Original articleContribution of the apparent diffusion coefficient in perilesional edema for the assessment of brain tumorsApport du coefficient de diffusion apparent de l’œdème périlésionnel pour l’étude des tumeurs cérébrales
Introduction
Diffusion-weighted imaging (DWI) has become a standard routine sequence in most clinical investigations [1], [2]. It involves a simple modification of a spin-echo sequence, where two gradient sensitizing pulses are applied before and after the 180 pulse. Diffusion imaging is sensitive to the molecular motion of tissues, allowing it to be used with great success in the setting of stroke [3], [4], where it is thought to be able to differentiate between cytotoxic and vasogenic edema. The occurrence of acute ischemia is accompanied by a decrease in the so-called apparent diffusion coefficient (ADC), which allows quantification of the diffusion characteristics of a given tissue. This has been applied to other pathologies such as brain abscess [5] and some tumors, and brain development [6] and aging [7], as well as for monitoring interventions [8]. The possibility of mapping the ADC allows the quantification of water movement. This has already been applied to tumors of the brain, head and neck [9], [10]. Previous studies have shown that ADC values reflect both cellularity and edema [11]. The present study aimed to address its capacity to determine the type of intracranial tumor based on the ADC values from the perilesional edema. To do this, we investigated a series of patients who had different types of intracranial tumors.
Section snippets
Patients
Sixteen consecutive patients (nine men, seven women; ages 35 to 82, mean age 58 years) were prospectively included, having been recruited from the neurosurgical clinic of our hospital over a period of six months (January to July 2001). All patients had undergone brain MRI because of an intracranial tumor. They were informed of the examination they were about to undergo and had given their consent.
The patients all subsequently underwent craniotomy and biopsy/surgery to obtain samples of tumor
Results
On histology, eight patients showed high-grade gliomas, four had cerebral metastases and four had low-grade gliomas (Fig. 3).
Discussion
This study showed that both high-grade gliomas and metastatic brain tumors have higher ADC values in the perilesional edema than do low-grade gliomas, indicating a higher water content and greater tissue displacement due to vasogenic edema, and probably secondary to a more aggressive histological reaction. Also, there is a tendency for the more malignant lesions to have lower ADC values within the tumor itself, probably due to necrosis. Therefore, DWI-derived ADC maps can be helpful in
Conclusion
ADC mapping of brain tumors and assessment of the ADC in the peritumoral lesion appears to be promising in the differentiation of tumors and in the assessment of local invasiveness. Glioblastomas, while having a low central ADC, have a high ADC in the periphery, reflecting a central high cellularity and peripheral vasogenic edema.
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2019, Journal of NeuroradiologyIn vivo assessment of tumor heterogeneity in WHO 2016 glioma grades using diffusion kurtosis imaging: Diagnostic performance and improvement of feasibility in routine clinical practice
2018, Journal of NeuroradiologyCitation Excerpt :Finally, we found higher MK and lower MD values in the VOIs including peritumoral edema (VOItu-ed and VOIed). These values agree with previous reports [13,32,35] and support their hypothesis that the infiltrative zone shows increased cellularity or a higher amount of non-infiltrated brain tissue. However, the MK values assessed from VOItu-ed and VOIed demonstrated less diagnostic performance for glioma grading and a lower correlation with the 2016 CNS WHO tumor grades than those obtained from VOIs without peritumoral edema.
Apparent diffusion coefficient and Magnetic resonance spectroscopy in grading of malignant brain neoplasms
2014, Egyptian Journal of Radiology and Nuclear MedicineCitation Excerpt :Lee et al. (10) explained this finding by the increased cellularity in the peritumoral region in primary tumors as a result of infiltration, while in metastatic tumors there is vasogenic edema with no infiltration. It is noted that the Guzman et al. (13) reported the ability of peritumoral ADC values to differentiate low from high grade tumors, contradicting our results. This contradiction could be attributed to the limitation of having a small population in this study.
Regional ADC measurements during normal brain aging in the clinical range of b values: A DWI study
2013, Clinical ImagingCitation Excerpt :The DWI technique has become present in clinical practice because it is helpful and sensitive for the detection of acute ischemic stroke in the early phase [3,4] while other imaging techniques, such as computed tomography, fail due to their reduced sensitivity for diffusion disorders. ADC measurements are useful for the quantitative assessment of pathological states of the brain, such as neurological disorders of the brain [5,6], the detection of tumours, the characterisation of lesions, and the evaluation of the treatment response [7,8]. Moreover, DWI has been used as a noninvasive, accurate tool for the evaluation of age-related differences and morphologic changes in brain structures [9,10] as a sensitive technique responsive to incoherent water motion, which depends on the brain's microstructure.