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Research ArticlePediatrics

Diffusion Imaging for Tumor Grading of Supratentorial Brain Tumors in the First Year of Life

S.F. Kralik, A. Taha, A.P. Kamer, J.S. Cardinal, T.A. Seltman and C.Y. Ho
American Journal of Neuroradiology April 2014, 35 (4) 815-823; DOI: https://doi.org/10.3174/ajnr.A3757
S.F. Kralik
aFrom Indiana University School of Medicine, Department of Radiology and Imaging Sciences, Indianapolis, Indiana.
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A. Taha
aFrom Indiana University School of Medicine, Department of Radiology and Imaging Sciences, Indianapolis, Indiana.
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A.P. Kamer
aFrom Indiana University School of Medicine, Department of Radiology and Imaging Sciences, Indianapolis, Indiana.
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J.S. Cardinal
aFrom Indiana University School of Medicine, Department of Radiology and Imaging Sciences, Indianapolis, Indiana.
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T.A. Seltman
aFrom Indiana University School of Medicine, Department of Radiology and Imaging Sciences, Indianapolis, Indiana.
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C.Y. Ho
aFrom Indiana University School of Medicine, Department of Radiology and Imaging Sciences, Indianapolis, Indiana.
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  • Fig 1.
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    Fig 1.

    A 4-month-old girl with poorly differentiated carcinoma of the left cerebral hemisphere. A, Representative axial image from ADC map demonstrates manual tracing with general exclusion of large areas of blood products represented by susceptibility artifacts. B, Histogram of all included ADC values of the tumor from the semi-automated method.

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    Fig 2.

    An 11-month-old boy with atypical teratoid/rhabdoid tumor. A, Axial T2-weighted image demonstrates a heterogeneous mass in the right frontal temporal lobe with peripheral cystic change, little peritumoral white matter T2 prolongation, and B, heterogeneous enhancement on postcontrast axial 3D T1-weighted image. C, Representative ADC manual region of interest measurement with a small region of interest within the lowest signal portion of the tumor and larger region of interest measuring the contralateral normal thalamus. D, Semi-automated histogram for the ADC values of the entire tumor.

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    Fig 3.

    A 12-month-old child with desmoplastic infantile ganglioglioma. A, Axial T2-weighted image demonstrates a heterogeneous mass in the left frontal lobe with cystic change, adjacent T2 prolongation, midline shift, and contralateral ventricular entrapment. B, Axial 3D T1-weighted image demonstrates a peripheral enhancing solid component along the dural margin. C, ADC map with representative manual region of interest evaluation within the solid components of the tumor and contralateral white matter. D, Semi-automated histogram for the ADC values of the entire tumor.

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    Fig 4.

    Scatterplot of the average absolute minimum ADC for all tumors by WHO grading.

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    Fig 5.

    Receiver operating characteristic curve for manual absolute ADC demonstrates a significant area above the 50% diagonal. Threshold according to the Youden index is ≤0.698 × 10−3 mm2/s for WHO grade III and IV tumors versus grade I and II tumors.

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    Fig 6.

    A, Summation semi-automated histograms of ADC values of all low-grade tumors compared with high-grade tumors. B, Overlay histograms of all low-grade tumors. C, Overlay histograms of all high-grade tumors.

Tables

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    Table 1:

    Tumor pathology with corresponding WHO grade and ADC values from manual ROI measurement

    Tumor TypeWHO GradeAverage Minimum ADC × 10−3 mm2/sADC Ratio ThalamusADC Ratio White Matter
    Desmoplastic infantile gangliogliomaI1.631.681.50
    Desmoplastic infantile gangliogliomaI0.881.050.79
    Desmoplastic infantile gangliogliomaI0.971.080.80
    Desmoplastic infantile gangliogliomaI1.140.870.76
    Choroid plexus papillomaI1.011.051.10
    Choroid plexus papillomaI0.921.160.79
    Choroid plexus papillomaI1.311.531.23
    Pilocytic astrocytomaI0.780.960.75
    Astrocytoma, focalII1.711.501.35
    Pilomyxoid astrocytomaII1.031.060.71
    Astrocytoma, diffuseII1.121.270.98
    Anaplastic ependymomaIII0.690.820.59
    Anaplastic ependymoma with tanycytic featuresIII0.540.570.47
    Choroid plexus carcinomaIII1.270.930.90
    Atypical teratoid/rhabdoid tumorIV0.670.530.41
    Atypical teratoid/rhabdoid tumorIV0.400.550.42
    Poorly differentiated carcinomaIV0.560.450.32
    Poorly differentiated carcinomaIV0.400.510.35
    GlioblastomaIV0.580.620.41
    P value, t test between low- and high-grade groups.0018<.0001.00042
    • Note:—All 3 parameters were significant between the difference of the means of the low-grade and high-grade groups. Of note, the choroid plexus carcinoma in our study is an outlier in the high-grade group.

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    Table 2:

    Semi-automated metrics including mean and standard deviations for low- and high-grade tumors

    Low-GradeHigh-GradeP Value (t test)
    Mean (×10−3 mm2/s)Standard Deviation (×10−3 mm2/s)Mean (×10−3 mm2/s)Standard Deviation (×10−3 mm2/s)
    Average1.7170.3771.4590.341.138
    Standard deviation0.4580.2470.6160.189.135
    Skew0.8030.7531.3720.704.111
    Kurtosis1.1292.5151.9802.754.501
    Peak location1.5180.4931.0750.275.023a
    Peak height, normalized0.0880.0410.0690.029.258
    5th Percentile1.130.1510.7780.267.007a
    10th Percentile1.180.1510.8580.260.008a
    25th Percentile1.320.1801.0160.278.018a
    50th Percentile1.680.4531.2700.349.037a
    75th Percentile2.010.5981.7920.564.411
    90th Percentile2.320.6812.3630.591.903
    95th Percentile2.500.7052.6960.541.518
    95th to 5th Percentile1.3770.7041.9180.560.080
    50th to 5th Percentile0.5550.4250.4910.273.695
    95th to 50th Percentile0.8210.4341.4260.362.004a
    • ↵a Significant P value.

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American Journal of Neuroradiology: 35 (4)
American Journal of Neuroradiology
Vol. 35, Issue 4
1 Apr 2014
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Diffusion Imaging for Tumor Grading of Supratentorial Brain Tumors in the First Year of Life
S.F. Kralik, A. Taha, A.P. Kamer, J.S. Cardinal, T.A. Seltman, C.Y. Ho
American Journal of Neuroradiology Apr 2014, 35 (4) 815-823; DOI: 10.3174/ajnr.A3757

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Diffusion Imaging for Tumor Grading of Supratentorial Brain Tumors in the First Year of Life
S.F. Kralik, A. Taha, A.P. Kamer, J.S. Cardinal, T.A. Seltman, C.Y. Ho
American Journal of Neuroradiology Apr 2014, 35 (4) 815-823; DOI: 10.3174/ajnr.A3757
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