of normally appearing white matter of the brain and spinal cord in cases of multiple sclerosis: a multi-parametric correlation in view of patient’s clinical status

ElSayed¹,

Eltoukhy

Asaad

et al. 2019

Egypt J Radiol Nucl Med

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“…Some studies used subjective placement of ROIs surrounding the tumor to examine FA and/or MD (3, 10, 12, 15, 16, 21, 23, 25–28). Several studies have employed experts to manually draw a perimeter around the tumor (4–7, 11, 14, 19, 22, 24, 29).…”

Section: Introductionmentioning

confidence: 99%

“…Several studies have employed experts to manually draw a perimeter around the tumor (4–7, 11, 14, 19, 22, 24, 29). In addition, the majority of previous studies were limited by small numbers of patients included in the studies (3–7, 10, 11, 14–16, 21, 22, 24–26, 28, 29). …”

Section: Introductionmentioning

confidence: 99%

High-grade Gliomas Exhibit Higher Peritumoral Fractional Anisotropy and Lower Mean Diffusivity than Intracranial Metastases

et al. 2017

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Differentiating high-grade gliomas and intracranial metastases through non-invasive imaging has been challenging. Here, we retrospectively compared both intratumoral and peritumoral fractional anisotropy (FA), mean diffusivity (MD), and fluid-attenuated inversion recovery (FLAIR) measurements between high-grade gliomas and metastases. Two methods were utilized to select peritumoral region of interest (ROI). The first method utilized the manual placement of four ROIs adjacent to the lesion. The second method utilized a semiautomated and proprietary MATLAB script to generate an ROI encompassing the entire tumor. The average peritumoral FA, MD, and FLAIR values were determined within the ROIs for both methods. Forty patients with high-grade gliomas and 44 with metastases were enrolled in this study. Thirty-five patients with high-grade glioma and 30 patients with metastases had FLAIR images. There was no significant difference in age, gender, or race between the two patient groups. The high-grade gliomas had a significantly higher tumor-to-brain area ratio compared to the metastases. There were no differences in average intratumoral FA, MD, and FLAIR values between the two groups. Both the manual sample method and the semiautomated peritumoral ring method resulted in significantly higher peritumoral FA and significantly lower peritumoral MD in high-grade gliomas compared to metastases (p < 0.05). No significant difference was found in FLAIR values between the two groups peritumorally. Receiver operating curve analysis revealed FA to be a more sensitive and specific metric to differentiate high-grade gliomas and metastases than MD. The differences in the peritumoral FA and MD values between high-grade gliomas and metastases seemed due to the infiltration of glioma to the surrounding brain parenchyma.

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“…19 DTI has been reported to distinguish high-from low-grade gliomas, 20 and in particular the MD measured in the tumor bulk achieved an accuracy of 91.4%. 21 However, in studies comparing multiple modalities, measures of perfusion were superior for grading, and a multimodality algorithm was best. 22 While DTI makes the assumption that water diffusion assumes a Gaussian distribution, diffusion kurtosis imaging (DKI) accounts for the fact that the highly organized architecture of brain parenchyma results in a non-Gaussian distribution of water diffusion.…”

Section: Diagnostic Clues In Standard Mrimentioning

confidence: 99%

“…For example, study of 31 patients demonstrated that DTI could reliably be used to predict invasion into the corpus callosum . DTI has been reported to distinguish high‐ from low‐grade gliomas, and in particular the MD measured in the tumor bulk achieved an accuracy of 91.4% . However, in studies comparing multiple modalities, measures of perfusion were superior for grading, and a multimodality algorithm was best .…”

Section: Introductionmentioning

confidence: 99%

Clinical Imaging for Diagnostic Challenges in the Management of Gliomas: A Review

Bonm

Ritterbusch

Throckmorton

et al. 2020

Journal of Neuroimaging

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Neuroimaging plays a critical role in the management of patients with gliomas. While conventional magnetic resonance imaging (MRI) remains the standard imaging modality, it is frequently insufficient to inform clinical decision‐making. There is a need for noninvasive strategies for reliably distinguishing low‐grade from high‐grade gliomas, identifying important molecular features of glioma, choosing an appropriate target for biopsy, delineating target area for surgery or radiosurgery, and distinguishing tumor progression (TP) from pseudoprogression (PsP). One recent advance is the identification of the T2/fluid‐attenuated inversion recovery mismatch sign on standard MRI to identify isocitrate dehydrogenase mutant astrocytomas. However, to meet other challenges, neuro‐oncologists are increasingly turning to advanced imaging modalities. Diffusion‐weighted imaging modalities including diffusion tensor imaging and diffusion kurtosis imaging can be helpful in delineating tumor margins and better visualization of tissue architecture. Perfusion imaging including dynamic contrast‐enhanced MRI using gadolinium or ferumoxytol contrast agents can be helpful for grading as well as distinguishing TP from PsP. Positron emission tomography is useful for measuring tumor metabolism, which correlates with grade and can distinguish TP/PsP in the right setting. Magnetic resonance spectroscopy can identify tissue by its chemical composition, can distinguish TP/PsP, and can identify molecular features like 2‐hydroxyglutarate. Finally, amide proton transfer imaging measures intracellular protein content, which can be used to identify tumor grade/progression and distinguish TP/PsP.

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Assessment of diffusion tensor imaging metrics in differentiating low-grade from high-grade gliomas

Abstract: We conclude that the combination of MD of the solid tumoral part and FA of the peri-tumoral region is a noninvasive method to differentiate low-grade from high-grade gliomas.

Cited by 104 publications

References 38 publications

Diffusion tensor imaging for assessment of normally appearing white matter of the brain and spinal cord in cases of multiple sclerosis: a multi-parametric correlation in view of patient’s clinical status

Diffusion tensor imaging for assessment of normally appearing white matter of the brain and spinal cord in cases of multiple sclerosis: a multi-parametric correlation in view of patient’s clinical status

High-grade Gliomas Exhibit Higher Peritumoral Fractional Anisotropy and Lower Mean Diffusivity than Intracranial Metastases

Clinical Imaging for Diagnostic Challenges in the Management of Gliomas: A Review

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