Advanced

AJNR - American Journal of Neuroradiology

This Article Abstract Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Price, S.J. Articles by Gillard, J.H. Search for Related Content PubMed PubMed Citation Articles by Price, S.J. Articles by Gillard, J.H.

Improved Delineation of Glioma Margins and Regions of Infiltration with the Use of Diffusion Tensor Imaging: An Image-Guided Biopsy Study

S.J. Price^a,b,c, R. Jena^d, N.G. Burnet^d, P.J. Hutchinson^a, A.F. Dean^e, A. Peña^a,c, J.D. Pickard^a,b, T.A. Carpenter^b and J.H. Gillard^c

^a Academic Neurosurgical Unit, University of Cambridge and Cambridge University Hospitals NHS Foundation Trust, Addenbrooke’s Hospital, Cambridge, United Kingdom
^b Wolfson Brain Imaging Centre, University of Cambridge and Cambridge University Hospitals NHS Foundation Trust, Addenbrooke’s Hospital, Cambridge, United Kingdom
^c Department of Clinical Neurosciences, University Department of Radiology, University of Cambridge and Cambridge University Hospitals NHS Foundation Trust, Addenbrooke’s Hospital, Cambridge, United Kingdom
^d University Department of Oncology, University of Cambridge and Cambridge University Hospitals NHS Foundation Trust, Addenbrooke’s Hospital, Cambridge, United Kingdom
^e Department of Neuropathology, University of Cambridge and Cambridge University Hospitals NHS Foundation Trust, Addenbrooke’s Hospital, Cambridge, United Kingdom

View larger version (54K): [in a new window]   Fig 1. An example of the biopsy findings from a region of tumor in a 41-year-old man who presented with seizures and a mild left hemiparesis. The T2-weighted image shows that the biopsy was taken from the center of the lesion and that histologic examination (above right) confirmed it as a WHO grade III anaplastic oligoastrocytoma. The tissue signature from this region shows significant increase in p (10% compared with normal side) with a significant decrease in q (12%).

View larger version (52K): [in a new window]   Fig 2. Biopsy from a region 2.5 cm from the target of Fig 1. The T2-weighted image shows it has been taken from a region that is apparently normal. Histologic examination, however, confirms normal white matter with tumor infiltration. The tissue signature in this region shows a significant increase in p without much change in q.

View larger version (50K): [in a new window]   Fig 3. Biopsies taken from 3.5 cm from the target of the patient in Figure 1. Both MR and histology show that this is from normal brain. The tissue signatures from this region show that both the p value and q values are similar to control values.

View larger version (50K): [in a new window]   Fig 4. A gadolinium-enhanced T1-weighted (left) and T2-weighted (right) image from a 67-year-old man who presented with headaches and a left hemiparesis. Our results have shown that we can identify a region around a tumor with decreased anisotropy (q, shown in green) that shows the limit of the gross tumor, and a region around this with normal anisotropy but increased isotropy (p, shown in red) that can identify the infiltrating tumor margin. These zones extend beyond the abnormal areas on both enhanced T1- and T2-weighted MRI