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J Neuroradiol. 2018 Feb;45(1):32-40. doi: 10.1016/j.neurad.2017.07.005. Epub 2017 Sep 1.

In vivo assessment of tumor heterogeneity in WHO 2016 glioma grades using diffusion kurtosis imaging: Diagnostic performance and improvement of feasibility in routine clinical practice.

Author information

1
Department of Neuroradiology, Eberhard-Karls University, Tübingen, Germany. Electronic address: johann-martin.hempel@uni-tuebingen.de.
2
Department of Pathology and Neuropathology, Institute of Neuropathology, Eberhard-Karls University, Tübingen, Germany.
3
Department of Neuroradiology, National Hospital of Neurology and Neurosurgery, University College London Hospitals, London, United Kingdom.
4
Department of Neuroradiology, Eberhard-Karls University, Tübingen, Germany.
5
Department of Neurosurgery, Eberhard-Karls University, Tübingen, Germany.
6
Centre of Neurooncology, Comprehensive Cancer Center Tübingen-Stuttgart, Eberhard-Karls University, Tübingen, Germany.
7
Department of Preclinical Imaging and Radiopharmacy, Werner-Siemens Imaging Center, Eberhard-Karls University, Tübingen, Germany.

Abstract

PURPOSE:

To assess the diagnostic performance of normalized and non-normalized diffusion kurtosis imaging (DKI) metrics extracted from different tumor volume data for grading glioma according to the integrated approach of the revised 2016 WHO classification.

MATERIALS AND METHODS:

Sixty patients with histopathologically confirmed glioma, who provided written informed consent, were retrospectively assessed between 01/2013 and 08/2016 from a prospective trial approved by the local institutional review board. Mean kurtosis (MK) and mean diffusivity (MD) metrics from DKI were assessed by two blinded physicians from four different volumes of interest (VOI): whole solid tumor including (VOItu-ed) and excluding perifocal edema (VOItu), infiltrative zone (VOIed), and single slice of solid tumor core (VOIslice). Intra-class correlation coefficient (ICC) was calculated to assess inter-rater agreement. One-way ANOVA was used to compare MK between 2016 CNS WHO tumor grades. Friedman's test compared MK and MD of each VOI. Spearman's correlation coefficient was used to correlate MK with 2016 CNS WHO tumor grades. ROC analysis was performed on MK for significant results.

RESULTS:

The MK assessment showed excellent inter-rater agreement for each VOI (ICC, 0.906-0.955). MK was significantly lower in IDHmutant astrocytoma (0.40±0.07), than in 1p/19q-confirmed oligodendroglioma (0.54±0.10, P=0.001) or IDHwild-type glioblastoma (0.68±0.13, P<0.001). MK and 2016 WHO tumor grades were strongly and positively correlated (VOItu-ed, r=0.684; VOItu, r=0.734; VOIed, r=0.625; VOIslice, r=0.698; P<0.001).

CONCLUSIONS:

Non-normalized MK values obtained from VOItu and VOIslice showed the best reproducibility and highest diagnostic performance for stratifying glioma according to the integrated approach of the recent 2016 WHO classification.

KEYWORDS:

2016 CNS WHO; Diffusion kurtosis imaging; Glioma; Grading; Integrated diagnosis; NAWM; Normalization; ROI; VOI

PMID:
28865921
DOI:
10.1016/j.neurad.2017.07.005
[Indexed for MEDLINE]

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