Glioma infiltration sign on high b-value diffusion-weighted imaging in gliomas and its prognostic value

Qiang Zeng; Chenhan Ling; Feina Shi; Fei Dong; Biao Jiang; Jianmin Zhang

doi:10.1002/jmri.25986

Glioma infiltration sign on high b-value diffusion-weighted imaging in gliomas and its prognostic value

J Magn Reson Imaging. 2018 Mar 1. doi: 10.1002/jmri.25986. Online ahead of print.

Authors

Qiang Zeng¹, Chenhan Ling¹, Feina Shi², Fei Dong³, Biao Jiang³, Jianmin Zhang^{1

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Affiliations

¹ Department of Neurosurgery, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
² Department of Neurology, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
³ Department of Radiology, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
⁴ Brain Research Institute, Zhejiang University, Hangzhou, Zhejiang, China.
⁵ Collaborative Innovation Center for Brain Science, Zhejiang University, Hangzhou, Zhejiang, China.

PMID: 29498144
DOI: 10.1002/jmri.25986

Abstract

Background: Glioma cells may infiltrate beyond the tumor margins revealed on conventional structural images.

Purpose: To investigate whether the presence of a glioma infiltration sign on high b-value diffusion-weighted imaging (DWI) can predict the prognosis of gliomas.

Study type: Retrospective cohort.

Subjects: Fifty-two patients with gliomas (14 WHO grade II; 13 WHO grade III; 25 WHO grade IV).

Field strength/sequence: 3.0T, including a T₁ -weighted contrast-enhanced (T₁ w-CE) sequence, contrast-enhanced T₂ -flair sequence, and a DWI sequence.

Assessment: T₁ w-CE images and contrast-enhanced T₂ -flair images were used for identifying the tumor region for enhancing and nonenhancing gliomas, respectively. The glioma infiltration sign was defined as the presence of a peritumoral abnormal high signal region on DWI map, which was adjacent to the tumor region and had higher signal than surrounding areas. This sign was assessed on a high b-value DWI map with b = 3000 s/mm² . For patients with glioma infiltration sign, DWI3000_max , DWI1000_max , ADC3000_min , and ADC1000_min were measured by drawing a region of interest over the peritumoral abnormal high signal region.

Statistical tests: Survival analysis was conducted by using Cox regression.

Results: Glioma infiltration sign was observed in 28 (53.8%) patients. The occurrence rate of this sign was 92.0% in grade IV gliomas, 30.8% in grade III gliomas, and 7.1% in grade II gliomas. The glioma infiltration sign could independently predict both the progression-free survival (hazard ratio [HR], 95% confidence interval [CI] = 8.58 [3.19-23.03], P < 0.001) and overall survival (HR, 95% CI = 11.90 [3.41-41.55], P < 0.001) after adjustment. For patients with glioma infiltration sign, DWI3000_max (P = 0.005) and ADC3000_min (P = 0.008) were both independent predictors of overall survival after adjustment, while DWI1000_max and ADC1000_min were not.

Data conclusion: The glioma infiltration sign on high b-value DWI is an independent predictor of poor prognosis in glioma patients. High b-value DWI might be a convenient method to detect glioma infiltration.

Level of evidence: 3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018.

Keywords: diffusion weighted imaging; glioma; magnetic resonance imaging; prognosis; tumor infiltration.