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. 2017 Feb 15;51(2):121-129.
doi: 10.1515/raon-2017-0010. eCollection 2017 Jun.

Diffusion Kurtosis Imaging of Gliomas Grades II and III - A Study of Perilesional Tumor Infiltration, Tumor Grades and Subtypes at Clinical Presentation

Anna F Delgado  1   2 , Markus Fahlström  1 , Markus Nilsson  3 , Shala G Berntsson  4 , Maria Zetterling  5 , Sylwia Libard  6 , Irina Alafuzoff  6 , Danielle van Westen  7 , Jimmy Lätt  8 , Anja Smits  4 , Elna-Marie Larsson  1
Affiliations

Diffusion Kurtosis Imaging of Gliomas Grades II and III - A Study of Perilesional Tumor Infiltration, Tumor Grades and Subtypes at Clinical Presentation

Anna F Delgado et al. Radiol Oncol. .

Abstract

Background: Diffusion kurtosis imaging (DKI) allows for assessment of diffusion influenced by microcellular structures. We analyzed DKI in suspected low-grade gliomas prior to histopathological diagnosis. The aim was to investigate if diffusion parameters in the perilesional normal-appearing white matter (NAWM) differed from contralesional white matter, and to investigate differences between glioma malignancy grades II and III and glioma subtypes (astrocytomas and oligodendrogliomas).

Patients and methods: Forty-eight patients with suspected low-grade glioma were prospectively recruited to this institutional review board-approved study and investigated with preoperative DKI at 3T after written informed consent. Patients with histologically proven glioma grades II or III were further analyzed (n=35). Regions of interest (ROIs) were delineated on T2FLAIR images and co-registered to diffusion MRI parameter maps. Mean DKI data were compared between perilesional and contralesional NAWM (student's t-test for dependent samples, Wilcoxon matched pairs test). Histogram DKI data were compared between glioma types and glioma grades (multiple comparisons of mean ranks for all groups). The discriminating potential for DKI in assessing glioma type and grade was assessed with receiver operating characteristics (ROC) curves.

Results: There were significant differences in all mean DKI variables between perilesional and contralesional NAWM (p=<0.000), except for axial kurtosis (p=0.099). Forty-four histogram variables differed significantly between glioma grades II (n=23) and III (n=12) (p=0.003-0.048) and 10 variables differed significantly between ACs (n=18) and ODs (n=17) (p=0.011-0.050). ROC curves of the best discriminating variables had an area under the curve (AUC) of 0.657-0.815.

Conclusions: Mean DKI variables in perilesional NAWM differ significantly from contralesional NAWM, suggesting altered microstructure by tumor infiltration not depicted on morphological MRI. Histogram analysis of DKI data identifies differences between glioma grades and subtypes.

Keywords: diffusion kurtosis imaging (DKI); glioma; grade; perilesional; subtype; tumor infiltration.

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Conflict of interest statement

Disclosure: No potential conflicts of interest were disclosed.

Figures

Figure 1
Figure 1
MRI in a patient with an oligodendroglioma grade II in the right frontal lobe, non-smoothed images. (A) T2FLAIR, (B) Axial Kurtosis, (C) Axial Diffusivity, (D) Radial Kurtosis, (E) Radial Diffusivity, (F) Mean Diffusivity, (G) Fractional Anisotropy, color coded, (H) Mean Kurtosis. Mean, axial and radial diffusivity 10-3 mm2/sec, fractional anisotropy, mean, axial and radial kurtosis and fractional anisotropy are dimensionless.
Figure 2
Figure 2
ROIs in a patient with an oligodendroglioma grade II. (A) Total tumor ROI. (B) Peripheral tumor ROI. (C) Central tumor ROI. (D) Perilesional ROI. All ROIs were drawn on non-smoothed images to increase the precision. ROI = region of interest
Figure 3
Figure 3
ROC curves presenting the best discriminating relative DKI histogram variables between glioma grades (II and III) and subtypes (astrocytomas and oligodendrogliomas). (A) Discrimination between glioma grades II and III with the kurtosis of radial kurtosis in peripheral tumor ROI, AUC = 0.815. (B) Discrimination between glioma subtypes astrocytoma and oligodendroglioma with the skewness of mean diffusivity in central tumor ROI, AUC = 0.732. (C) Discrimination between glioma grades II and III in astrocytomas with the skewness of radial kurtosis in peripheral tumor ROI, AUC = 0.812. (D) Discrimination between glioma subtypes astrocytoma and oligodendroglioma in gliomas grade II with the peak height of mean diffusivity in central tumor ROI, AUC = 0.660. (E) Discrimination between glioma grades II and III in oligodendrogliomas, with the peak height of fractional anisotropy in peripheral tumor ROI, AUC = 0.739. (F) Discrimination between glioma subtypes astrocytoma and oligodendroglioma in gliomas grade III with the kurtosis of mean diffusivity in perilesional ROI, AUC = 0.657. AUC = area under the curve; ROC = receiver operating characteristic; ROI = region of interest
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