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Glioma infiltration sign on high b‐value diffusion‐weighted imaging in gliomas and its prognostic value
Author(s) -
Zeng Qiang,
Ling Chenhan,
Shi Feina,
Dong Fei,
Jiang Biao,
Zhang Jianmin
Publication year - 2018
Publication title -
journal of magnetic resonance imaging
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.563
H-Index - 160
eISSN - 1522-2586
pISSN - 1053-1807
DOI - 10.1002/jmri.25986
Subject(s) - fluid attenuated inversion recovery , glioma , medicine , hazard ratio , infiltration (hvac) , magnetic resonance imaging , nuclear medicine , diffusion mri , confidence interval , proportional hazards model , radiology , physics , cancer research , thermodynamics
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 T 1 ‐weighted contrast‐enhanced (T 1 w‐CE) sequence, contrast‐enhanced T 2 ‐flair sequence, and a DWI sequence. Assessment T 1 w‐CE images and contrast‐enhanced T 2 ‐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/mm 2 . 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;48:643–651.