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12.07.2017 | Original Article

Effect of Perfusion on Diffusion Kurtosis Imaging Estimates for In Vivo Assessment of Integrated 2016 WHO Glioma Grades

A Cross-Sectional Observational Study

verfasst von: Johann-Martin Hempel, Jens Schittenhelm, Cornelia Brendle, Benjamin Bender, Georg Bier, Marco Skardelly, Ghazaleh Tabatabai, Salvador Castaneda Vega, Ulrike Ernemann, Uwe Klose

Erschienen in: Clinical Neuroradiology | Ausgabe 4/2018

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Abstract

Purpose

To assess the role of perfusion-related signal decay on diffusion kurtosis imaging (DKI) estimates for in vivo stratification of glioma according to the integrated approach of the 2016 World Health Organization classification of tumors of the central nervous system (2016 CNS WHO).

Methods

In this study 77 patients with histopathologically confirmed glioma were retrospectively assessed between January 2013 and February 2017 in a prospective trial. Mean kurtosis (MK) and mean diffusivity (MD) metrics from DKI were assessed by two physicians blinded to the study from a volume of interest around the entire solid tumor. Wilcoxon’s signed-rank test compared perfusion-biased and perfusion-corrected MK (MK_pb and MK_pc) and MD (MD_pb, MD_pc) values. One-way ANOVA was used to compare MK_pb&pc and MD_pb&pc values between 2016 WHO glioma grades. Spearman’s correlation coefficient was used to correlate them with 2016 WHO glioma grades. Receiver operating characteristic (ROC) analysis was performed on MK_pb&pc and MD_pb&pc for the significant results.

Results

The MK_pc values were significantly higher than MK_pb values (p < 0.001), whereas MD_pc values were significantly lower than MD_pb values (p < 0.001). For stratifying gliomas, MK_pb values (ROC AUC range, 0.818–0.979) showed a higher diagnostic performance than MK_pc values (ROC AUC range, 0.773–0.975), whereas MD_pb values (ROC AUC range, 0.744–0.928) showed less diagnostic performance than MD_pc values (ROC AUC range, 0.753–0.934). The diagnostic accuracy of MK_pb was 80.0%.

Conclusion

The MK and MD estimates of DKI are influenced by microcapillary blood perfusion; however, taking the effect of perfusion on DKI metrics into account does not substantially impact their overall diagnostic performance in classifying glioma according to the 2016 CNS WHO.

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Titel: Effect of Perfusion on Diffusion Kurtosis Imaging Estimates for In Vivo Assessment of Integrated 2016 WHO Glioma Grades
A Cross-Sectional Observational Study
verfasst von: Johann-Martin Hempel
Jens Schittenhelm
Cornelia Brendle
Benjamin Bender
Georg Bier
Marco Skardelly
Ghazaleh Tabatabai
Salvador Castaneda Vega
Ulrike Ernemann
Uwe Klose
Publikationsdatum: 12.07.2017
Verlag: Springer Berlin Heidelberg
Erschienen in: Clinical Neuroradiology / Ausgabe 4/2018
Print ISSN: 1869-1439
Elektronische ISSN: 1869-1447
DOI: https://doi.org/10.1007/s00062-017-0606-8

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Effect of Perfusion on Diffusion Kurtosis Imaging Estimates for In Vivo Assessment of Integrated 2016 WHO Glioma Grades

A Cross-Sectional Observational Study