Apparent diffusion coefficient in the evaluation of cerebral gliomas malignancy

Jelena Ignjatović; Dragan Stojanov; Vladimir Živković; Srđan Ljubisavljević; Nebojša Stojanović; Ivan Stefanović; Daniela Benedeto-Stojanov; Nebojša Ignjatović; Slađana Petrović; Aleksandra Aracki-Trenkić; Zoran Radovanović; Lazar Lazović

doi:10.2298/5817

Jelena Ignjatović Faculty of Medicine, University of Niš, Niš, Serbia
Dragan Stojanov Faculty of Medicine, University of Niš, Niš, Serbia
Vladimir Živković Ministry of Defence, Belgrade, Serbia
Srđan Ljubisavljević Faculty of Medicine, University of Niš, Niš, Serbia
Nebojša Stojanović Faculty of Medicine, University of Niš, Niš, Serbia
Ivan Stefanović Faculty of Medicine, University of Niš, Niš, Serbia
Daniela Benedeto-Stojanov Faculty of Medicine, University of Niš, Niš, Serbia
Nebojša Ignjatović Faculty of Medicine, University of Niš, Niš, Serbia
Slađana Petrović Faculty of Medicine, University of Niš, Niš, Serbia
Aleksandra Aracki-Trenkić Center of Radiology, Clinical Center of Niš, Niš, Serbia
Zoran Radovanović
Lazar Lazović Center of Radiology, Clinical Center of Niš, Niš, Serbia

DOI: https://doi.org/10.2298/5817

Keywords: glioma, diffusion magnetic resonance imaging, diagnosis, neoplasm staging,

Abstract

Background/Aim. Magnetic resonance imaging (MRI) is a key modality not only for lesion diagnosis, but also to evaluate the extension, type and grade of the tumor. Advanced MRI techniques provide physiologic information that complements the anatomic information available from conventional MRI. The aim of this study was to determine whether there is a correlation between apparent diffusion coefficient (ADC) maps of intracranial glial tumors and histopathologic findings and whether ADCs can reliably distinguish low-grade from high-grade gliomas. Methods. This retrospective study included 25 patients with MRI examination up to seven days before surgery, according to the standard protocol with the following sequences: T1WI, T2WI, FLAIR, DWI and post contrast T1WI. Data obtained from DW MRI were presented by measuring the value of ADC. The ADC map was determined by utilizing Diffusion-Perfusion (DP) Tools software. All the patients underwent surgical resection of the tumor. Histological diagnosis of tumors was determined according to the World Health Organization (WHO) classification. The ADC values were compared with the histopathologic findings according to the WHO criteria. Results. The ADC values of astrocytomas grades I (0.000614 ± 0.000032 mm²/s) were significantly higher (< 0.001) than the ADC values of anaplastic astrocytomas (0.000436 ± 0.000016 mm²/s) and the ADC values of glioblastomas multiforme (0.000070 ± 0.000008 mm²/s). The ADC values of astrocytomas grades II (0.000530 ± 0.000114 mm²/s) were significantly higher (< 0.001) than the ADC values of anaplastic astrocytomas (0.000436 ± 0.000016 mm²/s) and glioblastomas multiforme (0.000070 ± 0.000008 mm²/s). The ADC values of anaplastic astrocytomas (0.000436 ± 0.000016 mm²/s) were significantly higher (< 0.001) than the ADC values of glioblastomas multiforme (0.000070 ± 0.000008 mm²/s). The ADC values in the cystic part of the tumor for astrocytomas grades I (0.000775 ± 0.000023 mm²/s) were significantly higher (< 0.001) than the ADC values of anaplastic astrocytomas (0.000119 ± 0.000246 mm²/s) and glioblastomas multiforme (0.000076 ± 0.000004 mm²/s). The ADC values astrocytomas grades II (0.000511 ± 0.000421 mm²/s) were significantly higher (< 0.001) than the ADC values of glioblastomas multiforme (0.000076 ± 0.000004 mm²/s). Concluson. DWI with calculation of ADC maps can be regarded as a reliable useful diagnostic tool, which indirectly reflects the proliferation and malignancy of gliomas. The ADCs maps can both predict the results of histopathological tumor and distinguish between low- and high-grade gliomas, and provide significant information for presurgical planning, treatment and prognosis for patients with high-grade astrocytomas.

References

Rollin N, Guyotat J, Streichenberger N, Honnorat J, Tran MV, Cotton F. Clinical relevance of diffusion and perfusion magnetic resonance imaging in assessing intra-axial brain tumors. Neuroradiology 2006; 48(3): 150−9.

Baehring JM, Bi WL, Bannykh S, Piepmeier JM, Fulbright RK. Diffusion MRI in the early diagnosis of malignant glioma. J Neurooncology 2007; 82(2): 221−5.

Yamasaki F, Kurisu K, Satoh K, Arita K, Sugiyama K, Ohtaki M, et al. Apparent diffusion coefficient of human brain tumors at MR imaging. Radiology 2005; 235(3): 985−91.

Yang D, Korogi Y, Sugahara T, Kitajima M, Shigematsu Y, Liang L, et al. Cerebral gliomas: prospective comparison of multivoxel 2D chemical-shift imaging proton MR spectroscopy, echopla-nar perfusion and diffusion-weighted MRI. Neuroradiology 2002; 44(8): 656−66.

Zulfiqar M, Yousem DM, Lai H. ADC Values and Prognosis of Malignant Astrocytomas: Does Lower ADC Predict a Worse Prognosis Independent of grade of Tumor. Am J Radilology 2013; 200(3): 624−9.

Kallenberg K, Goldmann T, Menke J, Strik H, Bock HC, Stockhammer F, et al. Glioma infiltration of the corpus callosum: early signs detected by DTI. J Neurooncology 2013; 112(2): 217−22.

Wang S, Kim S, Melhem ER. Diffusion Tensor Imaging: Introduction and Applications to Brain Tumor Characterization. In: Pillai JJ, editor. Functional Brain Tumor Imaging. New York, USA: Springer Science Business Media; 2014. p. 27−38.

Hwang EJ, Cha Y, Lee EL, Yun TJ, Kim TM, Park CK, et al. Early response evaluation for recurrent high grade gliomas treated with bevacizumab: a volumetric analysis using diffusion-weighted imaging. J Neurooncology 2013; 112(3): 427−35.

Nakamura H, Murakami R, Hirai T, Kitajima M, Yamashita Y. Can MRI-derived factors predict the survival in glioblastoma patients. Acta Radiology 2013; 54(2): 214−20.

Ellingson BE, Timothy F, Cloughesy TF, Lai A, Nghiemphu PL, Pope WB. Cell invasion, motility, and proliferation level estimate (CIMPLE) maps derived from serial diffusion MR images in recurrent glioblastoma treated with bevacizumab. J Neurooncology 2011; 105(1): 91−101.

Yeom KW, Lober RM, Andre JB, Fisher PG, Barnes PD, Edwards MS, et al. Prognostic role for diffusion-weighted imaging of pediatric optic pathway glioma. J Neurooncology 2013; 113(3): 479−83.

Noguchi K, Watanabe N, Nagayoshi T, Kanazawa T, Toyoshima S, Shimizu M, et al. Role of diffusion-weighted echo-planar MRI in distinguishing between brain brain abscess and tumour: a preliminary report. Neuroradiology 1999; 41(3): 171−4.

Barajas RF, Rubenstein JJ, Chang JS, Hwang J, Cha S. Diffusion-Weighted MR Imaging Derived Apparent Diffusion Coefficient Is Predictive of Clinical Outcome in Primary Central Nervous System Lymphoma. Am J Neuroradiology 2010; 31(1): 60−6.

Zulfiqar M, Yousem DM, Lai H. ADC values and prognosis of malignant astrocytomas: does lower ADC predict a worse prognosis independent of grade of tumor?-a meta-analysis. AJR 2013; 200(3): 624−9.

Brasil Caseiras G, Ciccarelli O, Altmann DR, Benton CE, Tozer DJ, Tofts PS, et al. Low-grade gliomas: six-month tumor growth predicts patient outcome better than admission tumor volume, relative cerebral blood volume, and apparent diffusion coefficient. Radiology 2009; 253(2): 505−12.

Yin Y, Tong D, Liu X, Yuan T, Yan Y, Ma Y, et al. Correlation of apparent diffusion coefficient with Ki-67 in the diagnosis of gliomas. Zhongguo Yi Xue Ke Xue Yuan Xue Bao 2012; 34(5): 503−8.

Ristić-Balos D, Gavrilović S, Lavrnić S, Vasić B, Macvanski M, Damjanović D, et al. Proton magnetic resonance spectroscopy and apparent diffusion coefficient in evaluation of solid brain lesions. Vojnosanit Pregl 2013; 70(7): 637−44.

Bergui M, Zhong J, Bradac GB, Sales S. Diffusion-weighted imag-es of intracranial cyst-like lesions. Neuroradiology 2001; 43(10): 824−9.

Castillo M, Smith JK, Kwock L, Wilber K. Apparent diffusion co-efficients in the evaluation of high-grade cerebral gliomas. Am J Neuroradiology 2001; 22(1): 60−4.

Sinha S, Bastin ME, Whittle IR, Wardlaw JM. Diffusion tensor MR imaging of high grade cerebral gliomas. Am J Neuroradi-ology 2002; 23(4): 520−7.

Sugahara T, Korogi Y, Kochi M, Ikushima I, Shigematu Y, Hirai T, et al. Usefulness of diffusion-weighted MRI with echo-planar technique in the evaluation of cellularity in gliomas. J Magn Reson Imaging 1999; 9(1): 53−60.

Kono K, Inoue Y, Nakayama K, Shakudo M, Morino M, Ohata K, et al. The role of diffusion-weighted imaging in patients with brain tumors. Am J Neuroradiology 2001; 22(6): 1081-1088.

Tien RD, Felsberg GJ, Friedman H, Brown M, Mac Fall J. MR im-aging of high-grade cerebral gliomas: value of diffusion-weighted echoplanar pulse sequences. Am J Roentgenology 1994; 162(3): 671−7.

Bulakbasi N, Kocaoglu M, Ors F, Tayfun C, Ucoz T. Combination of single-voxel proton MR spectroscopy and common brain tumors. Am J Neuroradiology 2003; 24(2): 225−33.

Guo AC, Cummings TJ, Dash RC, Provenzale JM. Lymphomas and high-grade astrocytomas: comparison of water diffusibility and histologic characteristics. Radiology 2002; 224(1): 177−83.

Lam WW, Poon WS, Metreweli C. Diffusion MR imaging in gli-oma: does it have any role in the pre-operation determination of grading of glioma? Clin Radiol 2002; 57(3): 219−25.