Diagnostic Performance of Advanced MRI in Differentiating
High-Grade from Low-Grade Gliomas
in a Setting of Routine Service
Orasa Chawalparit MD*, Tumtip Sangruchi MD**, Theerapol Witthiwej MD***,
Sith Sathornsumetee MD****, Sirion Tritrakarn MD*, Siriwan Piyapittayanan MD*,
Prapaluck Chaicharoen MD*, Thanyaporn Direksunthorn MD*, Panida Charnchaowanish BSc*
Affiliation :
* Departments of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
** Departments of Pathology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
*** Departments of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
**** Departments of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Objective : To evaluate the usefulness of advanced MRI techniques in differentiating high-grade (HGG) from low-grade
gliomas (LGG).
Material and Method: Sixty-four patients with suspected gliomas were prospectively evaluated by conventional and advanced
MRI studies including MR spectroscopy (MRS), diffusion tensor imagining (DTI), and dynamic susceptibility contrast (DSC)
MRI. The parametric measurements of metabolic profile, cerebral blood volume, flow (CBV, CBF), apparent diffusion
coefficient (ADC), fractional anisotropy, and their ratios by internal normalization were analyzed to differentiate LGG from
HGG. Histopathologic findings were used as the gold standard.
Results : Forty-three cases with pathologically-proven gliomas were included. The best discriminating features between
HGG and LGG were CBV and CBF of the solid tumoral region (p<0.05) whereas the minADC/corpus callosum ratio for
DTI and the ratio of Cho/Cr for MRS of the solid tumoral region provided the best diagnostic performance (p<0.05). With
a predetermined threshold for each parametric measurement, the combination of all advanced MRI modalities was associated
with the best accuracy whereas the combination of DSC MRI and MRS provided the highest specificity. When all parametric
measurements were positive, the probability of HGG was 0.889.
Conclusion : Comprehensive advanced MRI studies provided better diagnostic performance than using conventional MRI
alone in the evaluation of gliomas.
Keywords : Gliomas, MRI, Advanced
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