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Differentiation of residual/recurrent gliomas from postradiation necrosis with arterial spin labeling and diffusion tensor magnetic resonance imaging-derived metrics

  • Diagnostic Neuroradiology
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Abstract

Purpose

The aim of this study is to differentiate recurrent/residual gliomas from postradiation changes using arterial spin labeling (ASL) perfusion and diffusion tensor imaging (DTI)-derived metrics.

Methods

Prospective study was conducted upon 42 patients with high-grade gliomas after radiotherapy only or prior to other therapies that underwent routine MR imaging, ASL, and DTI. The tumor blood flow (TBF), fractional anisotropy (FA), and mean diffusivity (MD) of the enhanced lesion and related edema were calculated. The lesion was categorized as recurrence/residual or postradiation changes.

Results

There was significant differences between residual/recurrent gliomas and postradiation changes of TBF (P = 0.001), FA (P = 0.001 and 0.04), and MD (P = 0.001) of enhanced lesion and related edema respectively. The area under the curve (AUC) of TBF of enhanced lesion and related edema used to differentiate residual/recurrent gliomas from postradiation changes were 0.95 and 0.93 and of MD were 0.95 and 0.81 and of FA were 0.81 and 0.695, respectively. Combined ASL and DTI metrics of the enhanced lesion revealed AUC of 0.98, accuracy of 95%, sensitivity of 93.8%, specificity of 95.8%, positive predictive value (PPV) of 93.8%, and negative predictive value (NPV) of 95.8%. Combined metrics of ASL and DTI of related edema revealed AUC of 0.97, accuracy of 92.5%, sensitivity of 93.8%, specificity of 91.7%, PPV of 88.2%, and NPV of 95.7.

Conclusion

Combined ASL and DTI metrics of enhanced lesion and related edema are valuable noninvasive tools in differentiating residual/recurrent gliomas from postradiation changes.

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Abbreviations

ASL:

Arterial spin labeling

AUC:

Area under the curve

DTI:

Diffusion tensor imaging

FA:

Fractional anisotropy

MD:

Mean diffusivity

NPV:

Negative predictive value

PPV:

Positive predictive value

TBF:

Tumor blood flow

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Author information

Authors and Affiliations

  1. Department of Diagnostic Radiology, Mansoura Faculty of Medicine, Mansoura, 13551, Egypt

    Ahmed Abdel Khalek Abdel Razek, Lamiaa El-Serougy, Gada Gaballa & Mona Talaat

  2. Department of Neurology, Mansoura Faculty of Medicine, Mansoura, Egypt

    Mohamed Abdelsalam

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  1. Ahmed Abdel Khalek Abdel Razek
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  2. Lamiaa El-Serougy
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  3. Mohamed Abdelsalam
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Correspondence to Ahmed Abdel Khalek Abdel Razek.

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No funding was received for this study.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in the studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Razek, A.A.K.A., El-Serougy, L., Abdelsalam, M. et al. Differentiation of residual/recurrent gliomas from postradiation necrosis with arterial spin labeling and diffusion tensor magnetic resonance imaging-derived metrics. Neuroradiology 60, 169–177 (2018). https://doi.org/10.1007/s00234-017-1955-3

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  • DOI: https://doi.org/10.1007/s00234-017-1955-3

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