Contribution of diffusion tensor imaging to delineation of gliomas and glioblastomas

Purpose To determine if the diffusion tensor imaging (DTI) parameters fractional anisotropy (FA) and mean diffusivity (MD) can differentiate between accompanying edema and tumor cell infiltration of white matter (WM) beyond the tumor edge as defined from conventional MRI in low‐ and high‐grade gliom...

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Published in:	Journal of magnetic resonance imaging Vol. 20; no. 6; pp. 905 - 912
Main Authors:	Tropine, A., Vucurevic, G., Delani, P., Boor, S., Hopf, N., Bohl, J., Stoeter, P.
Format:	Journal Article
Language:	English
Published:	Hoboken Wiley Subscription Services, Inc., A Wiley Company 01-12-2004
Subjects:	Brain - pathology Brain Edema - complications Brain Edema - diagnosis Brain Neoplasms - complications Brain Neoplasms - diagnosis cerebral tumors compression of white matter fibers Diffusion Magnetic Resonance Imaging diffusion tensor imaging Glioblastoma - complications Glioblastoma - diagnosis Glioma - complications Glioma - diagnosis Humans Meningeal Neoplasms - complications Meningeal Neoplasms - diagnosis Meningioma - complications Meningioma - diagnosis tumor border white matter infiltration
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Summary:	Purpose To determine if the diffusion tensor imaging (DTI) parameters fractional anisotropy (FA) and mean diffusivity (MD) can differentiate between accompanying edema and tumor cell infiltration of white matter (WM) beyond the tumor edge as defined from conventional MRI in low‐ and high‐grade gliomas. Materials and Methods We examined 12 patients with high‐grade gliomas/glioblastomas and eight patients with low‐grade gliomas and compared them to 10 patients with meningiomas, in which no tumor infiltration is expected. The tumor was defined as the enhancing area in glioblastomas and meningiomas and as the area of increased T2‐signal in low‐grade gliomas. FA and MD were measured in the center of the tumor and in the adjacent WM. The contralateral WM and internal capsule were used as an internal standard. Results Comparing the WM areas of increased T2‐signal adjacent to meningiomas and glioblastomas, we saw a trend (without significance) towards a reduction of FA, but not of MD, in glioblastomas. We found no changes of FA and MD in the WM adjacent to low‐grade gliomas (without T2‐signal increase) compared to the WM of the contralateral hemisphere. In meningiomas and high‐grade gliomas/glioblastomas, a narrow rim of significantly (P < 0.01) increased FA and decreased MD values around the enhancing tumor area was seen, whereas in low‐grade gliomas, such a rim could not be defined. There was no contribution of FA or MD to grading of gliomas. Conclusion In glioblastomas, a reduction of FA in the edematous area surrounding the tumor may indicate tumor cell infiltration, but a reliable differentiation between infiltration and vasogenic edema is not yet possible on the basis of DTI. The additional finding of a narrow rim of increased FA and decreased MD at the edge of glioblastomas (as well as in meningiomas) may be caused by com‐pressed WM fibers and/or increased vascularity, but does not contribute to exclude peripheral cellular infiltration. J. Magn. Reson. Imaging 2004;20:905–912. © 2004 Wiley‐Liss, Inc.
Bibliography:	istex:D255765420055B504FDFA750F6FF0C08F8EE2728 ark:/67375/WNG-NZJFJP6B-B ArticleID:JMRI20217 This article is a part of a thesis by A. Tropine. ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1053-1807 1522-2586
DOI:	10.1002/jmri.20217