Value of Diffusion Tensor Imaging in Differentiating
High-Grade from Low-Grade Gliomas
Siriwan Piyapittayanan MD*, Orasa Chawalparit MD*, Siri-on Tritakarn MD*,
Theerapol Witthiwej MD**, Tumtip Sangruchi MD***, Sarun Nunta-aree MD**,
Sith Sathornsumetee MD****, Parunut Itthimethin MD**, Chulaluk Komoltri DrPH*****
Affiliation :
* Department of Radiology, Siriraj Hospital Mahidol University, Bangkok, Thailand
** Department of Surgery, Siriraj Hospital Mahidol University, Bangkok, Thailand
*** Department of Pathology, Siriraj Hospital Mahidol University, Bangkok, Thailand
**** Department of Medicine, Siriraj Hospital Mahidol University, Bangkok, Thailand
***** Department of Research Development, Siriraj Hospital Mahidol University, Bangkok, Thailand
Objective : To determine the usefulness of diffusion tensor imaging (DTI) in differentiating high-grade glioma (HGG) from
low-grade glioma (LGG).
Material and Method: Patients with cerebral gliomas underwent conventional MRI and DTI before surgery. All proven
pathologies were classified into two groups, i.e. LGG and HGG. The authors measured fractional anisotropy (FA) and
apparent diffusion coefficient (ADC) values in region of interest (ROI) including solid tumoral region, necrotic region,
peritumoral edema, contralateral normal appearing white matter (NAWM) and normal corpus callosum as well as calculated
ADC ratios. Pairwise comparisons were performed by using the t-test. The ROC curves of imaging parameters were employed
to determine the best parameter for differentiating the two entities.
Results : Forty-three patients with cerebral gliomas, 17 with LGG and 26 with HGG, no statistical significant difference
between LGG and HGG using mean FA values in each ROI. The ADC and minimal ADC values of solid tumoral region and
peritumoral edema, the ADC and minimal ADC ratios of solid tumoral region are statistical significant to differentiate HGG
from LGG, p<0.05. The ratio ADC solid tumoral region to normal corpus callosum had highest predictive accuracy to
differentiate the two entities with AUC of 0.74.
Conclusion : The ADC value, minimal ADC value, and ADC ratios of solid tumoral region appeared to be useful for
differentiating HGG from LGG.
Keywords : Brain tumor, Glioma, DTI
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