Diffusion kurtosis imaging in evaluating gliomas: different region of interest selection methods on time efficiency, measurement repeatability, and diagnostic ability.

OBJECTIVES: Comparing the diagnostic efficacy of diffusion kurtosis imaging (DKI) derived from different region of interest (ROI) methods in tumor parenchyma for grading and predicting IDH-1 mutation and 1p19q co-deletion status of glioma patients and correlating with their survival data. METHODS: Sixty-six patients (29 females; median age, 45 years) with pathologically proved gliomas (low-grade gliomas, 36; high-grade gliomas, 30) were prospectively included, and their clinical data were collected. All patients underwent DKI examination. DKI maps of each metric were derived. Three groups of ROIs (ten spots, ROI-10s; three biggest tumor slices, ROI-3s; and whole-tumor parenchyma, ROI-whole) were manually drawn by two independent radiologists. The interobserver consistency, time spent, diagnostic efficacy, and survival analysis of DKI metrics based on these three ROI methods were analyzed. RESULTS: The intraexaminer reliability for all parameters among these three ROI methods was good, and the time spent on ROI-10s was significantly less than that of the other two methods (p < 0.001). DKI based on ROI-10s demonstrated a slightly better diagnostic value than the other two ROI methods for grading and predicting the IDH-1 mutation status of glioma, whereas DKI metrics derived from ROI-10s performed much better than those of the ROI-3s and ROI-whole in identifying 1p19q co-deletion. In survival analysis, the model based on ROI-10s that included patient age and mean diffusivity showed the highest prediction value (C-index, 0.81). CONCLUSIONS: Among the three ROI methods, the ROI-10s method had the least time spent and the best diagnostic value for a comprehensive evaluation of glioma. It is an effective way to process DKI data and has important application value in the clinical evaluation of glioma. KEY POINTS: • The intraexaminer reliability for all DKI parameters among different ROI methods was good, and the time spent on ROI-10 spots was significantly less than the other two ROI methods. • DKI metrics derived from ROI-10 spots performed the best in ROI selection methods (ROI-10s, ten-spot ROIs; ROI-3s, three biggest tumor slices ROI; and ROI-whole, whole-tumor parenchyma ROI) for a comprehensive evaluation of glioma. • The ROI-10 spots method is an effective way to process DKI data and has important application value in the clinical evaluation of glioma.

Comparative analysis of the diffusion kurtosis imaging and diffusion tensor imaging in grading gliomas, predicting tumour cell proliferation and IDH-1 gene mutation status.

INTRODUCTION: Few studies have applied diffusion kurtosis imaging (DKI) and diffusion tensor imaging (DTI) for the comprehensive assessment of gliomas [tumour grade, isocitrate dehydrogenase-1 (IDH-1) mutation status and tumour proliferation rate (Ki-67)]. This study describes the efficacy of DKI and DTI to comprehensively evaluate gliomas, compares their results. METHODS: Fifty-two patients (18 females; median age, 47.5 years) with pathologically proved gliomas were prospectively included. All cases underwent DKI examination. DKI (mean kurtosis: MK, axial kurtosis: Ka, radial kurtosis: Kr) and DTI (mean diffusivity: MD, fractional anisotropy: FA) maps of each metric was derived. Three ROIs were manually drawn. RESULTS: MK, Ka, Kr and FA were significantly higher in HGGs than in LGGs, whereas MD was significantly lower in HGGs than in LGGs (P < 0.01). ROC analysis demonstrated that MK (specificity: 100% sensitivity: 79%) and Ka (specificity: 96% sensitivity: 82%) had the same and highest (AUC: 0.93) diagnostic value. Moreover, MK, Ka, and Kr were significantly higher in grade III than II gliomas (P ≦ 0.01). Further, DKI and DTI can significantly identify IDH-1 mutation status (P ≦ 0.03). Ka (sensitivity: 74%, specificity: 75%, AUC: 0.72) showed the highest diagnostic value. In addition, DKI metrics and MD showed significant correlations with Ki-67 (P ≦ 0.01) and Ka had the highest correlation coefficient (rs = 0.72). CONCLUSIONS: Compared with DTI, DKI has great advantages for the comprehensive assessment of gliomas. Ka might serve as a promising imaging index in predicting glioma grading, tumour cell proliferation rate and IDH-1 gene mutation status.

Quantitative analysis of neurite orientation dispersion and density imaging in grading gliomas and detecting IDH-1 gene mutation status.

Background and purpose: Neurite orientation dispersion and density imaging (NODDI) is a new diffusion MRI technique that has rarely been applied for glioma grading. The purpose of this study was to quantitatively evaluate the diagnostic efficiency of NODDI in tumour parenchyma (TP) and peritumoural area (PT) for grading gliomas and detecting isocitrate dehydrogenase-1 (IDH-1) mutation status. Methods: Forty-two patients (male: 23, female: 19, mean age: 44.5 y) were recruited and underwent whole brain NODDI examination. Intracellular volume fraction (icvf) and orientation dispersion index (ODI) maps were derived. Three ROIs were manually placed on TP and PT regions for each case. The corresponding average values of icvf and ODI were calculated, and their diagnostic efficiency was assessed. Results: Tumours with high icvfTP (≥0.306) and low icvfPT (≤0.331) were more likely to be high-grade gliomas (HGGs), while lesions with low icvfTP (<0.306) and high icvfPT (>0.331) were prone to be low-grade gliomas (LGGs) (P < 0.001). A multivariate logistic regression model including patient age and icvf values in TP and PT regions most accurately predicted glioma grade (AUC = 0.92, P < 0.001), with a sensitivity and specificity of 92% and 89%, respectively. However, no significant differences were found in NODDI metrics for differentiating IDH-1 mutation status. Conclusions: The quantitative NODDI metrics in the TP and PT regions are highly valuable for glioma grading. A multivariate logistic regression model using the patient age and the icvf values in TP and PT regions showed very high predictive power. However, the utility of NODDI metrics for detecting IDH-1 mutation status has not been fully explored, as a larger sample size may be necessary to uncover benefits.

Pancreatic schwannoma: a case report and an updated 40-year review of the literature yielding 68 cases.

BACKGROUND: Pancreatic schwannoma is a rare tumor. Preoperative diagnosis of pancreatic schwannoma is challenging due to its tendency to mimic other lesions of the pancreas. We describe a case of pancreatic schwannoma and present a review of the cases currently reported in the English literature to identify characteristics of pancreatic schwannoma on imaging. CASE PRESENTATION: A 53-year-old male presented with a history of intermittent periumbilical abdominal pain and lower back pain for 1 week. Based on ultrasound (US) and computed tomography (CT) findings, we made a preoperative diagnosis of solid pseudopapillary tumor and performed a standard pancreaticoduodenectomy. Pathological examination showed that the tumor was composed of spindle cells with a palisading arrangement, and immunohistochemistry revealed strong positive staining for S-100 protein, which was consistent with a diagnosis of pancreatic schwannoma. At the 8-month follow-up visit, the patient was doing well without recurrent disease, and his abdominal pain had resolved. CONCLUSIONS: Although pancreatic schwannoma is rare, it should be included in the list of differential diagnoses of pancreatic masses, both solid and cystic. A tumor size larger than 6.90 cm, vascular encasement, or visceral invasion should elicit suspicion of malignant transformation.