Diffusion kurtosis imaging of gliomas grades II and III - a study of perilesional tumor infiltration, tumor grades and subtypes at clinical presentation

Delgado, Anna F.; Fahlström, Markus; Nilsson, Markus; Berntsson, Shala G.; Zetterling, Maria; Libard, Sylwia; Alafuzoff, Irina; van Westen, Danielle; Lätt, Jimmy; Smits, Anja; Larsson, Elna-Marie

Diffusion kurtosis imaging of gliomas grades II and III - a study of perilesional tumor infiltration, tumor grades and subtypes at clinical presentation

Volume 51 (2017): Issue 2 (June 2017)

By:

Anna F. Delgado, Markus Fahlström, Markus Nilsson, Shala G. Berntsson, Maria Zetterling, Sylwia Libard, Irina Alafuzoff, Danielle van Westen, Jimmy Lätt, Anja Smits and Elna-Marie Larsson

Open Access

|Feb 2017

Figures & Tables

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.

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

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

Results from analysis of perilesional and contralesional normal-appearing white matter

Diffusion histogram parameter	Perilesional NAWM	Contralesional NAWM	p

	Mean (SD) (n = 35)	Mean (SD) (n = 35)
	Axial diffusivity	1.26 (0.14)	1.38 (0.13)	0.000182
Radial diffusivity	0.67 (0.10)	0.53 (0.06)	0.000001
Fractional anisotropy	0.40 (0.11)	0.55 (0.09)	< 0.000000
Axial kurtosis	0.76 (0.07)	0.73 (0.08)	0.099422
Radial kurtosis	1.29 (0.24)	1.63 (0.16)	< 0.000000
Mean diffusivity	0.87 (0.07)	0.82 (0.04)	0.000009
Mean kurtosis	0.95 (0.09)	1.06 (0.05)	< 0.000000

Mean diffusion kurtosis imaging variables in tumor regions of interest (ROI) (mean (SD))

Glioma subgroups	Grade II	Grade III	p	Astrocytoma	Oligodendroglioma	p

	n = 23	n = 12		n = 18	n = 17
Axial diffusivity (mean (SD))	1.72 (0.19)	1.81 (0.35)	0.19	1.76 (0.28)	1.74 (0.24)	0.78
Radial diffusivity (mean (SD))	1.44 (0.20)	1.50 (0.34)	0.52	1.47 (0.31)	1.46 (0.17)	0.71
Fractional anisotropy (mean (SD))	0.12 (0.03)	0.13 (0.04)	0.22	0.13 (0.04)	0.12 (0.03)	0.10
Axial kurtosis (mean (SD))	0.47 (0.08)	0.48 (0.06)	0.47	0.46 (0.06)	0.49 (0.08)	0.68
Radial kurtosis (mean (SD))	0.53 (0.09)	0.53 (0.08)	0.77	0.52 (0.09)	0.54 (0.09)	0.54
Mean diffusivity (mean (SD))	1.54 (0.19)	1.60 (0.34)	0.71	1.56 (0.30)	1.55 (0.19)	0.96
Mean kurtosis (mean (SD))	0.50 (0.08)	0.50 (0.07)	0.50	0.49 (0.07)	0.51 (0.09)	0.66

Results from multiple comparison test and receiver operating characteristics curves in groups and subgroups of gliomas

	p	AUC
Discrimination between glioma grades II (n = 23) and III (n = 12)
The kurtosis of radial kurtosis in peripheral tumor ROI	0.0025	0.8152
*Discrimination between astrocytoma grades II (n = 10) and III (n = 8)*
The skewness of radial kurtosis in peripheral tumor ROI	0.0034	0.8116
*Discrimination between oligodendroglioma grades II (n = 13) and III (n = 4)*
The peak height of fractional anisotropy in peripheral tumor ROI	0.0066	0.7391
Discrimination between glioma types astrocytomas (n = 18) and oligodendrogliomas (n = 17)
The skewness of mean diffusivity in central tumor ROI	0.0191	0.7320
*Discrimination between glioma types astrocytomas grade II (n = 10) and oligodendrogliomas grade II (n = 13)*
The peak height of mean diffusivity in central tumor ROI	0.0110	0.6601
*Discrimination between glioma types astrocytomas grade III (n = 8) and oligodendrogliomas grade III (n = 4)*
The kurtosis of mean diffusivity in perilesion ROI	0.0174	0.6569

DOI: https://doi.org/10.1515/raon-2017-0010 | Journal eISSN: 1581-3207 | Journal ISSN: 1318-2099

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Language: English

Page range: 121 - 129

Submitted on: Aug 15, 2016

Accepted on: Jan 8, 2017

Published on: Feb 15, 2017

Published by: Association of Radiology and Oncology

In partnership with: Paradigm Publishing Services

Publication frequency: 4 times per year

Keywords:

diffusion kurtosis imaging (DKI),

glioma,

grade,

Related subjects:

Haematology, oncology,

Radiology

© 2017 Anna F. Delgado, Markus Fahlström, Markus Nilsson, Shala G. Berntsson, Maria Zetterling, Sylwia Libard, Irina Alafuzoff, Danielle van Westen, Jimmy Lätt, Anja Smits, Elna-Marie Larsson, published by Association of Radiology and Oncology
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

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