Intravoxel Incoherent Motion Diffusion-Weighted Imaging and 3D-ASL to Assess the Value of Ki-67 Labeling Index and Grade in Glioma

OBJECTIVE: To determine the proportion of intravoxel incoherent motion diffusion-weighted images (IVIM-DWI) and three-dimensional arterial circulation markers (3D-ASL) in Ki-67 labeling index (Ki-67 LI) and glioma grading. METHODS: According to the classification of diseases of the central nervous system dealt with by WHO in 2007, patients with stage II glioma were classified as low (n = 20) and patients with stages III-IV were divided into higher levels (n = 22). Prior to surgery, brain MRI, IVIM-DWI, and 3D-ASL were performed in all patients, and the actual water molecular diffusion coefficient (D), microcirculation coefficient (D∗), blood flow fraction (f), and cerebral blood flow (CBF) were measured. A rank sum (Mann–Whitney U test) was used to compare the four upper and lower level Ki-67 LI measurements. Spearman's method is used to identify the relationship between 4 groups of quantification and Ki-67 LI. Reciprocal grafting (ROC) curves were used to measure the diagnosis of four groups of glioma grading defects. RESULTS: There were significant differences in D, D∗, f, and CBF between the solid region of the tumor and the normal white matter contralateral to it (P < 0.05). The significant differences of rD, rD∗, rf, and rCBF were shown between patients with low-grade glioma and high-grade glioma (P < 0.05). Ki-67 LI was found to have negative correlation with rD (r = 00.693, P < 0.001) and rf (r = 00.539, P < 0.001), but similarly correlated with rCBF (r = 0.665, P < 0.001) in patients with glioma. Recipient efficacy for predicting advanced and secondary glioma from rD, rf, rD∗, rCBF, and Ki-67 LI raises AUCs of 0.819, 0.747, 0.719, 0.836, and 0.907, respectively. CONCLUSION: IVIM-DWI has good application value for preoperative grading of glioma.