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

Anna F. Delgado
Anna F. Delgado
, 
Markus Fahlström
Markus Fahlström
, 
Markus Nilsson
Markus Nilsson
, 
Shala G. Berntsson
Shala G. Berntsson
, 
Maria Zetterling
Maria Zetterling
, 
Sylwia Libard
Sylwia Libard
, 
Irina Alafuzoff
Irina Alafuzoff
, 
Danielle van Westen
Danielle van Westen
, 
Jimmy Lätt
Jimmy Lätt
, 
Anja Smits
Anja Smits
 y 
Elna-Marie Larsson
Elna-Marie Larsson
   | 15 feb 2017
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Article Category: Research Articles
Publicado en línea: 15 feb 2017
Páginas: 121 - 129
Recibido: 15 ago 2016
Aceptado: 08 ene 2017
DOI: https://doi.org/10.1515/raon-2017-0010
© 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
This article is distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.
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
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
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 parameterPerilesional NAWMContralesional NAWMp
Mean (SD) (n = 35)Mean (SD) (n = 35)
Axial diffusivity1.26 (0.14)1.38 (0.13)0.000182
Radial diffusivity0.67 (0.10)0.53 (0.06)0.000001
Fractional anisotropy0.40 (0.11)0.55 (0.09)< 0.000000
Axial kurtosis0.76 (0.07)0.73 (0.08)0.099422
Radial kurtosis1.29 (0.24)1.63 (0.16)< 0.000000
Mean diffusivity0.87 (0.07)0.82 (0.04)0.000009
Mean kurtosis0.95 (0.09)1.06 (0.05)< 0.000000

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

Glioma subgroupsGrade IIGrade IIIpAstrocytomaOligodendrogliomap
n = 23n = 12n = 18n = 17
Axial diffusivity (mean (SD))1.72 (0.19)1.81 (0.35)0.191.76 (0.28)1.74 (0.24)0.78
Radial diffusivity (mean (SD))1.44 (0.20)1.50 (0.34)0.521.47 (0.31)1.46 (0.17)0.71
Fractional anisotropy (mean (SD))0.12 (0.03)0.13 (0.04)0.220.13 (0.04)0.12 (0.03)0.10
Axial kurtosis (mean (SD))0.47 (0.08)0.48 (0.06)0.470.46 (0.06)0.49 (0.08)0.68
Radial kurtosis (mean (SD))0.53 (0.09)0.53 (0.08)0.770.52 (0.09)0.54 (0.09)0.54
Mean diffusivity (mean (SD))1.54 (0.19)1.60 (0.34)0.711.56 (0.30)1.55 (0.19)0.96
Mean kurtosis (mean (SD))0.50 (0.08)0.50 (0.07)0.500.49 (0.07)0.51 (0.09)0.66

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

pAUC
Discrimination between glioma grades II (n = 23) and III (n = 12)
The kurtosis of radial kurtosis in peripheral tumor ROI0.00250.8152
 Discrimination between astrocytoma grades II (n = 10) and III (n = 8)
 The skewness of radial kurtosis in peripheral tumor ROI0.00340.8116
 Discrimination between oligodendroglioma grades II (n = 13) and III (n = 4)
 The peak height of fractional anisotropy in peripheral tumor ROI0.00660.7391
Discrimination between glioma types astrocytomas (n = 18) and oligodendrogliomas (n = 17)
The skewness of mean diffusivity in central tumor ROI0.01910.7320
 Discrimination between glioma types astrocytomas grade II (n = 10) and oligodendrogliomas grade II (n = 13)
 The peak height of mean diffusivity in central tumor ROI0.01100.6601
 Discrimination between glioma types astrocytomas grade III (n = 8) and oligodendrogliomas grade III (n = 4)
 The kurtosis of mean diffusivity in perilesion ROI0.01740.6569
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Medicine, Clinical Medicine, Radiology, Internal Medicine, Haematology, Oncology
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