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Background : Supratentorial diffuse low-grade gliomas in adults extend beyondmaximal visible MRI-defined abnormalities, and a gap exists between the imagingsignal changes and the actual tumor margins. Direct quantitative comparisonsbetween imaging and histological analyses are lacking to date. However, theyare of the utmost importance if one wishes to develop realistic models fordiffuse glioma growth.  Methods : In this study, we quantitatively compare the cell concentration andthe edema fraction from human histological biopsy samples (BSs) performedinside and outside imaging abnormalities during serial imaging-basedstereotactic biopsy of diffuse low-grade gliomas.  Results : The cell concentration was significantly higher in BSs locatedinside (1189 $\pm$ 378 cell/mm$^2$) than outside (740 $\pm$ 124 cell/mm$^2$)MRI-defined abnormalities (p=0.0003). The edema fraction was significantlyhigher in BSs located inside (mean, 45 $\pm$ 23%) than outside (mean, 5 $\pm$9%) MRI-defined abnormalities (p<0.0001). At borders of the MRI-definedabnormalities, 20% of the tissue surface area was occupied by edema, and only3% by tumor cells. The cycling cell concentration was significantly higher inBSs located inside (10 $\pm$ 12 cell/mm$^2$) compared to outside (0.5 $\pm$ 0.9cell/mm$^2$) MRI-defined abnormalities (p=0.0001).  Conclusions : We show that the margins of T2-weighted signal changes aremainly correlated with the edema fraction. In 62.5% of patients, the cyclingtumor cell fraction (defined as the ratio of the cycling tumor cellconcentration to the total number of tumor cells) was higher at the limits ofthe MRI-defined abnormalities than closer to the center of the tumor. In theremaining patients, the cycling tumor cell fraction increased towards thecenter of the tumor.

Quantitative characterization of the imaging limits of diffuse low-grade oligodendrogliomas