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. 2020 Feb 21:85:e110-e117.
doi: 10.5114/pjr.2020.93397. eCollection 2020.

Multi-parametric arterial spin labelling and diffusion-weighted magnetic resonance imaging in differentiation of grade II and grade III gliomas

Ahmed Abdel Khalek Abdel Razek  1 , Lamiaa Galal El-Serougy  1 , Mohamed A Abdelsalam  2 , Gada Mohamed Gaballa  1 , Mona Mohamed Talaat  1   2   3
Affiliations

Multi-parametric arterial spin labelling and diffusion-weighted magnetic resonance imaging in differentiation of grade II and grade III gliomas

Ahmed Abdel Khalek Abdel Razek et al. Pol J Radiol. .

Abstract

Purpose: To assess arterial spin labelling (ASL) perfusion and diffusion MR imaging (DWI) in the differentiation of grade II from grade III gliomas.

Material and methods: A prospective cohort study was done on 36 patients (20 male and 16 female) with diffuse gliomas, who underwent ASL and DWI. Diffuse gliomas were classified into grade II and grade III. Calculation of tumoural blood flow (TBF) and apparent diffusion coefficient (ADC) of the tumoral and peritumoural regions was made. The ROC curve was drawn to differentiate grade II from grade III gliomas.

Results: There was a significant difference in TBF of tumoural and peritumoural regions of grade II and III gliomas (p = 0.02 and p =0.001, respectively). Selection of 26.1 and 14.8 ml/100 g/min as the cut-off for TBF of tumoural and peritumoural regions differentiated between both groups with area under curve (AUC) of 0.69 and 0.957, and accuracy of 77.8% and 88.9%, respectively. There was small but significant difference in the ADC of tumoural and peritumoural regions between grade II and III gliomas (p = 0.02 for both). The selection of 1.06 and 1.36 × 10-3 mm2/s as the cut-off of ADC of tumoural and peritumoural regions was made, to differentiate grade II from III with AUC of 0.701 and 0.748, and accuracy of 80.6% and 80.6%, respectively. Combined TBF and ADC of tumoural regions revealed an AUC of 0.808 and accuracy of 72.7%. Combined TBF and ADC for peritumoural regions revealed an AUC of 0.96 and accuracy of 94.4%.

Conclusion: TBF and ADC of tumoural and peritumoural regions are accurate non-invasive methods of differentiation of grade II from grade III gliomas.

Keywords: arterial spin labelling; diffusion weighted imaging; glioma; grading.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Grade II astrocytoma. A) Axial T2-weighted image shows intraaxial space occupying lesion of abnormal signal intensity seen in the right thalamic region with hyper-intense peritumoral region. B) Axial FLAIR image shows the difference between tumoural and peritumoural region. C) Axial post-contrast T1-weighted image shows faint diffuse enhancement. D) Arterial spin labelling perfusion map show scattered nodular areas of increased signal, and the calculated tumour blood flow of the tumoural and peritumoural regions were 26.3 and 12.7 ml/100 g/min, respectively. E) ADC map shows restricted diffusion, and the calculated ADC value of the tumoural and peritumoural regions were 1.23 and 1.43 × 10-3 mm>2/s, respectively
Figure 2
Figure 2
ROC curve of tumour blood flow (TBF). Selection of 26.1 ml/100 g/min as a cut-off point of TBF at the tumoural region to differentiate grade II from grade III gliomas revealed AUC of 0.69 and an accuracy of 77.8%. Selection of 14.8 ml/100 g/min as a cut-off point of TBF at the peritumoral region to differentiate grade II from grade III gliomas revealed AUC of 0.957 and an accuracy of 88.9%
Figure 3
Figure 3
ROC curve of apparent diffusion coefficient (ADC). Selection of 1.06 × 10-3 mm2/s as a cut-off point of ADC of tumoural region to differentiate grade II from grade III gliomas revealed AUC of 0.701 and accuracy of 80.6%. Selection of 1.36 × 10-3 mm2/s as a cut-off point of ADC of peritumoural region to differentiate grade II from grade III gliomas revealed AUC of 0.748 and an accuracy of 80.6%
Figure 4
Figure 4
ROC curve of combined tumour blood flow (TBF) and apparent diffusion coefficient (ADC). A) Combined TBF and ADC of the tumoural region revealed AUC of 0.808 and accuracy of 72.7%. B) Combined TBF and ADC of the peritumoural region revealed AUC of 0.96 and accuracy of 94.4%
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