Purpose: To noninvasively evaluate the value of three-dimensional pseudo-continuous arterial spin labeling (3D pCASL) and diffusion-weighted imaging (DWI) in diffuse gliomas grading as well as isocitrate dehydrogenase (IDH) 1 mutation status.
Methods: Fifty-six patients with pathologically confirmed diffuse gliomas with preoperative 3D pCASL and DWI were enrolled in this study. The Student's t test and Mann-Whitney U test were used to evaluate differences in parameters of DWI and 3D pCASL between low and high grade as well as between mutant and wild-type IDH1 diffuse gliomas; receiver operator characteristic (ROC) analysis was used to assess the diagnostic performance. Subsequently, a multivariate stepwise logistic regression analysis was used to identify the independent parameters. Besides, Kruskal-Wallis H test was used to examine the differences among grades II, III, and IV diffuse gliomas.
Results: All parameters but CBFmean showed significant differences between low- and high-grade diffuse gliomas. In ROC analysis, the AUC of CBFmax, rCBFmean, rCBFmax, ADCmean, and ADCmin were 0.701, 0.730, 0.746, 0.810, and 0.856 respectively. Only the value of ADCmin was identified as the independent parameter in the differentiation of low- from high-grade diffuse gliomas. All parameters but CBFmean showed significant differences among the three grades. And the values of CBFmean, CBFmax, rCBFmean, and ADCmean showed significant differences between mutant and wild-type IDH1 in grade II-III astrocytoma.
Conclusion: Both 3D pCASL and DWI could be useful tools for distinguishing low- from high-grade diffuse gliomas and have the potential to differentiate different IDH1 mutation statuses of astrocytoma.
Keywords: Diffuse gliomas; Diffusion-weighted imaging; Grading; Isocitrate dehydrogenase 1; Three-dimensional pseudo-continuous arterial spin labeling.