Perfusion, Diffusion, Or Brain Tumor Barrier Integrity: Which Represents The Glioma Features Best?

PURPOSE: This study aims to incorporate informative histogram indicator analyses and advanced multimodal MRI parameters to differentiate low-grade gliomas (LGGs) from high-grade gliomas (HGGs) and to explore the features associated with patients’ survival. PATIENTS AND METHODS: A total of 120 patients with pathologically confirmed LGGs or HGGs receiving conventional and advanced MRI such as three-dimensional arterial spin labeling (3D-ASL), intravoxel incoherent motion-diffusion weighted imaging (IVIM-DWI), and dynamic contrast-enhanced MRI (DCE-MRI) were included. The mean and histogram indicators from advanced MRI were calculated from the entire tumor. The efficacies of a single indicator or multiple parameters were tested in distinguishing HGGs from LGGs and predicting patients’ survival. Receiver operating characteristic (ROC) curve and multivariable stepwise logistic regression were used to evaluate the diagnostic efficacies. Leave-one-out cross-validation was further used to validate the accuracy of the parameter sets in glioma grading. Log-rank test using the Kaplan–Meier curve was utilized to predict patients’ survival. RESULTS: Overall, parameters from DCE-MRI performed better than those from 3D-ASL or IVIM-DWI in both glioma grading and survival prediction. The histogram metrics of V(e) were demonstrated to have higher accuracies (the accuracies for Extended Tofts_V(e)(mean) and Extended Tofts_V(e)(median) were 68.33% and 71.67%, respectively, while those for the Incremental_V(e)(mean) and Incremental_V(e)(75th) were 68.33% and 72.50%, respectively) in grading LGGs from HGGs. The combination of Tofts_V(e) histogram metrics was the one with the highest accuracy (81.67%) and area under ROC curve (AUC = 0.840). On the other hand, Patlak_K(trans)(95th) (AUC = 0.9265) and Extended Tofts_V(e)(95th) (AUC = 0.9154) performed better than their corresponding means (Patlak_K(trans)(mean): AUC = 0.9118 and Extended Tofts_V(e)(mean): AUC = 0.9044) in predicting patients’ overall survival (OS) at 18-month follow-up. CONCLUSION: DCE-MRI-derived histogram features from the entire tumor were promising metrics for glioma grading and OS prediction. Combining single modal histogram features improved glioma grading. TRIAL REGISTRATION: NCT 02622620.