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Ultra-high b-value DWI accurately identifies isocitrate dehydrogenase genotypes and tumor subtypes of adult-type diffuse gliomas

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Abstract

Objectives

To distinguish isocitrate dehydrogenase (IDH) genotypes and tumor subtypes of adult-type diffuse gliomas based on the fifth edition of the World Health Organization classification of central nervous system tumors (WHO CNS5) in 2021 using standard, high, and ultra-high b-value diffusion-weighted imaging (DWI).

Materials and methods

This prospective study enrolled 70 patients with adult-type diffuse gliomas who underwent multiple b-value DWI. Apparent diffusion coefficient (ADC) values including ADCb500/b1000, ADCb500/b2000, ADCb500/b3000, ADCb500/b4000, ADCb500/b6000, ADCb500/b8000, and ADCb500/b10000 in tumor parenchyma (TP) and contralateral normal-appearing white matter (NAWM) were calculated. The ADC ratios of TP/NAWM were assessed for correlations with IDH genotypes, tumor subtypes, and Ki-67 status; diagnostic performances were compared.

Results

All ADCs were significantly higher in IDH mutant gliomas than in IDH wild-type gliomas (p < 0.01 for all); ADCb500/b8000 had the highest area under the curve (AUC) of 0.866. All ADCs were significantly lower in glioblastoma than in astrocytoma (p < 0.01 for all). ADCs other than ADCb500/b1000 were significantly lower in glioblastoma than in oligodendroglioma (p < 0.05 for all). ADCb500/b8000 and ADCb500/b10000 were significantly higher in oligodendroglioma than in astrocytoma (p = 0.034 and 0.023). The highest AUCs were 0.818 for ADCb500/b6000 when distinguishing glioblastoma from astrocytoma, 0.979 for ADCb500/b8000 and ADCb500/b10000 when distinguishing glioblastoma from oligodendroglioma, and 0.773 for ADCb500/b10000 when distinguishing astrocytoma from oligodendroglioma. Additionally, all ADCs were negatively correlated with Ki-67 status (p < 0.05 for all).

Conclusion

Ultra-high b-value DWI can reliably separate IDH genotypes and tumor subtypes of adult-type diffuse gliomas using WHO CNS5 criteria.

Clinical relevance statement

Ultra-high b-value diffusion-weighted imaging can accurately distinguish isocitrate dehydrogenase genotypes and tumor subtypes of adult-type diffuse gliomas, which may facilitate personalized treatment and prognostic assessment for patients with glioma.

Key Points

• Ultra-high b-value diffusion-weighted imaging can accurately distinguish subtle differences in water diffusion among biological tissues.

• Ultra-high b-value diffusion-weighted imaging can reliably separate isocitrate dehydrogenase genotypes and tumor subtypes of adult-type diffuse gliomas.

• Compared with standard b-value diffusion-weighted imaging, high and ultra-high b-value diffusion-weighted imaging demonstrate better diagnostic performances.

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Abbreviations

ADC:

Apparent diffusion coefficient

ANOVA:

Analysis of variance

AUC:

Area under curve

CNS:

Central nervous system

DWI:

Diffusion-weighted imaging

EGFR:

Epidermal growth factor receptor

FLAIR:

Fluid-attenuated inversion recovery

FSE:

Fast spin-echo

IDH:

Isocitrate dehydrogenase

Ki-67 LI:

Ki-67 labeling index

KPS:

Karnofsky performance status

MRI:

Magnetic resonance imaging

NAWM:

Normal-appearing white matter

NEC:

Not elsewhere classified

ROC:

Receiver operating characteristic

ROI:

Region of interest

TERT:

Telomerase reverse transcriptase

TP:

Tumor parenchyma

WHO:

World Health Organization

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Acknowledgements

We thank all the patients who participated in this study.

Funding

This work was supported by grants from Guidance Project of Fujian Science and Technology Program (2022Y0024), and the Science and Technology Plan Project of Fujian Health Commission (2022GGA013).

Author information

Author notes

  1. Xueqin Wang and Xinru Shu contributed equally to this work.

Authors and Affiliations

  1. Department of Radiology, Fujian Medical University Union Hospital, NO.29 Xinquan Road, Fuzhou, 350001, Fujian, People’s Republic of China

    Xueqin Wang, Yingqian Geng, Yifan Sun, Huinan Xiao, Wanyi Zheng, Yunjing Xue & Rifeng Jiang

  2. School of Medical Imaging, Fujian Medical University, Fuzhou, 350004, China

    Xueqin Wang, Pingping He & Yiting Cai

  3. School of Basic Medical Sciences, Fujian Medical University, Fuzhou, 350004, China

    Xinru Shu

  4. Department of Pathology, Fujian Medical University Union Hospital, Fuzhou, 350001, China

    Xiaomei Hu

  5. MR Scientific Marketing, Siemens Healthcare, Shanghai, China

    Yang Song

  6. School of Medical Technology and Engineering, Fujian Medical University, Fuzhou, 350004, China

    Rifeng Jiang

Authors
  1. Xueqin Wang
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Corresponding author

Correspondence to Rifeng Jiang.

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Guarantor

The scientific guarantor of this publication is Rifeng Jiang.

Conflict of interest

The author Yang Song is affiliated with Siemens Healthcare China, but this company did not influence the conduct, reporting, or publication of the study. The remaining authors of this manuscript declare no relationships with any companies, whose products or services related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained from Fujian Medical University Union Hospital (2022KJT008).

Methodology

  • prospective

  • diagnostic or prognostic study

  • performed at one institution

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Wang, X., Shu, X., He, P. et al. Ultra-high b-value DWI accurately identifies isocitrate dehydrogenase genotypes and tumor subtypes of adult-type diffuse gliomas. Eur Radiol (2024). https://doi.org/10.1007/s00330-024-10708-5

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