Clinical Study
Quantitative analysis of glioma cell invasion by diffusion tensor imaging

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Abstract

We aimed to quantitatively analyze the invasion of glioma cells by diffusion tensor imaging (DTI). Twenty patients with glioma, who required surgical decompression, were included in this study. Peritumoral edematous regional tissues were harvested for tumor cell counting and cell density analysis to establish standards for degrees of tumor infiltration. Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values of water molecules in brain in five regions of interest (ROI) were measured by DTI: (i) the glioma region; (ii) peritumoral edematous tissue; (iii) surrounding edematous tissue; (iv) white matter; and (v) contralateral white matter. The correlation between FA and ADC values from different ROI, and degree of tumor infiltration was analysed. FA values tended to increase from the glioma region outwards, and the maximum amplification appeared between peritumoral edematous and surrounding edematous regions. FA values from peritumoral edematous regions were negatively correlated with the degree of glioma infiltration. ADC values increased significantly in the peritumoral edematous region, but changes in other regions were variable. FA values from peritumoral edematous regions should be used as an evaluation index for the invasion of glioma cells.

Introduction

The clinical treatment of invasive glioma cells remains difficult. A quantitative analysis of glioma cell invasion would be of value in clinical applications and experimental studies. There are well-developed methods for quantitatively analyzing the degree of tumor cell invasion in experimental studies. However, in clinical studies, measurements of tumor cell invasion remain controversial. Diffusion tensor imaging (DTI) is an MRI technique that has been used recently in clinical applications. It reveals abnormalities and destruction of white matter fibers and has been used to measure the degree of white matter damage in brain regions, thus providing the potential for quantitative analysis of tumor invasion.1 We used DTI sequence scanning to quantitatively detect fractional anisotropy (FA) values of water molecules in white matter in glioma and peritumoral edematous regions. FA values correlated with tumor cell counts and cell density analysis in corresponding regions, and were used to establish clinical standards for tumor infiltration.

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Patients

Twenty patients, comprising 14 males and six females, who were 51.3 years old on average (range: 19–73 years) were included in this study. All patients underwent surgical decompression of their tumours and the diagnosis of glioma was confirmed by histopathology. The postoperative pathological diagnoses (using the 2007 World Health Organization Classification of Central Nervous System Tumors2) were: pilocytic astrocytoma (grade I, n = 1); oligodendroglioma and astrocytoma (grade II, n = 6);

Comparison of DTI and routine MRI

Of the 20 patients with glioma, 10 patients (50%) had a DTI abnormality that was larger than the routine MRI abnormality, and visually distinguishable (Fig. 3) (two patients with grade I glioma; five patients with either grade II or III, and three patients with grade IV glioma). This region of difference between traditional MRI and DTI is the surrounding edematous region. Thus, DTI may have a role in displaying brain invasion by gliomas in the surrounding edematous region.

FA and ADC values from each ROI

FA values tended to

Discussion

It is valuable to be able to quantify the invasion of glioma cells to direct treatment. In ex vivo tumor cell experiments, migration and invasion assays have been used to quantitatively analyze the migration and invasion potential of tumor cells.[6], [7] In in vivo tumor cell invasion experiments, Kurebayashi et al.8 and Perry et al.9 transplanted glioma cells, which were transfected with various marker genes, into experimental animal brains and detected glioma cell invasion. This was used to

Acknowledgement

This study was supported by the Scientific Research Foundation of Chongqing Health Bureau, No. 07-2-009.

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1

The first two authors contributed equally to this work.

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