Comparison of Intravoxel Incoherent Motion Diffusion-Weighted MR Imaging and Arterial Spin Labeling MR Imaging in Gliomas

Gliomas grading is important for treatment plan; we aimed to investigate the application of intravoxel incoherent motion (IVIM) diffusion-weighted imaging (DWI) in gliomas grading, by comparing with the three-dimensional pseudocontinuous arterial spin labeling (3D pCASL). 24 patients (13 high grade gliomas and 11 low grade gliomas) underwent IVIM DWI and 3D pCASL imaging before operation; maps of fast diffusion coefficient (D∗), slow diffusion coefficient (D), fractional perfusion-related volume (f), and apparent diffusion coefficient (ADC) as well as cerebral blood flow (CBF) were calculated and then coregistered to generate the corresponding parameter values. We found CBF andD∗were higher in the high grade gliomas, whereas ADC,D, andfwere lower (allP<0.05). In differentiating the high from low grade gliomas, the maximum areas under the curves (AUC) ofD∗, CBF, and ADC were 0.857, 0.85, and 0.902, respectively. CBF was negatively correlated withfin tumor (r=-0.619,P=0.001). ADC was positively correlated withDin both tumor and white matter (r=0.887,P=0.000andr=0.824,P=0.000, resp.). There was no correlation between CBF andD∗in both tumor and white matter (P>0.05). IVIM DWI showed more efficiency than 3D pCASL but less validity than conventional DWI in differentiating the high from low grade gliomas.

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Arterial spin labeling in the grading of brain gliomas: could it help?

Egyptian Journal of Radiology and Nuclear Medicine ◽

10.1186/s43055-020-00352-6 ◽

2020 ◽

Vol 51 (1) ◽

Author(s):

Ahmed A. ElBeheiry ◽

Doaa M. Emara ◽

Amany Abdel-Bary Abdel-Latif ◽

Mohamed Abbas ◽

Amal S. Ismail

Keyword(s):

Perfusion Imaging ◽

Arterial Spin Labeling ◽

Spin Labeling ◽

High Morbidity ◽

Low Grade ◽

Dynamic Susceptibility ◽

High Grade ◽

Low Grade Gliomas ◽

High Grade Gliomas ◽

Brain Gliomas

Abstract Background Gliomas are characterized by high morbidity and mortality with low cure and high recurrence rates, which depends to a great degree on the angiogenesis of the tumor. Assessment of such angiogenesis by perfusion techniques is of utmost importance for the preoperative grading of gliomas. The purpose of this study was to assess the role of arterial spin labeling (ASL) perfusion as a non-contrast MRI technique in the grading of brain gliomas, in correlation with the dynamic susceptibility contrast perfusion imaging (DSC-PI). The study was carried out on 35 patients admitted to the Neurosurgery Department with MRI features of gliomas and sent for further perfusion imaging. Non-contrast ASL followed by DSC-PI was done for all cases. The final diagnosis of the cases was established by histopathology. Results Fourteen patients (14/35) had low-grade gliomas while twenty-one (21/35) had high-grade gliomas. In low-grade gliomas, four cases out of 14 were falsely graded as high-grade tumors showing hyperperfusion on ASL, three of which showed DSC-PI hypoperfusion. In high-grade gliomas, two cases out of 21 were interpreted as an indeterminate grade by ASL showing isoperfusion, however showed hyperperfusion on DSC-PI. ROC curve analysis showed ASL-derived rCBF > 2.08 to have 80.95% sensitivity, 85.71% specificity, and overall accuracy of 82.86% compared to 100% sensitivity, specificity, and accuracy of DSC-PI-derived rCBV and rCBF of > 1.1 and > 0.9, respectively. A significant positive correlation was noted between ASL and DSC-PI with correlation coefficient reaching r = 0.80 between ASL-rCBF and DSC-rCBF (p < 0.01) and r = 0.68 between ASL and DSC-rCBV (p < 0.01). Conclusions ASL is a relatively recent non-contrast perfusion technique that obtains results which are in fair agreement with the more established DSC perfusion imaging making it an alternative method for preoperative assessment of perfusion of gliomas, especially for patients with contraindications to contrast agents.

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Utility of intravoxel incoherent motion magnetic resonance imaging and arterial spin labeling for recurrent glioma after bevacizumab treatment

Acta Radiologica ◽

10.1177/0284185118759707 ◽

2018 ◽

Vol 59 (11) ◽

pp. 1372-1379 ◽

Cited By ~ 2

Author(s):

Fuminori Miyoshi ◽

Yuki Shinohara ◽

Atsushi Kambe ◽

Keita Kuya ◽

Atsushi Murakami ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Diffusion Coefficient ◽

Magnetic Resonance ◽

Tumor Progression ◽

Arterial Spin Labeling ◽

Spin Labeling ◽

Intravoxel Incoherent Motion ◽

Low Grade ◽

High Grade ◽

Resonance Imaging

Background Detecting recurrence of glioma on magnetic resonance imaging (MRI) is getting more and more important, especially after administration of new anti-tumor agent. However, it is still hard to identify. Purpose To examine the utility of intravoxel incoherent motion (IVIM) MRI and arterial spin labeling-cerebral blood flow (ASL-CBF) for recurrent glioma after initiation of bevacizumab (BEV) treatment. Material and Methods Thirteen patients (7 men, 6 women; age range = 41–82 years) with glioma (high grade, n = 11; low grade, n = 2) were enrolled in the study. IVIM parameters including apparent diffusion coefficient (ADC), true diffusion coefficient (D), and perfusion fraction (f) were obtained with 14 different b-values. We identified tumor progression during BEV therapy by MRI monitoring consisting of diffusion-weighted imaging (DWI), fluid-attenuated inversion recovery (FLAIR) imaging, and contrast-enhanced T1-weighted (CE-T1W) imaging by measuring tumor area. We also measured each parameter of IVIM and ASL-CBF, and calculated relative ADC (rADC), relative D (rD), relative f (rf), and relative CBF (rCBF) by obtaining the ratio between each area and the contralateral cerebral white matter. We calculated the rate of change (Δ) by subtracting values from those from the preceding MRI study, and obtained Spearman’s rank correlation coefficient (rs). Results Tumor progression was identified in nine patients (high grade, n = 7; low grade, n = 2). Negative correlations were identified between ΔrD and ΔDWI area (rs = –0.583), and between ΔrD and ΔCE-T1W imaging area (rs = –0.605). Conclusion Tumor progression after BEV treatment can be identified by decreasing rD.

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Arterial spin labeling MR imaging for differentiation between high- and low-grade glioma—a meta-analysis

Neuro-Oncology ◽

10.1093/neuonc/noy095 ◽

2018 ◽

Vol 20 (11) ◽

pp. 1450-1461 ◽

Cited By ~ 4

Author(s):

Alberto Falk Delgado ◽

Francesca De Luca ◽

Danielle van Westen ◽

Anna Falk Delgado

Keyword(s):

Mr Imaging ◽

Arterial Spin Labeling ◽

Diagnostic Performance ◽

Meta Analysis ◽

Spin Labeling ◽

Low Grade Glioma ◽

Cochrane Library ◽

Low Grade ◽

High Grade ◽

Operating Characteristics

Abstract Background Arterial spin labeling is an MR imaging technique that measures cerebral blood flow (CBF) non-invasively. The aim of the study is to assess the diagnostic performance of arterial spin labeling (ASL) MR imaging for differentiation between high-grade glioma and low-grade glioma. Methods Cochrane Library, Embase, Medline, and Web of Science Core Collection were searched. Study selection ended November 2017. This study was prospectively registered in PROSPERO (CRD42017080885). Two authors screened all titles and abstracts for possible inclusion. Data were extracted independently by 2 authors. Bivariate random effects meta-analysis was used to describe summary receiver operating characteristics. Trial sequential analysis (TSA) was performed. Results In total, 15 studies with 505 patients were included. The diagnostic performance of ASL CBF for glioma grading was 0.90 with summary sensitivity 0.89 (0.79–0.90) and specificity 0.80 (0.72–0.89). The diagnostic performance was similar between pulsed ASL (AUC 0.90) with a sensitivity 0.85 (0.71–0.91) and specificity 0.83 (0.69–0.92) and pseudocontinuous ASL (AUC 0.88) with a sensitivity 0.86 (0.79–0.91) and specificity 0.80 (0.65–0.87). In astrocytomas, the diagnostic performance was 0.89 with sensitivity 0.86 (0.79 to 0.91) and specificity 0.79 (0.63 to 0.89). Sensitivity analysis confirmed the robustness of the findings. TSA revealed that the meta-analysis was adequately powered. Conclusion Arterial spin labeling MR imaging had an excellent diagnostic accuracy for differentiation between high-grade and low-grade glioma. Given its low cost, non-invasiveness, and efficacy, ASL MR imaging should be considered for implementation in the routine workup of patients with glioma.

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The diagnostic value of intravoxel incoherent motion imaging in differentiating high-grade from low-grade gliomas: a systematic review and meta-analysis

British Journal of Radiology ◽

10.1259/bjr.20201321 ◽

2021 ◽

Vol 94 (1121) ◽

pp. 20201321

Author(s):

Hechuan Luo ◽

Ling He ◽

Weiqin Cheng ◽

Sijie Gao

Keyword(s):

Diffusion Coefficient ◽

Sensitivity And Specificity ◽

Clinical Decision Making ◽

Meta Analysis ◽

Intravoxel Incoherent Motion ◽

Cochrane Library ◽

Low Grade ◽

High Grade ◽

Low Grade Gliomas ◽

Brain Gliomas

Objective: This meta-analysis was carried out for assessing the accuracy of intravoxel incoherent motion (IVIM) parameters true diffusion coefficient (D), pseudo-diffusion coefficient (D*), and perfusion fraction (f) in differentiating low-grade gliomas (LGGs) from high-grade gliomas (HGGs). Methods: Literatures concerning IVIM in the grading of brain gliomas published prior to October 20, 2020, searched in the Embase, PubMed, and Cochrane library. Use the quality assessment of diagnostic accuracy studies 2 (QUADAS 2) to evaluate the quality of studies. We estimated the pooled sensitivity, specificity, and the area under the summary ROC (SROC) curve to identification the accuracy of IVIM parameters D, D*, and f evaluation in grading gliomas. Results: Totally, 6 articles including 252 brain gliomas conform to the inclusion criteria. The pooled sensitivity of parameters D, D*, and f derived from IVIM were 0.85 (95%Cl, 0.76–0.91), 0.78 (95%Cl, 0.71–0.85), and 0.89 (95%Cl, 0.76–0.96), respectively. The pooled specificity were 0.78 (95%Cl, 0.60–0.90), 0.68 (95%Cl, 0.56–0.79), and 0.88 (95%Cl, 0.76–0.94), respectively. Meanwhile, the AUC of SROC curve were 0.89 (95%Cl, 0.86–0.92) , 0.81 (95%Cl, 0.77–0.84), and 0.94 (95%Cl, 0.92–0.96), respectively. Conclusion: This meta-analysis suggested that IVIM parameters D, D*, and f have moderate or high diagnosis value accuracy in differentiating HGGs from LGGs, and the parameter f has greater sensitivity and specificity. Standardized methodology is warranted to guide the use of this method for clinical decision-making. However, more clinical studies are needed to prove our view. Advances in knowledge: IVIM parameter f showed greater sensitivity and specificity, as well as excellent performance than parameter D* and D.

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Differentiation of high-grade and low-grade diffuse gliomas by intravoxel incoherent motion MR imaging

Neuro-Oncology ◽

10.1093/neuonc/nov147 ◽

2015 ◽

Vol 18 (1) ◽

pp. 132-141 ◽

Cited By ~ 54

Author(s):

Osamu Togao ◽

Akio Hiwatashi ◽

Koji Yamashita ◽

Kazufumi Kikuchi ◽

Masahiro Mizoguchi ◽

...

Keyword(s):

Mr Imaging ◽

Intravoxel Incoherent Motion ◽

Low Grade ◽

High Grade ◽

Diffuse Gliomas

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Efficacy of Perfusion Computed Tomography (PCT) in Differentiating High-Grade Gliomas from Low Grade Gliomas, Lymphomas, Metastases and Abscess

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2017/24835.9917 ◽

2017 ◽

Author(s):

Lakshmikanth Halegubbi Karegowda

Keyword(s):

Computed Tomography ◽

Low Grade ◽

High Grade ◽

Perfusion Computed Tomography ◽

Low Grade Gliomas ◽

High Grade Gliomas

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Antibiotic Allergy and Blood Eosinophils Percent Could Be Prognostic Indicators of Glioma

10.21203/rs.3.rs-148347/v1 ◽

2021 ◽

Author(s):

Liming Cao ◽

Zhanghua Lv ◽

Weiliang Wang ◽

Xue Li ◽

Jing Shi ◽

...

Keyword(s):

Regression Analysis ◽

Cox Regression ◽

Tumor Grade ◽

Blood Eosinophil ◽

Low Grade ◽

High Grade ◽

Cox Regression Analysis ◽

Low Grade Gliomas ◽

Antibiotic Allergy ◽

High Grade Gliomas

Abstract Background: Antibiotic allergy and blood eosinophil percentage (EOS%) may play an important role in the prognosis of gliomas, but few studies reported the relationship between antibiotic allergy and glioma as well as EOS% and glioma. The aim of our study was to estimate the relationships between antibiotic allergy, blood eosinophil percentage (EOS%) and glioma prognosis and to conduct a nomogram model for glioma patients. Estimating the effect of antibiotic allergy and EOS% on glioma prognosis may conduce to finding low-cost and safe prognostic indicators of glioma.Methods: We conducted a retrospective cohort study with 656 glioma patients to estimate the associations between antibiotic allergy, EOS% and glioma prognosis by Kaplan-Meier and Cox regression analysis. Stratified analyses were performed according to tumor grade. We constructed a nomogram with age at diagnosis, gender, tumor grade, antibiotic allergy, EOS% to predict the survival probabilities of glioma. Results: During 12 months follow-up, a total of 227 patients were alive and 318 patients died. Antibiotic allergy and EOS% >1.65 conferred a survival advantage on glioma patients. In the stratified analysis by tumor grade, antibiotic allergy was significantly associated with the prognosis of the prognosis of low-grade gliomas (HR = 0.36, 95%CI: 0.13-0.97) and high-grade gliomas (HR = 0.58, 95%CI: 0.36-0.93) in the univariate Cox regression analysis. However, after adjusting for confounding factors in the multivariate Cox regression analysis, antibiotic allergy was only significantly associated with high-grade gliomas (HRadj = 0.50, 95%CI: 0.30-0.82); the relationship between EOS% and glioma prognosis was restricted to low-grade gliomas (HRadj = 0.50, 95%CI: 0.30-0.82). The C-index of nomogram was 0.74.Conclusions: Antibiotic allergy was a protective prognosis factor of high-grade gliomas, EOS% >1.65 was a protective prognosis factor of low-grade gliomas. The nomogram with antibiotic allergy and EOS% could effectively predict the survival probability of glioma.

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Correlation of dual energy computed tomography electron density measurements with cerebral glioma grade

The Neuroradiology Journal ◽

10.1177/19714009211047455 ◽

2021 ◽

pp. 197140092110474

Author(s):

Ritwik Chakrabarti ◽

Vivek Gupta ◽

Sameer Vyas ◽

Kirti Gupta ◽

Vikram Singh

Keyword(s):

Computed Tomography ◽

Electron Density ◽

Dual Energy ◽

Low Grade ◽

High Grade ◽

Cerebral Glioma ◽

Density Measurements ◽

Dual Energy Computed Tomography ◽

Low Grade Gliomas ◽

High Grade Gliomas

Objective To correlate dual energy computed tomography electron density measurements with histopathological cerebral glioma grading to determine whether it can be used as a non-invasive predictor of cerebral glioma grade. Materials and methods Fifty patients with suspected cerebral gliomas on imaging scheduled to undergo resection were included. We tested our hypothesis that with increasing glioma grade, increased tumor cellularity should translate into increased electron density and if a statistically significant difference between electron density of low-grade gliomas and high-grade gliomas is seen, we may have a clinical use of dual energy computed tomography as a non-invasive tool to predict cerebral glioma grade. A pre-operative dual energy computed tomography scan of the brain was performed, and electron density measurements calculated from the solid part of the tumor. Obtaining a ratio with electron density of contralateral normal brain parenchyma normalized these values. The minimum, maximum and mean electron density and their normalized values recorded between high-grade gliomas and low-grade gliomas were compared for presence of statistical significance. Results A statistically significant difference was found between all six parameters recorded (minimum electron density and normalized values, mean electron density and normalized values, maximum electron density and normalized values) between low-grade gliomas and high-grade gliomas. The predictivity ranged from 75% (for minimum electron density and maximum normalized values) to 81.25% (for mean normalized values). All six parameters were found to have statistically significant positive correlation with Ki-67 index. Conclusion Dual energy computed tomography electron density measurements in cerebral gliomas are predictive of pre-operative differentiation of low-grade gliomas from high-grade gliomas and show a linear, statistically significant positive correlation with Ki-67 index.

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