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Apparent Diffusion Coefficients in the Evaluation of High-grade Cerebral Gliomas

Mauricio Castilloa, J. Keith Smitha, Lester Kwocka and Kathy Wilbera

a From the Department of Radiology, CB 7510, University of North Carolina School of Medicine, Chapel Hill, NC 27599.



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  		FIG 1. GBM after radiation/chemotherapy.

A, Axial T2-weighted image shows a mass in the white matter (arrows) of the right occipital lobe, with surrounding edema extending into the temporal region. The mass is of heterogeneous signal intensity.

B, Corresponding axial contrast-enhanced T1-weighted image with superimposed grid shows position of voxel (arrowhead) with highest Cho/Cr and Cho/NAA rations.

C, Corresponding proton MR spectrum shows marked elevation of Cho (C), low NAA (N), and a large peak that probably corresponds to lactate (L).

D, Same contrast-enhanced image as in B shows position of voxel (arrowhead) identified as containing edema (compare with A).

E, Proton MR spectrum from voxel selected in D shows normal metabolites (choline = C, creatine = CR, and NAA = N).

F, ADC map shows position of ROIs corresponding to tumor (1) and edema (2). Values are 103.4 + 10.6 and 153.7 + 14.4 for tumor and edema, respectively.



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  		FIG 1. Continued.

G, Axial contrast-enhanced T1-weighted image with grid shows position of voxel (arrowhead) representing normal tissue.

H, Corresponding proton MR spectrum shows normal Cho (C), Cr, and NAA (N); lactate (L) is elevated as a result of therapy.

I, ADC map with ROI corresponding to area in G (1). ADC is 84.4 + 6.9.

J, ADC map with ROI (1) in normal brain tissue in hemisphere contralateral to tumor. ADC is 83.6 + 6.6.



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  		FIG 2. Bar graph of ADC values (s/mm2) for tumor, contralateral normal tissue, ipsilateral normal tissue, and edema for the group of 15 patients with high-grade cerebral gliomas. Note difference between tumor and normal brain but lack of difference between tumor and edema. * = statistically significant



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  		FIG 3. Plot of individual data points for tumor contralateral normal tissue, ipsilateral normal tissue, and edema. Note considerable overlap of all points





Copyright © 2009 by the American Society of Neuroradiology. Print ISSN: 0195-6108 Online ISSN: 1936-959X